Our new huge insurance deductable, not good.

[edhopper]

Last edited Mon Oct 7, 2013, 05:16 PM - Edit history (1)

We keep our employer based insurance and our premiums are about the same, BUT...

Our family deductible goes from $900 a year to $3000!!

AND our copay goes from 20% to 30%!

I am not sure how we can afford this without rationing some of the medical care we need. We really don't have the extra money this will cost now.

We do not get a subsidy (that is for exchanges only) and our tax deductions shrink because of the new 10% threshold. (And in our bracket we usually take the standard deduction anyway)

I really wanted single payer but accepted Obamacare as the best they could do.

Now it looks like I can't afford the healthcare I need because of changes brought about by it.

Don't know what to think.

[handmade34]

1. can you not get healthcare

through the exchanges and get a subsidy?

[wercal]

6. No subsidy if you are eligible for an employer sponsored plan.

[handmade34]

14. I guess states are different

Vermont lets people use the exchange if premiums are unaffordable through employer

[wercal]

42. The ACA was written to prevent people who are already insured from entering the exchanges

In order to qualify for the subsidy, your premiums through your employer sponsored plans have to exceed 9.5% of your income...that's where the scale starts.

So take an uninsured person making $50k...the exchanges put his annual premium at $6,000. That's 12% of his income, and he can expect to get subsidized $1,250 and pay out $4,750.

Now take the same person, except he is already insured through his employer. They split the premium 50/50, or he currently pays out $3,000. That is less than 9.5% of income, so he gets no subsidy. He will be required to pay full cost, or $6,000....or double, by switching from employer sponsored to exchange.

The vast majority of people who are currently insured will fall into this zone.

[wercal]

51. Well here is my original statement

No subsidy if you are eligible for an employer sponsored plan.

Often times on this board, I find people arguing with me over what they 'read'...but not what I 'typed'.

[Yo_Mama]

156. But it's defined - 9.5% of income for the wage earner

And that doesn't count the payments for the other family members. But even if insuring them would be unaffordable, still neither the wage earner nor the other members of the family can buy insurance on the exchanges and get subsidies. They can buy insurance, but no subsidy.

[wercal]

31. Let me rephrase that

You will only be eligible to the extent that your own portion of the premiums exceeds 9.5% of income. So your eligibility for subsidy is radically reduced out of the gate, by what your company already subsidizes your insurance. For most people (myself included) your eligibility for a subsidy will be effectively zero, if your company already sponsors a plan.

[wercal]

35. You don't get the same choice everybody else does

You will only be eligible for a subsidy to the extent that your own portion of the premiums exceeds 9.5% of income. So your eligibility for subsidy is radically reduced out of the gate, by what your company already subsidizes your insurance. For most people (myself included) your eligibility for a subsidy will be effectively zero, if your company already sponsors a plan.

This is an intentional feature, to prevent a wave of people, who are already covered, from getting the public subsidy.

[Roland99]

22. You can get a subsidy *if*....

the coverage for your self only from your employer would be 9.5% or more of household income.

You can always buy on the exchange vs. using employer-sponsored insurance but most likely wouldn't have a subsidy (unless the condition above is true)

[SheilaT]

70. The employer sponsored plan also must

include certain specific coverage. I don't know the details. I did recently get a letter from my employer (such letter being required by the ACA I think) explaining that our current coverage -- which is quite good by the way -- is such that none of us are eligible for the exchanges.

I am paying less than I would be on the exchange.

[Bo]

130. Sorry DUers But my Rates are EXPLODING under Obama care. It really hurts in the pocket book.

OUCH

[VanillaRhapsody]

2. BUT you have a maximum out of pocket...

and no pre-existing...AND no deductible no co-pay on diagnostics....AND your health insurance company cannot spend more than 20% on anything other than Healthcare for its members....should I go on?

[edhopper]

27. Not saying it doen't help

a lot of people. Just hurts us.

[VanillaRhapsody]

44. If its helping...its not hurting you...

How do you not understand that? Have you ever lived without health insurance? Do you understand how THAT feels?

[edhopper]

79. It will probably be a

net benefit to the country and help more people than not.

I am just one of the cases where it hurts.

I simply won't have the extra dew thousands of dollars health care will now cost me. Do you understand that?

[VanillaRhapsody]

81. Its a "net benefit" to you too...

You are now getting more bang for your buck....do you not understand that? You will need Healthcare....have you priced it lately? You cannot be pre-existed out...AND your insurance company now has to pay out 80% towards actual health not overhead...Do you need diagnostic tests? Cause NOW you wont have to pay for those out of your pocket! You are getting MORE healthcare not less....

[DireStrike]

117. As a bystander - you should be more calm in this situation. You aren't coming off very well.

Try more listening... if you want to make a point, use the Socratic method - ask questions to get where you want (or you may learn something.)

The poster is paying MORE and s/he can't afford it. That's the bottom line here. With changes this big, some people will be hurt. It's unavoidable.

[VanillaRhapsody]

134. He or she cannot afford not to...

[duffyduff]

143. The sticker shock is going to hurt a lot more people, I'm afraid.

This is basically healthcare rationing. People simply won't be able to afford the premiums, the deductibles, or both.

[stevenleser]

3. So what you are saying is you don't have coverage through ACA, but you are blaming ACA.

Your employer decided to get crappier coverage for your firm to keep premiums the same, is really whats happening here, right?

Not that I dont have empathy for you if you are in that situation, but it's not the ACA that is the problem here.

[HuckleB]

33. Exactly.

[stillwaiting]

37. This is the PRIME opportunity for employers to radically downgrade the coverage they give to their

employees.

They can say it's Obamacare's fault, and there's a good chance that many of their workers will believe them.

I personally will continue to demand single payer health care. The movement from the left to improve what we have must not lose steam.

The right certainly will take every step they can to discredit, weaken, and destroy Obamacare, and there will be lots of energy and attention dedicated to achieving their desired outcome.

[edhopper]

38. This might well be true

I think the ACA will help a lot of people. But I too would have favored single payer.

I put this here because it is troubling to us. I don't want to condemn the ACA outright. Just portray what has happened to this opne family in it's wake.

[VanillaRhapsody]

45. that is EXACTLY what you are doing...

you will have more "healthcare" than you ever had before...some without copays or deductibles....AND you cannot be pre-existed out. AND you have an out of pocket maximum...you won't be bankrupted by medical costs!

[Trekologer]

67. You will be able to tell if your employer is cheapening out on your W-2

Employers are required to tell you the contribution they make for health insurance costs.

[Bo]

131. LIke I said before I will pay more and get less under the new Obama Care

This is a reality for Millions of people.

[duffyduff]

144. Companies will eventually force our elected officials to put in loopholes so they can gut their

plans altogether.

This is the real motive here, just as there were loopholes regarding pensions.

[lanlady]

172. this is happening all over the place

I've heard numerous acquaintances complain that their companies' plans are jacking up co-pays and deductibles, and blaming it (falsely) on Obamacare. The $3000 deductible is becoming commonplace. The suits are using Obamacare as a convenient pretext to save money at the expense of employees. They were blaming Obamacare long before the law even went into effect! Yet workers believe them.

[kestrel91316]

72. [phone]

I have a cousin who is claiming the same thing. Her employer-sponsored health insurance premiums are going up and she is angry and blames Obamacare, claiming that she can't get subsidized insurance. HER LOCAL GOVERNMENT EMPLOYER ALREADY SUBSIDIZES IT.

She also says that people are being denied the right to take personal responsibility for their health care by not getting insurance. I informed her that NOT having insurance is a way of avoiding responsibility, not shouldering it. Once you've drained your wallet for that cancer treatment, lol, you are a burden on your fellow taxpayers.

I love her because she's my dearly departed cousin's daughter, but ZOMG, that girl has got Faux and Rushbo on the brain.

And she's got lupus, so she'd be among the permanently uninsurable if not for Obamacare. I think she must not realize that she's not tied to a crappy, underpaid job anymore.

[sobenji]

115. This.....

[Barack_America]

153. All policies are now regulated by the ACA...please read on...

His policy has been deemed to be ACA-compliant, yet he can't afford it due to the 9.5% maximum not applying to employer-based family plans. The so-called "family glitch" the IRS enacted in order to shave $48 billion or so off the ACA price tag.

Would love to see this covered on your show considering the impact it will have on lower-middle class and middle class families. It is by far the biggest problem I see with the ACA this far.

[stevenleser]

154. "All policies are now regulated by the ACA" seems a huge stretch.

A few provisions are mandated. That does not imply what you are suggesting.

[Barack_America]

158. I'm not sure what you think I'm implying.

All policies must now be compliant with the ACA regulations on costs and expenditures.

Listen, I'm a huge fan of the ACA, but this decision not to extend the affordability metric to families has me greatly troubled. It was clearly identified as a barrier to families getting health care, as they have been exempted from the personal mandate. I ask, why exempt these families rather than allowing them to participate in the exchanges? I think that's a fair question to ask. We're literally talking about millions of kids being intentionally left without access to health insurance. Families who do decide to continue coverage are going to be greatly stretched.

I worry that this could become a significant issue in future elections (i.e. "proof" that Democrats "don't really care" about middle class families).

[frazzled]

4. You don't go on the exchanges if you've got employer insurance already

I don't understand your complaint. This is not for people who currently have insurance. It's for people who need to get insurance on the open market. For them, it may be a good deal, compared to either having no insurance (because they were denied it for pre-existing conditions or couldn't afford it) or paying tons more for it.

This is not to comparison shop against your employer insurance (which is also subsidized). If your employer offers insurance, you can't buy it yourself on the exchange.

[frazzled]

29. Yes, but it is unlikely to benefit anyone with employer-offered insurance

because you most likely would not get a subsidy from the government (and most likely would lose the employer's subsidy). So it is pretty much tantamount, for most people, to not being an option.

In addition to losing any contribution, you'd be paying in after-tax dollars, as well.

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-
tax basis.

http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf

[frazzled]

68. Well then the exchange is the place to go

I think one thing people aren't considering (and the OP in particular) is that there is also cost-sharing (in addition to subsidies) in the ACA. These apply only if you are looking at the Silver plan, however.

So, in the OP's case, comparing a Bronze plan to his/her employer insurance is probably not the right way to go. Because he might be eligible for the cost-sharing, which would reduce the co-pays and deductibles.

All in all, unless you're very young maybe, Bronze plans don't seem like a great idea to me anyway.

[Pretzel_Warrior]

32. are you sure about that?

[leftstreet]

54. Not true

If your employer offers 'affordable' coverage, you can't use the exchanges

[leftstreet]

65. Yes it does

Whether you qualify will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won't be able to get lower costs on premiums or out-of-pocket costs in the Marketplace. This is true no matter what your income and family size are.

Affordable = 9.5% or less of household income

Congress defined "affordable" as 9.5% or less of an employee's household income, mostly to make sure people did not leave their workplace plans for subsidized coverage through the exchanges. But the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges.

http://www.usatoday.com/story/news/politics/2013/09/23/aca-family-glitch-issues/2804017/

[leftstreet]

78. No subsidies, as has been pointed out to you

Who could possibly afford to leave employer based coverage that costs less than 9.5% of income, without the employer's premium contribution, and purchase insurance somewhere else?

[sharp_stick]

5. How is your employer

based healthcare part of the ACA?

Maybe take a look at the exchanges and see if you can do better than your job is giving you.

[wercal]

8. The OP can't shop on the exchanges

And expect a subsidy, if he/she is eligible for an employer sponsored plan.

[sharp_stick]

9. Ah OK

was not aware?

[wercal]

84. Ok, once again, here is my original statement:

8. The OP can't shop on the exchanges And expect a subsidy, if he/she is eligible for an employer sponsored plan.

Once again, you are arguing with what you thought you read...not what I actually typed.

[Yo_Mama]

157. There are many mandated coverages that are new, and yes, the costs for many plans are more

Remember what the unions were saying? They were saying that it hurt their members. This is how.

This was, in fact, how ACA was designed to work. Cost-sharing was built in as a way of suppressing the usage of health care.

[Capt. Obvious]

7. What does your employer based insurance have to do with the ACA?

Your insurance changed because of the ACA?

Now it has to cover x, y, & z where before you were on your own for those?

[wercal]

10. The major changes I have seen that affect all insurance:

1. Coverage of member children until age 25
2. No lifetime limit on payout
3. Cannot be turned down for pre-existing condition

There is room for discussion on the merits of each of these, but its naïve to pretend the ACA doesn't affect all insurance plans. The exchanges are really just half of the story.

[Capt. Obvious]

13. Those are big fucking deals

Not to mention: charging women the same rates as men; covered women's health specific visits/meds/etc.

What I'm pointing out is that if your insurance changed that much because of these changes then your old insurance was garbage. With a deductible that low I'm sure the fine print would show such awesome lines (that were part of changes to my plan many years ago) as: chemotherapy is considered experimental and not covered.

[HuckleB]

34. +1

[wercal]

41. I don't know anything about the OP's insurance

I'm just pointing out that its wrong to be dismissive of his claim that ACA affected his premium.

Each of this items I listed have pros and cons, and they can be debated and discussed.

All I'm saying is that they definitely will affect premiums.

And I wouldn't characterize a plan that presently has a lifetime limit on payout as 'garbage'....as I imagine the vast majority of plans presently have a limit. I happen to agree with the removal of the cap myself, but I understand it comes with a cost.

My company already insures dependents 25 and under. I've used it myself for my kids, but I've always had a problem with it. My problem starts with the fact that we have 18 year old field personnel. So the 18 y/o who can't afford to go to college is employed, and essentially subsidizing a 25 y/o whose parents work in the office (like me) and can afford to send their kids to college. Even before ACA, I didn't think that was the right approach for our company. Somebody once suggested that we change to a premium based not on a flat rate, but as a percentage of income. That way the office person with the kid in college is paying a higher premium than a married 18 y/o...but it didn't fly, and frankly that may no longer be legal under ACA.

I agree that a plan that charges more for women probably is garbage. I have never encountered that.

[hedgehog]

60. The problem that you discuss isn't that the working 18 year old is

subsidizing the college bound 25 year old; it's that the 18 year old can't afford college.

[wercal]

86. So do you see a world where nobody enters the workforce until age 26 coming in the future?

I don't.

[hedgehog]

90. No - but the context implies that the child of the middle class office worker was going to school on

back of the 18 year old because the 18 year old couldn't afford college, not because the 18 year old chose not to go to college.

[wercal]

97. Can't afford/Don't want to go/Doesn't do well with academics, whatever

There are a variety of reasons why an 18 y/o might be working in the field for our company, and not being able to afford it is one of them. But it could also be a choice (perhaps academics aren't his strong suit).

But no matter why he isn't in college, is it right for him to subsidize the healthcare of a 25 y/o, who can afford college? There just seems to be a disparity between the 25 y/o 'kid' on the parents' plan, and the 18 y/o 'worker' who pays for the 'kids' healthcare.

Imagine if they were both the same age - 18 (one a 'kid' in college and one a 'worker'). The 18 y/o worker will subsidize 7 years worth of healthcare for the 18 y/o 'kid'.

And we can really take college out of the equation altogether. What if the 18 y/o 'kid' doesn't go to school, or have a job. He can sit at home (parents' house) and play video games, while the 18 y/o worker toils away to provide him insurance.

Again, this is something my company has offered for years, so ACA doesn't change our situation. But I've never thought it was fair, and now we don't even have a choice in the matter.

[hedgehog]

107. By the same token, why are the women in your company buying Viagra for the men,

or the older folk buying maternity care for the younger folk, etc.? As it is, the only reason for extending coverage to age 26 is the recognition that college or no, there is a lot of unemployment among that age group.

[wercal]

110. None of the examples you cite involve somebody flat out being subsidized 100%

A man's Viagra, a woman's mammogram...it all evens out (or at least gets close).

I just have a big problem asking young people to pay for their peers' insurance.

[canoeist52]

17. Coverage of children til age 26 not 25. That extra year matters to a lot of us.

[wercal]

26. OK I meant 25 y/o were covered.

[VanillaRhapsody]

46. Plus

if you need a mammogram or colonoscopy etc...those are covered with no deductible and no co-pay! AND you insurance company MUST spend 80% on actual healthcare OR refund you!

[sinkingfeeling]

11. How is your employer based insurance under ACA?

[Nye Bevan]

12. Many plans charge only a $20 or $25 copay for in-network office visits

even if you have not met your deductible.

And preventive care is free regardless of your deductible.

[bluestate10]

137. The deductible only kicks in for me in the case of major medical care, which I haven't needed.

Physicals for me are free. Office visits cost $15. Prescriptions are 50% paid for by the insurer. I have never had an out of pocket payment larger than $150 when I visited an out of network doctor when on a business trip.

[handmade34]

20. my thought too

the employee uses company ins. and the rest of the family check out the exchanges

[handmade34]

40. Vermont is a mess

I can't finish the online application (I keep getting kicked off in the middle)... I just printed the paper application and now will decide whether to just mail that or wait until all the kinks are worked out

[Mojorabbit]

61. There is a glitch with that in some cases

The problem seems to be the way the law defined affordable.

Congress said affordable coverage can't cost more than 9.5 percent of family income. People with coverage the law considers affordable cannot get subsidies to go into the new insurance markets. The purpose of that restriction was to prevent a stampede away from employer coverage.

Congress went on to say that what counts as affordable is keyed to the cost of self-only coverage offered to an individual worker, not his or her family. A typical workplace plan costs about $5,600 for an individual worker. But the cost of family coverage is nearly three times higher, about $15,700, according to the Kaiser Family Foundation.

So if the employer isn't willing to chip in for family premiums – as most big companies already do – some families will be out of luck. They may not be able to afford the full premium on their own, and they'd be locked out of the subsidies in the health care overhaul law.

Employers are relieved that the Obama administration didn't try to put the cost of providing family coverage on them.

"They are bound by the law and cannot extend further than what the law provides," said Neil Trautwein, a vice president of the National Retail Federation.
http://www.huffingtonpost.com/2013/01/30/obamacare-glitch-priced-out-of-health-care_n_2585695.html

[riqster]

24. Your rates and premiums are not impacted by the ACA.

I am in a similar fix, but it is not Obamacare's fault.

[JPZenger]

25. There is a big donut hole

As noted above, a low or middle income family is not eligible for subsidies through the exchange if the employee receives employer provided health care insurance that covers most of the employee's insurance costs. In that case, if their spouse and their kids don't have affordable coverage, there are no subsidies for their premiums.

As a result, many people with employer-funded insurance for themselves will still be stuck paying $10,000 to $15,000 a year to pay for health insurance for their spouse and kids.

It should also be noted that there will a separate set of exchanges posted soon to allow small businesses to easily compare and select insurance plans. Your employer may find something better for the same price. However, most insurance companies convinced businesses to renew early under their existing plans to avoid the evils of Obamacare. The effect was that those insurance companies delayed competition for a year.

[riqster]

28. My point is that if you are not buying insurance on tbe exchanges,

Don't run around saying how expensive your new ObamaCare is.

[wercal]

43. There are aspects of ACA that affect everyone's premium

People can discuss the merits of each of these items, but its wrong to pretend they don't exist.

[gulliver]

145. And wrong to assert they exist while not listing any. nt

[wercal]

146. I've polluted this thread with

Enough examples to risk being called a troll.

[gulliver]

147. Well I do see a lot of assertions repeated.

They are examples of unfounded assertions but not examples of how ACA supposedly affects everyone's premiums. Health care costs nationwide have been rising more slowly after ACA than before it.

[dkf]

123. There are 10 essential benefits necessary to every plan that only half used to cover.

Therefore the other half could have higher premiums as they have additional benefits.

10 health care benefits covered in the Health Insurance Marketplace

https://www.healthcare.gov/blog/10-health-care-benefits-covered-in-the-health-insurance-marketplace/

http://www.freep.com/article/20130921/NEWS06/309220043/10-benefits-health-care-reform-obamacare

[Ikonoklast]

30. This is deliberately mis-leading, and should be edited, You are blaming th ACA for your employer's

bad decision-making.

But you know this already, don't you.

[edhopper]

36. The NY State Exchanges

have deductibles of $3000 and $4000.

No subsidies for us and higher premium.

Can't be sure but looks like the employer just changed coverage to match it.

And of course the ACA has changed policies, don't be naive.

[ProSense]

39. The exchange is for people who

don't have insurance or already purchase insurance on the individual market. Those with employer-based health care do not qualify for subsidies on the exchange. Employers already pay a good portion of employees' coverage.

Those in the individual market are paying for their own health care in full. They will see significant savings on the exchanges.

[ProSense]

64. If an employer doesn't pay a portion, it's

likely the premium (for most people) will be more than 9.5 percent of income, and that qualifies a person to shop on the exchange.

If it's less, then you're in the same situation as all other employees.

[grantcart]

48. I am sure that you would be the one best qualified to answer this but

I am guessing that you did not intend to call yourself naïve and was addressing someone else.

On the other hand if you are in a disassociative state and have more than one personality in action on this thread at the same time you could alert against the other personality.

[PotatoChip]

96. Lol!

[edhopper]

104. Oh!

I see what i did there. funny.

[grantcart]

47. I am sure that you noticed changes in your employer's plans every year before ACA.

Without ACA you would have had even higher increases:

Now you have the following:

1) All preventative care - free
2) Children up to 26 can continue
3) The Medical Loss ratio for your plan has a ceiling of 20%.

Do you know what the medical loss ratio of your plan was before 2009?

[Motown_Johnny]

52. Where did you get these numbers from?

Are you sure you are comparing apples and apples? Does your employer contribute to your premium now? If so, are you counting that toward your cost?

All the information you provided is very general so I could be wrong but it really looks like you missed something.

[Lex]

59. Bronze, Silver, Gold is ACA.

You're talking about your insurance under your employer?

[pnwmom]

62. This new deductible is something your employer insurance decided to do--

not something the ACA forced or even encouraged it to do.

[markpkessinger]

77. That may be so, but . . .

. . . but the reality of the matter is that many employers will regard these new, higher deductibles as a new "standard," and adjust their employee plans accordingly. It is a problem that could have, and should have, been foreseen. (Then again, maybe it was and they just chose not to address it.)

[leftstreet]

83. By 2018 many employers will have to make adjustments

Depending on the cost of their contributions of course

How Obamacare Is Encouraging Employers To Cut Wasteful Spending And Promote Workers’ Health

By Sy Mukherjee on May 28, 2013 at 4:05 pm

In an effort to cut wasteful U.S. medical spending, certain employers will be scaling back expensive health plans available to their employees and encouraging workers to pursue more preventative and ongoing primary care. The move is being prompted by Obamacare provisions that encourage a more cost-sensitive and efficient approach to Americans’ health care than the status quo.

Recently-released government data shows that Americans’ medical bills are completely random, with some hospitals charging as much as $100,000 more for the same services performed at other facilities. In turn, that drives up the costs of many private health plans, and increases companies’ spending on employer-sponsored insurance.

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.

Companies aren’t waiting until 2018 to shift their health care models. Some are increasing their use of high-deductible health plans (HDHPs) — which charge workers low monthly premiums but high annual deductibles — in an effort to raise employees’ awareness of how much their health care consumption costs.

http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

[markpkessinger]

85. And these new, higher deductibles . . .

. . . will have the effect of making health care LESS affordable and hence, for many, less accessible, for those who have employer-provided insurance.

[leftstreet]

103. Oh yeah

That's really the 'meat' of the ACA

Not sure why there's so much bickering right now about legislation that applies to less than 20% of the population - a percentage most 'middle class' people don't give a shit about anyway

But just wait...

[Pretzel_Warrior]

91. wrong. you are plain wrong. MANNNNNY companies--even big companies have been moving

toward High Deductible/Low Premium as a way to shift more of the health care burden onto employees. Many people are feeling the squeeze on this. Long before Obamacare.

I hate the misinformation bullshit going on here on this site re: Obamacare.

[markpkessinger]

92. And many employers have NOT gone to such high deductibles . . .

. . . at least not as high as the deductibles under the ACA exchanges, although many more are likely to as a result of the new "standard" set by the ACA.

That may not be a convenient fact, but it is A fact.

[Pretzel_Warrior]

94. no. it is your supposition. Some large employers offer multiple levels of insurance

including more standard insurance with what has been seen as typical deductibles and copays but significantly higher monthly premiums. Most of the employers offering the High deductible plans also offer HSA's so a person can at least see their money leave their paycheck in a steady flow in anticipation of medical emergencies when one must meet deductibles.

The same thing will have to happen for people with these high deductibles. Save a bit here and there considering the premiums are much lower than people thought--get it into an HSA if you have an HSA qualifying plan.

it is still a lot better than someone not getting any coverage at all.

[edhopper]

95. So my insurance

having a threefold increase in the deductible that exactly matched the state exchange is just coincidence?

Your really are trying to sell that?

[Pretzel_Warrior]

98. your company is competing with other companies in the total compensation they offer--not exchanges

so the fact that your particular company chose to go with a plan that ends up with a deductible similar to a state exchange means nothing re: ACA.

Do you not understand the insurance companies bid on your company plan using a community rating. Putting all of your employees' healthcare situation into a community rating, they set premiums, etc. etc.

As someone else pointed out, good luck trying to find something in exchanges that even come close to matching your company's insurance. You'd have to pay the full premium--company would not pay the portion they do on your plan. And you'd be rated as an individual based on your age--no community rating.

I think you are over simplifying and playing right into medical insurance companies' hands of trying to blame THEIR greed and avarice on Obamacare.

[edhopper]

102. I still support the ACA overall

and hope we move to a public option at some point. But I happened to be one of the people who are worse off after the changes it has brought.
I wish i was just bitching about paying extra money and not seeing that i can't afford the medical care i currently need.

[Pretzel_Warrior]

105. I understand. That is why we must PUSH our Dems to make what would seem like radical

suggestions to alter ACA. Like including a public option in all states. Then moving it to expansion of Medicare with corresponding indexed tax increases in corporate and individual tax rates to help the U.S. budget on revenue side to manage this new entitlement reform.

Then Medicare, Medicaid, and all other insurance should be bundled into one SINGLE PAYER solution where we have maximum negotiating power with pharma companies, medical device makers, hospitals, and medical groups.

[edhopper]

108. Medicare for all

was a wonderful idea that almost went through.

[Travis_0004]

151. If the ACA limits profits, then there really isn't any greed

Insurance companies will charge what it cost, and make their profit. If they get the calculations a bit wrong, then they will issue a refund. If the plan cost goes up, and the deductible goes up, then its because it cost the insurer more money (since they can not make a higher profit). Now maybe the employer decided to subsidize less of the insurance.

ANd the fact is many changes take place in 2014 due to the ACA, and those changes will affect insurance rates. You can make the argument that they are good changes, and had to be done, but you are an idiot if you don't think those changes have an impact on insurance rates, some of which are reflected in the OP's new higher premium.

[pnwmom]

138. The reality of the matter

is that employers have been free all along to offer or not to offer insurance, and to make these policies as good as as bad as they wanted to. The ACA is placing requirements on the employer, but unfortunately the employer mandate has been delayed for a year.

[hedgehog]

63. I am certain we will hear plenty of anecdotes from people who had a better

deal before the ACA kicked in. However, the real question is not whether everybody is doing better but whether most people are doing better, including the people who couldn't buy insurance for any price before the ACA!

[DevonRex]

71. Is the cost over 9-1/2% of your household income? If so you can use the exchanges. nt

[edhopper]

89. My overall costs will exceed that

my premium cost will not. the deductible and new 30% copay will triple my medical costs, maybe more.
I don't have that amount of money, I will have to decide which medical problems not to treat.

[DevonRex]

113. I have a furloughed federal employee working on this right now.

So you'd better be serious. I mean it. We're getting the shaft right now but we're happy to help when real people have real problems. And when we're not at the hospital.

It might take awhile. When do you have to enroll in your employer's plan? I you've already done it, let me know now.

[edhopper]

126. Thanks for the offer

but I will sort this out with aid of family.
I am not asking for help with my medical, just describing my situation for edification to DU and to stimulate conversation.
I can still deal with serious health problems and will have to pull back on the type of quality of life pains that affect us all.

[DevonRex]

132. "What if I have job-based Insurance?"

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

Your plan may not meet the standards.

[Barack_America]

152. Not true. The 9.5% applies to the employee alone.

Costs for the family's premiums are allowed to exceed that, as decided by the IRS. It's called the "family glitch".

[karynnj]

75. Your employer changed the plan

Your plan is not changed due to ACA - other than the requirements such as kids up to 26 staying on and certain requirements as to what the plan includes. I suspect that the employer is either paying a smaller share or their costs went up and they chose to increase the deductible.

[leftstreet]

80. Employer ACA changes won't kick in til 2018

How Obamacare Is Encouraging Employers To Cut Wasteful Spending And Promote Workers’ Health

By Sy Mukherjee on May 28, 2013 at 4:05 pm

In an effort to cut wasteful U.S. medical spending, certain employers will be scaling back expensive health plans available to their employees and encouraging workers to pursue more preventative and ongoing primary care. The move is being prompted by Obamacare provisions that encourage a more cost-sensitive and efficient approach to Americans’ health care than the status quo.

Recently-released government data shows that Americans’ medical bills are completely random, with some hospitals charging as much as $100,000 more for the same services performed at other facilities. In turn, that drives up the costs of many private health plans, and increases companies’ spending on employer-sponsored insurance.

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.

Companies aren’t waiting until 2018 to shift their health care models. Some are increasing their use of high-deductible health plans (HDHPs) — which charge workers low monthly premiums but high annual deductibles — in an effort to raise employees’ awareness of how much their health care consumption costs.

http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

[DireStrike]

119. ?

The post you respond to says that the employer changed the plan. The article you posted to counter says, in part:

Companies aren’t waiting until 2018 to shift their health care models. Some are increasing their use of high-deductible health plans (HDHPs) — which charge workers low monthly premiums but high annual deductibles — in an effort to raise employees’ awareness of how much their health care consumption costs.

[leftstreet]

120. I didn't post to 'counter' the statement

In 2018 employers will have to abide by that particular part of ACA legislation

Some employers may already be launching the changes. Who knows?

[DireStrike]

121. Understood. -nt-

[bluestate10]

139. Yes. Sounds like the employer purposely shifted to a lower level plan, for example a Bronze

level plan from a Silver or Gold level plan. The employer could have done this for several reasons, none good. First, the employer could have seen what exchange rates will be and is trying to capture those savings while providing worse health care insurance to employees. The perception could be that not many employees would get seriously injured or ill. Another reason could be that management are right wing shills who want to create a political environment by screwing employees.

[karynnj]

168. Even before ACA started, many companies moved in this direction

Several years ago, AT&T moved to a high deductible plan from a much lower priced plan -- leading us to take my husband's plan rather than mine - until he retired. AT&T changed after what had been Southwest Bell, headquartered in Texas bought AT&T. One thing that may have encouraged that move is the existence of healthcare accounts which allow people to use pretax money to pay for out of pocket expenses - a Republican preferred way of dealing with health care costs.

What it seems that this employer may be doing is - in effect - lowering the salary package without lowering the wages. As the exchanges get more mature, I would think that there may be some small businesses (the only ones that can use the exchanges now) moving to the exchanges. Especially if the small business has had someone (s) with serious health care costs, their employees might get a better deal on the exchange if they are given the cost (after tax) the employer would have paid for insurance.

This kind of transitioning away from employer healthcare could create more support for the public system as more will see it as benefiting them. I think that it has been the existence of employer based healthcare insurance - a fantastic benefit for those who have good plans - that has made the US unique in NOT having a national healthcare insurance.

[Warpy]

82. You can think that a major accident or illness is not going to bankrupt you

Yes, poor people getting the bronze plan won't see their out of pocket expenses decrease. However, if they've managed to buy a shabby fixer like I did, they won't lose it if they get sick.

That's a big deal right there if you've ever been poor and uninsured. You don't get Medicaid until you're destitute, or at least you didn't.

[markpkessinger]

122. That's all well and good, but . . .

. . . speaking as a diabetic, unmanaged chronic diseases afflict as many or more people than a single, major illness. And they can be deadly if not closely monitored and managed.

[Warpy]

125. if all else fails, contact the manufacturer directly

because they have "compassionate" deals for people who are too poor to afford their products. You can also consider getting your prescriptions filled in Canada, that saved my ass for a long time until they went generic.

I know all about poorly controlled chronic illness. It's what disqualified me from getting insurance for nearly 3 decades.

[bluestate10]

140. Health insurance is all about risk estimation.

People have to analyze their risk level and buy insurance that match their risk profile. Healthy people that are careful, have good driving records, don't smoke or drink heavily can guess that they won't trigger the higher deductible or hospital visit costs that Bronze level plans trigger.

[Warpy]

149. Unfortunately, it's people 50 and up who will likely have to choose it

because they've reached their corporate date of expiration and are working a patchwork of McJobs to get by until they can get early social security.

This is why the Medicare eligibility should have been lowered to 55. Damn that worm Lieberman to the world he wanted the rest of us to live in. He blocked it single handedly.

[Pretzel_Warrior]

88. EDIT YOUR POST! You've been corrected by many in the thread

time for you to come around and admit this is to do with your company's High Deductible/Low Premium plan--something that companies have been moving to for YEARS prior to Obamacare/ACA.

Be honest and fix your post title.

[edhopper]

93. done

[Pretzel_Warrior]

101. thank you

[Puzzledtraveller]

99. Sorry to hear this

not surprised at all.

[JDPriestly]

100. You have to ask yourself whether your deductibles would have gone up anyway.

My deductibles on my Medicare plan have skyrocketed.

I suspect that they would have gone up without the ACA because staff went on strike in my healthcare provider's company. I think the money is to cover likely increased costs.

[edhopper]

106. Probably some

maybe a few hundred dollars, which I would have found somewhere (who needs heat in the winter?). But they went up over 3X and the copay is now 30% instead of 20%. That is more money than I have available. I will have to ration my healthcare.

[JDPriestly]

112. Mine went up by a lot too, and Social Security has not gone up commensurately.

2013, Max. out of pocket $3,400. 2014, $5,900.

Lab tests and x-rays went up $10 but MRIs went down $20.

Generic drugs went up from $7 to $10. Brand-name from $40 - $45. (30-day supply).

The changes would not be huge if seniors were working and had more than Social Security coming in, but most aren't and don't. Any rise will be tough on a lot of seniors.

[bluestate10]

142. ALL. You company made a decision to have you foot the more of bill for your health care.

Many people realize how much of their health care premiums and costs companies pay for. The ratio that companies pay is around 10 to 1.

Companies increase the amount that employees pay for several reasons, only one is good. Rates for employees may rise do encourage employees to take better care of themselves and shift more to preventable care. Or the company may be a bastard employer that wants higher profits at the expense of it's workers.

[Laelth]

109. Health insurance companies suck.

Don't know what else to tell you.

I can say that Medicare runs at 95% efficiency (95% of the money allocated and spent through Medicare actually pays doctors and other health-care providers) whereas the health insurance companies had to be drug, kicking and screaming, to agree to operate at 80% efficiency under the ACA.

So much for Reagan's argument that anything government can do the private sector can do better (and, presumably, more efficiently). It was a lie then, and it's still a lie today.

-Laelth

[SlipperySlope]

111. I'm waiting to hear from my company.

We should be hearing in the next couple weeks what the changes are to our coverage and premiums.

[Blue Idaho]

114. Are greedy companies playing into the hands of Single Payer?

I think so. Every time an employer opts to provide a shitty health care plan with less value for more money it pushes the system closer and closer to single payer. I say Medicare E - Medicare for everyone!

[DireStrike]

118. Do you have a union? Any leverage with your employer?

This is entirely due to your employer's choice of health insurance provider.

Ask your employer for the information that went into making this decision. If they won't provide it, why not? Consider whether organizing your fellow employees might be a viable avenue to getting this fixed.

Don't let them weasel out and blame it on Obamacare.

[edhopper]

129. No I don't

but it's a good thought

[haele]

124. That happened to us last year BEFORE the ACA.

If it's related to the ACA, it would be primarily because your employer no longer has as much negotiating clout with the Insurance Companies, not because it's more "expensive" for the insurance companies, the health care industry, or your employer...

Our insurance premiums and deductables are going up again - however, this year it's only going to be 5%, not at the average 15% it has been doing for the last 10 years.

They jack it up because now, they have a framework they can "meet", and they don't need your employer as much as they used to.

Haele

[Warpy]

127. You can think what we all think--it's a lousy plan and the best we could expect

from a Congress infested with Republicans and Blue Dogs.

Medicare was a disaster when it started, too, and required a lot of tweaking before it operated correctly. This plan is no different.

What we need to do is GOTV to make sure Democrats show up next year to give us the kind of Congress that will make sane amendments to the law.

[MadrasT]

128. I am in the same boat.

I don't "blame" the ACA and I am glad it is helping people but my employer based coverage costs way more than it used to and I have a huge deductable that I never had before.

[barbiegeek]

133. I've never heard of $900/YR DEDUCTIBLE. our family deductible has always been 3-6,000

[Myrina]

135. Well, I've registered 3 times, with my 3 different emails (home, work and kid's)

... gone thru all the 'profile setup' bs, got to the 'success!' screen, got the validation email, clicked on the hyperlink and been told all three times that A USER PROFILE WITH THAT INFORMATION DOES NOT EXIST.

Yet when I try to create a 'new' profile using that same email address, I get an error that says 'A PROFILE WITH THAT EMAIL ADDRESS ALREADY EXISTS'.

And when I click on the 'forgot username' or 'forgot password' links, it tells me it's sending me an email to reset, but I never receive it.

Honestly, if it's this fucking difficult just to set up, do they really think people are going to have any kind of confidence in the system actually working?


Flame away, fanbois ....

[bluestate10]

136. Blame your employer. The employer is shifting more of the cost of your health insurance

to you. It is a chicken shit move, but there are companies that will try it. But some companies are choosing to go the other way, providing better insurance.

What many people don't understand is that companies pay a 10 to 1 ratio of cost for employee health care, that is a major cost item for many companies. A high Silver level or Gold level plan can cost as much as $1500 per month for a family, most employees pay as little as $60 per month of that amount.

Sounds to me like a group of unethical people are running the company you work for. If there is true, then your company almost surely have other ills that are costing it much more than insuring the health of employees.

[mimi85]

141. Exactly!

I was thinking the same thing. We have this huge thread debating this and that and it all just boils down to a crappy employer.

[Travis_0004]

155. This is not always true.

Where I work, our plans are going up quite a bit, and our company is paying the same percent of the cost they always have. Since I work in accounting and pay the bills, I know for a fact, at least in our case, my boss is not paying less. In fact, his cost went up just as much.

[gulliver]

148. Well it looks like you've taken a leap of logic on this one.

What makes you think you "can't afford the healthcare I need because of changes brought about by" Obamacare? If you jump to conclusions like that, maybe you haven't really researched your options, Obamacare or not.

[edhopper]

150. it will be

An extra $3000 or $4000 a year or so. State exchange price similar, no subsidy.
Can I get the extra cash from you?

[JNinWB]

160. Ed, perhaps, you can arrange a compromise with your employer.

If your employer raises your ins premium contribution above the 9.5% (?) amount, this might allow you to purchase a better family plan on the exchange and qualify for a subsidy.

Win/win. Your employer does not have to subsidize (or manage) your insurance and you have 4 plans to choose from on the exchange with potential subsidies.

[Lex]

161. My insurance premiums AND deductibles have been jumping every year

for years . . . pre-Obamacare.

[edhopper]

162. so you had your deductible

Triple and go up several thousands of dollars?

[Lex]

163. Yes over the course of a few years. Now my deductible is 5K.

And I pay $332.00 / month. This year is actually the first year it didn't jump up in a long time.

[edhopper]

165. wow

I just don't have a family budget to accommodate several thousand more a year. I will have to dig into my retirement savings or go into more debt.

[haele]

164. In 2008, I paid $210 a month for 3 people, and had a deductable of $2500.

Doctor's visits were $15 or $25 (specialist), $20 for urgent care, $50 for ER, $150 for hospitalization, 10% "Co-Insurance" for certain procedures, $20 for basic labs, X-rays, etc...meds were <$5, $15 (name brand), $25 (patent). Not including dental and vision. It was a really good deal back in 2008.


This year, I pay $435 a month for 3 people, and have a deductable of $10K for the family, an FSA of only $5200, $35/$50 for doctors, $35 for Urgent Care, $100 for ER, $300 for hospitalization; meds are 100% until deductable of $3000, then <$15 generic and 30% name brand or patent. Co-insurance is 20% across the board - X-rays, labs, procedures, whatever.
Oh, again, not including dental or vision. Not so good, but I can't get cheaper anywhere else. I can actually deduct medical costs from my taxes this year, even after we blew through the FSA.
Oddly enough, the premium this year is actually $40 a month cheaper than we had in 2012, though our deductable did go up by $3K.
So, yeah - deductables have gone up, and up, and up. What you're seeing is not unusual for most plans.

And this is a "Employer-provided PPO Plan" - the same plan I've had since 2002.

Haele

[edhopper]

166. our plan

Only pays a percentage, not a copay. So a Dr. visit can cost us $100 and up. And now our part is now 30% meaning a 50% increase in our cost AFTER we meet the deductible.f

[haele]

170. Sounds like your plan is a catastrophic plan or a "health coupon" plan like they advertise on TV.

In situations where health care is provided as a company benefit, your employer picks the plan based off what s/he thought was most cost-effective for them, not necessarily what is the best overall for the employees.

Insurance companies have had a habit of steering smaller companies to the more lucrative (for them) catastrophic plans rather than to plans that can actually provide services for people that can have medical conditions - like kids, allergies, high blood pressure, etc.

They'll take most of the premiums paid (between you and your employer) and convert them into an account that pays "their" percentage of any negotiated health cost, leaving you to pay the rest out of pocket. If you're lucky, they'll roll it over every year without taking too many fees out of it...

As for rate increases; even HMOs have seen increases in premiums and co-pays.

Unfortunately, there's not much you can do about it if you need access to health care. And everyone will need that access sometime during their lives, no matter how "well" they take care of themselves.

Haele

[regnaD kciN]

159. If it's "employer-based," it's NOT "Obamacare"…!

It's your employer and their insurance company deciding to "off-load" more costs onto the employees…as they've been doing every renewal period for years, long before the ACA. As a matter of fact, one of the impetuses for the ACA was precisely the constantly-climbing costs of private, "free-market" health insurance.

It looks like that phenomenon has come back to bite you. That stinks. If you want to get mad at the ACA, get mad at the limits and loopholes (insisted on by guess who?) that wouldn't allow you to forego your employer's plan and use the exchanges instead. But it's not "Obamacare" that has caused the jump in your rates.

[aznativ]

167. My deductible went up from $3K annually to

$12700!

Also, premium goes up from $449 / mo to about $600 ish (no subsidy). That is for a silver plan.

Dont know if I'll go with Bronze as I will definitely burn up my deductible as my wife and I are both in/out of the doc quite a bit. My employer no longer offers family coverage as of Jan 2014 so now I have to go with this.

Not very happy.

[cbdo2007]

169. You would still likely pay more in taxes for Single Payer than you are paying now.

Add up the portion you pay each month for the full year to get the annual amount, then add in your deductible. Now what percentage of your income is this amount?

Not sure why so many people think "single payer" will just be free for everybody.

[edhopper]

173. Premuim plus deductible plus copay =

about 20%

You really think I will be taxed 20% of my income for single payer?

[dionysus]

171. emploers getting shittier plans has nothing to do with the ACA. i just came from a company

where BCBS was raising our policy 20% a year... years before the ACA.

[Mellow Drama]

174. We need SINGLE PAYER...NOW!

Enough of this bullshit. The GOP has done everything they could to derail ACA, and as a result, they have spooked the insurance companies, who are doing their final grab. What we REALLY need to do is to hit the tax code, preferably through executive order or just the senate and the president if necessary, and just tax the rich. There is more than enough to pay for everyone's healthcare needs without having us break our own budgets, which is being orchestrated by the demons on the right.