We've just been royally screwed by my husband's employer and health insurance co.

[LiberalEsto]

Last year he had a good health plan through his job, with which we had reasonable co-pays of $15 and $30 for doctor and specialist visits. This year, somehow, he's been switched to a
high deductible ($4000) plan with a Health savings Account.

Nobody bothered explaining any of this to us. I just called the mail-order prescription company to find out about some prescriptions that were supposed to have arrived a week ago but hadn't. They said the doctor had not called them in, but that the bill would be about $300. I was shocked and said the last time it came to $56. And the time before that.

When he had open enrollment in November, the form said if we didn't choose a different plan, we'd be put on the same plan. As far as I remember, that is.

I called the insurance company to check and they confirmed that we are now on this high deductible plan, but added brightly that we might be able to save(?) some by having a Health Savings Account. I've always heard that those are a total joke and useless.

I don't know where we are going to get the money to go back and pay every doctor, dentist, pharmacy and lab the full amount for visits made this past month.

I guess this is the insurance industry's revenge for the ACA. The bastards.

[Loryn]

1. That's messed up.

I thought the employer had to notify you of all options during Open Enrollment.

They had to know the changes to your health plan would be this significant.

[denverbill]

2. I've had an HDHP for several years, by choice.

My company contributes $600 to an HSA for me choosing that plan. I contribute the difference between the cheapest non-HDHP and my premium and put that into the HSA as well. I haven't had many expenses so I've managed to save a few thousand dollars into the HSA, more than enough to cover my deductible if I have a bad year for expenses.

My wife switched to a HDHP last year. She had some prescription shocks like you. She switched to a different drug which was much less costly but equally effective. She had way more expenses than me and so spent a lot out of pocket, but if she had a big expense she would just increase the amount she was putting into the HSA. She might have been better off with the old plan as well, but she is doing the HDHP again this year. We'll see how it works.

I don't know if I'd blame the insurance industry. I think it's the employer that makes the decisions what plans to offer.

[LiberalEsto]

4. I was already getting all generics on the prescriptions

so the price they quoted was a huge shock.

It looks like it's going to be a problem paying for asthma meds. My tree pollen allergies are going to start any day and last through April.

The insurance company probably raised the prices on its plans so the employer picked a cheaper option.

[denverbill]

6. Yes I can understand the shock. My wife was pretty shocked at hers as well.

You might still mention it to your doctor if you have to contact him about the prescriptions anyway. It's possible there are less expensive alternatives. Maybe not in your case, but it doesn't hurt to ask.

[The Velveteen Ocelot]

3. Depending on your situation, the HSA isn't such a bad deal.

An insurance policy that didn't have a high deductible and copays would be even better, but those seem to be disappearing. The HSA is actually somewhat useful in that you can deduct contributions to it from your taxes (up to a certain amount which I don't remember), and the money is yours forever. You can carry it over to the following years, and take it with you if you change jobs or retire. If you spend it on approved medical expenses you never have to pay any tax on it, but you can use it for anything (it just becomes taxable income in that year).

I still have some money in mine even though I retired a couple of years ago and now have Medicare. If something comes up that Medicare or a supplement doesn't cover I can still use that HSA money.

[TexasBushwhacker]

5. I have no doubt that some employers used Obamacare

as an excuse to change to high deductible plans that cost them less and pocket the difference. On the other hand, there may have been things that your husband's insurance didn't cover before that are required under Obamacare, like mental health coverage, for example. You also have to consider that there are no pre-existing condition issues anymore, and there are no lifetime caps either. Depending on what the lifetime cap was on you husbands previous policy was, you could have hit it with a single bypass surgery, transplant, or treatment for cancer.

In any case, health savings accounts aren't a bad deal, provided you are sure that you will be using the money you are putting into them for health expense at some point. They also favor someone who is in a higher tax bracket, because they are just tax free savings, not unlike an IRA. If you decide to withdraw money from a HSA for anything other than medical expenses, you will have to pay tax on it.

[Tuesday Afternoon]

7. Our company has given us until 1/31 to make changes to our plans. Not so with your husband's?

My insurance went up, too Yeah, the Insurance Companies are pissed. The Rat Bastards.

[LiberalEsto]

8. Just spoke to my husband - it looks like the company pulled a fast one on everybody

Nobody has bothered talking to the employees about how to set up a health savings account or anything, and it's been in effect almost a month.

My husband doesn't have a clue what to do next but he sent an email to his manager asking for answers.

Thanks everyone for the info on HSAs. It's really helpful.

[elleng]

23. Maybe 'everybody' would be interested in some action

against the 'company,' LibEst?

[haele]

9. Ouch. Insurance companies and prescription providers take advantage of plans where there's an HSA.

We've had this problem for the past three years.
Your prescription bill will go down once you hit their "deductible", which is has been calculated to get as much out of pocket as they can before you hit the limit. Two years ago (before ACA) our company changed from a blanket co-pay/deductable tier to "Consumer Control" medical plan with a FSA/HSA package; if we got the FSA/HSA (which maxed at $6K before tax deductions) we were also given a $3K out of pocket "plan deductible" by our pharmacy provider to meet before they dropped down to the reasonable "tier" costs they had before. (BTW, we no longer get any options to the HSA this year; it's either the HSA or out of pocket full price)

Unfortunately, an HSA isn't maxed out at the beginning of the year, so we only had what we (and my employer on a one-time benefit) had put into it as we were going along - $200 every two weeks, with whatever is left over from the previous year or if the employer will put in an initial benefit contribution to cover excessive costs the first month.

My spouse is disabled and one of his medications - the one that allows him to get out of a chair or bed and go for short distances like to the bathroom without moaning in pain - is a biologic that costs (with insurance) $1420 a month. He had to go onto the pharmaceutical manufacturer's "[FITB medicine] assistance program" to get any sort of relief from the cost, and even then, we had to go through hoops to prove hardship because our household wasn't at the poverty line. (Seems lots of the $500K and above a year don't like paying $1450 a month for a single medication, either).

Anyway, the way things were going, for two years, we ended up hitting our pharmacy deductible in March and even with the assistance program, are on track to hit it by the end of February this year (he's seeing another specialist every month for a new problem that often develops with his condition). After that, the costs dropped down to "reasonable" ($50 for the biologic, $40 for name brands, $5 for the rest).

So, for two years prior, the pharmaceutical "insurance" provider still managed to pick at least $2000 out of our "after tax" pockets (because of our HSA balance) before we hit it, because there is no cost relief until you hit the deductable and we kept maxing out our HSA every week the first three months just in doctor's visits and the regular medications. We paid enough post-tax out of pocket to be able to at least get it back as a deduction on the IRS return this year.

This year, we're going ahead and paying Novartis that one-month's full cost for the meds (and drop them down to $5 a month the rest of the year according to their plan), and perhaps save $800 in the long run. Your doctor might be able to get you signed up on one of those programs. I'm not "happy" with programs like this - I think they're basically a fig-leaf to try and make those parasitical companies seem better while they're feeding off the government and the consumer, but for the time being, they're about the only option most people have to keep pharmecy costs reasonable.

At least we will be able to buy meds and see the doctor without worrying about not having enough in the HSA for doctor's appointments, labs, and meds during the month.

HSAs are great if you don't have a lot of doctor's visits and prescriptions, but games the insurance companies play to get as much of those pre-tax funds from you through "deductible limits" and the "legal" IRS yearly limits on contributions if you have a chronic condition suck.


Single payer now! And include drugs and dental, damnit!

Haele

[alarimer]

10. This may have been the default option if you did NOT choose another plan.

This was the way ours was this year. We were put in the higher deductible option unless we took steps to enroll in another plan. But this was communicated more than adequately by HR. It sounds to me like that company did not communicate it very well. Maybe on purpose. And now it's well past open enrollment so you have no choice for now.

[LiberalEsto]

11. We were not communicated with adequately

Last edited Tue Jan 28, 2014, 12:18 PM - Edit history (1)

Originally the benefits form said if we didn't choose another option, we would stay on the current plan

Then at the last minute, everyone was told that unless you signed up, you'd have NO coverage in 2014. So my husband signed up.

But nobody explained how the new plan works. Nobody told him about the HSA thing or how to set it up.

Another section of his company just lost a big contract, so this may be why they're screwing the employees on health coverage.

Here's what HR wrote him:

Company X "is only offering the high deductible plans this year. The decision was based on survey data and what is trending in the market."

In other words, they're only out to screw us this way because every other employer and insurance company is out to screw their workers using this high-deductible method.

[discntnt_irny_srcsm]

12. I own a small company (an S-corp)

The only employees are myself and my 2 daughters who are 25 and 27. They each have individual coverage in our group plan and my wife and I have coverage as a couple. When I started the group policy 6 years ago, the cost for the whole group was about $1400/month. For that we got family doc = $20, specialists = $35 and Rx $10/$20/$40 (generic/brand/~formulary). The cost has been rising and at last year's renewal was $2168/month. Coverage is now $35/$50 for docs and generic Rx = $7. All other Rx are half of the cash price capped at $125.

The ACA site saves us $0. Blue Cross tried to force me to go for the HSA/high deductible also. What a scam! Why do they get to market drugs at $5/pill (3x a day) or $690/oz for some injectables?

Why am I so poor? Insurance..

[dawg]

13. There needs to be price-leveling for group plans.

Small businesses like ours pay through the nose while the Fortune 500 companies are able to negotiate huge discounts. Big companies have every advantage, and they use it to drive small businesses out of their way. Insurance prices should be fixed and uniform for a particular age cohort, regardless of employer size.

[LiberalEsto]

14. I like that. Uniform prices make sense

and a single payer system in the U.S. would make even more sense

I'm sick of looking at these insurance companies and their cutely named categories like Optimum Silver, Optimum Gold, Optimum Platinum, Optimum Plutonium, Optimum Silver Choice, Optimum Silver Choice Plus, Optimum Silver Choice Plus Premium, etc etc etc and trying to guess which one will screw us the least financially.

Each company has several dozen completely different nicknames for their scams -- I mean plans -- and it is impossible to guess how to compare a plan like Optimum Plutonium Choice Plus at one company with another company's categories like YourPlus, YourPlusFirst, YourPlusFirstOption, YourPlusFirstOptionXtra, etc. and maybe a third company's PurpleOne, PurpleOneSuper, PurpleOneSuperExtra, PurpleOneJumboExtra, and so on.

Of course this is done on purpose to make it virtually impossible to sift through the cutesy names to find one that would actually make economic sense for one's needs, IF such an option exists.

I hate insurance companies.

[Enthusiast]

34. I would like to remind you that U.S. health insurance companies do not contribute

anything to health care. They are only a PARASITIC middle man taking a cut of "FREE MONEY".

Western European health care systems are far cheaper than the U.S. model. And they are more effective. The French health care system is the most expensive yet it comes in at less than 2/3s of the cost of that of the U.S.

The reason for this is profit. In the U.S. everyone along the line takes a profit cut. The health care service providers have to make a profit just as the insurance companies and the pharmaceutical companies.

This costs all of us. For one thing care is rationed to preserve profits for the insurance industry. And care is denied by the insurance industry.

This is why we desperately needed a strong public option in the new health care legislation. We needed a public option that could evolve into a system that did not include a parasitic insurance industry or for-profit health care services providers.

Before this can happen we have to remove money from the legislative process. Well, you know what we are up against.

[discntnt_irny_srcsm]

15. ^^^ this! Agreed!

[hunter]

18. Small business ought to be hammering for single-payer.

It would make them more competitive with big business, they could hire people who are trapped in their current jobs by health plans, and everyone would be playing on the same field, health care costs paid for by taxes.

It would also make it a lot easier for people to leave corporate jobs they hate to start innovative new small businesses.

The ACA helps, my wife and I have both been uninsurable as self-employed people because of chronic health conditions, and we've run out COBRA's to the bitter end, but it doesn't go far enough.

The U.S.A. really needs a first-world kind of health care system, one without dozens of financial parasites who don't provide actual medical care taking a huge cut every time one sees a doctor, stays in a hospital, or pays for a prescription.

I've no problem with doctors, nurses, researchers, and the workers and managers who producing pharmaceuticals or medical equipment making good money. I do have a problem with Wall Street-Insurance-Marketing types bleeding away 30% and more of this nation's health care dollars.

[Kali]

16. prescriptions for lots of things went up like crazy a couple of months ago

I am not amused by the stores still advertizing 4 and 5 dollar generic prescriptions. I wonder what the meds are? must be a couple left at that price or they wouldn't be able to advertize it - I know it sure as hell isn't the once-ubiquitous and cheap generic, low-dose thyroxin that is now over $20 a month.

[LiberalEsto]

17. I suspect this is their "You want the ACA? Okay, we'll give you the ACA...OUR way"

We are being punished by the drug companies, the insurance companies, the employers, the whole healthcare industry for having the outrageous nerve here in the U.S. to want decent healthcare like people have in other industrialized countries.

[Blue Diadem]

20. They carry levothyroxine on the $4 list.

Don't know if that is the same as what you need.

http://www.walmart.com/cp/1078664?povid=cat5431-env198764-moduleB120712-lLinkFC44DollarPrescriptions

[elleng]

24. That's about what I pay for it,

have been for a long time, but had Federal BC/BS, and now, Medicare is my 'primary.' Must say, I feel so privileged, being a Federal retiree/annuitant.

[Blue Diadem]

19. You should get negotiated pricing for the Dr. visits, lab etc.

It will still be much higher than the co-pays you were accustomed to. A usual Dr. visit for us runs around $100 now, with the Dr. billing $160 to ins. We've had a HSA for several years, not by choice. My husband's employer contributes a portion to the account but it in no way makes up for our increased cost.

Have you checked elsewhere for your prescriptions? We've been lucky in that regard, Walmart pharmacy has the $4.00 program for quite a few prescription meds and my husband has been able to get his 3 prescriptions from them. One of my friends switched to them for getting insulin. Hers isn't on the $4 program but it saves her 1/2 of what she'd normally pay.

[NewJeffCT]

21. the main benefit of an HSA account

is that your contributions to it are tax deductible and you can use those contributions to meet your deductible. Some employers also contribute a matching amount to your HSA account as well. You might want to check into that.

They've been around for a while now - I remember during a job interview in 2005 or 2006, the woman interviewing me was bragging about her company's high deductible HSA plan and how great it was. ("Consumer Driven" she said.)

However, I also remember that HMOs became "big" in the 90s because the old indemnity health insurance plans with big deductibles supposedly didn't help hold down medical costs. Now, we're switching back to health insurance with deductibles because HMOs didn't hold down medical costs. What goes around comes around.

Personally, I don't like them, but we did benefit in 2013 from it. My wife rescheduled a minor surgical procedure from Dec 2012 to January of 2013. We paid for the surgery and met the annual deductible with the HSA account. So, we basically had no medical expenses the rest of 2013 because we had met our deductible in early January. (The plan we have has reduced co-pays once you exceed the deductible, and when my wife went back for a follow-up procedure, it was 100% paid for because we went past the deductible.)

Of course, if don't have the money in your account, you're stuck...

[LiberalEsto]

22. We don't have a health savings account because we didn't know about the change

until yesterday. I don't know whether we'll be able to set one up or not since we're already a month into the year.

My husband has started looking for another job with better insurance, because we don't have the up-front money. Don't know if he will find one, but it's worth a shot.
.

[NewJeffCT]

25. How big is his company?

If there is this big of a change to the company's insurance, whoever is in charge of benefits/HR really dropped the ball in not letting your husband and others know about this change.

[LiberalEsto]

27. It is a big international company

He probably received an email from HR about the health plan presentations and ignored it because he gets hundreds of emails every day.

Most of his emails are urgent, regarding production and database issues for a federal agency that have to be taken care of immediately. He rarely takes breaks or lunches, and usually puts in late nights and weekends. He gets up at 4:30 or 5 am and checks his work website for production problems which he has to deal with immediately from home.

The original notice about benefits re-enrollment said if you chose not to change your current plan, you could just skip filling out the form and you would automatically be re-enrolled in your current plan. Then all of a sudden, things changed when HR notified everyone that they HAD to fill out a form or lose coverage entirely. I don't think he has any recourse against the company.

[NewJeffCT]

29. A big international company

probably makes sure they don't have any legal ramifications in cases like this - they probably have a big enough legal team to make sure.

However, when filling out the form, there should have been some sort of accompanying pamphlet, flyer or some other sort of handout that explained some of the differences between the old & new plans. At least in that case, you could have been prepared?

[No Vested Interest]

31. Suze Orman recommends Health Savings Accounts very highly, for

some of the reasons already mentioned on this thread.
I respect her advice & opinions.

Perhaps you can tell your physicians of your problems with high prescription costs.
They might be able to prescribe alternatives at lower cost.

[No Vested Interest]

32. IIRC, Suze Orman recommends funding the HSA fully at the beginning of the year, if possible.

If not possible, then make it a priority for saving for it.
Apparently, it can be used as a sort of emergency fund.

[LiberalEsto]

33. Regarding the prescriptions, I'm already on generics for everything

but without the co-pay system, prescriptions for 4 generics for 90 days still adds up. With the co-pays last year, I paid $56 for a 90-day mail-order supply of 4 generic prescriptions; now it will be closer to $300.

I'm sure the HSAs have some advantages, mostly for employers and insurance companies, but the problem is that there has to be money in them. We don't have an HSA yet.

We were blindsided by this change, and missed the Dec. 6 deadline for opening an HSA account at a particular bank, simply because my husband did not know about it. He is busy working his butt off, like I said, early mornings and late evenings and weekends as well as his usual 10-hour work days.

From what we read in the on-line info, which we saw yesterday for the first time, if he'd opened the HSA by 12/6 the company would have deposited $500 into it as starter money, and then added $500 more, bit by bit in the rest of the year's pay periods. I don't know if that can be done now.

He also found out that the other three people working on his group project all opted out of this health plan because the deductible is so high. They went on their spouses' health plans instead.

[Enthusiast]

35. Suze Orman is a right wing corporate mouthpiece. I have zero respect for Suze Orman.

That is all.

[LynneSin]

26. Sorry to hear of your troubles but HSA are of good value

I have about $1500 between money I put into mine and incentives from my company. The money I put it in is pulled pre-tax so I'm spending less money to get more benefits. Since I'm relatively healthy I usually find that I have a few hundred leftover at the end of the year. If I do I'll use it for a few extra things like getting my new glasses and more contact lenses.

[LiberalEsto]

28. We both have chronic medical conditions that require a number of prescriptions

and we've already had a few doctor and dentist visits this year. We're going to have to contact every provider and pay the full amount retroactively, from what little we have in savings.

But thanks for telling about your experience.

[whistler162]

30. Seems the quick answer on setting up a HSA

is to contact a local finacial institute, likely your bank or credit union, and see if it is a IRS-qualified institution.

https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Health-Insurance-Basics/FAQs-on-Health-Savings-Accounts.aspx

"How much can I contribute to my Health Savings Account (HSA)?
As of 2014, the annual contribution limit for single tax filers for an HSA is $3,300. If you file taxes as a family, it is $6,550. You can make contributions up until April 15 of the following year. Filers over the age of 55 may add an additional $1,000 toward the annual contribution.

What are the catch-up contribution provisions?
As of 2014, the catch-up provision for those over 55 remains at $1000.

Who will administer my HSA?
Since the Health Savings Account is set up separate from your qualified high deductible health plan, you can choose any qualified, IRS-approved institution, such as a bank or credit union, can administer your Health Savings Account. Please keep in mind that setting up your HSA account and funding it is entirely your responsibility, and cannot be done through your health insurance provider."