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<p>I think that is a good philosophy, GP – one that applies to your decision in 2012 to withdraw from your grandfathered $3500 deductible health insurance plan, in favor of a higher deductible, lower premium plan.</p>
<p>You made your life choice, it did not come with a guarantee, and no one is magically coming to your rescue with a do-over. </p>
<p>I’m glad to learn that you welcome that concept. It’s been hard to discern that positive attitude in your other posts.</p>
<p>“Seriously, if the problem was this inexpensive, then it probably made sense to lift the caps.”</p>
<p>The why didn’t they?</p>
<p>Hayden said a long time ago the costs to remove the caps are low.</p>
<p>^ Yet, they didn’t remove them voluntarily because they wanted to be able to sell dirt cheap insurance which wasn’t worth the paper it was written on.</p>
<p>Emilybee, :).</p>
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<p>Back in the dark ages, when I was heavily involved in benefits planning for a Fortune 100 company (20,000 active employees + a similar number of retirees), in a rich ASO (self-funded) plan, we would hit the $1M cap about once every other year. It was usually premies. (NICU’s are EXPENSIVE.)</p>
<p>When we raised the cap to $2M, it was a 1.75% hit to the actuarial premium, which wasn’t much, but it was a lot more than $75. (Don’t know why I remember that # so vividly.) Of course, costs were much lower then.</p>
<p>:) 
:)</p>
<p>Some on this board have out and out said that they don’t see a problem with caps. Then the issue becomes at what point does a cap truly compromise the effectiveness of insurance. I’ve known one million dollar caps go up into smoke a number of times. Some caps are even less than that. But some people are perfectly happy with them figuring they’ll deal with the issue later. So, a lot of people liked the insurance they had with the caps. Kept some premium rates low. Figured the chances of hitting the limits, just as many have said here, were very low and they were willing to take the chance.</p>
<p>The problem is that those who lose out on those odds have to get subsidized by the rest of us and by government. With everyone paying the values for insuarance with no caps, the deficit should be less, is the theory. But this are some of the changes that enrage people as it does infringe on their choices. The same happened with a lot of things. A lot fo screaming as social security forced people into that system. Car insurance, oh, the screams when it was required to get liablilityinsurance when registering a car. Any tightenig of laws, loss of freedom gets some people, a lot of people upset, and when it comes to paying more, it really burns a lot of folks. </p>
<p>There is also the issue that statements were made that have not panned out in terms of what is happening. They should have been caveated but they were not. I have friends whose inadequate insurance will be dropped. He has a small company and is not required to provide insurance and so he will not. Everyone will get a raise equal to prior insurance cost and the employees will have to get their own insurance my friend tells me. The insurance did have a max of about a million. My friend and her DH have other excellent coverage thorugh her job, so it was not an issue for them, but that max could have been a problem to anyone who had a catastrophe with huge medical costs. But the employees all loved that coverage. Local hospitals took it and the deductibles were pretty low, especially if an HMO or PPO option were taken. So there are a lot of complaints there. The fact of the matter is that even that capped policy was getting expensive and my friend’s H was going to drop the coverage anyways. ACA made it easier.</p>
<p>The problems of getting on the exchanges has been a major issue. I don’t know anyone signed up and ready to pay or whatever on the NY exchange. Anyone signed up and set to go here?</p>
<p>I have leeway as my son doesn’t age up for a few months into 2013, but am curious as to any real person having gotten the insurance all set for 2014.</p>
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<p>This happens even with the ACA. Others pay for those who don’t pay, no matter how you structure it. It comes down to a matter of philosophy about who should bear the burden and in what proportion, how to disincentivize unnecessary care, how to incentivize healthy living, and who should make the decisions about all of this.</p>
<p>What an interesting point, Bay. We are all still paying just more directly and the insurance companies have millions and millions of new customers most of whom will never come close to using what they are forced to spend. This gets stranger and stranger.</p>
<p>“I don’t know anyone signed up and ready to pay or whatever on the NY exchange.”</p>
<p>I don’t know anyone, personally, either. But I am not in the habit of discussing things like that, in more than a general way, with my friends or acquaintances. </p>
<p>However, people in NY are signing up:</p>
<p>“In just under two weeks, the number of New Yorkers who have enrolled in health insurance plans through the state’s online market, NY State of Health, jumped 58 percent, to 76,177. Of that number, 41,021 have enrolled in private insurance plans and 35,156 in Medicaid, according to the state Health Department. More than 250,000 New Yorkers have now used to website to shop for plans since its Oct. 1 launch.”</p>
<p>[Capitol</a> Confidential » Big jump in enrollment on state?s Obamacare website](<a href=“http://blog.timesunion.com/capitol/archives/200239/big-jump-in-enrollment-on-states-obamacare-website/]Capitol”>Big jump in enrollment on state’s Obamacare website - Capitol Confidential)</p>
<p>I got the $75 from a study that BClintonk linked. Just an estimate…</p>
<p>bluebayou…</p>
<p>What kind of costs did you see? Multi milions every other year?</p>
<p>dstark,</p>
<p>Most preemies are likely eligible for SSI. See, [SSI</a> benefits for premature children](<a href=“http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/368]SSI”>http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/368)</p>
<p>If they are eligible for SSI, they are automatically eligible for medicaid. So medical care shouldn’t be a problem for preemies who hit their insurance cap.</p>
<p>A friend’s husband had a liver and pancreas transplant a few years ago and was sick for years. I assumed that would cause a great financial hardship for the family but she said no Medicaid took care of everything. I assume now that’s because of the disability. He did quit work about a year before the operation and has since passed away.</p>
<p>Sorry about your friend, actingmt. I didn’t even know they could transplant a pancreas.</p>
<p>Diabetes…</p>
<p>Wow, that knocks out your liver and pancreas? Yikes!</p>
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<p>As an aside, at the time that my former company raised the cap to $2MM, we discussed eliminating it altogether, but the ASO admin recommended against it. (Remember, it was a self-funded plan; we just paid a % to a major insurer for claims processing.) But the reason that the Admin/insurer recommended keeping some cap level was to give their high claims specialists leverage when negotiating with hospitals and docs. (Just throwing out a different pov.)</p>
<p>fwiw: we always raised the cap when an ee was about to reach it.</p>
<p>edited to repsond to dstark’s question: these cases were always difficult, but rare, so there was no real ‘trend’. One year, we had twin preemies, who racked up a half a mill each in a few short months. Another cases, rather sad, was a widow of an ee with mental and physical issues; it was chronic, and went on for years. Another case was a hunting accident where the buckshot pierced the liver and intestine in multiple sites, allowing sepsis to set in before the ee got to the hospital. Then we had a couple of recurring cancers. Sloan Kettering, Mayo and MD Anderson aren’t cheap!</p>
<p>Calmom, I always take responsibility for MY actions and try to learn from MY mistakes. However when the govt pulls the rug out from underneath me, I have a right to be a little miffed (maybe a lot). </p>
<p>When I changed plans in 2012, nobody knew (and I mean nobody) that there would be significant premium increases or the severe narrowing of the networks. I would bet even you didn’t know. Remember, our President was promising everyone could keep his/her plans and doctors, so I am not sure why I should take the blame for this intentional misdirection by our govt. </p>
<p>I am more than happy to accept the full consequences of the decisions I make in my personal and business life, but usually I am able to make these decisions with a modicum of sourced information that I can rely upon.</p>
<p>Bluebayou… Interesting cases…</p>