February 15, 2013

Health Care Costs Revisted


 
Two years ago I wrote about the tremendous inflation in health care costs in the post,  How am I supposed to Pay For This?  At that point I seriously wondered how I'd be able to pay the huge in rate hikes every year for Betty and me until I was old enough for Medicare. The health insurance industry seemed to have a rather twisted business model: drive away almost all your customers while trying to keep only the healthy ones who could afford the highway robbery rates. Is this what we are facing during our satisfying retirement?

Since that post was written there has been a lot going on, some of it good but most still confusing and potentially hurtful. So-called Obamacare became law about one year prior to my article. I have no interest in debating the political aspects of the law. Since the most important parts still haven't taken effect and won't for almost another year I do want to look at a few of the changes that are looming ahead of us.

After the Supreme Court ruling allowed the major parts of the law to proceed, states, insurers, and companies are scrambling to get ready. One of the key elements is that insurers will have to offer a policy to anyone who wants one, regardless of their health. The insurers will not be allowed to charge more in premiums to someone who has an expensive medical conditions. State or government-run "exchanges" will make policies available to those who cannot afford a private policy. Since these exchanges have yet to be set up no one really knows what the final costs might be for individuals and companies that continue to offer health coverage.

From personal experience I do know that the individual policies that Betty and I carry have increased at close to 17% per year since the bill first passed Congress. I would guess they are attempting to build up their cash reserves before unhealthy people can buy their product. These companies face another huge change in their approach. After years of treating the individual market as an annoyance, the law now forces them to actually pay attention to the individual buyer

Of course, once I reach 65 in 2014 I am all that interested in a standard health insurance product in any case. I will be in the market for a supplemental policy to help with the 20% Medicare doesn't cover, plus the various deductibles and the "donut hole for drug coverage."

A good friend sent me a large packet of information that her small business must understand in their response to the various mandates and directives. I don't envy her or any business owner the tasks of complying with all the new rules. I read through the Power Point slides she sent and became confused after the 20th one...with 49 more to go! While there are too many unknowns yet to make a definitive statement, I am willing to bet that many small businesses will face substantial increases if they want to continue to offer coverage, penalties if they figure incorrectly, or they may choose to simply stop offering coverage and let the individual purchase coverage through the private offerings or the government exchanges.

With that fresh introduction, here are portions of the original post that continue to resonate with most of us.

Costs Are Insane

My wife and I have been in the individual health insurance market for 32 of our almost 37 years of marriage. Today, just paying the premiums on policies with very high deductibles and no drug coverage consumes 25%  of our gross income each year. Even with me covered by Medicare in 1 more year, by the time my wife is old enough for coverage I expect we'll be forking over closer to 35%.

A simple 2 or 3 day stay in a hospital costs more than $20,000. The average hospital stay in this country is 5 days and the cost is $44,000. Two years before she died my Mom broke her leg. The cost was $110,000. Medicare and her supplemental policy paid all but $1,000 after the bill was cut by more than 70%.Note I said she broke her leg...she didn't have a heart transplant or anything fancy. Just a broken bone that we probably all have had at least once while growing up.

Those numbers make no rational sense. The entire system is based on the premise that those without insurance pay more than those with coverage. Hospitals agree to provide certain services and costs paid for by an insurance company at an extreme discount and then make their profit on hugely inflated charges that you have to pay. At the same time they are required by law to treat anyone who walks into their ER, regardless of that person's ability to pay.

We all have to take responsibility for keeping as much of our money out of the pockets of doctors, hospitals and insurance companies. Exercise, eating well, keeping stress low, and so on are steps every one of must and can take to prevent financial ruin from a preventable health issue. 

Your Turn To Help Us All

My questions for you, though, are more basic. Since we are all in this together maybe we can learn from each other. Maybe you have discovered a way to get decent health care without filing for bankruptcy. Maybe you have a horror story about costs or health care problems you want to scream about from the rooftop. How exactly do you cover your health care costs?

One favor: please avoid blaming a political party, president, or policy. While there is plenty of blame to go around and this problem has been festering for years, that is not my goal with this post. I hope we can help each other by comparing our situations.

Look at each of these scenarios. Which one describes you? Please answer one or more of the questions under that heading. You can leave your comment anonymously if you'd like. But, I really hope we can get a dialog going about this issue and share strategies.

If you are covered by Medicare:
  • Do you have supplemental coverage?
  • Do you purchase Part D?
  • Do you use an Advantage policy instead?
  • Are you worried about restrictions on what is covered?
If you are in the individual market (insurance not provided by work or government):
  • How rapidly are your premiums increasing each year?
  • What benefits or costs have increased while the policy gets more expensive?
  • Are you afraid your insurance company will stop covering individuals?

If you are covered through work or a pension:
  • Has coverage changed since you left work?
  • Have your costs gone up?
  • Are you worried your company may eliminate health coverage?

If you have no insurance (like 47 million of us):
  • Are you skipping medical tests, procedures, and pills due to cost?
  • What would you do if hit with a major medical expense?
  • Do you use the emergency room for treatment of non-emergencies?

In all fairness to the insurers and others involved in providing care, there are an increasing number of studies that show we, as Americans, are not helping this situation with our refusal to change how and where we live. Dr. Richard Johnson, of UCLA Medical School and host of several PBS shows says:

"The CDC monitors the health of Americans over time using portable clinics to visit and examine a solid sample of the American people. This article in JAMA Internal Medicine due out Monday validates what primary care clinicians already know: Americans are unwell and rapidly becoming sicker, and “care as usual” is failing clinically and financially. In less than one generation, comparable groups of middle aged Americans (ages 46-64) have gone from 32% saying they are “in excellent health” down to 13%. The portion needing canes and wheelchairs has doubled, and over half of us get no physical activity, up from 17% since 1990.

The patient, the United States, is getting sicker and the usual medical treatments are failing. It is time to step back to make a better diagnosis—what is the underlying disease? I suggest that in the US we have created isolating environments, high in calories and low in walking and physical activity. Every doctor knows what does not work: merely telling patients to eat less and move more. It is time to create environments, physical and social, educational and commercial, that promote health, not disease. Sometimes in medicine we need to watch and wait, but with this epidemic for America, that time is long past."

We are very likely a large part of the problem. But, that doesn't change the reality of a health care system that has become unaffordable to many of us. 

I really am looking forward to lots of comments and lots of feedback. Be as open as you are comfortable being in explaining your situation and answering these questions. I can't think of a subject that affects a satisfying retirement any more than this.


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46 comments:

  1. We're in the bucket below:

    If you are in the individual market (insurance not provided by work or government):
    How rapidly are your premiums increasing each year? To my surprise, they only went up 3% this year.
    What benefits or costs have increased while the policy gets more expensive? They re-added maternity care to our policy as a result of the ACA (Affordable Care Act), which I sincerely hope I never need to use in my early retirement! That's been the only change thus far.
    Are you afraid your insurance company will stop covering individuals? No. Our carrier, Kaiser, has been in the state for a very long time, and is a well run, well regarded HMO.

    We have a high deductible plan, which does include drug coverage and preventative care with minimal out of pocket. Our combined premiums for two adults, age 57 and 50, including medical, dental and vision are $450 a month

    I can tell you that as a result of having a high deductible plan, we pay a lot of attention to our diet and exercise habits in the hopes of remaining in our current excellent states of health. Although we can afford to pay the deductibles should it ever come to that, we certainly would prefer to remain healthy and not need to.

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    1. Compared to the coverage Betty and I have you have hit the jackpot. Our individual policies have a $5,000 deductible, no dental for either of us, vision for me and very limited for Betty, no drug coverage for her and very limited for me...all for %839 a month. I'm sure there are people who are paying much more, but we are healthy, rarely go to the doctor, and still burn through a lot of money each year for very little return.

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  2. Good morning, Bob!

    In anticipation of going on Medicare last October, I thought long and hard -- and did a lot of figuring -- to come up with "the plan" that would make financial sense to me. I decided not just to look at premiums and itemized benefits. Instead, I looked at my own personal "worst case" financial scenario under each insurance option I reviewed. What I came up with works for me.

    I chose a High Deductible ($2100) Plan F policy to supplement Medicare, and a relatively high deductible ($325) Part D prescriptions policy. Without bothering you with the details, what I've ended up with is a situation where my premiums are $2400 per year including Medicare Part B, but my "worst case" financial exposure in case of illness is limited to less than $5000. Past the $5000, I'm covered 100% (with prescriptions a "wobble" factor).

    As I said, this works for me. I can handle and provide for a $5000 worst case (which still includes all my routine medical visits and incidental prescriptions throughout the year).

    Cheers!

    Alex in Virginia

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    1. That's a good way to analyze things, Alex. Of course, the reason Betty and I pay nearly $10,000 a year in premiums is for a worst case scenerio....like heart or lung issues.

      My potential out of pocket is $7,000 for each of us, plus prescription costs, plus the monthly nut. Seriously, I don't know how the majority pay for all this.

      A root canal job just cost $1100...all out of pocket, and that is after a $400 discount for paying cash.

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  3. You posted: we, as Americans, are not helping this situation with our refusal to change how and where we live.
    I am intrigued by the statement "where we live". Where is the healthy place in the US climate-wise? My husband and I retired to the sunny south along the Atlantic seaboard in what use to be rice fields and pine forests to escape the cold winters up north. While we are outside and physically active more days of the year but I am not convinced that these landscaped 'swamps' are the healthiest place to live. Mold and mildew; mosquitos and bugs.

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    1. Here is a list of the 10 unhealthiest cities in the country, with Huntington being the worst. I believe this is based on diet, weight, exercise and so forth, and not on mold or bugs:

      175.Kingsport-Bristol, TN-VA Metropolitan Statistical Area
      176.Fort Smith, AR-OK Metropolitan Statistical Area
      177.Chattanooga, TN-GA Metropolitan Statistical Area
      178.El Paso, TX Metropolitan Statistical Area
      179.Okeechobee, FL Micropolitan Statistical Area
      180.Brownsville-Harlingen, TX Metropolitan Statistical Area
      181.Mobile, AL Metropolitan Statistical Area
      182.McAllen-Edinburg-Mission, TX Metropolitan Statistical Area
      183.Laredo, TX Metropolitan Statistical Area
      184.Huntington-Ashland, WV-KY-OH Metropolitan Statistical Area


      Notice that all of them are in the south. I can't tell you why that is true, but it is.

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  4. We own a small business with one employee so we have to buy our own health insurance.Ken is 58, I am 59. Luckily,neither of us have had any medical problems .We don't take prescription drugs. For minor ailments we use a naturopath and I also see her for $100 per year annual well woman check up.We only get blood work done every few years. For the past 5 years we've been with the AARP AETNA HSA plan. We can put away up to 7500 in a tax deductible savings account. We have a 3000 deductible each and the coverage is not great by most peoples standards but will cover us if bad stuff happens.We pay $355 a month and we have no "office visit" coverage. 80/20 for the rest.

    I had to have a facial skin tag removed last year, I negotiated a $200 cash payment, no insurance was billed.This covered the two office visits in total. I also had some exhaustion issues when we moved last summer, went to our acupuncturist for 2 visit to realign my energy, I rested up, and it cost of $60 per visit. We tend to use natural health care providers.(Not covered anyway, by most insuranceI .)

    We have no prescription coverage but if we were to have serious illness and needed hospitalization, drugs, doctor visits in the hospital, it is all covered 80/20 at Aetna's contract rates. After we pay out of pocket 10,000 total per year, insurance kicks in 100%.

    For years our premiums went UP every year. This past year it went DOWN by $10..since Obamacare now says if the insurance company does not PAY CLAIMS that equal a certain percentage of PREMIUMS they collect, they HAVE to collect LESS PREMIUMS. So,Aetna must have been denying a lot of claims!!

    I am not completely comfortable with our coverage but not willing to pay more.

    We stay pretty healthy but frankly, I need to lose 20 pounds and we need to reduce the stress in our lives due to our business issues.I don't feel QUITE as chipper and healthy as I did a few years ago! We sometimes eat bad stuff to reduce stress..and yes, Americans need to encourage a culture of emotional,spiritual and physical health vs. consumerism and stress! I feel the need to improve some of our health habits this year and to reduce stress in general. My husband meditates daily,I am going to resume that practice.

    Long winded post.. but I am enjoying reading everyone's thoughts here.

    We have 5 more yrs. till medicare, if things get bad maybe we can move to Mexico and use THEIR coverage till we are eligible for Medicare!?????? Then move back?????? THis is a crazy thought that Americans should not have to think about!

    I am worried about how much our premiums will be when the exchanges kick in and insurance companies have to cover EVERYONE. Being in the health care field,I also worry how messed up the transition is going to be.We should be able to sign up for exchanges by OCTOBER and we have not heard a word about the details..??

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    1. Thanks for such a detailed answer. All these facts really help others. Yes, the exchanges are supposed to be set up to the point where folks can sign up and all the costs are known by October.

      States like Arizona just decided to go along with the federal program so are going to have to really struggle to get things in place by fall. Odds are very good there will be all sorts of mistakes and screw ups with something this complicated left until the last minute.

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  5. My husband is a retired State of AZ employee (16 years) who currently works for another employer. We get our insurance through that employer. If he had totally retired our insurance through the state would cost us more than his pension check is each month. Not complaining as we are thrilled to still get some sort of pension check, but we do get a little tired of hearing from others how state retirement must be so wonderful with all of the benefits, etc. My husband hopes to stay employed until we both reach Medicare age(2.5 yrs.). At that point, supplemental insurance from the state will be slightly less than his pension check at today's prices. I suspect that by then it will probably be higher. None of this includes dental or vision insurance. They will probably be beyond our means. We had hoped to retire earlier, but, since my husband had heart surgery, we realize that we cannot afford to be without good insurance. Another occurance of the problem would be financially disasterous and certainly jeopardize, if not end, our retirement plans if we weren't covered. We are college educated professionals and never thought that insurance concerns would be the ruling consideration of our retirement timing. Thankfully, he enjoys his job and life, for now, is great.

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    1. The health care "elephant in the room" is something that none of us assumed would so dominate our planning and decision-making. We decide where to work and how long to stay employed based on the ability to afford enough coverage to keep us from financial ruin.

      It wasn't supposed to be this way, was it? How did the health care system get so out of whack? Can it be fixed before it leaves many of us choosing between food or heat and pills?

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  6. I felt pretty comfortable when my husband retired from the Army.
    This year the premium doubled, with doubling for every year in foreseeable future. They also decided that only those with 40 miles can use the military hospital system. That will go to 30 miles soon.
    A bit different then the "free healthcare for life" we were "promised" for volunteering to serve.
    It is the elephant in the room.
    My mom pays about $500 a month for her Medicare supplimentals......
    Far better then my sister, who pays about $900 for her policy.

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    1. We are all at the mercy of changing regulations regardless of any "promises" made. Frankly, I don't think any promise or guarantee made by any business or government agency is worth the paper it is printed on. They know you have no recourse.

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  7. My husband and I both work for a hospital and then I work for an insurance company(heath insurance).Guess where we get our health insurance coverage? under the hospital thru my husband.I have run the numbers every way and this is how we get the most inclusive coverage for the least money.If I got health insurance thru the company I work for we would be broke.Right now for coverage of 2 people health/dental/vision is approx 250-300 per month.Our co-pays are 25 for PCP 35 for specialists.This price also includes a drug coverage and meds are in 3 tiers most expensive being $35.We are 58 so my hubby or myself will need to stay working for this hospital till 65 then we will see what the choices are.In our area my insurance company and others have gone up double digits every year for the last 10 years.I will work for this insurer but I would not have their insurance unless last choice I had.

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    1. Will you consider adopting Betty and me if we can be covered under your husband's plan?

      OK, so you work for a health insurance company so maybe you have some sort of explanation: they price a product in such a way that the majority of their target customers can't afford it. Then, they take the customers they do have and try to run them off with double digit increases every year, all while cutting coverage and services and routinely denying coverage for an expense.

      Is the whole thing a scam or some sort of Bernie Madoff scheme? What kind of business model is it that seems to go out of its way to run off customers?

      I seriously don't understand.

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  8. While I have worked for only large employers, their health insurance was never as good as what I could by into from my wife's employer (a county in NY state, where we lived formerly). Even though she is retired I still do so, with the caveat that we lost dental and vision coverage when she retired. Our medical premium for the great coverage we have, even here in TN, is $133 per month, with no increase this year (I was shocked). I then buy dental coverage for us from my employer for $82 per month, for a grand total of $215 per month.

    When I had emergency eye surgery last year Deb's insurance paid 100% of everything, without even a co-pay of $17. Even though we technically have no eye coverage, they have also been paying much of the cost of both of our routine eye exams and so forth. Any miscellaneous costs such as co-pays a I cover from a Health Care Spend Account that I have set up with my employer. After reading what many people have to pay, including yourself, we are blessed that we were able to plan the way we did.

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    1. Heavens, you have hit the health care cost containment jackpot, Chuck (and Deb).

      I think this is what drives so many folks crazy - how costs vary so much from person to person, state to state, situation to situation. I bet if you asked twenty people in your neighborhood all twenty would be paying wildly different amounts, and probably look at you with envy.

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  9. I recently transitioned to part-time at age 53. My wife and I are now on BC/BS COBRA under my employer's plan, with $1500 deductible each for $13,000 per year premium. Insurances under the Exchange is scheduled to be available 1-1-14, and we will likely obtain that coverage (we have a six month cushion and a fallback plan to avoid any gaps) due to pre-existing conditions.

    Sidebar --- we can't get individual coverage despite the fact we have been "health nuts" our entire lives --- you can't exercise away cancer and certain other conditions .... (but grateful for treatments and excellent prognosis) .....

    Some may be interested in what is projected to be available under the Exchanges and the potential tax credits. Here is one site I located, which provides information up to a certain income level and then shows NA above that. Perhaps there are better sites for estimating premiums and tax credits. Anyway, here is one I located: http://laborcenter.berkeley.edu/healthpolicy/calculator/

    I'd be interested in anyway has located other premium estimators.

    Happy weekend to all.

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    1. $13,000 for COBRA coverage? Oh my. Is it any wonder so many people just give up and show up at an emergency room, knowing they must be treated?

      I live in constant fear that by mistake my wife's premium will not be paid some month and the insurance company will use that as a reason to dump her. Of course, under the new law pre-existing conditions can't be used to deny coverage, but at what cost?

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    2. Bob, Interesting point you make. I also was in fear that the bill that came each month for our insurance premium, which always had less than a week until due, would be missed for whatever reason, and they would drop us. This year my wife was offered the chance to have the payment automatically deducted from her pension check, and I reimburse her for the amount. I am glad we had that option to lessen one more thing we had to worry about.

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    3. There was no sticker shock for us because I was an owner prior to my transition so I knew (and paid for) the full cost. Still, it is a significant cost and an unknown cost for the future.

      I wanted to mention that you and Betty may wish to take a look at the exchange later this year for Betty, especially to determine if you/she can qualify for the tax credits (which are based on modified adjusted gross income).

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    4. Chuck,

      I have B of A pay the bills 2 days before due. Plus, in reality there is a 30 day grace period before cancellation. Still, I do check on the first of every month to be the bank paid the premiums.

      Rick,

      Yes, Betty will certainly be a prime candidate for the exchanges. The way our income is managed we will qualify for tax credits to help pay for it.

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  10. Wow! reading your blog and the comments makes me grateful for the decision we made to volunteer in 2004 to take early retirement when the rail company my husband (then age 54) worked for had a force management reduction with enhance pension and it included the promise of health insurance continuation but with slightly higher premiums. They also put in the materials that there was no gaurantee that in the future early retirees would be covered but those already retired would be grandfathered. I had investigated carrying our own individual health insurance and it would have been 12,0000 to $18,000 a year in the Northeast where we live. In 2004 as early retirees we paid a total of $328 per month for the two of us including dental ( $1500 maximum per year) and a prescription drug plan of $30 copay for 90 day supply of the drugs he was on. We were on Aetna's 80/20 plan, maximum $3000 out of pocket for each of us per year and no lifetime maximum. When he was diagnose with cancer- the bill was 3 million before Aetna started to negotiate with the hospital. Of this- we ended up paying $6,700 over the 2 years. Unfortunately he lost his battle with cancer. I was very fortunate to be continued in the company's plan. I switch the next year open enrollment to a high deductible plan paying $115 a month and an annual possibility of $4000 out of pocket. I'm pretty healthy so I bet if I could go a year without medical problems the first $4000 I put in the HSA would fund me for the next. I keep adding the maximum to the HSA every year building it up for tax free withdrawal to cover health cost when I need it and to pay for Medicare premiums. The high deductible insurance choice now covers wellness checkup and gynecological test but not the lab work that goes with them. To get more retirees to take the high deductible the company started contributing $1200 to the HSA for the last two years. So even though I pay now $1800 yearly ( $150 monthly) in premiums for the combine health and dental coverage I'm out of pocket only $600.

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    1. I'm sorry for your loss and appreciate you sharing the full story. $3 million for cancer costs? We'll stop right there.

      You have a good deal compared to so many other people.

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  11. We spend a lot for long term care insurance. Not sure it is worth it but would hate for one of us to be left with nothing if the other required care for a long time. What do you think?

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    1. Long term care insurance is becoming a problem. Several of the companies that sold this type of policy has left the business. Those left continue to raise the rates, sometimes, by huge amounts every year.

      Why? People are living longer and health costs are through the roof so selling someone a policy that may have to pay off for years and years ends up costing the company too much money.

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  12. I've been in the same boat as you -- paying for individual insurance in my late 50s and early 60s, watching the premiums go up and up, and waiting to qualify for Medicare, which I assume (hope) will provide decent coverage at a reasonable price. So I know all about the problem. But as for an answer -- haven't got a clue. Lemme know if/when you figure it out! Meanwhile, I eat my veggies and try to keep up the exercise.

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    1. The only answer I can figure out is pray for health as long as possible and then a quick death. I can think of few things worse than a lingering decline.

      One more year for Medicare..I'm holding on. My wife = 6 more years until Medicare...duck and cover is all we can do.

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  13. Here is a link to a site which explains things in a sort of understandable manner. Still--where are we on the exchanges?????? Ken and I will have to buy insurance from one of them in just 8 months!


    http://www.kevinmd.com/blog/2012/12/cost-health-insurance-2014-ready-sticker-shock.html

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  14. Medicare premiums are almost as much as what my husband and I pay now, aren't they? Over $100 per person?? And that's for 80/20 coverage? And in Arizona there are fewer and fewer doctors accepting medicare patients. There are VERY few specialists who take medicare. So i don't really expect better insurance at retirement.I guess much less deductible though.

    Reading all these stories makes me so sad. 3 MILLION for cancer costs?

    Part of my job involves filing medical claims for patients. When their care is denied, they call me wondering "WHY won't my insurance company pay for my necessary health care??" Well, the public seems to not realize in THIS country INSURANCE COMPANIES are in BUSINESS to make MONEY. They are NOT in the business of providing you health care! They negotiate unreasonably low rates with a group of doctors to provide you with care, and then
    good luck STILl getting some of your claims paid to your doctor! Read some of the statistics on HOW MUCH BONUS MONEY and salaries Aetna,United, and Cigna CEO's are bringing home to THEIR families.

    At one time, before the laws changed, Cigna was "rewarding" doctors in their HMO system,monetarily, for NOT REFERRING patients to specialists. And for NOT treating them too many times per month. This is now against the law.

    I don't want to retire outside of my country but all these posts is making it sound like a good option!!!!

    DENTAL AND VISION coverage? Surely you jest!! Ken and I will be doing to Algodones in the summer for dental and vision care over he border.

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    1. Those who scream the loudest about a "government takeover" of health insurance don't understand the basic fact you state: health insurance companies are not in the business of providing health insurance. They are also the people who have very generous plans through work that mask the real cost of medical care in this country.

      My parents once griped that their copay for some pills had gone from $3 to $10 for 3 months. I so wanted to give them a basic lesson in the economics of health care and that their $10 pills were being subsidized by me.

      For me, paying $110 a month for Medicare B (A is "free") plus something around $100 a month for supplemental is still half of what I pay now.

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  15. I am grateful to be covered by a govrnment plan from my former employer. I pay 10% of the premiums which is covered now by sick leave I had left when I retired. I also have drug coverag. The copays for some drugs have increased from $20 for a 3 month supply to $50. It is a great deal.

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    1. Thank your lucky stars and hope someone doesn't find a way to mess up your good deal.

      Delete
  16. A shame to have to think this way in our beautiful country, but again, We'd have to cross the border if we needed expensive meds. At least where I am in Az. is only a few hours drive to Mexico. Where citizens don't even need a prescription for many common drugs such as antibiotics and birth control pills.

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  17. A good friend of mine is a skilled RN in a local LARGE corporately owned .She has many years experience.The premiums for her family health care plan have become too exorbitant for her to keep that coverage.Her spouse has a better plan at his work,so they switched over (luckily that was an option!) Isn't kinda mean that a large hospital corporation can't provide it's CAREGIVERS with better insurance? These are people working 12 hour shifts, extra shifts,overtime, caring for intensively ill adults,babies in NICU, and on cancer units. Maybe the exchanges will offer a better deal.. so companies can offer better plans??

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    1. A few single ladies we know take a once every three month road trip across the border near Yuma to get their drugs in Mexico. They can't afford to buy what they need here. One of them also had some dental work in Mexico, at 20% of what a dentist wanted in Scottsdale.

      I'm sure you aware of the growing business of having major surgery done in India or some other country at 90% less than stateside charges.

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  18. While on vacation in Thailand, I met many Australians who were on a medical vacation. Basically they have their yearly checkup / dental work/ surgeries all done in Bangkok or Phuket. And then they recuperate by taking a vacation.

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    1. This is becoming more common. I've read of companies in the U.S. that put together a travel package in a country like India or Thailand that includes the surgery and recoup/vacation time, all for much less than just the medical part at home.

      Sad, but true!

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  19. OMG yes my husband and I will adopt you and Betty! then we can all have reasonable heath care cost AND if you do need care we seriously have The Best( or kick @ss) doctors and hospitals.The one we work for is 565 beds and partners with Cleveland Clinic.I can not say enough about our hospital network and the "other one" in Rochester is just as good! We are rivals in the best sense.Ted Turner came here for cardio and he had money to go anywhere.How ever insurance companies like the one I work for our mucking up health care every chance they get.

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  20. Oh and as far as a Bernie Madoff scheme lol Nawwww we got him beat! Where else can you cut services to people for lifesaving,life altering, game changer situations all the while you give yourself double digit raises that make a non profit money? Of course they have mumbo jumbo to explain this that makes people's eyes glaze over and they don't understand.Truthfully over 10 years ago as a nurse I did not understand, fast forward and today I know more than I ever wanted to.I have had enough personal experience and years as a nurse to know this is not right.Do no harm right? Lots of people forgot the key phrases to live by like that one and do unto others? I'm just sayin

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  21. Bob:
    I'll join in and give you another perspective...
    My wife an I work for a major defense company, so it's a large employee healthcare pool, and should be able to contain cost, correct? Well, how about $1,350 for employee +1 per month for their retiree (pre-65) healthcare plan with 15% out of pocket. That's just medical. Dental and eyecare is additional. Here are my thoughts on why healthcare cost have gotten out of control. When I was a child in the 60's, the average diagnostic tool was a chest x-ray, now it seems there are more diagnostic tests than Apple has apps! And the hospitals and doctors are going to use them as they invested in them or are fearful of litigation in diagnosis. This is why out of US medical procedures are growing in popularity. I believe the only way to significantly reform healthcare is to limit litigation and or ration healthcare. Very unpopular steps, I agree, but society cannot continue to be burdened with these rising costs forever. The economy just can't improve GDP growth with increasing healthcare costs (and the rising price of oil - second largest factor).

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    1. Another reason for the cost increases seems to be the change from how doctors do their job. My family doctor pretty much just refers me to a specialist for everything other than a cough. Even though I have PPO coverage and referrals aren't needed to a specialist, the system has made doctors so afraid of legal issues they farm out virtually everything. And, that equals costs on top of costs.

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  22. Sorry Bob for venting! Thanks for all the info to compare though this post was so informative and helps us all know what's going on.

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  23. I agreee.tort reform MUST happen in order for physicians to feel safe enough to follow their JUDGEMENT vs. ordering tests to cover their butts.My son is a healthy 39 year old who had a hip injury due to working out..A couple of orthopedic guys wanted to do pretty much full body CT scans. My son looked up side effects and opted OUT of the radiation and increased risk of cancer. CANCER! He adopted a yoga program which totally healed his hip and he is back to his vigorous work outs.

    His health insurance would have paid almost 100%for the unnecessary tests and god knows what awful invasive "treatment." This is wrong.

    by the way--I looked up what health insurance for me and my husband would cost us in Massachusetts under their "exchange" program,.We now pay $355 a month for a not so great AARP Aetna plan.A MUCH WORSE "Bronze" plan with MUCH MORE OUT OF POCKET costs to us would run us $1350 a month in the Mass. plan !!!!!!! I am getting very worried about what is going to happen in October with exchanges.



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    1. All of us are going to be watching the evolution of the exchanges very closely since so much is up in the air.

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  24. For me, retirement is a time that you should enjoy and cherish. It is some sort of achievement for all the hard work that you have done. What better way to savor it is the absence of worrisome bills and unexpected expenses. That's why the healthcare costs in retirement should be settled while you are still working and employed. Prepare, prepare.

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