Skip to main content

Hi everyone,

I work at a small law firm which covers me at 100% with a group health insurance plan with Anthem/BCBS. However we got a interoffice memo today that starting November 1 when the new policy year goes into effect, the firm will only pay $750.00 per month per person and we will be individually responsible for anything over that amount. I am curious as to what the monthly cost of each of your insurances is. In my case it had been $881 or so as of this past year. But the game changer going forward is that I am now getting Remicade infusions at $10,000.00 per infusion at an increased rate of every 6 weeks.  If rates are up 15% (as I am told) I am guessing I will have to pay $150-$200 out of pocket per month after the firm's $750 monthly contribution.  I was wondering what the monthly costs are for the rest of you. Thanks.

Last edited by CTBarrister
Original Post

Replies sorted oldest to newest

Poucho,

My out of pocket max was $3,000.00 and I hit it pretty quickly this year.  After that covered at 100%.  But my premiums were paid by the firm at 100% so that basically I was only out of pocket $3,000.00 which all things considered is not that bad, especially when you consider Remicade is billed at $10,000.00 per infusion.

Going forward I am going to pay $150-$200 per month for the premium which will get taken from my salary.  Thus my total out of pocket between premiums and deductibles could be closer to $5000 this year.

Jen,

Canada has a different medical care system than we do.  The USA is not the place to be if you are a sick person, bottom line.  If you are a young and sick American and have some portability I would suggest moving to Canada or Europe, although I am not sure how good the actual quality of the medical care is in the EU.  I must say, all of my medical providers are top notch.  I had thyroid cancer surgery as well in 2015 and my surgeon and endocronologist and PCP at Yale are all top notch specialists.

Last edited by CTBarrister

I have a family policy, so not sure how it would compare to a single. I pay $288/month, but my employer kicks in over $20,000 annually to pay the balance of the cost of the policy. I have pretty good coverage- $500 deductible, 10% coinsurance, and $1500 out of pocket max, I think. Rx is separate out of pocket max, with a tiered formula. 

This is a great source for averages and ranges of employer sponsored health insurance costs, types, how premiums are split between employee and employer, etc.

https://www.kff.org/health-cos...lth-benefits-survey/

 

Boy I am getting raked over the coals. I work at a car dealership that is not  corporate owned , and have about 5 car lines in our group. We have medical mutual. My nephew lives in NYC and he is a bartender with crappy insurance and he has had horrible digestive issues and some days cant even function. He finally went to a great GI and since he didn't have insurance he had to pay $700 upfront for just the office visit. Doc told him he cant run the gammet of tests he needs until he get some type of insurance which hes trying to get.

I am retired and not qualified for Medicare yet. My husband and I pay $3 a month for our family plan (cheapest plan-HSA qualified). We qualify for premium assistance, otherwise our monthly premium would be about $1350- or $675 each. However, my individual deductible is $4800 and annual ou of pocket maximum is $6550. I reached both limits before the end of February, thanks to Remicade infusions. Fortunately, Remicade provides copay and deductible assistance.

Even though we do not pay higher rates due to pre-existing conditions, our premiums are high due to our age and zip code. We definitely worry about the ACA being gutted. Health care costs are our greatest expense right now, even with assistance. 

Jan

I am right now trying to choose between one plan that has a $1500 deductible and $3000 maximum out of pocket but would require a $63 weekly payroll deduction or about $250 a month towards the premiums, or another plan that has a $3000 deductible and a $5000 maximum OOP with no contribution towards the monthly premiums. The advantage of the first plan is the low deductible and maximum OOP, but the disadvantage is that I pay $250 a month for premiums. The advantage of the second plan is that I can open a health savings account, put up to $3400 in it towards medical bills including my $3000 deductible, and get a line item tax deduction. I am discussing the tax advantages with my accountant and have to make a decision by Thursday on one or the other. What's not clear to me is whether the payroll reductions on the first plan would be permitted to reduce my taxable income because I am also having money taken out for an IRA, and if so whether it's better to take a reduction in taxable income as opposed to a line item deduction. The premium payments from payroll would amount to $3200 annually vs. the other plan in which I can put up to $3400 in an HSA. I am also on Remicade which I presume will cause me to go to the maximum out of pocket no matter what I select.

CT, we chose the HSA qualified plan for the same reasons, many years ago when my husband was still working at his firm. I spent hours crunching the numbers and they all wound up costing us a similar amount out of pocket because we are both high level health care users. The only real difference was the multi-level tax benefit. We were able to put that money away, tax free, and save it for the future. It seems like a small amount, but over time, it has added up. If you are interested in investing yours in Vanguard accounts, only HSA Administrators has that option (or at least that was the case for the years we investigated it).

The rub is that you need to expect a big hit at the beginning of the year. We just plan for it.

Jan

Jan Dollar posted:

I am retired and not qualified for Medicare yet. My husband and I pay $3 a month for our family plan (cheapest plan-HSA qualified). We qualify for premium assistance, otherwise our monthly premium would be about $1350- or $675 each. However, my individual deductible is $4800 and annual ou of pocket maximum is $6550. I reached both limits before the end of February, thanks to Remicade infusions. Fortunately, Remicade provides copay and deductible assistance.

Even though we do not pay higher rates due to pre-existing conditions, our premiums are high due to our age and zip code. We definitely worry about the ACA being gutted. Health care costs are our greatest expense right now, even with assistance. 

Jan

I would kill to have that coverage

Jan,

I spoke to my local bank in Connecticut, People's United Bank, and they do HSA accounts. I am thinking of opening one up there. My IRA is with Vanguard. People's told me I would get a debit card to use once money is put in the HSA. I would then get credit card like statements which would be generated for all medical payments, on a monthly basis I presume. I don't know if there is any advantage in using Vanguard over People's which is where all my personal checking and savings accounts are.

Last edited by CTBarrister

My only point regarding Vanguard was if you were planning on using it as investment savings, rather than drawing it out during the year. They tend to be the lowest cost brokerage.  All HSA accounts are set up pretty much the same, where they have checking account for moving money, and an investment account or money market for earning and compounding. You don’t have to use it each year, like you do with an FSA. My account with HSA Administrators has an ATM card for using at point of service. We do it all online and it is linked to our local bank account for easy transfers. It’s up to you. I am sure your local bank would be happy to hold your money.

Jan

I pay a little over $1,800.00 per month.  $2000 deductible then they pay 100% after that if I use an in network provider.  They also pay medication after I reach deductible.  Before I had J-Pouch surgery I hit my deductible real fast but not anymore.  The price is ridiculous!  I’ve checked into cheaper policies but I can’t use the doctors or surgeon that I now use.  Deductible much higher too.

Last edited by ceew

I literally had no idea what you paid out of pocket.  Yes, I am Canadian.  My whole life I wanted to live in the states Florida.  But now I know if my parents originally from Poland settled in the states I would be officially bankrupt I work for myself.  Two surgeries in three months and one left to go countless attempts with meds Hermia etc.... trying to send me into remission from my colitis which didn't work. 

What would happen if you didn't have insurance you work for yourself like I do?  And surgery was your ONLY choice.  Before my surgery, I was hospitalized for 5 weeks trying to get me into remission again.  Guessing your health care would not pay for that.

My heart is truly breaking for all of you suffering and paying out of pocket it's not fair.

My suggestion move to Canada we take everyone. 

And the doctors are amazing I have 100% faith in my surgeon's knowledge and medical skills.

 

Add Reply

Post
Copyright © 2019 The J-Pouch Group. All rights reserved.
×
×
×
×
Link copied to your clipboard.
×