Walmart Health Insurance

[MrsKirkley]

Here's a breakdown of the plans for 2014. All rates I listed are for non tobacco users.


The deductible on the HRA plan for employees is $2,750. For families (including partner and/or children), it's $5,500. After the deductible is met, insurance pays 80%. The annual out of pocket maximum on the HRA plan is $5,000 for employee only coverage and $10,000 for family coverage. Monthly premiums are as follows: $36.80 for a non-smoking employee, $123.80 for an employee and partner, $59 for an employee and children, $147.80 for an employee, partner, and children.

The deductible on the HRA High plan is $1,750 for employees and $3,500 for families (including partner and/or children). After the deductible is met, insurance pays 80%. The annual out of pocket maximum is the same: $5,000 for employees only and $10,000 for families. Monthly premiums are: $122.60 for employee only, $310.40 for employee and partner, $172.80 for an employee and children, and $339.20 for an employee, partner, and children.

[SoCalDem]

1. High plan = 7570.40 out of pocket BEFORE insurance pays 80%

emp-partner-kids..

and I bet copays are NOT included in the deductible...or drugs or dental or vision or mental health.. and for most people, that threshhold will not be reached before the new year starts and they have to start over..

[Nye Bevan]

3. By law (the ACA) drugs must be included.

Also, pediatric (but not adult) dental and vision must be covered, and mental illness is required to be covered on exactly the same terms as any other illness. And bear in mind that all preventive care is free under the ACA, regardless of whether the deductible has been met (regular check-ups, shots, mammograms, etc.)

[401A]

8. free "Preventive" is NOT always true.....

Yes, there might be some "preventive" doctor visits that will be paid for (by the insurance companies, which get their monies from the members of that insurance pool).

HOWEVER, it is ONLY covered at 100%, if and ONLY if it is billed with a preventive code: what this means is, as soon as the doc finds something during your "free" and "preventive" visit, your visit becomes DIAGNOSTIC and it will be switched to (in most cases) a visit that gets covered according to your Deductibles, Co-Pays, Coinsurance, etc.

IOW, many people will innocently go to their doctor for a visit, believing hook-line-and-sinker that they're "entitled" to a Free Doctor visit, because after all, this is Obamacare. The doc however, who wants to make money, discovers something, and boom---that "free" visit costs you the unsuspecting patient Big Bucks. Then, the doctor will send you to his or her favorite Specialist for further evaluation (costing more Big Bucks). You will probably make your appointment with that Specialist and incur another bill, long before you ever learn about the cost of your supposedly "free" visit.

These "free" preventive visits are DESIGNED to make money for: 1) the insurance companies (they don't have to pay for it if the doc finds something); 2) as well as for the Doctors & Clinics (if they find something, they can send you on to their friends); 3) and also the Big Pharma companies (they can prescribe several prescriptions for what the doc finds).

There is NO free lunch, anywhere on Earth. "Free" preventive visits do not improve your health---they are moneymakers for somebody. It has to be that way, why would anybody work or provide goods, for nothing? Obamacare is not charity---it is designed to make money for the big 3--Insurance, Doctors, and Big Pharma.

[TBF]

9. "Preventative Care" -

Preventative care under the private United Health care my husband and I have (and pay high premiums - over $2K month) is often free just as you'd expect. "Free" in the sense that we do not pay additional co-pays - we go in for physicals, flu shots, basic xray and dental cleanings, pap smears - and aren't even charged for office visits. Of course we've already paid a stiff premium every month.

I'm not sure why you've signed up on this website other than to complain about Obamacare. No, it is not a universal single-payer system. If that is what you thought it would be then you weren't paying attention the past few years. And even a single payer system is not "free" - the costs are simply paid by tax dollars.

What is it you are trying to say?

ETA - I am coming to the conclusion that many folks have absolutely no idea how insurance coverage works. With our UH care we also have high "deductibles" but it's not like we have to pay for every office visit the first few months until we "meet" those amounts. Those deductibles are for specific things and most years we get all of our preventative care without paying very much at all towards those "deductibles".

[uppityperson]

10. Are you saying screening for cancer and other diseases does nothing for the patient?

Last edited Wed Jan 8, 2014, 02:20 PM - Edit history (1)

I agree that Obamacare did not go far enough and insurance companies still make too much money. But you seem to be saying that preventative care does nothing for the patient.

Edited to add that a visit can switch from preventative to diagnostic if something is found but telling people to avoid going to a doctor because they might be diagnosed with something is REALLY bad advice. Finding health issues early is a good thing and preventing them is even better. All of which these preventative visits are for.

[NRaleighLiberal]

11. So I suppose you avoid doctors, it isn't about health, it is about money. How is your health?

That is quite a cynical view you have there....

[gopiscrap]

12. welcome to DU

[LuvNewcastle]

2. That's not a good deal at all.

I qualify for subsidies, so I could probably get a gold or platinum plan for just a little more. I guess it's better than nothing, but that's all it is.

[Myrina]

4. It's better than my ACA "options" ...

Bronze plan, single 47 yo nonsmoking female.
No subsidies available due to income.
$230/mo (which I could handle) plus $6,000 annual deductible. $50 office calls, 40% co-pay.

Unless I lose a limb or a major organ I would never meet that deductible.
And even if I met it, there's no way I could pay it.

[B Calm]

6. On Walmart wages I'm sure they could do better with ACA

(because of the subsidies) than what Walmart is offering them.

[Myrina]

7. You're right ... but I'm just amazed at those deductibles ...

... who - making under $100k/yr - can cough up $6K for a DEDUCTIBLE? That makes the coverage essentially useless.

My last employer's plan had a $3K deductible & when I had my tubes tied, of course I got billed for $3k plus 20% co-pay (another $1600) and it took me over a year to pay it off. The only thing having insurance did was delay the billing long enough for me to come up with a plan.

[SoCalDem]

5. I have seen Walmart paychecks.. They are pretty skimpy

For a full-timer, the insurance is probably okay as long as they are willing to gamble on coverage if someone gets really sick, and they have the extra cash to cover the deductibles..

Most people who work at walmart (the ones I know) are there because it's the only job they can find and they struggle to pay rent, buy food, gas for the car, car insurance..Most come up short and subsidize the family with credit cards (which only makes for another bill to pay)..

Hopefully they have a partner and that partner has a better job