New Teaching Contract

[girlontheroad]

I am self employed and got to learn all this last year when my cobra coverage ran out. Crankin one thing that saved me was that my state requires if you can't get coverage elsewhere which I couldn't because of pure existing conditions at the time, and you are just coming off an employers plan the company has to offer you one to two plans that are comparable to your previous coverage. The key is not to let it lapse. That allowed me to have similar coverage when other options were not available to me. It currently costs me $1200 a month but the benefits are good. A very nice person told me about this requirement on the phone when they told me they couldn't cover me or I would have been in trouble. The thing that floors me about insurance is the difference in negotiated costs it gives you. I just had major surgery that the hospital charged $60,000 for and which they accepted about 7,000 for with the negotiated rates. Had I not had insurance I would owe the whole $60,000. As opposed to my max out of pocket of $6000. And that was just the hospital bill. My insurance premiums more than paid for themselves this year even with the increase but the whole thing seems like a scam when you look at what gets paid. And I realize how fortunate I am to be able to pay the premiums.

[Crankin]

Well, our situation isn't really related to Cobra; more retirement that may occur before one or both of us are eligible for Medicare and various Medicare supplements. In all reality, we are pretty sure we can work out a deal with the company to continue the benefits, if we pay a larger portion and DH would be willing to stay on in a consultant role. The company doesn't have very many employees in their fifties (all younger), and the CEO is the same age as my DH and he can't fathom why people stop working.

[OakLeaf]

You know what's most distressing to me about this thread?

The expressed and implied resentment toward others who have barely adequate coverage.

What Irulan described as "Cadillac" coverage (a metaphor that was devised to set working stiffs against each other) is barely adequate. It's more like a Nissan Versa with 100,000 miles on it. It'll get most people where they need to go most of the time, but if you put any serious demands on it, you'll find it isn't enough.

Take my coverage, just for example. By today's standards, it's good coverage. I might consider a higher deductible lower coverage plan if it were available to me, but because I have a couple of minor but chronic pre-existing condition, I'm stuck with the conversion plan that I transferred from COBRA in the early 1990s. I'm not insurable on the open market, and I'm not eligible for open enrollment unless I go uninsured for six months, and I'm not ready to take that risk. I'm aware that I'm very lucky to be able to afford EITHER my insurance premiums OR the medical care I need, so go ahead and resent me for my good luck. But I want to illustrate what so-called "Cadillac" coverage really is.

Just take physical therapy - something lots of us have been through and many more will need. My plan gives me 20 sessions. That's plenty for someone who's working out a bit of plantar fasciitis or a back strain. Have a stroke or get in a serious accident? Not so much. Remember that so-called "out of pocket maximums" apply only to benefits that are covered in the first place. So, if you need months of physical therapy, after the first 20 sessions they're all out of your pocket. My deductible is $500, my out of pocket maximum is $2000, and I wound up paying over $10,000 out of pocket last year ... yep, the equivalent of almost four months' premiums. And that's with relatively minor injuries, no hospitalization, no surgery, no scans outside of a few plain films, no super expensive medications.

Also: manual manipulation counts as "physical therapy" and it's subject to the session limit regardless of whether it's performed by a PT and billed as PT, or performed by a DO and billed as OMM. But a hand injury that's normally rehabbed by an occupational therapist with stretching, strengthening and massage - the same modalities a PT would use - is not covered at all, because it's OT.

Dental? (got my sixth crown this year) Zilch. Vision? (thank goodness my vision at least is uncomplicated and I'm just wearing single vision contacts) No coverage there either. Mental health coverage? That depends on the diagnosis (talk about crazy). Acupuncture? Forget about it. But it covers my prescriptions and my allergy shots, covers the emergency room when I need it. So that's considered "Cadillac" coverage.

That's what I pay, I don't have a choice of insurance, but I'm lucky enough to be able to afford it. Think about how most people would be able to pay for insurance. Think about what someone who's really sick or badly hurt would have to pay.

Then you start to understand why there are constantly fundraisers for people to cover their medical expenses ... let alone their living expenses while their ability to work is reduced or nonexistent. And you really understand whose interests it serves to have us resenting each other, rather than the ones who are profiting from all this.

[lph]

I'm finding this whole thread rather distressing. I wish you could all move here.

[Becky]

This thread reminds me of why I still work where I do and why I'll be here for at least another 10 years.

[Selkie]

This thread reminds me of why I still work where I do and why I'll be here for at least another 10 years.

Me, too, but I'm down to 73 months and 4 days until I can retire at full pension (but who's counting?).

I hope that the health insurance reforms that are going to be implemented have a positive impact on the system. I'm ashamed to admit that I haven't paid too much attention to it because I am blessed to have a good plan. That said, I pay a good bit in premiums and every year, my premiums increase (while my salary has been frozen for the past two years and looks like it will be for 2013---another year without a COLA).

Early in my adulthood, I had no health insurance and was out of pocket for everything. I will be forever indebted to Planned Parenthood, which provided me healthcare when I otherwise would have been without.