New Teaching Contract

Just read this entire thread with interest as we (my DH and I, both retired) are in the process of looking at individual health insurance plans prior to our move back to the US in the spring. We have had a catastrophic Latin American plan provided by a UK company for the past year an a half that we've been living in Belize and have not used it once. But it's not something I'd take the risk of going without.

I've been comparing plans using ehealthinsurance.com, and it looks like we'll be applying for the very least expensive plan that UnitedHealthcare offers, the Saver 80, with the highest deductible ($10K each for my DH and myself). It covers preventive care (because that is mandated by law), which is in many years all we ever get or need. And other than that, it covers just inpatient care if we should ever meet the deductible (no outpatient coverage). They also have an interesting new benefit where if you don't meet your deductible in a given year, it is reduced by 20% the next year, and so on until it is reduced by 50% max.

The base cost of the plan is $358/mo for the two of us. To get a plan that covers more (Rx, outpatient care, etc.) the costs just go up up up. Since we retired early, we knew we'd have to pay for most of our medical care other than really huge catastrophic problems, which we hopefully won't have for a long, long time.

We just feel very fortunate that we can afford to self-insure up to the limits of our deductible and pay for our own dental and vision care. So many people could not do this, and could not manage a $10K deductible, so have to pay for much more expensive policies. We also have no children to cover.

I do realize how lucky we are, and how very fortunate we were for decades to have "Cadillac" plans sponsored by our large corporate employer. We are very healthy and use very little health care, even in our 50s, but it may not always be that way. And an accident can happen to even the healthiest person.

I just hope we get approved!

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Originally Posted by Irulan

These kinds of plans, as wonderful as they are for those who have them, are part of the problem in that real costs are hidden. I mean, if you are paying $2400 a year for coverage, and a handful of change, that doesn't begin to cover the actual costs of checkups, regular visits, prescriptions etc for two people assuming you have regular type issues.... but then again, the system is so screwed up, who knows what things really cost, eh?

We were out to dinner a few weeks ago and one of the guys works for Big Pharma, regional sales rep or something. For some reason the conversation got on to health care costs, and he was saying it was so great that no one had to pay more than $5 for a prescription. I was all, "what planet do you live on?" He was, "you can get yours at Walmart for $5, right?"
Well, the answer is absolutely not. He didn't believe me at first but It's not on the list. My plans doesn't cover it, and it's $300/month at most box stores last time I checked. Thank God for Costco Pharmacy.

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My husband works for the Federal Govt (Dept of the Navy as civil service, good luck figuring out what exactly the cost of the plan actually is. I do have pay a good portion of any lab work. It's somewhere between 40 and 50% for any lab work done. I know this because I know how expensive that can be without insurance. And my old doctor did what she could with not doing more than she had to with lab work then, and got me a discount by having it billed to the office instead of billed directly to me. Although I did see what the cost was before the deduction.) Our insurance is through an insurance company that is apparently only for govt employees and actually has very few doctors even in a military city that takes the coverage. The other insurance packages from other companies which are very similar in benefits are between $50 and $100 more per paycheck than the one we have. The one through Blue Cross Blue Shield is the most expensive and actually covers less, yet is the one my husband was told is the one most people opt to use.

I know you are correct about Walmart not carrying some prescriptions. They don't even carry the birth control I take, forget getting it for $5, you can't even get it there. Actually that prescription I pay more than $5 for anyway (well until that part of the ACA kicks in).

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Originally Posted by Irulan

Probably me. :D I think you and I are on the same page about this.

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I'm with the both of you. As I've gotten older, I've become more and more progressive in my views. :)

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Originally Posted by OakLeaf

I don't think anyone suggested it was "free." On the consumer side, it's consistent from individual to individual, which is the key point of this thread ... on the provider side, costs aren't inflated with huge marketing bills and duplicative administrative expenses.

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To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

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Originally Posted by Koronin

The one through Blue Cross Blue Shield is the most expensive and actually covers less, yet is the one my husband was told is the one most people opt to use.

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I'd hazard a guess that's because most doctors, hospitals and labs are in-network with BCBS. Knowing whether your provider is covered is just as important as knowing whether the service is covered.

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Originally Posted by tulip

I do not pay the same premium as every other 45 year old woman; the insurance company considers more than just age and sex.

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Your state allows that. Mine doesn't. When my insurance company raises my premium, I get a form letter with a grid on the back. It's got three columns, "Male," "Female w/o Maternity," and "Female w/Maternity," and ten or twelve columns with (mostly) five-year age ranges. Those are the only criteria they're allowed to use in setting premiums for individual policies.

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Originally Posted by tulip

I do not see how anyone on a normal income could afford that; it's like having 3car loans or an extra mortgage!

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They can't. That's why over 18% of all adults in the USA are uninsured, and over 70% of adults under 25..

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Originally Posted by tulip

I just want people to know that there are options. They might be hidden and take a while to uncover, but I was surprised to find out that affordable options do exist.

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Again - in your state there are options, and I'm glad that there are. In a few states there are even more options. In most states, there are not, at least not unless and until the ACA goes fully into effect (and we have yet to see what may happen with that, in terms of either implementation or affordability).

My first husband has several family members in the insurance industry, so if anyone is familiar with the options in my state, they are. He is older than I, but his health history at the time was similar. After our divorce and after his COBRA ran out, he couldn't afford premiums. He went bare for a couple of years, longer than the six months it took for him to be eligible for open enrollment. He found a fly-by-night policy that claimed to cover catastrophic conditions, after that company went out of business he went bare for another couple of years, until he was able to get eligibility for VA. If it weren't for the VA he'd still be uninsured.

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Originally Posted by lph

To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

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Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

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Originally Posted by malkin

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

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However, I've deliberately stayed away from the Universal needed in US sub topic as that tends to descend into the political fairly quickly. Unless everyone on TE is unanimous and there's no debate?:D

More crazy tidbits: My sis is a lawyer, fairly high up, for a major, national health insurer. She won't use their product, but uses her husband's. Some of her more famous sayings, while helping our mom w/Medicare...." I work in the industry and I don't understand the paperwork".

My SIL, who has worked her whole life until she has a debilitating stroke at 47, is fully disabled and on Medicaid. They recently sent her a letter stating that her income of $1079 a month ( yes, that's what she lives on) is $300 too high to qualify for full benefits, and she now has a $2000 copay she has to meet before she has any coverage. She can barely pay her rent and utilities, and they've done this. I've been trying to call in for MONTHS and the state systems doesn't allow you to talk to real people.

I will stop for the moment.

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Originally Posted by OakLeaf

I'd hazard a guess that's because most doctors, hospitals and labs are in-network with BCBS. Knowing whether your provider is covered is just as important as knowing whether the service is covered.

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I'm sure of that. I was still living near Charlotte when hubby got this job. My old doctor there took any coverage they knew about because they wanted to make sure if their current paitents ended up with different insurance for any reason they would be covered there no matter what. When I was choosing a plan I also looked up doctors on line where I was moving to. Of course not knowing anyone here had no idea who was/was not worth seeing. Strange part about that is the doctor I ended up picking who takes our insurance is apparently one of the best in the area. Like my old doctor she tries to make sure she takes any insurance she knows about. Of course here well over half the population is military and many of them just use the facilities on base. I picked the doctor I did because she does have over all good reviews on line (the major complain is wait time), and a big thing is that as long as you are a patient you do not need an apt to see her or the nurse practitioner, you can go as a walk in. (Which I was extremely thankful for a couple weeks ago). The vast majority of doctors here do not allow walk ins, you have to call for an apt. before they will see you. I figured being able to walk in if need be was worth waiting a bit longer in the waiting room.

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Originally Posted by malkin

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

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Ditto. I guess that is what concerns me most. I have similar issues to an earlier poster with pure existing conditions and realize how fortunate I am to be able to afford the premiums. I wouldn't expect that would be the case in most situations and if I couldn't it would mean having to return to a job I am glad to be rid of rather than working for myself. It just seems that those who can't afford it have a double whammy. Not only can they not count on insurance help with costs but they are saddled with no insured rates that are significantly higher than for the person in the next chair with the same treatment. My surgery just really brought this issue home to me recently. And this thread has made it clear that The options available vary greatly from state to state making the debates more complex.

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Originally Posted by malkin

Of course, like everyone I am concerned about my own health care and coverage, but I also believe that there is enormous value in living in a community where EVERYONE is covered. I rarely hear this mentioned in US discussions about the issue.

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Absolutely. Health care for our country is about values. I lobbied for health care reform, favoring a plan such as medicare for all or a plan presented by Senator Wyden which was also simple and would cover everyone. I so burnt out on the lobbying effort that I had to retire. :(
I do know more than anyone should have to know about the varied complicated mess that is individual state options on health care coverage.

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Originally Posted by lph

To me the real bonus is not that our health care is "free", because it's not, but that paying for it is not optional. And that good health care is not only for the well-to-do or for those who plan well. It has a cost, but these are still good things in my book. But I realize that these are hot political topics in the US and I won't pretend to know what it's like. It's a different world.

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I like hearing about your country's system, actually. In the US, some view being required to hold health insurance as a violation of their constitutional rights (or---egads---the US descending into "socialism"). At the risk of being "flamed" or inviting a heated discusssion, I'm going to say it :eek:: there are those who use the constitution to justify selfishness (example: those who think that having to pay taxes violates their constitutional rights and see it as akin to having the government steal your hard earned income).

I'm not going to flame you for that, that for sure. I remember similar arguments way back, when i lived in Wyoming, and they were putting seatbelt legislation into play. People actually said things like, " no ones going to tell me what do, I can send my family through the windshield if I want..." (Really, not making that up)

For a thorough,non biased comparison of five Westernized capitalist countries and their variations on single payer health care systems, Frontline did a very good piece several years ago. Singapore, Germany, Japan, UK, and one other nation are compared to the US system. It's only about 50 minutes long
http://www.pbs.org/wgbh/pages/frontl...roundtheworld/

Well, I guess there's a kind of bizarre logic in being allowed to send your family through the windshield if you want, as long as you pay for the ambulance, the ER and every minute of sewing them up again afterwards yourself... Justifying, quantifying and paying for the trauma to everybody else who witnessed it, friends, co-workers and family is a bit harder.

Sorry to be facetious, but it's really hard for me to get my mind around the idea that society as a whole somehow does not suffer and therefore should not care about or try to prevent bad things happening to individuals.

Where does the line get drawn at the role of government in protecting individuals from themselves? How much power do you want to give your government over you?

Veronica

Personally, quite a lot. For someone else, maybe not so much. I'll leave it at that.

I have no problems with the government protecting us from ourselves. You can flame me for this, but it generally comes down to the old "individualist" vs. "collectivist" mentality in various cultures/countries. I get to see first hand about some of this, as my DH is a director in a US based, but multi-national company. He deals with employee situations all over the world, and believe me, it seems a lot more civilized in other places. Now, I have nothing to complain about, but as LPH says, the right to good health care should be a given.
OK, I said my piece, you can go back to your regularly scheduled conversation.

One thing for certain, when finding a family doctor, as a patient I focus on:

*convenient/accessible location
*covenient hrs.
*good rapport with the doctor: aka someone I can ask all sorts of questions and not get brushed off. And from doctor, who conveys current info.
*choice of another doctor in urgent situation, if my doctor is not immediately available

I have never spent any time or need to, figure out what sort of arrangement there is between doctor and some other party on insurance since I haven't had catastrophic/major illnesses, surgeries yet. But even if I did, it's not going to change for whatever extra out of pocket costs there will be, no matter which doctor I choose on my own in any city in any province. It will always be what the province has set for special drugs by legislation and what additional costs patient will have to pay.

Depending on the income (lower income), disability (if any) and age (ie. seniors), there may be some discounting.


Yes true, regular medical lab tests, pap test, breast cancer screening.. are not out of pocket billed. In fact, the provincial health authorities send notices to all women as a reminder. I know I've lived in Ontario, B.C. and Albera.

Depending on the province, there are some differences for certain services that a resident will have to pay if not covered by an extended employer paid health care benefit..ie ambulance services, certain drugs.

to answer :

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Where does the line get drawn at the role of government in protecting individuals from themselves? How much power do you want to give your government over you?

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I would want govn't to control over ...alot in the areas of health care and public safety. Example: Alberta dentists don't have a much of a fee cap on their services. It's pretty shocking to pay hundreds of dollars just for teeth cleaning and check-up. B.C. and Ontario have stronger controls on capping fees for dentists. Very different.

After working for a provincial regulatory agency on fire safety and haz mat clean-up, then at a major construction engineering project, you really do want govn't regulatory control plus follow-up inspection and fines....to protect people. The private sector will cut corners and it's pretty shocking what can happen quickly... I've seen it.


I expect our Canadian income tax rate might be different (meaning a bit higher) than some of the state income tax state rates which might account again, for some people very resistant to perceived govn't control which they tend to equate to govn't costs.

Not all of our elected officials are all that bright. There's the "Legitimate rape," guy who thinks, "women can shut that whole thing down." Or the guy who thinks if we send too many troops to Guam the island will tip over. I don't want either of those guys deciding what I can and can't do. :D

Veronica

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Originally Posted by Veronica

Or the guy who thinks if we send too many troops to Guam the island will tip over.

Veronica

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whoa, missed that one!

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Originally Posted by Veronica

Or the guy who thinks if we send too many troops to Guam the island will tip over. :D

Veronica

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I missed that one too! Is he on the science committee? You know the group: when the NASA scientists who built and launched the Curiosity rover testified before the science committee one of our esteemed, wise, learned representatives asked them if they saw Armstrong's footprints where they landed. :)

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Originally Posted by Veronica

Not all of our elected officials are all that bright. There's the "Legitimate rape," guy who thinks, "women can shut that whole thing down." Or the guy who thinks if we send too many troops to Guam the island will tip over. I don't want either of those guys deciding what I can and can't do. :D

Veronica

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We always have someone telling us what we can and cannot do. Right now it is primarily insurance companies. Unless government tells them otherwise, they decide who gets insured. They decide the cost. They decide what medical procedures will be covered. They decide what doctors you can see. And because costs are so high, and inflated to give artificial discounts to insurers, you pretty much have to be insured.

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Originally Posted by goldfinch

We always have someone telling us what we can and cannot do. Right now it is primarily insurance companies. Unless government tells them otherwise, they decide who gets insured. They decide the cost. They decide what medical procedures will be covered. They decide what doctors you can see. And because costs are so high, and inflated to give artificial discounts to insurers, you pretty much have to be insured.

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+1 Who's to say that all of the insurance company directors are smarter than the "legitimate rape" and "island tipping" guys.

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Originally Posted by Artista

+1 Who's to say that all of the insurance company directors are smarter than the "legitimate rape" and "island tipping" guys.

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Not to mention that at least we elect the government but not the insurance companies.