is the only one working and I am worried for my husband.

What kind of work do you do normally? What advanced training/education do you have? Not trying to be disrespectful of your privacy.

to do with the post I made that my husband will lose his insurance because it is too much. WHEN I WORK THE INSURANCE PLAN THEY OFFERED WAS HALF OF MY PAYCHECK!


WE SHOULD NOT HAVE TO HAVE THIS TYPE OF LIFESTYLE WHERE WE ARE FORCED INTO 2 OR THREE JOBS JUST SO WE CAN MAKE ENDS MEET BECAUSE INSURANCE COST TAKE 1/4 TO 1/2 (AND I KNOW PEOPLE WHO WORK 1 JOB JUST FOR THE HEALTH CARE AND HAVE TO WORK ANOTHER JOB TO PAY BILLS)

THERE IS NO REASON FOR HEALTH COST TO BE SO HIGH IN THIS COUNTRY AND THERE IS NO REASON WHY A FOR PROFIT SYSTEM SHOULD OUT WEIGHT THE BASIC HUMAN RIGHTS OF A CITIZEN!

WE NEED UNIVERSAL HEALTH CARE!


the average american pays 22% in taxes of that 22% 18 % goes to militiary and defense. how about this radical crazy idea! ONLY 10% goes to defense and 4% go to a universal health care system and 2% go to education and 2% to repair the roads I travel upon or keeping the water I drink clean or protecting my food from BS industry wants to put in it!

we are the only western nation that military budget is 500 BILLION! OUR "ENEMY" CHINA Defense budget is 58 BILLION!

OUR SOCIETY IS FUCKED UP!

If so, it sounds like they have stopped doing that, so he is stuck paying the entire amount.

Alternately, the ACS provides for grandfathering - if an insurance plan existed prior to 23 March 2010, they may be exempt from the rate review rules. Your husband's plan may fall under this exemption.

Rebates were (and are) not a certainty; insurance companies only need to provide them if they did not meet the standard for the medical loss ratio.

So much depends on the state you live in - you should take a good look at this website: http://www.healthcare.gov/law/index.html and see if you can find some answers for your questions; he may be eligible for some sort of state subsidized health insurance.

I feel for you and hope it works out well for you and your husband.

hugs.

he looked the other way and swept the PSU issue under the rug.

I don't know enough to help, but I hope you do get some good help here. Can you contact your Congressperson or Senator. Hopefully they aren't Republicans!

Try to keep this kicked. I'm sure knowledgeable people will see your thread eventually. Please don't think that no answer means no one cares. That isn't the case on DU.

correct me if I'm wrong)

page 2
If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits.

snip

A new credit will assist small businesses with fewer than 25 workers for up to 50 percent of the total premium cost.

snip

page 3
The Patient Protection and Affordable Care Act expands eligibility for Medicaid to lower income persons and assumes federal responsibility for much of the cost of this expansion.

Beginning on January 1, 2014, all children, parents and childless adults who are not entitled to Medicare and who have family incomes up to 133 percent FPL will become eligible for Medicaid.

I thought there was a cap on that.

Is that the cap you're thinking of?

................

still digging here for more . . .

Apparently there's a loophole in the law.

It works out as a pay cut under another name.

The exchanges must be up and running by 2014. Then the fees and penalties will start for unaffordable premiums and it looks as those will be used to provide assistance to the un-insured in buying their own coverage.

I think this gentleman's employer/insurer is just trying to make some extra cash off of him or trying to force him to drop coverage, which then he'll receive assistance from the ACA, once it's ready in 2014, to buy other insurance of his own choosing. I have no idea what he's going to do until then, as I am uninsured myself.

Not that I am a great expert either, just trying to establish the basis-in-fact that you're speaking from.

I am willing to admit that I don't know, because failure to do so is the path to fascism.

ins. premiums for people with lower incomes.

set up by HEW, perhaps that is because Kansas has refused to make any level of its own decisions about this by rejecting the federal money that would have made that local decision making process possible.

There is also the fact that the ACA implements the possibility that individual states can opt out of the HEW implementations and CHOOSE their own Single Payer structures in order to meet the ACA mandate.

If a state refuses to set up an exchange itself, the federal government will set up an exchange for that state.

The state won't get fed funds, if it opts out, thinking that would force most states to use them. But some states will opt out, anyway. Tea Party states.

Perry can't stop that from happening, although he'd like to.

in Nov his insurance cost per pay check will be $300 (which would leave us basically $150 after taxes) making it $600 a month AND it is only him on the insurance not both of us. He has Blue Cross Blue Shield.

with his diebetes?

Or you either. But that's not until January 1, 2014. Almost a year and an half from now.

screwed. I haven't been able to find a job.

This is generic but you get the idea:

http://www.health.com/health/article/0,,20456466,00.html

That's half a premium right there - and you're paying the premium - or should be - out of pre-tax dollars so you're realizing more of a savings on paying the premium than you realize. And if anything ELSE happened, broken leg, etc - then what? You'd lose everything.

I'd also find out why the premiums went up so substantially and why the company didn't shop the insurance around and find a better deal. Something does not sound kosher about all this.

How big is the company? What is the median age? Male/female ratio. Are the women mostly of child-bearing age or past? Have there been several people who've had extremely significant claims lately that hubby knows about?

I'd go talk to HR. Ask questions.

I'd also contact my local social services to find out about medical assistance in your area.

I don't see where there are cost controls.

Furthermore, here's a link to an article about how the insurance companies are already manipulating the "spend at least 80% of premium dollars on healthcare" issue. They do it by redefining what constitutes healthcare.

Be not fooled; Insurance Companies Still Gaming the System

https://www.commondreams.org/view/2012/07/30-3

and, ergo, "what constitutes health care" has NOT been defined by what necessarily benefits patients or improves their health, "what constitutes health care" NEEDS to be re-defined.

The fact that "what constitutes health care" HAS been defined by for profit systems means that PROFIT is the primary characteristic of "what constitutes health care" and IF we want to proceed toward a real possibility of Single Payer Health Care, we must address rising COSTS especially as the PROFIT motive contributes to those rising costs. If we don't do that, that is address rising costs as they are produced by profits, if we don't do that, Single Payer WILL BE IMPOSSIBLE, . . . ergo "what constitutes health care" as it has been defined by FOR PROFIT systems, NEEDS TO BE REDEFINED to place the care of patients as the highest priority, not profit, and thus not only do better for patients (in health care resources that are widely recognized to produce some of the worst results on earth - BECAUSE "what constitutes health care" has been defined by PROFIT, not by patients), but also reduce costs thus making it possible to provide more coverage for more people.

You can read more about that from the primary source on that subject of redefining "what constitutes health care", which should be a little more complete than and provide at least some balance to a secondary source such as Common Dreams:

http://dpc.senate.gov/healthreformbill/healthbill52.pdf

that's doing the defining.

What the author takes issue with is, as I noted above, a nurse calling her monthly to recount what meds she is taking and then making an appointment to do the same thing the next month, and calling it healthcare is a waste of time. Especially since the company was denying her NEEDED medication for pain - post surgery.

I don't think very many people are reading the entire Detailed Summary of the ACA.

to the health(sic) insurance companies.

In fact, she describes efforts to make them more accountable as "well-intentioned" which is being charitable, IMO.

President Obama is REALLY in it to insure profits to Ins Co.

I also think there are a lot of people who have not thought about how the for-profit model has generated a lot of practices and procedures that come out of the medical underwriting/managed care model and which are implemented by freelance health care consultants who earn high fees for "risk managing", i.e. pre-determining "care" in order to protect the high profits that pay high salaries.

As far as opinions regarding Pres. Obama's motivation for implementing the ACA, it's not a discussion that can be engaged in at this point in time.

This will all shake out eventually and we will see how it (the ACA) works in practice.

conditions:

page 2

Provide assistance for those who are uninsured because of a pre-existing condition

snip

Premiums will vary only by family structure, geography, actuarial value, tobacco use, participation in a health promotion program, and age (by not more than three to one).

Cap insurance company non-medical, administrative expenditures

exclude him due to pre-existing. Of course there will be the little matter of affording what insurance exists then.

and our illustrious governor is blabbering about not expanding the Medicaid and forgoing additional federal funds for that purpose. We have yet to see if that happens.

Second, 2014 is a long way off for someone in the position that the OP is in. It is like no help at all right now.

I wish I had answers, but I don't.

you need to find out what the cost of meds for your husband will be without insurance. It may be well over the $600 per month that the insurance will cost, and you will have to make decisions based on that. I don't know if you would be eligible for any aid, but you need to look into that ahead of time also.

That rebate, if there is one with your insurance company, would go to the person or company paying the bill---the employer. I would hope that they would pass that on to the employees, but I don't know if they will disclose it or not. My boss, I expect will not.

No TV internet is our only means of communicating and we drop our cell phones.


We are down to One income I am looking for a job none in my area.

We are screwed.

It really sucks. But keep looking into every possibility to help you. Maybe even there is a diabetes foundation that can provide help if he does have to lose his insurance. Be pro-active.

that the check to the insurance company is written by the employer. Even if the employee is paying all of the premium by payroll deduction, the rebate check (if there is one) would be written to the employer. I may just be mistrusting, but I think it is quite possible for the employer to keep the money and not notify the employee. But the employee will not be the one getting the rebate check.

I ever worked it was set up like hubby where the insurance is taken out of the pay check and you pay half or 3/4th and employer pays whatever they want to.

This is robbery and should seriously be investigated.

Not everyone will be.

send out the rebates.

And even those who don't meet the 80% requirement will, in many cases, only be giving refunds on those accounts which had total claims that equalled less than 80% of their premiums. For example, if your husband's employer paid a premium of (for round figures) $10,000 and the group filed claims totalling $8,500, then a rebate would not be forthcoming.

But remember, even if the company paid no claims for your husband's employer, there still wouldn't be a rebate unless the total that the company had paid out for their total book of businenss was less than 80% of the premiums that they'd taken in.

If I remember correctly, you are in PA and have Blue Cross/Blue Shield. This indicates (I think) that they do not have to rebate anyone because they met the MLR ratio.

http://companyprofiles.healthcare.gov/states/PA/companies/81033/med_loss_ratios?naic_num=&search_method=&search_term=Highmark+Blue+Cross+Blue+Shield&tgt_tab=overview

I got to this from a little news article here.

http://abcnews.go.com/blogs/politics/2012/07/health-insurance-rebates-is-your-check-in-the-mail/

I hope this helps. And I am sorry that this will not solve any of your problems with the rates you will be required to pay. Best of luck finding a way to deal with your situation.

would enjoy it)

probuably it will all go to the company as they will say the rates are low due to them or somesuch, but i dont think the employee whould get 100% unless they pay 100%.

But it really isn't the business of the insurance company to know if you pay a share of the premium. That is the company's policy. And so the insurance company can only send the rebate to the company. I am sure that many companies will reimburse the employee for any rebate they receive. I am equally sure that all companies won't. Mine would not....I am positive. Well, unless they HAD to do it or go to jail. But who will know???? I am just saying that it is a possibility.

I was asking nurses about barriers to completing a series of immunizations, and she said "well, around here, it's usually people losing their jobs, so they lose insurance and can't finish the immunization".

Jeez.

And fuck Corbett, by the way.

England celebrate their health care system for the world to see and I hear wingers making fun of the olympic opening.

here might be your preference, if not then the NHS would be miles better. I think a lot of this stuff comes down to personal situations.

so an NHS situation would certainly be better for me. And everyone else I know who is struggling.

Your post precisely sums up what's wrong with the system -- if you're doing well, it's fine. If you're not, well, you're completely screwed.

but at other times then a NHS system would be preferable. Maybe having the ability to do both, a single payer system but allow people to have health insurance if they want, kinda like BUPA in the UK.

I have had great health insurance in the past, but no longer have it now, so I'm with you 100%.

I have two part-time jobs - one taking care of my 88-yo dad, which doesn't provide health insurance (although he did treat me to a shingles vaccine yesterday) and one free lancing.

Although I'm busy now with freelance work and earning good money, it will be months before I see any of it -- at that time, I'll be able to consider looking for insurance. If that dickhead Corbett would set up exchanges, it might help somewhat; I don't have another employee and don't earn enough to be able to play tax games with health insurance.

The system sucks for freelancers, just as many people are finding that as a work-around in an economy where there actually is work, but no one wants to hire.

For-profit insurance companies should not be allowed anywhere near a healthcare system. End of story.

able too, if im say willing to pay 10,000 to get surgery on my shoulder that the NHS deem not neccessary adn i have a surgeon who will do it then why not.

and they can do whatever they want to with it and pay any amount of money for whatever surgery they want.

It's people who don't have a choice, such as the OP.

We need a single payer system.

Ensure consumers have access to an effective appeals process and provide consumer a place to turn for assistance navigating the appeals process and accessing their coverage

Across individual and small group health insurance markets in all states, new rules will end medical underwriting and pre-existing condition exclusions.

if you could. Where do you live in PA. Are you near Philly so you could consider moving to Jersey or near Maryland or near the New York border? All of those states are more reasonable in terms of starting to set up high risk insurance exchanges.

Obviously moving to Canada or Britain would be even better but less realistic.

Look into bcbs plans, they have pretty affordable ones x

have been taking $150 a paycheck for his coverage. I will be looking at the prices though thank you.

My insurence is called hospital surgical plus, awesome benefits.

especially with pre-existing. Or increase the rates substantially.

It doesn't make sense his insurance is increasing so much. From what I'm hearing nearly all ins company's are lowering theirs. Something isn't right about this. Sounds like his company is crooked. Unless something happened to their employee pool, or they had a large number of very signficant claims. then maybe.

The COMPANY could - and should - shop the policy around and I'm positive they could get a better deal.

From what I've read, employers are either dramatically increasing their premiums or dropping health insurance all together.



Here's one article:http://insurance.about.com/od/HealthIns/a/Large-Employers-Revamping-Health-Benefit-Programs-For-2012.htm

The NBGH survey found that employers estimate their health care benefit costs will increase an average of 7.2% in 2012. That is slightly lower than this year's 7.4% average increase, but it is on a higher base and it still sharply outpaces the economy's anemic growth and business conditions in this weak recovery. To help control those increases and begin driving down costs to avoid the Cadillac tax, employers are planning to use a wider variety of cost-sharing strategies.

Employers indicated those changes would include:

More than half of respondents (53%) plan to increase the percentage that employees contribute to the premiums.
39% plan to increase in-network deductibles.
About one in four employers plans to increase out-of-network deductibles (23%), and
out-of-pocket maximums (22%) next year.


And another: http://money.cnn.com/2012/07/24/pf/health-coverage-employers/index.htm

NEW YORK (CNNMoney) -- One in 11 employers is planning to drop health insurance coverage for workers over the next three years because of the high expense, according to a report from consulting firm Deloitte.

While Deloitte's 2012 survey of employers -- conducted before the Supreme Court's ruling in June to uphold health reform -- showed that 9% of them planned to stop offering health care coverage

our premiums are going down.

Our PPO about 10% and our HMO about 5%.

We were initially "offered" a 12% increase as a bargain basement rate for such a "good" customer. It took many days to keep the increase this small. I can't change insurers either as my husband has a very serious PEC that nobody else will touch.

Anecdotal evidence doesn't outweigh the realities for the rest of us out here....

And they shopped the heck out of it. They got it *down* from 18%.

ours went down.

Maybe I should have our agent call your agent?

your husband's premium compared to premiums for comparable males without diabetes. I wonder if the ins co isn't trying to force him out of the insured group, or just make some more money off of him before ACA goes into effect.

ACA has premium standards and means to enforce them. That stuff isn't in effect yet, but when it is, it goes like this:

Any employer with more than 50 full-time employees that does not offer coverage and has at least one full-time employee receiving the premium assistance tax credit will make a payment of $750 per full-time employee. An employer with more than 50 employees that offers coverage that is deemed unaffordable or does not meet the standard for minimum essential coverage and but has at least one full-time employee receiving the premium assistance tax credit because the coverage is either unaffordable or (the employer) does not cover 60 percent of total costs, will pay the lesser of $3,000 for each of those employees receiving a credit or $750 for each of their full-time employees total.

is his plan an individual plan? if it is, there may be an individual plan that would work. don't know under the new ACA, but can they still charge extra for pre-existing?

sP

The prices are a lot less than pharmacies here in the states. I order my blood pressure meds from a Canadian pharmacy.

We struggled to stay insured through 2 huge insurance premium raises and state budget cuts totaling 22% since August 2009. We have already cut everyone's wages twice, top down. I've personally lost $600 a month in income since August of 2009.

Nothing else we could do. It was either drop the insurance, or go out of business.

At least we don't have to lay anyone off yet.

(BTW, we provide necessary, critical life services to severely disabled persons).

I really think that when more and more middle managers and upper managers have to go out on the open market and find their own insurance, the pressure will really begin to build for single payer. Once companies begin dropping insurance coverage (which more and more will do I predict since there's now going to be options for their employees to get it elsewhere), it may be another pressure point on congress to get it done.

why would there ever be an inceptive to capitalize on someone's life? Pretty fucked up and sick.