<p>[Division</a> of Pensions and Benefits](<a href=“http://www.state.nj.us/treasury/pensions/open-2013.shtml]Division”>http://www.state.nj.us/treasury/pensions/open-2013.shtml)</p>
<p>I thought we had heard that government unions were outraged because their health plans were so expensive they’d be vulnerable to the Cadillac tax. How then are we now to believe that those same government health plans have cheap total premiums?</p>
<p>Dstark you asked in post #2970, “If I have a kid that is going to school and another kid eligible for medicaid, financially, they should be off my plan, right? Actually, doesnt the kid who goes to school qualify for medicaid in many states?”</p>
<p>It depends upon your plan. If you are on an employer plan like we are, we pay the same amount if we have one child on the plan or whatever number, so it’s free premium wise to have our kids on our plan. Also the more on the family plan, the quicker the chances are that the deductible is reached since it is a family deductible. When you have three plans, with three deductible, if they are sizeable, it might be better to pay a little more in premium and have everyone on the same plan so that the family deductible would be met sooner and the insurance kicks in. Of course, that all depends upon what health care needs you have that year. </p>
<p>So you have to run the numbers. I have a friend with one college aged child To add him to their health plan, last year, meant it cost more than if he went on the college health care plan, so they did not for last year and this. Next year, he turns 26 and he’ll be on ACA indivdual plan if the cost would be lower than his college plan COBRA costs. If he gets a job with employer health care, that would be ideal. They are a family who does not benefit from ACA. Their costs are going to go up as their state has little choice in health care companies on the market, and the costs were high already. So they have been doing health care premium gymnastics for years now. </p>
<p>As for Medicaid, it depends upon the state. I am wondering how complete Medicaid coverage is, Dstark. When my son hurt his hand, Medicaid would have paid for all of ER costs to do the initial repair, but had he ended up with loss of use and feeling in it requiring expert hand surgery, finding a surgeon who has a good track record and rep and expereince to deal with this that would take Medicaid would have been a problem. A lot of doctors do not take Medicaid patients. Whether that will change in the expanded Medicaid for those states (NY is one of them) under ACA, is something I do not know. AnIf I have a kid that is going to school and another kid eligible for medicaid, financially, they should be off my plan, right? Actually, doesnt the kid who goes to school qualify for medicaid in many states?y one here know? I should find out as my son is right at the line where he may well be Medicaid eligible. If he is I might just bump his income up so that he qualifies with the lowest possible income to be outside of the Medicaid plans. Most doctors, clinics, Urgent cares, etc, do not take Medicaid around here.</p>
<p>I am not expecting changes for my family. </p>
<p>I personally havent seen a family doctor for over 10 years. I did have a cardiologist who I havent seen for 2 years. Anthem loves me. I promised my daughter I would start seeing doctors in 3 years.</p>
<p>These rates do not look particularly cheap to me:</p>
<p><a href=“http://www.state.nj.us/treasury/pensions/hb_open_enrollment_2013/state-monthly-rates.pdf[/url]”>http://www.state.nj.us/treasury/pensions/hb_open_enrollment_2013/state-monthly-rates.pdf</a></p>
<p>They don’t seem to be age adjusted. If those are the average rates over all employees of all age groups, which seems to be the case, they look expensive.</p>
<p>“finding a surgeon who has a good track record and rep and experience to deal with this that would take Medicaid would have been a problem.”</p>
<p>This is exactly what I am worried about. I have heard the reimbursement rates for exchange and off-exchange plans are going to be at the same level as Medicaid.</p>
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<p>The reimbursement rates are whatever the insurance companies negotiate with the providers. In different areas, providers have different amounts of negotiating power. If there are a lot of small provider groups, the insurance companies can play one group off the other, but if there are not very many provider groups-- for example, in areas where there is one hospital chain-- then the providers have more power.</p>
<p>CF, I like their high deductible plan and I would imagine the provider network is excellent.</p>
<p>CF, this is what doctors are telling me.</p>
<p>I am in the NJ Direct15 and that does not meet the definition of a Cadillac plan. </p>
<p>I believe the cost of the plan to an individual would be much more expensive than the premium cost the State pays.</p>
<p>They are not age adjusted.</p>
<p>Goldenpooch, it’s all about ages. Of course a premium that is averaged over all age groups is cheaper than a premium for old folks like us!</p>
<p>“tom1944, I totally agree you. Allow us to have the plans offered to state employees. I would take that in a NY minute.”</p>
<p>My H works for NYS. In Box 12 of his W2 it shows the state pays $16, 690/yr for our health care (family plan.) On top of that we pay a premium of $320/month. Why you would want a plan that would cost you that much is beyond me, but…</p>
<p>Cpt… You make a lot of good points. You reminded me that just because I may save money
On premiums doesnt mean I save money by having a kid gets his own plan. </p>
<p>I have one daughter that qualifies for medicaid and probably always will. The doctor selection with medicaid does bug me and I think medicaid was a pain the butt. </p>
<p>However, I did call Kaiser and Kaiser said they will take my daughter if My wife, myself or my daughter are full payers for 6 months. I figure at some point I will join Kaiser and take my daughter with me. Forget ACA. I dont know how many doctors take new patients around here which is anither reason I am leaning towards Kaiser. Kaiser will take me. The Kaiser around here has a good reputation, but not as good as UCSF.</p>
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<p>We can’t even evaluate whether the plans are more expensive unless we age adjust them. It makes no sense whatsoever to compare a non-age-adjusted plan to an age-adjusted plan.</p>
<p>emilybee, is that a high deductible plan?</p>
<p>GP, the doctors are full of …</p>
<p>Actually, medicaid reinbursement is going to be increased for 2 years also. </p>
<p>Lots of anxiety out in the medical world.</p>
<p>Well, if I am a member of the group, you wouldn’t have to age adjust me</p>
<p>dstark, you think the doctors are bluffing? I hope they fold before Dec 15.</p>
<p>“emilybee, is that a high deductible plan?”</p>
<p>No. Deductible is $2000/yr per person. We also pay $20 co-pay when we go to a participating provider. Labs are usually $40. It does include dental and vision - though I go to an out of network dentist. H and DS go to an in network one. </p>
<p>If we go to a participating provider we do not have to satisfy our deductible before our insurance pays. It has been years since anyone in my family paid anything towards our medical deductible. What I pay for dental does go towards the dental deductible, but I still only pay the amount of the bill not covered by my insurance (about 2/3.) </p>
<p>My plan is a PPO with 80/20 if I go out of network. The state offers around 20 different plans (some only good in certain regions) and where I am (Cap. District) we have a choice of between 5-6, iirc. </p>
<p>I admit it, we get great benefits, but that is part of the deal when you go into public service. Relatively low salaries but great bennies and a very good pension when you retire.</p>
<p>dstark, I had a very experienced agent tell me to beware of Kaiser. He said they are very good with preventative care (extremely organized and computer savvy) but if you get sick and need specialized care, things can go downhill very quickly. Just one guy’s opinion, but he has an excellent reputation in my town.</p>