Besides the limitations being put on the Exchange based networks, we are also seeing most employers going to High Deductible Plans. Thus most employer based plans now have deductibles in the $6,000 per individual and $12,000 per family, before the insurance pays. That deductible applies to everything including prescriptions as well as general medical coverage such as hospitals, infusion centers etc.
The employers are encouraging their employees to soften the blow by opening Health Savings Accounts (HSA). The HSA allows an employee to put pre-tax dollars into an account they can use for medical bills and prescriptions. Unlike Flexible Spending Accounts (FSA), the HSA can be carried over from year to year. So these are helpful but are deductions that come out of the employees salary and although the contributions reduce taxable income they also reduce take home pay. Besides going to the high deductible plans, most employers have passed on premium increases to their employees over the years. This past year some employees have seen premium increases of 50% or more.
All of this means that we are all paying more for less coverage than we had just 5 years ago. Medical costs continue to grow at a pace that is much higher than non-medical related consumer price index (CPI). Historically it is at least twice as high. So while Medicare and Social Security increases are tied to the CPI, actual medical costs are increasing at a much faster rate. This is really putting a burden on all of us and one that is not sustainable. I worry that in order to pay for my cancer treatments and drugs, I will have to work until I die or are simply physically unable to continue. Retirement is becoming less of an option for all of us in the U.S.
Forums
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Converting to an individual health insurance plan
Ron Harvot wrote:
I'm new to the site, and new to cancer. Will introduce myself in the next days, but this statement caught my eye.
Fortunately, my cancer emerged the month of my 65th birthday, not before, and so I had Medicare and a MediGap Supplemental Plan F that pays what Medicare doesn't.
In the last 2 months I've seen and been operated on by an osteo tumor surgeon at Stanford, been seen by two oncologists there, had biopsies and PET scan, Stanford hospital stay for a week and skilled nursing for a month – and I've been covered 100% except for my wheelchair transport between Stanford and the nearby facility and adaptive things for the home.
While I agree the state of insurance is abysmal (the stories in this thread are horrendous), I'm curious why you would not be fully covered once you retire? Is it that Medicare fails to pay for some of the chemo drugs, or ... ?
I feel so blessed. Medicare premium is low, and my Medigap policy is $140/month. For that, I get full coverage, or am I missing something?
It's grossly unfair and wrong what so many of you must go through financially to get health care!
I worry that in order to pay for my cancer treatments and drugs, I will have to work until I die or are simply physically unable to continue. Retirement is becoming less of an option for all of us in the U.S.
I'm new to the site, and new to cancer. Will introduce myself in the next days, but this statement caught my eye.
Fortunately, my cancer emerged the month of my 65th birthday, not before, and so I had Medicare and a MediGap Supplemental Plan F that pays what Medicare doesn't.
In the last 2 months I've seen and been operated on by an osteo tumor surgeon at Stanford, been seen by two oncologists there, had biopsies and PET scan, Stanford hospital stay for a week and skilled nursing for a month – and I've been covered 100% except for my wheelchair transport between Stanford and the nearby facility and adaptive things for the home.
While I agree the state of insurance is abysmal (the stories in this thread are horrendous), I'm curious why you would not be fully covered once you retire? Is it that Medicare fails to pay for some of the chemo drugs, or ... ?
I feel so blessed. Medicare premium is low, and my Medigap policy is $140/month. For that, I get full coverage, or am I missing something?
It's grossly unfair and wrong what so many of you must go through financially to get health care!
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moonscape - Who do you know with myeloma?: me
- When were you/they diagnosed?: 11/2015
Re: Converting to an individual health insurance plan
Robert
You stated, "Unfortunately, I have no choice about converting to an individual policy, and the options that I've seen so far don't look very promising"
There are two types of individual private insurance plans - those on the Exchange or Marketplace, and those off the Exchange and out of the Marketplace.
The plans on the Marketplace are typically less expensive and inferior to the plans off the Exchange. I was able to find a comparable individual policy to my previous group policy. It was a little more expensive, but that may have just been typical year-to-year cost increases.
I went online to the major insurer and purchased directly from them.
You stated, "Unfortunately, I have no choice about converting to an individual policy, and the options that I've seen so far don't look very promising"
There are two types of individual private insurance plans - those on the Exchange or Marketplace, and those off the Exchange and out of the Marketplace.
The plans on the Marketplace are typically less expensive and inferior to the plans off the Exchange. I was able to find a comparable individual policy to my previous group policy. It was a little more expensive, but that may have just been typical year-to-year cost increases.
I went online to the major insurer and purchased directly from them.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Converting to an individual health insurance plan
Hi,
Based on my experience, I would encourage staying on COBRA / employer insurance as long as possible. Seven years ago my husband took early retirement along with continuation of health insurance thru age 65. Initially the premiums were $450/month with a low deductible (around $1,500). Within 4 years, the premiums rose to $1000/month with a $6,000 deductible. Last year (fall 2015) we were informed premiums / deductibles would increase again, and decided to buy insurance on the exchange.
What a mistake! Although our premiums are $400/month with a high deductible ($12,500), nothing has been covered. I hike / walk most days and in March injured my knee (small meniscus tear). I had the same injury 3 years ago on other knee and it was quickly corrected with arthroscopic surgery. But, with the exchange insurance, they prefer least invasive first, so had a cortisone shot that didn't work, waited 5-6 weeks for Orthovisc approval, had 3 injections that didn't work, and when I went back they told me try diclofenac for a month or two. Also prescribed trazodone since I can't sleep due to not exercising. This week got a letter from insurance informing me that ALL of my treatment is being reviewed and may not be authorized, so our deductible is still $12,500. I knew I would pay out of pocket till we reached the deductible, but expected insurance to allow my payments toward deductible. They did send a grievance form and informed me that insurance can approve but authorize.
Decided to find another ortho doctor considered 'in net,' with insurance, but once I started contacting other doctors learned they were NEVER on the plan I was sold. Unclear why our insurance has them listed as in their network. I should have contacted doctors 'in net' to learn if they really are in net before purchasing this insurance. This exchange insurance has not covered anything - they won't even cover (allow to go towards deductible) Synthroid. I contacted our insurance and asked if my annual SEPE test with doctor visit would be covered and told it should be ... but I doubt it.
We are hoping to buy better insurance for 2017 and have 4 years till we are on Medicare. I wish we had kept the employer insurance. I know my knee would have been corrected by now. I am skipping all doctor visits till we have good insurance again.
Based on my experience, I would encourage staying on COBRA / employer insurance as long as possible. Seven years ago my husband took early retirement along with continuation of health insurance thru age 65. Initially the premiums were $450/month with a low deductible (around $1,500). Within 4 years, the premiums rose to $1000/month with a $6,000 deductible. Last year (fall 2015) we were informed premiums / deductibles would increase again, and decided to buy insurance on the exchange.
What a mistake! Although our premiums are $400/month with a high deductible ($12,500), nothing has been covered. I hike / walk most days and in March injured my knee (small meniscus tear). I had the same injury 3 years ago on other knee and it was quickly corrected with arthroscopic surgery. But, with the exchange insurance, they prefer least invasive first, so had a cortisone shot that didn't work, waited 5-6 weeks for Orthovisc approval, had 3 injections that didn't work, and when I went back they told me try diclofenac for a month or two. Also prescribed trazodone since I can't sleep due to not exercising. This week got a letter from insurance informing me that ALL of my treatment is being reviewed and may not be authorized, so our deductible is still $12,500. I knew I would pay out of pocket till we reached the deductible, but expected insurance to allow my payments toward deductible. They did send a grievance form and informed me that insurance can approve but authorize.
Decided to find another ortho doctor considered 'in net,' with insurance, but once I started contacting other doctors learned they were NEVER on the plan I was sold. Unclear why our insurance has them listed as in their network. I should have contacted doctors 'in net' to learn if they really are in net before purchasing this insurance. This exchange insurance has not covered anything - they won't even cover (allow to go towards deductible) Synthroid. I contacted our insurance and asked if my annual SEPE test with doctor visit would be covered and told it should be ... but I doubt it.
We are hoping to buy better insurance for 2017 and have 4 years till we are on Medicare. I wish we had kept the employer insurance. I know my knee would have been corrected by now. I am skipping all doctor visits till we have good insurance again.
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DianeM
14 posts
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