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One thing I want to know. (Original Post) Rustynaerduwell Oct 2020 OP
I have employer healthcare that is awesome. onecaliberal Oct 2020 #1
+1. for your post. Minus a zillion for your situation. Sorry. yonder Oct 2020 #9
The system is a wreck. Navigating it by myself, not having a clue what I needed to do. onecaliberal Oct 2020 #13
They love it compared to what they THINK the ACA, MFA, etc., would be like. Hoyt Oct 2020 #2
Not necessarily. Ms. Toad Oct 2020 #12
More expensive than the total cost the employer AND employee paid in premiums, coinsurance, etc.? Hoyt Oct 2020 #15
COBRA was an option - BUT - it initially appeared it would not be, Ms. Toad Oct 2020 #18
Sorry you two had to go through that, plus worrying about getting coverage. Hoyt Oct 2020 #19
I have work insurance and hate it FreeState Oct 2020 #3
There are unions that have pretty great insurance. LakeArenal Oct 2020 #4
I like my employer provided heath care MissB Oct 2020 #5
Holy buckets. I am envious. MontanaMama Oct 2020 #6
Union covered job MissB Oct 2020 #8
I do. But my employer pays about 2/3 of the premiums Roland99 Oct 2020 #7
I have good health insurance BainsBane Oct 2020 #10
My daughter's last two employer plans have been awesome. Ms. Toad Oct 2020 #11
I am currently on Medicare. I'm old. PoindexterOglethorpe Oct 2020 #14
They are people who have a good job with good insurance coverage, MineralMan Oct 2020 #16
I agree. I have great insurance through my employer... zackymilly Oct 2020 #17
There are far too many variables for anyone to know if they have a good plan MoonlitKnight Oct 2020 #20

onecaliberal

(32,898 posts)
1. I have employer healthcare that is awesome.
Fri Oct 23, 2020, 12:15 AM
Oct 2020

Right up until almost 4 years ago when my husband had a stroke. EVERYTHING is out of network and the cost spiral out of control. We ended up with a 270,000 out of picket bill. A lot of people who think they like they’re employer healthcare because they’ve never experienced a catastrophic health event. Our system is broken and pathetic. What kind of people want to profit from death and sickness?

yonder

(9,676 posts)
9. +1. for your post. Minus a zillion for your situation. Sorry.
Fri Oct 23, 2020, 12:52 AM
Oct 2020

It shines a light on our awful HC/insurance system and how little protects most of us from huge changes in our lives brought on by medical needs.

onecaliberal

(32,898 posts)
13. The system is a wreck. Navigating it by myself, not having a clue what I needed to do.
Fri Oct 23, 2020, 01:21 AM
Oct 2020

Not knowing the hidden rules and obstacles put in place to deter people who desperately need help from obtaining it. The insurance companies are out of control.
In every other way it is a great plan. I have affordable deductible, low co pays my employer contributes and a cap on out of pocket expenses. ( for covered costs only) Found that out real quick. I’m beyond disgusted at what passes for human these days.

 

Hoyt

(54,770 posts)
2. They love it compared to what they THINK the ACA, MFA, etc., would be like.
Fri Oct 23, 2020, 12:15 AM
Oct 2020

They are wrong, but the Public Option is what allows them to experience it firsthand.

Ms. Toad

(34,092 posts)
12. Not necessarily.
Fri Oct 23, 2020, 01:04 AM
Oct 2020

My daughter's two employer-based plans were far better that the ACA plan she was on in the gap period between her two employment-based plans.

Part of the challenge was the multiple out-of-pocket maximums she incurred in a single year. BUT - the ACA plan (even subsidized) was more expensive than either employment-based plan.

 

Hoyt

(54,770 posts)
15. More expensive than the total cost the employer AND employee paid in premiums, coinsurance, etc.?
Fri Oct 23, 2020, 09:15 AM
Oct 2020

If the employer plan is better, one can take COBRA and continue it between jobs.

You do have a point that a lot of folks are comfortable with their employer plans. That's why I like the idea of a Public Option that doesn't force anyone to take the ACA plan. Although, I don't think a Public Option or MFA is going to be anywhere near as inexpensive as people think/hope.

Ms. Toad

(34,092 posts)
18. COBRA was an option - BUT - it initially appeared it would not be,
Fri Oct 23, 2020, 10:50 AM
Oct 2020

and we weren't notified it was until 2 months after the job ended.

The issue is that COBRA isn't available in bankruptcy when the business is completely terminating (which this one did). HR stopped responding to inquiries pretty much the day the notice of liquidation came out, and about a month after the stores in our area were completely shut down we discovered that employees might actually be entitled to pay for 2 months (some employees got notices to that effect - no explanation why they were eligible, no notice to the employees at other stores). It turned out that a few stores were large enough to have required a 2-month notice . . . that apparently made everyone eligible for COBRA since they had to continue the health care plan for those employees, so about a month later we finally got a notice about COBRA.

Even with the higher premium, the COBRA plan they offered would have been a better deal, since she had already met her out of pocket maximum for the year. Her medical expenses are approximately $17,000/month. So she had $2000 out of pocket (OOP) in July, when her old plan started, $2000 in March when she was forced out of work and onto the ACA, and $3500 in June when she was eligible for the work plan (or $6,000 more under the ACA if she continued it, since she lost the subsidy when a work plan became available) then $3500 more in October when the new work plan year started.

So COBRA would have saved her $5500 in medical paymentns. For those months it would have cost about $3250 more in premiums for COBRA, so still a better deal. Unfortunately - BUT - at $17,000 bucks a month in medical care, we could not go without a plan hoping they might offer a retroactive COBRA plan.

That entire process was a nightmare - we even got our senators involved (one of whom was involved in writing the ACA), and his office was not even aware that there are both premium subsidies and cost sharing subsidies. That rendered them incapable of answering the question we asked about whether the cost sharing subsidies would disappear when she became eligible for work insurance (they do . . . we had hoped she would be able to stay on the ACA without subsidies to take advantage of having already hit her OOP maimum, but not only did the premiums jump $100/month, she would have had to pay the difference between the $2000 subsidized cap and the $8,000 unsubsidized cap.) I even went back and read the law to see if we could get an answer. Ultimately, we had to sign up for the first unsubsidized month, see the OOP max jump, and then cancel it.

This isn't an issue for most people - most people don't have $20,000 infusions every 7 weeks + MRIs, colonoscopies, and expensive medication. So most people don't reach the $2,000 OOP, let alon an $8,000 one in a single month. So insurance agents aren't used to looking at insurance by adding hte OOP max to the premium to get the price for a month or two of gap insurance - and they aren't used to answering the kind of questions we asked about what happens to the cost-sharing subsidies once you become eligible for a work plan.

Every single person told us - we'll just have to wait until that happens and then we'll see what the system generates. Really??? There are rules that govern it. I want to know what the rules are, since it I've had "systems" that were programmed incorrectly - and, at least theoretically, the system implements the rules as they are programmed in. But no one, even my senator's office, could tell me the actual rules - and most told me I was crazy for even asking the question (only the premiums will go up since you pick the OOP as part of the plan. Wrong.)

As for Public Option/MFA - they should be cheaper thant he ACA, since they cut out the insurance companies. Our medical costs are the highest in the world in part because the cash costs are higher to underwrite the discounts under insurance contracts and the uncollectable costs. Those largely vanish once the government is paying directly for the care, virtually all bills are paid, and cash prices don't have to be jacked up to cover the other two.

FreeState

(10,582 posts)
3. I have work insurance and hate it
Fri Oct 23, 2020, 12:17 AM
Oct 2020

Blue Shield Anthem PPO - cost $40 for copay.

I have to fight them for standard screenings every year. Colonoscopy cost me almost $1200 a year.

LakeArenal

(28,845 posts)
4. There are unions that have pretty great insurance.
Fri Oct 23, 2020, 12:20 AM
Oct 2020

I have a friend in the county treasurer’s office that has great health insurance.

MissB

(15,812 posts)
5. I like my employer provided heath care
Fri Oct 23, 2020, 12:22 AM
Oct 2020

But I’d be happy to give it up if we had Obamacare for all.

I pay $100-ish/mo for a family of four. Max out of pocket (out of network) would be $7500. Most dr visits cost about $20. I don’t need referrals. ER visits have a $75 copay, waived if admitted. It works all over the country so my college aged kids are covered.

If we could get Obamacare for all, I’d be happy to pay more in taxes. Seriously. Everyone should have great coverage. No one should go bankrupt because of medical bills. No one should avoid the ER because they can’t afford the care.

MontanaMama

(23,337 posts)
6. Holy buckets. I am envious.
Fri Oct 23, 2020, 12:37 AM
Oct 2020

My husband and I have always been self employed. Our current monthly premium for our family of 3 is $2000 a month with a $4000 per person deductible with a max out of pocket for the family of $8500. This is a silver level policy from Pacific Source. There are only two companies in my state that offer policies on the individual market. This is the beast deal I could get.

MissB

(15,812 posts)
8. Union covered job
Fri Oct 23, 2020, 12:44 AM
Oct 2020

That’s a bunch of it right there.

We do have a deductible - it’s like $250/person max of $750 for the family. I’ve been fortunate to never actually hit that. We don’t use much in the way of health care (other than PT, two of us are always in PT).

Right when I stepped back into the workforce DH’s health care options at his private employer got bleak- like $5k a year out of pocket before insurance kicked in. That’s not health care- that’s catastrophic coverage.

It’s downright criminal to charge $2k/mo for coverage.

Roland99

(53,342 posts)
7. I do. But my employer pays about 2/3 of the premiums
Fri Oct 23, 2020, 12:39 AM
Oct 2020

I’m VERY lucky

Employer-based options are patently unfair tho

Ms. Toad

(34,092 posts)
11. My daughter's last two employer plans have been awesome.
Fri Oct 23, 2020, 01:02 AM
Oct 2020

Her billed healthcare costs are $200,000 each and every year (same diseases as Jamie Redford's son just died from). Both jobs were slightly above minimum wage. Both premiums were reasonable (less than $100/month), and her total out of pocket expenses for the first one was $1500/year. The new one has lower premiums - but the out of pocket is capped at $3500 (and she only has to work 25 hours/wee, to keep it).

$200,000 worth of health care for $1500 + reasonable premiums, or $3500 + reasonable premiums - that's a bargain.

My insurance through the university I work at is good, but not nearly that good.

Private employer-based insurance has actually been very good to us for the 40-ish years we've been on it.

That doesn't mean I want to stick with an employer-based system for the country. But when it works, it generally works pretty well.

Probably not the reply you were hoping for, but that's been our reality.

PoindexterOglethorpe

(25,898 posts)
14. I am currently on Medicare. I'm old.
Fri Oct 23, 2020, 01:46 AM
Oct 2020

In the past I had pretty decent health insurance through employers. However, and this is probably the most salient point, I have always been astonishingly healthy and have made almost no use of the health care.

About a decade ago I tripped over my own two feet in my driveway and broke my arm. It was a non displaced hairline fracture of the ulna, so just barely a break. I'm forgetting what my co-pays were for the ER visit and then the follow ups with a doctor. About two years later I got a check from the insurance company for, I dunno, about $35. I was completely confused by that, contacted the insurance company, and it turned out that for one of the visits I should not have been charged the co-pay. Lucky me.

When I see things like $2,000/month for family coverage, I cannot begin to imagine. My family income (back when I was married and had kids) was maybe double that. At best. How do people afford it? 50% of my income to health insurance? Maybe I'm just even poorer than I thought.

MineralMan

(146,331 posts)
16. They are people who have a good job with good insurance coverage,
Fri Oct 23, 2020, 09:18 AM
Oct 2020

most of which is paid for by their employer. That's great, until the economy causes your employer to lay you off or eliminate your position. Then you have zip. Nada. Then, you have to find your own insurance and pay for the entire amount of its premium. Then, you will appreciate ACA.

zackymilly

(2,375 posts)
17. I agree. I have great insurance through my employer...
Fri Oct 23, 2020, 09:26 AM
Oct 2020

...but if I wasn't working, I'd be in deep doo doo.

MoonlitKnight

(1,584 posts)
20. There are far too many variables for anyone to know if they have a good plan
Fri Oct 23, 2020, 11:07 AM
Oct 2020

1. Employer based - but you have nothing if the job goes away.
2. A low cost plan is great if you don’t need it.
3. A high cost plan is great if you end up needing it but if you don’t you feel ripped off.
4. Every plan tries to minimize paying for what they can to maximize profit.
5. State rules add a whole list of other variables.

Even with Medicare, some people love the Advantage plans. But if you get the wrong disease you are screwed. If you go traditional Medicare and something to help with your 20%, you pay more monthly but have more coverage for something catastrophic.

We need to cover both. Good affordable preventative care and treatment AND a plan that covers the big stuff so you don’t have to choose between bankruptcy or death. And you should ideally not have to depend upon an employer to provide it.

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