Fang, I’d bet you 5 to 1 that faculty polling would have netted an approval number north of 85%. That is, right up until they realized what it meant to them personally. Even for people who are just fine with the way the sausage was made, it has to be unsettling to come to the realization (late) that your money was on the ingredients list.
As bluebayou suggested: Cadillac tax. If that doesn’t strike you as a part essential to the whole, think of the underlying principle of the whole process - the more fortunate were always going to have to give up in order for the rest to be covered.
Maybe they thought Harvard was going to absorb it, maybe they thought the taxpayer was somehow going to subsidize them too, maybe they just didn’t think at all… my guess as to most likely… but… expect the hypocritical whining to spread and grow.
I think it will quiet quickly. The NYT article is not the be-all. And Harvard is subsidizing qualified employees who earn up to 95k. The prices are crazy low. Just because some are in a tizzy, and work for H, doesn’t mean this is a rational problem. As ever, the media gets people roiled up. Did you look at their plans? They’re good.
thanks lookingforward and somemom. I knew they had to cover a “true” emergency, but it is scary to think that if an ER visit turns into an inpatient admission it negates the ER classification. I wasn’t sure I followed the detail in the legalese. Does that mean the whole visit, (ER and inpatient) is not paid? The plan I’ve been leaning towards is actually a UHG HMO.
If an employer provides an HSA that is free and nearly worthless must the employee take it? This is one employee whose boss is covering his family and her only. Everyone else at the business is going insurance free for now but she can’t however she wants an exchange plan and the insurance guy told her that can’t happen as long as the boss offers her the crappy plan which he probably will continue to do because it’s the only way his family gets covered I think. Ugh.
Is the question whether the person would be entitled to buy insurance with a subsidy, if their employer provided them worthless insurance? The person wouldn’t be entitled to a subsidy if the insurance was ACA-compliant.
But anyone can purchase unsubsidized insurance, if they choose to do so.
Hmm. It’s probably going to be too expensive without a subsidy but the HSA doesn’t actually cover anything such as 300-dollar prescriptions and 150-dollar office visits and a 7-thousand dollar deductible and all of that so although it is probably ACA-compliant it does not cover the important things and she does not consider it insurance at all right now and wants Obamacare. But, it sounds as though she is probably out of luck until something happens to fix this situation.
@myturnnow, I read that info to say that the ED admission and the subsequent in patient care is all treated as one in network visit until the day the hospital and/or insurance company determine the patient can be transferred to an in network hospital, after that, if you don’t move, it is out of network. I read the part about not being ED meaning that the in patient not ED deductible and co-pay and co-insurance apply.
There are so many companies and plans in all the different states, this is something each person should check for themselves in their location
thanks somemom. you mean ER admission,right, not ED? that info is helpful, except it relates to a plan that includes out of network services which HMOs do not. I called UHG to ask the super simple question about whether their HMO covers ER care out of state. They could not answer that! I found the info myself.
Afraid to have the HMO due to a chronic illness, that could present out of town,but OTOH, being recently laid off I likely will not be out of town too much. My concern with going with the PPO, in addition to doubling the cost of the HMO, is that none of my local hospitals or docs are in that BC network. That scenario actually presents more risk to me, in terms of the likelihood of that medical situation arising.
ED and ER are basically interchangeable. Some say Emergency Room but “Dept” is more in use, afaik.
We don’t know your exact wording when you called. Maybe the confusion is asking if ER is covered OOS. No, you can’t use ER out of nwk for a non-emergency and see if treated as “in nwk.” Maybe the way to ask is, "IF I have an emergency and go to the closest hospital, which is out of nwk, will it be covered as in nwk?
I’m sure you covered with your doctors, what they advise needs a trip to emergency. Or are you anticipating something different or where the line between emergency and non is blurred?
thanks again. yes I asked if a true emergency arises while out of my network area would ER/ED be covered
not questioning what is an emergency, not one who has ever used an ER for anything but a true emergency
I was noting that the language in the UHG post earlier and the link, reference non network providers. in the HMO case there is NO non network coverage at all, except in the case of an emergency visit to an ER/ED.
Marie, if the employer’s policy doesn’t cover doctors’ visits and prescriptions, I don’t understand how it could be ACA-compliant.
If the policy does cover doctors’ visits and prescriptions, but it has a high deductible (but still under $6000-odd), then she might not be able to get a better policy on the exchange, even if she were able to get a subsidized plan.
It’s an HSA and it includes the basic preventative care that makes it ACA compliant but she has to pay 100-percent of everything up to 6-thousand dollars and then after that there are co-pays so by September she may be spending less than 600-dollars a month for her medication with this free work insurance. I suggested she quit and go on Medicaid but she needs to pay rent. It’s kind of weird that your boss can hold you captive in crummy a health care plan, though.
I think that Marie is saying that the employer is providing a high deductible HSA – possibly Bronze level. Those policies DO cover doctors visits and prescriptions, but only after the high deductible is met. The policy would also cover preventive services without charge, but apparently Marie’s friend has higher expenses than that. An HSA compliant plan wouldn’t have a $7K deductible for an individual, but maybe that is a reference to a family plan, or else rounding up the maximum out-of-pocket for an individual.
I suspected that might be the case, but I also suspect that Marie’s friend would not be much better off going to an exchange plan. She’d probably have to go to a Gold plan to get the deductible down, and that can be expensive, especially if Marie’s friend is our age. The question would be, could she get a plan with a low deductible for less than $6350/year? Maybe, if her income was low enough.
It’s 6,500 + co-pays, I think. She is the lowest paid employee and the only one who is sick and on the company insurance. No-one else wants it but the boss and his wife and kids. Ugh.
I think it’s $6350 and that includes all copays and co- insurance; that’s the maximum out of pocket allowed. I’m not saying that’s a fantastic plan, but she’s unlikely to be able to do better on the exchange, because she’d have to pay bigger premiums to get a lower deductible. Her total max out of pocket is going to be $6350, provided she stays in network.
Marie’s point is that her friend’s pay is probably low enough that she would qualify for subsidies from ACA – probably going for a Silver plan – but she can’t get the subsidies because the crappy plan provided by the employer is “affordable”. The friend would be better off if the employer didn’t offer insurance – maybe the friend should ask her employer whether he would help fund an HSA – if not, I think that the friend probably should be looking for other work. She’d actually be better off working for an employer who provided equivalent pay but didn’t offer benefits, because then she could qualify for subsidies. In the meantime she’ll just have to live with that plan. It looks likes the employer opted for the cheapest plan he could find - and the employer is probably funding his own HSA to the max and figures that his family can afford the out-of-pocket maximum. For someone who is more affluent that makes some sense, especially if medical costs are low – HSA’s are a great deal for financially secure people who never go to the doctor - but it’s a horrible plan for the low paid employee.