Health Insurance

[Knowsitall]

That was really nice of folks like Donut to help a guy out but his future may be very bleak without disability insurance.He would be well advised to get a legal oponion on the pre existing condition killing his claim.

The one pre existing condition we have is that we shall die and public insurance companies will do most anything to avoid paying a claim .My experiece is hat fraternal organization or group plans are easier to satisfy.

Anyone who is 35 years old should buy right now all the insurance needed for drugs,extened care living and disability and death insurance now while they are in good health and the insurance premium is afforable.

You will be sorry if you do not.

[Wallace]

A word of warning....

Don't go to an insurance physical unprepared. It is NEVER a routine procedure.

ALWAYS:
Take adequate time off work so you are relaxed and your blood pressure is normal.
Eat a frugal diet with no alcohol for three days beforehand and fast for a minimum of 14 hours.

NEVER:
Allow an insurance nurse to do an examination if you are rushed or tired.
Allow a company to take a sample of non-fasting blood.

Insurance companies look for any excuse to increase your premium. I have lost count of the number of people who have been sent to me with "elevated cholesterol" found on an insurance examination. Repeating the test on a proper fasting sample usually shows normal levels. But by then it is too late. The person is stuck with an increased premium and there is NOTHING that your doctor can do to change it. In my experience they never change their minds. And once your rating is changed, insurance companies share their findings with all others. Get a bad rating once, and you are totally screwed.

Just a few tips

[WishingWealth]

In USA Today.
Employers put health coverage in workers' hands

...As health insurance costs continue to rise, some employers are adopting a controversial new approach: ending group coverage and giving employees $50 to $200 or so a month to help them buy their own.

The shift is touted as a lower-cost way for employers to offer workers some kind of health coverage, while making smaller and more predictable financial contributions toward that coverage. Like other companies considering the switch, Ilios will pay a portion of employees' medical costs into tax-free accounts that workers can tap. It also will provide a link to an independent website where workers can compare price quotes from a variety of insurers.

...

re: 'price quotes from a variety of insurers'
Bloody country we have here, why can't we have a country and considerate employers like those. Instead of a single payer, we would have choices.

WW

[brucecohen]

The US employer-based health insurance system is about to get hit by a tidal wave. The baby boom chart here indicates that births peaked in 1958 at ~4.3 million and then continued at 3-4 million/year. So the bulk of boomers will START turning 50 this year. Based on anecdotal experience in my own family and among friends, 50 seems to be when people start falling apart and health care spending rises sharply. Employers have been reducing coverage for years and the article linked by WW points to a new form of DB-to-DC shift in which they'll abandon group plans. As the bulk of boomers moves through their 50s and into their 60s, massive political pressure will drive some huge revamp of the US system in 10-15 years. Absent action by whoever's in power during 2009-2016, the US could wind up with a single payer system by default as growing numbers of retired and semi-retired boomers rely on their Medicaid and Medicare programs.

[pitz]

brucecohen, I was in Texas for the weekend and went out for dinner with a friend (a Registered Nurse) who does medical claims review for a HMO. (bizarrely, there's better money and working conditions involved in pushing paper, than there is in doing actual nursing work).

She told me that the HMO she works for has developed a computer system that, based on certain illnesses, computes a cost to the insurance company. Based on the predicted cost of treatment, the insurance company (ie: her, and her managers) make a decision whether to 'recommend' that an employee be terminated without cause from their job (with health insurance) and paid whatever severance is required by law.

For instance: Husband works at a job with health insurance, makes $70k/year, and the common law would give him 2 weeks per year of severance. So the cost of severance is equal to 20 weeks pay, which is roughly $25k.

Wife, insured on the same plan, is diagnosed with a medical condition that requires long-term therapy, or an expensive procedure. Basically, if the cost of treatment is judged to be greater than $25k, then the husband will probably be targetted for layoff.

This is pretty scary stuff -- people are being selected for layoffs at firms motivated not by merit, and not by direct salary costs, but rather, based on medical claims experience. I don't know if this is illegal or not, but its happening in the US right now, and I can only bet it will become much more common.

[AltaRed]

Employers have been reducing coverage for years and the article linked by WW points to a new form of DB-to-DC shift in which they'll abandon group plans. As the bulk of boomers moves through their 50s and into their 60s, massive political pressure will drive some huge revamp of the US system in 10-15 years.

In my own case for ~5 years on a US plan, I saw my blue chip employer increase employee contributions in lock step with increases in employer contributions plus increased employee co-pays. A before tax HSA (Health Spending Account) component also came into play (for US citizens in particular - not ex-pats) by the time I retired.

While I generally agree health costs increase with age, aka baby boomers, I also saw more emphasis being placed on obesity as a bigger issue than age. There is statistical evidence shown by some studies that health care costs have skyrocketed for kids of all ages as well as 20somethings. That also showed up as an ever increasing theme in our health plan literature, promotion of lifestyle questionaires, and even some suggestion that coverage percentages might need to depend on lifestyle choices in the future.

[brucecohen]

From Benefits and Pension Monitor:

Even though U.S. employers are spending more for health coverage, availability for workers has stayed mostly level in recent years, says data from the Employee Benefit Research Institute (EBRI). It also shows that the number of employers providing retiree health benefits has suffered a big decline. EBRI says 12.7 per cent of private sector employers covered retirees in their policies in 2007, down from the 21.6 per cent in 1997.

[patriot1]

This is pretty scary stuff -- people are being selected for layoffs at firms motivated not by merit, and not by direct salary costs, but rather, based on medical claims experience.

And much bigger are the following:

- people staying in jobs they don't like and aren't productive at just to keep the medical insurance
- employers not hiring people likely to incur above-average health care costs (i.e. over-50's, obese, smokers, even women likely to have kids)

The employer-based health insurance system is throwing a huge spanner into the gears of the US labour market, just at a time when labour mobility and efficiency is more important than ever.l

[WishingWealth]

Paul Krugman on Health Care in the US.
NYT: http://www.nytimes.com/2008/10/06/opini ... an.html?hp
Health Care Destruction

...
In short, the McCain plan makes no sense at all, unless you have faith that the magic of the marketplace can solve all problems. And Mr. McCain does: a much-quoted article published under his name declares that “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”

I agree: the McCain plan would do for health care what deregulation has done for banking. And I’m terrified.

Excerpt cherry picked to align with WW's biases.

WW

[brucecohen]

Paul Krugman on Health Care in the US.
NYT: http://www.nytimes.com/2008/10/06/opini ... an.html?hp
Health Care Destruction

...
In short, the McCain plan makes no sense at all, unless you have faith that the magic of the marketplace can solve all problems. And Mr. McCain does: a much-quoted article published under his name declares that “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”

I agree: the McCain plan would do for health care what deregulation has done for banking. And I’m terrified.

There's a point that Krugman did not include: as a cancer patient, John McCain could not obtain insurance under his own program. Indeed, if McCain is as much opposed to "government-run" health insurance he claims, he should be asked why he elects to be covered by the federal employees plan instead of the one at his wife's company. It's because including him in the much smaller insured pool at her company would send the group premium through the roof.

[WishingWealth]

...
Most Americans under 65 currently get health insurance through their employers. That’s largely because the tax code favors such insurance: your employer’s contribution to insurance premiums isn’t considered taxable income, as long as the employer’s health plan follows certain rules. In particular, the same plan has to be available to all employees, regardless of the size of their paycheck or the state of their health.

This system does a fairly effective job of protecting those it reaches, but it leaves many Americans out in the cold. Workers whose employers don’t offer coverage are forced to seek individual health insurance, often in vain. For one thing, insurance companies offering “nongroup” coverage generally refuse to cover anyone with a pre-existing medical condition.
...

I also find that part interesting; that's nothing new, this is the system as it has existed for ?? decades.
Somehow, because it's the US system, we are often told by our friends right of center that it's sort of the Gospel; this is the way God meant it to be and our ([mostly] one payer) way is anathema to The Way.

Our system was also not an addenda to the 10 Commandments; I don't know why those to the South of us believe their funding system is a natural law.

WW

[tedster]

I am 73 and a ret'd P. Eng. As such I am supposed to get a really good coverage from Manulife for health. I just got a package from Blue Cross and for what apppears to be the same coverage.. i.e everything except drugs, the Blue Cross premium is half. Anyone shed some light on why? I really can't figure it all out.

[AltaRed]

My take is that once one becomes a senior, any Manulife discount that would normally be applicable on a group 'relationship' basis during working years, no longer applies. I would ask Manulife the same question you have asked in your post.

[marty123]

I'd think that drug coverage would be the most expensive part of a health plan. Also, switching to a half-price plan that excludes pre-existing conditions could be a mistake. I wouldn't take this lightly.

[fenderbass]

In BC, we have mandatory health insurance (MSP) and PharmaCare that cover visits to a doctor & hospital as well as prescription drugs. The quarterly premiums and deductable are based on family income. Since I collect a decent company pension as well as receiving CPP & OAS, my quarterly payments are $288 and my yearly deductable is $1,600 at which point Pharmacare pays 70% and once family maximum of $2150 is reached, 100%. Since this insurance coverage is more or less basic, I added a Blue Cross Health Care Plan for extra coverage. However, my monthly premium jumped 20% to $133 in January which will bring my total yearly health care premiums to $2748. I am considering cancelling my Sun Life Policy and instead, placing an amount equal to the monthly premiums into a seperate bank account-self insuring. I'm just wondering if anyone else has faced the same situation and if so, what was the final decision.

[Norbert Schlenker]

Blue Cross or Sun Life

I'm in BC too. I self-insure but that doesn't mean it's right for you. What does your supplemental policy cover?

[fenderbass]

Sorry Norm, supplemental insurance is Blue Cross. I chose Option D which is for extended health care & private or semi private hospital & prescription drugs & vision care-pretty much the works! My wife & I are healthy and between us probably spent no more than $200 yrly on prescriptions. I tried to move to a less expensive option but once you take Option D, you can't change for 2 yrs. This particular plan was designed specifically for my employer's pensioners and if I choose to cancel my coverage, I can't get back into the plan.

[brucecohen]

I chose Option D which is for extended health care & private or semi private hospital & prescription drugs & vision care-pretty much the works!

When I went out on my own in 1997 I consulted a guy in my ski club who's a broker for health insurance plans, almost entirely group. He advised me to self-insure. I did and, despite a big unexpected dental surgery bill, broke even. Now, thanks to my wife, I'm back in a group plan. At present, I'm pretty much breaking even -- up a bit one year and down a bit the next. I take comfort in limiting the increased cost of drugs as I advance in geezerdom and encounter more ailments.

We did not buy coverage for private/semi-private hospital room. As a heart patient, I've spent a fair amount of time in Ontario hospitals and have found that you get the accommodation that's available -- period. I've been in a private room, semi-private and 4-person ward. Also, most patients are discharged within a few days.

I've worn glasses since I was a little kid and have never understood the rationale behind vision coverage for adults. ISTM that getting $200-$300 every two years simply encourages people to get new glasses for stylistic reasons -- and the new stylish glasses will cost 2x or 3x the insurance cover. My understanding is that your vision doesn't change much after you reach bifocal age, often in your middle or late 40s. That's been my case.

BTW, are you aware that the premiums paid for private medical and dental insurance qualify as tax creditable medical expenses?

[pmj]

BTW, are you aware that the premiums paid for private medical and dental insurance qualify as tax creditable medical expenses?

IIRC - premiums for health insurance when travelling out of Canada, or even out of province, also qualify.

[adrian2]

Anyone who wants catastrophic drug coverage can just move to BC. There is a public program here called Pharmacare that picks up prescription costs at successively higher levels depending on income. There is a calculator here to give people an idea of coverage.

Above about $35000 net income IIRC, there is a 3% deductible, a 30% copay after that, and a 4% annual maximum. Discounts for seniors, lower percentages for lower incomes. Paid for by fellow taxpayers.

Action, not excuses, on drug coverage

In Canada, we have been mulling the notion of a national program to cover the cost of prescription drugs for more than half a century.

The philosophical/moral arguments for pharmacare are powerful and compelling. The economic ones are almost as strong.

Medicare was introduced gradually in the 1950s and 1960s because of an untenable situation. Families were being bankrupted by hospital and physician bills, and patients were going without treatment – even for life-threatening conditions – for lack of money.

The answer was a universal insurance program that was state-funded, a pooling of risk across the entire population that would ensure no one would go without essential care. A single-payer system could also contain costs.

Today, an eerily similar situation exists with prescription drugs. People with conditions such as cancer (particularly if they are treated outside hospital), multiple sclerosis and rheumatoid arthritis can face debilitating out-of-pocket expenses.

[...]

There is real fear that by doing what is acknowledged as the right thing, Ottawa will open a can of fiscal whoopass and saddle itself with a burdensome expense that grows like a tumour.

It’s not an unreasonable fear.

Look at the situation in Quebec. It was the last province to adopt medicare (in 1970), but the first to create a universal drug insurance program (1996).

It is mandatory in the province to have prescription drug insurance – purchased either from private companies or from the provincial health insurance program.

In its first year, the provincial drug program collected $169-million in premiums and required $700-million in state funding. A little more than decade later, premiums are forecast to have risen to $732-million and the state contribution to $2.5-billion.

[...]

A drug plan doesn’t have to pay for everything, but it needs to cover the essentials and do so fairly.

Instead of dragging their feet on this issue and prolonging the injustice for many Canadians, our political leaders and policy-makers need to put their noses to the grindstone and implement a series of measures that will make catastrophic drug insurance feasible, affordable and sustainable.

Enough with the excuses already.