Since most of the other health care reform provisions have not been delayed, several aspects of our existing plans would still need to be changed for 2014 to meet the new federal requirements. In addition, given our employee demographics and our significant 2014 medical premium increase, we believe the new plan designs are important to manage ongoing and increasingly expensive health care costs and will provide another savings vehicle to help you prepare for future retiree health care costs.This was the letter I received from my company about our 2014 health plan.
Let me tell you about 'managing' your health care costs. In January of this year, I went to the ER with severe stomach pain. They diagnosed me with acute appendicitis and I had an appendectomy. Simple in-out operation, less than 24 hours. That cost me around $2,500. When I went to the ER, I thought it was going to be my gall bladder - I already knew that it had to come out at some point. So I put off having my gall bladder out, because I've been trying to pay off the appendectomy, and my hubby's stent.
Fast forward to March, and more severe stomach pain. I thought for sure this was my gall bladder this time. We called 911 and I went to the ER. After a long night of vomiting and pain, they released me, still undiagnosed, with a prescription for Phrenergan and one for Bentyl. And a bill for $810. Plus a bill from Medstar for $637. This was the same hospital that had diagnosed my previous stomach pain as appendicitis.
So now I had an ER bill for nothing, basically, as well as the bill for the appendectomy and the bill for the stent. I thought that they had missed something. I kept having vomiting and stomach pain attacks. I went to my primary and started the process of getting scheduled for a choleostomy (gall bladder removal.) I met the doctor, went to a different hospital, and had the gall bladder removed. The doctor told me it was 'nasty.' Apparently I had a gangrenous gall bladder from having postponed the surgery so long.
So 'managing' my health care by postponing a necessary surgery just about got me dead. Is this what they mean by managing my health care? What do they expect me to do? How can I save on necessary surgeries? Do it myself? I hear they sell a home lobotomy kit - basically it's a bottle of whiskey and an ice pick.
I don't know what the future's going to bring, but I'm looking at my numbers, and what the company is offering isn't good enough.
They're offering me two plans - a bronze and a silver. The bronze is a 'hope you don't get sick' plan. Barely enough coverage to qualify as coverage. The silver plan is worse than the plan I have right now. The individual deductible is going up from $300 to $400. The family deductible is going up from $900 to $1200.
The out of pocket maximum also goes up from $3,500 per individual/$9,000 per family
to $5,500 per individual/$11,000 per family.
Per month, the silver plan from my employer would cost me $400 for me and my spouse. This is $100 more than the plan I had in 2013, and it covers much less.
So what I'm getting right now from my employer is $4,400 more a year for worse insurance.
I'm holding my breath until October 1st, so I can see what the federal marketplace has available. According to this table, we should be getting around $718 a month in tax subsidy to afford insurance. This means that if I go with the federal marketplace to buy insurance, I could spend around $300 a month, plus the subsidy, to buy some insurance that might be adequate for our needs.
As far as I can tell (and even with the long conversation I had with Yadira over at the Health Insurance 101 website, I'm still confused) I think what this means is that I will only qualify for the subsidy if I use the federal marketplace. I can't find much information on what insurance will be available - all I can find is Aetna, which offers a PPO for Texas that's $718 per month.
So essentially this is a majorly confusing clusterf***. I hope that we can get a major information campaign going to help everybody very quickly, because this isn't going to be easy.
The only bright spot in all this mess is that I've burned through my deductible for the year, so my thyroidectomy won't cost me anything. I figure I'd better get all the vestigial organs removed this year, because next year I'll have to get the wire cutters out and remove them myself.