Worst health insurance ever?

In My Humble Opinion
1

So I just switched jobs a few weeks ago. They hadn’t taken me off the mailing list yet for the old job, and I got a copy of their new health plan. Just for comparison purposes, here’s a brief summary of the plan before the change:

Premiums were 45 dollars for single, 160 dollars for employee and spouse, 148 dollars for employee and children, and 234 dollars for employee and family, per pay period (two weeks). There were copays for office visits, 25 for primary care, 35 for specialty, and I don’t remember what the others were. Labs and diagnostics were 100% covered, decent prescription coverage, no deductible, and I can’t remember what the out-of-pocket maximum was, but I know it wasn’t too bad.

The new plan is just awful. It starts off on a positive note…the first 500 dollars is covered completely, and there are no copays. But, the full discounted rate for each office visit is coming out of that 500 dollars, and 100% of the cost of labs and diagnostics and prescriptions.

After your 500 dollars is used up, there’s a 3000 DOLLAR deductible. You pay 100% of the full cost of everything until you hit 3000 dollars. That’s for single. For family, it’s 6000 dollars.

After your deductible, you pay 30% of everything, until you reach the out of pocket maximum, 10,000 dollars for single, 20,000 dollars for family.

I told my mom about it, and she says, “well, that’s not too bad…” and I said, “huh? how can that not be bad?” and she says, “well, I assume the premiums are a lot cheaper.” Nope! Same price.

All of my former coworkers that I’ve stayed in touch with are currently seeking employment elsewhere.

Now, maybe I’m naive. Maybe I’ve been a tiny bit pampered with the much better (and much cheaper) health coverage I’m used to (my first real job where I actually got healthcare coverage was with my “new” employer, who I also worked for prior to moving). But isn’t this awful? I’m wondering how exactly they expect to hold on to decent employees. What’s the worst healthcare coverage you’ve ever seen? (Besides not having any at all, of course, that’s obviously the worst.)

2

I’d call that the “incentive to stay healthy” plan. Yes, it’s the worst I’ve ever seen.

I’m afraid as a government employee, I’m a bit spoiled regarding this issue.

3

I work for a giant outsourcing company that takes care of the benefits administration for millions of people. Yes, that is pretty freakin bad. It sounds like it would be better to go without the insurance for the vast majority of people. By some kind of catastrophic protection on the side and be done with the whole thing.

4

That is truly awful coverage.

The quality of coverage, and what you get for your money, has been on the decline for years.

I have to admit, I’m a bit spoiled too. However, even my coverage is not really all that great, compared to what I had.

I pay (or will starting in January) $142.00 a pay period (every two weeks) for self and family coverage. I currently pay $105.00. However, I belong to an HMO.

Co-pays are $15.00 a visit, unless it’s a well-child visit. I have around a $25.00 copay for prescriptions, more if I opt to NOT go with the generic drug. Additionally, some types of drugs are not covered.

If I’m hospitalized for any reason, I will have a $200.00 copay PER DAY for the first three days of my hospital visit. Additionally, there is another $200.00 copay per day for the first three days for docs, procedures, etc.

Being an HMO, I must use the HMO docs, unless my PCM refers me to an outside doc. Additionally, I cannot see a specialist on my own, my PCM must refer me, or I’ll have to pay full cost. The only exception is for OB/GYN care.

There’s more (less really), but I can’t find my brochure right now.

5

These are called high deductible plans and we will probably be seeing more of them. They are not truly evil, as they are an alternative to dropping healthcare coverage entirely as many employers have done.

One advantage of this type of plan is that it tends to make those with a long-term health issue (one that will carry through the “doughnut hole”) pay attention to how to most cost-effectively manage the condition. For example, the Medicare prescription drug plan is like this and I’ve seen a number of letters to advice columns from seniors (well, at least allegedly) wondering if it’s OK to consider generic drugs to save money. Whiskey-Tango and all that! Most of us with managed healthcare of any type have had to consider generic drugs a long time ago (anyone who wants a great debate on generic drugs, feel free to start your own thread). But apparently there are people who had such good health coverage or health before that they have just been going on their merry way subsidizing the pharmaceutical companies’ ad budgets.

Also, these plans can be much less expensive for the company. It’s a shame your former employer is apparently not passing along any of the savings. Or maybe it’s not a shame, maybe it’s the only way they’re staying afloat, who knows. But some companies save enough with this type of insurance to give employees a health savings account to pay the deductible with. Or at least offer a 401-k type account so the employee can pay the deductible with pre-tax dollars, and the money in the account is something of an investment.

Anyway, make sure you know the whole story before you assume it’s as horrible as it sounds at first glance.

6

It is a strange type of HDHP. My problems with it are thus:

  1. The $500 of initial coverage may disqualify him from starting a Health Savings Account.

  2. The premium isn’t any lower than the traditional coverage

  3. the benefits once you reach your deductible are still pretty crappy. The better HDHPs have zero or veryl low copays once you hit the deductible.

  4. The Out of pocket is very high. Your total risk exposure should be $3000-$5000 including your deductible

  5. The sad thing is that most companies can go to a HDHP (like $1500 deductible with $10 copays after) AND fully fund the employees’ HSAs AND still save significant amounts of money.

The OP’s company needs to find a new insurance broker.

7

That $500 first dollar coverage sounds like an HRA. I agree that you’d be better off with a plan with which you could couple an HSA, especially one with an employer contribution.

Any idea what your employer’s share of this was? Nobody gets single coverage for $90 per month.

As noted above, you may be better off with a government job, for which our tax dollars typically subsidize a much richer benefit than is available in the private sector.

8

Really? Around here you can get an individual HSA-qualified HDHP from a Blue Cross plan for about $70-$120/month if you’re in your 20s and healthy.

9

My health care plan was so bad, it actually became an issue in the Nebraska race for US Senator.

10

That plan sounds horrible, and I’ve had some pretty crappy healthcare plans in the past. We just got private healthcare insurance for a family of five (two of the kids can’t be insured), and that only cost about as much as the OP is paying!

11

I stand corrected. I was referring to group rates, rather than individual, since that was the OP’s question. Age rating like this clearly can help if you are indeed young and healthy. Likewise, I’m guessing that the same individual health plan charges several hundred dollars per month, single coverage, for folks at the other end of the risk spectrum.

12

In my last job the health care plan was major medical only. I paid 100% of the first $2000. Then 80% of everything after that. Luckily my wife and I were healthy and didn’t have any kids. The first ob I had when we were just married offered no health care. I got a nasty sinus infection told the doc I had no coverage and just prescribe penicillin (I knew it was the cheapest). He took pity on me and gave me a 10-day supply of samples.

Current employer allows a choice between: major medical with an HSA, an HRA ($500/head) with HSA or the “traditional” low deductible copay plan. Each obviously more expensive than the last.

The best part is everyone, no mater what plan, gets $300 in preventative health care coverage as the first layer. This is no-copay coverage. I’ve never used it all. I’m sure I will once I break the 40 year mark.

13

Make that “I paid 20% of everything after that”

14

That sounds just like the plan I am on now, only I don’t get the first $500 paid. I have a $3000 deducatable I have to meet before insurance picks up anything, but then they pay 100% of most stuff. However, the difference is that this is insurance I picked up by myself, not through a company. You can get the same coverage pretty much by shopping around and buying your own policy for a few hundred a month for a healthy family. My guess is the company is picking up a tiny portion of this bill, although they could have added riders that are hard for individuals to get (prescriptions, pregnancy, etc.) So it’s probably a little better than just buying your own coverage, but not by much.

I think it’s crappy coverage for a company to offer, but I also think it’s going to become more common.

15

I actually switched (voluntarily) the coverage for my wife and I to a plan similar to the one you describe, this past year, when it was offered by my employer. The HRA amount was $1000 for the two of us, then the out-of-pocket deductible is (I believe) $3000.

However, in our case, one incentive was that the premiums are considerably lower. For single coverage there is no premium; adding my wife made it around $30/month (compared to $110 or so for the PPO we used previously). If the premium were the same I wouldn’t have switched.

It is definitely a “stay healthy” insurance plan, and despite the fact that we both are generally healthy, we managed to burn through the $1000 by September. The office visit amounts are discounted slightly from what an uninsured person would pay, but the money still gets eaten up remarkably fast by visits and the cost of prescription drugs.

If we had health issues or children, I wouldn’t feel comfortable with this kind of insurance. I think it’s going to become more common, though; my employer (who does offer a choice of plans) certainly cheerled for it when it was introduced.

16

I can’t believe the premiums stay the same in the OP’s plan.

We had pretty bad health care but we’ve droppedit. I had knee surgery, and after the surgery, they wouldn’t pay for anything. On some of the bills, things went on so long with phone calls between me and insurance, me and hospital, and hospital and insurance SOLELY BECAUSE OF THE INSURANCE COMPANY’S REFUSAL TO PAY that I started getting notices from bill collectors.

The insurance company just delayed, delayed, delayed, and then sent a fucking bill collector after me.

That was about the time I wrote our person in charge of health care at my company a 2 page letter, and shit got taken care of after that. We dropped them the next chance we got.

17

Through my employer, I pay $354 a month for Hallboy and myself for coverage with a PPO. The copays are only $15 per office visit (nothing for well-child visits), $50 emergency room (waived if admitted) and the premiums include dental (six month cleanings are covered 100%), vision and long/short term disability. Prescription plan is good (I pay up to the first $50, then it’s a $10 copay after that per calendar year).

It costs me a lot of money (a lot of money to me), but I love, love, love not having to worry if something goes wrong, how can I pay to see the doctor? The last job I had, the insurance was HORRIBLE. I don’t recall how much it cost me, but I made the mistake of falling down the stairs on my birthday and needed three months of physical therapy, which I found out later, was NOT covered under my insurance until I’d met the $5,000 deductible. At one point, I needed to see a specialist for a growth I had in my mouth (oral surgeon, or an EENT), and the closest specialist who participated in their plan was in the NEXT STATE. Of course, I could have paid out of pocket to see the specialist…I told them to find me a physicial who did participate who wasn’t more than 30 minutes, or I’d throw a very public fit. They found one, but not without a bunch of phone calls and lots of stress on my part.

18

Thanks for validating me, I’m glad to hear I’m not THAT naive. :slight_smile:

It just makes me that much happier to be working in my new job, where my insurance is cheaper AND much, much better. No copays for primary care visits, preventive care is 100% covered, copays are specialty visits 25 dollars, urgent care 35, and ER 45, 100% coverage for emergency transport, good prescription coverage (with my old job, my prescriptionists cost me 45 dollars a month, with my new one, they’re 10 dollars every 3 months through the mail order pharmacy, though I did have to switch to a different birth control pill), no deductible, and everything else, labs, diagnostics, hospitalization, is 90/10 up to the yearly out of pocket maximum of 1000 dollars (2000 for family), no limit on benefits. I pay 63 dollars/month for single, family is 189.

I have the more expensive of the two plans available, and the difference is the cheaper one has a deductible of 250 dollars for single, 500 for family, it’s 80/20, the out of pocket maximums are 2000 for single and 4000 for family, and that one costs 25 dollars a month for single, 75 for family.

I thought about going for the cheaper one, but I figured I’m STILL paying less than I was at the old job, so what the heck.

19

“Prescriptionists?” Niiice. Make that “prescriptions.”

20

Wow. These types of discussions just baffle me. Here in the UK there is always a wailing and a gnashing of teeth relating to how dreadful the NHS is, but at least you only have to worry about bankrupting yourself with medical bills if you need some $5,000 per week super-duper cancer drug that’s not on the approved list. Not being able to afford simple antibiotics isn’t usually a problem.

So how is this system better than the dreaded Socialised Medicine ™ again?