Affordable Care Act (AKA Obamacare)

[jim]

Turns out I do have vision. I'll be damned, thought they got rid of that.

I have a $300/year individual deductible, $900/year max for family. My out of pocket max is $1800/individual, $5400 for family. That's in network, if I go out of network it's 550/1650 deductible max, and 3550/10650 out of pocket. I have to pay 10% in network, 20% out of network. My head is ready to explode.

I think I'm getting screwed. I didn't know any of this stuff until you guys got me curious.

[jim]

I also think costs are up because the med companies need to pay for hot chicks on TV ads constantly reminding old men that they should try to get more boners.

[cardsfantx]

The insurance industry does suck, but besides that, the biggest reason premiums and other out of pocket costs are so high is because the prices charged for medical services are huge and way out of line with prices in the rest of the developed world.

maybe for some (surgeries and such which is not my expertise/have no idea), but not others...i'll give you an example.

i'm in the health care industry. the company i own is a home health agency...we send nurses and therapists to patients homes to treat them.

- i pay my nurses and therapists the same amount as when i started this business in 2009...not one penny more.

- the insurances companies pay me less than what they paid me in 2009; it's gone down every year (approx 25% less is reimbursed now than was in 2009). so i pay my people the same, but am getting paid 25% LESS for their services than i was in 2009.

- the patients pay MORE in premiums and deductibles (obviously) for their insurance, than they did in 2009.


so the patients pay the insurance companies MORE for my services, and the insurance companies turn around and pay me LESS for those services...that sound fishy to anyone? why do the insurance companies need to increase their premiums/deductibles more? i'm not collecting more....i'm collecting less as a matter of fact.

[jim]

The insurance industry does suck, but besides that, the biggest reason premiums and other out of pocket costs are so high is because the prices charged for medical services are huge and way out of line with prices in the rest of the developed world.

maybe for some (surgeries and such which is not my expertise/have no idea), but not others...i'll give you an example.

i'm in the health care industry. the company i own is a home health agency...we send nurses and therapists to patients homes to treat them.

- i pay my nurses and therapists the same amount as when i started this business in 2009...not one penny more.

- the insurances companies pay me less than what they paid me in 2009; it's gone down every year (approx 25% less is reimbursed now than was in 2009). so i pay my people the same, but am getting paid 25% LESS for their services than i was in 2009.

- the patients pay MORE in premiums and deductibles (obviously) for their insurance, than they did in 2009.


so the patients pay the insurance companies MORE for my services, and the insurance companies turn around and pay me LESS for those services...that sound fishy to anyone? why do the insurance companies need to increase their premiums/deductibles more? i'm not collecting more....i'm collecting less as a matter of fact.

Nah... I'm sure there is a perfectly good explanation for it.

[heyzeus]

The insurance industry does suck, but besides that, the biggest reason premiums and other out of pocket costs are so high is because the prices charged for medical services are huge and way out of line with prices in the rest of the developed world.

maybe for some (surgeries and such which is not my expertise/have no idea), but not others...i'll give you an example.

i'm in the health care industry. the company i own is a home health agency...we send nurses and therapists to patients homes to treat them.

- i pay my nurses and therapists the same amount as when i started this business in 2009...not one penny more.

- the insurances companies pay me less than what they paid me in 2009; it's gone down every year (approx 25% less is reimbursed now than was in 2009). so i pay my people the same, but am getting paid 25% LESS for their services than i was in 2009.

- the patients pay MORE in premiums and deductibles (obviously) for their insurance, than they did in 2009.


so the patients pay the insurance companies MORE for my services, and the insurance companies turn around and pay me LESS for those services...that sound fishy to anyone? why do the insurance companies need to increase their premiums/deductibles more? i'm not collecting more....i'm collecting less as a matter of fact.

Nah... I'm sure there is a perfectly good explanation for it.

Yes, and it is dividends to their shareholders.

[Jocephus]

The insurance industry does suck, but besides that, the biggest reason premiums and other out of pocket costs are so high is because the prices charged for medical services are huge and way out of line with prices in the rest of the developed world.

maybe for some (surgeries and such which is not my expertise/have no idea), but not others...i'll give you an example.

i'm in the health care industry. the company i own is a home health agency...we send nurses and therapists to patients homes to treat them.

- i pay my nurses and therapists the same amount as when i started this business in 2009...not one penny more.

- the insurances companies pay me less than what they paid me in 2009; it's gone down every year (approx 25% less is reimbursed now than was in 2009). so i pay my people the same, but am getting paid 25% LESS for their services than i was in 2009.

- the patients pay MORE in premiums and deductibles (obviously) for their insurance, than they did in 2009.


so the patients pay the insurance companies MORE for my services, and the insurance companies turn around and pay me LESS for those services...that sound fishy to anyone? why do the insurance companies need to increase their premiums/deductibles more? i'm not collecting more....i'm collecting less as a matter of fact.

Nah... I'm sure there is a perfectly good explanation for it.

[jim]

The insurance industry does suck, but besides that, the biggest reason premiums and other out of pocket costs are so high is because the prices charged for medical services are huge and way out of line with prices in the rest of the developed world.

maybe for some (surgeries and such which is not my expertise/have no idea), but not others...i'll give you an example.

i'm in the health care industry. the company i own is a home health agency...we send nurses and therapists to patients homes to treat them.

- i pay my nurses and therapists the same amount as when i started this business in 2009...not one penny more.

- the insurances companies pay me less than what they paid me in 2009; it's gone down every year (approx 25% less is reimbursed now than was in 2009). so i pay my people the same, but am getting paid 25% LESS for their services than i was in 2009.

- the patients pay MORE in premiums and deductibles (obviously) for their insurance, than they did in 2009.


so the patients pay the insurance companies MORE for my services, and the insurance companies turn around and pay me LESS for those services...that sound fishy to anyone? why do the insurance companies need to increase their premiums/deductibles more? i'm not collecting more....i'm collecting less as a matter of fact.

Nah... I'm sure there is a perfectly good explanation for it.

Yes, and it is dividends to their shareholders.

What made you such a cynical person zeus?

[Swirls]

Turns out I do have vision. I'll be damned, thought they got rid of that.

I have a $300/year individual deductible, $900/year max for family. My out of pocket max is $1800/individual, $5400 for family. That's in network, if I go out of network it's 550/1650 deductible max, and 3550/10650 out of pocket. I have to pay 10% in network, 20% out of network. My head is ready to explode.

I think I'm getting screwed. I didn't know any of this stuff until you guys got me curious.

See, that's where having an HDHP can come in handy. You said your family has had 5 surgeries recently - I know you and your son and it sounds like most of your family is quite active, so hospital/clinic visits are probably somewhat common (at least compared to me, who has gone to see the doctor a grand total of like twice in the past five years). You know you're going to spend money every year - some years more than others. Rather than paying $500/paycheck and potentially $5400 in a year, you could be paying something like $25-50/paycheck and putting $500/paycheck into your HSA using pre-tax dollars, which would make it more like only $300-$350 out of your pocket. Once your HSA is full, you'd only be paying the $25-50 instead.

If you're able to stay relatively healthy, once you have enough money in your HSA to cover your max out of pocket expenses, you never need to put any more money into it. When you eventually have a major expense, you're already completely 100% covered no matter what. So in essence, you're just saving yourself those long-term monthly premiums. More money to spend elsewhere.

[jim]

That sounds smart. They don't offer anything like that where I work, but I guess I could just go outside.

[cardinalkarp]

Turns out I do have vision. I'll be damned, thought they got rid of that.

I have a $300/year individual deductible, $900/year max for family. My out of pocket max is $1800/individual, $5400 for family. That's in network, if I go out of network it's 550/1650 deductible max, and 3550/10650 out of pocket. I have to pay 10% in network, 20% out of network. My head is ready to explode.

I think I'm getting screwed. I didn't know any of this stuff until you guys got me curious.

All the deductible BS and percentage's confuse the hell out of me as well.

Although, your monthly premiums are pretty high in comparison to what I currently pay ($195/mth for my wife and I for health, dental, and vision), but from what I gather AT&T's benefits are still pretty decent.

Don't try to argue that fact w/ some of the employees that have been here for 20+ years though, because they still think they/we should get free benefits!