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Post by compwalla on Sept 27, 2017 16:07:06 GMT
I just have a very hard time with the government determining how much in profits a private organization can make. I have a very big problem with a private organization deciding who lives and who dies and profiting from the suffering of people. For-profit healthcare -- there is no profit or incentive to keep people healthy or to actually pay when they get sick. Time and again we have seen that, left to their own profiteering devices, businesses will screw people over, ruin the environment, adulterate, poison, and willfully harm people in the pursuit of money. In the absence of regulation, people will be harmed and exploited for profit. Healthcare should simply NOT be a for-profit business. Ever. Healthcare and profits are fundamentally incompatible.
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Post by #notLauren on Sept 27, 2017 16:07:12 GMT
How dare they earn 3.3%
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Post by #notLauren on Sept 27, 2017 16:09:09 GMT
I just have a very hard time with the government determining how much in profits a private organization can make. I have a very big problem with a private organization deciding who lives and who dies and profiting from the suffering of people. For-profit healthcare -- there is no profit or incentive to keep people healthy or to actually pay when they get sick. Time and again we have seen that, left to their own profiteering devices, businesses will screw people over, ruin the environment, adulterate, poison, and willfully harm people in the pursuit of money. In the absence of regulation, people will be harmed and exploited for profit. Healthcare should simply NOT be a for-profit business. Ever. Healthcare and profits are fundamentally incompatible. Show me one government agency that operates in the black and provides the services they were meant to, in the manner they were meant to and I may very well agree with your position. However, the problems that veterans have faced with health care from the VA make me very leery of the idea that our government can actually perform in the manner you believe they will.
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Post by crazy4scraps on Sept 27, 2017 16:23:17 GMT
Insurance is a for profit business and until that changes everyone will continue to see their rates rise. You can go ahead and blame the ACA for the increase, but the insurance companies aren't stupid...they saw an opportunity to raise rates and not have to take accountability...the big, bad wolf, aka Obama, bore the brunt of the blame. Agree! Our rates (self employed) had been going up every year long before the ACA became law. My hope is for congress to finally come together to fix what needs fixing. Same here. Double digit percentage increases EVERY year LONG before ACA was a thing.
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Post by papercrafteradvocate on Sept 27, 2017 16:24:55 GMT
no.. if the state doesn't have strict control over rates.. uncertainty creates higher rates.. they don't know whether there will be the supplemental funds allocated every month.. trump is playing games with it. also discouraging people from signing up.. by dissing it all the time, cut funds to create publicity to sign up... less people on health care.. more expensive for everyone. the individual market is the worse.. and they could fix it in congress. but I don't think it will happen. Not to mention Trump is not honoring the payments to insurance companies--he's clearly stated many times before that he was going to let the ACA implode. Who better than to get that going? Trump. Hold back all those payments and fuck around with what they've been doing in the Congress--tgeyvr created a volatile war on insurance and insurance does not like unpredictability.
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Post by #notLauren on Sept 27, 2017 16:30:42 GMT
Agree! Our rates (self employed) had been going up every year long before the ACA became law. My hope is for congress to finally come together to fix what needs fixing. Same here. Double digit percentage increases EVERY year LONG before ACA was a thing. But pre-ACA, my rates were much lower. So a double digit increase was not nearly as damaging to our finances as it is now. For example: Pre-ACA, my dh and I were paying under $700 per month, very low deductibles and any in-network health care visits required only a co-pay even if we hadn't met the deductible. Now, we pay $1100 per month, have astronomical deductibles, pay out-of-pocket until we reach those deductibles and have less coverage overall..
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Post by lbp on Sept 27, 2017 16:32:33 GMT
I had a huge response typed out but decided against it.
Nothing argued here is going to help the fact that I have to tell employees who have worked here over 20 years that we can no longer afford to pay 1/2 their health insurance and they will need to find it on their own.
We pay a living wage, but still some of our employees make choices that keep them living paycheck to paycheck. Some don't even have bank accounts to be able to pay for the insurance. I shouldn't worry about that, but I do.
Maybe I can have one of the local banks come in and help them set up a checking account and at least take a portion of their check and direct deposit it into that account so that they won't have to worry about how to physically pay their bill.
28% is absurd!
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Post by crazy4scraps on Sept 27, 2017 16:42:56 GMT
Same here. Double digit percentage increases EVERY year LONG before ACA was a thing. But pre-ACA, my rates were much lower. So a double digit increase was not nearly as damaging to our finances as it is now. For example: Pre-ACA, my dh and I were paying under $700 per month, very low deductibles and any in-network health care visits required only a co-pay even if we hadn't met the deductible. Now, we pay $1100 per month, have astronomical deductibles, pay out-of-pocket until we reach those deductibles and have less coverage overall.. Maybe so, but pre-ACA our health care bills (self employed) were still high because we paid it ALL. There was/is no employer match because we ARE the employer. We were also younger then, had no pre-existing conditions, no children and didn't make as much money as we do now, so those increases hurt substantially more while actually paying for less.
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Post by katieanna on Sept 27, 2017 17:28:52 GMT
I've shared before but I will again. We got on Christian Healthcare Ministries and it's literally been a godsend. We pay $300/month for both of us, we spend $40 extra a quarter and get unlimited coverage - including some per-existing for the first 3 years then full coverage. Our share is $500 per event. If we talk the bill down, we don't even have to pay the $500. It DOES work, I put in a claim and have been reimbursed. AND, it met the ACA requirements so no penalties. I haven't read the rest of this thread so I don't know if anyone replied to this post or not. I have CHM, too. I switched from BC/BS the first of the year when I found out that my insurance was going up 70% in 2017. It's definitely a godsend, extremely affordable. BUT - it is NOT an insurance plan. IOW, it doesn't work like regular insurance. You don't have an insurance ID card to show your provider when you receive care. You let the provider know that you are self-pay and try to get a discounted rate, if you're able. After you pay for your medical treatment(s), you send in your claim and then you are reimbursed. Still...it's much better than the astronomical healthcare plans that are out there. I'm shocked when I hear the prices people are paying just to say they have insurance.
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freebird
Drama Llama
'cause I'm free as a bird now
Posts: 6,927
Jun 25, 2014 20:06:48 GMT
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Post by freebird on Sept 27, 2017 17:36:08 GMT
I've shared before but I will again. We got on Christian Healthcare Ministries and it's literally been a godsend. We pay $300/month for both of us, we spend $40 extra a quarter and get unlimited coverage - including some per-existing for the first 3 years then full coverage. Our share is $500 per event. If we talk the bill down, we don't even have to pay the $500. It DOES work, I put in a claim and have been reimbursed. AND, it met the ACA requirements so no penalties. Can I ask what state you live in? Many states limit who can provide health care in that state. I'm in Missouri. States limit Health insurance? is that what you meant to say? It's not insurance, it's a health share, there's a big difference. You can also pick any healthcare provider you want, there's no requirements or groups you have to be in.
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Post by gale w on Sept 27, 2017 18:03:04 GMT
Insurance is a for profit business and until that changes everyone will continue to see their rates rise. You can go ahead and blame the ACA for the increase, but the insurance companies aren't stupid...they saw an opportunity to raise rates and not have to take accountability...the big, bad wolf, aka Obama, bore the brunt of the blame. Agree! Our rates (self employed) had been going up every year long before the ACA became law. My hope is for congress to finally come together to fix what needs fixing. Ours did too. They went from 500 something to 600, then to 680 (an example-I don't know the exact amount but close to that), then 750. Then it suddenly jumped to 1100 post ACA. Then 1480 which is where ours is now (with a 7K x2 deductible and 60/40 copay after it's been met). So yes, it did go up every year but not like it did after the ACA went into effect. Now we're stuck with only ONE company selling in our state next year. I'm terrified to shop for policies in the next couple months.
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Post by compwalla on Sept 27, 2017 18:18:41 GMT
Show me one government agency that operates in the black and provides the services they were meant to, in the manner they were meant to and I may very well agree with your position. However, the problems that veterans have faced with health care from the VA make me very leery of the idea that our government can actually perform in the manner you believe they will. In the black? What does that even mean? Like paying for themselves? That's not what taxpayer funded services do. How do fire departments or police departments operate "in the black?" Civil asset forfeiture? Fuck that noise. Public services cannot operate "in the black" because they are publicly funded. Government != Business and measuring their relative effectiveness by the same standards is simply not possible. And I have personally been the beneficiary of government run health care nearly my entire life. It is an amazing system where decisions on what care I need have been made by my healthcare providers without interference from an insurance company. If a military provider said I needed it, I got it. It is not a perfect system (because there isn't a perfect system) but the ease and peace of knowing that care or medication I needed would not be denied if my doctors felt it was needed is something every American should enjoy. There are many people who bristle at the way DoD handles healthcare but they are very good at it. They push you like MAD to make healthy choices, to eat right, to exercise, to prevent disease because when the system is paying for you cradle to grave, the incentive is there to keep you from getting sick in the first place. There is no profit for DoD in treating diabetes with expensive meds. They don't want to pay for that so the best way to keep from paying is not denying coverage but by making sure you never get diabetes in the first place. They won't pay for weight loss surgery until you've made the proper effort on your own to eat a healthier diet and exercise. They don't blithely prescribe antibiotics or pain killers or recommend surgery before physical therapy. They make vaccinations compulsory for most people. (Like you can't get cleared for orders unless your whole family is vaccinated) This is very different to what civilian healthcare is like where a lot of care is patient-driven and docs often respond to patient demand. Pediatricians say the parents get mad when they don't prescribe antibiotics for every illness. That's not how the military healthcare system rolls. I have had my issues with Tricare but every problem I've ever had with them has stemmed from the Tricare contractor dicking me around in the same way BCBS and United Healthcare dick people around. It's always an insurance company problem, not a health care problem. For example, Tricare required you to see your primary care doctor for a referral to OB when you got pregnant. So I went to my PCM who had me do a pregnancy test which was positive. Humana Military refused to pay for that PCM office visit because my primary diagnosis was "pregnancy" and this was considered OB care and I couldn't get OB care paid for without a referral. WTF? If I had been closer to a bigger military treatment facility, the scenario would have been 1) make an appointment with flight medicine 2) take the pregnancy test 3) go down the hall and make my first OB appointment. The End. A single stream of healthcare, single payer, would have made things so much easier. Nothing in the world can convince me that for-profit healthcare is good or makes sense or that any form of government health care will be worse than the shitshow we have now.
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scrappinmama
Pearl Clutcher
Posts: 4,894
Jun 26, 2014 12:54:09 GMT
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Post by scrappinmama on Sept 27, 2017 18:32:47 GMT
My rates have been going up before Obama was even elected. I remember back in the 90's, we used to have choice between multiple HMO and PPO plans. Then it became a choice between HMO and a couple PPO plans. Then just a choice between 2 PPO plans, each year prices going up. This was all before Obamacare. Now we don't even have a choice at work. It's one high deductible plan. People are going broke trying to cover their medical expenses. How is this even a problem in our country? It's ridiculous that we can't solve this problem.
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Post by cmpeter on Sept 27, 2017 18:43:00 GMT
That's crazy. I'm sorry you are dealing with that.
I track premiums that I pay for our insurance. It averages 4% increase per year. We have a high deductible HSA plan. Our deductible is currently $2,500, it was $2K 5 years ago when we started high deductible. Our employer contributes $1,100 to my HSA every Jan to help off set that and I max out my contributions every month. I work for a large (60K) company and benefits have always been a priority for recruitment and retention.
I'd be interested in hearing how our rates compare to other large employers. Is it our size that keeps benfits reasonable? I pay $260 a month for my plan.
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Post by LisaDV on Sept 27, 2017 18:48:19 GMT
Family policy here at about 1800/mo with dental and vision. Dental doesn't include the orthodontist that we just started utilizing for ds. We just went to the mayo for dd at the end of Aug and have to go back in a couple of weeks for more testing. They are in network so the bills will get adjusted, but insurance doesn't pay until we hit the 14,000 out of pocket max. DH is self employed. I'll have to eat the next increase until dd is back to 100%. But dang. This is not good. We need an insurance overhaul.
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inkedup
Pearl Clutcher
Posts: 4,837
Jun 26, 2014 5:00:26 GMT
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Post by inkedup on Sept 27, 2017 18:52:43 GMT
Any time health care and health care reform are discussed by the media and our politicians, a huge elephant in the room is left unaddressed: the inordinate amount of influence that pharmaceutical and insurance lobbies carry in our political system.
Ridiculous insurance increases happened long before Obama was even in office. I was the VP of personnel for a large company for a few years, starting in 2001. The company employed a few thousand people in several different states, as well as in Canada and Mexico. Our rates were increased every. single. year., in spite of the fact that our employee population was, on average, young and healthy. In 2004, due to some unusual circumstances in our group, our premiums shot up 40-something percent. By the time I left that job in 2010, we paid about 400% more for our coverage than when I started working there. It cost nearly $500 to insure a single, young, healthy employee whose insurance cost about $100 a month at the beginning of the decade.
While we argue about Obamacare and who is to blame, the insurance and pharma companies cheer for whatever "reform" is offered to us. Think about that. Real reform would take the profit out of medicine and neither of these enormous lobbies would benefit from that. Insurance companies aren't, generally, interested in keeping people healthy. There's not a lot of profit in that. And you can't sell drugs to healthy people.
Real reform, IMO, starts with campaign finance reform. Get big money out of politics. We know that our elected officials are basically bought and sold by lobbies with more money than you or I could ever dream of, and yet we allow this to continue.
Before we will see real change on ANY level in this country, we need to work together to overturn Citizens United and to reform campaign finance laws.
Make our politicians work for US again.
Democrats and Republicans have both sold the US Taxpayer to the highest bidder, and they continue to do so while we fight over which side is more right.
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Post by compwalla on Sept 27, 2017 19:13:49 GMT
That's crazy. I'm sorry you are dealing with that. I track premiums that I pay for our insurance. It averages 4% increase per year. We have a high deductible HSA plan. Our deductible is currently $2,500, it was $2K 5 years ago when we started high deductible. Our employer contributes $1,100 to my HSA every Jan to help off set that and I max out my contributions every month. I work for a large (60K) company and benefits have always been a priority for recruitment and retention. I'd be interested in hearing how our rates compare to other large employers. Is it our size that keeps benfits reasonable? I pay $260 a month for my plan. We compare every year to see whose plan is more affordable. This year for the first time it was my husband's. We pay $2313 per year to cover the whole family. Our family deductible is $4000. He works for the post office and is on the union health plan. Last year my company's cheapest health plan cost less than the union but the deductible is much higher, $10,000. That one is also bundled with an HSA and my company puts $1100 a year in there. I don't really care about the deductible because we have Tricare as our secondary payer and the deductible for Tricare is $300 for the whole family. We pick the family plan based on the network and total cost. I work for a fortune 500 and I do think that is one reason our plans are pretty good. If we cared about deductible and only had one payer, both the union and my company have more robust plans that cost more. The fancy plan with the union costs $3345 a year and many things are cheaper or have a smaller co-insurance. Like maternity care on the fancy plan is covered at 100% and so is all lab work. And the deductible is much smaller, broken down by service until a total of 4k is reached. So surgery is 15% cost share, $300 deductible. If we didn't have Tricare, we'd probably be on the fancy plan.
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scrappinghappy
Pearl Clutcher
“I’m late, I’m late for a very important date. No time to say “Hello.” Goodbye. I’m late...."
Posts: 4,306
Jun 26, 2014 19:30:06 GMT
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Post by scrappinghappy on Sept 27, 2017 19:16:09 GMT
Insurance is a for profit business and until that changes everyone will continue to see their rates rise. You can go ahead and blame the ACA for the increase, but the insurance companies aren't stupid...they saw an opportunity to raise rates and not have to take accountability...the big, bad wolf, aka Obama, bore the brunt of the blame. They raised their rates because they were required to include high risk people with pre-existing conditions. That is a direct result of Obamacare. They payouts substantially increased over what they had been previously; hence the rates increased. But their profits did not decrease - greed all around
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Deleted
Posts: 0
Jun 18, 2024 14:59:24 GMT
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Post by Deleted on Sept 27, 2017 19:17:22 GMT
Insurance is a for profit business and until that changes everyone will continue to see their rates rise. You can go ahead and blame the ACA for the increase, but the insurance companies aren't stupid...they saw an opportunity to raise rates and not have to take accountability...the big, bad wolf, aka Obama, bore the brunt of the blame. They raised their rates because they were required to include high risk people with pre-existing conditions. That is a direct result of Obamacare. They payouts substantially increased over what they had been previously; hence the rates increased. And the younger (healthier) people did not sign up and pay into the system. Took the penalty instead because it was affordable.
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PLurker
Prolific Pea
Posts: 9,752
Location: Behind the Cheddar Curtain
Jun 28, 2014 3:48:49 GMT
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Post by PLurker on Sept 27, 2017 19:51:13 GMT
Insurance is a for profit business and until that changes everyone will continue to see their rates rise. You can go ahead and blame the ACA for the increase, but the insurance companies aren't stupid...they saw an opportunity to raise rates and not have to take accountability...the big, bad wolf, aka Obama, bore the brunt of the blame. Not going to pretend to know the answers, but my thoughts came round to insurance companies and 'they can so they will'. And they will blame what ever party is in power at the time. Which is why if they repeal and replace ACA they should slow down and do it right. Close all the questionable loopholes. aka "do it right"
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Post by ruralgirl on Sept 27, 2017 20:54:12 GMT
First I want to say, I am happy that people with preexisting conditions can't be denied care or charged higher premiums because of their condition. That should never happen and that is wrong IMO. I'm not a Trump or Obama fanatic so my opinion and situation is not because of my love or hate for either of them.
With that being said, other than what I mentioned above, the ACA and our current healthcare situation has absolutely got to change.
Here is an actual example of how negatively the ACA has impacted my family. I am self-employed and my husband works at a small company that does not provide any benefits (no healthcare, no retirement, nothing other than pay). That means 100% of those expenses are on us. I don't think a lot of people understand just how much these insane increases and high deductibles are affecting families because they have an employer contributing to these costs or maybe they qualify for a subsidy, or maybe they make so much that paying $16K+ for insurance a year is not an issue but that is not the case for my family. Also, that $16,000+ is for the bottom-level healthcare plan with a $7,500 deductible. So every time we go to the doctor, just keep adding to that $16K. No vision coverage and I currently need it but can't afford it. Before the ACA, being self-employed I could shop around for insurance and had a low-deductible, low-cost plan. I think the biggest yearly increase was around $40/mth. My insurance has gone up over $800/mth in a 2-year span since ACA and there are no options to shop around. So I basically now get to take my income and pay for insurance that I can't use and pray nothing happens that I need to use it, pay my taxes (self-employed people pay the full 12.5% Social Security & Medicare whereas employees only pay 6%), and be left with not much else. I feel like no one cares about people in this situation. I've worked so hard to do things right, work my way up, we have a practical mortgage, used cars, and here I am paying more than a mortgage payment for health insurance I don't want to use. I need to save for my retirement, I want to be able to help my 2 kids that are in college, but I have no extra money to save for anything because of ridiculous health insurance premiums that put me behind each month. Still waiting to hear what the increase for next year will year. Very frustrating. I can't believe they don't have enough smart people out there who can come up with a solution but it seems like they really don't care. Our healthcare situation has just become a Trump vs. Obama issue. I guess it's hard to be passionate about something unless it actually affects you? Certainly none of the people in the government or who should be working to come up with a solution are affected. Their insurance is paid for and they probably are well paid on top of their great benefit package.
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Post by gypsymama on Sept 27, 2017 21:28:00 GMT
i know i've said this before, but with my full time teacher aide pay and stbxdh's truck driver pay, in NY, we qualified for totally free fidelis... no copay no deductible, $1 for meds (went to healthcare.gov and it sent me to nystatofhealth). i'm not going to argue and i'm not putting any more info out there, just know there's a lot of options.
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Post by papercrafteradvocate on Sept 27, 2017 21:31:33 GMT
No one will every convince me that the insurance companies are not in this for themselves and will keep increasing BECAUSE THEY CAN. Congress keeps them "safe". Lobbyists, bought and paid politicians.
Insurance companies FIRST AND FOREMOST have a responsibility to their shareholders and investors.
Secondly, to their CEO's and employees.
Then to their lobbyists and politicians.
They don't give a flying fuck about those who NEED healthcare--they are the liability.
So--it's not the ACA that raised prices, (or government plans before that). It's the insurance companies needing to be profitable for their people.
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Post by hop2 on Sept 27, 2017 23:01:05 GMT
Do we limit how much people can leave to their heirs? ‘We’ or ‘They’ already do that As someone who has been screwed by the government in a rather modest inheritance they definitely do. If you don’t believe me ask family farmers who have farmed for generations how that works out anymore when your family inherits the farm. It’s one of the biggest reasons family farms have dissapeared to developers in the last 20 years because no one has cash to pay the taxes. Same issue for a single proprietor family mom& pop business. That’s why my husbands family no longer has a dry cleaners or a candy store in Brooklyn. The inheritance tax was more than annual income so they were forced to liquidate to pay the taxes when my husbands grandparents died. ( AND that’s without owning the property! Just the equipment & the business )
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Post by SweetieBugs on Sept 27, 2017 23:17:46 GMT
Our rates, coverage for a family, are going down by 35% next year. We have Blue Shield in Northern California and my DH is a state employee. We had been paying 7 to 15% increases over the past several years. This decrease is a huge surprise.
I should edit to add that the base monthly premium is $1956 which is a lot but the state provides an allowance, based on my DH's years of service (and bargaining unit) of $1540 so the end result is very affordable. Another reason why California's public employees costs so much.
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Post by genny on Sept 27, 2017 23:39:25 GMT
I've shared before but I will again. We got on Christian Healthcare Ministries and it's literally been a godsend. We pay $300/month for both of us, we spend $40 extra a quarter and get unlimited coverage - including some per-existing for the first 3 years then full coverage. Our share is $500 per event. If we talk the bill down, we don't even have to pay the $500. It DOES work, I put in a claim and have been reimbursed. AND, it met the ACA requirements so no penalties. Thanks for sharing. I will be looking into this, we are self employed as well and our insurance is killing us. The options through the marketplace in our state and county have dwindled to nothing - we literally have 2 options and neither are very good. The insurance we have now just sucks - there isn't a doctor closer than 2 hours away that I can see for my neck. When my son ruptured his ear drum this summer he had to drive an hour and a half to see an ENT! Ugh. That said, they have paid well and on time, etc and have some good things about them, but I need to be able to see a dr in town, especially if I have to have surgery on this neck thing.
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scrappinmama
Pearl Clutcher
Posts: 4,894
Jun 26, 2014 12:54:09 GMT
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Post by scrappinmama on Sept 27, 2017 23:52:24 GMT
That's crazy. I'm sorry you are dealing with that. I track premiums that I pay for our insurance. It averages 4% increase per year. We have a high deductible HSA plan. Our deductible is currently $2,500, it was $2K 5 years ago when we started high deductible. Our employer contributes $1,100 to my HSA every Jan to help off set that and I max out my contributions every month. I work for a large (60K) company and benefits have always been a priority for recruitment and retention. I'd be interested in hearing how our rates compare to other large employers. Is it our size that keeps benfits reasonable? I pay $260 a month for my plan. We have the same deductible as you. We have to meet the deductible before anything is covered, including prescriptions. Employer contributes $1000 to our HSA. I think we pay $700 a month for medical, dental and vision. Two years ago we had a lower deductible and prescriptions were covered. That's not an option anymore. Just the high deductible one. Price increased slightly, but we get worse coverage. 2 of us are on daily medication, so the prescription prices really hurt. We had to put more on the HSA to cover them.
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Deleted
Posts: 0
Jun 18, 2024 14:59:24 GMT
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Post by Deleted on Sept 28, 2017 0:17:35 GMT
We need single-payer. non-profit, non-marketing, non-duplicative health care.
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Post by lisae on Sept 28, 2017 0:18:41 GMT
I usually receive my dreaded health insurance letter in October and as has already been said, rates were going up far more than anything else long before the ACA. Still it is ridiculously high. I expect to be at $1000 per month for ONE person for next year. I live in one of those counties that only has one insurer though I really don't think that makes too much difference.
The real issue is the underlying cost of healthcare and no one wants to tackle a problem so big. I also think because Medicare pays so little of what hospitals and doctors charge that the doctors and hospitals charge the rest of us and our insurers more to make up the difference.
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Post by annie on Sept 28, 2017 1:38:50 GMT
I've shared my story here before, but suffice it to say, medical insurance and its high costs decimated my lower middle class family. We could only afford high deductible insurance, took a chance on it because we've always been quite healthy, and then bam - everything seemed to go wrong in one bad year. We're in major debt now from medical bills and there is no end in sight. I could cry just typing it out again.
Fuck the insurance companies and all those politicians who don't give a shit about ordinary people just trying to survive. I am as frugal as can be, don't have cable, don't take trips, etc... I don't need to be rich, I just want to not panic nearly every day about how I'm going to pay my bills, largely thanks to healthcare costs and healthcare debt.
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