Healthcare

[bholler]

Her last job was about $140 bi weekly. But with double the copays and $2500 deductible per person family deductible of $7500. With them paying 80% after that is met. That was in the architecture dept of a grocery store chain.

 

[mcdougy]

Right, are the drugs covered under the insurance plan?

 

[bholler]

Right, are the drugs covered under the insurance plan?

Covered no some are discounted. When she was on Lyrica that was anoth $300 of so a month. But not all policies have any sort of prescription plan. Her new job has a decent prescription plan. But she is only using her medical marijuana card now it is controlling her pain much better with fewer side effects and less money

 

[Jan Pijpelink]

I pay $133 every 2 weeks with a family deductible of $1,125. That is health, dental and vision. $20 copay. We have not seen a family doctor in 20+ years. I see my cardiologist once every 18 months.

 

[peakbagger]

One of the concepts with co pays and deductibles is to tie the health care user into the cost for medical services. Prior to co pays, both the patient and the doctor tended to order tests and procedures "just in case". It didnt cost the consumer so they just went along with the doctor. Once the consumers started to have to pay copays that tended to reduce the "just in case" testing. Most plans have a maximum out of pocket cap per family and individual on a yearly basis. Once all the deductibles and co pays add up to the maximum out of pocket then the insurance pays everything. The ACA plans completely cover some preventative care like yearly wellness checks (basic physical), preventative blood and other testing and a few other items, so people have no reason to avoid preventative health care.

The other big change several years ago was to introduce Heath Savings Accounts (HSA)s. Each individual can set aside pre tax a maximum amount of money per year to cover any out of pocket health expenses. If they do not spend it, they keep it for as long as they live until they need it or want to spend it. Any money in the account comes out tax free as long as its spent for health care. Linked to the HSA are high deductible health care plans, they cost less but the insured has to spend some significant amount of money before the plans pay anything. That significant amount is generally about what the yearly HSA contribution covers. Since the money is coming out of my pocket I have a big incentive to find the best deal for the services I need. There is still a maximum out of pocket. If someone is healthy and rarely uses medical services, its a better deal on a yearly basis. The big plus with the HSA is its the best individual tax shelter a typical tax payer can get. The money is tax deductible going in and as long as its spent on medical services someday, it comes out tax free including any growth. If there is money in the account when I pass it goes to my heirs (Its a lump sum taxable event so best idea is spend it befire they inherit it .

The sad part is most people just leave the money sitting in a default bank chosen by their employer getting minimal interest. What they dont realize is HSAs are owned by the employee and are portable so they can put the HSAs in any plan they choose, frequently at lower cost than the default bank the company uses. Note; many companies kick in some money towards the HSA contribution and their payroll department prefer to keep it easy and send one check to one HSA firm. By law they have to send it to where the employee chooses but many payroll departments reportedly will fight it because its a bit of extra work for them.

There are several firms that run HSAs that allow the money to be invested in plans similar to a 401K. Thus it can become a totally taxfree investment plan, better than a Roth or IRA. When my former company rolled out the HSA option, a former coworker and I independently researched plans and picked the same well rated one. I have access to several Vanguard funds, the yearly fees are low .Obviously stocks go up and down but I am still up around 9% per year over a five year period even with the current market drop and fairly conservative investments. Rather than raid the HSA for normal medical expenses, most just pay out of pocket for the small stuff, the HSA is there are as medical emergency account. GIven its tax status, its probably one of the last account I will ever take money out of. Unfortunately once i go on medicare I dont think I can make yearly contributions, but in the 4 years before I get to Medicare I will be making contributions even if I am not working. Worse case is its way of converting some IRAs to tax free accounts. It will not be huge pot of money but it will be good reserve account.

 

[Ashful]

Everyone should read peakbagger’s last post at least twice. Three times for mcdougy. j/k

My employer also pays the majority of my yearly copay into an HSA account, as well as dental and vision. This is pretty standard, at least for professional salaried employees, but less so for hourly employees.

 

[SpaceBus]

So the "best" plans are wrapped up in a tax free savings account that can accumulate wealth but everyone is afraid to spend it? The cheapest option by far is TriCare for all, and then people don't have to put feeding their mouths above having a clean bill of health. Perhaps those "just in case" tests could have saved a life. I had a "just in case" test in the army and it saved mine. Same thing at the hospital last year.

Sounds like all non TriCare plans are just trash. I'm with the Canadian dude. I've also used the German and UK Healthcare a few times and they might have a better setup than TriCare even. Italy is definitely terrible, but that's a different issue than coverage.

 

[maple1]

An insurance plan with zero deductible? Does your homeowners or auto insurance have zero deductible?

No, there is not always an expense when we see a doctor, once you have hit your olan year deductible. After reaching the individual or family deductible, you typically pay 0% to 20% of the bill on a good plan, depending on the type of service.

I think zero deductible was a choice on our home & auto - but of course the premiums are higher. Has been quite a while since we took it out so not 100% sure and I don't feel like digging things apart to look for papers. But I do know 100% for sure that my professional liability insurance has 0 deductible, I just got the renewal documents for that 2 days ago.

That seems quite often to be something overlooked & not factored in when some try to compare across borders. They only try to compare premiums vs. taxes paid. Which would be a way fuzzy exercise no matter what anyway. But trying to also factor in deductibles that would need paid, along with what is left that you personally pay percentage wise, gets way more fuzzy but also tips the scales further (albiet by an unknown amount). We have no deductibles to pay here or bills to settle.

 

[festerw]

Fester, that's alot of money imo between you and your employer...would you consider your plan as top end, above average, common or minimal?

The amount I pay is probably about average. The plan itself honestly who knows, there are so many different copay/deductible options it would be difficult to narrow it down.

Do companies typically include eye and dental care as well?
Do the healthplans include life insurance as well?

Vision and dental are offered also both through different carriers it's cheap enough to not really be much of a concern. The coverage percentages especially on dental are awful usually something like 40-50% on non preventive stuff. My wife had 2 crowns done last year and the cost would have been around $1500 after insurance. Only nice part is you can double up on coverage so if you're married and both employers offer dental/vision you can get it though both, that's not an option for medical.

Life insurance isn't included but is also a separate carrier. I pay something like $10/month for 500k policy on all of us.

Right, are the drugs covered under the insurance plan?

They're covered under a different section of my medical. I pay 10% of generic, 20% of preferred brand, 40% of non preferred brand. All cost there gets applied to the deductible.
Mine may not be the normal since it's through Aetna who owns CVS/Caremark.

 

[Ashful]

So the "best" plans are wrapped up in a tax free savings account that can accumulate wealth but everyone is afraid to spend it? .

What do you mean? Why would you be afraid to spend it? You can’t take it with you when you die, and you can’t use it for anything other than medical expenses, without paying penalties. It is pre-tax money set aside by you or your employer specifically for medical expenses. It is another way for employers to compensate employees with a lower tax burden on both parties, a good thing, overall.

 

[peakbagger]

BTW, not sure about other health systems but England rations their health care system. Here is a long article that covers the details https://www.vox.com/2020/1/28/21074386/health-care-rationing-britain-nhs-nice-medicare-for-all Other systems ration the health care by limiting options. A really big savings for nationalized systems is there are generally outright bans or severe limits on sueing for malpractice with nationalized programs. One US doctor I talked on once claimed his malpractice insurance was close to 6 figures and if he had more than a couple of claims he would have to go work for a government entity that didnt need malpractice insurance. In a nationalized system, if the doctor has too many issues they just move him somewhere else in the system. I live near the border and more than a few local doctors and dentists left the Canadian health care system , they can make much more money in the US.

There is no such thing as a free lunch but there is lot of waste in US systems. There are lots of intermediate profit making entities between the US health care system and consumer. Tricare for all is nice concept but the US budget is paying for it with no concern for profit and loss. The VA system is definitely not a poster child for well run system to the point where they had to hand off care to local providers who can bill at full rate. Its is interesting that private entities like Martins Point (Maine and NH ) are private entities that can do if for less than a directly administered system.

A big thing many do not consider is that private insurance indirectly subsidizes Medicare and Medicaid. In both Medicare and Medicaid cases the government sets the rates they will pay for service substantially below the actual hospital cost. The hospitals then have to find a way of paying for this gap as well as paying to maintain services for the uninsured folks that show up at their doors. How the hospitals make up the difference is building it into their rates charged to insurance plans and seeking higher revenue patients. If you see a hospital advertising a specialty, odds are its a good revenue procedure, things like cardiac care, joint replacement and cancer care all have high revenue and that offsets the losses for the work they do at a loss. Switch to a Tricare or Meidcare for all and these hospital go bankrupt. its happening all over rural America and is moving into the suburbs. No doubt CV-19 will take out a lot of shaky ones. The reality for many in rural states is they may have to travel several hours to get to hospital for major services. I know in my rural region all the hospitals are "Critical Care hospitals" that act as gateways to much larger hospitals near large populations centers. They have an emergency room to stabilize the patients and a helipad to ship patients out of town. They do have one or two specialties to try to offset the high percentage of uninsured or people on government programs that pay less than costs. In the case of Eastern Maine the closest major hospital is in Bangor and they have been buying failed critical care hospitals who are bankrupt. Unfortunately the net result is Eastern Maine Medical system is also bankrupt and most options are they will become a critical care hospital feeding patients to southern Maine.

I know a few doctors and in off the record conversations they know the existing system is unsustainable they just hope they have their loans paid off and are retired before it comes tumbling down. A crisis like this may be the excuse to prop it up. All major first world economies have the same issues, the populations are getting old and they will have increasingly tough times living up to promises they made. One of the tricks is to limit citizenship and have large portion of the population not covered

 

[tlc1976]

We have the option of a HSA but whatever doesn’t get spent we lose at the end of the year. And you have to designate what you set aside at the beginning of the year. You pay for the plan with every paycheck so if you lose your job for whatever reason you owe the rest of the year’s money right there. You used to be able to spend your remainder on OTC meds and things. But everyone was doing that so they made it so not much of anything qualifies without a prescription. So I don’t use it. To get any worthwhile savings I will have to risk losing much more than I would save. Especially this year with anything but emergency procedures shut down.

I’m surprised to read about people who can keep what’s in their HSA. That would definitely be a nice way to put away tax free dollars without having to risk it in the stock market or whatever.

 

[maple1]

We have the option of a HSA but whatever doesn’t get spent we lose at the end of the year. And you have to designate what you set aside at the beginning of the year. You pay for the plan with every paycheck so if you lose your job for whatever reason you owe the rest of the year’s money right there. You used to be able to spend your remainder on OTC meds and things. But everyone was doing that so they made it so not much of anything qualifies without a prescription. So I don’t use it. To get any worthwhile savings I will have to risk losing much more than I would save. Especially this year with anything but emergency procedures shut down.

I'm not seeing any reason to sign up for something like that - unless I am missing something?

 

[peakbagger]

We have the option of a HSA but whatever doesn’t get spent we lose at the end of the year. And you have to designate what you set aside at the beginning of the year. You pay for the plan with every paycheck so if you lose your job for whatever reason you owe the rest of the year’s money right there. You used to be able to spend your remainder on OTC meds and things. But everyone was doing that so they made it so not much of anything qualifies without a prescription. So I don’t use it. To get any worthwhile savings I will have to risk losing much more than I would save. Especially this year with anything but emergency procedures shut down.

I’m surprised to read about people who can keep what’s in their HSA. That would definitely be a nice way to put away tax free dollars without having to risk it in the stock market or whatever.

You have your acronyms confused (easy to do ) . You have an "old school" Flexible Spending Account (FSA) not a HSA. Nothing personal but In most cases it means that your company doesnt really care that much about employee benefits. FSAs are basically dinosaurs. As I mentioned, someone in HR and payroll dont want the extra work.

 

[tlc1976]

I'm not seeing any reason to sign up for something like that - unless I am missing something?

The only reason anyone does is if they’re guaranteed a certain amount they will spend, and they’re in a position where their job is secure even when the ones lower on the ladder get laid off. Like say they got a big surgery lined up for next year that really needs to be done. You’ll save maybe 12%.

 

[tlc1976]

You have your acronyms confused (easy to do ) . You have an "old school" Flexible Spending Account (FSA) not a HSA. Nothing personal but In most cases it means that your company doesnt really care that much about employee benefits. FSAs are basically dinosaurs. As I mentioned, someone in HR and payroll dont want the extra work.

Thank you for clarifying.

 

[peakbagger]

With an HSA its your money to deal with and you can put it under many administrators in addition to the one your company may choose. Note since my new company doesn't contribute and I pay for health insurance on my own through ACA my company is not involved at all. The key thing your company has to step up to is offering a high deductible heath care option. If they contribute to the HSA that is great but they dont have to but usually do as the high deductible plan costs them less.

I use Heath Saving Administrators (Healthsavings.com), they are much lower fees than my prior companys plan and they offer Vanguard funds that are top ranked and they are no load. I have the choice of keeping all or some of the money in cash. I just picked a bond fund for 1/3, a mixed fund for 1/3 and and equity fund for the rest. The equity fund is obviously way down but the other funds offset it.

Remember if there is a big health care expense in one year, excess medical expanses over 10% can still be deducted for 2020. Not great and hope you dont need it but its there.

 

[Ashful]

I'm not seeing any reason to sign up for something like that - unless I am missing something?

The FSA is an old system, I really didn’t know anyone still used them. The benefit is that they’re a tax shelter, so if you know roughly how much you spend on medications and doctors + dentists + other, you can set up your paycheck with holdings to automatically pull that amount out of your pay each month, and lower your taxable income. If I recall, you could even use it for things like chiropractic care and massage or spas, so there were ways to use up the money, but it was a “use it or lose it” system. The modern HSA has no such stipulation, it is your money, it never goes away, you are just limited to how much you can put into it each year.

 

[festerw]

One benefit of the FSA is usually the funds are available immediately while you "pay it off" over the year. Instead of the HSA where you can only use what you've contributed to the current date.

 

[paulnlee]

What is the yearly cost of your policy?

After reading the posts since yesterday there's a lot of difference when still working and being "retired". I pay $200.00 +/month to Verizon and Medicare takes $3200.00 +/yearly from my social security.

 

[Sodbuster]

I wouldn't be so quick to call an FSA a dinosaur, we still have one, and my wife's employer has 51,000 employees. It's all pretax money, so you save on your taxes, the biggest problem is figuring out how much to take out each year. We have until, I believe it's March of the following year to use the money. I generally shoot for running out before the end of the year, rather than trying to pinch it at the end.

 

[Ashful]

I wouldn't be so quick to call an FSA a dinosaur, we still have one, and my wife's employer has 51,000 employees. It's all pretax money, so you save on your taxes, the biggest problem is figuring out how much to take out each year. We have until, I believe it's March of the following year to use the money. I generally shoot for running out before the end of the year, rather than trying to pinch it at the end.

Sorry, if you're referring to me. I just thought most had switched over from FSA to HSA a few years ago, as my employer and my wife's both switched the same year. I had assumed it was a wholesale change-over.

 

[bholler]

Sorry, if you're referring to me. I just thought most had switched over from FSA to HSA a few years ago, as my employer and my wife's both switched the same year. I had assumed it was a wholesale change-over.

My wife's previous employer has an fsa still. Her current employer doesn't offer any because their medical benifits are good enough it isn't required. Our system is just way to complicated with way to many companies taking their cut in-between the patient and healthcare provider.

 

[Ashful]

My wife's previous employer has an fsa still. Her current employer doesn't offer any because their medical benifits are good enough it isn't required. Our system is just way to complicated with way to many companies taking their cut in-between the patient and healthcare provider.

Agreed, there's lot to not like about the implementation and operatio of our system. But to bastardize an old quote from Winston Churchill, "it's the worst system in the world, except all the others."

 

[bholler]

Agreed, there's lot to not like about the implementation and operatio of our system. But to bastardize an old quote from Winston Churchill, "it's the worst system in the world, except all the others."

That statement is true for those than can afford our system. But for those who can't it isn't any better. Unless you make so little you get govt provided benifits. That discorages low income people from increasing their income above a certain level.