Medical Insurance Enrollment questions

[Chief Roundup]

Alright it is that time of year again. The college I work at it changing insurance companies from Blue Cross Health Advantage to UMR that is using United Healthcare.
The new company is pushing the High Deductible Health Plan. I am now trying to figure out if it is worth it for me to switch from my PPO/FSA to the HDHP/HSA.
I am not sure how to figure out the costs that would be different. They cannot provide me information ahead of time as to the "discounts we will get at our PCP" over what paying full price would actually cost. They cannot provide me information as to what prescriptions that I take will actually cost with the southern scripts, mail order company, that we will be required to use.

Any advice would be greatly appreciated.
Hoping that there is a medical insurance agent/consultant on here!!!

[Third Eye]

Originally Posted by Chief Roundup

The Blue Cross Health Advantage, the insurance we had in 2019, had the same deductible but they paid 80% on the way to the deductible not only paid after that deductible.
I had an x-ray a few months ago I had to pay $59 as my portion of that and it is the first imaging that I had had done under that policy.
Now, with United Healthcare through UMR new to us in 2020, I have to pay out $1500 before they will start to pay the 80% on the way to the maximum out of pocket of $5000.

Yeah, as mentioned by someone else, you had a $0 deductible plan previously which would be way more expensive than what you have now. Sounds like your employer used to pay a lot of the cost share and were tired of doing that. I think your gripe is with your employer rather than your insurer.

[lewdog]

Originally Posted by Third Eye

Yeah, as mentioned by someone else, you had a $0 deductible plan previously which would be way more expensive than what you have now. Sounds like your employer used to pay a lot of the cost share and were tired of doing that. I think your gripe is with your employer rather than your insurer.

This.

Know what you signed up for and the terminology.

[Chief Roundup]

Originally Posted by Third Eye

Yeah, as mentioned by someone else, you had a $0 deductible plan previously which would be way more expensive than what you have now. Sounds like your employer used to pay a lot of the cost share and were tired of doing that. I think your gripe is with your employer rather than your insurer.

Our price went up from $118 a month to $135 a month for shittier insurance.

[Chief Roundup]

Originally Posted by lewdog

This.

Know what you signed up for and the terminology.

Oh I don't understand all the bullshit and they try to do that on purpose it seems. The agency and our administration told us all that we would not notice much of a difference. There have been complaints by over 50 of the employees about this insurance already.

[Third Eye]

Originally Posted by Chief Roundup

Our price went up from $118 a month to $135 a month for shittier insurance.

Right, which is your price, not what the insurance costs. Your portion basically stayed the same while your employers portion of the cost share cake down significantly.

[Chief Roundup]

Originally Posted by Third Eye

Right, which is your price, not what the insurance costs. Your portion basically stayed the same while your employers portion of the cost share cake down significantly.

They told us all in the meetings that their cost also increased 25% with this new policy but it was significantly less than the increase to stay with Blue Cross Health Advantage plan that they had prior.

[Third Eye]

Originally Posted by Chief Roundup

They told us all in the meetings that their cost also increased 25% with this new policy but it was significantly less than the increase to stay with Blue Cross Health Advantage plan that they had prior.

Well I don’t know what to tell you. Somewhere, something is breaking down, but without intimate knowledge of everything, I couldn’t begin to guess where.

[Fat Elvis]

Originally Posted by Chief Roundup

They told us all in the meetings that their cost also increased 25% with this new policy but it was significantly less than the increase to stay with Blue Cross Health Advantage plan that they had prior.

Originally Posted by Third Eye

Well I don’t know what to tell you. Somewhere, something is breaking down, but without intimate knowledge of everything, I couldn’t begin to guess where.

Well, the repeal of the individual mandate penalty, for starters.....

It not like people weren't told this crap was going to happen.

[Fat Elvis]

Originally Posted by Chief Roundup

Man I hate the insurance game bullshit.
This new insurance sucks. It is United Healthcare by UMR. We had Blue Cross Health Advantage before. Both insurances had a $1500 deductible with a $5k out of pocket clause. What I have found out now after trying to use it is that the new insurance is that I have to pay out $1500 before they pay a dime. Then they will pay 80% up to the $5k where then they would pay 100%.
It turns out that the insurance is basically for a person to get a co-pay to see their PCP and to get a co-pay at the pharmacist. IMO that is not much insurance and seems damn expensive for $135 a month.
I can get better insurance for cheaper through TrumpCare. I am trying to get my employer to allow me a "life event" to get out of this crap insurance.

UMR is a subsidiary of United HealthCare.

You can't get cheaper insurance through "TrumpCare." Well, you could get cheaper insurance, but the crap that is now allowed that is cheaper will ultimately cost you a *lot* more money as they, in actuality, don't cover anything.

[Third Eye]

Originally Posted by Fat Elvis

Well, the repeal of the individual mandate penalty, for starters.....

It not like people weren't told this crap was going to happen.

Yeah, that has nothing to do with the current discussion.

[Fat Elvis]

Originally Posted by Third Eye

Yeah, that has nothing to do with the current discussion.

Well, yeah, it actually does...when you allow those who are least likely to use the insurance to leave the risk pool, costs tend to go up for everyone else. Anthem and UHC aren't just going to rely on local employer based aggregates for individual actuarial analysis; they are looking at a national scale.

This was the first year that the individual mandate wasn't enforced, so the insurance companies were probably pretty aggressive in their cost structure and why you saw a premium increase of over 25% (at least for the employer) year over year. You can probably expect double digit increases year over year going forward.....

[DaFace]

Originally Posted by Chief Roundup

Our price went up from $118 a month to $135 a month for shittier insurance.

Not sure what shelter you've been able to hide under. That's been the trend in health insurance for 20 years.

[Chief Roundup]

Originally Posted by Fat Elvis

UMR is a subsidiary of United HealthCare.



You can't get cheaper insurance through "TrumpCare." Well, you could get cheaper insurance, but the crap that is now allowed that is cheaper will ultimately cost you a *lot* more money as they, in actuality, don't cover anything.

There are several people I know that have that insurance, TrumpCare. One had a hernia surgery recently, total out of pocket was $800.

Sent from my SM-S906L using Tapatalk

[Fat Elvis]

Originally Posted by Chief Roundup

There are several people I know that have that insurance, TrumpCare. One had a hernia surgery recently, total out of pocket was $800.

Sent from my SM-S906L using Tapatalk

I don't think you understand the difference between "Trumpcare" and the ACA (Obamacare). People who purchased their health insurance from the marketplace, like the people you mentioned, bought a plan that is regulated by the ACA. You can thank Obama for that. What had been traditionally known as "Trumpcare," the AHCA, did not pass the Senate. With the SC ruling that the individual mandate penalty not being enforceable, a bunch of psuedo-insurance "policies" became available in certain states; those "policies" have about as much value as a degree from tRump University.

[Third Eye]

Originally Posted by Fat Elvis

Well, yeah, it actually does...when you allow those who are least likely to use the insurance to leave the risk pool, costs tend to go up for everyone else. Anthem and UHC aren't just going to rely on local employer based aggregates for individual actuarial analysis; they are looking at a national scale.

This was the first year that the individual mandate wasn't enforced, so the insurance companies were probably pretty aggressive in their cost structure and why you saw a premium increase of over 25% (at least for the employer) year over year. You can probably expect double digit increases year over year going forward.....

For the record, I’m a health actuary at a major insurer (not United or one of the Blues), so I’m intimately familiar with how commercial insurance is priced.