# Health insurance



## endrow (Dec 15, 2011)

Now that I parked the combine for the year. One job that I have is the search for health insurance for my wife and I and my son's family of 5 with two on the way. the past couple years I've purchase that during the Open Enrollment time I think our only option is to use that Marketplace. I think a lot of Republicans that shot their mouths off should realize it's worse now then the past couple years prior. In Pennsylvania it's County specific and the county I'm in there are only two plans available for my wife and I and neither of those plans use the doctor's we would use and they are higher priced than before and they put up the levels where they subsidize or help you out in those plans. Anyone else on here applying for health insurance during open enrollment where does anybody see any good alternatives


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## IH 1586 (Oct 16, 2014)

I don't use the market place cause as soon as I put in my sons live out of state it turns into a mess I don't want to deal with. I've gotten my insurance through this company.

*Davevic Benefit Consultants, Inc.*
902 South Center Street
P.O. Box 976
Grove City, PA 16127
www.davevic.com


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## Teslan (Aug 20, 2011)

Well I always get pitched these medical cost sharing groups. Like Medishare. Samaritan Health Care. Liberty health care. I can't bring myself to try them and take the risk. I know others that do and like them. They are significantly lower priced, but none actually guarantee coverage and that is what scares me.

Our family premium went up $400 a month this year. So I'm at $1400 a month for the 4 of us. I got our plan off marketplace. Last year I tried for the subsidy but I didn't like all the paperwork and it claimed my sons would have to be on medicaid. The paperwork for the subsidy doesn't really work well for farmers or real estate agents. They always want the per month that you earn. We would have lost our subsidy halfway through last year when they ask you to update your income. I think that's how I understood it. Plus I didn't want to deal with medicaid for our kids. And we would have lost that also. For next year we wouldn't qualify for any subsidy based on this years income. Which isn't right either. What if my wife doesn't sell any real estate. What if the price of hay tanks and every thing gets ruined.

Stupid Obamacare.

So I'm just staying with the plan we had last year. Which here is Anthem Blue Cross and Blue Shield. One thing I noticed about them rather then the Humana we had for years is Anthem must negotiate way lower rates on medical costs then Humana. So that is one thing to consider with insurance companies. Though I don't know how you would know the costs. For example I have some blood work done every year. With Humana it always cost about $400. Its at the first of the year so that always goes to my deductible. With Anthem Blue Cross and Blue Shield it cost $75. Which I can't believe is enough to really cover the blood tests. I used to have to get a CT scan every year. With Humana it was always $6000. I did an estimate with Anthem and they are showing $1500. So I'm a little angry with Humana.

The funny thing is I got a letter from Anthem yesterday saying if I'm happy with my plan just pay the new premiums when they come. I'm not happy with the plan, but it is my best choice. So I'll suck it up.


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## endrow (Dec 15, 2011)

On the marketplace this is about our only choice


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## Teslan (Aug 20, 2011)

endrow said:


> On the marketplace this is about our only choice


What's silly about these plans is the bronze plan and the gold plan have the same out of pocket. Who cares about the deductible. If you have anything major you are blowing past that deductible and past that max out of pocket at the same time. And the gold plan will cost you a lot more per month. So your real deductible is that Max out of pocket. If you just go once or twice a year for a regular doctor visit you won't get any where near that deductible.


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## Teslan (Aug 20, 2011)

What I want for health insurance is just something to cover emergencies, or major diseases like cancer. I can handle doctor office visits just fine. But the government thinks I need more. But I can kinda see their point of few also. Think of all the people out there that don't plan for themselves that the government has to manage for them.


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## somedevildawg (Jun 20, 2011)

Teslan said:


> What I want for health insurance is just something to cover emergencies, or major diseases like cancer. I can handle doctor office visits just fine. But the government thinks I need more. But I can kinda see their point of few also. Think of all the people out there that don't plan for themselves that the government has to manage for them.


I agree 100%....we have the latter already btw, it's what they're trying to get your children on.....


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## somedevildawg (Jun 20, 2011)

I'm now in a group  so mine went from down about 500 per month with a lower deductable, but it's still way, way, too high....


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## Teslan (Aug 20, 2011)

Sometimes I feel like we just need to get it over with and put everyone on Medicare. It’s going that way anyways. If the government allows it there still will be clinics, hospitals, doctors that choose to be outside that system if people want different care and are willing to pay for it. It is that way where my wife is from in Panama and it works quite good in a small country.


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## somedevildawg (Jun 20, 2011)

Teslan said:


> Sometimes I feel like we just need to get it over with and put everyone on Medicare. It's going that way anyways. If the government allows it there still will be clinics, hospitals, doctors that choose to be outside that system if people want different care and are willing to pay for it. It is that way where my wife is from in Panama and it works quite good in a small country.


You mean Medicaid right.....Medicare is totally different as well it should be, you actually had to pay for it....but I don't feel like that at all, I think the hospitals should take care of the indigent and write the invoices off. Healthcare shouldn't cost a arm and a leg to get a splinter out......monopolies in the healthcare industry should be frowned upon. Instead I see small hospitals being gobbled up by the larger ones and the larger ones being gobbled up by the even larger ones....all cash cows btw, because no one has to pay for anything, but they get paid for everything, especially when it comes to wellness and prevention....how about the knee/back brace that you qualify for on the commercials.....it's not for me, I didn't get the invite....it's not for Medicare, they didn't get the invite either, it's just for Medicaid recipients. Need some long term health care, hope you're on Medicaid because it covers a lot....Medicare/private insurance? Not a penny.....
The ultimate goal of the gubmit seems to have everyone "beholden and reverent" to them by way of entitlements....


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## Teslan (Aug 20, 2011)

somedevildawg said:


> You mean Medicaid right.....Medicare is totally different as well it should be, you actually had to pay for it....but I don't feel like that at all, I think the hospitals should take care of the indigent and write the invoices off. Healthcare shouldn't cost a arm and a leg to get a splinter out......monopolies in the healthcare industry should be frowned upon. Instead I see small hospitals being gobbled up by the larger ones and the larger ones being gobbled up by the even larger ones....all cash cows btw, because no one has to pay for anything, but they get paid for everything, especially when it comes to wellness and prevention....how about the knee/back brace that you qualify for on the commercials.....it's not for me, I didn't get the invite....it's not for Medicare, they didn't get the invite either, it's just for Medicaid recipients. Need some long term health care, hope you're on Medicaid because it covers a lot....Medicare/private insurance? Not a penny.....
> The ultimate goal of the gubmit seems to have everyone "beholden and reverent" to them by way of entitlements....


Yes Medicaid. You are right about the hospital systems getting bigger. We have two systems in Northern Colorado. They compete with hospitals, clinics, doctors. But prices? No! People try and tell me hospitals are losing money. I can't see it. When I see hospitals being built that from the outside and the lobbies look like 5 star hotels. My insurance is out of network at one of them. Except in an emergency. So I guess if I'm half dead and I get taken to the one that my insurance is out of network they won't charge me extra for it.

Man I hate health insurance now. I'm only 42. What are our premiums going to be in 10 years? And the politicians GOP and Dems just use bandaids.


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## Hayjosh (Mar 24, 2016)

Teslan said:


> What I want for health insurance is just something to cover emergencies, or major diseases like cancer. I can handle doctor office visits just fine. But the government thinks I need more. But I can kinda see their point of few also. Think of all the people out there that don't plan for themselves that the government has to manage for them.


 I Really feel for you guys essentially paying a second mortgage for health insurance. I pay $60/month for me and my wife through my employer plan and my brains splat when I see a $1400/mo premium. That is undathomable to me. I'm so shielded and detached from this healthcare mess I don't know what's good and bad.


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## Teslan (Aug 20, 2011)

Hayjosh said:


> I Really feel for you guys essentially paying a second mortgage for health insurance. I pay $60/month for me and my wife through my employer plan and my brains splat when I see a $1400/mo premium. That is undathomable to me. I'm so shielded and detached from this healthcare mess I don't know what's good and bad.


how good is that plan for $60 a month? I ask because I see so many people asking for go fund me things for various illnesses when I thought they had jobs from employers that paid for health insurance. Though I suspect many people can't afford the deductibles. But you are right $1400 a month is high. And it will probably be $1800 next year. I can see why people stay in jobs that offer health insurance.


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## endrow (Dec 15, 2011)

Hayjosh said:


> I Really feel for you guys essentially paying a second mortgage for health insurance. I pay $60/month for me and my wife through my employer plan and my brains splat when I see a $1400/mo premium. That is undathomable to me. I'm so shielded and detached from this healthcare mess I don't know what's good and bad.


 you are fortunate to have a $60 plan from your employer. Does your plan have any out-of-pocket cost in the way of deductibles or co-pays


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## Hayjosh (Mar 24, 2016)

I should add the context that I work for a large animal health company (the 'orange' one, for those of you who use our products, which will be most all of you), and they treat us very well. We're also a large multi-national corporation with over 10,000 employees so we get good group rates to begin with, but then the company subsidizes a substantial portion of our premium as part of their benefits offering.

My plan is a health reimbursement account (HRA) and is the cheapest plan offered. It's more of a pay as you go plan, which is better suited to people who don't go to the doctor a lot. It means I basically pay EVERYTHING until my deductible is met, and then I only pay 10% after that until my out of pocket max. In this plan I have an account through the insurer and my company deposits money into that account every year. My insurance claims are automatically billed to and paid from this account. If I don't use what my company deposits one year, it rolls over into the next. So if my deductible is $1400 and my company contributes $400 to my account every year, then the amount of deductible I pay out of my pocket is only $1000 (or less if I haven't had any claims in several years). I did the math and if I were to pay a year's worth of premiums, meet the deductible AND the out of pocket max, it was still several hundred dollars cheaper than paying ONLY the premiums for a different plan they offer. So with this HRA, I'm not paying high premiums for services I might not ever use.

For my wife and I we have a $2100 deductible and employer kicks in 600 to my account every year, so I'm really only responsible for 1500 of that deductible. Once deductible is met we pay 10% coinsurance until our out of pocket max of 3750 is met, and then insurance pays for everything. This coinsurance includes emergency room, hospital, prescription drugs, etc. Basically everything a 'regular' plan covers. Except with a regular plan, your copay does not contribute to your deductible or out of pocket max. In my case, every I pay contributes, so I think it's a pretty good plan, it just means I'm paying more up front initially. Preventive health care like physicals, immunizations, etc are completely covered and cost me nothing.

The point I wanted to make originally though (and forgot) is one benefit to being on an insurance plan as opposed to paying for everything in cash is you pay the negotiated rate and not the standard rate. Which is the same in my case too, even though I'm paying for the doctor visit myself, it's still the negotiated rate with my insurance company which is still significantly cheaper than what the 'normal' rate would be. So that still needs to be accounted for when you think you're almost better off with a 'catastrophic only' type of plan. Paying the negotiated rate could still save you hundred or thousands of dollars, depending on what kinds of claims you have.


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## Hayjosh (Mar 24, 2016)

Also, to clarify I guess I'm paying $124/mo for me and my wife. The 60 I was thinking of was per pay period. Still, 124/mo compared to some of these figures I'm seeing that might as well be mortgages is pocket change. I don't know how you guys do it.


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## swmnhay (Jun 13, 2008)

Just got notice mine went up another $200 a month.BCBS.

I already have the max deductible of $6500 I wish they would just offer a catastrophic policy at a low rate just to cover yourself in case of a major health issue.


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## Teslan (Aug 20, 2011)

Hayjosh said:


> Also, to clarify I guess I'm paying $124/mo for me and my wife. The 60 I was thinking of was per pay period. Still, 124/mo compared to some of these figures I'm seeing that might as well be mortgages is pocket change. I don't know how you guys do it.


Your plan reminds my of the plan I had in 2010.......Except still cheaper then back then. I think I was paying $550 a month, but there was just 3 of us then. Do you know how much your company subsidizes your premium? They can't just have had a decent insurance group plan and only be paying $124 a month for the premium with that low of deducibles?

This is what I don't get. Your company is huge. That's good. Your deductibles are low and out of pocket seems low. Even if your company is kicking in $1000 a month for your premium that still sounds like a better plan then is available for any self employed person anywhere. I make this point because why can insurance companies offer those kinds of group plans, but not those kinds of individual and family plans to a self employed market that most likely in every state far exceeds your companies number of employees. I just don't get it. Well I get that the government/banking systems don't really like self employed people.

And I know Trump was trying to get trade associations able to form as a group like a company to get more favorable group rates for it's members. But the GOP failed with even that. I don't understand why that is not allowed anyways. When I first starting buying my own health insurance I could have formed a group of 2 to get a better policy for my wife and I. It would have been the same price as an individual policy, but covered more things. Like pregnancy.

I am not criticizing your company. They are doing great for you. I'm criticizing the system. The system that the politicians aren't willing to fix right.

And this isn't all Obamacares fault either. Insurance companies always offered better plans to companies.


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## Teslan (Aug 20, 2011)

swmnhay said:


> Just got notice mine went up another $200 a month.BCBS.
> 
> I already have the max deductible of $6500 I wish they would just offer a catastrophic policy at a low rate just to cover yourself in case of a major health issue.


Don't think about how much work you have to do just to pay for that bloated policy......Then the more work you would have to do to pay for the deductible. If you didn't have to pay that you could afford a $100k pickup.


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## Hayjosh (Mar 24, 2016)

Teslan said:


> Your plan reminds my of the plan I had in 2010.......Except still cheaper then back then. I think I was paying $550 a month, but there was just 3 of us then. Do you know how much your company subsidizes your premium? They can't just have had a decent insurance group plan and only be paying $124 a month for the premium with that low of deducibles?
> 
> This is what I don't get. Your company is huge. That's good. Your deductibles are low and out of pocket seems low. Even if your company is kicking in $1000 a month for your premium that still sounds like a better plan then is available for any self employed person anywhere. I make this point because why can insurance companies offer those kinds of group plans, but not those kinds of individual and family plans to a self employed market that most likely in every state far exceeds your companies number of employees. I just don't get it. Well I get that the government/banking systems don't really like self employed people.
> 
> ...


I can tell you one thing--I know how much I pay for a bag of saline from Baxter to do my work. It used to be around $12. I saw somebody's hospital bill one time and they were charged over $200 for their IV drip.


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## Teslan (Aug 20, 2011)

Hayjosh said:


> I can tell you one thing--I know how much I pay for a bag of saline from Baxter to do my work. It used to be around $12. I saw somebody's hospital bill one time and they were charged over $200 for their IV drip.


Well take for example on the price of a vet and any surgery. Compared to the price of a similar procedure for a human. A few years ago I had to have a dogs leg amputated. $800. I bet to have say an arm on a human amputated would cost $50k. For basically the same surgery and same recovery.


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## glasswrongsize (Sep 15, 2015)

Yeah, but the hospitals cant get away with the same things as the vets do. Heard ad on radio yesterday for Joe's vet and taxedermy service" and the slogan??...."either way, you get your pet back".

Partly it is gouginh (people will pay more for a human's life than an animal's...as it should be), partly it is the high cost of lawyers and tort, and add the high cost of gummint intervention and you have a mess. That's on the health CARE side.

On the health INSURANCE side, anyone that is actually PAYING for health insurance is also paying for someone else's who is unwilling to take responsibility for their own bills. Then add that the gummint has free health INSURANCE for the people who refuse to work, and subsequemtly have plenty of time and othing better to do than go to the ER everytime they have a sniffle.... rant barely started, but I will auit there

Mark


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## somedevildawg (Jun 20, 2011)

Good thing.....I already felt my BP rising b)


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## somedevildawg (Jun 20, 2011)

Last time I got stitches it was from my vet.....


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## PaMike (Dec 7, 2013)

I love the fact that they enacted a max deductible to protect us from having a bad insurance. So now instead of having bad insurance we will have no insurance at all because before long no one will be able to afford the plans....


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## endrow (Dec 15, 2011)

The Republicans really could have made a difference here in this Health Care thing and they changed absolutely nothing.


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## Teslan (Aug 20, 2011)

I just wonder though if without Obamacare if we would be at these premium costs anyways. Mine was going up a lot as it was from 2005 to 2009. Of course we added a kid in that time also.


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## Grateful11 (Apr 5, 2009)

Teslan said:


> I just wonder though if without Obamacare if we would be at these premium costs anyways. Mine was going up a lot as it was from 2005 to 2009. Of course we added a kid in that time also.


It might have made a little difference but like you said premiums have been rising for years before O'care took place.

I still have to wonder if insurance companies would have had to take in people with pre-existing conditions if there would have ever even been an Obamacare.


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## somedevildawg (Jun 20, 2011)

endrow said:


> The Republicans really could have made a difference here in this Health Care thing and they changed absolutely nothing.


1/2 of em ain't got a set..... RINO's

Wolves in sheeps clothing......


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## PaMike (Dec 7, 2013)

Teslan said:


> I just wonder though if without Obamacare if we would be at these premium costs anyways. Mine was going up a lot as it was from 2005 to 2009. Of course we added a kid in that time also.


ObamaCare isn't the entire problem, but it is part of it. We went to a "self insured" plan. Really all it did was allow us to bypass the ObamaCare regulations and get a rate based on our ACTUAL health track record, and not have our rate based on the ObamaCare Age/Gender/Tobacco Status rate table.

Our plan allowed for a refund of 50% of our unutilized costs. IN other words, if our carrier based our rates on 70K in claims, and we only had 60K in claims, we get a refund of 5k.. This year when we got our renewal our rates jumped by 17%, but then when we got our refund it basically zeroed out the increase...So even though we came in way under in utilized claims the carrier still thought it needed a 17% rate increase...the system is rigged....



endrow said:


> The Republicans really could have made a difference here in this Health Care thing and they changed absolutely nothing.


..but why do they care? They have their own healthcare system. If they had the plans we have results would happen...


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## Teslan (Aug 20, 2011)

PaMike said:


> ObamaCare isn't the entire problem, but it is part of it. We went to a "self insured" plan. Really all it did was allow us to bypass the ObamaCare regulations and get a rate based on our ACTUAL health track record, and not have our rate based on the ObamaCare Age/Gender/Tobacco Status rate table.
> Our plan allowed for a refund of 50% of our unutilized costs. IN other words, if our carrier based our rates on 70K in claims, and we only had 60K in claims, we get a refund of 5k.. This year when we got our renewal our rates jumped by 17%, but then when we got our refund it basically zeroed out the increase...So even though we came in way under in utilized claims the carrier still thought it needed a 17% rate increase...the system is rigged....
> 
> ..but why do they care? They have their own healthcare system. If they had the plans we have results would happen...


where and through who did you get this self insured plan?


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## endrow (Dec 15, 2011)

First year of ObamaCare my luck I needed hip replacement my monthly health insurance payment was $900my out of pocket was $14100. Now my deductible and max out of pocket are below $9k but the policy for that same policy would be $2400....


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## mlappin (Jun 25, 2009)

swmnhay said:


> Just got notice mine went up another $200 a month.BCBS.
> 
> I already have the max deductible of $6500 I wish they would just offer a catastrophic policy at a low rate just to cover yourself in case of a major health issue.


Thats all I had forever, which is what insurance was meant to cover, broken bones, heart attack, cancer and so on. People demanding low co-pays and that insurance should cover everything has gone a long ways towards making it so unaffordable.

My wife's been on disability for awhile now, Medicaid for everyone isn't that great an ideal either.


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## PaMike (Dec 7, 2013)

Its a plan through Aetna. Any broker that deals with them would have access to it. I think there is a min of like 5 or 10 participants. It really isn't "self funded" as you would traditionally think. You buy stop loss insurance so that you don't have an unexpected additional costs. The "self funding" part allows you to bypass the ObamaCare pricing and get a true price quote bases on your groups medical history.


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