Have insurance through small business; pay the majority. Its a good plan; but Oxford/UHC is the last insurer in NY to offer PPO to small businesses (mostly owned and staffed by boomers so underwriting is tough)
There is a cost to insuring our populace. No one seems to mention that decisions life coverage for prior conditions etc are all a way of cost shuffling. Someone (individual; insurer; state; fed) pays for care because it is never denied in our country in an emergency
My employer pays the entire premium for my family, as that is a concession we agreed upon many years ago instead of a raise and my pay is significantly under market. My copay are $40 for office visits, $40 for most prescriptions, and $250 for ER visits. I also have a $500 annual deductible per person for prescriptions.
My company who I've worked for for the last 25 years is on the verge of going out of business, so I am quite concerned about health coverage. I will likely start my own company, so I'll be buying coverage out of pocket. I'm very concerned about the Trump care plan that passed the house today. I'm not sure how I'll be able to afford a plan with my wife's preexisting conditions. Due to some investment property we own we thought we were pretty well set for retirement, but the thought of what I'm hearing healthcare coverage will cost for my family is pretty terrifying.
as an aside, my brother went to a lunch thing with linda mcmahon yesterday here in indy. one topic was, that he brought up, is how do small businesses get this off of their books as an employee "benefit"? universal health care. he said she was taken aback by this and asked the room who else felt that way. about 50% or more raised their hands.
health care is a huge cost for small businesses and even though those costs go up, employees still also want raises every year.
we figured out last year that the ACA was a better deal for the guys than us providing it, other than the guys would want raises equal to what we took away and adjustments every year after that. just can't please everyone.
[Edited on 5/4/2017 by LeglizHemp]
interesting comments about the skyrocketing costs of health care under Obama and the obvious link to low and stagnant wages made by some small business owners here.
as far as skyrocketing, insurance has gone up between 4 and 20% every year for the last 30
lots of small businesses don't pay that much of employees benefits either
its all a shell game
people don't look at insurance as wages...just the way it is
Insurance prices were skyrocketing way before Obama took office. Seems how that is so easily forgotten. If you think prices are high now, and you have any preexisting condition, just wait and see how quickly you will appreciate what we have now. Maybe in the long run this will be a good thing if it eventually leads to single payer down the road.
i have insurance from work. i am the employer (president) of 21 people. but i gave my resignation to the stockholders (family) in january, after 30 years,so later this year i'm gonna have to get my own insurance. i'm only 55, 56 later this year. LOL on top of that i'm going to australia for 3 months so i need to be covered while i'm there. this pre-existing condition thing has me concerned as i've had a heart attack 6 yrs ago. LOL, exciting times.
we have provided insurance for over 30 yrs to employees, so i have watched how it works for a long time. my opinion is that % wise rates are not going up anymore than they ever have.
we pay 100% after 5 years and 75% have been with us over 5 yrs. up to $1800 a month, they pay any over that.
[Edited on 5/4/2017 by LeglizHemp]
[Edited on 5/4/2017 by LeglizHemp]
Heart attack 6 years ago...glad you are still with us!!!
The way it used to work in the individual market before ACA on preexisting conditions is some insurers would accept you as long as:
1) you had no gap in coverage longer than 63 days (according to a certificate of coverage I have)
2) if the condition existing 6 months prior to the application or enrollment date, benefits would be provided for the preexisting condition after a 12 month waiting period.
ACA did away with the waiting period that some plans (group and individual) used.
Insurers could also 'rate' you accordingly, since a preexisting condition puts them at greater financial risk and therefore they charge you more. Which, not trying to be a dick, but people who are at risk of costing insurers more should pay more. My wife has a preexisting condition, which I will get into in a minute. But what I mean is that I am exposed as well and I believe that "she" or "us" should be exposed to higher costs because she creates higher costs. That gets into the philosophical part of the debate I guess.
Sometimes if your preexisting condition in in the past, they may not rate you as having a preexisting condition. So if your heart attack was 6 years ago and you show no signs of another issue and are in good health, that heart attack may not count. My wife had cancer some time ago and insurance companies don't care about that, she has another issue that caused her a problem.
My employer pays the entire premium for my family, as that is a concession we agreed upon many years ago instead of a raise and my pay is significantly under market. My copay are $40 for office visits, $40 for most prescriptions, and $250 for ER visits. I also have a $500 annual deductible per person for prescriptions.
My company who I've worked for for the last 25 years is on the verge of going out of business, so I am quite concerned about health coverage. I will likely start my own company, so I'll be buying coverage out of pocket. I'm very concerned about the Trump care plan that passed the house today. I'm not sure how I'll be able to afford a plan with my wife's preexisting conditions. Due to some investment property we own we thought we were pretty well set for retirement, but the thought of what I'm hearing healthcare coverage will cost for my family is pretty terrifying.
Nice deal for you on one hand with the benefits, but sorry to hear your company may be going out of business.
If you are considering starting a business then DEFINITELY consider making your wife an employee. Group plans did not ban preexisting condition applicants before. I know because I did this, I'll touch on that in my next post. I think it is fair to say that nobody really knows what the future of health insurance will look like next year and beyond. But the way it was before is that group employer sponsored plans had to accept preexisting condition applicants, but they could rate them a higher premium - still considerably lower than what an individual plan premium would've been. Once the dust settles and you know where things stand I encourage you to talk to a insurance broker in your area and see what the options are. It may not be great, but it may not be dire either.
Throughout the years I detail below my individual health insurance plan has included: $5000 deductible, 100% co-insurance (50% non-network except ER is 100% regardless of network), office visit, ER, urgent care, impatient, outpatient, diagnostic services like x-ray and lab work, drugs all 100% after deductible, “overall annual benefit period maximum” $7.5m – no optional maternity, dental, vision or life coverages.
In September of 2016 I received a letter stating that my plan does not follow all the ACA rules and that a government set deadline of January 1, 2018 means my current plan can no longer be offered, so this would’ve been the last year for my “cheap” plan.
With that in mind, in December of 2016 I got a quote from healthcare.gov and if I were to buy an ACA compliant plan then it would’ve cost me $274 for bronze ($6750 avg deductible on various bronze plans), $329 for silver and $364 for Gold ($4700 deductible). The cheapest ACA plan for me would mean 87% increase over my current plan (plus have a higher deductible).
I do not qualify for premium “assistance” subsidy which had a $67,500 income threshold.
Thankfully I am relatively young (early 40s) and relatively healthy and have enjoyed these individual premiums:
2017 – $146.47 (now covering transgender transition surgery and treatments – I have “gender dysphoria treatment” benefits...yippee!)
2016 – $120.23
2015 – $111.68
2014 – $95.33
2013 – $78.26
2012 – $59.90
2011 – $53.32
Prior to this I had a group plan (of 2) for my business in which my wife was an employee ($5000 deductible)
2010 – $760.64 (me $211.10, wife $524.54)
2009 – $835.64 (me $199.16, wife $636.48)
2008 – $924.76 (me $253.35, wife $670.11)* after this rate hike we shopped the plans in 09 and 10 to find lower premiums*
2007 – $708.12 (me $191.85, wife $507.27)
2006 – $691.86 (me $201.78, wife $484.98)
My wife has a preexisting condition. She is a breast cancer survivor, but the insurance companies did not count the cancer as a preexisting condition because it hasn’t been present for 6 or 12 months prior to here application. She does however have an ongoing issue with rheumatoid arthritis which puts her on the preexisting condition list. When she left an employer sponsored plan, I “hired” her so she could get on a group plan (which did not discriminate against preexisting condition eligibility because she had no gap in coverage from her prior employer to me). Currently she works for a non-profit organization and is an ACA enrollee. I don’t know how many couple are like this, but much of our finances are separate and we pay a lot of our own bills. I know little about her ACA costs, but do know some pros and cons she has gotten out of it. From what I've gathered, here premiums are very cheap compared to the services she receives (pays less than benefits received). However, she has had problems getting some providers to accept the Ohio exchange Care Source provider's insurance (recently had to cancel a surgery due to that). I will look into her payments and post what I can at some point.
To be repetitive (I'm good at that) say it costs 10K per year per person to cover their health care that's the cost. Who pays for it is the question. But sick old people cost money; young healthy ones generally don't. Whichever system is in place there will be winners and losers but the total cost will be the same (included in that cost are services rendered by hospitals/doctors without compensation
To be repetitive (I'm good at that) say it costs 10K per year per person to cover their health care that's the cost. Who pays for it is the question. But sick old people cost money; young healthy ones generally don't. Whichever system is in place there will be winners and losers but the total cost will be the same (included in that cost are services rendered by hospitals/doctors without compensation
That is true the cost does get spread around, but to what point should it?
I'm pretty sure you aren't suggesting that in a $10k example that an sicker older person and a younger healthy person shouldn't have the same premium, each $5000 a year ($416 a month). But in reality the trajectory that some progressives want is putting us closer to that. The sicker older person should pay more because they are using more of the benefits. While they were younger and healthier they should've enjoyed lower premiums that are more associated with being younger and healthier and less use of the system. Such as in my case with the individual premiums I've been paying up to this point.
If I was in ACA I today would be looking at nearly $300 a month, which that might be a bargain still compared to some people and some cases. But in my case, it's not a bargain because I know what private insurance that I've had for several years cost before. I'm not getting anything better (actually worse in terms of out-of-pocket deductible). I didn't cross a milestone age or have a condition that dictated an increase of nearly double. No, it's arbitrary just because the Government says so, they want me to bear more of a burden than I have to pay for somebody else...when in reality since I use very little benefit of the system, I've already been paying for somebody else. Now they say it's not enough, pay more.
We know what insurance is and what it exists for. I hear so often that "republicans don't know how insurance works", but really I think that Democrats are trying to get insurance to be something and do something it is not intended to do.
Look at all other forms of insurance, life insurance, home insurance, auto insurance....if you apply for life insurance you are going to be subjected to underwriting and the results of your physical, urine sample, blood work, family history, alcohol consumption, tobacco or drug use, even some recreational activities - all of those things get taken into consideration for the insurance company to determine the risk of insuring you and they come back with a benefit / premium figure.
Same with home insurance. Two homes next to eachother on the same street may or may not have the same premium from the same insurer. Often an insurance agent comes out to the home to inspect the construction, the condition, any liability issues and one home may be deemed a higher risk to insure than another and therefore have a higher premium.
Auto coverage...if you have some accidents or tickets in your past you can pay more. The type of car you are insuring plays a role. Two people may pay different rates based on their history and vehicles covered.
When we pay insurance premiums the truth is that most of us will not need to rely upon our policies being acted upon (or in life insurance it is a length of time/maturity situation) and that the money goes to pay for somebody else's claim. And that has always happened in health insurance too. But in health insurance, insurers have and rightfully should look at who they are insuring and what risks are associated with that person, just as all the other insurance products do and come up with an appropriate premium based on risk of insured. But here we meet resistance and we are told that is unjust and that is not how insurance is supposed to work.
It pains me to defend insurance companies, I'm not a fan of their practices overall. But insurance is what it is and I accept it for what it is.
It would be much more honest for progressives to put all their time and effort to pursuing the single payer option instead of trying to transform insurance industry into something it is not.
I want things to work as they should and I think that private health insurance is being asked to do something it was not designed for. We have this hodgepodge of a system and it's seems like it is all cobbled together and nobody can agree on what it should or shouldn't be doing. Just throw the whole thing away and start over is what really needs done.
From Senator Sherrod Brown (Ohio), a list of pre-existing conditions with coverage lost under #Trumpcare:
AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer's/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn's disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson's disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, ulcers.
From Senator Sherrod Brown (Ohio), a list of pre-existing conditions with coverage lost under #Trumpcare:
AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer's/dementia, anemia, aneurysm, angioplasty, anorexia, anxiety, arrhythmia, arthritis, asthma, atrial fibrillation, autism, bariatric surgery, basal cell carcinoma, bipolar disorder, blood clot, breast cancer, bulimia, bypass surgery, celiac disease, cerebral aneurysm, cerebral embolism, cerebral palsy, cerebral thrombosis, cervical cancer, colon cancer, colon polyps, congestive heart failure, COPD, Crohn's disease, cystic fibrosis, DMD, depression, diabetes, disabilities, Down syndrome, eating disorder, enlarged prostate, epilepsy, glaucoma, gout, heart disease, heart murmur, heartburn, hemophilia, hepatitis C, herpes, high cholesterol, hypertension, hysterectomy, kidney disease, kidney stones, kidney transplant, leukemia, lung cancer, lupus, lymphoma, mental health issues, migraines, MS, muscular dystrophy, narcolepsy, nasal polyps, obesity, OCD, organ transplant, osteoporosis, pacemaker, panic disorder, paralysis, paraplegia, Parkinson's disease, pregnancy, restless leg syndrome, schizophrenia, seasonal affective disorder, seizures, sickle cell disease, skin cancer, sleep apnea, sleep disorders, stent, stroke, thyroid issues, tooth disease, tuberculosis, ulcers.
That can't be said with any certainty. Insurers are still required to cover preexisting conditions, but the multiple at which an insurer rates a preexisting applicant vs a non preexisting applicant changes. And then if a state opts out you have to see what the high risk pool looks like.
To come out definitively and say that people with those conditions will not be able to have insurance isn't accurate.
I don't want to carry the water on this, the AHCA is probably going to be a mess like the ACA is. I do want to try and voice some other side of the arguement.
Remember, ACA wasn't all roses. I mentioned my wife being on ACA. So she has Care Source the Ohio state exchange. She needed foot surgery. Her foot doctor schedules her his typical place for surgery (a privately owned surgery center) and they do not take Care Source. Ok, the doctor says well I also perform surgeries at this nice new local hospital (a Mercy Health Partners hospital), nope they don't take Care Source either. So she finds out that another hospital does take Care Source (a Steward Health Care facility), nope...foot doctor doesn't work there. So no surgery.
If you paint one side of the picture as being bad, atleast acknowledge there was some bad on the other side as well, because there is alot of shit to spread around here.
