health insurance not tied to employment

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defiantbadgirl -> health insurance not tied to employment (4/24/2013 4:26:32 PM)
Private individual health insurance policies have been available for years, but many Americans are unable to afford them. With subsidies beginning in 2014, that will change, at least for those who aren't stuck with employee health insurance. The problem with health insurance being tied to employment is, companies can terminate employees if they or someone on their policy develops a condition that's expensive to treat so they can keep premiums lower. Is it true that people who already have health insurance through work won't be eligible to sign up individually on the exchange? Would dropping employee health insurance and paying the fine make a person eligible to sign up individually on the exchange the following year? How can US citizens make themselves eligible for subsidized individual health insurance on the exchange and get away from employment based health insurance?

DomKen -> RE: health insurance not tied to employment (4/24/2013 4:39:37 PM)
IIRC to get subsidized insurance your employer has to not offer insurance and your income must be below a threshold or you must be considered uninsurable (pre existing condition). BTW I'm pretty sure insurers can't arbitrarily raise premiums on companies any more so you probably have nothing to worry about.

DesideriScuri -> RE: health insurance not tied to employment (4/24/2013 5:14:16 PM)
quote: ORIGINAL: defiantbadgirl Private individual health insurance policies have been available for years, but many Americans are unable to afford them. With subsidies beginning in 2014, that will change, at least for those who aren't stuck with employee health insurance. The problem with health insurance being tied to employment is, companies can terminate employees if they or someone on their policy develops a condition that's expensive to treat so they can keep premiums lower. Is it true that people who already have health insurance through work won't be eligible to sign up individually on the exchange? Would dropping employee health insurance and paying the fine make a person eligible to sign up individually on the exchange the following year? How can US citizens make themselves eligible for subsidized individual health insurance on the exchange and get away from employment based health insurance? I'm sure there is something within the HR world that prevents a company from firing an employee simply because they are causing their insurance premiums to rise. I can ask my ex when she gets back from her HR convention (about Obamacare, not surprisingly enough). To whoever wants to answer: If an employer charges an employee for premium costs, is it possible for that employee to get a subsidy for the premium if his/her income is low enough?

erieangel -> RE: health insurance not tied to employment (4/24/2013 10:03:41 PM)
I'm not sure. But my agency is very generous when it comes to health insurance. In fact, according to the High Mark representative I've spoken with, we have some of the best coverage in NW PA, better even than High Mark offers their own employees. My agency purchased all employees a policy with a $2,500 deductible and then resold those policies to us, allowing us to chose what deductible we want; the lower the deductible the higher the premium. When I first started working, because I had very little in savings, I carried no deductible and it cost me $60-$90 every 2 weeks (premiums went up each year). Last July, which is the month our new health insurance contract is signed, I decided to pick up a $500/$1000 deductible (single/family) Since I'm single, I'll never have to meet the $1,000 mark. That plan costs just $34 every 2 weeks. Because the policy actually has a $2,500 deductible, the agency pays the first $2,000; I'm responsible the last $500. I've not yet paid anything toward my deductible since last July. The agency is also self-funded for dental and eye care. Employees pay nothing for that insurance.

DesideriScuri -> RE: health insurance not tied to employment (4/25/2013 4:04:24 AM)
quote: ORIGINAL: erieangel I'm not sure. But my agency is very generous when it comes to health insurance. In fact, according to the High Mark representative I've spoken with, we have some of the best coverage in NW PA, better even than High Mark offers their own employees. My agency purchased all employees a policy with a $2,500 deductible and then resold those policies to us, allowing us to chose what deductible we want; the lower the deductible the higher the premium. When I first started working, because I had very little in savings, I carried no deductible and it cost me $60-$90 every 2 weeks (premiums went up each year). Last July, which is the month our new health insurance contract is signed, I decided to pick up a $500/$1000 deductible (single/family) Since I'm single, I'll never have to meet the $1,000 mark. That plan costs just $34 every 2 weeks. Because the policy actually has a $2,500 deductible, the agency pays the first $2,000; I'm responsible the last $500. I've not yet paid anything toward my deductible since last July. The agency is also self-funded for dental and eye care. Employees pay nothing for that insurance. Great opportunities, there, erieangel. Your premium (that you pay) is based solely on the amount of the $2500 deductible you are choosing to pay, but everyone is getting the same level of coverage, right? How much does this plan cost the employer? Is this something that is going to be considered a "Cadillac Plan?"

erieangel -> RE: health insurance not tied to employment (4/25/2013 6:19:13 PM)
quote: ORIGINAL: DesideriScuri quote: ORIGINAL: erieangel I'm not sure. But my agency is very generous when it comes to health insurance. In fact, according to the High Mark representative I've spoken with, we have some of the best coverage in NW PA, better even than High Mark offers their own employees. My agency purchased all employees a policy with a $2,500 deductible and then resold those policies to us, allowing us to chose what deductible we want; the lower the deductible the higher the premium. When I first started working, because I had very little in savings, I carried no deductible and it cost me $60-$90 every 2 weeks (premiums went up each year). Last July, which is the month our new health insurance contract is signed, I decided to pick up a $500/$1000 deductible (single/family) Since I'm single, I'll never have to meet the $1,000 mark. That plan costs just $34 every 2 weeks. Because the policy actually has a $2,500 deductible, the agency pays the first $2,000; I'm responsible the last $500. I've not yet paid anything toward my deductible since last July. The agency is also self-funded for dental and eye care. Employees pay nothing for that insurance. Great opportunities, there, erieangel. Your premium (that you pay) is based solely on the amount of the $2500 deductible you are choosing to pay, but everyone is getting the same level of coverage, right? How much does this plan cost the employer? Is this something that is going to be considered a "Cadillac Plan?" Yes, everybody gets the same policy, just the deductible differs. I'm not sure how much the policies cost the agency, I'd have to look at my latest pay stub, which is online at work. If I remember, I'll do so tomorrow and let you know. And I hope this isn't going to be a "Cadillac Plan". There is a lot of things it doesn't cover, like health club memberships and stuff so it shouldn't be Cadillac. It's just a nice plan that the agency has made as low cost as possible for the employees. The fact that we can chose our deductible and our premium to fit our budgets helps greatly.

LookieNoNookie -> RE: health insurance not tied to employment (4/25/2013 8:23:13 PM)
quote: ORIGINAL: defiantbadgirl Private individual health insurance policies have been available for years, but many Americans are unable to afford them. With subsidies beginning in 2014, that will change, at least for those who aren't stuck with employee health insurance. The problem with health insurance being tied to employment is, companies can terminate employees if they or someone on their policy develops a condition that's expensive to treat so they can keep premiums lower. Is it true that people who already have health insurance through work won't be eligible to sign up individually on the exchange? Would dropping employee health insurance and paying the fine make a person eligible to sign up individually on the exchange the following year? How can US citizens make themselves eligible for subsidized individual health insurance on the exchange and get away from employment based health insurance? BadGirl...here's the deal: EVERYONE, whether they have insurance....or not, whether employed or not, will be able to purchase health insurance via state health exchanges. (Except of course for those that can't and....they too will be fully covered). That's a wonderful thing for most. There will be no "lower premiums". Health costs will rise between 25 and 90% between now (depending on the level of care you're willing to pay for.....or not) and 2016 based on very basic mathematical facts (and anyone that tells you otherwise either doesn't know how to use a calculator or....is a complete moron): There is now no longer any "end" for insurance companies. No limit...good for patients. Bad for payers. It used to be (generally) $1,000,000.00 lifetime coverage (unless you were very wealthy and could afford greater/larger coverage), now it's entirely unlimited. You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. That's also (universally) a good thing because, no one wants to see anyone suffer but....you on the other hand, will, because....someone has to pay. That would be you (or, ultimately, the "everyone" that is ultimately....you). And that's the way it works :)

FunCouple5280 -> RE: health insurance not tied to employment (4/26/2013 9:32:56 AM)
Until this spawns the necessity to legislate health and regulate human behavior to control costs! Or we move to the dreaded death panels....

mnottertail -> RE: health insurance not tied to employment (4/26/2013 9:36:30 AM)
We have the death panels now, the new death panels will not have a direct pecuniary interest in your cakking.

FunCouple5280 -> RE: health insurance not tied to employment (4/26/2013 9:40:52 AM)
Lol so sensitive!

tazzygirl -> RE: health insurance not tied to employment (4/26/2013 10:34:36 AM)
quote: Is it true that people who already have health insurance through work won't be eligible to sign up individually on the exchange? Would dropping employee health insurance and paying the fine make a person eligible to sign up individually on the exchange the following year? How can US citizens make themselves eligible for subsidized individual health insurance on the exchange and get away from employment based health insurance? Will anyone be allowed to buy from the exchanges? No. Initially, exchanges will be open to individuals buying their own coverage and employees of firms with 100 or fewer workers (50 or fewer in some states). Most Americans will continue to get insurance through their jobs, not via the exchanges. Most will be people who are eligible for subsidies, which will average an estimated $4,600 per person in 2014. Undocumented immigrants will be barred from buying insurance on the exchanges. What about federal workers? Members of Congress and their staffs will be required to buy through exchanges if they want coverage from the federal government. Other federal employees will continue to be covered by the Federal Employees Health Benefits Plan (FEHBP) . What types of subsidies does PPA CA provide to people buying health insurance? New eligibility rules enacted under PPACA – as revised by the recent Supreme Court decision on the law – give states the option of extending coverage in Medicaid to most people with incomes under 138% of poverty. For people with somewhat higher incomes (up to 400% of poverty), PPACA provides tax credits that reduce premium costs. People with incomes up to 250% of poverty also are eligible for reduced cost sharing (e.g., coverage with lower deductibles and copayments) paid for by the federal government. The premium tax credits and cost-sharing assistance will begin in 2014. Who is eligible for premium tax credits? Citizens and legal residents in families with incomes between 100% and 400% of poverty who purchase coverage through a health insurance exchange are eligible for a tax credit to reduce the cost of coverage. People eligible for public coverage are not eligible for premium assistance in exchanges. In states without expanded Medicaid coverage, people with incomes less than 100% of poverty will not be eligible for exchange subsidies, while those with incomes at or above poverty will be. People offered coverage through an employer are also not eligible for premium tax credits unless the employer plan does not have an actuarial value of at least 60% or unless the person’s share of the premium for employer-sponsored insurance exceeds 9.5% of income. People who meet these thresholds for unaffordable employer-sponsored insurance are eligible to enroll in a health insurance exchange and may receive tax credits to reduce the cost of coverage purchased through the exchange. http://www.kff.org/healthreform/upload/7962-02.pdf

tazzygirl -> RE: health insurance not tied to employment (4/26/2013 10:41:01 AM)
quote: There will be no "lower premiums". Health costs will rise between 25 and 90% between now (depending on the level of care you're willing to pay for.....or not) and 2016 based on very basic mathematical facts (and anyone that tells you otherwise either doesn't know how to use a calculator or....is a complete moron): There is now no longer any "end" for insurance companies. No limit...good for patients. Bad for payers. It used to be (generally) $1,000,000.00 lifetime coverage (unless you were very wealthy and could afford greater/larger coverage), now it's entirely unlimited. http://www.forbes.com/sites/rickungar/2013/03/26/proof-that-obamacare-rate-shock-is-an-ugly-insurance-company-deception/ “Overall, we find that loosening the rate bands from 3:1 to 5:1 would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers, once subsidies are taken into account. This is not only the case for all likely purchasers, but also for two populations of particular concern: the 10 million 21-27 year olds who are currently uninsured and the 3 million who currently have nongroup coverage.” By suggesting that the insurance company claims are merely ‘unfounded’, The Urban Institute is being quite kind as I would suggest a far harsher explanation for their scare tactics. What the insurance industry is not telling you—as revealed by The Urban Institute study—is that the overwhelming majority of young people who would be charged a higher premium to make up for the lower premiums to be paid by their elders will either be covered by the premium subsidies offered via the insurance exchanges or eligible for Medicaid under the expansion of the program extending health coverage to those earning 133 percent above the federal poverty line. Therefore, as clearly stated by the report, the lowered premium costs to the oldest participants in an insurance plan “would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers.” According to the study, here are the estimates: 92 percent of people ages 21 to 27 projected to buy an individual plan in an exchange in 2017 are expected to have incomes less than 300 percent of the poverty line, so they would be eligible either for Medicaid (if their state expands it) or for substantial subsidies to help pay premiums in the exchange. Similarly, 88 percent of 18- to 20-year-olds projected to buy a plan in the exchange are expected to be eligible for premium subsidies or Medicaid. .......... quote: You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. All tax payers already do and have for some time. Which is cheaper? The cost of a visit and meds or the hospital stay? quote: That's also (universally) a good thing because, no one wants to see anyone suffer but....you on the other hand, will, because....someone has to pay. You (generic) already are.

FunCouple5280 -> RE: health insurance not tied to employment (4/26/2013 11:07:16 AM)
Yet this was merely an opinion piece in forbes..... If you read the comments below there is still great debate. Think tanks imagining where rates will be are more-or-less fortune tellers. Only time will tell what will actually happen. The righ/left banter over the cost effects of the ACA is more mental masturbation than scholarly understanding. I think costs of insurance have to rise in some regard if you cannot exclude pre-exsisting conditions. I am in support of that as we need to cover them. However, this dire belief they will spiral out of control is unfounded. My biggest concern with the bill is the mountains of additional bureaucracy it creates and trees that will be slaughtered to accomdate it (figuratively speaking).

LafayetteLady -> RE: health insurance not tied to employment (4/26/2013 12:34:04 PM)
quote: ORIGINAL: tazzygirl quote: You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. All tax payers already do and have for some time. Which is cheaper? The cost of a visit and meds or the hospital stay? The talk about covering horrifying diseases, regardless of stupid decisions...which exactly are they? Should we not cover any cancers to people who smoke, regardless of whether or not the cause of the cancer could be attributed to smoking? Shall we just say certain cancers, like lung cancer? Not all lung cancer is caused by smoking. My dad died of lung cancer that was completely unrelated to smoking. What about HIV/AIDS coverage? Should we not cover them because they must have been promiscuous? Perhaps shin splints shouldn't be covered, because the person jogged too much. I don't know if dental is in any of this, but I guess cavities shouldn't be covered because people stupidly ate food that rotted their teeth. Foot problems for wearing the wrong shoes, guess you will continue to suffer those bunions. Bladder incontinence in females since they had children and maybe didn't watch their weight or exercise enough during and after pregnancy to prevent the problem. If you have diabetes, we will only treat you if you fall within the correct weight range, so we know you didn't cause this yourself. As you can see, you could really blame any person for any health problem they have. Health insurance shouldn't be only if you are healthy.

misanthropicdom -> RE: health insurance not tied to employment (4/26/2013 1:27:12 PM)
quote: ORIGINAL: LookieNoNookie You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. Insurance is, by definition, distribution of risks over a large population, otherwise it would not work. Auto insurance is no different, and I can amend your statement, above, by saying of auto insurance: "You, as a payer in the system, will pay for everyone in America that has any number of horrifying accidents while driving drunk, or texting, or fighting with their kids, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs." And yet, most people have car insurance, and many states make it mandatory they do so. And somehow, the world did not end, we were not all forced to become Socialists as a result as some (not you) have predicted will happen. We are the only industrialized country in the world where a hard working person's life savings and home can be consumed by a disease in middle age, where a hospital can send a $16,000 bill for a colonoscopy to an uninsured patient (happened to a good friend just last week), where some states (like California) exempt insurance companies from anti-trust regulation, allowing them to collude, blacklist the really ill, keep a shared list of people's pre-existing conditions, and raise rates as they please. The state of health care in the U.S. is currently a national embarrassment.

DesideriScuri -> RE: health insurance not tied to employment (4/26/2013 1:31:03 PM)
quote: ORIGINAL: LafayetteLady quote: ORIGINAL: tazzygirl quote: You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. All tax payers already do and have for some time. Which is cheaper? The cost of a visit and meds or the hospital stay? The talk about covering horrifying diseases, regardless of stupid decisions...which exactly are they? Should we not cover any cancers to people who smoke, regardless of whether or not the cause of the cancer could be attributed to smoking? Shall we just say certain cancers, like lung cancer? Not all lung cancer is caused by smoking. My dad died of lung cancer that was completely unrelated to smoking. What about HIV/AIDS coverage? Should we not cover them because they must have been promiscuous? Perhaps shin splints shouldn't be covered, because the person jogged too much. I don't know if dental is in any of this, but I guess cavities shouldn't be covered because people stupidly ate food that rotted their teeth. Foot problems for wearing the wrong shoes, guess you will continue to suffer those bunions. Bladder incontinence in females since they had children and maybe didn't watch their weight or exercise enough during and after pregnancy to prevent the problem. If you have diabetes, we will only treat you if you fall within the correct weight range, so we know you didn't cause this yourself. As you can see, you could really blame any person for any health problem they have. Health insurance shouldn't be only if you are healthy. So, the responsibility to pay for health insurance will be primarily on the taxpayer (especially if you are "rich")? What responsibilities are on the receiver of that largesse? Does a person have a responsibility to take up a lifestyle that requires as little medical care as possible? If so, who is going to make sure that responsibility is lived up to, and how?

LookieNoNookie -> RE: health insurance not tied to employment (4/26/2013 3:37:47 PM)
quote: ORIGINAL: tazzygirl quote: There will be no "lower premiums". Health costs will rise between 25 and 90% between now (depending on the level of care you're willing to pay for.....or not) and 2016 based on very basic mathematical facts (and anyone that tells you otherwise either doesn't know how to use a calculator or....is a complete moron): There is now no longer any "end" for insurance companies. No limit...good for patients. Bad for payers. It used to be (generally) $1,000,000.00 lifetime coverage (unless you were very wealthy and could afford greater/larger coverage), now it's entirely unlimited. http://www.forbes.com/sites/rickungar/2013/03/26/proof-that-obamacare-rate-shock-is-an-ugly-insurance-company-deception/ “Overall, we find that loosening the rate bands from 3:1 to 5:1 would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers, once subsidies are taken into account. This is not only the case for all likely purchasers, but also for two populations of particular concern: the 10 million 21-27 year olds who are currently uninsured and the 3 million who currently have nongroup coverage.” By suggesting that the insurance company claims are merely ‘unfounded’, The Urban Institute is being quite kind as I would suggest a far harsher explanation for their scare tactics. What the insurance industry is not telling you—as revealed by The Urban Institute study—is that the overwhelming majority of young people who would be charged a higher premium to make up for the lower premiums to be paid by their elders will either be covered by the premium subsidies offered via the insurance exchanges or eligible for Medicaid under the expansion of the program extending health coverage to those earning 133 percent above the federal poverty line. Therefore, as clearly stated by the report, the lowered premium costs to the oldest participants in an insurance plan “would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers.” According to the study, here are the estimates: 92 percent of people ages 21 to 27 projected to buy an individual plan in an exchange in 2017 are expected to have incomes less than 300 percent of the poverty line, so they would be eligible either for Medicaid (if their state expands it) or for substantial subsidies to help pay premiums in the exchange. Similarly, 88 percent of 18- to 20-year-olds projected to buy a plan in the exchange are expected to be eligible for premium subsidies or Medicaid. .......... quote: You, as a payer in the system, will pay for everyone in America that has any number of horrifying diseases, regardless of your efforts to refrain from stupid decisions. Theirs will affect your coverage costs. All tax payers already do and have for some time. Which is cheaper? The cost of a visit and meds or the hospital stay? quote: That's also (universally) a good thing because, no one wants to see anyone suffer but....you on the other hand, will, because....someone has to pay. You (generic) already are. I agree with most of that. There's a lot of value in the concept.

tazzygirl -> RE: health insurance not tied to employment (4/26/2013 6:11:23 PM)
And thats just it... its a conception. How the reality will pan out, no one knows yet. We are taking health care coverage in a different direction than we have known... and far different than any other country. Maybe this will work out. Maybe not. But reality is, what we had wasnt working. Too many were against a NHS, and so many were fighting against single payer.... both of which other countries are using, for good or bad. So many see the negatives in this. I dont like all of it. Never have. But I can see potential. Someone has bigh blood pressure. Better to get them on meds, and cheaper, than to do nothing and pay for the much higher cost of a stroke or dialysis. Dental problems (There seems to be an ability to add coverage for dental and eye, LL) can cause a host of issues, including heart complications. Isnt it far cheaper to pay for the dental than an ICU stay for heart issues? Diabetes. Yes, some are caused by obesity, some genetic, some medication induced, some some are a secondary issue to a primary illeness. Regardless, the medications to treat are still much cheaper than surgery to remove limbs, disability and even dialysis (at least 900 dollars a visit, three times a week, for life, all funded by disability). That 150 dollar vial of insulin, 100 dollars for testing strips and a visit to the Doctor every 3 - 6 months sure is a lot cheaper, at least to me. Cancer. Caught in the early stages has a far better chance of survival than later stages. End of life care is expensive. Lumpectomy costs - For patients not covered by health insurance, a lumpectomy typically costs about $10,000 -$20,000 or more. http://health.costhelper.com/lumpectomy.html For patients not covered by health insurance, a mastectomy typically costs more than $15,000 -$55,000 or more, not including breast reconstruction http://health.costhelper.com/mastectomy.html The earlier the treatment, the cheaper the cost.

erieangel -> RE: health insurance not tied to employment (4/26/2013 9:03:43 PM)
quote: Dental problems In the days when I was medicaid, I had a hard time finding a dentist who would take medicaid. I also was on medication that gave me dry mouth. Over the course of 15 years and a lack of proper dental care, my teeth rotted due to the dry mouth. I now wear dentures, not because I didn't brush/floss but because PA medicaid paid dentists so little that few of them were willing to participate in the program, at least in my city. That problem still exists today. Just this week, I had a client looking for a dentist. We called around. We didn't find a dentist near a bus line that takes medicaid, but we did find one that serves low income patients on a sliding fee scale (go figure). My client decided he'd go to the intake, find out how much it would cost for the necessary dental work and pay out of pocket if the cost is manageable for him, even though he's on medicaid. Otherwise, he's waiting more than a month for an appointment at a dental clinic.

tazzygirl -> RE: health insurance not tied to employment (4/26/2013 9:37:41 PM)
Oh but didnt you know the belief is that medicaid is free care all the way around? (please note the sarcasm is not directed at you, erie [;)] )

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