r/HealthInsurance • u/blastman8888 • 19d ago
Employer/COBRA Insurance Why has my employer group insurance gotten so lousy I have been there for 25 years
I have worked for the same company a large public utility since the early 2000's. My health insurance was great up until about 2015. Prior to that $100 a month pre-tax taken from my check for my entire family. Doctor visits were $10 I was never denied any tests. Deductible was $500 then later $750. Since I never went to the ER never used it.
After 2015 they moved us to a HSA the deductible was $1000 they offered to pay for $500 of it. It seemed okay the increase in primum evened out. Then each year they increased the primum, and deductible without offering to pay for more of the deductible. Now were at $4000 and $850 a month premium. My insurance denies just about every test my doctor orders. I needed an MRI for my neck because I have a paralyzed diaphragm which is because the phrenic nerve exits the neck spinal area has been damaged I have no idea how. My insurance wanted me to go to PT for 2 months I went once the PT said he had no idea how to treat me since my nerve is dead my diaphragm is thin as paper doesn't move at all.
I finally just paid cash for the MRI $580 of course I could not apply that to my deductible. This was just the start of the denials it's been one after the other.
Contrast my neighbor has ACA subsidized pays $600 a month deductible is $500 never denied anything and his doctor visits are $10.
I'm forced to take the employer insurance I'm told I can't get ACA. Why was there a shift before unemployed got lousy insurance employees got good insurance now it has flipped.
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u/Old_Draft_5288 19d ago
Healthcare has just gotten exponentially more expensive and that’s the answer to all of these questions
The person you know, just happens to be lower income and not have access and it’s getting subsidized
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u/blastman8888 19d ago
He is a real estate agent I think he has a way to pay his bills without it showing up as income.
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u/Old_Draft_5288 19d ago
I mean, that’s really not relevant to your topic, but sure
Also, you know, Real estate is kind of a mess right now?
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u/blastman8888 19d ago
I know what it costs to live in my neighborhood and he just bought a new BMW. I don't have anything against him if he can get insurance cheap not a problem for me. I would like to also get insurance cheap.
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u/anonymowses 19d ago
Realtors generally have very nice cars to drive clients around. It's probably leased.
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u/Organic-Class-8537 19d ago
Just tossing out there that a large percentage of People who look like they’re making bank are just scraping by and are in debt up to their eyeballs.
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u/strawflour 18d ago
Either your neighbor makes less money than you think or your neighbor is cheating on his taxes. Either way not really something to aspire to
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u/TreyfromMedcore 19d ago
Yeah, this is unfortunately a pretty common story now.
Back in the day, employer health plans were way richer because the risk pool was healthier, costs were lower, and companies used them as a big perk to keep employees around. Then after the ACA came in, a few things shifted. Medical costs kept going up faster than wages, so employers started switching to high-deductible plans with HSAs to keep their own costs under control.
At the same time, ACA marketplace plans came with subsidies to make them affordable for people in certain income ranges. That means if your neighbor qualifies, they can get a plan with lower premiums, a lower deductible, and better copays than what you’re stuck with — and for way less money out of pocket.
The kicker is, if your employer offers a plan that meets the ACA’s “minimum value” and “affordability” rules, you can’t get those subsidies. So even if your plan costs more and covers less, you’re locked in unless you leave the job or have a qualifying life event.
And yeah, the denials are another layer of it. Pre-authorization for stuff like MRIs has gotten a lot stricter over the years. It’s a cost-control thing for the insurance company, but for people who actually need care, it just feels like they’re blocking you at every turn.
It’s not that unemployed people suddenly got better insurance — it’s that ACA subsidies made the marketplace plans affordable for some people, while employer coverage kept getting more expensive and less generous. If you’re over the subsidy limit, you just eat the cost increases with no relief.
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u/blastman8888 19d ago
The strange thing was my wife needed an MRI of course they denied the cost for the insurance was $600 but when asked the imaging place how much to pay cash it was $230.
I would think insurance should get a better discount then paying cash it's like they don't care just pass the cost on to the end user.
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u/TreyfromMedcore 19d ago
Sometimes they don’t want the hassle of filing a claim with the insurance company. They can just get cash today and be on their way.
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u/DandyWarlocks 19d ago
I would sincerely love to know where you're getting an MRI that cheap.
I've had to pay out a pocket before and the minimum I've paid out of pocket was 2K
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u/dehydratedsilica 18d ago
One possibility is hospital pricing vs. independent imaging centers: https://clearhealthcosts.com/blog/2012/11/affordable-mri/
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u/blastman8888 18d ago
Not sure if you have a SimonMed imaging it's really low budget that is where I got low price $280 this was before covid everything was cheaper. They are usually in shopping strip centers.
The walls are hollow drywall you can hear every conversation in every room almost. I guess HIPAA doesn't care about installing sound proofing sit long enough in a ER exam room you already know all about the two patients on either side of you nothing to do but sit there and listen.
My wife had an MRI of her hip last year it was a nicer place it was $580 you have to shop around. Always ask for cash price no insurance. If your paying through insurance where you had a deductible the price will be much higher.
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u/trowelgo 14d ago
Shop around. I had to have a scan a while back. My hospital network was $2000. The competing, in-network hospital network was $4000. A free standing imaging center was about $450.
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u/tiramisutra 18d ago
lol! My insurance approved my lumbar MRI in May this year.it was around $2,500 with insurance. I guess I should have paid privately.
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u/Comfortable_Two6272 17d ago
This is typical for imaging and other healthcare expenses if paying cash. Rxs, dr visits etc.
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u/Character-Signal8229 19d ago
I deal with insurance for the company I work for, and it's just terrible and is getting worse every year. I have been involved in insurance since before ACA, and it's only getting worse. Prices went up immediately when ACA was enacted. Everyone was expecting this and dealt with it. Prices skyrocketed again after Covid.
Last year Cigna wanted to raise our premiums 34% because we had two cancer cases. 34% raise for over 170 people because 2 employees got sick and, god forbid, had to actually use the insurance. What about actually using your huge network and balancing prices?! They are collecting premiums and the majority of people never use them for anything major; and when you do - you immediately get hit with a price hike.
Prices are increasing, deductibles are increasing, co-pays are increasing. At some point this will become unaffordable for pretty much anyone other than Apple, Google, etc. I hate all the insurance companies! Rant over.
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u/SenselessNoise 19d ago
Provider prices are increasing because there's no regulation on what they can charge, nor is there any competition in huge swaths of the country thanks to mergers and vertical integration (further exacerbated by the inevitable decimation of rural health clinics as a result of the BBB). The reasons for the price increases are myriad (unfettered non-compliance with the Hospital Price Transparency Rule, AMA fuckery, C-Suite compensation packages at for-profit/"not-for-profit" providers, etc.).
Insurance costs are increasing because MLR allows insurance to retain more premium dollars in profit as a result of provider prices increasing (but up to a certain point, hence the denials). So there's not a whole lot of incentive for insurance to negotiate lower prices beyond how much a plan sponsor is willing to pay, which impacts the coverage offered (and therefore risk exposure) and offloads costs onto the employee.
No country with socialized healthcare or a single-payer option allows providers to charge essentially whatever they want. Addressing care costs would automatically lower insurance profit thanks to MLR, which would lower premiums.
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u/blastman8888 19d ago edited 19d ago
They just pass along all the costs they won't lose any profits. I don't know what the answer is American Healthcare seems to have a priority of profits first. My employer has 16k employees not massive but we still seem to get hit with price increases. I dread every October when open enrollment comes around. We were with Cigna and express scripts now were with Aetna and Caremark which I have heard is even worse although Aetna been little better then Cigna was at least my personal experience. My wife's OB doc doesn't take Aetna she refuses to change doctors now were paying cash. Some point might be easier to pay cash I'm finding cash is cheaper then what insurance has negotiated. That doesn't make any sense. Her Doctor said cash price is $100 insurance is $150. Something strange going on with that I wonder if doctors pay to contract with these large insurance companies they are told they can charge more insurance just pass it along to the patient either through high detectable or raise the rates.
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u/Character-Signal8229 19d ago
We do the same thing with urgent care. I have a high deductible plan, and was charged over $900 last time I used it (because I haven’t met my deductible yet). The next time I went, I paid their cash price which is $150. Insanity. This should be illegal.
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u/Comfortable_Two6272 17d ago
Makes perfect sense. Your dr has way less admin costs with a cash patient vs insurance.
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u/maroonllama96 19d ago
Things did change when ACA went into effect because people who weren’t able to get coverage before it was passed finally had a way to become insured. Also, people who had pre-existing conditions were able to get coverage. This meant a LOT more people could get insurance and get care, which means the people with chronic conditions were added and their care costs more.
Something that has been happening more recently is the buying of medical facilities by corporations and inflating the number of executives. Add on to issues of inflation and fewer providers, and it is a recipe for higher costs.
Oh, don’t forget the shareholders for both the insurance companies and the hospital systems. Why healthcare, including insurance, isn’t not-for-profit is beyond me.
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u/blastman8888 19d ago
This has been happening there are 2 large healthcare originations in my area they are buying up 80% of the private practices. I was looking for a new PCP I was looking going back to a smaller office had a few doctors. When I checked their website they said the cost to run the office had become too much their choice was to move to a monthly payment plan you pay $1500 a year for better care, or they would have to sell their practice to one of these two health care systems. They went with the $1500 a year I noticed on google reviews there were lot of complaints patients that had been going there for years said they could not afford the $1500 a year membership fee. 95% of our doctors all sold out.
I'm stuck with one of these two now I noticed that even though my insurance doesn't require referrals I'm no longer able to make appointments with a specialist unless my PCP approves. There must be some reason they are doing that.
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19d ago edited 19d ago
[deleted]
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u/blastman8888 19d ago edited 19d ago
We never knew how good we had it when I was in my early 20's 88-91 my first job moving out of my parents house I had to get high deductible private insurance. It was $150 a month $1000 deductible with $10 copay doctor visits. I remember filling out the pre-existing illness form most people just lied on those in those days nothing was electronic. Unless you were being treated for something at the time no way for them to find out. I never used the insurance in those days didn't even go to doctors. I knew guys got into car accidents with no health insurance had to file bankruptcy.
What your describing with your daughter that seems to be the latest games in healthcare shuffle the patient around to make money. My PCP now have you sign a paper not allowed to talk about anything other then what you put on the appointment have a 10 min limit.
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u/Comfortable_Two6272 17d ago
My ims back then required proof of prior continuous coverage or covered nothing for 6 -12 months. Year 2000 ish.
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u/Comfortable_Two6272 17d ago
A lot of that is inflation too. More patients. Less providers. Price increases. For profit insurance. Private equity owned health care. Seeing it in vet medicine now too.
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u/Comfortable_Two6272 17d ago
In my Area specialists require referral due too many patients. Already scheduling out 6 months without self referrals. Partly aging population. Retiring drs. Only going to get worse.
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19d ago
[deleted]
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u/maroonllama96 18d ago
That’s frustrating! I don’t think companies that provide insurance should also provide the health care. They can get money from people in two or three different ways all at the same time while denying anything that might actually help someone.
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u/blastman8888 18d ago
When I had UHC in 2010 it was great I got the bends scuba diving in 2010 on vacation in Florida was taken by helicopter to a hospital to get treatment all the bills came out to 100k all I paid was $100.
I was worried about the life flight ride I had heard of people having to pay thousands for those it was all covered.
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u/JediSnoopy 19d ago
States had high-risk pools and insurance companies were required to offer HIPAA plans (two of their most popular plans) as guaranteed issue plans for those with pre-existing conditions. These were very expensive plans but they were assessed to the persons being insured.
The ACA took that away and added subsidies on top of everything else to guaranteed issue plans so we are all paying for our neighbors' plans. When government money, known as taxpayer dollars, are involved in anything, the costs go up substantially. See: college tuition, government contractors.
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u/maroonllama96 18d ago
Even without subsidies, we are still paying for our neighbors’ healthcare. People who visit community hospitals, people who don’t pay their bills, and the people who were in those high-risk pools that chose to go without because those plans were so expensive and needed treatment they couldn’t afford means we pay more in healthcare.
I believe there are some things that should not be driven by profit and one of those is healthcare. I don’t believe the government or an insurance company should tell me what procedures I can or cannot receive. That should be left up to my doctors, not some bean counter in an office somewhere.
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u/JediSnoopy 18d ago
Suppose we go that route and anything your doctor suggests is suddenly paid for by the taxpayer...do you think it would stop some doctors from suggesting procedures that are unnecessary in order to have the government pay for it? Should there be no oversight regarding how money geared toward medical care is spent?
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u/maroonllama96 18d ago
There are probably some doctors that would do that, yes. Right now there are doctors who have to spend hours on the phone doing peer-to-peer reviews to get medically necessary procedures and treatments approved because an insurance company does not want to pay. These aren’t even experimental or untried treatments.
When I talk about taking the middleman out of healthcare, I’m not talking about a free for all. There can and should be guidelines and oversight. Those need to be created by doctors/providers, not someone whose focus is a bottom line or how much money they can get for shareholders. Those guidelines should be written in plain language and published on websites.
You keep bringing up the government. Forgive me if I am making an incorrect assumption. Do you believe corporate insurers and hospital organizations whose interests are stocks and shareholders are better at providing healthcare? I don’t trust that most corporations or the government have the public’s best interest in the forefront.
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u/JediSnoopy 18d ago
I think more competition is the answer. Insurance companies, like most businesses, are for profit. That's not necessarily a bad thing. When businesses have to compete for customers, it's a healthier atmosphere for all. Insurance should be portable. People should be able to move and take it with them even across state lines, for example.
When government runs insurance or health care, there's no competition, hence, no motivation to get better and plenty of opportunities to gouge the taxpayers. Insurance companies have departments that oversee costs; government should, too.
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u/MajesticComparison 18d ago
Competition only creates an incentive to create a minimal viable product/service. Corporations by their nature seek consolidation in order to increase profit.
Government cares about delivering a services or good, corporations only care about profits and will do everything legal and illegal if they can get away with it. There are many fantastic government programs, you just need to properly fund it.
Why do we question welfare for people but never welfare for corporations.
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u/JediSnoopy 18d ago
"Government cares about delivering a services or good,"
I'm not convinced this is entirely true. To attribute ulterior motives to corporations but not government is naive. Any organization of people, whether in a corporation or in a government (or a charity, a book club or a birthday party) is going to have some people who care more about their own self interest than for others. Individual people are inherently flawed; hence, large associations of people will be flawed as well. To pretend that government rises above that is dangerous. And this is not a partisan comment; this is true of any political party running any government.
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u/maroonllama96 18d ago
Thank you for this explanation and food for thought. Right now it seems to be that the insurance companies are buying each other and the providers. It seems like it is a race to see how little they can pay while adding more hoops to jump through for providers and consumers.
I do believe the government needs more oversight with spending.
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u/pnutjam 18d ago
I do believe the government needs more oversight with spending.
This is a 3% problem, the waste in gov is minuscule compared to the profits getting sucked out by for profit (and even "non-profit") companies. Jokers like they guy you're discussing just want the status quo because it's good for them and they don't care about anybody else.
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u/cabinetsnotnow 18d ago
"Also, people who had pre-existing conditions were able to get coverage. This meant a LOT more people could get insurance and get care, which means the people with chronic conditions were added and their care costs more."
This is a huge part of it. I understand that it's not fair that some people couldn't get health insurance before the ACA, but now we're getting dangerously close to the point where no one will have health insurance because they simply can't afford it. Except the rich, of course.
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u/RandSand 19d ago
Have you kept track of how much the employer portion towards the insurance been?
They may have tried to keep their costs the same by increasing the deductible on their plan.
Doing so simply kicks again down the road until they can no longer increase the deductible anymore and premiums will go up across the board.
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u/mamalion3 19d ago
I have had to change internal process because cost has gone up so much since Covid. I have seen certain items double in cost just since 2021. I saw a claim pre 2021 where a doctor will use foam to create an arm cushion and wrap up your arm/shoulder billed for $186. I saw a 2025 claim for the same thing same facility billed for $486.
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u/pennywitch 18d ago
You know how insurance companies can’t discriminated against you for pre-existing conditions anymore? Sooo, they can absolutely still discriminate against employers whose employees use too much insurance the year before, and raise prices accordingly.
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19d ago edited 18d ago
[deleted]
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u/Organic-Class-8537 19d ago
It then there are kids like my son, who was born just after ACA passed and on his first three months had about 2.5 million ok medical expenses. Pre ACA he would’ve hit his lifetime maximum and thereafter been uninsurable.
Yeah, those were the good ole days.
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19d ago
[deleted]
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u/Organic-Class-8537 19d ago
Thank you. What’s dumb is the vast majority of people who bitch about the ACA wouldn’t be willing to give up the basic tenants that made prices spike.
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u/anonymowses 19d ago
Don't forget that before the ACA there could be annual and lifetime limits. That was a safety net for the insurance companies.
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u/maydayjunemoon 19d ago
The life time max payment would have killed me many times over though. I am a cancer patient with metastatic cancer. I have been in treatment for 8 years with good quality of life. There are many like me out here.
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u/blastman8888 19d ago
I had private health insurance back then we called it high deductible $1000 nothing compared today I hear of 15k-20k deductibles. They hand you that pre-existing conditions form unless you were being treated for something we just forgot about all our previous problems. Electronic records were non existent in the 1970s' and 80's. Possible insurance companies kept claim records I never put anything down on those forms. I figured claim ignorance or forgot about it mostly busted arms and legs other injuries from doing stupid stuff when I was a teenager.
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u/Comfortable_Two6272 17d ago
Mine covered nothing for 6-12 months unless you provided proof of prior continuous coverage. Annual max. Lifetime max. Tons of exclusions. Year 2000 ish. Buying (without a job insurance) was basically not possible back thej if had pre existing issues (which most do). My relative was charged a ton more for her 5 yo due to a case of strep throat. I was denied due to history of migraines. It was way 💩 back then.
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u/sarahjustme 19d ago
I have medicaid, and we have the same hoops that you do. Not exactly relevant to the money issue, but if you're medically complex, all insurance is a headache.
Before the ACA (which approximately lines up with your timeline), insurance could deny any coverage to entire groups of people. Tons of working class adults had zero coverage, and even those who could get coverage through their work, had to deal with restrictions on pre-existing conditions. Unfortunately, your age and current health issues might make the past look better than it was.
Anyhow the current state of affairs with health care, really underlines the shell game we all play. Now that lots of much sicker people have insurance, and healthcare itself is also getting to be more and mote expensive, insurance companies are struggling to balance the books on the backs of their customers, while still offering some sort of minimally affordable coverage to employers who are mandated to offer it to all their employees.
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u/blastman8888 19d ago
I was born in the 60's so I was employed for several years under the old system. I always tried to get group health insurance could not block pre-existing conditions. If I lost my job I got cobra so didn't have a problem with the next employer. I was young and healthy like most people don't need health insurance in their 20's. I always worried that if something happened never wanted to go without insurance. Today not sure anyone can afford health insurance if employer offers lousy expensive insurance your locked in with that plan. My mother has an advantage plan she pays $250 a month for but can hardly use it other then an office visit.
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u/sarahjustme 19d ago
I'm probably about 10 years younger than you. I had a major medical event when I was 17, and my parents had good insurance for me, I probably got far better care than I would under any insurance today. (6 months of hospital care with all the bells and whistles). But because I now had a major pre existing condition, I couldn't get any regular insurance on my own, and employer insurance was very restrictive for any major needs- if I was able to work. Charity care and lots of learning about home care and self care. Im actually an RN because of that.
After the ACA passed I was able to get consistent coverage with the part time or contract work, and with expanded medicaid, I can also qualify for coverage even when I can't work. But yeah I've cost "the system" many millions of dollars over the years, and the cost comes out of the paychecks and taxes of working adults. It sucks for everyone.
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14d ago
I hate to say it but I private pay for a concierge doctor and private pay for my weight loss medication. Our insurance is a self funded ERISA plan. Our premiums are very low but I am seeing more and more intrusion into my private life by work. They even wanted to take me off my weight loss medication and put me on a dangerous fat based diet.
I pay less than 100 a month for a single person in premiums for a PPO. The family plans are a joke cost wise. Our deductible is 500 and coinsurance is 3000. As of late they now give us free procedures like MRIs, colonoscopies, and other surgeries. The thing with that is, they are completely in control and you have to travel for these procedures. You can have them done normally, but it isn’t free or cheap.
They even want us to go to PCPs that are free. It is not a requirement that we use the service but the providers are garbage. I find it much easier to just have direct relationships with my PCP and self-pay for his reduced MRIs and CTs. I can get a CT for like 200 bucks with him and an MRI for like 300.
I view work insurance as more of a stop loss measure for catastrophic things like car accidents, hospitalizations, and catastrophic things like cancer. The advantage there is I have hospital indemnity insurance as well as another form of hospital indemnity like insurance that will cover catastrophic out-of-pocket costs.
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u/blastman8888 14d ago
I see the USA headed toward concierge health care system for middle and upper class. Lower class will have a tax funded system. Subsidies for healthcare is same as public funded healthcare you get minimum health care service much like Canada. If you want more have to pay cash. The problem I'm in my employer monthly premiums are $800 for my wife and I. It use to be $250-300 just in the last 5 years it jumped $80-100 a month each year.
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u/Which-Ad-2020 19d ago
If we all had universal health care, this would solve the discrepancy issues. Having healthcare tied to our employer is stupid.
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u/SyntaxError_22 19d ago
See if you can apply your out-of-pocket expenses towards your deductible. I haven’t done it in a while, but I used to send medical treatment expenses paid oop to the insurance and had it apply towards the annual deductible.
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u/_Dapper_Dragonfly 19d ago
Premiums are up, copays are up, coinsurance percentages are up, and denials are up. I believe many employers are doing their best to offer what they can, but it's getting harder every year.
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u/Business-Penalty9060 18d ago
I think most people are in a similar situation, as I am as well. I make too much money to qualify for any subsidies and have to pay outrageous premiums for no care at all. Seems like people benefit for barely working or not working at all. Things need to change
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u/RoundChampionship840 18d ago
Are you appealing the insurance denials? Insurance companies will often reverse their denial decision if you go through the appeals process.
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u/guitarwidow 17d ago
I just received my renewal information for 2026 (small business owner). The rates have gone up 22% this year for the same plan and also increased the deductible and copay charges. Last year they had gone up 20%. It’s not your employer, it’s the insurance companies. Their rates keep going up, nothing you can do other than pay the new rate for mostly the same coverage, or downgrade the plan. And from talking to other business owners this is everywhere.
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u/BadgerSTL26 17d ago
Universal Healthcare needs to be a thing in the USA. Cheaper and all of us would be healthier.
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u/Kooky_Winner4236 17d ago
I had one child pre-Obamacare and the second child post Obama care. First delivery cost me $14 second delivery cost me 3850. With the same insurance.
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u/rahah2023 17d ago
True insurance costs have increased but - Your COMPANY is offsetting the increased costs to you and likely continuing to pay what they did 15 years ago. They also purchase crappy insurance to save $ trying to lower costs and these policies & rules of the crappy insurance are denying your coverage
You can switch during open enrollment to a policy on your state exchange but it will not be subsidized by the ACA bc you have access to private insurance- I looked into this last season as our private insurance through my husband’s company had doubled in cost in 3 years… but the exchange policies were about $500 more per month so we are still taking the crappy coverage from his company
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u/Comfortable_Two6272 17d ago
You can get ACA. Just not a subsidy.
Your employer is passing costs on and cutting back on benefits. Not all employer ins is this crappy. My employer cigna was slightly better than my ACA Market place Cigna.
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19d ago
[deleted]
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u/health__insurance 18d ago
Many insurance plans are running at a loss this year, kid. Nearly every health insurance stock is in the tank: United, Centene, Cigna, Elevance, Humana
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u/wyliec22 18d ago
People don’t want to face the reality of healthcare cost increases nor the cyclical nature of premiums and loss ratios. If an insurance company has $1 billion remaining after paying claims, people come with pitchforks. If the same company loses $1 billion next year, it’s totally ignored.
Healthcare has an incredible matrix of cost drivers and cross-subsidization. Judging from many people’s experiences with socialized healthcare, it’s no panacea either.
Among several drivers of cost increases are:
- ACA eliminating underwriting, waiting periods and lifetime maximums. These advances increase cost…but are not inherently bad or wrong.
- Advances in medicine (medicine, technology, surgical procedures) - these treatments are often additive - they treat previously untreatable or conditions with poor treatment options. Also, improvements in addressing rare diseases with a limited population to which it applies. These advances increase cost…but are not inherently bad or wrong.
- Regulatory mandates - HIPAA, ICD10, ANSI X12, EHR data sharing and patient access. These advances increase cost…but are not inherently bad or wrong. They also drive consolidation of smaller practices and rural healthcare facilities to spread the overhead costs.
- Security - 15 years ago, how big of a threat was hacking and ransomeware?? Security investments are a seemingly black hole. Organizations are often hit with thousands of attacks daily and all it takes is one to get through. The cost of tools and training to educate everyone from administrators to surgeons to housekeeping staff is again, additive, and while absolutely necessary, doesn’t directly improve treatment or outcomes. These are also costs were less or didn’t previously exist.
Everyone wants more and better for less cost and easier access…and the numbers won’t support this. To make wholesale improvements to the ‘system’, EVERYONE (hospitals, doctors, pharma, employers, patients along with State and Federal entities) need to negotiate in the best interest of all…and there’s not much likelihood of that happening…..
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u/Practical_Pickle7311 19d ago
Our health insurance is the post office and before ACA it was fantastic. Since ACA has passed we get to pay taxes on life insurance that we are going to drop because we can’t afford it. The health insurance is ok, but we pay a lot more for higher co pays, $35 for PCP, $50 for specialists, $350 for ER, $7500 out of pocket cap, in network only and if you see someone out of network it is on you and doesn’t go against OOP cap. Fewer doctors are accepting the insurance BCBS, and when you turn 65 you have to enroll in Medicare. I’m seeing tons of commercials on TV sand Im thinking their premiums are going to increase, why else would they spend so much money on advertisements? Something needs to be done with healthcare in the US. The ERs are overflowing with uninsured which causes undue stress on hospital staff and patients who are true emergencies. I’m just afraid that insurance and C-suite adm are not going to allow anything to change. Everyone should have access to quality, affordable, and timely healthcare.
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u/Kalenie9744 18d ago
That's the thing. Even the people who had good insurance through the state or fed are feeling the pinch that those of us in the private sector felt finally. They want you to believe its Obama. Nope, the grift just pivoted to you. BCBS is extra awful. I have negative experiences with them also.
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u/Practical_Pickle7311 18d ago
Well, my experience has been great better than Aetna but because it is a federal plan it does have different rules sometimes I have to remind them of that. I will say my husbands salary has not kept up with inflation and it seems the small increase he gets is how much health insurance goes up. Lots of postal employees are looking for smaller premiums. I stay with them because I have multiple health issues. I’m worried about when he retires, Medicare is not what most people think it is, it is very confusing, expensive and if you choose the wrong plans you could be facing having care or not having care. Privatization is not the answer, greed from the insurance industry comes out.
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u/Kalenie9744 18d ago
My spouse has Medicare and I'd be super grateful to have his plan. Sorry that you aren't having the same experience but I can't wait til I qualify.
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u/Practical_Pickle7311 18d ago
What makes you say this, I only have experience with federal employee plans and they have been very good, its just not the same as it used to be to be. When I look at medicare my concern is finding doctors that accept it and the copays/co insurance scare me.
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u/HealthcareHamlet 19d ago
Look into when ACA plans went into affect. Sucks but it's true...
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u/QuantumDwarf 19d ago
You’re right. Back then there weren’t as many biologics. Or oncology agents. Or diabetes treatments. Or blood clot preventive medicine.
Maybe, just maybe it has less to do about the ACA and more to do with new treatments, a sicker populations and greedy pharmaceutical companies.
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u/maydayjunemoon 19d ago
My cancer medication plus all the other medication and specialists I now need cost my insurance company about $250,000 a year. I pay $809 a month plus $7,000 a year out of pocket. My oncologist told me people who lived for 1-2 years with my diagnosis in the 90’s are now living decades in some cases. It depends on cancer subtype, and the ability to stay away from things that kill immunosuppressed people among other things, but it happens.
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u/blastman8888 19d ago
I don't think they can max out medication even back then. I might be wrong wasn't max policy only for hospital or treatments. I've been lucky enough not to have any serious health issue my sister passed from cancer back in February her care wasn't great. The system of doctors was poorly coordinated not sure it would have made any difference. Her oncologist had her in the hospital because a tumor was on her spine the hospital had no way to give her radiation treatment to get rid of the tumor. They had no way to transport her to the place that did. They told her to discharge herself against doctors orders daily to get the treatment her BF drove her to the place to get the radiation and back to the hospital she would get re-admitted. It was the craziest thing ever heard of. None of the doctors would sign off on the plan fearing they get sued .
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u/DandyWarlocks 19d ago
Hi I've been chronically sick since I was 16. I have been on very expensive medication since I was 25 so pre ACA. There was a cap on my treatment and medication on every insurance plan I had pre ACA-and these often carried over it was a lifetime cap. So if we still had those I would be crippled by now. Just to give you an idea. And I'm 44 right now.
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u/QuantumDwarf 18d ago
I’m terrified what will happen if we go back to that. I’m already terrified what happens with the ending of the ACA expanded subsidies.
I also recognize that BECAUSE there are now no annual or lifetime caps, it allowed drug companies to dramatically increase the prices of drugs that already existed, like Humira. So double edged sword. You can’t regulate greed unfortunately.
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u/blastman8888 18d ago
Never understood why insurance companies can't force drug companies to lower their price like Europeans. Perfect example is the GLP-1 drugs $100 in the UK here they are $1000.
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u/QuantumDwarf 18d ago
I don’t think it’s the insurance but agree. We (US) are subsidizing everyone else.
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u/Comfortable_Two6272 17d ago
They could. There was yearly and lifetime max. Hit that and $0 was paid for anything
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u/QuantumDwarf 18d ago
I’m so thankful you have this! My partner has similar options for their rheumatoid arthritis. Prior to biologics she probably would have been disabled and in crippling pain. It literally saved her life. She feels guilty about the absurd price tag. I can’t imagine where she’d be in a world before the ACA and Medicaid expansion (depending on income).
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u/shuzgibs123 18d ago
We are in the same boat. My husband also requires a biologic for severe Crohn’s. We both hit max out of pocket every January. I don’t know the answer, but I do know that no drug should cost $250k/year. No one can afford that, so how in the hell does that make sense? I also know that none of these drug commercials with catchy jingles should be allowed. What is their purpose? They only drive up the costs. I don’t need to ask my doc about a drug. My doc already knows about it.
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u/maydayjunemoon 18d ago
The drug commercials irritate me as well, especially after I learned they recruit patients with specific diseases to do focus group type question for pharmaceutical advertising.
“Sure, I’ll dwell on my trauma for a nominal amount of money, so you can perfect your commercial marketed to suffering people!” /s
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u/Wonderin63 19d ago
Yeah it’s unfortunate that you couldn’t get scammed for junk insurance that didn’t cover anything but your check up.
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u/mamalion3 19d ago
Back in the good ole days pre ACA. Since then medical costs have gone up sky high. The use of high cost medication has also increased. Also a thing to think about is 25 years ago you were well...25 years younger and your risk was lower. If you work with people that are old, possibly unhealthy and overweight, smokers and need lots of high cost medication then everyone pays for it. I see counties that have low turn over of employees and their premiums go up a lot each year but every year they have heart attacks and need skilled nursing and lots of high cost cancer treatments and diabetes. Yeah they didn't have those issues 20 years ago when they started that job out of HS! Sucks for the new young people replacing those literally dying while employed. We used to see people retire and take the burden off employer health plans...now they have to work till they die and everyone is paying the price for 85 yr joe and his wife......
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u/blastman8888 19d ago
10 years ago it started to change not 25. There were lot of old guys working there when I got there many had been there 40-42 years.
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u/maydayjunemoon 19d ago
And some of us who took great care of ourselves get cancer in our 30’s. It’s the lottery no one wants to win. 1 in 3 Americans will get cancer in their lifetime, and it’s starting to happen at younger and younger ages.
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u/Organic_Tackle_4034 19d ago
I pay $700 a month for insurance I can’t afford to use. I’m just an old homemaker, and my husband is retired. Letting the government (Obama) mess with our healthcare was the biggest mistake ever.
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u/paradoxofpurple 19d ago
I disagree. I was uninsurable without continuous coverage waivers through my father's employer health insurance before the aca. Thanks to childhood migraines, depression, acne, asthma, and various injuries, most of my health issues even now were considered pre-existing and would not have been covered.
After my parents got divorced, my mom and I were dropped from our private insurance because my mom needed to get treated for her migraines, and I had 3 er visits and a surgery in one year, and that process tapped out some benefit cap.
We also didnt have mental health benefits, free preventative care, covered birth control, maternal benefits and others that were made mandatory in compliant plans.
Yeah, it was cheaper back then, but companies could kick you off the plan for actually using it, or raise your rate to impossible levels to push you off. They could deny you care if they deemed that it was tied to another "pre-existing" issue.
If you're paying that much for health insurance on the aca after subsidies, you have a pretty decent income. If thats employer insurance, you should look at the aca.
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u/QuantumDwarf 19d ago
I mean. Before the ACA pretty much everyone was denied coverage for pre existing conditions. My dad was self employed and couldn’t get coverage for my step mom because she had high blood pressure.
ACA started in 2014. Since then the number and prices of biologic drugs have skyrocketed plus all the new meds for diabetes, weight loss meds and blood clots.
But sure. It’s obamas fault 🤣🤣
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u/Kalenie9744 18d ago
Agreed. I had an employer who wouldn't offer insurance until the ACA made him. When it was explained to him that the fine is more than the cost to insure, he was on board suddenly. Greed is why our costs are so high. Definitely not Obama.
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u/blastman8888 19d ago
My father had lot of pre-existing health problems because he always had group health insurance no way to kick you out. Self employed had groups you could join like a credit union. I'm not saying all that was great what they did before but this was big reason my parents always pushed for collage and getting a degree in something that I could get a good paying job. I remember my parents telling me don't ever want to end up without insurance.
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u/Upstairs_Fuel6349 19d ago
I had good insurance through a good job and hit both yearly and then lifetime caps due to needing treatment pre-ACA...
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u/Kalenie9744 18d ago
All the kiddos covered on their parents insurance til they're 26. Are you one of those? I was off my parents insurance at 18. My niece and nephew stayed on their dad's insurance til they were 26 and had children on the plan. We never had that option when I was that age, so things have always been bad. Trust us.
Changing drs was a thing back then too. My dad's insurance changed every year to get those cheaper rates. The lies people spin about the ACA dont help.
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u/IpsaLasOlas 19d ago
I believe it is private equity involvement in for profit heath care that is the biggest issue. Profit before ppl. Before ACA you could be denied insurance for preexisting conditions (so you couldn’t switch jobs), your kids came off your plan as soon as they finished HS or college and let’s not even discuss mental health coverage or lack thereof. It’s easy to blame Obama - but greed is the problem.
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u/mamalion3 19d ago
It isn't just private equity involvement. These big insurance companies are publicly traded. CVS was a top performer in the S&P 500. CVS owns aetna. Anthem owns Cigna. If you have investment that has a share of that stock via index fund or whatever...and you expect a profit on your investment then what...funny isn't it. We want lower drug costs but we want our investment to do well.
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u/Kalenie9744 18d ago
Yep all the kiddos today complaining got almost 10 years more time on their parents insurance than Gen X had.
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19d ago edited 19d ago
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u/blastman8888 19d ago
I have no choice I'm forced into taking my employer health insurance they don't offer a choice. I've been there too long to leave now few years away from retirement age I can get a pension. Ill probably stay till 62 to build more in my 401k. Every year I dread the open enrollment last year it jumped $1000 in deductible.
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u/ShelterElectrical840 19d ago
My deductible is $3000 and one bloody nose that wouldn’t stop met it early in the year.
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u/blastman8888 19d ago
They make sure I'm only allowed to apply 80% to the deductible because they only pay 80%. When they do approve something cost me $1000 only $800 is applied. Around November once in awhile I make it over $4000 they pay few hundred dollars.
What is dumb is they are denying services they aren't even paying for because they don't pay. This year I didn't even bother with insurance for blood work I got a much better deal going with function health 160 tests done for $365 about what I would have paid for 10 different tests they pay for. Some reason they pay more then I can pay with cash.
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u/maydayjunemoon 19d ago
And the generations below you won’t get pensions. They are at the mercy of how the stock market performs and how well they can do with their small contributions plus employer match. With inflation and housing costs, interest rates, tariffs, it’s not like most middle class people who would have gotten a pension will have what you do when you retire with your pension. Not to mention that they will have to retire at an older age. We all have things to complain about. It won’t get better with the pull yourself up by your bootstraps capitalistic mentality.
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u/blastman8888 18d ago
401k what I'm talking about they put 6% in. They also have a little savings plan they put 2% in of your salary. The old school pension that is calculated off your 2 highest years salary stopped being offered 25 years ago I missed that boat by few years. Those only offered now by Governments.
You have to get a good education I did it without collage it was a mistake 100% of the younger folks I work with in IT are all collage degreed they move up much faster then I did. Most of my peers I started with are all managers now I'm still stuck back as a front line employee.
Also have to put lot of money away in deferred savings and non deferred savings friend did that started when he was 18. He now has 5M saved it's been almost 40 years since he started saving. He can retire at 55 not struggling has big savings account buys new cars every 5 years.
What I see ones that struggle they are not saving before spending.
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