Our insurance just keeps getting higher as the coverage gets worse

[Ann.without.an.e]

It is ridiculous.  We don't even meet deductible most years.  It seems silly to keep paying for it.  We are paying out far more than our deductible which we don't even meet.

 

Our prescription deductible is now $6,000.  Is that normal?  

[Guest]

I know what you mean.  I did the math about 10 years ago and figured that *because we could absorb* a big deductible, and because a lot of the health care we use is not covered by insurance, it was a lot cheaper to pay for catastrophic health *insurance* (which is not "health care coverage") with a $10,000 deductible.  It was $340 a month for the three of us.  It is now $780, but some of that rise is due to our aging, but some of it is due to the requirements the State Legislature put in requiring coverage for mental health care and (of all things) colonoscopies.  I did the math and the amount of money we pay in differential for the colonoscopy coverage is more than I would pay cash for the same number of colonoscopies.  Gah.

 

In a year, my dh will go on Medicare and in 4 more years, I will and we won't be paying for our kid anymore.

 

I have maybe once or twice paid more per month than I would have paid for health coverage.  Those times were when I had a basal cell carcinoma removed from my nose, then two reparative plastic surgeries.  We didn't even meet the deductible under those conditions.  

 

On an annual basis, catastrophic coverage and paying out of pocket has worked out as a net plus compared to paying much higher rates for health coverage.  

 

But that is *us*--it is not true for everyone.  

[SparklyUnicorn]

That sounds pretty wretched. 

 

 

[Lanny]

Try to hang on. The current system, if you buy on the Exchanges, is dying.  The Congress will (hopefully) come up with some way to repair or replace the current system.  The two most popular features of ObamaCare (coverage of Pre-Existing conditions and being able to keep "children" on your policy, until they are 26 years old) they are going to try to keep, at all costs.  The problem is how they are going to pay for this...  Many or all of the big insurance companies are losing lots of $ on this, and pulling out of markets, so one possibility would be to permit insurance companies to sell across state lines.  How those companies would be regulated is something I believe they will need to work out.  Until now, if you live in a state, the state insurance commission licenses and regulates insurance companies that do business within the state. If a Consumer has a complaint, they go to their state insurance commission. How that would work, if the individual companies are not licensed in each state, I don't know. Also, they state insurance commissions I believe approve the rates a company can charge in their state.  When I lived in TX, the state wrote the Homeowners and Auto Insurance policies, so at that time (possibly not today), one could shop among competing companies, and be quoted a rate for the same coverage. Comparing Apples to Apples and not comparing Apples to Oranges.   This is the URL of the TX Dept. of  insurance http://www.tdi.texas.gov/   A huge part of the problem is the Pharmaceutical companies and their "donations" to members of Congress.  There are no simple solutions to complex problems. Again, if you can hang on, hopefully they will try to make this work better, by fixing or replacing.  

Many or all of the big insurance companies are losing lots of $ on this, 

 

Don't cry for the big insurance companies -- they are doing just fine.  Consider some of the biggest:  

 

Anthem's stock price was around $40 in 2008, today it is $160.

Cigna's stock price was around $50 in 2008, today it is $150

 

Others are similar.  Most of the big insurance companies make so much profit that they are returning their profits as dividends to stock holders and even sinking their extra cash into stock buyback programs.

[Lanny]

I have no tears for the health insurance companies. However I understand that they have a Fiduciary Responsibility to their Stockholders. The corporate officers can be sued by Shareholders. Their employees and customers are a lower priority legally than their Shareholders. Their are plenty of folks eating the same Pie. The patients and their doctors are getting screwed. Many doctors are quitting.

 

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[Guest]

I have no tears for the health insurance companies. However I understand that they have a Fiduciary Responsibility to their Stockholders. The corporate officers can be sued by Shareholders. Their employees and customers are a lower priority legally than their Shareholders. Their are plenty of folks eating the same Pie. The patients and their doctors are getting screwed. Many doctors are quitting.

 

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I have located a network of doctors in our area who don't deal with insurance.  At all.  Cash only.  

 

Office calls are cheaper, because they don't have to deal with the insurance companies.  Lower overhead.  There is a $25 annual fee to belong to the network.  

 

My primary care physician is not part of this network, but when he retires I'll probably move to one who is.  

I have no tears for the health insurance companies. However I understand that they have a Fiduciary Responsibility to their Stockholders. The corporate officers can be sued by Shareholders. Their employees and customers are a lower priority legally than their Shareholders. Their are plenty of folks eating the same Pie. The patients and their doctors are getting screwed.

 

If you believe this, why on earth do you think that selling across state lines would make any difference?

[Liz CA]

I have located a network of doctors in our area who don't deal with insurance.  At all.  Cash only.  

 

Office calls are cheaper, because they don't have to deal with the insurance companies.  Lower overhead.  There is a $25 annual fee to belong to the network.  

 

My primary care physician is not part of this network, but when he retires I'll probably move to one who is.  

 

Interesting! I should check into this as well as I just signed up for medical shares and it is viewed as self-pay.

Did you just google and they popped up? Are they a group or did you have to check out everyone individually?

 

ETA: I just found this: http://selfpaypatient.com/2016/09/06/the-wedge-a-new-tool-for-finding-cash-only-doctors/

and one of the docs in my greater area is Dr. John Kasch. :lol:

Edited February 24, 2017 by Liz CA

[Guest]

Interesting! I should check into this as well as I just signed up for medical shares and it is viewed as self-pay.

Did you just google and they popped up? Are they a group or did you have to check out everyone individually?

 

ETA: I just found this: http://selfpaypatient.com/2016/09/06/the-wedge-a-new-tool-for-finding-cash-only-doctors/

and one of the docs in my greater area is Dr. John Kasch. :lol:

 

I happened to have taken a friend's recommendation for a chiropractor and he is part of the network and told me about it.  :0)

[Annie G]

Going through old paperwork last weekend we ran across documents from when dh and I were first married.  He had just started a new job and it was the insurance info.  Our cost was $10 a month for a family plan. Hospitalization paid 100% of a semi private room for first 180 days and paid 100% of first $5000 of hospital expenses. Next $5000 it paid 80% then after that it was back to 100%.   $100 deductible for one person, max of $200 for family. 

 

Sure, wages and costs have increased a lot since then, but it was very affordable. At the time I was making $10 an hour- imagine now being able to work one hour to pay monthly premiums. And I was just a cake decorator!!

 

Attolia, our deductibles are crazy high, but not for prescriptions.  Boo for your insurance!

[Crimson Wife]

Yes, unfortunately. Back when DH first got out of business school in '06, we had a PPO plan through his job with a $500 per person deductible and a $1500 out-of-pocket max. This year the PPO option has a $4500 per person deductible and a $6,850 out-of-pocket max. We will hit both as we have every year since our youngest was diagnosed with special needs.

 

We could've switched to Kaiser HMO with a lower deductible and OOP max. However, Kaiser was the insurer who denied my DD's cochlear implant surgery. They keep costs down by rationing care and I'd rather pay more out-of-pocket than have us denied beneficial treatments.

[EMS83]

I'm sorry, Attolia.   :grouphug:  :grouphug:  :grouphug:

[Guest]

If you believe this, why on earth do you think that selling across state lines would make any difference?

competition.

 

our state insurance hoo haw was a nightmare a number of years ago and alllll the insurance providers left except one which had a terrible reputation. after we got a new commish, we got 4 choices.  Colorado had 43 or more.  We paid $340.  My dh's bff, an insurance broker in Colorado,could have gotten us better coverage at $290 but it was across state lines.  Lack of competition freezes prices.  

[Guest]

ps sorry for the mistakes in typos,  I just did my nails.  Haha

 

[Carol in Cal.]

I think that allowing insurers to sell across state lines would be a consumer disaster, because it would imply that there would be just one insurance commission, a national one, for them to have to lobby and persuade every time they wanted to change coverage or prices.  Also, some state insurance commissions are quite innovative, which is helpful.  The CA one, for instance, was part of the original long term care insurance partnership experiment, which ended up benefiting people in many other states once everyone saw how well it worked out.

[Lanny]

If you believe this, why on earth do you think that selling across state lines would make any difference?

 

There is a potential that more companies would participate in a given state, if they could sell across state lines. At this time, I believe there are many markets where there is only one company offering insurance.  There would be a cost savings to the insurance companies (that possibly/hopefully they would share with Consumers) if they could have a larger marketplace, without dealing with the Insurance Regulators, in 50 states, one at a time.  It would be more efficient, if the individual state insurance regulators were cut out of the equation.  Also, possibly they could have flat rates across states with a similar COL.    Another issue here is the Medical Malpractice thing.  I spoke with a man in IL (across from St. Louis, MO) about 10 years ago. He was  I think an Orthopedic Surgeon.  He'd never had a claim filed against him. When he got the notice from his insurance company they were going to raise his insurance by an additional $100K, for the next policy year, he began making plans to close his practice and retire.  

[Crimson Wife]

Allowing insurance sales across state lines would help consumers who don't want to pay for non-medically necessary things that some states mandate, like IVF. I'm sorry but my premiums should not go to treating the results of natural age-related fertility declines.

 

Surgery to clear a blocked tube? Fine.

 

Medication to treat PCOS? Fine.

 

You waited until your late 30's or 40's and now you aren't able to conceive naturally? That's not a disease so if you want IVF, pay for it yourself.

[FaithManor]

Crimson, I take some serious offense to your last paragraph. My Dd lost an ovary to chocolate cyst at 22 years of age. The other ovary is a bear to keep healthy. But sure...you go right ahead...all infertility requiring IVF is because of some selfish female refusing to have kids until she is thirty!

 

Good grief. Judgey much?

[Valley Girl]

Crimson, I take some serious offense to your last paragraph. My Dd lost an ovary to chocolate cyst at 22 years of age. The other ovary is a bear to keep healthy. But sure...you go right ahead...all infertility requiring IVF is because of some selfish female refusing to have kids until she is thirty!

 

Good grief. Judgey much?

 

And all the women who didn't MEET their spouses until they hit their 30s or so...too bad, I guess. I suppose they just should have had their kids while young and single. So much for the whole married-with-two-parent-homes-are-important thing.

 

 

(This post is NOT intended as a slap at anyone who had children young, out-of-wedlock, or anything else.)

[QueenCat]

Going through old paperwork last weekend we ran across documents from when dh and I were first married.  He had just started a new job and it was the insurance info.  Our cost was $10 a month for a family plan. Hospitalization paid 100% of a semi private room for first 180 days and paid 100% of first $5000 of hospital expenses. Next $5000 it paid 80% then after that it was back to 100%.   $100 deductible for one person, max of $200 for family. 

 

Sure, wages and costs have increased a lot since then, but it was very affordable. At the time I was making $10 an hour- imagine now being able to work one hour to pay monthly premiums. And I was just a cake decorator!!

 

Attolia, our deductibles are crazy high, but not for prescriptions.  Boo for your insurance!

 

I don't think ours was ever that low! But it is impossible to make a true comparison of today vs "years ago" without knowing how much your husband's employer contributed to the premiums. "Years ago", quality insurance was one of the major things employers used to draw employees that would stick around.