Forgetting my insurance limitations

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Health insurance in the States isn't complicated, it's barbaric. It's a miserable hodge podge of private policies (that are really only affordable if you're young and healthy), group policies through employment (that employers are now doing their darndest to wiggle out of), Medicare (for seniors) and a quasi-federal policy administered by the states for the poorest people (called Medicaid). Then some states have high risk policies for adults, more have a program for children.

There are huge gaping holes. And there's no control on prices of medications. Mine would run somewhere around $750 per month if I didn't have a Cadillac policy (due to my husband being a retired State employee); his would run @ $600 per month. We pay @ $130 per month for both of us. A great deal for us; unfortunately there are millions and millions of people who don't have benefits.

It's a disgrace. And much greater minds than mine have attempted to grapple with the problem and it simply continues to worsen.
 
I agree with Georgia, and I manage a benefits program!

A lot of the problem is that the majority of small companies are self-funded. This means that they pay claims up to the stop gap. But, what it also means is that one person in a company with a serious illness can drastically change everyone in that company's premiums, and it's usually a dependent with the serious medical condition, not an employee. Example: We have a spouse of an employee with breast cancer. By the time her claims are done, it will easily hit $1 million. This means that the plan as a whole is over by approximately 40% of the expected run rate. This trickles down to every employee sharing the increase cost of that incident by their rates jumping by approximately 18% and increasing the cost of the insurance to the company by $120,000 per year to approximately $450,000 per year. My boss keeps joking (at least I think he's joking) that he's going to start feeding the employees greasy, fat laden foods so they'll kick the bucket and get off the plan!

This is why small employers are perceived as "gouging" their employees, because they are self-funded and it only takes one large claim to skew the whole plan.

For large employers, they have, by law, what is called "rating flexibility." When a large employer chooses a company such as BC/BS or United, they are being quoted a fairly good rate for the company. BUT, what can jump their rates up 10% is the health questions at enrollment, not before! So, if you have employees that have chronic health problems, have had issues in the past such as AVR, the ratings flexibility program dictates that the rates will jump 10%. Less common is the fact that, if your enrollment questions come in and everyone's pretty healthy, it can drop them by 25%. Our broker jokes that, if one person had a hangnail in 1986, they would consider that a risk and jump you 10%! This jump is in addition to the insurer increasing the maximum experience premium, not a replacement of it! That's why you see rates jumping 35-40% in one year.

One thing that's unique about the company I work with is that the large claims are coming from the senior level and VP level staff! I laugh at the irony of it!
 
Georgia, thanks. My kids all have insurance. It is me, the mom, who has none. To date I am so healthy, so active. I take synthroid b/c I lost my thyroid on my last pregnancy. Took a toll on me. But, I can find that pretty cheap on the internet, not much diff in price from what I was paying with ins.

The thing I am worrying about is if I have heart problems too. I need ins. I will get a real job next year, this year I am a substitute teacher and a mom. I am just so worried. I have symptoms, but ignoring them. Don't want to have a pre-existing condition. My father and my daughter have BAV. I know I must as well. But not gonna go there. I can't. No, I can't. I can't ask for a check up as a cash patient, no I can't. I won't go there, I can't afford to. Plus, it will all be fine, it always is, and I am strong and active, really. Thanks for listening!
 
Where in Wisconsin are you looking & what kind of work? I have some thoughts specifically related to WI employment - and insurance. Feel free to PM me & I'll try to offer some help.

Cris
 
della_anne noted:
"It sucks that there is so much uncertainty involved with the job market. People with health conditions need stability and when you can't get that, it gets frustrating. Its disappointing and discouraging. It means that people with health conditions need to work harder to get what they need."


How true, ironic, frustrating, and downright staggering. Throughout my job searches, I keep running into brick walls that for a "normal" job seeker would just be a bump in the road that they can get over or around with no residual problems. But for those of us with health issues, the brick wall knocks you down and doesn't let you back up ... or crossing that line.

Aye.



Cort, "Mr MC" / "Mr Road Trip", 32swm/pig valve/pacemaker
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"Heaven knows how long it's been since I felt so out of place" ... Garth Brooks ... 'Learning To Live Again'
 
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