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Feeling the insurance $$ pain for 2014

Discussion in 'Parents of Children with Type 1' started by BrendaK, Nov 5, 2013.

  1. BrendaK

    BrendaK Neonatal Diabetes Registry

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    We have Anthem BCBS of Ohio PPO for our insurance through my husbands employer. It is a great policy -- covers CGMS, pump stuff, no problems with anything (and we've had a lot of medical bills). We pay for it though with premiums and we will REALLY pay for it next year. Our premiums are staying pretty much the same, but the coverage is going to hurt. Actually, the coverage is the same, it's the deductible and OOP maximums that are changing. I hear this is VERY common across the board.

    Currently we have:
    $400 individual/$800 family deductible. We pay 20% after that until the $1500 individual/$3000 family out of pocket maximum for the year.

    New 2014 coverage is
    $1000 individual/$2000 family deductible. We pay 20% after that until the $3000 individual/$6000 family out of pocket maximum.

    OUCH. That's a huge change in the pocket book from last year. Plus we have Express Scripts that will no longer cover Novolog.

    I am super thankful to have insurance in the first place, I know many others do not. I am wondering who else is affected by crazy changes in their policies. And, BTW, this is the very best option the company offers. The other deductibles are between $2500 - $5000 per person, more for a family. It's not the company that is suddenly being stingy with benefits -- it's Anthem raising the rates so much that this is all the company could afford. Things are getting pretty crazy out there.
     
  2. nanhsot

    nanhsot Approved members

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    What makes me crazed is blaming pre-existing conditions on rate hikes. Seriously?? *WE* are paying for those conditions for the most part. Looking at my EOB for his pump and my insurance paid $880, their contracted part. Me? I paid 20% of the actual price (pump + supplies), which equals $200 over 10 months. I am paying more for the pump than my insurance has to.

    It's a crazy crazy world. I'm also thankful for insurance, but I'm going to go bat crazy if I keep hearing that the reason prices are rising is due to pre existing conditions. Those with the conditions know quite literally that the consumer is taking the hit on a LOT of the costs of things.
     
  3. Lexie251

    Lexie251 Approved members

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    I could not agree more. I about had a stroke when I went to the pharmacy in January. We had to switch to walmart brand on everything besides insulin. My first bill was $1000. I think what makes me the madest is when she was diagnosed three months supply was $150 cause of where I was in my deductible. I feel like diabetes should be treated different then other medicines since its a must for our children to survive. I have been researching Canada for her supplies.
     
  4. MomofSweetOne

    MomofSweetOne Approved members

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    I'm still reeling in shock at the income of the Express Scripts CEO. $12.8 Million and they're cutting our meds because they need to cut costs? I know where I'd start cutting & it wouldn't be with meds. His 50% raise sure wouldn't have happened.
     
  5. obtainedmist

    obtainedmist Approved members

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    We are self employed and have always paid 100% of our health insurance premiums. I'm feeling very thankful that we can put our 21 yo with T1D on a difference plan...finally! Not being part of a company sponsored insurance plan, we have been stuck for 3 years due to pre-existing. Now, we have dd on a plan that has higher premiums but saves us $500/year because it covers more with a lower deductible. My husband and I are going with a more modest plan. Our son in CA has qualified for a subsidy and can afford his own insurance for the first time! I'm thrilled!
     
  6. sincity2003

    sincity2003 Approved members

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    We are another Anthem BCBS member here. Our current plan is $750 deductiblee per person, $1500 family, pays 80/20 after that and no deductible on our prescriptions, but we do have "plan minimums" on the prescription side, meaning something that cost us $9 on his old BCBS plan costs us $50 right now.

    Next year, we have 2 options. We can take a $500 deductible per person, $1,000 family, pays 90/10 and no deductible on prescriptions or we can do the high deductible plan, which is $2500 deductible, pays 80/20 after it's met, but that $2500 also applies to our prescriptions. If we take the first option, our insurance more than doubles each week. If we take the second option, our premium goes up $1 a week, but then we have to come up with that $2500. Right now, we're taking the second one and just stocking up on all his prescriptions in December, so that we have until March to save up the $2500. Also, we won't have the stupid plan minimum clause, so that $8 prescription will go back to around $8 and not the $50 we've been paying.

    In 2015 our only option will be the high deductible plan, so we figured we might as well get used to it this year.
     
    Last edited: Nov 6, 2013
  7. Beach bum

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    We have pretty much seen the same type of increase. We know our co-pays on scrips is going up, but not sure of the exact amount. Still waiting on that letter.

    If I hear one more time it's due to pre-existing conditions, I think I'm going to scream.:eek:
     
  8. sincity2003

    sincity2003 Approved members

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    My husband's employer did not blame it on pre-existing conditions. They came right out and told us, in a letter, that our current plan is considered a Cadillac plan and if we kept it, they would have to pay a penalty tax on it. They are willing to do it for one more year, to give everyone time to transition, but after that, they will not pay the penalty and will not offer the plan.
    Basically, our insurance is "too good" and since everyone can't have it, neither can we :(
     
  9. MomofSweetOne

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    Same here. Ours will change as soon as the penalty is about to kick in.
     
  10. Kunkfam

    Kunkfam Approved members

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    This is what bothers me about the changes! I'm sorry that your insurance is changing so drastically! There has to be another way to help others with healthcare WITHOUT making it worse for the ones that already have good coverage! I know I am shooting myself in the foot for saying this but I greatly dislike most of the changes that are being made. Our right of choice is being taken away and I am not ok with it!
     
  11. Beach bum

    Beach bum Approved members

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    I think this is going to become a common occurrence in the next year for many.

    We are "fortunate" in the respect that hubby's company offers 3 different plans to choose from. They have a "cadiallac," mid-level and bare bones plan. Basically it's out of necessity since they are a world wide company and have to offer something for everyone, including expats. Plus, the majority is based in MA and it's been several years where insurance coverage is mandatory.
     
  12. Gomod71

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    My husband's employer's policy was $2500 per person deductible ($5000 fam), and diabetes supplies only covered at 50%. I feel your pain! :(

    We ended up putting my son on the state insurance and pay the out of pocket premium because we make too much (barely!) for the lower medicaid rate.

    It kills us to pay the monthly premium but when I figured it out dollar for dollar, it was the better route to go. At least with the State Husky insurance, all his pump supplies, Dex and sensors and strips are covered 100%, with managable $10 copays for insulin. We also didn't pay a dime for his pump when it was time for a new one.

    Good luck!
     
  13. MEVsmom

    MEVsmom Approved members

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    We are fortunate to have the BCBS federal employees plan and from what I can tell the changes are not staggering. I cannot complain about any insurance though as my family gets way more out of the plan that we pay in premium, no matter how you look at it. I have two children with chronic illnesses, one of them terminal, with a whole heck of alot more expense than T1D. I figure that my children together take about $3000 worth of medication/supplies per month at least and I am not bearing a ton of the burden. We will meet our deductible in the first few months of the year I would suspect and then it will all be covered 100%. We have had 2 ICU visits in less than 8 months, one for each and my older daughter was in the hospital for 10 days. We also got a new wheelchair, the second in three and a half years that cost BCBS $8,000. I am getting the winning end, no matter how I look at it as my premiums are less than $500/mo and the deductible is something like $7500...still way less than $36,000 +.
     
  14. liasmommy2000

    liasmommy2000 Approved members

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    My employer provided insurance has gone up every year for several years. Probably every year for the last five years. Premiums mostly, some copays. Same coverage otherwise, great coverage of D supplies, no copays for most, they cover DME at 100%.

    This year my premium went down by $3 a month (lol, woo hoo, party time) and copays went up slightly ($5 increase for office visits and a $25 increase for emergency room visits without admittance) . Same coverage for D supplies and DME.
     
  15. KatieSue

    KatieSue Approved members

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    Mine has gone up the last few years too - copays, premiums etc. $5 this year, $5 the next. Dr. visits started out as $10 now we're up to $35.
     
  16. sincity2003

    sincity2003 Approved members

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    I don't believe anyone would be here complaining (if that's what we want to call it) if their co-pay was going up $5 or $10, or their insurance was going up $5 or $10 a month. In our case, if we want a plan comparable to the plan we have right now, we will pay more than double what we pay this year. And it's directly related to the ACA and it's determination of a Cadillac plan that is unfair because not everyone can have that plan.

    The ACA was designed to help 6% of the population. What about the other 94%?
    Also, the employer mandate was postponed to January 1, 2015, so even if your employer didn't cancel your plan this year, or offer it to you at a much higher price, don't think it won't happen next year at this time when it kicks in. That's when the penalty tax on these so-called Cadillac plans kicks in.
     
  17. Megnyc

    Megnyc Approved members

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    2 things about the "Cadillac Tax"

    1. Like most excise taxes it only applies to the amount over the threshold which is $27,500 for family coverage, which works out to a premium of $2300 a month. Anything over that will be taxed at 40%.

    2. It doesn't start until 2018.

    http://www.uhc.com/united_for_refor...ovisions/excise_tax_on_high_cost_coverage.htm

    We have seen minimal changes. I think the premium went from $330 to $346 a month for family coverage. $200 deductible then 90% coverage until the $1500 individual out of pocket max. Family out of pocket max is $2000 I believe. The only changes are that if you have a same sex partner you get $41 a month to pay for the tax on their coverage and copays for office visits and prescriptions now count towards out of pocket max.
     
  18. mamattorney

    mamattorney Approved members

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    I was just asking my husband about this (we use his insurance). He said the company kept the plan, but since the increase was pretty big, employees are going to have to share more in the cost. Not sure what the increase will be paycheck to paycheck yet. We pay about $400/mo in premiums now.

    It's a Cadillac plan as well. Not sure how much it goes over the limit.
     
  19. Jordansmom

    Jordansmom Approved members

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    No offense, but I think a lot of people are calling their insurance policy a "Cadillac plan" without knowing that it really is. Whether that is a personal misconception or misinformation being passed on from an employer wanting to reduce insurance costs and then blame it on the Affordable care act.

    "A 40 percent excise tax will be assessed, beginning in 2018, on the cost of coverage for health plans that exceed a certain annual limit ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). Health insurance issuers and sponsors of self-funded group health plans must pay the tax of 40 percent of any dollar amount beyond the caps that is considered "excess" health spending.

    How many people actually have a family policy that costs $27,500 a year? That's a premium of $2,300 per month. We almost always choose our employers best coverage and the total cost including employer and employee premium is nowhere near $2,300 a month. Plus the tax doesn't go into effect until 2018, so any employer claiming they're cutting benefits this year because of the tax is full of crap.

    The problem is so many people are falling for the scam hook, line, and sinker. The reality that companies are cutting coverage is devastating for people in our situation and those who are affected can't change it. But check the facts of your individual situation and start placing the blame where it belongs.
     
  20. sincity2003

    sincity2003 Approved members

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    My husband works for one of the largest employers in the country. They have right on their site the breakdown of what they pay/what we pay. Our plan is definitely a Cadillac plan. Our plan was also supposed to be a grandfathered plan.
    The blame belongs solely with those who passed the law in the dead of night saying, "We have to pass the law to know what's in it" and "If you like your plan, you can keep your plan, period."

    While I believe all people should have access to health care, the ACA isn't the way to do it. The name alone leads one to believe it's affordable. Those of us having our plans canceled and plans that cost more and cover less don't think this is affordable.

    Where exactly would you like me to place blame? That big, bad insurance company that pays out hundreds of dollars every month to keep my DS alive?
     

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