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Post-COBRA Coverage Choices: What Next? April 24, 2012

Posted by Admin in Blog Math, Healthonymous, Money.
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18 months is a long time-until the end is near. My employer-provided COBRA coverage April 30th, 2012.  I have appreciated the coverage very much, and it seems to be a relic from another time.

The main concern I used to have was how to maximize my choices in the individual insurance coverage market. Now, I am resigned to the bad choices, at least until the Supreme Court rules in June 2012. [Then it might get worse]

U.S. Supreme Court, 1998.

U.S. Supreme Court, 1998. (Photo credit: Wikipedia)

In my state there are fewer than 5 companies that offer individual coverage in my town. Not much competition there.

  • Deductibles: Used to a $250-$500 annual deductible? Kiss that one goodbye. The lowest annual deductible is $750, and that will be going up this summer to $1000. I contacted the state Insurance Commissioner and that apparently is perfectly legal. The annual deductibles go up to $10,000.
  • Monthly premiums: these range from $170 to more than $500 per month for one person. I know many people out there have more people to cover. How many folks do you know that didn’t even take COBRA, due to the cost?
  • Co-insurance or cost-share: Used to an 8o%-20% plan where you are responsible for 20% of the covered amount? Well, that is increasingly difficult to secure as well. I’ve even seen 50/50 plans. That means the insurance covers 50% of some amount and you pay the other 50%. That is after your monthly premium. Then you have to go through the calculation of whether it applies to your deductible or not.

For example, I learned yesterday that the plan I may select would cover an MRI like this: (as a cancer survivor I have had several of these in my life)

  1. Monthly premium $442
  2. Current deductible $750, in July increases to $1000
  3. Cost of MRI: about $2000
  4. Coverage pays the first $400 only
  5. The rest of the $2000 ($1600) charge would first go to my deductible of $750 if I need the MRI in the next two months.
  6. Out of pocket so far in one month $442+$750, then $850 remains. I pay 20% of that $850-$170.
  7. Total out-of-pocket that month = $1362

Whoa-Stay healthy for the rest of that month! Survive on reduced grocery budget! Other choice: go without coverage like many other Americans!

Health uninsurance rates in the United States ...


2010 Expenses-Update March 20, 2010

Posted by Admin in Cancer, Health Insurance, Healthonymous.
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Insurance changes are trickling in for 2010. First up, only 24 massages per year, or 2 per month from my employer-provided insurance. And this is with a prescription!

(This was, I heard to bring it in line with other “alternative therapies” in the market). Well then. I’ll have to tell my lymphatic system to get on an “alternative” schedule, I guess!

My first compression sleeve of the new year-not covered due to an improper procedure codes. I’ll call my “provider” and see if they need a new code. As far as I know my ICD9 code and prescription on file are sufficient. The cost listed on the “EOB” $194.00. (Explanation of benefits) I need between 2-4 of these per year-as the compression degrades with use. This is a tool to manage my lymphedema.

On the other hand, I just read my first dental EOB more carefully (cleaning, cavity spotting, good grades for flossing-finally and learned that I have orthodontia coverage $1000 of “lifetime” coverage. Hmmmmm. No one is too old for orthodontia anymore-check out your workplace!

In early 2010, I leapt back into the mental health department and found a new therapist.  This costs $90/hour. However, it has been worth it so far. I forgot how helpful just the right question can be-forcing me to consider an answer to a question I had not thought of myself.

Since my weekly out-of-pocket expenses last fall had averaged $90 per week, (see post called Goodbye to 2009 under Expenses) I had taken a holiday from appointments, save the massages, in order to catch up financially.

2010 to date: $150 massage co-pays; $180 for therapist; $194 pending for compression sleeve, $180.22 paid on fall medical bills; $33.80 for initial dental cleaning…..

Total: $738.02 or $67/week for $2010.

Open Season-er-Open Enrollment November 12, 2009

Posted by Admin in Diary, Health Insurance, Money.
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It’s that time of year again. Open Enrollment. Gone are the days of company meetings, fat glossy brochures and new employee benefits.

Well, I take that back. My employer has added a brokerage option to the 401(k) plan. Which by the way, has no match-but I digress.

Our health care plans have about a 12% increase in them for 2010. I am receiving a 1.5 % raise soon, so that will balance out. In actual dollars, as I am responsible for one person only, my “cost-share” of 15% is still a “good deal”. But as frequent Full Coverage readers can track in the weekly expense posts (search under diary or weekly); my out-of-pocket costs are often 2x/3x higher than the monthly premium.

I just read a column by Ezra Klein who asserts that although productivity per worker is up, all of the wages increases we should have received in the last two or three decades went to health care costs (mostly borne by our employers through action taken in the 1950’s). (Read this post for the 4 accidents that created our current system) He does seem to have a few studies to back him up, so let’s accept the premise for now.

Then he writes about the converse. If health care costs could decrease (that bending the curve thing you might have read about) then it seems there is evidence for the notion that wages might rise again. HR 3962 won’t be bending the curve for at least 3 years though. Sigh.

The traditional fee-for-service model is supposed to begin a transformation under HR 3962. However, due to the recession, I think that our personal productivity will continue to rise in 2010, until each company perceives that it has reached a “tipping point” where they add to staff again. Or not. My current industry may not do that, as their revenues are in sharp decline-in the aggregate.

In September I wrote about how my employer has a section 125 plan for dependent care, transportation costs and medical /dental/vision premiums. But no flexible spending plan where fund can be set aside for over the counter medicines, deductibles and such. I spoke with the correct person and was given the answer that “it had never been part of the discussion”. Maybe next year it will be. With almost no raises, plus furlough days, the company could increase the ways we could reduce our taxes, and to be able to pay the multiple deductibles on a pre-tax basis would be a great addition.

That would be a great way to help me remember the 1980’s and 1990’s when Open Enrollment rolls around again next year.

Left Government vs. Right Government November 9, 2009

Posted by Admin in Health Insurance, Healthonymous.
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>Left and right view of the US

 

Where Do You Fall

How you feel about the recent US House health care bill (HR 3962) might depend on where you see yourself on this chart?

It appears in a book being released today (Nov. 10th, 2009) in the US. For information on the book click here.

Consider the following beliefs about society from the chart:

Left:  One for all and all for one

Right:  Survival of the fittest

These contrasting beliefs make it impossible to argue with some R’s or   Libertarians (we have several in the family) about health care reform or almost any government role save defense. I remembered this when I read a review of two biographies of the famous “radical individualist”, Ayn Rand, this past weekend. Some of her books were in my childhood home and I did read The Virtue of Selfishness, The Fountainhead and Atlas Shrugged as an impressionable “tween”.  But I grew up. Now I am a passionate, citizen activist, progressive, government-loving liberal so I guess I wasn’t too tainted. The “radical individualists” in my family live and breathe their ideology.

I’m not saying that it is bad to be an ideologue, but it is a lonely place. For my relatives, it has just gotten lonelier, as most of the family email list has gotten fed up. The errant relatives have told us we can’t see the truth and “we ignore it at our peril”. But this quote from Ms. Rand tells me that this is all part of the plan:

The hardest thing to explain is the glaringly evident which everybody had decided not to see.” source (more…)

“Let’s Take Our Medical History” Nobody Ever Planned This… October 20, 2009

Posted by Admin in Health Insurance.
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This story, heard last weekend on the radio program This American Life was very illuminating about how we got our imperfect health care and employer based group insurance system. There were 4 steps in the last hundred years that got us to the system we have now. They were all accidental.

The high points are:

  • At the turn of the 20th century hospitals were …”dark dirty places where the poor went to die”.  This gradually changed to marketing them as places with happy outcomes: come here to have babies, tonsils out, appendectomies etc.
  • In the 20’s, someone notices that Americans are paying more for cosmetics than health care. Baylor University began to offer a plan for .50/month for 21 days in the hospital a year to teachers. This eventually evolved into Blue Cross…
  • WWII: The war economy. Wage and price controls encourage more employers to add health insurance plans in order to attract workers during the war, as labor was scarce.
  • A bureaucrat at the IRS made a routine ruling in 1943 that in some cases employers don’t have to pay taxes on health insurance premiums for their workers.  It entered the IRS code formally in 1954. Participation increased.

There is a great story towards the end about what if  employers provided our food insurance instead of our health insurance. Makes you think about the system and maybe that keeping two facets of our current system; employer based instead of community based plans and tax subsidized through employers might not be a good idea.

Community based coverage instead of employer based coverage I get.  But removing the tax subsidy? That worries me a little unless my wages would go up to compensate or I could control a tax subsidy of my own. How to equalize that benefit is one of the $64,000 questions.

Listen to the show. What do you think?

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