Healthcare deductables

toomuchbaloney · Jan 31, 2015

With all the regulation that existed prior to ACA you're really going to try and say that healthcare existed in a free market? I don't think that word means what you think it means.

Are you advocating for removal of all regulations to promote a "truly free" market for health insurance and health care?

Red Kryptonite · Jan 31, 2015

We can never remove all regulation, obviously, but we can reduce it to minimum, and the ones that make sense, to free the market as much as possible. Example, not allowing purchase of health insurance across state lines. We can purchase literally every other kind of insurance across state lines, but not health insurance. This restriction makes little sense and causes massively increased cost as every health insurer must have 50 different operational organizations instead of just one. That's a regulation that is outdated, could easily be gotten rid of, and by itself would reduce costs by billions by going away.

MunoRN, RN · Jan 31, 2015

Buying insurance plans is a good idea, but it already exists. You can buy multi-state plans, and states are free to standardize their regulations to make that even easier. I can't say that I see any more progress towards happening the near future, the current plan still allows states to regulate themselves and the proposed alternatives by conservatives only reinforce the rights of states to regulate their own insurance.

What other 'free-market' suggestions are there?

toomuchbaloney · Feb 9, 2015

Buying insurance plans is a good idea, but it already exists. You can buy multi-state plans, and states are free to standardize their regulations to make that even easier. I can't say that I see any more progress towards happening the near future, the current plan still allows states to regulate themselves and the proposed alternatives by conservatives only reinforce the rights of states to regulate their own insurance.
What other 'free-market' suggestions are there?

I think we get the same response from GOP legislators...they are just not certain.

valliloves · Feb 12, 2015

What in the world just happen to insurance deductibles? I was just offered an AMAZING pay for a position in the MICU as a new grad (out-lying hospital paying higher than the medical center in Houston). I will have my start and explaining of all things on Feb 16th, but was given material to read before hand. First off, do hospitals now only offer health savings plans? I don't want my hard earned money just sitting in someone else's pocket. I've heard of health savings plans before the AHA, but it was always an option. Not a requirement. But the recruiter didn't know the details of the plans, so I have to wait to get clarification on this. So feeling uneasy about this, I started looking at possibly getting my own insurance through BCBStx. The deductibles are $6000 for a $170 plan, RIDICULOUS!! What happened to deductibles of $300. ARE THEY SERIOUS!!! No one is speaking on this!! This is HIGHWAY ROBBERY!! Come on now, $6000!! Who uses this much that is healthy before your benefits kick in. This should have been addressed in the State of the Union speech!!

Are you saying that the BCBStx plan is $170/mth with a $6K deductible? Are you saying that you have to meet the deductible before ANY benefits kick in like preventative, office visit copays, etc? If so, you can work out a cash payment discount with your doctor's office if you should need to see him/her for anything other than preventative. Sounds like a pretty good deal if you are healthy like you have mentioned in your OP.

What's the summary of the benefits?

Also, a health savings account might be a good option for you. The $ that you put into the account comes out of your pretax pay and you don't have to pay taxes on it. Figure out what you would spend on non-preventative care visits per year at the doctors office and budget accordingly. At least you will have control over your healthcare. You might be well to do to consult with someone who has a lot of knowledge on a HSA to see if it's right for your situation. It's right for a lot of healthy and working professionals like yourself.

In the end, we all dislike the rising healthcare costs here and we all dislike the increases in premiums, etc, but we are all responsible as citizens to do our part and be responsible for our health. Also though, we are required to have insurance now so it's better to take the emotions out of the equation and figure out which plan or option best fits your particular situation and budget accordingly. Best wishes! :)

MatrixRn · Feb 12, 2015

Yes deductibles have gone up prior to the ACA, but for some plans the jump post ACA is shocking and for some cost prohibitive. [speaking from personal experience mine went from zero to $1,400 bucks.]

Seriously folks this is hit or miss.

I work for a large insurance company and talk to members all day long who are trying to figure this whole mess out and get the care that they need.

Since it is the beginning of the year, the deductibles are playing in people's minds. They fuss about the money that will need to be spent out of pocket for a procedure and because of that they are questioning the necessity of the test or procedure.

Does it make the patient think about the money that is spent for healthcare? Yes.

Does it delay care? Yes.

Will this create problems for the patient? For most procedures, no. Biopsies etc should have a second opinion.

MatrixRn · Feb 12, 2015

Are you saying that the BCBStx plan is $170/mth with a $6K deductible? Are you saying that you have to meet the deductible before ANY benefits kick in like preventative, office visit copays, etc? If so, you can work out a cash payment discount with your doctor's office if you should need to see him/her for anything other than preventative. Sounds like a pretty good deal if you are healthy like you have mentioned in your OP. Best wishes! :)

Speaking from someone who takes calls all day long from folks out there many folks are confused about preventative care. There is no deductible or co-pay for preventative care.

But if someone is not healthy--and isn't that what we were trying to do, give folks who had per-existing conditions care? That means they are not healthy and they will NEED TO PAY FOR CARE until they meet that $6 K deductible.

It is not an easy task to listen to a member being told they need to pay $4,000 for a colonoscopy because the person is 48 instead of 50 years old.

valliloves · Feb 12, 2015

But if someone is not healthy--and isn't that what we were trying to do, give folks who had per-existing conditions care? That means they are not healthy and they will NEED TO PAY FOR CARE until they meet that $6 K deductible.
It is not an easy task to listen to a member being told they need to pay $4,000 for a colonoscopy because the person is 48 instead of 50 years old.

Yeah, that I can understand. I thought the OP said she/he is healthy though? Luckily, the hubbs and I found a plan last year through a company called Assurant. He wanted to get a colonoscopy because precancerous and cancerous polyps run in his family. He is 44. Our plan was $535 for both of us. After the colonoscopy, he ended up only having to pay $1K and some change and they found nothing.

This year, the insurance carrier decided they wanted to increase the premium to $765. We are both healthy so we saw more sense in canceling, paying the penalty this year and working out cash discounts with our doctors. Thankfully, his employer decided they wanted to offer benefits for all of their editors. I think it's an employer developed plan. I don't really know. It has a Multiplan PPO logo on it, but the company dba and payroll is printed on the card. Now, we are paying $250/mth for literally the same coverage we were getting before and it was pretty great coverage.

MatrixRn · Feb 12, 2015

Yeah, that I can understand. I thought the OP said she/he is healthy though? Luckily, the hubbs and I found a plan last year through a company called Assurant. He wanted to get a colonoscopy because precancerous and cancerous polyps run in his family. He is 44. Our plan was $535 for both of us. After the colonoscopy, he ended up only having to pay $1K and some change and they found nothing.
This year, the insurance carrier decided they wanted to increase the premium to $765. We are both healthy so we saw more sense in canceling, paying the penalty this year and working out cash discounts with our doctors. Thankfully, his employer decided they wanted to offer benefits for all of their editors. I think it's an employer developed plan. I don't really know. It has a Multiplan PPO logo on it, but the company dba and payroll is printed on the card. Now, we are paying $250/mth for literally the same coverage we were getting before and it was pretty great coverage.

Yes the OP did ask the question how healthy people could spend that much, and the answer is they don't. I just extrapolated from there and discussed non preventative care.

Good for you finding a plan that works for you and your husband. My plan fees this year jumped up from $50 to almost $150 per pay period [just for me - if I added hubbie it would have been $234!] plus there was a $1400 dollar deductible. I dropped the plan.

To the OPs point I saw no way, as a healthy person, I could justify spending 300 bucks month for my once per year check up.

Red Kryptonite · Feb 12, 2015

To the OPs point I saw no way, as a healthy person, I could justify spending 300 bucks month for my once per year check up.

While I feel the same way, unfortunately I can't make the same choice. I carry the insurance for the whole family and as much as the plan sucks, with kids in sports and a hubby who rides a motorcycle....I'm not paying for the annual checkup. I'm paying for the hope that if a severe injury or illness occurs it might not ruin us financially. Even with the much higher deductible, that's still more manageable than what it would cost without insurance. And that's how they get you.

If the deductible goes much higher, though, that equation will change. To a hanging-onto-the-bottom-ledge-of-middle-class family like mine, ten or fifteen thousand dollars may as well be a million.

MunoRN, RN · Feb 13, 2015

Deductibles and premiums for employer provided plans have actually been increasing drastically since before Obamacare was passed. The rapid increase in the inflation of employer sponsored insurance was actually one of the reasons health insurance reform was pursued in the first place.

While I'm sure everyone would like to pay little in both deductibles and premiums, it's not a mathematical reality.

Your premiums involve a few different cost factors; one is that the costs of healthcare are widely variable, for instance about half our total healthcare costs (about $1.5 trillion) are owed by only 5% of the population, or about $100,000 per year for each of these patients in this 5%. Obviously, most people can't pay that themselves, so unless we're willing to just cut these folks off from healthcare, the rest of us need to share that cost. Your premiums also go to pay for own risk of a very large bill, a typical ICU stay will cost over $100k. If you want your premiums to be less by covering less of your potential large bills, then you need to be willing to pay more before that kicks in, in other words you need to be willing to pay a larger deductible.

You could also just refuse to contribute your own fair share by not purchasing insurance and take advantage of the fact that expensive acute care is legally required to be provided to you whether or not you chose to pay for it, which just shifts your costs to others, which to me just seems blatantly socially irresponsible.