We now have a $12000 family annual deductible

[Disneychick75]

Are you dropping the insurance and paying the penalty for no insurance?

Looks like it unless the company decides to continue insurance coverage. That's iffy at this point.

 

[gracie1]

Looks like it unless the company decides to continue insurance coverage. That's iffy at this point.

I dropped my health insurance. I will just pay the penalty.

 

[Happy Snowman]

I dropped my health insurance. I will just pay the penalty.

And if you fall down and break your leg.....what then???

 

[Jaime4004]

Our insurance is switching from a $500 family deductible 90/10 plan to a $5000 deductible 100% plan starting in 2015. After doing a bunch of calculations, we will only be paying out an extra few hundred dollars or so a year for the switch, which isn't too terrible all things considered.

However, since this is the first year of the switch, we are just now setting up an HSA to begin in 2015 (our premiums have always been pretax), and I am due with our second child in February. Before it would have been an immediate $500 expenditure, and now we're looking at an immediate $5k expenditure. In the future, the high deductible plan won't be much different cost wise for us once we get the HSA established, but 2015 will be tough.

So yes, not all high deductible plans are bad, but going from a $500 hospital bill to $5000 all at once sucks. The yearly cost will average out, but it's the immediate outlay of cash that will hurt. We are trying to figure out if there are any elective things/things we've been putting off to get done in 2015 since we'll meet the entire deductible early on.

This happened to us one year, DS was in the hospital for a few days in January and it ate up the deductible right away. Good news is that it often takes the hospital months to bill it, so you might still have time to save up... But we took advantage of that and saw that MD whenever, without having to calculate if it was really worth it, which is what I normally do. (Like DH seeing ortho for his shoulder pain, knee pain, etc., usually i'd tell him to take some advil and suck it up. ) Refilled as needed meds monthly instead of a few times/year. Ex. migraine meds were about $200 and I would fill it a few times/year. Instead filled it more often because it didn't cost anything, and had plenty for the following year.
This year DH met his individual deductible so he's squeezing in one last ortho visit before the end of the year (he thinks he's still 20 but his joints don't agree ) because come January, we'd be paying for it.
But cost-conscious people don't worry about us being insurance hogs, generally my 3 kids and I only see the doctor once/year for physicals, which is why we do the high deductible plan in the first place, it usually works out better for us...

 

[Marionnette]

And if you fall down and break your leg.....what then???

Probably the same thing that the uninsured did prior to the ACA - get the leg taken care of and then deal with the bills in whatever way possible when they come along. IMO, the major thing that has changed as a result of the ACA is who cannot afford health insurance. It used to be the working poor. Now it's the solid middle class (those making too much to qualify for subsidies) that are making the tough decision to go without health insurance. The ACA didn't erase the line that separated the "haves" from the "have-nots". It just moved the line.

 

[kamik86]

I wish some people at my work saw the posts here when our health insurance info comes out.

There is only one thing I hate about our insurance (the spousal surcharge) which we got around this year by having DH go on his own insurance.

Otherwise our high deductible plan isn't too bad. $66 a week for an emloyee to cover just themselves (we have no children) with a 1500 deductible and $3000 out of pocket max.

the only thing I don't understand is if it is more then just the employee on the plan (employee and spouse or employee and child/children) the deductible and out of pocket max double to 3000/ 6000.

Lets say I was pregnant and due late in the year. With all the doctors visits etc I hit the 1500 before the birth. However when the baby is born how does that work? What is my out of pocket max 3000 or 6000 since the baby will be on the plan too with the life changing event of their birth?

 

[Marionnette]

I wish some people at my work saw the posts here when our health insurance info comes out.

There is only one thing I hate about our insurance (the spousal surcharge) which we got around this year by having DH go on his own insurance.

Otherwise our high deductible plan isn't too bad. $66 a week for an emloyee to cover just themselves (we have no children) with a 1500 deductible and $3000 out of pocket max.

the only thing I don't understand is if it is more then just the employee on the plan (employee and spouse or employee and child/children) the deductible and out of pocket max double to 3000/ 6000.

Lets say I was pregnant and due late in the year. With all the doctors visits etc I hit the 1500 before the birth. However when the baby is born how does that work? What is my out of pocket max 3000 or 6000 since the baby will be on the plan too with the life changing event of their birth?

Every plan that I have looked at which has deductibles includes both individual and family deductibles. IOW, if an individual in your family consumes $3000 in medical care, they have met their deductible and any subsequent costs for that person are handled according to your plan (80/20 coinsurance, copays only, etc.). It can vary from one plan to another.

Your family as a whole could meet the family deductible without any of them meeting the individual deductible. Let's say that there are 3 people in the family and each consumes $2000 in health care. That would meet the $6K family deductible even though none of them hit the $3K individual deductible.

Regarding a baby born during the year, it would be just like adding any family member to your plan as a result of a "life changing event". The child would have their own individual deductible for the year but it would also count toward the family deductible.

 

[jenm2878]

I wish some people at my work saw the posts here when our health insurance info comes out.

There is only one thing I hate about our insurance (the spousal surcharge) which we got around this year by having DH go on his own insurance.

Otherwise our high deductible plan isn't too bad. $66 a week for an emloyee to cover just themselves (we have no children) with a 1500 deductible and $3000 out of pocket max.

the only thing I don't understand is if it is more then just the employee on the plan (employee and spouse or employee and child/children) the deductible and out of pocket max double to 3000/ 6000.

Lets say I was pregnant and due late in the year. With all the doctors visits etc I hit the 1500 before the birth. However when the baby is born how does that work? What is my out of pocket max 3000 or 6000 since the baby will be on the plan too with the life changing event of their birth?

The baby immediately counts as a second person, so if your deductible was $1k/person or $2k family max you would owe the $2k and would be subject to the larger OOP max. That happened to us when my first son was born. We had $250/person or $500/family deductible, and we were billed $500. With this baby, it's a $5k family max or $2500/person so we'll get billed the $5k. The nice(?) thing then is that if any of the 4 of us need care for the rest of the year it will be 100% covered.

 

[Disneychick75]

Probably the same thing that the uninsured did prior to the ACA - get the leg taken care of and then deal with the bills in whatever way possible when they come along. IMO, the major thing that has changed as a result of the ACA is who cannot afford health insurance. It used to be the working poor. Now it's the solid middle class (those making too much to qualify for subsidies) that are making the tough decision to go without health insurance. The ACA didn't erase the line that separated the "haves" from the "have-nots". It just moved the line.

That's how my husband and I feel. We've been subsidizing the uninsured for 35 years. Now, we'll be the uninsured if the business doesn't cover our insurance.

 

[sam_gordon]

The baby immediately counts as a second person, so if your deductible was $1k/person or $2k family max you would owe the $2k and would be subject to the larger OOP max. That happened to us when my first son was born. We had $250/person or $500/family deductible, and we were billed $500. With this baby, it's a $5k family max or $2500/person so we'll get billed the $5k. The nice(?) thing then is that if any of the 4 of us need care for the rest of the year it will be 100% covered.

I don't think the bolded is correct for everyone. IIRC, for our policy, the entire hospital stay for the birth is on the mother's coverage. The baby doesn't go to their "own" coverage until after they leave the hospital.

BTW, we are "solid middle class". We got to keep our plan, keep our doctor, and only have moderate increases (<10%) in yearly premiums. Basically no change under ACA and before.

I think (at least some) employers and insurers are using ACA implementation as an excuse to raise rates/reduce coverage.

 

[morgan98]

I think (at least some) employers and insurers are using ACA implementation as an excuse to raise rates/reduce coverage.

I believe this is going on in some cases as well. My husband and I both work in very competitive, technical fields. While we have had some premium increases, it has not been anything outrageous and the coverage has not dramatically changed. We are also fortunate in that we are each covered by our own employers and have no dependents to cover, so that is not as big of a hit financially either.


Seems that in many ways, the ACA has made medical insurance even more confusing for many people, and it is difficult to figure out what is part of the ACA vs. employers contributing less towards coverage.

 

[jenm2878]

I don't think the bolded is correct for everyone. IIRC, for our policy, the entire hospital stay for the birth is on the mother's coverage. The baby doesn't go to their "own" coverage until after they leave the hospital. QUOTE]

That may be true. I remember being surprised that they counted my son immediately, but they explained that he fell under 'temporary coverage' and was covered from the moment of birth until 30 days afterwards. By 30 days we needed to give them his info/ss# and all that so he would be 'officially covered.' We would have met the $500 deductible regardless that year, but I was surprised they counted him from the get go. We have the same insurance company but a different plan for 2015, so I'm counting on kid #2 being counted from birth as well.

 

[johde]

I can certainly empathize with the OP. I haven't been through the entire thread but I read the first several pages. I'm in the middle of wading through my choices for next year in the individual insurance market. I'm looking at a $6,000 deductible for an individual. The premium will be $1,800 a year less than my current plan with a $2,500 would be (in both cases they are HSA plans that pay 100% after deductible).

The ACA though is a mess. When you look up choices of plans in my area 5 companies come up. The 3 cheapest of those (the ones the tax subsidies are based on) don't have the local hospital or more than 2 or 3 local primary care physicians in network. In one case, the nearest hospital is over 50 miles away as the crow flies let alone trying to drive there. The ACA is keeping prices down by going to small networks for many of the health insurance plans. That may be fine if you live in the big city but if you live if the country or in a small town a small network may be no network.

 

[Happy Snowman]

That may be true. I remember being surprised that they counted my son immediately, but they explained that he fell under 'temporary coverage' and was covered from the moment of birth until 30 days afterwards. By 30 days we needed to give them his info/ss# and all that so he would be 'officially covered.' We would have met the $500 deductible regardless that year, but I was surprised they counted him from the get go. We have the same insurance company but a different plan for 2015, so I'm counting on kid #2 being counted from birth as well.

He was covered from birth but usually delivery charges are billed to the mother. IF something happened to him outside of a normal birth, ended up in ICU or needed a surgery, etc., those would have been billed under his name and if you were on a single plan, the billing would have ultimately ended up being a family plan (or employee + child or however your company does the divisions).

 

[Happy Snowman]

Response from my UK friend:

"18 weeks is the max "target" for waiting to see a consultant in the UK .It is a target only and there is no law backing it up .after the consultant says ok ,then the wait continues .Prior to seeing the consultant ,we have assessment which can also be weeks .In my case , it was another year before I tested again I needed special funding agreement this tokk 4 months (panel only meet monthly) .I got funding approved in November but then had to wait till next June for operation."

...so, take it for what it's worth but your "law" for 18 months doesn't always work

Me, I called my dr, said I wanted an evaluation, got my appointment the next week, surgery on my schedule--which was originally scheduled for 2 weeks later because of work commitments on my side, then postponed due to a major family illness....but easily rescheduled.

 

[Gracie09]

I don't think the bolded is correct for everyone. IIRC, for our policy, the entire hospital stay for the birth is on the mother's coverage. The baby doesn't go to their "own" coverage until after they leave the hospital.

BTW, we are "solid middle class". We got to keep our plan, keep our doctor, and only have moderate increases (<10%) in yearly premiums. Basically no change under ACA and before.

I think (at least some) employers and insurers are using ACA implementation as an excuse to raise rates/reduce coverage.

DD had her own hospital bill. Actually she had two bills one alone and one under me and it took 2 years to get that straightened out. And that was pre ACA.
Our coverage has gone up a few dollars a month for the same plan pre and post ACA. DH's company(who we have coverage through) came out and said they were encouraged to look at increasing the employee contribution as an easy way to save money but opted not to do that. They continued to cover at the same percentage as before.

 

[mommasita]

Response from my UK friend:

"18 weeks is the max "target" for waiting to see a consultant in the UK .It is a target only and there is no law backing it up .after the consultant says ok ,then the wait continues .Prior to seeing the consultant ,we have assessment which can also be weeks .In my case , it was another year before I tested again I needed special funding agreement this tokk 4 months (panel only meet monthly) .I got funding approved in November but then had to wait till next June for operation."

...so, take it for what it's worth but your "law" for 18 months doesn't always work

Me, I called my dr, said I wanted an evaluation, got my appointment the next week, surgery on my schedule--which was originally scheduled for 2 weeks later because of work commitments on my side, then postponed due to a major family illness....but easily rescheduled.

Well, I am not in the UK, so I won't presume to know. I hate 3rd or 4th hand.info. it is like rumors to me.

But this happened to me this week, and you can see where I am located...

My Blood Pressure has been getting VERY low, so Tuesday I called my GP.. I went in today at 11:20.. He finds it very unsettling, actually dangerous.. I am going for bloodwork at 7am, and seeing a cardiologist at 2pm tomorrow.. No wait basically, and not a dime of cost.. A cardiologist is a specialist.


BTW my second brain surgery was on my schedule so to speak, although I find that a little bizarre way to put it. He was the surgeon, myself the patient.. The first offer was that week, and I wanted to fully prepare my children, and myself, so wanted an extra week..

You may want to believe what is fed to you, and I have NEVER understood it.. .. It can work ,and it does work. Is it perfected, no.. But reading this thread, makes me really sad for some people. You don't choose your health..

 

[Happy Snowman]

Well, I am not in the UK, so I won't presume to know. I hate 3rd or 4th hand.info. it is like rumors to me.

But this happened to me this week, and you can see where I am located...

My Blood Pressure has been getting VERY low, so Tuesday I called my GP.. I went in today at 11:20.. He finds it very unsettling, actually dangerous.. I am going for bloodwork at 7am, and seeing a cardiologist at 2pm tomorrow.. No wait basically, and not a dime of cost.. A cardiologist is a specialist.


BTW my second brain surgery was on my schedule so to speak, although I find that a little bizarre way to put it. He was the surgeon, myself the patient.. The first offer was that week, and I wanted to fully prepare my children, and myself, so wanted an extra week..

You may want to believe what is fed to you, and I have NEVER understood it.. .. It can work ,and it does work. Is it perfected, no.. But reading this thread, makes me really sad for some people. You don't choose your health..

apples to oranges---we were talking elective procedures not acute care....and your care is not free....

 

[mommasita]

apples to oranges---we were talking elective procedures not acute care....and your care is not free....

I still am.. Seeing as I live here, I do know a lot of people having elective surgeries.. I will admit they are not the next day, and they shouldn't be.. Emergencies should be first and foremost..

My second surgery was elective..
Right now it is acute, but honestly it wouldn't matter, my care would be the same.. I would being seeing a Dr, it is just a matter of where. In the ER, or through my GP.

And free was not a word I used. .. I, and others mentioned our taxes being higher, we are aware..

I don't think this is a perfect system, but I do think it works, and works very well.. From this thread, your system is not perfect either.. As you didn't appreciate someone telling you how to do your job, I certainly can't stand by and read things that are totally incorrect.. Like the not choosing your Dr bit..

 

[NFLDERS]

I still am.. Seeing as I live here, I do know a lot of people having elective surgeries.. I will admit they are not the next day, and they shouldn't be.. Emergencies should be first and foremost..

My second surgery was elective..
Right now it is acute, but honestly it wouldn't matter, my care would be the same.. I would being seeing a Dr, it is just a matter of where. In the ER, or through my GP.

And free was not a word I used. .. I, and others mentioned our taxes being higher, we are aware..

I don't think this is a perfect system, but I do think it works, and works very well.. From this thread, your system is not perfect either.. that it is.. 99 to As you didn't appreciate someone telling you how to do your job, I certainly can't stand by and read things that are totally incorrect.. Like the not choosing your Dr bit..

Snowman is obviously trying to convince himself now. I'm thinking he needs to chill before a melt-down, take 2 aspirin and call his Doctor in the morning. Don't worry, be Happy Snowman.