People with preexisting conditions increase the cost of healthcare. But the insurance companies cannot use preexisting conditions as a blanket to justify the continuous rate increase. People are classified with preexisting conditions only when they change insurance company or when they start a new enrollment. But don’t forget that people with continuous insurance coverage through employers also have preexisting conditions but the insurance companies cannot deny coverage. And I guess the number of people with preexisting conditions covered by employers are probably very high. So, insurance companies cannot blame on preexisting conditions to hike rates.
Actually, this is inaccurate re ACA. ACA mandated that insurance companies spend at least 80% of revenues on healthcare. Therefore, raising premiums would have a very limited effect on increasing profit margins. Anyway, there was no profit because the rolls of non-payers outstripped payers, and there was no profit. Premiums rose simply to try and keep up with rising costs, but mathematically it is already at the point of fiscally impossible.
So, someone who is getting something free or at a vastly mandated reduced cost because someone else is paying for them is now a customer? I thought customers where those who paid a fair price for what they received. Just saying…
How long would your grocery store survive if 60% of its customers were paying lower prices than marked on the food items and the grocery store was forced to “give” them the food anyway? And what if this applied to everything in the store, i.e., even the most high foods and products which got the highest discounts since everyone should allowed to have lobster and steak? (The answer is the grocery store would survive three months tops before going in the red.)
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“People with preexisting conditions increase the cost of healthcare. But the insurance companies cannot use preexisting conditions as a blanket to justify the continuous rate increase. People are classified with preexisting conditions only when they change insurance company or when they start a new enrollment. But don’t forget that people with continuous insurance coverage through employers also have preexisting conditions but the insurance companies cannot deny coverage. And I guess the number of people with preexisting conditions covered by employers are probably very high. So, insurance companies cannot blame on preexisting conditions to hike rates.”
Group insurance covers everyone so there are young and healthy paying into it, not just old and sick.
For example, NYS employees heath insurance covers 50,000 employees plus their families. The vast majority are not sick.
And our rates do go up every year but it’s an insignificant amount. Last year we paid $385/month for our family insurance and this year we will pay $408/month. The state picks up 70% of our premium cost. It also depends on where you live in NYS. Those in the NYC metro/downstate pay double what we in the Cap District pay. We also have numerous plans to choose from - similar to the ACA marketplace.
There is no way to make health insurance relatively afforable unless you have younger and healthy in the group.
I forgot to note that what you pay for coverage also depends on salary and grade range. So we pay about twice as much for our plan then those who make less.
For those with college students OOS did you move your kid onto his/her college’s insurance plan because your coverage was mainly limited to in state care?
I don’t think people with continuous insurance coverage don’t incur high healthcare costs. Many professional people with high salaries and good insurance coverage still have serious and deadly illnesses that cost ton of money to treat but they are not classified as having “preexisting conditions”. More than 10 years ago one of my kids was denied coverage when I applied for new insurance (I was on 18 month COBRA before that). My kids always had insurance coverage until that point of time. To get insurance coverage for my family I had to quit my consulting job and worked fulltime for an employer that had good insurance coverage. My family then was no longer having “preexisting conditions”. The definition of “preexisting conditions” is vague and can be easily manipulated.
My H could not enroll for three months in his employer group plan. It was a mandatory wait time. That should be a permissible lapse time.
Another employer covered you after only one month. It just depends.
My kid is over 26…but she had to switch to a plan in her new state when she enrolled in professional school. She has an individual plan purchased directly through Anthem. Her plan in this state was a HMO, so did not have coverage in her new state. Her professional school does not provide any health insurance through the school…and her school isn’t the only one.
My career is only possible because of the ban on underwriting based on pre-existing conditions.
If it goes (or if it stays but is financially unsustainable without the individual mandate), either my husband or I will have to give up our small businesses and get a day job.
@Hanna you HAVE a day job…it’s just not one where you workmfor somoeone else who provides you with benefits.
My self employed kid is in the same situation. He works a ton…but he is self employed.
The other way to reduce costs is to reconsider how we allocate resources for patients near the end of life. We heard a lot about death squads etc., but the reality is that we expend a lot of medical resources on people in their last years. We do this even when the costs are high, the marginal increase in extension of life is quite small, and there may even be a significant decline in quality of remaining life because we are choosing low odds of success interventionist care over palliative care. In the US, we still seem to think of death as the enemy that we must fight at all costs, rather than as the inevitable. Other countries don’t spend the same resources marginally extending life, regardless of quality. If we can change the conversation about aging and death, we could dramatically reduce medical costs and simultaneously improve the last months/years of people’s lives.
“I don’t think people with continuous insurance coverage don’t incur high healthcare costs. Many professional people with high salaries and good insurance coverage still have serious and deadly illnesses that cost ton of money to treat but they are not classified as having “preexisting conditions”. More than 10 years ago one of my kids was denied coverage when I applied for new insurance (I was on 18 month COBRA before that). My kids always had insurance coverage until that point of time. To get insurance coverage for my family I had to quit my consulting job and worked fulltime for an employer that had good insurance coverage. My family then was no longer having “preexisting conditions”. The definition of “preexisting conditions” is vague and can be easily manipulated.”
But there is a continual entry of young and healthy into the pool. And it’s not like our insurance is cheap. It’s about $17k/yr per family - just the bulk of that is paid for by the state. State workers also tend to retire earlier as the have a great pension/retirement bennies. They don’t have to work until they are too sick to or until they drop dead. The majority retire around age 55. H will be 62 because he started with the state late - when he was 32. And depending on ones Tier age of retirement to get full pension has changed. The tier above H was 55 with 25 yrs of service. His tier is 55 with 30 years - which is why he is waiting until he is 62. Plus, his pension is based on his last 3 years of salary and he is at his highest ever now - which means better pension for him.
In NJ the average age of retirement for State workers is 62. That will be increasing since the retirement age has been raised
We have an ACA HMO in the Chicago area. When our D13 went downstate to UIUC, she was out of the area network for the HMO. Students going away to college (a certain distance) qualifies as moving.
It took a couple phone calls to BCBS of IL to get an accurate answer on this. We weren’t sure if we had to “double pay” for the insurance (the one at home and the one at school).
We had the option of dropping her from the HMO here at home and signing her up for an ACA plan in Champaign County, or signing her up for the UIUC student major medical insurance.
For our D16, same thing. She went OOS, and we looked into the ACA plans in that state in her city, and we looked at the student plan.
In both cases, we opted for the student plan, dropping the kids from the HMO at home.
[quote[For those with college students OOS did you move your kid onto his/her college’s insurance plan because your coverage was mainly limited to in state care?
[/quote]
We happened to lose our family insurance shortly before my current kid in college left for school. So we bought a BCBS plan that included the national network. As was discussed in another thread recently, though, some of the blues have dropped the national network from individually sold plans this year (still have it many of their negotiated corporate plans, though). We had to switch my kid to the other BCBS in our state (fortunately we have two in our state!) so she could continue in a plan with the national network.
When our employer group plan announced premium increases it was stated that it was because insurance companies raised rates after the provision to cover children until 26 was added. At first the employer absorbed the increase, later premiums were increased for employees.
But young people seem to be the healthiest and individual policy premium rates were based on age.
I also thought that while children are covered until 26, maternity care is not covered, is that the case with all insurance companies?
If premiums are based on a fixed percentage of income, that would be fair, wouldn’t it?
“For example, if I had gotten ACA for my family, my DSs and I would have been mandated to pay for coverage for mammograms, pap smears, birth control, and child birth? Huh? For whom?”
So there should be discrimination in health insurance based on a persons sex?
How would you feel if your health insurance did not cover Prostate problems? or Testicular cancer?
Or other medical issues found primarily or only in men?
THAT was one of the hallmarks of the ACA- WOMEN could NO LONGER be discriminated against regarding the kind of medical care that was covered -simply because they were WOMEN.
No.
@mommdc well…maybe. My kid had a decent paying job until she had her $300,000 emergency medical issue. Her income dropped to zero.
I’m sure she isn’t the only one who has emergency issues that prevent them from continuing to work, and draw a higher salary.