First, the “in network”/”out of network” issue we’re having is because a medical provider here was billing some of our in network charges as out of network and by the time we discovered it, there was a good bit of money that was owed us. This happened when Vince was still working and we had Blue Cross of MN. This was not a problem with the insurance but a problem with the provider here. Still not resolved.
The problem I’m having with no out of state coverage is with insurance through the open market, the exchange, Obamacare . . whatever you want to call it. It’s ridiculous. I’m not being political . . there’s enough blame to go around with this. I’d love to see our politicians live with this insurance and every time they went home to visit Granny or to an out of town football game, their coverage ceased to exist. But no . . they live by a totally different standard from how the rest of us live.
For those of you who still have employer provided health care . . be thankful!
Here’s an article I was reading this morning and it looks like in 2019, whether it’s HMO or PPO, if you’re buying it yourself, there’s not going to be any out of state coverage. Just read your policy, talk to your agent . . whatever . . but be sure you know whether you have coverage before taking a trip. Again, always know what your policy includes but employer provided policies are probably different. Medicare is different . . Vince has been totally pleased with his Medicare coverage, and while it’s not cheap, it has paid everything Vince has submitted, without questioning anything. The premiums are based on income tax returns from two years prior and though you can get the premiums reduced by showing a “life changing event” i.e., retirement . . and, therefore, less income than your two years ago income tax returns reflect. But, as soon as they review another year’s income tax return, the premium goes right up again and you have to file the same papers you filed before. Small hassle .. but worth it.
How crazy is it that simply traveling from one state to another, within the United States, you lose your coverage? And who would have thought it would come to this.
The “virtual doctors” are still reasonable. It’s $75 without insurance for MD Live. We’ve used Doctor on Demand with our previous insurance. Most of those have a list of what they can treat and we’ve both been happy with the doctors we’ve talked to when we used their services.
Our insurance situation in this country is truly a mess . . again, not blaming either party and if you’re blaming one part or the other, you really need to change the channel or do a little research. There is plenty of blame for all sides. I’m not even sure if it isn’t in such a mess now that it cannot be fixed, or at least not fixed to be back to how it was when most of us considered it to be adequate. What I have now is definitely not adequate and it’s outrageously expensive. I pay over $1,000 per month and have an almost $15,000 annual out of pocket limit and that’s just for me.
So . . make sure you know what coverage you have and don’t have and stay healthy.
And for those of you who think you’re fine . . I didn’t go to the doctor once in all of 2017. As soon as Vince retired, really within weeks . . I had to go to the doctor three times and was in the hospital once . . not a dime of which was paid by my insurance.
Mary M says
I so agree with you. I ended up taking COBRA from my employer who downsized rather than buy on the open market. I retired early and I cant complain about my coverage. I am so glad I could afford COBRA.
Shirley Hobbs says
My husband is younger than me, so has a few more years to work. We have an HSA through his job, where the employer pays our full premium and we contribute what we used to pay in premiums to the HSA account. We get to carry the excess over every year, building our balance from year to year. This will provide a nice cushion when we finally both go on Medicare. We have never ever met our annual deductible so instead of seeing our monthly premiums “disappear” every month (when we rarely go to the doctor), we now see that same amount of money building in our HSA. But I agree with you, Congress has ruined health care for us. Shame on them.
Liz says
I was also self employed and went through the individual market. I opted for a PPO plan since I could have greater control and when I did the calculations, there was only a slightly lower cost to the HMO option. I was looking at the total premium costs, co-pays, max out of pocket costs. I also looked if the plan was eligible for me to contribute to a HSA, so consider the tax-implications. If I went with the HMO, I would have had to pass by three hospitals before getting to the network hospital. And I would have had to change doctors, which was not acceptable since I was getting closer to 65. A lot of MDs will take you as a Medicare patient if you have history with them. Otherwise, they put a limit on the number that they take.
I’ve mentioned it before, and unfortunately Judy doesn’t have this option yet, if you can, look for a direct patient care group. I pay a flat amount each month and can see my doctor in person, via email, on a video link, or even a house call if I am that sick. For my labs and radiology needs, I can file with Medicare or they’ll pay for the test at cost and pass it along to me. They have a limited pharmacy so if needed, I could get some drugs there. They may have a markup for the tests, but it is small compared to the standard mark-up. I noticed that the lab also has a direct pay plan – pay in cash and you access the results online and then decide who gets to see the results. The costs were very low compared to the prices listed for insurance companies.
And – the yearly cost for this doctor plan is less than one month of my pre-Medicare insurance ($900 for the year vs $1,168 for a month!).
Remember that the prices you see on bills are the “suggested retail price”. Just like dealing with car salesmen, you can always ask for the cash price, without any insurance filing. It may be far less than what the price is that you have to pay, after “insurance discounts”, especially if you know you will never meet your deductible. However, since your payment never goes through the insurance company, you still have to meet the deductible if you get sick later.
And, this year, I went on Medicare. When looking for the additional insurance plans, I mentioned my physician arrangement and the costs. The consultant thought it was a great setup and recommended a high deductible plan for the supplemental. Note, the “high deductible” was far lower than my previous one and was still higher than what I paid for in actual costs – I think the deductible is $2,500 for plan F vs $6,500 for previous insurance.
Disclosure – my degree is in hospital administration/accounting and I worked at auditing firms, hospitals, and non-profits as an administrator who had to negotiate the benefit packages. So, I know what to look for and what to do in health care situations. It is tough to navigate the business if you don’t know the situation.
Linda in NE says
Congress ruined health insurance for the majority of the population (except themselves) and the insurance companies are happy with it. Wouldn’t you like to charge enormous premiums and provide minimal service? I’m actually astounded that companies can sell health insurance the doesn’t pay if the customer sets foot outside their state of residence and lands up in a doctor’s office or hospital. That’s limiting one’s freedom of travel. What about the people living in one state and the only hospital for miles is in the neighboring state? It’s not unusual for people in rural areas to have that situation. I can’t imagine driving 85-90 miles, crossing the bridge into Yankton and not being covered by insurance I paid an arm & a leg for.
I’m afraid the only way to fix it is for everyone to say ‘enough’ and refuse to buy it. But we know that’s not going to happen because everyone is conditioned to believe they need insurance and have had to much fear instilled in them about what could happen if they don’t have it. Heck, nowadays people with insurance go bankrupt if anything major happens & they actually want the treatments that have the best chance of saving them because insurance doesn’t want to pay for anything but the bare minimum. I didn’t have any insurance for 13 yrs. before Medicare kicked in because it would have taken the lion’s share of our combined income. In the meantime I paid for my prescriptions & what few office visits I had out of pocket and came out ahead.
Liz says
Unfortunately, one of the issues you mentioned was actually part of the bill. When I looked for insurance, they asked if I was in county A or B since the city limits crossed county lines. That would have changed everything for me, including what hospitals I could go to.
Some of these obscene rules were a “feature, not a bug”. The long-term intention was to destroy the great health care system that we had, not fix it. I am in a more urban area (OKC-Edmond),so I have a few more options than Judy. She is in a more rural area, so fewer options.
I am a low user of healthcare (unless I am clumsy), so I was happy with a major-medical plan.For several years, I had to pay for pediatric health, dental, vision, maternity, mental health care when I didn’t need it as a 62-64 year old single female. The only benefit I got from my insurance was the negotiated discounted price, which I had to pay since I didn’t meet my deductible, Now that was a waste of money. I could have spent it on more fabric or something else!
The intention of that health bill was to destroy the insurance system to force everyone onto a single payer system. Again – it was a feature, not a bug.
Sandi B says
And therein lies the rub: goal of single-payer health care. It stinks.
Mary says
Contact your state insurance commissioner. Pehaps they can help or if enough people complain some action will take place.
Val says
I am so very grateful that I have Canadian Health care. My deductible is $25 once a year for prescriptions and I am not out of pocket for either visit to the ER, once for a suspected heart attack with all the resulting tests and once with a broken hand and all the resulting follow up. $400 Is designated as a medical tax on my return and that is the maximum that people pay each year. The only disadvantage is that you have to be referred to specialists and changing your Dr can take some time. You can go to any local hospital er without cost. But there is no out of pocket generally speaking. There are wait times for non emergency surgeries..e.g. knee replacements but they, along with rehab are free. However if you have an accident and blow out a knee you get surgery(at least here) as soon as you are stable for it and there are no charges except for walker rental perhaps. I don’t know about that stuff for sure. Our health care carries over into the other provinces and into the US to a degree but we might have to pay up front and get it back later.
Ethelann Wood says
Check on a “temporary” health insurance policy. They are usually sold for a specific time such as one – three months. They re for people on vacation, kid’s camps, etc. They have a deductible you pick but are good for any emergency that might occur when you are out of your area. They are not tied to “trip” insurance.
Moneik Stephens says
I’m shocked to hear what people pay for health coverage. My MIL was on an Obamacare plan and it was $250 a month and I thought that was high. I was able to help her get a state job with better insurance (no premium) and she was able to have both hip and knee replacement in the same year plan and the max out of pocket was $4500. She’s 60, so a few more years until retirement. I also work for the state and while our premiums are free to employees, the family only pays $70, which is extremely reasonable and one of the reasons I took a lower paying job to have better insurance. Our high deductible is $3000 for family, which we rarely reach because we’re young and healthy. It also pays for one yearly visit with no out of pocket. Our prescriptions go toward our deductible and we get $1000 a year toward our HSA for doing a well visit, online health assessment, and a couple “healthy” activities. Easy and free to complete for getting that money.
Judy Laquidara says
That’s what I’m saying . . I don’t think most people realize how some are suffering with this horrible/expensive health insurance. I’m not sure those in Congress even care but I can’t believe they are happy with what it’s turned into. As far as your MIL’s premiums, every state is different and there are subsidies but as the household income rises, they decrease and are completely phased out. Not saying she was getting a subsidy but that would explain the premium difference. As far as government employees . . they’ve always had the best of the best as far as benefits.
Trust me . . it may be “free” to you but someone, most likely taxpayers, are paying for it. Not much is free these days.
Edit to Add: I’m not criticizing you for doing it . . I’d do it too if I could. And, like you said, you took less pay to get the better benefits. My main point is that most people don’t even realize how horrible this insurance is for many of us. But, for those who are happy with it . . I’m happy for them. I am thankful that I was able to get it. Anything is better than nothing and at 64, even with no pre-existing conditions, who knows if I would have been able to get an individual policy before the AHCA. I am just very thankful I’ll soon be able to get Medicare.