Insurance costs vent

[Selkie]

DH and I own a small business.  We provide health insurance for our employees and pay for the bulk of it.  Price increases since the ACA took effect have been enormous, as has the amount of time that needs to be spent on insurance paperwork (in the form of endless forms and questionnaires from the government).  

 

All of our employees have spouses and kids, and everyone is healthy with no major illnesses or long term health problems.  The monthly cost for each family is between $1200 - $2000.  For DH, our three kids, and myself, we are paying $1920 per month - so it is not surprising to me at all that Moxie is paying $1500/month.  Our insurance agent warned us that price increases will probably be even steeper next year (but that was before the election, so who knows what will happen with the ACA now).

 

We believe that providing insurance is important and helps us to retain quality employees.  However, the huge increase in price means that we now have less money to put towards salary increases for our workers.  I've talked to many other business owners who are in the same exact situation.  It really stinks. 

 

 

[MyLittleBears]

There have been millions legal American citizens who cannot afford health insurance both before and after ACA but at least with ACA a lot of folks get subsidies. My parents could not afford health insurance for 3 years before ACA and I think blaming it on illegal immigration (which does concern me too) is incorrect IMO. I blame it on the sucky for profit health care system we have. When people lives are at stake as it is with health care then profits really should not be part of the equation and true non-profits without excessive executive salaries should be running the show.

 

 

 

At the risk of sounding like a broken record I said it was PART of the problem, NOT the whole problem, and more as a cost increase prior to ACA. It is naive to think that its not a factor of it at all. For what it's worth my parents and immediate family had very good insurance prior to ACA.  Now we have an unbelievably high deductible and my parents who are on the ACA program have a hard time paying for it. I don't know why the problem of the uninsured couldn't have been addressed on it's own. Like maybe offer some kind of incentive to the insurance companies to insure them while removing competition. Why did the whole country have to be dragged into it? KWIM. Actually I do know why.... but that would be too political for this board.

Edited November 18, 2016 by MyLittleBears

[Laura Corin]

How are costs of medical care determined? Do doctors charge what they want? Or do they get paid what they get paid (determined by various factors controlled mostly by the government)?

Doctors are on salary when they work for the NHS. Specialists can take private patients in addition, if they like, but career advancement comes through their NHS work.

[Liz CA]

Yes, most of us ranting about the ACA really got screwed. I think I've mentioned before but we went from a little over $400 monthly be a high deductible to $1700 a month and a high deductible for a healthy family. The cheapest plan hubby says he saw for us that the cheapest bronze plan right now is apparently $2009 (I thought it was more but he was quoting me the cheapest with maternity coverage that time, which was $2300-ish) with a $10,500 deductible, which is even worse than the catastrophic plan we had before.

 

And yes, it still covers pretty much squat.

 

I'm so thankful for CHM, even though they're going to take another month or two to reimburse my current birth and we have to hold bill payments on a credit card until then. It's a small price to pay to avoid those costs. We are already just shy of medical bankruptcy from our carried medical debt, not the least of which was those cost increases under the ACA before we finally buckled and dropped it.

 

It sucks and I'm sorry your family is being smacked as well :(

 

Would you PM me - or post here (whatever you are more comfortable with) which CHM you are using. I am considering this very seriously after a recent thread by creekland who is also using this option.

[Guest]

Christian Healthcare Ministries. It was kind of a tie for us between them and Samaritan, but CHM was a better fit. We have the kids and me on two gold shares and my husband on bronze, along with brother's keeper, their catastrophic add on.

Edited November 18, 2016 by Arctic Mama

[Laura Corin]

Meena, it's worth considering that a tax payer health system if it cut out the insurance companies should reduce the burden on the middle class. Single payer systems are cheaper worldwide. Higher taxes maybe, but very low health costs beyond that.

 

For comparison, I pay, as a secretary, 20 per cent income tax on everything over ten thousand pounds income or so. Sales tax is high, at 20 per cent, but I have paid zero for health care in the last eight years beyond taxes, apart from a mouth guard to stop me grinding my teeth. Both children had braces. I have seen specialists several times, the dentist every six months, had a minor procedure under anaesthetic, and many GP consultations.

 

I do understand that the US is a big country, but it's also a country that impresses others by its innovation and problem solving. It's worth dreaming big.

[La Condessa]

Wow.  I'm so sorry for those that are struggling with health care costs.  This is a good reminder for me on those days when I am wrestling with the budget and those job offers for dh to switch to private practice start to look especially appealing--government employee pay may stink, but the benefits are a huge blessing. 

[HS Mom in NC]

Making the taxpayers fund a broken system isn't a real solution-it's avoiding the root of the problem.  Before we discuss the pros and cons of the taxpayers funding the system, we need  to come up with a system that isn't fundamentally faulty to begin with.   I have yet to hear any politician for or against taxpayer and privately funded systems lay out some sort of in depth diagnosis of the problems and detailed solutions to each of them.  It's either yes or no from the idiot politicians on taxpayer funding-not solutions. Both approaches are a bunch of mindless BS.

Our payments for a family of 5 with no unusual, chronic conditions going on has TRIPLED in the last 5 years. We're paying $1500 a month.   That's dramatically more than it increased in the 2 decades before. 

My husband's sub-contractor has 6 kids, ages 1-11.  His wife had uneventful, uncomplicated, normal vaginal deliveries with ALL of them at the SAME hospital with the SAME doctor. The first cost $5,000.  The last one cost $20,000.  That right there is a fundamentally broken system and not the gradual increase in cost over decades.

 

The first thing that needs to happen is employers need to take all those funds that they use for employee benefits, including health insurance,  and they need to pay those funds directly to employees in additional to their salaries and wages.  That way employees can make their own choices about coverage (avoiding the Hobby Lobby problems) and so the employees as voters can understand exactly what's going on in the real world with medical insurance.  They'll be more motivated to hold politicians responsible for the politicians' views and legislative activities if the voters aren't insulated from the realities. They can also make their own decisions about things like retirement because we're talking about adults, not children for heaven's sake. Being removed from decision making about things that directly affect their health and their elderly years is just wrong.  Give people back the control over their own lives.

[Guest]

Bingo. Especially to your last paragraph. Divorcing coverage from employment and group benefits is a key step in reform. Offering tax incentive to the individual and not the employer is a great way to do that, though some employees may still use it as a perk/benefit it isn't financially incentivized in quite the same way.

[SparklyUnicorn]

Doctors are on salary when they work for the NHS. Specialists can take private patients in addition, if they like, but career advancement comes through their NHS work.

 

Yeah this is the huge difference here.  This is something that would somehow need to change before any of this works better. 

[mom2scouts]

With the UNaffordable Care Act, we can pay over 20% of our income on subsidized insurance before we ever use it. Oh, and none of our local doctors take the subsidized plans we're eligible to use. Now, if we decide it's too expensive for us to buy, we even have the pleasure of being fined. We are generally healthy and rarely go to the doctor. I haven't been to a doctor in over 10 years for both cost reasons and because I'm healthy. Since I usually only have minor health issues, I just hope it gets better.

[Guest]

Yeah this is the huge difference here. This is something that would somehow need to change before any of this works better.

Totally agreed.

 

What I'm noticing here are doctors bailing out of practices like crazy. I've had three friends in this calendar year have pediatricians suddenly retire or sell their practice. I've had other friends whose doctors have suddenly gone concierge. Considering I don't know that many people that's a lot in 12 months. It's taken me 4 months to get a meet and greet with a GP so I can become an established patient.

 

My obgyn told me unless you are in a specialty that performs surgeries like obgyn, ortho, etc. or an elective surgeon (like plastic) there is no money left. They can't make enough to justify the hours and the liability cost, not to mention the bloated staffs. So they're getting out. I think that's going to be the straw. Who is going to be stupid enough to pay over 200k for medical school (not counting undergrad) to net 100k (or less) a year, you know? Right now we easily import and attract a lot of foreign MDs, but that will stop too if the salaries stop. They'll go somewhere else. It's not going to be instant, but I think we have a supply and demand problem coming up soon. Nurse Practioners and PA's can only do so much. We're still going to need our MD's. so basically my point is everyone, except the insurance companies themselves are getting screwed in this bargain. The docs are getting hit as hard as the patients. They still have to buy their own insurance too!

[Happy2BaMom]

I had someone in the know (meaning who really studied and understood a LOT about the health care system) tell me that the basic problem with the ACA was that it took an already hopelessly broken system and then just piled a *&(^-load of paperwork and requirements on top of that broken system. (And I say this as a member of the usual "Left"...whatever that means anymore, I'm not quite sure). 

 

We cannot have profit coming out of healthcare. And I'm old enough (50) to remember when non-profit really meant that...it meant that executives might make (depending on the year you look) ~$150K - $250K per year (seriously...that same insurance brokerage I worked for also did a lot of company-sponsored life insurance, at 1-2x annual salaries, so I saw quite a lot of salaries of non-profit execs. They were very modest, comparatively speaking. That was was non-profit used to mean.) Not 14 million for the guy at the top and probably 10 million for the couple of people below him and 5 million for the next level down, and couple million more for various brokerages in each city plus on and on and on. Doctors have already been screwed down to the max. They have no more blood to give. Americans pay the most (or near the most) of all developed countries for a comparably much lower level of care. Pretty amazing, actually. 

 

However, I don't expect this to change with whatever is coming down the pike. Republicans are not going to remove or reduce profit-taking....it's too much a part of the free market philosophy. Nor will they ever stretch into single payor. From an academic standpoint, it will be interesting. Sigh. 

 

Edited to add: some of those non-profit salaries were from large regional non-profits, not national. So the national ones would be higher, but I would bet money they were comparatively in-line with the regional ones. Non-profit used to mean you accepted low salary as part of the package of providing good to the community and certain other perks (access to those in leadership, events, etc.). 

Edited November 19, 2016 by Happy2BaMom

[Laura Corin]

. Who is going to be stupid enough to pay over 200k for medical school (not counting undergrad) to net 100k (or less) a year, you know? 

 

FWIW, the US forces extra costs on doctors by making (in most cases) students wait to start training until they already have an undergraduate degree.  In the UK, you can start training as a doctor from age 18 (although many will have had gap years in related volunteering, because showing experience is key to being admitted to a programme).  Here's one programme in Scotland.  It looks as if by age 24-25 you are ready for a foundation year as a supervised doctor and by age 25-26 you can practise.

 

http://www.ed.ac.uk/medicine-vet-medicine/undergraduate/medicine/mbchb/6yearmbchb

 

Of course, if you want to specialise, then there will be further training.

Edited November 19, 2016 by Laura Corin

[J-rap]

 

The first thing that needs to happen is employers need to take all those funds that they use for employee benefits, including health insurance,  and they need to pay those funds directly to employees in additional to their salaries and wages.  That way employees can make their own choices about coverage (avoiding the Hobby Lobby problems) and so the employees as voters can understand exactly what's going on in the real world with medical insurance.  They'll be more motivated to hold politicians responsible for the politicians' views and legislative activities if the voters aren't insulated from the realities. They can also make their own decisions about things like retirement because we're talking about adults, not children for heaven's sake. Being removed from decision making about things that directly affect their health and their elderly years is just wrong.  Give people back the control over their own lives.

 

The concern I have with this is that more and more big insurance companies are backing out of offering independent (non-company) plans.  Or what they do offer isn't nearly as comprehensive as the company plans.  For example, a few  years ago, my just-over-26-year-old ds (so no longer on our plan) was able to get an independent BCBS plan for about $108/month (high deductible, but it was mostly for emergencies).  We've been told that BCBS has now pulled all of their individual plans like that (at least in our state).  

 

When my dh became disabled, we had the option to stay on the company plan, or go independent.  We really struggled with that decision, but decided to stick with the company plan at least for another year.  After that, it really became a no-brainer.  The company plan was so much better, so much more comprehensive with a broader coverage area.  The independent plan by the same company was terrible and more expensive.  Not a single specialist on my dh's care time was covered by the independent plan, but they were covered by the company plan.  Again, this is the same insurance company.  (And we did comparisons with three major insurance companies in our state, and it was the same with all of them.)

[HS Mom in NC]

The concern I have with this is that more and more big insurance companies are backing out of offering independent (non-company) plans.  Or what they do offer isn't nearly as comprehensive as the company plans.  For example, a few  years ago, my just-over-26-year-old ds (so no longer on our plan) was able to get an independent BCBS plan for about $108/month (high deductible, but it was mostly for emergencies).  We've been told that BCBS has now pulled all of their individual plans like that (at least in our state).  

 

When my dh became disabled, we had the option to stay on the company plan, or go independent.  We really struggled with that decision, but decided to stick with the company plan at least for another year.  After that, it really became a no-brainer.  The company plan was so much better, so much more comprehensive with a broader coverage area.  The independent plan by the same company was terrible and more expensive.  Not a single specialist on my dh's care time was covered by the independent plan, but they were covered by the company plan.  Again, this is the same insurance company.  (And we did comparisons with three major insurance companies in our state, and it was the same with all of them.)

 

That's the opposite experience we had when my husband was employed by his former company.  Employees had the option of sticking with the company plan or taking the money and buying their own the last time they switched providers.  Half the employees, like my husband, found better options on their own. We did.  We payed less for the plan that keep my middle daughter's neurologist (she had chronic migraines at the time.) 

 

The company owner's son came down with leukemia and it directly increased the cost for everyone on the company plan so eventually everyone bailed out and took the find their own option.

 

I still don't see why the same number of people employed at the same place should be given a better deal by one insurance company than the same number of people who aren't employed at the same place through that insurance company.

 

[mommyoffive]

Christian Healthcare Ministries. It was kind of a tie for us between them and Samaritan, but CHM was a better fit. We have the kids and me on two gold shares and my husband on bronze, along with brother's keeper, their catastrophic add on.

 

How does this work? 

 

2 shares covers you and all your kids?

 

Do you pay more monthly to cover everyone's bills?  Is that how it works?  The monthly amount pays for everyone bills? Do you have medical bills still?

[Guest]

How does this work?

 

2 shares covers you and all your kids?

 

Do you pay more monthly to cover everyone's bills? Is that how it works? The monthly amount pays for everyone bills? Do you have medical bills still?

There are lots of details on the website but CHM has a max limit per family of three shares, so whether you have three people in the family or ten your monthly cost doesn't scale up beyond that. For a married couple you would have to purchase a share for each person, and a single person would buy one share. But once you start having kids they all fall under the remaining share.

 

This alllws for some customized coverage. I need maternity and have more health issues than my husband or kids, but my kids by the number of them tend to have more emergency instances we would want reimbursed. So my husband has the cheaper plan where we pay more per incident before the cost sharing kicks in, whereas my kids and I pay the first $500 of a bill or incident (group of bills relating to the same condition) and submit the rest for reimbursement.

 

We also have an additional program we pay into quarterly called Brother's Keeper that takes off the lifetime cap on coverage and gives no upper limit, and this cost varies but tends to run about $40 for me and the kids. They scale it depending on how many families are in need of it and it's peace of mind for me to know I'm not out of luck with cancer or a massive health emergency because my care doesn't cap out at 5-10 million over a lifetime, this program augments that.

 

Basically routine health care like well babies and vaccinations and physicals are out of pocket, along with dental and vision that isn't fixing a problem (eye surgery would be covered, jaw surgery would very likely be shared too, but not routine exams and cleanings). Maternity is covered. Things like the allergist or physical therapy or whatever are all shareable after the initial amount of your share you pay out of pocket ($500, $1000, whatever - that depends on which type of share you buy). Monthly cost varies by share too - gold shares cost a little more per month than bronze shares, but reimbursement has a lower ceiling and they will even allow older members and preexisting conditions in maintenance to be reimbursed on a sliding scale after the first year. It's pretty darn flexible.

 

The downsides are three, that I can think of off the top of my head - CHM is slow, we just called and they're still a month out from reimbursing the pregnancy and birth bills I submitted at the beginning of October. Usually it takes them 2-3 months to reimburse if all documentation is in order but longer if anything is missing, and there is a lot of paperwork. This leads to another downside - we usually have to pay out of pocket as a cash patient, negotiating discounts, and wait to be personally reimbursed. Some doctors are fine waiting for CHM to pay us bdfore demanding payment in full but many specialists don't and it's not fun to pay some or all of a huge balance and have it sit on a credit card until they send us a check. It's better than eating it entirely though - which is where we were at before because of our high deductible. In this way Samaritan and Medishare are both quicker.

 

Last downside is that some things still are painfully expensive, like checkups for all the kids. We shop around for the least expensive provider we like but when a $180 bill is multiplied by five or six kids it adds up fast, and that is not a shareable expense because each kid is their own 'incident'. So if that checkup turned out to be part of a treatment for something big or expensive enough, like radiology or intervention services, it could be grouped together under that incident and shared. But cumulative small bills end up being our responsibility and we pay them out of pocket because. One kid doesn't exceed the incident max alone, but the cost still accrues. However that was the case with our HSA/catastrophic plan as well, and we just budget in that there are a certain number of small bills yearly we have to save for. The monthly cost of CHM is reasonable enough that it's not a big burden, but I'd say 80% of our current medical costs are the accruing wellness bills that are part of staying healthy, not premiums or monthly shares or big medical expenses. We have some of that left over from our time on our previous plan the ACA ruined but it's definitely a breath of relief to be paying much less now both monthly and gross to medical, because our biggest recurring expense was maternity and that is reimbursable in full from first appointment to birth, whatever or wherever the birth ends up being.

 

So. CHM has downsides but all in all it is a much more cost effective plan for our family and has helped get us, legally, out from under the aforementioned crushing premiums and ridiculously high deductible I've referenced before. We do still pay a fair bit out of pocket as part of routine medical and health care but it's perfectly reasonable and a thing that can and should be budgeted for, but any big issues or emergencies or health crises are covered, including small but frequent treatments for the same condition. The beauty of the incident style system is that things like a bone break or sinus surgery and all appointments and follow ups are grouped together as a single incident with bills added on, so you're only responsible for the first $500 of each incident and acquiring as many discounts as possible so the cost you are sharing with the ministry is as low as it can be.

 

Slow reimbursement and up front payment for some offices isn't super awesome, but it's also not a deal breaker by any means. Many families keep a credit card specifically for that and pay the entire balance when the reimbursement is mailed.

 

As for medical bills and debt, most of the worst of it is residual from the previously super expensive plans and some health issues I had. Plus we have babies frequently and our maternity coverage was poor and then non-existent, so we were essentially buying a 'car' every 18-24 months and trying to pay that down on a single income. We did fine until our monthly premiums skyrocketed and then we couldn't pay the out of pocket costs and premiums, both, so we had to go into debt. CHM doesn't cover bills out of hand - you submit them after the fact and mke arrangements with each office based on their payment policies (so you're essentially a cash paying patient) but any single bill or incident in excess of $500 is all reimbursed beyond that first chunk for us. So if my bill is $650 I can share it and receive $150 reimbursement. For my husband, I believe he is responsible for the first $5000 of any incident. He keeps CHM for himself purely for catastrophic coverage and is healthy as a horse with no recurring medical care, so the higher incident cost isn't a big deal for the cheaper monthly share amount, but if we need it we can eat the first 5k of any big event like a heart issue or accident. The gold shares make much more sense for me and the kids.

 

I hope that helps :)

Edited November 19, 2016 by Arctic Mama

[J-rap]

That's the opposite experience we had when my husband was employed by his former company.  Employees had the option of sticking with the company plan or taking the money and buying their own the last time they switched providers.  Half the employees, like my husband, found better options on their own. We did.  We payed less for the plan that keep my middle daughter's neurologist (she had chronic migraines at the time.) 

 

The company owner's son came down with leukemia and it directly increased the cost for everyone on the company plan so eventually everyone bailed out and took the find their own option.

 

I still don't see why the same number of people employed at the same place should be given a better deal by one insurance company than the same number of people who aren't employed at the same place through that insurance company.

 

 

That's interesting.  I wonder if it depends on the state?  

[Liz CA]

Arctic Mama, thank you for the details above.

I am shopping around now and have - so far - researched Liberty Shares, Samaritan's and CHM. It is just for myself at this point as dh is insured through employer, as of now completely paid by employer as well.

Liberty appeals to me because there seems to be fairly little paperwork beyond submitting bills and the physician submits directly to Liberty if I understand their plan correctly.

I will look into Medishare next.

Anyone else who has experience with any of the Share Plans, please chime in!

 

PS: Arctic Mama: Sounds like you have had your baby and I missed your birth announcement. :) Congrats!

Edited November 20, 2016 by Liz CA