Thread Drift

[rebeccaC]

This discussion makes me really thankful Ellie chose and pays for Kaiser Permanente coverage (a non-profit) for all employees and families. I have a $20 copay for both prescriptions and each office visit as needed even specialists. $0 for preventive services. I do what’s needed to stay healthy and fit so I don’t use it much but a couple of other employees and their families do need it and are very thankful for having it. Ellie knows it also makes for less stressed and more productive employees and feels it's a good investment in her employees.

Since California set up its own ACA exchange, prices for that are also lower here than the states that for political reasons didn’t.

i've never understood the making an insurance profit off someone being ill.....universal health care ftw

[ny biker]

i've never understood the making an insurance profit off someone being ill.....universal health care ftw

Yes! Totally agree.

Our insurance plan is allowed to violate some ACA provisions, apparently. Old coverage limitations are grandfathered. Next year's coverage will be worse, with more copays and deductibles. And it's very hard to find out in advance if something will be covered.

[Catrin]

I had an FSA before moving to our high-deductible plan with HSA account. For the FSA they were required to have proof for every expenditure by the IRS regardless of how obvious an allowed expense. I certainly prefer the HSA account over the FSA, though moving to the CDHP plan itself certainly took some adjusting that first year. All preventative services are covered however, not just one. I've never heard of that NY Biker, so sorry to hear they've been able to get away with that. In the end, for us, they made our CDHP more attractive financially to us than the traditional HMO.

[Crankin]

My insurance (Blue Cross PPO) is like what Rebecca discussed, except it is not an HMO, like Kaiser. I don't have to get referrals for anything, no limits of on things like PT, and reasonable co-pays (20.00-50.00) for various services and drugs. The cost to us has gone up over the years, but, still quite reasonable compared to what i hear from others. Employees at my work have a choice of the same plan (we get it through DH's work), but pay a lot more money for their premiums.
I would never buy one of the high deductible plans. I know they are cheaper premiums, but good health care is pretty important to me. I've had enough things, that while not life threatening, could have been costly if I hadn't had this insurance. My insurance paid for one of my kid's experimental surgery to cure his Raynaud's, 12 years ago, 2 cardiac caths for DH, and a few MRIs/CT scans for me, all for 20.00 co-pays. No complaining here.

[Catrin]

Glad it's worked well for you Crankin. My employer is in the process of phasing out the traditional HMO, and new employees do not have that option. They have raised the premiums, deductibles, and co-pays so much for the HMO that there is no difference in the out of pocket limit for either plan and, indeed, it's slightly higher for HMO plans. We USED to have an HMO like you describe, but that ended in 2008 or so. Even under the HMO the employee is responsible for a sizeable percentage of tests, scans, and surgeries. I try not to remember what our insurance USED to be like, that doesn't do me any good.

[Crankin]

I guess it is really up to employers (yes, I know this sucks) to decide how important wellness and keeping employees healthy is, without breaking the bank. There is no deductible on my plan, or any of the others offered by DH's or my employer. The difference is, that at my work employees do have a choice of a plan where you have to use certain doctors and you can't go to any of the big name hospitals in Boston. While I don't run down there, like some of my friends do, I want to have the choice, and it is worth it to me, to pay for this. When I was sick a few years ago, I went to Brigham and Woman's for a second and third opinion from 2 rheumatologists and a neurologist. While it probably wasn't necessary to that extent, the advice they gave me stopped me from any more rounds of searching. I have recommended one of the doctors to several people, including my own patients.
Of course, like California, Massachusetts has several things that are mandated to be paid for, which I am supremely thankful for.

[Pax]

When we moved to FL we had to switch insurance from our usual State of Illinois HMO to an Open Access plan they offer for people living/working out of state. We went from fantastic coverage with livable deductions to bizarre coverage (drive an hour to Orlando,to see the covered ortho instead of the one who's highly rated and a block from our house), and super high co-pays.