How much do you pay for health insurance? - PeachParts Mercedes-Benz Forum

kerry · #1 04-23-2004, 09:41 PM

It's open enrollment time at work. Next years prices have just been released. HMO/PPO family coverage $871 per month. $25 co-pay primary care. $40 co-pay specialist. $15/40/60 co-pay for prescriptions (generic/brand/non-forumulary). This is for state employees.
I'm curious what other people pay for health care nowadays.

Kuan · #2 04-23-2004, 09:52 PM

WHAT?!?! $871/month?

$105 per month family coverage, $20 copay, $15 max on prescriptions.

MTI · #3 04-23-2004, 10:05 PM

$0 per month, under wife's employer that pays 100%. $8 co-pay for visits; $15 co-pay for prescriptions. Last year under my employer it was $468/mo. for the same plan.

JCE · #4 04-24-2004, 12:30 AM

Under CalPers the insurance benefits and costs vary with the agency you work for, with Highway patrol having the best plans and lowest costs, and Cal State University employees/retirees towards the bottom.

For a Cal State University employee, the state contributes $661/month for the employee and spouse. (If you are already covered under your spouse's insurance, you can elect to have no insurance, and the state will increase your monthly check by $100 in gratitude for saving them $661/month on your plan!) Then the fun starts. You choose which HMO or PPO you want to pay into. For HMOs, depending on which one you pick - some only cover certain cities, counties, or catagory of employees - the employee monthly HMO "contribution" rates range from $0 - $220 over and above the state's $661.

PPOs are a different story. They used to have 3 competing plans to choose from. Then, in the interest of efficiency

they decided to custom design a single plan and hire just one of the former PPO provider companies to underwrite and manage the custom program. Rates went up 50% and benefits decreased 25% over a 3 year period. (another 25% increase in contributions and 20% reduction in benefits last summer - can't wait to see what we get this July)

In addition to the states'cs contribution of $661/month, the monthly cost to the employee for the PPO plan is now $458/month for employee and spouse for a plan that gives you 75-95% of covered and pre-approved procedures, $15-$45 per Rx copay, and $20/visit doctor's office co-pay, (up $15 per visit since last year!), assuming you are using 'preferred provider' hospitals, pharmacies, and doctors and have met your $1000 yearly deductible. If not, the price is adjusted upwards accordingly. The state decided to offer a less expensive PPO with even less benefits and coverage if the price is too steep for the above: $68 for a greatly curtailed and capped plan with greater co-pays and annual deductibles.

#5 04-24-2004, 07:40 AM

You guys get off easy in the Great Insurance State, we paid $961 a month for an HMO.

We down sized to an 80-20 plan with no prescriptions for $286.

We changed that since the VA is now providing full health, dental and prescriptions for me for the low low low price of wounded in action.

suginami · #6 04-24-2004, 11:26 AM

I pay about $400 / month for my family for an HMO, with a $10 office co-pay / $15 for a specialist.

bluerhino · #7 04-24-2004, 11:39 AM

Company pays $950 a month for me and my family. I have an option to cancel my insurance and they will add $950 a month to my paycheck. Very tempting but since my wife is self employed I have to stick with it. There's that big deductable I've seen lately on some plans with a cheaper monthly premium. Anybody got experience on big deductable plans? If I could get one, say for a monthly premium of $500 then I would have some extra for the toys.

kerry · #8 04-24-2004, 11:50 AM

I should add that the State does give each employee $250 towards their benefits. It also requires that each employee buy health, dental and life insurance. Dental is $55 per month, $150 deductible, pays 50%, no orthodontics, and maximum benefit of $1000 per yr. Life insurance is about $10 per month minimum.

If you decide not to purchase benefits, there is a $200 per month administrative charge.

Why are the State plans so expensive? You would think that the State could negotiate a cheaper rate. When I first became a State employee, I had been buying health insurance from Kaiser. I just walked in off the street and purchased a plan. The cost of that plan was significantly lower than the Kaiser plan offered to State employees.

I wonder what is the actual cost to the company for those people paying such paltry sums.

mplafleur · #9 04-25-2004, 02:08 PM

Quote:

HMO/PPO family coverage $871 per month. $25 co-pay primary care. $40 co-pay specialist. $15/40/60 co-pay for prescriptions

I think that's pretty much in line with what we pay. That's an auto company/supplier coverage. The company covers all but $105 of that which is out-of-pocket for me.

I do think it's quite high. A few years ago I was self-employed and paid $400 a month including spouse and children.

What does blow though, is that if I deny coverage (wife could cover me), I would only get back $50/month of that $870.

blackmercedes · #10 04-25-2004, 05:39 PM

Quote:

Originally posted by kerry edwards
HMO/PPO family coverage $871 per month. $25 co-pay primary care. $40 co-pay specialist. $15/40/60 co-pay for prescriptions (generic/brand/non-forumulary).

That is just a few dollars per month shy of what we pay each month, in total, for federal and provincial income tax! My wife's employer pays $88 per month for health coverage, the remainder is paid from our taxes. Since the tax burden for health care is about 27% of the provincial budget, you could make the stretch of saying that we pay $88 plus 27% of the $190 a month in provincial taxes we pay. That would be a total of about $140 a month for health care costs, EXCLUDING prescription coverage and vision/dental. Those are another $100 a month or so.

I think for the $240 a month we pay (in total) we get great service.

We have no co-pay or deductibles on the basic health care, which includes all and any visits to a family doctor, specialist and all non-elective procedures. It includes emergency care, but not the ambulance ride, which is odd. It includes all pre and post natal care. It includes immunization and public health services including post-partum counselling and other family counselling matters. It includes the home visitation services for nurses during the period when a family has a newborn. It also includes unlimited calling to a 24hour nurse-run hotline system which has cut down on ER visits. It includes any and all medical testing as ordered by physician. There is no quibbling or denial of service. If a doctor orders the service for a patient, it will be performed.

HOWEVER, there is a caveat compared to the US system. Not one person has "superior" coverage to another. Testing and services are performed solely in order of need, not in order of willingness to pay. This is a hot topic! There is a minority (usually wealthy folks) that believe that we should adopt a system where the higher the income, or willingness to pay, the higher on the list one should be. This makes sense in a Damn-the-topedoes-Darwin-is-king-capitalism-rules-everything system, but is not a great fit in our culture. With a growing gap between rich and poor, even in Canada (adoption of US style policies...), we are debating this topic more and more.

So, when you look at my $240 per month figure, you have to examine it in terms of value for service and compare it to your own situation.

Botnst · #11 04-25-2004, 05:43 PM

Family policy with dental. Gov pays 1/2= about $365. Buncha co-pays. PPO. Its a good policy that has always paid on time. I pay close attention to charges and have often found over-charges. Its usually under $50 and almost always against the insurer (not against me). Just infrequently enough and patternless that I can't quite call it a conspiracy.

In comparison, I make lots of gov purchases each month and rarely have vendors over-charge me (uh, the gov) on items. Is there something special about medical billing that increases teh error rate? Anybody else notice this or am I overly suspicious?

B

kerry · #12 04-25-2004, 10:12 PM

John:
How does your coverage work out of the country? My in-laws are in their 80's and retired in Ontario. If they come to the US, they have to buy very expensive health insurance to cover them when they are here. The result is that they rarely come to the US because of their fixed income.
Is it the same in all provinces? I'm guessing that there must be some limits because if there weren't the shrewd would visit the US and get a procedure done immediately, rather than wait in line.
I think in the EU, there are reciprocal medical agreements of some kind.

I think your system is economically and socially superior.
The puzzling issue, is, why is it economically superior? It seems to be a clear example of the better efficiency of a state managed health care system over capitalized medicine.

By the way, I noticed a couple of oddities in the interim Iraq constitution posted the other day. There was no right to bear arms but a right to health care. I guess everyone's going to think that Hilary wrote the constitution.

Botnst · #13 04-25-2004, 10:37 PM

Aren't the provinces and federal gov squabbling about who is going to pay for "unanticipated" cost overruns?

I used the quotes because its so predictable. Whenever gov in a free market starts "controlling" prices whatever portion is uncontrolled will rise. The gov will react by increasing the scope and degree of price controls. Eventually quality and/or availability will decrease.

Its in the cards. Read'em and weep.

B

blackmercedes · #14 04-25-2004, 11:56 PM

Quote:

Originally posted by Botnst
Aren't the provinces and federal gov squabbling about who is going to pay for "unanticipated" cost overruns?

No squabbling in the US? uh, sure...

We have a system that is far from perfect, but works in many ways that suit us.

Not all "gov't systems" are failures. The US is the only developed nation other than South Africa that does not have state-run health care.

The theory of the Public Good mandates that some systems must be far reaching to achieve an economy of scale. Health care is a prime example. By having every person enrolled in the plan, we achieve maximum diversification of risk.

Roads are built by private contractors (doctors are here...) but the price is controlled (through the bidding process...our doctors also negotitate fee schedules) and the public benefits as the nation owns the roads.

Most nations have realized the benefit of a healthy population and the "freedom" from economic disaster thanks to uncontrolled health problems. There is a cost to the nation as a whole for illness.

However, this is not a debate of public vs. private systems. Public systems exist in many many nations and are under attack not because they are expensive or inefficient, but because a group of individuals wish to maximize profit from a system that currently does not. The US has choosen a path of pure capitalism in their health care system, with a mish-mash of gov't funding trying to fill in gaps. Sort of like trying to hit a moving target. But, the US is a democratic nation and that is their choice. We, in Canada, also live in a democracy, and have chosen a different path.

Here's some info on health care costs in OECD nations...

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

95benzman · #15 04-26-2004, 12:20 AM

I have horizon blue cross/shield $417.14 per month
Single coverage. I hope I never need to use it .
But it is a must. Hospitals won't touch you without it.
take care.

joe moon