Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktBackground
We bought the business my husband worked for the 23 years prior in 2001. We moved it from Huntington Beach to Riverside, CA, brought one employee with us and hired two more. I quickly became a payroll, tax, insurance, quick books, import/export, and photo shop expert of sorts. One of my trickiest jobs though was maneuvering through the maze of health insurance issues. We slogged along for about four years in this manner approaching retirement age. About six years ago we decided to move the business to our back yard and built a warehouse, transformed two bedrooms into offices, brought in three more phone lines with an elaborate phone and intercom system and set up a wired network for the computers etc. and voila we’ve been working from home since 2006. Our employees had drifted off one by one and we kept downsizing as necessary due to both our interest in slowing down and the business climate, so the move ended up being fortuitous. One of the expenses that always caused the most consternation, other than lease agreements of course, was the cost of health insurance.
Small Group Insurance
We originally planned to be semi-retired by this year and in many ways we’re close. When we built the warehouse and moved the business home, according to city ordinance, we are not allowed to have employees unless they live in the home. Obviously, before making this kind of commitment and the expense of building a warehouse, I needed to verify that with just the two of us we could maintain an employer provided health insurance plan. Luckily, any business with between two and twenty employees qualifies for small group insurance. Here in CA you’re required to submit tax returns and DE6 verification as proof, and sole proprietorship plus one employee qualifies. Otherwise, we’d be stuck searching the individual market, and at our age it would probably be priced exorbitantly or nearly impossible to qualify, even though we are quite healthy still. Honestly, we already feel we’re paying exorbitant prices so it’s difficult to imagine anything higher.
In addition to the yearly increases, based on some formula I’ll never be able to decipher, rates increase every five years on your birthday. In other words, when a person turns 60 their rate jumps up compared to someone who is 55. Since 2005 our rates increased substantially and by 2008 we were paying $1600/mo for the two of us for what is comparatively a modest plan with lots of cost sharing. I began looking around for a change on our renewal date of Nov. 1 and managed to switch from Health Net to Blue Shield and we saved about $3000 in 2009, but of course the real savings came with even more cost sharing. Last year I turned 60 (yippee), and so of course we faced another big increase, and by Nov. of 2010 we were looking at $1700 per month. The obvious thing was to begin looking around again. By this time I had taken over the job and no longer used an agent, so I’m pretty familiar with the ins and outs. I have learned that it’s much easier to make changes if you stay within the same company umbrella rather than change carriers.
A local access HMO 30 saved our bacon and we managed to lower our monthly cost to $1500 and keep our doctors group, local hospital and network of specialists that we’re somewhat familiar with. We received our new cards and put them in our wallets.
Yesterday
Every year in September my husband and I begin our yearly exams and let the doctors poke and prod us within reason. Neither of us has been to the doctor since we received our new insurance cards November of last year as we had a good year health wise. My appointment was yesterday morning and I showed up with bells on since I hadn’t been in the office since last year, and was chatting with the usual suspects (a couple of whom I’ve known for 30 years) and what not, when the gal at the desk called me up to speak with her. “I have good news and bad news”……………Oh no. “You’re covered but you need to go to Pomona to see your new doctor” and I quietly shrieked “You’re kidding me right?” Apparently, some wires were crossed last year and we were put into a local access group that’s about 40 miles away. So I flew home and called the insurance company and lo and behold our medical group doesn’t belong to a local access HMO and the nearest one is in Pomona, which apparently the card I’ve had in my wallet for the last 10 months clearly states.
You can switch health providers as long as they accept the insurance you have, but you can only switch health care plans once a year on your renewal date. So right now I have routine blood work and imaging referrals on hold until after Nov. 1, when we’ll switch to yet another plan. If anything happens to either of us in the meantime we get to go see a doctor we’ve never seen who’s 40 miles away. My husband told me yesterday, “No more horse back riding until after Nov. 1st for you young lady”.
Here’s the tricky part. In order to keep our premium in the $1600 range (OMG) we’re switching to an HMO 40 which, if you know anything at all about health insurance, just increased our cost sharing not incrementally but almost unaffordably. I’d say my horse back riding days are over. Another twist, as I had the one prescription I take without any renewals going forward, I went ahead and paid the cash customer fee to see my doctor. In the last 10 months we’ve paid $15,000 for health insurance with only a few prescription costs and I still had to spend $90 for a doctors appointment, sheesh.
I’m not really sure if people who have employer provided large group insurance understand the trials and tribulations or the cost of health insurance compared to the rest of us, so I’m curious what other experiences might be shared by our little group here.
Filed under: Uncategorized | Tagged: healt insurance, HMO, local access, small group |
All Things in Moderation 
The main reason I pursued a new job as vigorously I did was insurance. I could see the writing on the wall. It had not been communicated to me, but it was clear my insurance in the coming year would be $24,000 (a 106% increase from the previous year, or 112%, I don't remember now) if the company stuck with Blue Cross. I believe they ended up going with some mystery insurance company, but I'm not sure: I had left by then. Part of a pool of 5000 employees, my insurance is $9000 per year. That's a far cry from $24,000. Prescriptions are $10 more. Coverage works differently, worse in some places, better than others (I'm under Cigna now). But, on the whole, I'm glad. And I like my job a lot, but it was insurance that ended up making me make the leap.They offer cheaper solutions with much poorer deductibles, and if I was single and childless, I might go that route instead. However, I'm not, so the more expensive route for me!
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But like a rock always suspended over my head, I know medical insurance will be a problem again–and perhaps until I die, if Medicare goes away. But . . . whatcha gonna do? Gotta take life a day at a time.
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I think a lot of people make the same kind of decisions, especially with children, around health care and insurance issues. We would have gone with a catastrophic only policy I think, but that option isn't even offered in the small group pool. A little over $19,000 for two healthy, albeit older, people just seems outrageous to me. And that doesn't include the costs of our share if we do happen to get sick.
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"Gotta take life a day at a time."Especially on a Friday.
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High deductible policies are usually the only other real option. But I'd go without. And, I agree, outrageous, but it's done based on what people in your demographic, collectively, might cost them . . .
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As a healthy, young, male, married to a healthy, young, female, my interactions with health insurance has laregely been non-existent. I also was fortunate enough to have a fantastic health plan at my old firm that was pricy, but mean that when I had my ACL replaced I paid nary a dime. This is all about to change significantly with my son due in 7 weeks and a less awesome health plan. Needless to say, I'm not looking forward to it. What has always struck me about the health insurance is that it is so difficult to understand. I barely understand the EOB's I get, mostly I just look at the amount due and write a check or fill in my credit card information. It probably isn't even worth the time it would take to better understand it. I know lots of people that have made employment decisions based largely, if not primarily, on health insurance, included my 24 year-old sister-in-law who recently changed jobs. My mom and mother-in-law chose their jobs in no small part to health insurance. It's easy to sort of ignore that, but there might be some significant economic waste if people are working jobs that don't utilize their human capital just because the job offers better health insurance.
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The obvious solution is to get rid of employer provided health insurance and replace it with a single payer system that we can all buy into from birth, whether through a tax or premium system, I don't care. I know it's a pipe dream but that's where we're headed anyway, might as well get it over with.
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ashot: I have no idea why they pay some stuff and don't. I have a bill that's about a year old that I haven't paid, mostly because they seemed to have billed me 3 times for 1 thing, and I want it broken down and they can't . . . and I think it's just because they want to try and get more money out of the insurance company. But it's hard to tell, because it's all so dense. Single-payer can't ever cover everything, but, clearly, some basic level of universal healthcare, +extra insurance to cover other stuff, is likely to be where we end up.
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I had dreamed of going the independent route in my career. Then I discovered I had an incurable, chronic, progressive disease which would eventually put me in a wheelchair. So I developed new priorities and, quite frankly, looked for ways to have my needs met without going bankrupt by age 55.For the most part, I pulled it off. But with health care costing what does in this country, not everyone can or will. In simple terms, I see America's health care split between the haves, the strugglers, the finger-crossers, and those on the outs. That's how we ration medical services here. Is that what's best for the country? Lots of different views on that. Lots of disagreement. Lots of money at stake.
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It's as if we've become a nation being consumed by the medical industry. MsJS, we have friends who faced a similar predicament, unfortunately the health complications came after branching out on their own. It has been a major struggle to keep ahead of the medical bills and the unfortunate disease. I think you made the right decision for you and I wouldn't mind having breakfast at your house either.
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I don't accept that our "system" rations. Rationing requires a rationing authority. Our health care is not rationed. Just as our food isn't rationed.The the incentives in our "system" distorted by the tax and insurance laws, as well as the exploding government health care programs. Single payer/socialized medicine cannot solve those problems; it can only contain costs with true rationing. My vote is no.MsJS, have my admiration and respect, however, for dealing with your situation.
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Wow, my typing is horrible. Sorry.
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And if you think your retirement benefits, even in private industry, are safe, think again.This might be an interesting book to read. America is in the midst of a retirement crisis. Over the last decade, we've witnessed the wholesale gutting of pension and retiree healthcare in this country. Hundreds of companies have slashed and burned their way through their employees' benefits, leaving former workers either on Social Security or destitute — and taxpayers with a huge burden that, as the baby boomer generation edges towards retirement, is likely to grow. It's a problem that is already affecting over a million people — and the most shocking part is, none of this needed to happen.As Ellen E. Schultz, an investigative reporter for the Wall Street Journal, reveals in her new book, "Retirement Heist," it wasn't the dire economy that led these companies to plunder their own employees' earnings, it was greed. Over the last decade, some of the biggest companies — including Bank of America, IBM, General Motors, GE and even the NFL — found loopholes, abused ambiguous regulations and used litigation to turn their employees' hard-earned retirement funds into profits, and in some cases, executive compensation. Schultz's book offers a relentlessly infuriating look at the mechanisms they used to get away with it.
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QB, I get what you mean about rationing. I believe rationing can occur without an authority managing it. You don't. OK. Let me rephrase then. Americans' access to affordable quality health care differs dramatically. I would posit that some of the reasons why are structural and, to some degree, have been reduced in other industrialized nations. lms, long ago I worked briefly at a large company whose name you would all recognize that plundered the pensions. So did many of its direct competitors. It's been going on for at least 25 years.Breakfast anyone?
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