Octopus Overlords

And I almost had the snarky quote block ready.

BAM!

I can't complain too much, since having insurance has (at least temporarily) saved me from bankruptcy. My hospital bills last year alone totaled around $200,000.

So my new sheet this year has demoted everyone from BCBSND Blue Choice 90 to BCBSND Blue Saver 80. By doing that, they've managed to keep the premium cost this year close to the same as last year. Truthfully, I would have rather if they'd given me the option to keep my old plan, which was slated for a 28% increase (thanks in part to me I'm sure).

Last year deductible: $1,500 and 90/10
$25 co pay for doctor visits.
This year deductible: $2,600 and 80/20
I now pay 100% of doctor visits up to the $2,600.
Doesn't sound like much, but to me, what I just wrote there is gigantic.

Last year OOP: $4,500
This year OOP: $5,000

Last year 2 week premium (employee half): $134.89
This year 2 week premium (employee half): $135.65
Total monthly premium is now $587.80

So my premium costs are high, but I am still managing to pay them.
What could conceivably drive me to bankruptcy though is the $5,000 OOP per year max. With all the tests I'm required to do now to keep my CDL license, I'm not sure yet how high my total OOP will actually go each year. I mean, the worst is over (last year), but I know I'll still be struggling with the deductible and the OOP from here on out.

Starting next year, premium almost doubles, copay doubles, max oop doubles. Corporate tells us how excited they are to bring us in line with industry standards...

Industry standards are about excuses for poor, lazy management. Remember when business leaders wanted to be the best? (not just claiming it, like the Drumph)

Got my packet over the weekend.

I'm in the high deductible plan (called HD1 here). Two other plans are offered, another high deductible plan with high premiums but lower deductibles (HD2) and a standard PPO with the highest premiums and lowest deductibles (PPO). In all cases the premiums are going up by $17/month. For HD1 that is a 18% increase, but it's only a 7.7% for HD2 and a 5.1% for the PPO. So for covering a family, HD1 is about $110/month, HD2 is around $240/month, and PPO is around $350/month.

The deductibles (personal/family) stay the same for HD1 ($2800/$5600), but increase for HD2 and PPO. There is no change to the company's contribution to our HSA (for HD1 and HD2 only) - $1200/year donated in January. There is no change in coverage other than which prescriptions are covered (as managed by CVS/Caremark).

We sign up for Dental every 2 years and this is the year. There is no change in coverage. I have to double check the premium...I think it goes up about $5/month.

We sign up for Vision every year and there is slight change in coverage around payment for lens coatings. It think that was the only think that changed - they now cover one coating. I think the cost increased $5/month.

stessier wrote: There is no change in coverage other than which prescriptions are covered (as managed by CVS/Caremark).

have fun with that

Knock me over with a feather - just got our details for next year. No deductible changes / no premium changes / increased credit for wellness screening. And while not health care related - they added a loan consolidation benefit. I just refi-ed my student loans but I can shave another 2% off by going with this option.

Also, having been through a few rX companies - the one I had the least trouble with by far was CVS/Caremark. Our previous one Express Scripts was harder to use IMO from a reimbursement standpoint. Ordering was harder as well. I know they are well-regarded but it was a step down from CVS/Caremark imo.

My company renewed our tiny Blue Shield group for a 3% raise in costs. I was happy with that.

hitbyambulance wrote:

stessier wrote: There is no change in coverage other than which prescriptions are covered (as managed by CVS/Caremark).

have fun with that

We've had them for the last 5 years. Never had any problem, but we aren't on any maintenance medications so really only use them for random illnesses.

Things changed pretty drastically for me this year. Excluding a couple of fringe PPO/HMO options that I don't consider, we basically have a Gold/Silver/Bronze trio of plans to pick from. I looked at the numbers last year, and the Gold was my best option. For full family coverage (wife and kids), my premiums were $277/month. We had a deductible of $2,600, "coinsurance" of 90% (i.e., after meeting deductible, insurance pays 90% of costs and we pay 10%), and an out-of-pocket maximum of $6,000. They nearly doubled premiums on Gold this year.

Gold
Premium: $424/month
Deductible: $2,600 (family)
Coinsurance: 90%
Out-of-pocket Maximum: $8,000

Silver
Premium: $160/month
Deductible: $3,000 (family)
Coinsurance: 80%
Out-of-pocket Maximum: $10,000

Bronze
Premium: $50/month
Deductible: $5,000 (family)
Coinsurance: 90%
Out-of-pocket Maximum: $12,000
Bonus: Company will match first $1,000 of HSA contributions

Since we hit our out of pocket maximum every year, it's really a question of adding the premiums and out of pocket maximum to find what we'll end up paying.
Gold - $13,088
Silver - $11,920
Bronze - $12,600

If I add in the HSA match that's only available with the Bronze plan, though, that drops its total cost to $11,600. Last year's total cost was $9,324, so Bronze costs $2,276 more than Gold did last year. I'm going for the Bronze!

Wow. You have some awesome insurance. What you get this year for a family. I got last year for one person. Though I must admit I have no idea how much the company contributes to the monthly premium. I play almost nothing. $60 a month but that is no indicator of how much I am subsidized by the company. They don't publish this information, so as not to create friction, I think. Where people getting their entire families insured are getting some obscene amount more subsidized in coverage then say someone like me.

Not looking forward to the increases in December. This year has already been insanely expensive and it's not done yet and I think I am actually approaching that $8000 out of pocket maximum. I would have blown right past it if they put rehab in my FMLA after my three days of for heart surgery. Which makes me want to fit more stuff in this year before the reset.

Update with some real numbers. The options I am looking at for in-network, covering just myself are:

Choice Plus
$65/month (They say it would be $518/month but company is covering a chunk of the cost)
$800 deductible
$3000 max out of pocket
20% Coinsurance (preventative care is fully covered)

Consumer Choice
$40/month (They say it would be $497/month but company is covering a chunk of the cost)
$1500 deductible
$3000 max out of pocket
20% Coinsurance (preventative care is fully covered)
HSA available - company contributes $250 - you can roll over $500

Consumer Max
$20/month (They say it would be $458/month but company is covering a chunk of the cost)
$3000 deductible
$5000 max out of pocket
20% Coinsurance (preventative care is fully covered)
HSA available - company contributes $500 - you can roll over $500

Haven't seen the details yet so I don't know what's happening with deductibles but we were informed that our premiums with United Healthcare are going down 15%.

WTF.



Thanks Obama!

Toe wrote:HSA available - company contributes $250 - you can roll over $500

Are there really different rules for HSAs? I thought one of the benefits was that they were all the same, portable, and the money never disappeared. After 5 years I'm up to $6000 in my account and only donate around $3000/year.

company is now super trying to push HDCP, including announcement emails, mail fliers, informational meetings, etc. the mail flyer is rather insultingly worded and maybe just a bit misleading on all the 'benefits' of HDCP. my company is well known for being overly penny-pinching/cheap (and i am soon being laid off so they can hire someone else in Canada for a much lower salary), so i am 100% suspicious of their motives here.

HDCP is better for the company and varies greatly in benefit for the user. I like it but I don't have any children and can max out my HSA which is nice when say you get hit with a 10000 dollar dental procedure like I did earlier in the year. I have friends who max out the HSA and spend it all and come out if pocket to hit the out of pocket max. You have to really analyze your own situation if you have a choice.

My packet came last week. It is sitting on the kitchen table. I'm afraid to open it.

malchior wrote:HDCP is better for the company and varies greatly in benefit for the user. I like it but I don't have any children and can max out my HSA which is nice when say you get hit with a 10000 dollar dental procedure like I did earlier in the year. I have friends who max out the HSA and spend it all and come out if pocket to hit the out of pocket max. You have to really analyze your own situation if you have a choice.

Yeah, if you start an HSA when you are young and healthy, they seem great. Until you realize that you are effectively insuring yourself, without the advantages of pooling risk.

$0 increase but CVS pharmacy was kicked out of system and they're forcing prescription need pre-authorization to push preferred meds.

With two insulin-dependent diabetic children and a wife with complications from surviving two car accidents, we max out every year on the out-of-pocket on the expensive HD plan.

Mandatory coverage under Obamacare is critical to our family's long-term survival. I have a well paying career, but handling insurance is nearly a second job for my wife. She knows how to pursue our appeal rights and to juggle the bill payments.

Going to try to get better on tracking the total expenses for tax deductions and HSA in 2017 -- we've been treading water dealing with health insurance the past 3 years.

Zarathud wrote:$0 increase but CVS pharmacy was kicked out of system and they're forcing prescription need pre-authorization to push preferred meds.

Interesting. We have Blue Shield and they are dumping current drug setup and going all in for CVS. But Blue Shield has been a pain for my wife getting one med she prefers.

HSA contribution was cut nearly $1,000. OOP maximum went up $2,000 by applying a 10% copay after we have hit the $4,000 deductible in our high deductible plan. Premium went up another $1000 in my case. Yeah....That's $4,000 in increased fees in a year where I got a 1% increase.

We also heard the spiel about "bringing us in line with industry standard." It's really painful to the folks at the bottom of the pay pyramid and there's been a lot of sqwaking about it. A few years ago I shopped my services around and one of the reasons I stayed on board was the gold plated health care. With the increase, we're still WAY better than what several places in town are offering.

Isgrimnur, Sep 21, 2016 wrote:And for cross reference purposes (pay periods are 2 weeks):

Self $35/period (my selection)
+ kids $177.74
+ spouse $225.83
+ spouse and kids $356.18

And again, spouse coverage is not available if coverage is available through my wife's work, which it is.

Self $35/period (my selection)
+ kids $190.10
+ spouse $241.56
+ spouse and kids $380.90

No increase in OOP maxes ($6k/12k) in network.

Effective November 1st.

July 2017 our union negotiated a 4% pay increase. October I get my merit raise which is 5% Jan 1st my healthcare plan goes up 8.2%. So my 9% raise goes down to 0.8%

I don't think math works like that, unless your plans is going up 8.2% of your salary.

Company had a shitty year so I'm expecting the plan that couldn't possibly get worse to somehow get much worse.

As it is, there is no benefit until I hit a $12K deductible. The cost is so high that my wife, who ostensibly makes 50% of what I do but doesn't pay for insurance, brings in almost identical take-home pay.

Midway through Wife's acquisition of a bionic mouth, our dentist decided to drop out of Delta's preferred provider network. Apparently all the cool dentists are doing it since Delta cut their allowable charges for the second year in a row; to hear our dentist tell it, the professional rebellion is so widespread that Delta is ending their PPO next year. What that means is that instead of paying the capped price, we will now have to pay retail, and Delta will reimburse only 60% of the capped amount rather than 80%. And that means that her remaining procedures are going to be a lot more expensive if she doesn't change doctors (which neither of us wants to do). Even routine cleanings went from being free to costing $60 out of pocket, so I'll be cutting those back to once a year.

We are hoping that her employer will dump Delta, or at least offer Blue X as an alternative. That's the only network he's in now, and we would pay handsomely for that.

I work for a really tiny company, so they outsource the benefits to a PEO (professional employer organization). We just switched PEOs, and I switched my insurance to a high-deductible plan, where I don't actually have to pay a premium (the company covers 100% of it). So between not having a premium or a co-pay, and the deductible and OOP max on the "regular" plan that they offer, and depending on how much I actually need to go to the doctor, I'll have to see if I come out ahead this way.

It seems the only way to play the game these days is to either never get sick, or go whole hog for the out-of-pocket max if you do.

Yup. We finally hit our annual deductible, so I'm in the processes of making various doctor's appointments now, fully expecting that I'll need a head gasket replacement or a new transmission. Hopefully I can fit that all in between now and January, because then it's back to hoping nothing goes wrong between January and September.

am I reading that right, that you hit your annual deductible in September - and that’s the “nothing goes wrong” scenario? On the plus side I guess, if something goes wrong, you’ll hit it faster I suppose.

RunningMn9 wrote:am I reading that right, that you hit your annual deductible in September - and that’s the “nothing goes wrong” scenario?

That is correct. We are maintenance healthcare consumers. I think we have a $5K annual deductible with our plan. Now that we've hit it, I think it's 90/10 for additional services rendered. Our healthcare plan is total garbage. Unless, I guess you're a healthy, single 25 year old male. Then it's probably terrific.

...and I am waiting to get my Sciatica diagnosed until next year because we haven't touched our deductible this year. They are going to want an MRI to diagnose it and I would be 100% out of pocket on it. No thanks.

Smoove_B wrote:

RunningMn9 wrote:am I reading that right, that you hit your annual deductible in September - and that’s the “nothing goes wrong” scenario?

That is correct. We are maintenance healthcare consumers. I think we have a $5K annual deductible with our plan. Now that we've hit it, I think it's 90/10 for additional services rendered. Our healthcare plan is total garbage. Unless, I guess you're a healthy, single 25 year old male. Then it's probably terrific.

How are you spending $5k on maintenance health care?!

Oh, there's lots of stuff. Nothing I'm comfortable sharing on a public discussion forum though. I can say that I have spent exactly 0 dollars and 0 cents on healthcare this year. Same as last year...and the year before. But other people in my household? There you go. For me this year? Go big or go home...at least over the next 3 months. I think you'd need to go back about 5 or so years to find my last point of service. And even during routine well visits the doctor's office managed to submit my blood testing in such a way that I was hit with a $500 lab bill. If they coded it correctly, it would have been $50 or some other token amount. This is why I refuse to go to doctors. It's absolutely impacting my health but so is arguing with insurance companies and front-end office workers that don't understand how to code a test.

Regardless, this year was slightly different with some more testing and general procedures done than in prior years. I think we usually hit the deductible closer to November.

Smoove_B wrote:

RunningMn9 wrote:am I reading that right, that you hit your annual deductible in September - and that’s the “nothing goes wrong” scenario?

That is correct. We are maintenance healthcare consumers. I think we have a $5K annual deductible with our plan. Now that we've hit it, I think it's 90/10 for additional services rendered. Our healthcare plan is total garbage. Unless, I guess you're a healthy, single 25 year old male. Then it's probably terrific.

So major surgery for everyone as Christmas presents?

Got the packet last night.

For the High Deductible plan we are in - () indicate increase/decrease from 2017

Premium - $140/month (+$26 - 23%!)
Individual deductible - $2900 (+100)
Family deductible - $5800 (+200)
Co-insurance after deductible is met - 15% (+5%)
Dental with 2000/year max benefit - $49/month (+$4)

HSA contribution max went up a bit, but I think that limit if federally mandated.

The other plans (another High Dedutible - but less high- and a PPO) also increased, but at a much lower rate.

Not real happy and don't appreciate the notes throughout the packet that while the increases are high, they are still less than the companies we consider competitors for our talent.

stessier wrote:Got the packet last night.

For the High Deductible plan we are in - () indicate increase/decrease from 2017

Premium - $140/month (+$26 - 23%!)
Individual deductible - $2900 (+100)
Family deductible - $5800 (+200)
Co-insurance after deductible is met - 15% (+5%)
Dental with 2000/year max benefit - $49/month (+$4)

HSA contribution max went up a bit, but I think that limit if federally mandated.

The other plans (another High Dedutible - but less high- and a PPO) also increased, but at a much lower rate.

Not real happy and don't appreciate the notes throughout the packet that while the increases are high, they are still less than the companies we consider competitors for our talent.

damn, I would kill for that insurance......

There isn't a day that goes by that I wouldn't gladly bury a body for my employer. $0 premiums for an excellent PPO plan.