Yes, includes co-pays and co-ins, unless otherwise stated. What’s the co-ins percent ? Zero? No charge for ongoing OV, labs, most tests or for in-patient? Is the trick that you almost ever get to that deductible? In effect, that you’re pre-paying, somewhat like concierge?
On the surface, I don’t get it either, it’s huge. That’s why I say one needs to dig in to the details and run numbers.
But CF- is this a plan with some wider number of providers/hospitals, considering the CA issues we always discuss? Could that be a difference, a higher premium for less limited doctor choice?
I called up Blue Shield. They assured me that the provider network for their individual plans, for the PPO, is the same for all metal levels. The person assured me that if a provider takes one metal level, like Platinum, then they take all metal levels, for example Silver. The insurance broker I talked to said the same thing.
I think the anomaly is just because I live in a high cost area. The max out of pocket is a constant all across the country, but the cost of health care is so high here that the difference between the costs for the various levels is also high. I don’t think this particular Platinum plan makes sense for anyone.
@LasMa. Under the new system it IS rationed by price. Can’t afford the 2K/month unsubsidized plan for 2 so that you can actually see a doctor, well then take the subsidized plan (not rationed by price) and NOT your doctor. Simple
Not greater, but it does not really change the tiers you mention. One tier largely remains the same, people employed by large (private or government) employers with generous medical insurance plans, shielding them from the costs and most aspects of rationing. The other tier of the individual market before the ACA had to deal with pre-existing conditions making it impossible for many to get any insurance at all, or the fear of recission for an otherwise irrelevant omission in on’e lifetime medical history on an application years ago. With the ACA, insurance is now available to all, but the cost is plainly visible to those buying as individuals.
Those employed by large employers that shield them from the obvious rationing decisions should realize that the rising costs of medical care do affect them indirectly – the employers may have to cut back on pay raises or other benefits, or reduce the number of employees, because the cost of medical care keeps rising.
Prior to the ACA a H and W could be included in group insurance if their small business was structured properly. A sole proprietor could also get group coverage if their business was structured appropriately. Family businesses which included other members but did not pay W2 wages could qualify as a group. The rates were not necessarily great, but there were not preexisting condition issues and the provider networks were often as extensive as those offered by large companies. Small family businesses are now being forced into the individual market. They are no longer able to ‘keep their plans and their doctors’ but must instead purchase more expensive policies with less provider options.
This contributes to the growth of the two tier system.
My pov is not relevant; and if we go down that path of stating what we are “fan” of, the thread will be locked.
Instead, I was just making a statement about basic health economics. Rationing services the only way to maintain costs, when demand far exceeds supply. Fortunately, some service rationing is actually good for our health, since it is based on good scientific data (such as frequency of exams).
Rationing services is not the only way to maintain costs.
To pretend that healthcare costs are primarily a supply and demand issue is silly.
Doing something about the specialty pharmacies that are jacking up the price of existing drugs, looking at business practices of companies like Valeant, etc would be a start.
Vertex charges $300,000 for cf medication. It 's not like there is some huge demand for this medication. The people who do need this medication really need this medication.
My father in law is looking to move to an assisted living facility. The specialty pharmacy that supplies the drugs to residents of the facility charges $1,000 more a month for drugs that my father in law can buy himself. My father in law is complaining. So, the assisted living facility is thinking about letting my father in law buy his own drugs and then adding a $125 per month surcharge because my father in law is supplying his own drugs. Lol. The assisted living center doesn’t want to lose its share of the cut from the specialty pharmancy.
I am not sorry to see a company like Valeant have troubles.
$2800 a month for two? Seriously? Sounds like the fanciest Cadillac plan I’ve ever heard of. Must come with free weekly massages, installation of a free hot tub, and zero co pays or deductibles.
Cuz you know we have to chase people off those high cost Cadillac plans, because they’re so unfair. Unless, you pay for them yourself, and then they just sound like a ripoff.
It’s not a Cadillac plan in the sense that it has free massages. It does not have zero copays and zero deductibles; it has copays of $20-$40 per doctor visit, copays for drugs, and coinsurance for hospital stays. I’m not buying a Cadillac, I’m just driving the car on expensive roads. I live in a high cost area.
Here are the prices available for me and Mr. Fang:
The cheapest Bronze plan is $1150 a month.
The second cheapest Silver plan, the reference plan for subsidies, is $1550 a month, Anthem (yuck).
The most expensive Platinum plan is $2850 a month.
If your area is cheaper (and it probably is), congratulations.
Huh? Your example is the epitome of supply and demand. In this case, the specialty pharmacy is the supply.
Many residents of the assisted living facility pay for the speciality pharmacy’s service = demand. Your FIL, however, chooses Plan B, the lower cost competitive option. If enough folks did as your FIL, the demand would drop from specialty pharmacy and voila, they’d lower price or go out of business quickly.
(Alternatively, as you note the Assisted Living facility would lose its cut. If so, it might have to raise the rent. Regardless, this may not a health care issue per se, but a pricing/profit issue for the assisted facility, which includes activities of daily living – non-medical.)
But of course, you know all of that because you are an extremely educated about health care.
btw: supply/demand is also true about drug manufacturing. The drug manufacturer holds the supply, and can raise the price to what the market will bear. (Granted, that is due to a patent, but without a possible patent, the expensive drug might not even exist.) If you don’t want to pay for the new & improved, heavily advertised drug, you can always ask for the generic from last year’s formulary. May not work as well, or the old ver might work better.
And yes, there are corrupt companies in health care like in a bunch of other industries. (VW comes immediately to mind.)
I have no gripes with the ACA. My kids both would not be insurable without it. I’m just disappointed that so many insurance providers are bailing on the exchanges…and that doctors are choosing not to participate with many of the plans offered.
Both kids had multiple choices for plans last year…and not just HMO plans. This year…both are facing just HMO plans…with huge issues with doctor coverage. Huge. Like their doctors are not taking any of the plans on the exchanges. None!
I believe this is a kink in the ACA that needs to be addressed.
Pharmacy billing prices have almost nothing to do with its acquisition prices. It is based on a price which does not exist. It is a magic number which no one actually pays. However, you have to game that number to ensure the best possible reimbursement rate.
If the specialty drug is an IV it is billed through part B. If it is a regular injectable, than it is part D. Medications acquired through an assisted living are billed through part D with the exception of the part B medication like IVs. However, if the person is in a nursing home or hospital, it is billed through part A until benefit is exhausted. However, all this means nothing if the patient has a part C plan.
If the goal is to decrease cost, you need to decrease access. You need to have a limited number of providers. HMOs should be cheaper than traditional PPOs. People make a big deal about the VA system. What they don’t always realize is how limited a person’s options are in the program. They will only cover one medication in a class, with a few exceptions, without prior authorization. You can only go to a handful of clinics in a given area. The VA tries to use less physician and more mid-levels and other providers. Most people would not tolerate the system.
The provider list United Healthcare uses for Wisconsin more or less covers the same providers in their standard provider list. It is an EPO and so you will need referrals to see specialists, but the goal of this is to decrease cost.
Next year, we will see generic Lantus insulin and it will be interesting to see how it will effect the biologic market. For it is the first major biologic to go generic/biosimilar.
"It’s not a Cadillac plan in the sense that it has free massages. It does not have zero copays and zero deductibles; it has copays of $20-$40 per doctor visit, copays for drugs, and coinsurance for hospital stays. I’m not buying a Cadillac, I’m just driving the car on expensive roads. I live in a high cost area.
Here are the prices available for me and Mr. Fang:
The cheapest Bronze plan is $1150 a month.
The second cheapest Silver plan, the reference plan for subsidies, is $1550 a month, Anthem (yuck).
The most expensive Platinum plan is $2850 a month.
If your area is cheaper (and it probably is), congratulations"
The total employee plus employer cost for my plan, for me and two kids is about $9700/yr (they make my husband get his own plan because he works for the company). The area doesn’t matter as far as the cost. It’s the same copay as yours for doctor visits, low copays for drugs, and a deductible of $250/yr, I think. It’s really good insurance, covers virtually everything and anyone that you want to see, and it seems bizarre that the cost can be so different. I live in a fairly high cost of living area.
I guess the prediction that the ACA was going to bring down the cost of health care has not come true. But it does seem to me that if one big company can cover their employees very well, and for very little (with no exclusions for pre-existing conditions, ever)—that with so many people buying the ACA plans, they would have been able to figure out how to bring the price down a little more.
It is very hard to bring down the price of healthcare when the price of old drugs keeps skyrocketing, and when important and novel drugs like Solvadi costs $1K per pill.
Unless, of course, we let the market really be free on pharmaceuticals, and allow legal import of Rx drugs from Canada and other countries. Arbitrage is a wonderful thing.
What is your point, busdriver? That a big company in my area should be able to cover their employees for less money? That doesn’t seem to be the case, unless you think that the big tech employers in Silicon Valley are somehow paying more for insurance than they could if they were only smarter. I know what Mr. Fang’s old employer paid for insurance-- we’re on COBRA so we pay it now. It’s a lot more than $9700 a year for a family, I can tell you that.
Health care costs are complex, but one big reason for the high prices in my area is Sutter Health (ptui). They buy up hospitals and medical practices. They have a quasi-monopoly, so they can jack up prices, and they do. The other non-Sutter hospitals play chicken with the insurers too.
Also when comparing employer-paid insurance to insurance that an individual buys, consider that most on this thread are on the high end of the age gradations. Employers pay the same amount for each employee, whatever the age. If you work for a company with a lot of young employees, then the insurance per person is going to be a lower amount than if the same employer was employing mostly ancients like us. I’m buying insurance for a couple in their sixties, whereas Mr. Fang’s old employer was buying insurance for people with an average age of 30. Naturally they pay less per person than we do.