an insurance question for the Americans

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ivy6
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   Posted 1/26/2010 11:43 PM (GMT -7)   
I have the impression that your employer tends to provide your health insurance, and dictates what company will provide your health insurance. Is that correct? I seem to remember a lot of threads where people have run into strife because they've left one job and started another, meaning they've been forced to change insurance companies, and the new company won't accept them because of pre-existing health insurance.

Is that correct?

Why is that? Are you allowed to take out health insurance on your own behalf, and keep it no matter who employs you, or is it mandatory to change companies every time you change jobs?

Ivy.

ps. No political discussions, please: I'm not interested in hearing any more about Obama's health care bill, and political discussions tend to get too polarised here anyway. I'm just curious & trying to understand something I heard on the news today.
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GDen
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   Posted 1/26/2010 11:55 PM (GMT -7)   
Nope, as long as you don't let coverage lapse another health insurance company can't deny you for a pre-existing condition. If you have gaps between employment, you can use COBRA as an extension to prevent a lapse in coverage, or just get your own policy.

It seems most companies just offer policies from one or two health insurance companies.

One interesting idea here is health insurance exchanges which is a way of creating insurance pools outside of employers and would allow individuals greater selection and keep policies regardless of employer. But they seem to have problems getting established.
Cimzia, Asacol


ivy6
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   Posted 1/27/2010 12:44 AM (GMT -7)   
"would allow individuals greater selection"

What does that mean? Can't you go to any insurance company you want?
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GDen
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   Posted 1/27/2010 1:31 AM (GMT -7)   
Not if you want your employer to pay for it. There's plenty of info about exchanges via Google.
Cimzia, Asacol


randynoguts
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   Posted 1/27/2010 1:52 AM (GMT -7)   
ivy,, you can purchase any plan you want ... as long as they are licensde to operate in your state.. thats why people are upset with the obama care plan.. it will not open up competition . they will not allow insyurance companies to sell all over the country which would increase competition and decrease the price.. the compaies know they have a near monopoly, so they dont give a crap. that one thing would decrease cost more than any other besides lowering lawsuit awards for minor mistakes.. hey, if they kill you or maim you thats one thing but if you have finger that doesn't heal 100% its not worth 100 million bucks.
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ivy6
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   Posted 1/27/2010 2:31 AM (GMT -7)   
Still confused.

Why did employers start paying for insurance in the first place? Why didn't they just allow you to buy the scheme you wanted with your salary (and mandate that everyone bought insurance)?

Do employers get some sort of bulk discount on insurance costs if they can guarantee that they'll supply the insurance company with x number of clients?
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Post Edited (ivy6) : 1/27/2010 2:39:08 AM (GMT-7)


GDen
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   Posted 1/27/2010 3:41 AM (GMT -7)   

FallColors
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   Posted 1/27/2010 6:46 AM (GMT -7)   
We can buy from any insurance company that sells in our state. Some employers - usually larger companies -- offer health insurance as part of an incentive for you to work for them. You don't have to accept what they offer -- you can buy on your own.

Many employers who offer insurance actually offer to pay only a portion of the cost and you have pay the rest. Large employers often can negotiate "group discounts" from insurance companies because they have large numbers of employees who will buy insurance plans. This measn cheaper prices for you and your employer. So if you like an insurance plan offered through your employer, it is often cheaper to buy that then if you buy directly from an insurance company yourself.

If you cannot afford insurance for whatever reason, there are safety net programs that may be able to help you as long as you qualify (and the qualifications are often bewildering to sort through):
-- government-run Medicaid (poor and without insurance).
-- government-run Medicare for older folks.
-- government-run Social Security if you are disabled.
-- State or local government-run free clinics.
-- Charity clinics and hospitals, and other private groups that help those in trouble.
-- Hospitals can't turn you away in an emergency, but you typically do have to pay the bill over time. The bills can be beyond the abilty of people to pay.
-- I've probably missed a few too.

There are people who slip through the safety net, so to speak. Usually these are younger healthy folks who haven't purchased insurance but when they get sick find out they don't qualify for government or a free program for whatever reason. The debate often centers on these folks and whether anyone is responsible for their health care costs other than themselves. Other debates include the general cost of healthcare and drugs.

I am sure I have not described every scenario. The bottom line is that health care is expensive, and the larger debate centers on whether the government should run helathcare for everyone (we pay through our taxes and have to live with what they offer) or whether we should use the free market and be able to purchase any insurance coverage that we personnally can afford - directly from insurance companies or through our employers (but government controls wlll need to be lifted, such as certain state laws that only allow certain insurance companies to sell plans in their state).

I purchase through my employer and have never had a problem keeping insurance when I have changed employers. I'm satisfied with the responses of my insurance company. They have paid out as they said they would, and I haven't had anything denied or delayed (including remi or humira). I do know of folks who haven't had good experiences, but they change companies until they found a better one.

Hope this helps.
Diagnosed with Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


Rider Fan
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   Posted 1/27/2010 10:59 AM (GMT -7)   
FallColors said...


If you cannot afford insurance for whatever reason, there are safety net programs that may be able to help you as long as you qualify (and the qualifications are often bewildering to sort through):

What is the definition of cannot afford though.  Is it means tested or if your insurnce premium is $500 a month and you take home $2,000, does that mean 'you can afford it'?
33 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira 2/27/09. Proferrin iron pills.

Tried SCD, didn't work, now avoiding gluten and dairy.


Go Saskatchewan Roughriders!


MMMNAVY
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   Posted 1/27/2010 12:02 PM (GMT -7)   

For example say one is a teacher who cannot find a job so you become a substitute teacher (a friend had this happen who has another autoimmume issue) ... even if you are able to work a 40 hour week which is not always availible your monthly take home pay is around 1300 dollars, you have no benefits (unlike normal teachers who have usually pretty good benefits such as great insurance to make up for the poor pay).  You can buy an individual plan on your own, but when it costs more then whole entire salary for that month for insurance there is a problem.


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Howlyncat
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   Posted 1/27/2010 12:21 PM (GMT -7)   
Question for Rider...does sask not hv the type of health care Ontario has ...ohip...just wondering..i know i count my blessings for our hc coverage here sorry to butt in as a canuck but had to ask rf question...lyn
                          
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GDen
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   Posted 1/27/2010 12:57 PM (GMT -7)   
To qualify for a lot of gov't programs it appears one must have a net worth no greater than $2000. For Social Security disability one has to be almost bed-ridden. Other clinics and programs qualify according to income related to the Federal Poverty Level.
Cimzia, Asacol


ivy6
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   Posted 1/27/2010 2:03 PM (GMT -7)   
Thanks, all, and especially to Fallcolors, because your post must have taken *ages* to type.

Thanks for the interesting information. I feel much less confused now.

How much do some of you pay for your insurance each month, if you don't mind my asking?

I.
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Nanners
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   Posted 1/27/2010 2:11 PM (GMT -7)   
My insurance is provided as a benefit from my employer. I do have to pay about $37 each payday for my portion of the insurance and that amount is deducted from my payroll on a tax free basis. I hope that helps.
Gail*Nanners* Co-Moderator for Crohns Disease & Anxiety/Panic
Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
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Rider Fan
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   Posted 1/27/2010 2:27 PM (GMT -7)   
Howlyncat said...
Question for Rider...does sask not hv the type of health care Ontario has ...ohip...just wondering..i know i count my blessings for our hc coverage here sorry to butt in as a canuck but had to ask rf question...lyn

Hi!  Actually I'm in MB.  But medical care is covered here, den***ts are not, eye exams are about $50.  Drug costs are means-tested through the provincial insurance plan.
33 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira 2/27/09. Proferrin iron pills.

Tried SCD, didn't work, now avoiding gluten and dairy.


Go Saskatchewan Roughriders!


FunGuy
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   Posted 1/27/2010 2:29 PM (GMT -7)   
I've been forced to change my GI doctor several times as I changed jobs and was compelled to accept new insurance. Also had to change my GP, my Dentist and pediatrician when the kids were small. The reason you want healthcare insurance from your employer is for the group rate. This is especially important when you have a chronic condition like Crohn's. As far as buying your own insurance; not only is there a huge hole were many don't qualify for medicaid, the premiums,for those with insurance, have risen at such a rate that more and more people are falling through that hole all the time. Those that make the sacrifice and buy their own insurance will often find things like deductibles that take away their rent money or lifetime caps that leave them out in the cold when they get sick. They also find that their condition may be excluded.......
Sure you can go to a hospital but, they will send your bill to collections and bankrupt you. Largest cause of bankruptcies in the US is medical bills. They have been known to dump patients, literally put 'em in a taxi and send them away. Not to mention that if you wait until you need an ER instead of taking preventative care in the first place you are not getting the best care for you or your child. You need to have your cholesterol corrected BEFORE the heart attack. You need the anti-biotic BEFORE the pneumonia.
I have insurance and my feelings on this are mostly aimed at my fellow human beings. I do hope to benefit from legislation that will hold costs down however.
 


ivy6
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   Posted 1/27/2010 2:38 PM (GMT -7)   
I know it's a fraught issue, but could we keep current politics out of it, please? I already know where a lot of you stand on the US health reform issue (and most of you probably know what I think too :-) ) but right now, I'm just trying to understand the system as it currently stands.

So, Nanners, am I right in thinking that you pay a little more in $70 / month for your insurance; ie a bit more than $840 a year? Does that cover *everything*, or do you have a lot of out of pocket expenses as soon as you need a prescription and / or end up in hospital?
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FunGuy
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   Posted 1/27/2010 2:41 PM (GMT -7)   
Did I say something political?
 


ivy6
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   Posted 1/27/2010 3:03 PM (GMT -7)   
It was getting pretty close :-). All it'll take is for someone to respond, and bingo! we'll have a political discussion.

I appreciate what you're saying, though (and agree with you, esp about preventative care).
Co-Moderator Crohn's Forum.

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FunGuy
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   Posted 1/27/2010 3:14 PM (GMT -7)   
Yeah I admit I had a hard time walking that line. Guess I was successful though by your response. We all know how hard it is to get a good GI that you feel comfortable with and while the 1st one I lost I don't miss the two I lost after that I was happy with. I think I am happy now though I suspect he wants to refer me to a shrink sometimes. lol
 
One more thing about employer insurance is that normally the employer pays the larger share of the premiums.


GDen
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   Posted 1/27/2010 3:22 PM (GMT -7)   
So... ivy... what's it like in whatever country you're in??
Cimzia, Asacol


FitzyK23
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   Posted 1/27/2010 3:34 PM (GMT -7)   
Ivy, the amount we pay through our employer is just the premium. We still pay co-pays and deductibles. So, on top of my premium I can pay anywhere from $10 - $40 for medication a month depending on whether it is a preferred medication in the eyes of the insurance company. I can get 3 months for the cost of 2 months if I go mail order. I pay $15 to see my regular doc and $30 to see a specialist like a GI. If I have a procedure, I have to pay a certaint amount (I think $200) out of pocket and then insurance covers the rest. Some people have co-insurance where they have to pay a percent.

Group insurance is only available at bigger employers. Usually places that only employee 5 or so people don't offer group. If you have a pre-existing condition you can't just go buy insurance outside of a group and in the states where you can it is very expensive ($1500-$2000/month from what I've heard.) In some states, group insurers have to cover everything no matter what. In others, you can not have more than 60 days without insurance before you start your new job. If you do, they can make you wait 6 months for coverage or for coverage of your pre-existing condition.

If you lose your group plan you can "cobra" it. That means you pay the amount that you AND your employer were paying on your behalf in order to keep your coverage. This can run between $500 and $1000/month on average. If you lost your insurance because you lost your job it can be difficult to afford that.

You can't get "old people gov't insurance" until you are 65 so a lot of people in the 50-65 range have trouble convincing an insurance company to insure them if they don't work for a group insurer. If you have a group insurer you can put your spouse and minor children on your plan and in some states a "domestic partner" - a monogomous b/f or g/f (even if it is the same sex) who you live with. You can not put adult children or elderly parents on your plan.
27 Year old married female lawyer.  Diagnosed w/ CD 5 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant but can handle anything cultured and do well w/ lactose pills and lactaid. For Crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 


ivy6
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   Posted 1/27/2010 3:35 PM (GMT -7)   
Anyone who earns over a particular amount pays a levee to fund our health care. From memory, I think it's about 1.5% of your salary.

That provides:
* free care in a public hospital
* subsidised access to any medicines that are on the subsidy list (and that's a LOT of medicines). It's about $5.10 per prescription for people on pensions and low incomes, and about $30 for people on "regular" incomes.
* a few other things are covered: a basic level of psychotherapy (depending on state), hearing tests & basic optometry (depending on state and income), certain basic dentistry (depending on state, and usually for low income earners only).


You can opt out of paying the tax levee and take out your own private health insurance, which means you can stay in a swankier private hospital. However, although private hospitals tend to have nicer rooms, the best facilities (scanners, surgeons, large range of expert doctors, etc) tend to be in the public hospitals. I live in a regional town, and a lot of the people with private health insurance end up in the public hospital anyway, because that's the only place they can get appropriate treatment.

I like the way that everyone who earns enough just pays a % of their income, instead of it being a flat rate for everyone. That means - in principle, anyway - that nobody suffers too much hardship.

Ivy.
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Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


GDen
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   Posted 1/27/2010 3:50 PM (GMT -7)   
FitzyK23 said...
If you have a pre-existing condition you can't just go buy insurance outside of a group and in the states where you can it is very expensive ($1500-$2000/month from what I've heard.)

In my state, high-risk pool insurance for somebody (non-smoking male) in their 30s ranges from $298/mo to $118/mo, depending on deductible ($1000 to $10K). For people with lower incomes, rates are lower ($213/mo to $85/mo). Another option for people with pre-existing conditions is group of one (or more) health insurance, but its rates are more than double high-risk pools.
Cimzia, Asacol


Rider Fan
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   Posted 1/27/2010 3:50 PM (GMT -7)   
Sounds reasonable to me Ivy.
33 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira 2/27/09. Proferrin iron pills.

Tried SCD, didn't work, now avoiding gluten and dairy.


Go Saskatchewan Roughriders!

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