Get ready for sticker shock on your health insurance costs
Before you start celebrating the pending passage of a healthcare bill in Congress, you might want to make sure you have enough savings to offset the huge out of pocket costs coming your way.
Reports out of the Senate Finance Committee on what individuals and people would have to payis not exactly a reason to pop those corks. Unless, of course, you're a health insurance CEO already making the down payment on your seventh vacation home.
The Senate Finance Committee, considered to be the top dog on Capitol Hill on drafting the bill in the absence of Sen. Ted Kennedy,
"is considering an income threshold of 300 percent of the poverty level, or $54,930 in gross annual income for a family of three, to keep the legislation's 10-year cost at $1 trillion." Or $35,000 for a family of one.
Meaning if you are below that amount, you get a public subsidy to pay part of your premium. If you earn more, you're on your own.
Premiums averaged $12, 680 for family coverage in 2008, or $4,704 for an individual, according to the Kaiser Family Foundation. That's a national average; ratchet the number much higher if you live in, say, New York, Los Angeles, or San Francisco.
Even in the heat of the current debate, the insurers are not exactly exercising restraint, as in the report todaythat Anthem Blue Cross wants to raise rates an average 23 percent and as high as 32 percent on individual health insurance policies in Connecticut.
Next, remember these figures cover only premiums, not all the additional bills that are all-too-familiar for people with insurance now.
How much does that add? More than 17 percent of Americans under 65 already have high deductible plans, and the average deductible alone for those ranged from $1,923 for single policies to $3,883 for family policies, which for the most part you must pay before the insurer pays for anything.
That's it, right? Not so fast. Then there's the co-pays, doctor fees, lab fees, late fees if you miss your payment, bills that can literally nickel and dime you to death. Sound far fetched? Consider this added note from the Los Angeles Times:
"A co-pay as little as $10 can prevent a woman from getting a mammogram, according to a study published last year in the New England Journal of Medicine. Many other studies have shown that prescription drug co-pay increases of as little as $5 can dissuade older patients from filing prescriptions."
Nurses can introduce you to a lot of those patients, people who won't fill a prescription ordered by their doctor because of the cost, or who will take their meds every other day, or cut their pills in half to share with family members, reducing the effectiveness.
In fact, the story of the past year has been the crisis faced by families with insurance. As evidenced most recently in the study showing medical bills account for 62 percent of personal bankruptcies in the U.S., and three-fourths of those are people with insurance.
If you're counting on the public option to hold down costs, the Wall Street Journal today quotes White House Chief of Staff reminding us that avenue remains highly tentative.
"The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview. "The goal is non-negotiable; the path is" negotiable.
The upshot is the bill expected to pass can force people to buy insurance, but it won't keep people from going broke when they have to go to the doctor. Or from paying their premium and skipping the needed doctor visits and waiting until they are so sick they end up in an emergency room. Or from just breaking the law and subjecting themselves to the fine.
All of these scenarios have occurred in Massachusetts, the laboratory for individual mandate where the state is reeling from the expense of subsidizing payments to the insurance giants, which responded by capping enrollment and limiting covered services.
There's plenty of other danger pointshere as well. Also on the docket in the Senate Finance Committee bill, are:
provisions that could lead to higher insurance rates for adults in the 55-to-64 age category and higher out-of-pocket costs for certain people who buy their own insurance.
And, if you buy the cheapest plan, which you can bet many would, they may set a cap of covering only 65 percent of the premium.
But, don't worry, they are offering "under one scenario" to limit out-of-pocket costs to "$11,600 for a family and $5,800 for an individual."
Well, that will be a relief for all those women who already have to because of the $10-co-pays, and the people with the cheap plans that don't cover such frills as dental work, eye care, or long term care.
Notice that all the plans talk about people who are under 65. That's because at 65 another option is available, Medicare, which guarantees you basic healthcare coverage regardless of your ability to pay.
Though not a perfect system, it works, and is about to celebrate its 44th anniversary at the end of this month. Too bad Congress and the President have taken the idea of extending Medicare to everyone off the table.
















Isn't American politics grand? I should have laid odds when the healthcare debate began, that the lobbyists would turn a threat to the cash cow their clients have been bleeding to death, into a WIN for the insurance industry. Revolution NOW!
July 7, 2009 4:29 PM | Reply | Permalink
I hesitate to comment about health care because I have medicare, but I have thought throughout this effort to insure everyone that Congress could very easily make it worse instead of better. I don't trust them to put together a decent insurance package.
July 7, 2009 4:30 PM | Reply | Permalink
Thanks for these posts!
You are reminding people that the whores of Capitol Hill have no intention of creating a health care system that serves the people. They are intent on creating a system that only increases profits for the parasites. This is a hard truth for many to accept but it is reality. Keep fighting!
July 7, 2009 11:45 PM | Reply | Permalink
Ah, the joke also known as the health care reform.
"All of these scenarios have occurred in Massachusetts, the laboratory for individual mandate where the state is reeling from the expense of subsidizing payments to the insurance giants, which responded by capping enrollment and limiting covered services."
Maybe if health insurance was banned and abolished outright and people were stuck with 100% out of pocket every time, then our Fearless Leader and his fearless cronies would wake up and realize where the problem actually resides.
July 8, 2009 1:31 PM | Reply | Permalink
Where the problem really resides Lalo?
Source
July 8, 2009 1:42 PM | Reply | Permalink
I think the Medicare premiums that the government publishes for people who haven't paid enough in to qualify might be an important indicator of actual cost.
For most people, who paid into FICA for the required amount of time,the premiums for Part Bare $96.40 a month and nothing for Part A (hospitalization.)
But if you're someone who worked off the books and didn't pay in for at least 30 quarters of employment, your Medicare Part A premium is not free, it is $443 per month.
Add in the Medicare Part B premium of $96.40 per month and you've got the government suggesting that Medicare's current value is a total premium of $539.40 per month for one person, no?
Source:
http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100
July 8, 2009 2:11 PM | Reply | Permalink
P.S. You say: But, don't worry, they are offering "under one scenario" to limit out-of-pocket costs to...$5,800 for an individual." But I see that Medicare charges a senior who has not paid into the system for 30 quarters a premium for 12 months of $6,472.80 for one person, that is quite a bit more than the $5,800 that you say gives sticker shock. Apparently, there is no way around the sticker shock unless the medical system itself, not just insurance, is reformed.
July 8, 2009 2:17 PM | Reply | Permalink
And the $6,472 Medicare number does not even include Part C, drugs!
It's looking ever clearer to me that the number we are looking at is around $6,000 per year per person, even if we had single payer. So ok, give a big downward adjustment from Medicare for all the young healthy people to be included in the pool, maybe $5,000 per year. The cost of the health delivery system is the main cost, there are no miracle answers, single payer is not a free pony, it would just deliver a one-time savings and then we would return to the main problem.
July 8, 2009 2:44 PM | Reply | Permalink