<p>How much is insulin a year? Depends on the dosage? </p>
<p>Somebody I grew up with doesnt have squat. Seemed to move from one friend’s house to another. Didnt have health insurance. Said she couldnt afford insulin.</p>
<p>Well…she went into a diabetc coma. Cost of care this year is over 1 million bucks.</p>
<p>Lerkin, It is a small business plan.</p>
<p>dstark, Our broker came up with 9 options to choose from. One we deleted right away because Stony Brook Hospital doesn’t accept it. Others we deleted because they covered 80% and as we all know, a 20% gap in medical care can bankrupt a person. Imagine one major thing happening and the 20% gap costs associated with it. One we deleted because the deductible was too high before coverage kicked in. It sort of boiled down to the business getting hit with the increase or us (and our employees) having to pay out of pocket for the high deductibles. Next time, we may have to go with the high deductible.</p>
<p>Great commentary about the union complaint in Forbes. If it’s allowed , here’s the link <a href=“http://www.forbes.com/sites/theapothecary/2013/07/15/labor-leaders-obamacare-will-shatter-their-health-benefits-cause-nightmare-scenarios/[/url]”>http://www.forbes.com/sites/theapothecary/2013/07/15/labor-leaders-obamacare-will-shatter-their-health-benefits-cause-nightmare-scenarios/</a></p>
<p>The healthcare choice challenge is in reading the small print and projecting scenarios.</p>
<p>dstark,</p>
<p>I agree there are many people who do not have health insurance because they cannot afford. But there are also many people who do not have it, because they choose not to have it. They think they don’t need it … until they do.</p>
<p>I see it every day with guys that work for our business. One guy was the highest paid employee in my business (he was pulling more then guaranteed salary for one of the partners). Yet, he did not bother to enroll into health insurance until it he broke his leg. He was really upset that his new health insurance did not cover his incident.</p>
<p>Then there is another guy, who every year when the insurance costs are increased complains that he buys health insurance and almost never uses. I think there is a fundamental divide between the views what health insurance is for. I think it should not be used for minor things like cold, it should be designed for major stuff like cancer. But I think I am in minority regarding this thinking.</p>
<p>NY,</p>
<p>I understand that, but are you sure that you share a risk pool with other small businesses like yours?</p>
<p>NYSmile, I agree about gaps. There wasnt an out of pocket cap?</p>
<p>One thing about these policies is they are recalculated every year by the insurance companies. My daughter used to work for a health insurance company. Even if you are in a small group plan, if a person or two comes up with an illness, the costs to everybody in the group can go up. The larger the plan, the less likely a couple of people are going to affect somenody’s rates. </p>
<p>Group plans can be dropped too if they arent profitable.</p>
<p>Lerkin, ACA is addressing your issues.</p>
<p>dstark, yes, group plans can be dropped. We used to have an Empire Blue Cross group plan for our business, but they dropped that particular plan. I think two options had caps around $15,000-$16,000 after deductibles of around $2500 singles/$7500 family. The slight savings in cost of these plans didn’t make up for the possible out of pocket expenses.</p>
<p>lerkin: We are a good 2 1/2 hour drive from the nearest city. Any medical plan pooled together with our specific type of business would mean we would have to travel as far as a 2 hour drive to find a doctor that accepts the plan. We refuse to go that route.</p>
<p>dstark,</p>
<p>Are you talking about penalty? I think the penalty is laughable, especially in the beginning. Even in later years, it is still cheaper for those who are healthy to pay the penalty until they need health insurance. </p>
<p>Or is it something else?</p>
<p>^ Not only an oop cap, but specifically what requires the 20% co-pay. My D’s echo may be covered at 100%, since it arose from an annual (which itself cost $20.) Ordinarily, diagnostic radiology and lab services would be at 20%. And etc. I think the unfortunate part is that you ave to be freaking obsessive to really understand what applies and how.</p>
<p>Insurance plans that cover 100% of expenses is going to be expensive. Just as nysmile said that having to pay 20% of health expenses can bankrupt a person (been there, done that and have the tee shirt), so an insurance company can lose money paying all expenses.</p>
<p>Even at paying 80% of our family’s medical expenses (and we have a very high out of pocket max before the ins pays 100%) our insurance company has lost money on our family every year for the past 15. Insurance companies are businesses, not charities. And though profits can be obscene, they take a big risk in covering small businesses.</p>
<p>That being said, our health insurance rates for 2014 are going to be exactly the same as they are this year, and were last year. We are fortunate in that, though not in the deductible, co-pay and out of pocket max, which are remaining the same but are pretty high.</p>
<p>
</p>
<p>you won’t be saying that after October…I have the highest deductible possible. BC/BS is upping my premium 50%, specifically stating ACA as the reason…I find it hard to believe carriers in most every other state won’t be doing the same. The healthy will be subsidizing everyone else.</p>
<p>The penalty is more than zero. People are going to do the calculations and decide if they should pay the penalties or buy insurance. Because many people have trouble with arithmetic, there will be some mistakes. People will adjust. The prices of ACA insurance will adjust over time. Insurance companies adjust their rates too.</p>
<p>
</p>
<p>Had an excellent job with a good company. Company was taken over, and his entire division was liquidated. H tried very hard to make a living in his field or in any field where he could use his professional knowledge and skills (no benefits). H–an MBA from a top 10 school and a CFA–took jobs such as closing manager at a supermarket (no benefits) and night shift warehouse worker (no benefits) to bring in some extra $$. We paid for insurance ourselves when the [hugely expensive] COBRA ran out. We paid for insurance with $15K deductible per person. The premiums rose and rose until they were over $400 per month for the two of us (S was covered through a state plan). Over the time that we were so insured, we paid well in excess of $40K for health insurance, while never collecting a dime of benefit. We postponed care. We just waited for the pain to go away. I did not go to the dentist for 10 years. We never ran to the emergency room because we had a sore throat. I sought care twice: once I was suffering from bronchitis so severe that I was coughing up blood and developed asthma; the other time I had uncontrolled menstrual bleeding that left me severely anemic (hematocrit 24). Yes, I went to the emergency room, because my GP’s office sent me there both times. I had a D&C with no anesthetic–the standard of care is general anesthesia, because “the women kept screaming”–because it would have cost us $3K for me to set foot in the OR. The hospital forgave its part of the bill, but we had to pay the OB/GYN. Note that we paid for all of this out of pocket. Never hit the deductible. Eventually, with the last premium increase of 18% or so we decided that we could no longer “afford” insurance, which was costing us something like 15% of our income. (Obviously, the vast majority of people with that kind of income are working jobs with no health insurance and can’t afford to buy it.) We dropped it. After one year, H was diagnosed with prostate cancer. I was diagnosed with T2 diabetes. Within a single month.</p>
<p>Are you telling me that someone in those circumstances doesn’t “deserve” to get a price break? How long do you have to be without insurance before you don’t “deserve” to get a price break?</p>
<p>And we were luckier than a lot of people. We had a lot of home equity. We had savings. </p>
<p>And now we are really lucky. Shortly after H had prostate surgery–thanks to the Sister of Mercy, a group that really walks the walk–he finally got a real job in his field, which came with health insurance. We have an HSA with a higher deductible. Because we are part of a corporate group, we are covered despite pre-existing conditions. That would NEVER have happened otherwise. I am thankful for it every day.</p>
<p>Edit: crossposted with a lot of people, notably Lerkin who explained hiw view further. </p>
<p>But I have to comment on this:</p>
<p>
</p>
<p>And you BELIEVE them??? :rolleyes:</p>
<p>How did you learn they are upping it because of ACA- and could it be short term gouging, which is another matter?</p>
<p>Geeps, the costs to BC/BS did not go up 50 percent because of ACA. You believe it if you want.</p>
<p>Consolation, thanks for your post. I love your post. </p>
<p>Sorry about your ordeals.</p>
<p>^ no, but my premium will be. Preferred rates have gone away, healthy will subsidize everyone else. Average increase is about 18%, much more than previous 4-5 years.</p>
<p>From BCBSRI filing"</p>
<p>“there are significant premium increases driven by the onset of taxes and fees due to the ACA.”</p>
<p>“It is important to note that the reinsurance program is temporary, and as it is phased out there will be an additional 11% increase needed in future years. But for the impact of the reinsurance payments, the overall average rate increase needed in this filing would have been more than 30%.”</p>
<p>Choices are very limited in the state exchange being set up in California. Several of the smaller health insurance companies have decided not to participate. And those that are participating in the state exchange are limiting the health provider choices of those who get their policies in the state exchange.</p>
<p>Blue Shield is limiting it’s providers in the state exchange to only one-third of it’s usual providers.</p>
<p>UCLA Hospital is a provider under only one plan. Cedars-Sinai Hospital is not included in ANY of the current plans in the state exchange. </p>
<p>So if your doctor has privileges at Cedars-Sinai and that is the hospital in your area where you are getting your treatment, and you need to get a plan in the state exchange you are just SOL. Or if you have the ‘wrong’ plan and you need the high-tech, high-quality medicine provided at UCLA, you are also SOL.</p>