Need thoughts on Health Insurance

[MossRoad]

Does your company offer a higher deductible plan? We are fortunate enough to be able to afford a very high deductible and it saves considerably on the monthly costs. As I recall, if no one got sick for about the first two years and we banked the savings, that would be enough to build up our deductible fund.

 

[Western]

Not at her Co. Moss, they offer only 2 plans now and this is the best one out of the 2, a little more $ monthly but better on the high end coverages.

 

[coffeeman]

The Blues have open enrollment once a year in my area. It only comes around in Jan or Feb, though. I understand rates are ok at with this offer. Somtime there are state plans that are reasonable if you meet income limits. Of course this depends on your state.

I have a friend that had a state plan for about $90 a month. Much of the plan was funded by tobacco settlement with state. He got a triple bypass. Lost circulation in feet and toes. He had doctored for a year and finally they cut off 3 toes on one foot and two on another. He was dropped from state plan as he was not working. One of rules is you must work to take advantage of state plan. State put him on medicade. Now a year and a half later he is ready to work, but his old job is not there. So, he files for unemployment and gets $220 a week. Now state says he makes too much money to get medicade. So a guy who worked all his life and owns a small modest house is now left out in the cold.

It's the average working people who want to work that are treated like crap. He would have been better of going on drugs and blaming his mom for his dirty deeds. The world would keep him, rent a house for him, give him spending money, buy him a car, send him to school and get him some tools to start a job.

Cheers.....Coffeeman

 

[Western]

Checked with BC/BS $1569 per month!!! Guess my our deal through my wife's job really isn't that bad.

I guess it is like grampa said, "we work to afford to die"

 

[jonyyuma]

Bird, thanks for the breakdown on medicaide...> I must admit sticker shock at it, after all you are retired? Looks like I need to keep my job for as long as possible.Plus that situation really is not what I desire..

 

[ronjhall]

There was a time when I was foolish enough to think our health care insurance would be less when we got on Medicare. Well, we're there so now we pay:
]
$96.40 for wife's Part B (deducted from her social security)
$115.40 for my Part B (it's more expensive if not deducted from social security
$321.82 for Medicare Supplement for both
$327.32 for Medicare Part D (prescription medicines)
$48.75 for both for Dental
$10.29 for both for Vision

All of it except Part B is through the city and with United HealthCare. If Medicare covers something, then the Supplement pays the deductible and co-pay, but if Medicare turns it down, then the insurance also pays nothing and we pay it all. There's always a co-pay for prescriptions; up to $100 for a 90 day supply. On most dental claims, United HealthCare can find a way to reject each claim, or at least pay much less than the Dentists expected them to pay.

Our insurance cost for both of us is less here in Michigan.

Part B is same as your wife.

$242 for Medicare Supplement for both, No doctor fees, no deductible or co-pay BCBS Legacy plan.

$30 for Medicare Part D (prescription medicines) for both of us. Humana Walmart Plan. $361 per person deductible each year. Low or no copay. This plan is good for me since I take no medications yet.

$76 Dental. No problems with what is payed. Dentist checks price and advises us on cost before each procedure. Many of our friends that visit the RGV are using dentist in Mexico with good results and cost. We are considering this option. Cost for most services would be less than our current copay.

The company that I retired from gives me a medical saving plan to pay for the insurance and medical cost. It covers all but $100 of each months bill.

Company I retired from also offers insurance at almost double the above plan prices. Plus deductible and copays.

I choose to go out on my own and shop for Insurance. Many people that retire are forced to use the insurance plan that is offered by company they retire from. They resell their insurance plans to retired persons at inflated prices.

 

[Bird]

Yeah, Ron, it's a gamble no matter which way you go. I could drop the insurance we have through the city and go out on our own, as you've done, but if city retirees ever leave the city insurance, they can never get back on it. At least one insurance salesman (here on TBN) said it appears that the city is either subsidizing or getting a discount on MY part of the AARP supplement but not my wife's. As for the Part D (prescriptions), for the last 3 years, mine have cost no more than a couple of hundred a year, but until this year, my wife's cost enough (according to the insurance company) that they paid out more than the premiums we paid.

 

[dmccarty]

I track our health care expenses in a spread sheet because we have so many bills I need to compare the EOB statements with the bills to minimize mistakes. Usually mine. The spread sheet keeps a running total including mileage costs.

I try NOT to read the running total of our health care expenses other wise I might add to our expenses.

For as much money as I pay, it is has been worth every danged cent. Without the expensive health care my family has gotten I do not think I would have a family.

We have had some real numb nuts for doctors. One almost killed our baby. But the OTHER doctors have more than made up for the idiot doctors. We have had billing issues which have mostly, if not all, been due to twits in the billing office not doing their jobs.

We just made a short trip to where my grandmother was born and raised. While there, we visited the family grave site. My great grandfather died at a very young age compared to today. He caught one of the killer flu's back in the 20/30's and never really recovered. Family lore is that eventually he died from what the flu had done to him. My wife's great grandfather also died young, about the same time, and for the same reasons. Kinda weird.

Later,
Dan

 

[300UGUY]

I track our health care expenses in a spread sheet because we have so many bills I need to compare the EOB statements with the bills to minimize mistakes. Usually mine. The spread sheet keeps a running total including mileage costs.

I try NOT to read the running total of our health care expenses other wise I might add to our expenses.

For as much money as I pay, it is has been worth every danged cent. Without the expensive health care my family has gotten I do not think I would have a family.

We have had some real numb nuts for doctors. One almost killed our baby. But the OTHER doctors have more than made up for the idiot doctors. We have had billing issues which have mostly, if not all, been due to twits in the billing office not doing their jobs.

We just made a short trip to where my grandmother was born and raised. While there, we visited the family grave site. My great grandfather died at a very young age compared to today. He caught one of the killer flu's back in the 20/30's and never really recovered. Family lore is that eventually he died from what the flu had done to him. My wife's great grandfather also died young, about the same time, and for the same reasons. Kinda weird.

Later,
Dan

My mother's father lost both of his parents in the flu epidemic of 1918? Just took out some folks, left others.

 

[ronjhall]

Yeah, Ron, it's a gamble no matter which way you go. I could drop the insurance we have through the city and go out on our own, as you've done, but if city retirees ever leave the city insurance, they can never get back on it. At least one insurance salesman (here on TBN) said it appears that the city is either subsidizing or getting a discount on MY part of the AARP supplement but not my wife's. As for the Part D (prescriptions), for the last 3 years, mine have cost no more than a couple of hundred a year, but until this year, my wife's cost enough (according to the insurance company) that they paid out more than the premiums we paid.

I forgot to mention that when I left the company insurance I could not go back. The HR person that handled my retirment was the one that recommended that I shop for better insurance for cost and benefits. Took me 3 years to get my act together and do this. It has saved us over $6000 a year in premiums alone.
My 92 year old mother is the one who got me pointed in the right direction for the plan we are on.
In Michigan it is best to stay away from a Advantage plan for Medicare. The key word is Supplemental. Calling on any Medicare Insurance plan here in Michigan will always send you to a agent selling Advantage plans.

 

[Bird]

I forgot to mention that when I left the company insurance I could not go back. The HR person that handled my retirment was the one that recommended that I shop for better insurance for cost and benefits. Took me 3 years to get my act together and do this. It has saved us over $6000 a year in premiums alone.
My 92 year old mother is the one who got me pointed in the right direction for the plan we are on.
In Michigan it is best to stay away from a Advantage plan for Medicare. The key word is Supplemental. Calling on any Medicare Insurance plan here in Michigan will always send you to a agent selling Advantage plans.

Ron, as many people as there are using the Advanage plans, they must be good for some people, but I've never heard anyone say anything good about them.

 

[drgill]

Insurance companies are the biggest cause of high healthcare costs in our country. Note that I don't specify for profit or not for profit (BCBS) because either way the money paid in by you or your employer funds individuals' profits (could be investors in the for-profit case or company executives in the non-profit case). To call this insurance is ludicrous. The payments made to insurance companies are enough to cover healthcare costs- sort of like installment payments. The insurance company takes on no risk, which is the definition of insurance- risk sharing.

I've worked in healthcare 33 years so I've seen the dirty insides of the way the system works. You'd get mighty PO'd if you saw the way insurance companies make collecting on claims so dang difficult for healthcare providers. I'm against ObamaCare, but for a national healthcare plan- one that specifies a single-payer system. Obamacare went out of its way to make sure insurance companies didn't get penalized. Why should we (individuals and companies making insurance payments) have to guarantee the profits of these companies? All they're doing is collecting the payments, trying to pay as little as possible for any claims and pocketing the leftover.

PH

I agree. Everyone having access to health care is wonderful goal but not if it bankrupts the country. There has to be a better way. I was thinking about primary care-like facilities where you could receive basic medical care at a reasonable price (subsidized by the government). For example, if your kid broke his leg you could take him there and have the bone set and a cast put on. Maybe it could be staffed by nurse practioners. There has to be some way of accomplishing this.

 

[brin]

I agree. Everyone having access to health care is wonderful goal but not if it bankrupts the country. There has to be a better way. I was thinking about primary care-like facilities where you could receive basic medical care at a reasonable price (subsidized by the government). For example, if your kid broke his leg you could take him there and have the bone set and a cast put on. Maybe it could be staffed by nurse practioners. There has to be some way of accomplishing this.

I think you are exactly right...County health departments could be used for this purpose and administered locally..not by the Feds...Hospitals could also have adjoining fast care centers with nurse practitioners that handled less serious needs thereby freeing up the ER's for serious emergencies...

 

[Sigarms]

I think the cost of obamacare will be so far more extreme for the country than we think, no facts to back that up, but why do it behind closed doors and the leadership, (Dems Pelosi) said it would take time to find out what was in the package!!

We give to many "perks" for "free" already, but who is it really "free" for??

Sorry, gets me PO'd, I am not rich and don't have much, but what I have my wife and I have worked for. Maybe I have to much pride, but I don't want to be in a handout line and I'm afraid this bill (HC) along with guvment spending will force that on most of us. Never thought I'd be living in Europe and I don't even have the tourist photos!!

Although I don't particularly care for the current president, I do think he's getting a bad rap for his nickname when it comes to health coverage.

The fact is, the US is one of the few "modern industrialized" nations on the planet that doesn't have mandatory health coverage for it's citizens.

This was going on LONG before this guy got into office.

Have a buddy who is in medical sales, the margins are unthinkable in most industries I know. Drug companies? come on.

All I do know is that anyone of us, if we have some major medical issues, could bankrupt us in a heart beat. That's what's really scary.

Personally, health insurance is just like any other type of insurance in my eyes, legalized crime.

Perhaps due to the fact that I'm getting older, I happen to believe that everyone of us has a right to be covered for health care, and you shouldn't run the risk of losing your life's savings if you're hospitalized. For the record, I've had health insurance for the last 20 years or so and pay a pretty penny for it. Please don't think I'm looking for a handout, but it's to the point as I get older that the medical system in the US is for the most part a money making machine.

 

[KennyG]

Have a buddy who is in medical sales, the margins are unthinkable in most industries I know. Drug companies? come on.

All I do know is that anyone of us, if we have some major medical issues, could bankrupt us in a heart beat. That's what's really scary.

Personally, health insurance is just like any other type of insurance in my eyes, legalized crime.

I know these are common thoughts, but all drug companies are publicly traded corporations. All insurance companies are publicly traded companies or mutual companies (owned by policy holders). If they are making so much money, just invest in the companies and let the dividends pay for your health care costs.

That actually won't work because, as a sector, pharmiceuticals are losers - return less than the overall stock market. This is because the one company that has a current hot drug makes lots of money in a given year and rest lose because they can't recover their research costs. Insurance company investments are solid, but won't put you on easy street either.

The bottom line is that we have demanded a very high level of health care in this country (beyond what Europe has) and we are getting it through a relatively inefficient delivery system. Until that gets addressed, the cost will remain high. To some extent, I accept that because I think, as a country, we are wealthy enough to pay for more health care than other countries. High tech state of the art medical care will never be cheap and I'm OK with that as long as we do something about the efficiency and prioritization of the system.

 

[Sigarms]

Buy a brand name drug and compare it's cost to an "off brand".

I almost fell over dead when I went off Lipatore (sp) when the doctor prescribed an off brand name and I saw the cost difference.

Our son had a consultation the other week with a doctor. For a 10 minute chat, the tab was $545, of which we had to pay $10. So, if we didn't have insurance, would the bill have been substantially less?

The fact is, if you're dying, you'll pay anything to live. I may be wrong, but that's the way I see it.

All that said, Wake Forest Hospital is a big employer locally. They're building "mini" hospitals all over the place. Kicker is, couple of years ago when I spending time in the burn unit, the hospital was severely understaffed. Can't figure out how they have the money to build more hospitals when they can't find enough people to work in the ones they already have.

Perhaps it's just me, but I can't help but think that the insurance companies and hospitals want to make sure you don't have a clear understanding of exactly what is going on.

 

[Bird]

They're building "mini" hospitals all over the place. Kicker is, couple of years ago when I spending time in the burn unit, the hospital was severely understaffed. Can't figure out how they have the money to build more hospitals when they can't find enough people to work in the ones they already have.

I know some doctors have complained about Medicare and Medicaid not paying enough, and I know they usually submit a huge bill to Medicare, then Medicare approves a third or less of what was billed. I do wonder, if a person doesn't have insurance, will that person be stuck for the huge initial billing?

Now I don't know how much "profit" the doctors around here are actually making, but it really is incredible to me to see the number of hospitals and the huge luxurious facilities that doctors have built and are still building within 15 miles of our home.

I think in general the medical care situation in this country is a disgrace, but there's enough blame to go around; doctors, insurance companies, and us . . the patients or consumers.

You see, I'm so old I remember when we just paid the doctor; no insurance. Now a medical office usually consisted of one doctor, one receptionist, and one nurse. And when a patient didn't pay at the time, one of those people mailed a bill later . . to the patient, not an insurance company.

And then we got insurance, so when a patient asked a doctor what something would cost, the doctor's answer was to not worry about it, your insurance will pay for it, or pay most of it. How many of us are old enough to remember that? It's happened to me more than once. So, we didn't worry about it, the insurance will pay it. And the doctors quickly learned to charge more.

So we got a receipt, bill, or statement from the doctor, filled out a little form, and mailed it to our insurance company. At least our insurance would then mail us a check within 3 to 6 weeks (depending on which company my employer was using that year).

So insurance companies started "negotiating" fees with doctors, hospitals, and clinics, in an effort to improve their profits; not to do anything to improve health care. The rules got more complicated, all the medical care providers had to hire more help and do more paper work. So they had to charge more to cover that additional manpower expense. So it's now really convenient for the patient, no forms to fill out, no stamps to buy to mail a claim form, don't have to go to the bank to deposit the check received. But we pay dearly for that convenience in higher doctor and drug costs and higher insurance premiums.

Now that's my opinion; yours may vary.:laughing: So what can we do about it? I sure don't know.

 

[KennyG]

Good points Bird. I have BC/BS and the great advantage is their negotiated rates. I have a high deductable policy so, barring a crisis, I end up paying everything myself. However, when I get billed the cost is always reduced by 20% to 50% because of the BC/BS negotiated rates. I assume the poor guy with no insurance gets billed for the full amount.

Medical insurance really didn't exist until WW2 for most people. You didn't need it because the doctor could either fix you up for a small cost or you died. There weren't many options.

 

[Western]

This out to hack you guy's off a bit as it does me.

My wife is an ADON at a rehab/retirement center. She has seen where a patient needing and electric wheel chair has 2 options as far as the wheel chair co. are concerned. 1st is patient as payer and the range is $1000-$7000. If the patent can use Medicaid, the same Chair company will charge Medicaid up to $20,000 + for the same da%# chair.

Have you seen the stores selling those high end "wheel chairs" and claim they will get you approved through medicaid??? Who get's ripped off in that deal???

I think, though necessary, Medicaid and Medicare are full to the brim with fraud. If it isn't fraud it should be, the cost should be the same for the patient and the taxpayers.

 

[300UGUY]

I know some doctors have complained about Medicare and Medicaid not paying enough, and I know they usually submit a huge bill to Medicare, then Medicare approves a third or less of what was billed. I do wonder, if a person doesn't have insurance, will that person be stuck for the huge initial billing?

Now I don't know how much "profit" the doctors around here are actually making, but it really is incredible to me to see the number of hospitals and the huge luxurious facilities that doctors have built and are still building within 15 miles of our home.

I think in general the medical care situation in this country is a disgrace, but there's enough blame to go around; doctors, insurance companies, and us . . the patients or consumers.

You see, I'm so old I remember when we just paid the doctor; no insurance. Now a medical office usually consisted of one doctor, one receptionist, and one nurse. And when a patient didn't pay at the time, one of those people mailed a bill later . . to the patient, not an insurance company.



And then we got insurance, so when a patient asked a doctor what something would cost, the doctor's answer was to not worry about it, your insurance will pay for it, or pay most of it. How many of us are old enough to remember that? It's happened to me more than once. So, we didn't worry about it, the insurance will pay it. And the doctors quickly learned to charge more.

So we got a receipt, bill, or statement from the doctor, filled out a little form, and mailed it to our insurance company. At least our insurance would then mail us a check within 3 to 6 weeks (depending on which company my employer was using that year).

So insurance companies started "negotiating" fees with doctors, hospitals, and clinics, in an effort to improve their profits; not to do anything to improve health care. The rules got more complicated, all the medical care providers had to hire more help and do more paper work. So they had to charge more to cover that additional manpower expense. So it's now really convenient for the patient, no forms to fill out, no stamps to buy to mail a claim form, don't have to go to the bank to deposit the check received. But we pay dearly for that convenience in higher doctor and drug costs and higher insurance premiums.

Now that's my opinion; yours may vary.:laughing: So what can we do about it? I sure don't know.

My doctor gave up her solo practice because she had to employ a full time person just to collect from the insurance companies. And they frequntly took a year or more to pay. She joined a group practice.