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What's the use of employer sponsored coverage?
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amother
Natural


 

Post Thu, Jun 02 2016, 10:39 am
I'm just so frustrated. I'm 'fortunate' enough to have medical benefits through my company, yet my coverage is so much worse than my friends who have Medicaid. It's ridiculous that the providers and products that I need shouldn't be available on my commercial insurance plan. And those things that are, I have a huge deductible to shell out before I get any benefits.

Lousy coverage!! And I'm supposed to be grateful?
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pesek zman




 
 
    
 

Post Thu, Jun 02 2016, 10:42 am
That's because your employer bought a Lousy plan. Bigger companies generally have more buying power and can negotiate better contracts, often with choices of which level plan works for you) and smaller companies don't.

What does gratitude have to do with it?
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amother
Natural


 

Post Thu, Jun 02 2016, 10:46 am
Regarding the benefits package - I know. It's just frustrating...

But A - my employer is very proud of himself that he offers coverage and often talks about it as if it makes him a better person, (so that's fake gratitude to him) and B - if I'm thankfully not living in poverty, and not eligible for Medicaid, that's a big deal and I should be grateful, its just hard needing to shell out hundreds/thousands for things that others get for free...
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thunderstorm




 
 
    
 

Post Thu, Jun 02 2016, 10:48 am
amother wrote:
I'm just so frustrated. I'm 'fortunate' enough to have medical benefits through my company, yet my coverage is so much worse than my friends who have Medicaid. It's ridiculous that the providers and products that I need shouldn't be available on my commercial insurance plan. And those things that are, I have a huge deductible to shell out before I get any benefits.

Lousy coverage!! And I'm supposed to be grateful?



Since Obamacare regular insurance sucks!!! My biggest worry nowadays is not the roof over my head, food or tuition...but healthcare!!!! We get only partial through the employer and pay premiums , deductibles and copays and now we found out the local hospital was removed from our plan as well!!! Everyone is up in arms, it's not just you. Go to Walgreens, every person picking up medication throws a tantrum why their meds cost so much.
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Amarante




 
 
    
 

Post Thu, Jun 02 2016, 12:36 pm
Obamacare has nothing t do with employer insurance.

The cost of insurance is very very expensive as anyone who buys for themselves knows.

All companies are lowering the actual benefits to employees to save money by offering plans with higher deductibles, copays and smaller networks to save on premiums.

I know how expensive it is for small employers to purchase insurance especially for small businesses as I was in charge of pricing plans for employees of a small business. The small businesses receive no benefits of scale and are functionally charged the premiums for individual plans which means that an older employee costs more to insure.

We made a decision to drop coverage because our workers were relatively low paid and would therefore benefit from buying actual Obamacare policies on the exchange since they were all eligible for subsidies. We increased everybody's pay to reflect the cost of their buying insurance themselves.

This was beneficial to them because their families could now also be covered through subsidized plans and the plans they bought were less expensive with better coverage than we could provide.

The reason why employer coverage used to be so critical before obamacare was because many people couldn't get insurance because of précis ting conditions but with employer insurance that wasn't relevant.

Obamacare has nothing to do with the high cost of insurance since that is a decision made by the insurance companies or if you get through your employer, the decision of your employer. Obamacare is really only relevant to people without employer insurance who at now guaranteed the right to buy insurance and are eligible for subsidies depending on income. certain basic medical necessities must be included and there can be no cap on lifetime benefits. This is one reason why premiums rose fr so people as they had junk policies with limited coverage which they only discovered when they had some kind of critical illness that was expensive treat.
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MagentaYenta




 
 
    
 

Post Thu, Jun 02 2016, 12:50 pm
Amarante wrote:
Obamacare has nothing t do with employer insurance.
...Obamacare has nothing to do with the high cost of insurance since that is a decision made by the insurance companies or if you get through your employer, the decision of your employer. ...


Snipped for brevity.

Each state regulates insurance carriers and addresses policy pricing and costs to consumers. In my state ins. companies must go the the state regulatory agency for ins. and request and justify a rate increase. This is regardless of who purchases the policies (employers or consumers).

The PPACA has been a convenient scapegoat for those that don't understand how benefits are purchased by the employer or how insurance companies are regulated in their states.

Amarante, thank you for a well thought out and articulated post.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 12:55 pm
Amarante wrote:
Obamacare has nothing t do with employer insurance.

The cost of insurance is very very expensive as anyone who buys for themselves knows.

All companies are lowering the actual benefits to employees to save money by offering plans with higher deductibles, copays and smaller networks to save on premiums.

I know how expensive it is for small employers to purchase insurance especially for small businesses as I was in charge of pricing plans for employees of a small business. The small businesses receive no benefits of scale and are functionally charged the premiums for individual plans which means that an older employee costs more to insure.

We made a decision to drop coverage because our workers were relatively low paid and would therefore benefit from buying actual Obamacare policies on the exchange since they were all eligible for subsidies. We increased everybody's pay to reflect the cost of their buying insurance themselves.

This was beneficial to them because their families could now also be covered through subsidized plans and the plans they bought were less expensive with better coverage than we could provide.

The reason why employer coverage used to be so critical before obamacare was because many people couldn't get insurance because of précis ting conditions but with employer insurance that wasn't relevant.

Obamacare has nothing to do with the high cost of insurance since that is a decision made by the insurance companies or if you get through your employer, the decision of your employer. Obamacare is really only relevant to people without employer insurance who at now guaranteed the right to buy insurance and are eligible for subsidies depending on income. certain basic medical necessities must be included and there can be no cap on lifetime benefits. This is one reason why premiums rose fr so people as they had junk policies with limited coverage which they only discovered when they had some kind of critical illness that was expensive treat.


Not to hijack the thread, but Obamacare has EVERYTHING to do with the high cost of insurance. This is because under Obamacare, insurances are *required* to cover pre-existing conditions, full cost of birth control so women pay 0, and not charge women more than men, even their their actual health care costs are many times more expensive and many other mandates. Guess what that translates to? More expensive premiums for everyone. You can argue till the cows come whether or not these are good things, but when the government puts all kind of mandates on insurance companies, the insurance companies will raise costs. (Try to think of it this way: what if the government put a mandate on car insurance companies that they can't charge males between the ages of 18 and 25 a rate higher than females, even though statistically, the male will cost the insurance company more - ie- have more accidents? They will just raise the price for the females so that they are in compliance with the law. They're not going to just sit back and lose money. So too all these mandates - what exactly does "FREE" birth control mean? It just means they make the premiums high enough to absorb their cost in making the bc pills free.)

OP, if it's some satisfaction, many insurance plans don't require you to get a referral from your PCP in order to see a specialist. For me, this is worth lots of $$$$$$$$. On the other hand, Medicaid requires you to go through some very time consuming hoops (and missed work days while you wait around in doctors offices) to get referrals.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 12:59 pm
MagentaYenta wrote:
Snipped for brevity.

Each state regulates insurance carriers and addresses policy pricing and costs to consumers. In my state ins. companies must go the the state regulatory agency for ins. and request and justify a rate increase. This is regardless of who purchases the policies (employers or consumers).

The PPACA has been a convenient scapegoat for those that don't understand how benefits are purchased by the employer or how insurance companies are regulated in their states.

Amarante, thank you for a well thought out and articulated post.


Are you not aware that PPACA put onerous FEDERAL mandates upon insurance companies? Such as the "preexisting condition" requirement?
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amother
Azure


 

Post Thu, Jun 02 2016, 1:01 pm
Insurance is a nightmare. I wish there was a return of catastrophic only policies. We pay a fortune and none of our doctors even take our insurance. On the rare trip to the ER we get a $1000+ bill and end up fighting with the hospital and insurance company.

I have to agree that high rates are not Obama's fault (and trust me I'm NOT from the Obama fan club). It's been 10 years since I worked in HR and had to shop insurance policies every year for our company. Plans were going up 10-13% a year back then too.

Remember when you have insurance through work, your rates are affected by the other employees. If your young and healthy perhaps you can do better on your own and ask your employer to pay you some amount for declining the employer coverage?
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sky




 
 
    
 

Post Thu, Jun 02 2016, 1:04 pm
Comparing my company coverage to Jersey care seems to be at a major disadvantage because my copay is so high. For example if I take 3 kids in for sick visit it costs me $90!!
On Jersey care it is free.
So some acquaintances will take their kids in 'just in case' and I'll wait it out much longer.
Jersey care covers silly things - like Tylenol. So every time they visit the dr they will request a 'prescription'.

But on the other hand my coverage is for a much larger selection of doctors. I'm covered much better when traveling. My kids get speech under my plan and I get to pick from a much larger selection of specialists. In those ways I come out ahead.

But I do pay so much a month, and my employer pays so much a month that the copays are really killers.. (I've been taking a kid to a specialist once a week now to monitor something -> that is $160 a month in copays alone and then prescribed tier 3 meds are $90 - its crazy !!)

I do believe some of Obama care laws have increased expenses. For example my insurance used to not cover nursing pumps (medicaid did). It would make a lot more sense to just go out and buy the pump rather then pay the insurance over head. I believe now they are required to supply it. All that makes rates go up exponentially. It did save me on well visit copays. I don't believe I can be charged that anymore.


Last edited by sky on Thu, Jun 02 2016, 1:09 pm; edited 3 times in total
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amother
Azure


 

Post Thu, Jun 02 2016, 1:04 pm
Orchid wrote:
Not to hijack the thread, but Obamacare has EVERYTHING to do with the high cost of insurance. This is because under Obamacare, insurances are *required* to cover pre-existing conditions,


Perhaps laws vary state to state, but we always had a once a year open enrollment period where any employee could get on the company's policy no matter what their state of health. Granted it drove everyone else's costs up if you had a bunch of employees (or employee's spouses, kids) with serious medical conditions or medical histories. But they were always allowed access. Way before anyone knew who Obama was.
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MagentaYenta




 
 
    
 

Post Thu, Jun 02 2016, 1:06 pm
Orchid wrote:
Are you not aware that PPACA put onerous FEDERAL mandates upon insurance companies? Such as the "preexisting condition" requirement?


Certainly there are those like you who feel that ending pre-exiting conditions as onerous. There are those that feel that capping administrative costs of insurance companies is onerous as well. Not everyone feels that way.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 1:17 pm
MagentaYenta wrote:
Certainly there are those like you who feel that ending pre-exiting conditions as onerous. There are those that feel that capping administrative costs of insurance companies is onerous as well. Not everyone feels that way.


(So are you in agreement that the federal government has issued mandates under PPACA? You seemed to be arguing that point in your first post).

But in any case, your entire post is besides the point. Forcing companies to not decline anybody on the basis of pre-existing conditions can be the greatest thing since sliced bread. But it is a fact that it will drive up the cost.

See again my example with car insurance. If the govt comes down and forbids car insurance companies from "discriminating" rates between men and women, prices will go up.
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Amarante




 
 
    
 

Post Thu, Jun 02 2016, 1:19 pm
I'm shocked that frum women would complain about coverage for woman's health. Besides the issues of fairness,clue last time I checked pregnancy was not through immaculate conception nor did women need birth control in less there was a man involved.

All insurance operates most efficiently when there is a large pool which includes healthy and those who are unfortunate enough to requir expensive care.

Anyone who ever had to purchase insurance as an individual is grateful for the abolition of prefix sting coverage because it made it impossible for any middle aged person to obtain. And not to mention anyone unfortunate to have had cancer or who has diabetes. My friends daughter was diagnosed with cancer and aged out of her parents policy. Without obamacare she would be unable to obtain insurance.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 1:19 pm
amother wrote:
Perhaps laws vary state to state, but we always had a once a year open enrollment period where any employee could get on the company's policy no matter what their state of health. Granted it drove everyone else's costs up if you had a bunch of employees (or employee's spouses, kids) with serious medical conditions or medical histories. But they were always allowed access. Way before anyone knew who Obama was.


Obamacare has issued hundreds of pages of mandates that insurance companies must follow. They might be wonderful, amazing, fantastic and the advent of mashiach, BUT THEY WILL RAISE COSTS.
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bluebird




 
 
    
 

Post Thu, Jun 02 2016, 1:19 pm
You'd all be singing a different tune about costs if you had a pre-existing condition and needed to change insurance or job but couldn't because you'd lose your health care.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 1:21 pm
Amarante wrote:
I'm shocked that frum women would complain about coverage for woman's health. Besides the issues of fairness,clue last time I checked pregnancy was not through immaculate conception nor did women need birth control in less there was a man involved.

All insurance operates most efficiently when there is a large pool which includes healthy and those who are unfortunate enough to requir expensive care.

Anyone who ever had to purchase insurance as an individual is grateful for the abolition of prefix sting coverage because it made it impossible for any middle aged person to obtain. And not to mention anyone unfortunate to have had cancer or who has diabetes. My friends daughter was diagnosed with cancer and aged out of her parents policy. Without obamacare she would be unable to obtain insurance.


OHMYGOSH after this I am done. Are you deliberately obfuscating? Where did anyone on this post "complain" about coverage for women's health?

I stated a fact, and that is that due to extra mandated coverage on women's health, prices will go up. And maybe I think the pre-existing condition is AMAZING (I in fact gave no opinion on it, at all). All I said was this mandate, as with any other mandate, will DRIVE PRICES UP. Whether the idea behind them is great or not.
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MagentaYenta




 
 
    
 

Post Thu, Jun 02 2016, 1:23 pm
bluebird wrote:
You'd all be singing a different tune about costs if you had a pre-existing condition and needed to change insurance or job but couldn't because you'd lose your health care.


Exactly, think of stuff like diabetes, Crohn's, high blood pressure, arthritis, a history of cancer, just to name a few.
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Orchid




 
 
    
 

Post Thu, Jun 02 2016, 1:23 pm
bluebird wrote:
You'd all be singing a different tune about costs if you had a pre-existing condition and needed to change insurance or job but couldn't because you'd lose your health care.


Again and again and again and again, pre-existing conditions might be amazing. I did not state my opinion on them at all.

I simply stated (multiple times) that this mandate, as with all other mandates, drive the price up. In response to the poster that said "obamacare has nothing to do with the price of private insurance." But it does. When the federal government swoops down and puts on mandates (WHICH MIGHT BE AWESOME) that will effect the cost of insurance.

whatever.
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amother
Azure


 

Post Thu, Jun 02 2016, 1:23 pm
Orchid wrote:
Obamacare has issued hundreds of pages of mandates that insurance companies must follow. They might be wonderful, amazing, fantastic and the advent of mashiach, BUT THEY WILL RAISE COSTS.


I don't work in the insurance industry and have been out of HR for many years already. I don't have a clue what all the mandates are and what the impact is.

I simply stated that 1. Insurance costs were already rising rapidly before Obama was a blip on the radar, and 2. at least in my state, once a year, employees with pre-existing conditions were able to get onto the company health care policy. So having employees with serious medical issues drive up rates for the whole company is not something new. The end. I do not favor Obama or Obamacare, but the above is true regardless.
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