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  1. #16
    Join Date
    Jul 2005
    Location
    Illinois
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    3,853

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    Holy crap, I've got it made and didn't realize it! I pay $52 a month for an HMO with $20 office visits, $10/$26/$45 prescription co-pays, and a $200 fee if I use the emergency room.

    Electra Townie 7D

  2. #17
    Join Date
    Nov 2002
    Location
    the dry side
    Posts
    4,367
    Um, yeah. And you were wondering why people are talking about the cost of health care?
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  3. #18
    Join Date
    Feb 2005
    Location
    Concord, MA
    Posts
    13,394
    I know I'm lucky. In addition to the above, we have unlimited mental health benefits and prescriptions are 20.00, 30.00 or 50.00. ER visits are 200.00, but that just went up from 50.00.
    Our task will be to find similar coverage when DH stops working. We will be able to afford to pay a good amount, but we are more concerned with the continuity of coverage. DH takes 4 prescriptions, and even though he is incredibly healthy since his surgery, he cannot stop taking them. My Prolia is also covered, but I did have to go through some weird mail order pharmacy that Blue Cross insists I use, where incredibly stupid people with really thick regional accents constantly barrage me with phone calls. I now have it arranged that they call my doctor directly to deal with shipping the injection to her.
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  4. #19
    Join Date
    Apr 2011
    Posts
    133
    Well, as a substitute teacher, I don't get benefits at all, so I pay out of pocket for my insurance.
    The system is preposterous. I was looking into dental and you can't really get individual dental insurance. You have to be on a group plan to get some type of coverage. It needs an overhaul system-wide. Teachers aren't the only people getting the short end of the stick.
    Jen

  5. #20
    Join Date
    Jul 2012
    Location
    Plantation, FL
    Posts
    45
    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.
    --2012 Trek Lexa with Terry butterfly saddle.

  6. #21
    Join Date
    Feb 2005
    Location
    Concord, MA
    Posts
    13,394
    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.
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  7. #22
    Join Date
    Sep 2007
    Location
    Uncanny Valley
    Posts
    14,501
    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.
    Last edited by OakLeaf; 01-02-2013 at 04:32 AM.
    Speed comes from what you put behind you. - Judi Ketteler

  8. #23
    Join Date
    Sep 2006
    Location
    Oslo, Norway
    Posts
    4,066
    I'm finding this whole thread rather distressing. I wish you could all move here.
    Winter riding is much less about badassery and much more about bundle-uppery. - malkin

    1995 Kona Cinder Cone commuterFrankenbike/Selle Italia SLR Lady Gel Flow
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  9. #24
    Join Date
    Mar 2008
    Posts
    2,704
    This thread reminds me of why I still work where I do and why I'll be here for at least another 10 years.

  10. #25
    Join Date
    Oct 2004
    Location
    Arlington, VA
    Posts
    1,993
    Quote Originally Posted by Becky View Post
    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.

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  11. #26
    Join Date
    Nov 2002
    Location
    the dry side
    Posts
    4,367

    New Teaching Contract

    I'm not resentful. I accept our options and choices, and am grateful that we can afford to fill the holes ourselves. I do think the system is totally f-ed up; the disparities and inefficiencies are down right terrifying. I think it's important for everyone to be aware of what is happening out there. I know this is sliding into the dreaded political territory.
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  12. #27
    Join Date
    Feb 2005
    Location
    Concord, MA
    Posts
    13,394
    I just feel lucky. I am not resentful. But, I don't know how to fix the problem any differently. I guess I am also lucky that I live in a state where 98-99% of the people have coverage. What I have found is that there are some people, usually in a "low risk" category, as far as their health goes, who have chosen to not get insurance through the Mass Health Connector and they basically just pray they don't get sick. These are people who are working, usually in their 20s-30s, in no benefits jobs. They don't want to pay for the 200.00-300.00 a month for a moderate coverage plan. They can afford it, but it eats into their disposable income. My son was in this position. We insisted he pay for insurance, and then after 3 years, he let it lapse. For 2 years, he had no coverage and he did have 2 medical things where he ended up paying a good amount out of his pocket. These weren't life threatening things, but, you can see how it could have easily snowballed. Believe me, benefits were a very big part of his decisions in taking the next job, and the one he just got in November. His wife's employer offers terrible benefits and she finally went on his plan. I am not sure what her reasoning was not to do it in the first place, but they are starting to think about maybe having kids and she's been going to the doctor, doing proactive things, now that she has insurance.
    This shouldn't vary so much from state to state, but I am not going to get into the political aspect of it.
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  13. #28
    Join Date
    Jul 2005
    Location
    Illinois
    Posts
    3,853
    Monetarily it seems to be a toss up in my life, I have typically worked jobs with excellent benefits but very poor pay. Someone mentioned $1200 a month for healthcare? That is well more than half of my pay for a month.

    Seems like "good benefits" come with an indentured servant component, even if I wanted to leave my job and try my luck elsewhere I can't because of the cost of healthcare.

    Don't you gals wonder how many wonderful entrepreneurial ideas out there are withering on the vine,] because the person with idea can't afford to risk the leap into non insured status?

    Electra Townie 7D

  14. #29
    Join Date
    Oct 2002
    Location
    San Francisco Bay Area
    Posts
    9,324
    I started this thread to kind of work for myself how I felt about this new contract since I have to vote on it. Much of my resentment is towards my union - they insist teachers at a site all be treated the same, regardless of performance. We have years of testing data to look at and some teachers just stink at their jobs. They continue to teach as if we have the clientele we had 15 years ago and refuse to adapt. It's likely that because of the school's declining test scores, we're going to start receiving the "assistance" of coaches which means an increase in meetings and paperwork for all of us, including the few teachers whose test scores are not declining. Yet this same union thinks this variance in benefit compensation is fine. And yes, I do resent those teachers who refuse to adapt and whine every time we have any sort of staff development designed to help them becoming better at engaging their students.

    We'll never get anything into the contract about teacher performance unfortunately.

    Since the change in benefit compensation really doesn't affect me, I've come to the conclusion to not let it affect my voting decision. I appreciate hearing from all of you about how important good health insurance really is. I've had the good fortune to have no significant health issues and since I'm on Thom's plan, I never really paid attention to how much we pay.

    Veronica
    Last edited by Veronica; 01-02-2013 at 12:26 PM.
    Discipline is remembering what you want.


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  15. #30
    Join Date
    Feb 2005
    Location
    Concord, MA
    Posts
    13,394
    Veronica, I felt exactly the same way. I ended up going from a right to work state where the union was just something I could say no to (and I was also part of a merit pay program) to a highly unionized and politicized teaching force. Usually, I am a true blue Massachusetts liberal, but these teachers sickened me for the same reasons you state. They just hated the kids, couldn't deal with working with kids from different cultures and viewed anything innovative as "extra." Well, they mostly left or retired and I stayed. When I left in 2007, I was one of the oldest teachers in the school, and I had only been there 9 years. What scared me was that a few of the younger teachers were taking up the "cause." I would have gladly accepted the chance to have my pay based on my performance. My kids' test scores were always the highest in grade 7 English. What other professional job has the same pay for everyone, irregardless of their performance?
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