Open Enrollment time- how's your insurance looking?

financialdiva · October 2013

I carry our insurance, and my company just announced their insurance package. It's pretty bad. They are moving away from the traditional type where you have a minimal co-pay for doctor's visits and prescriptions, and now we have to meet some insanely high deductible before any visits other than wellness visits will be covered. So, every time I go to the pediatrician, it will cost me $125 per visit, plus any medication at full price until I hit a $6k deductible, then I'll pay 20%. It's basically catastrophic insurance plus well visits. Not great for a family with small children.

And of course, our monthly premium isn't going down, but my company is at least putting a small amount ($600) into my HSA, so at least that's something. I'm grateful to have coverage, but disappointed at what is happening, though, not surprised.

What about you all? How's your coverage changing for 2014?

Nechie122 · October 2013

DH will still get a traditional PPO but this year, for the first time, they're charging a $1,200/year "penalty" (on top of the higher premium) to get coverage for a spouse if the spouse can get coverage through his or her own employer. So DD will continue to be on his insurance and I'm at the mercy of my own employer ... and this year, we're moving to high-deductible plans as the only option. They are putting money into an HSA for us but I forget how much. The deductible isn't as high as yours, at least for an individual. I want to say $1,400?

ETA: We were already paying $500/month for our family PPO this year; I'm not sure how much that will change.

Sunidaze · October 2013

I've just looked at the open enrollment information and honestly doesn't look like much has changed at all for the employees...a few tweaks here and there, but that's about it...just a small increase in what we pay, but that happens every year.

jess9802 · October 2013

Unless you're Medicare eligible you must be covered on my company's plan as an employee. From talking with our administrator it seems likely that the firm will choose to renew effective December 1, keeping our coverage the same as this past year. The firm pays the premium for employees and picks up $3k of our $5k deductible, so that's good.

My husband's company doesn't have their 2014 plans on their benefit site yet (Open Enrollment starts 11/1), but he said there's not going to be many changes. He has the coverage for DS and SS and I'll be added to it in 2014. That plan covers preventive care 100%, but all other care must be paid from the HRA account and then out of pocket up to the deductible. The company contributes $2250 to the HRA account per family per year and the funds roll over. That will be good b/c DS will need another echocardiogram next year and that is $$$.

kristennd · October 2013

They didn't change our coverage at all this year.

LoCarb · October 2013

I have not received any information on open enrollment...yet. Weird.

I would not be happy with the high deductible insurance. It would break me financially.

Karla CS · October 2013

They haven't felt the need to let us know about any insurance changes yet. And there's always changes. Luckily, the last 'big' change they made was to offer Kaiser, which was awesome, especially since we were planning to get pregnant at the time.

My company does a really good job with it for the employee (We have a no-deductible plan, $20 office visits, and the cost to deliver the baby (no matter how she'd been delivered) was only $250.), but it's an arm and a leg to add children or a spouse. DH is on his own plan, which he doesn't like, but saves us about $250 a month.

UnexpectedlyExpected · October 2013

My company did note that their cost for insurance is going up but the employees will still pay the same amount and coverage will not change. It cost $55 a month for my daughter and I and our deductable is still $300 per person.

DaisyJanie · October 2013

Our deductible went up a little bit, our premium actually decreased a little bit which seems weird. We are enrolling LO in dental care this year. It's really more of a discount plan than insurance, but it should be worth the small cost.

MammaBear81 · October 2013

We had a High deductible insurance plan and DH's last job. They can be awesome, but they cn also suck big time. DH's job at lest put $2K in his HSA to help cover the $4K deductible, and then we put the other 2K in the HSA so at least we could use pre tax dollars to pay the deductible. Not to mention the plan was $94 per month VS the $300+ per month for the crappy insurance that didn't cover anything, so *technically* we saved over 2K in premiums making the high deductible a wash

DH now works for a hospital with awesome insurance, I don't know if we will have any changes for this year, I think open enrollment doesn't start until November 1st.

jf198400 · October 2013

It seems like a lot of companies are moving toward the high deductible plans. I think they sound terrible for families. It's bad enough paying $25 copay everytime we go to the pedi, I can't imagine paying $125 yikes. Luckily I am on DH's insurance and they still have a PPO and they cover most of the premium cost. We are extremely lucky.

aglenn · October 2013

Yes, high deductible plans are increasingly becoming the only option. They can be great if you are young and don't use them much and can build up some HSA funds. But with little kids in day care, not so much.

I'm on DH's plan because even with the "spousal surcharge" it is cheaper than my plan at work. They took away their PPO last year and went to a high deductible plan, except that we happen to live in one of the areas where they also offer a local HMO. We switched to the HMO and it has been a much better choice for us. My kids go to the doctor non-stop in the fall and winter so there is no way we would avoid spending the whole deductible on the other plan.

ss+el · October 2013

Mine doesn't start for another week, so once we see the plans we will have 2 days to decide if we should stay on my insurance or switch to DH's. Fortunately, I took those two days off for DS' birthday but he'll be in school for most of the day, so I can kill my brain while he's gone.

preggersin2011 · October 2013

I would try to max out my HSA contribution if I were you. The only change I had for my company was 13->15% expected increase in employee contribution to the premium.

MammaBear81 · October 2013

Idk if I would consider mine high deductible. I have the monthly premium and the usual $25 copay for dr visits. I opted for the HRA acct, my employer puts in a certain amount to start each year and then we can do activities and physicals in the beginning of the year to earn more money. That money gets applied to any out of pocket expenses I may incur. Once its gone I have to cover the difference up to the deductible which is 3k. If the money in my HRA doesnt get spent it carries over to the next year. In the 2yrs we have had the plan I have not paid out of pocket for anything but my copay.

DH has the same plan with his employer.

With a high deductible plan you pay 100% of everything until your deductible is met, if you don't pay in full until the 3K deductible is met then you are on a regular medical plan that shares insurance costs (i.e. 80/20 90/10)

aglenn · October 2013

MammaBear81 said:

Idk if I would consider mine high deductible. I have the monthly premium and the usual $25 copay for dr visits. I opted for the HRA acct, my employer puts in a certain amount to start each year and then we can do activities and physicals in the beginning of the year to earn more money. That money gets applied to any out of pocket expenses I may incur. Once its gone I have to cover the difference up to the deductible which is 3k. If the money in my HRA doesnt get spent it carries over to the next year. In the 2yrs we have had the plan I have not paid out of pocket for anything but my copay.

DH has the same plan with his employer.

With a high deductible plan you pay 100% of everything until your deductible is met, if you don't pay in full until the 3K deductible is met then you are on a regular medical plan that shares insurance costs (i.e. 80/20 90/10)

HRA plans can allow doctor office copays but still be "high deductible" for everything else. HSA plans, by law, can only except certain things from the deductible (like preventive care). All other medical and drug expenses have to go to the deductible first.

(I'm a benefits consultant).

Sunidaze · October 2013

I have actually been in a HSA for the last two years. Depending on circumstances, it isn't that bad...yes the deductible is high and that sucks. My company contributes $500/annually for single coverage and $1000 for family coverage. I contribue the max pre-tax amount. It is a great option for young single health people to get into and then build up their savings so that way when the need arises, their deductible is taken care of. Wasn't such a smart move for me to get in there. I looked at it from the standpoint of both my daughter and I (DH is on his own plan) are healthy and well visits, immunizations, etc. are covered 100% no co-pay, etc. However, what I didn't take into consider is round one of tubes for LO last year and round two of tubes paired with an adnoidectomy this year. Her individual deductible was met in May of this year and any other visits outside of wellchecks as well as any prescription meds would be covered 100%. And then there's me...I am on one medication that, because of my plan, I pay retail for...$180/month. And semi annual skin checks. Our open enrollment period is next month...I'm going back to the more traditional plan.

QueSrah · October 2013

Open entrollment hasn't started here yet. So far I know our PPO plan will remain available and unchanged, but it sounds like the employee contribution to the premium is going up significantly (well over 20%?). My company is huge, so it's still a lot cheaper to cover the family on my plan than for DH to use his company's insurance.

mexicolombiana · October 2013

Well it's been a disaster signing up through healthcare.gov. I finally got through and the plans are ridiculously expensive with huge deductibles and out of pocket costs.

We pay $819.38 per month out of DH's paycheck for health insurance through his company. And that's with the employer paying 55% I believe.

We have BCBS PPO. We may switch to HMO if it's cheaper next year. It doesn't appear our costs are going up. They better not, I personally think $819 a month is a lot of money for insurance for our family of 4. Plus out of pocket costs every time we go anywhere.

rubber_chicken · October 2013

financialdiva, that sounds like the coverage being offered through my husband's work next year. his company got bought by a company down in Texas and now we get their sh*tty Texan insurance. they're going to start losing employees, because we're used to the good stuff up here.

looks like we're staying with my company's plan, which bums me out cuz I hate Aetna. HATE.

SoMoNY · October 2013

not great, sorry about formatting

Currently, the emergency room copayment is $50, in 2014 it will be $150 after the deductible
Currently in-network office visits, short-term rehab, and urgent care are covered at a $20 or $30 copay. In 2014 the services listed above will be covered at 85 percent co-insurance after the deductible is met. (For e.g. the average negotiated rate for urgent care in NYC is $132, so your co-insurance would be $19.20 after the deductible is met)
Currently Infertility is covered both in and out-of-network. In 2014 it will covered in-network only
Additional services will be subject to pre-authorization and “medical necessity”.
In 2013 the out- of-network reasonable and customary reimbursement percentile is 90. In 2014 it will be the 80th percentile (this could mean higher out- of-pocket costs when using out- of- network providers/facilities). **
In-network preventive care remains covered at 100 percent in 2014.
Use the UHC cost estimator tool to figure out by provider, zip code, and procedure your out- of- pocket costs when paying co-insurance (located on UHC’s mobile app orwww.myuhc.com). For example, you can price out what the negotiated rate would be for a primary doctor visit as well as your share of the doctor’s visit.

bullybutt · October 2013

wife07mom09 said:

thanks to ACA my family plan is going up I think about $100 a month. Deductible went up, co insurance went up and OOP went up. I hope the people I am paying for by this legislation are happy because we already use a LOT of healthcare dollars and this will likely stretch us more.

How is ACA affecting you if you get insurance through your company? Premiums typically go up annually, regardless. What "people" are you paying for? The new ACA is allowing those "people" to now sign up and have insurance for themselves, on their own dime.

aglenn · October 2013

ACA does increase the underlying cost for employer group plans. It is a simple fact, even if you ignore the previously uninsured who are signing up for coverage and likely driving up overall costs for the insurance company. Even for an employer group plan that is self-insured (and therefore not impacted by anyone's claims but its own) and covers the exact same population as the prior year, ACA adds costs due to several factors: additional taxes and fees payable to the government, additional government reporting and disclosure, mandated benefit coverage (free preventive care, no dollar limits on any essential health benefits, and a long list of others), elimination of pre-existing condition clauses, mandated coverage of dependent children to age 26 (even if they are working and have access to their own plan), etc., etc., etc.

So, while wife0709 is not correct that "those people" are driving up her costs, the ACA probably does play a role in her increased costs.

SoMoNY · October 2013

bullybutt said:

wife07mom09 said:

thanks to ACA my family plan is going up I think about $100 a month. Deductible went up, co insurance went up and OOP went up. I hope the people I am paying for by this legislation are happy because we already use a LOT of healthcare dollars and this will likely stretch us more.

How is ACA affecting you if you get insurance through your company? Premiums typically go up annually, regardless. What "people" are you paying for? The new ACA is allowing those "people" to now sign up and have insurance for themselves, on their own dime.

The ACA required insurers to insure kids up to age 26 - that isn't free

The ACA also has a per insured fee - the insurance firms are passing that along as they should

The people getting subsidies, where do you think some of that money is coming from?

mslmk11 · October 2013

We haven't had a huge change in our coverage, they've been making changes over the last couple years to acclimate the employees I suppose. Two years ago (I think) they did away with the PPO plan and only had the high deductible plans, well and an option with a HRA instead of an HSA. They contribute $700 to help meet the deductible every year and it rolls over, and they reward us with deposits up to $750 ($375 for me and spouse each) for healthy behavior (Wellness checks, exercise programs, etc) so we could get $1450 if we worked at it. I signed up for a 950/1900 deductible, the cost increased a bit from this year, but not that significantly. They prepared us last year that certain plans would increase this year.

It was a bit of an adjustment going from PPO plan to the other plan, but with how my company has it set up, it actually was much better - DH doesn't really get sick but once a year and he just goes to the minute clinic, and preventive care is covered 100%, and with the HRA, that gets depleted (Along with an FSA I have) before any out of pocket expenses come into play.

I LOVE my employer. I think they are really focused on their employees and being a best place to work. They have their insurance through Aetna, and I've loved the experience I've had with them, but it appears that my company self-insures our insurance (medical, dental and health) so maybe that's why because the claims are paid by my company, not Aetna *Shrug*

But your HDHP does sound pretty ridiculous! Do they not cover preventive care, or are you saying that anytime you have to take LO to the pedi for non wellness visits it'll cost $125?

mommyton&e · October 2013

amy052006 said:

wife07mom09 said:

thanks to ACA my family plan is going up I think about $100 a month. Deductible went up, co insurance went up and OOP went up. I hope the people I am paying for by this legislation are happy because we already use a LOT of healthcare dollars and this will likely stretch us more.

How is ACA affecting you if you get insurance through your company? Premiums typically go up annually, regardless. What "people" are you paying for? The new ACA is allowing those "people" to now sign up and have insurance for themselves, on their own dime.

Lots of HR offices are spinning this tale -- your premiums are going up because of ACA. No, what is really happening is that your company is shifting the always rising increased cost to you while keeping their contributions stable. ACA makes a great scapegoat for employers. Meanwhile, our premiums went up a whole $11 a month, so I guess thanks Obama!

My employer has a "Cadillac plan" currently. In order to avoid the 40% excise tax, they are increasing our cost to decrease theirs to avoid the tax. They are doing this slowly over the next couple years until 2018 when the law takes effect. Currently my employers pays 100% of premiums for employees that make under a certain yearly amount. They will no longer be able to do this come 2018.

MoreThanABride · October 2013

We are switching to high deductible. The deductible is $3000 for the family, but the premiums are about $8000 less than the hmo plan we have been on, so it is an easy decision.

virginiagirl11 · October 2013

Our premium went up slightly. I need to look at the plans again and determine whether the HSA is still a good choice for us because we got hit pretty hard this year with medical costs. I feel like we're always at the doctor. This year we paid $600-$700/mo. in health insurance on top of maxing out our $3,000 deductible, and I think that's ludicrous.

Btw, our benefits advisor came in this week to meet with all of our employees and she was clearly not happy with the ACA. That's fine and all, but I found it incredibly unprofessional that she passed her judgments along to our employees because they were misleading and not always correct. Please, if this is your line of work, keep your opinions to yourself when you're presenting the material.

SoMoNY · October 2013

virginiagirl11 said:

Our premium went up slightly. I need to look at the plans again and determine whether the HSA is still a good choice for us because we got hit pretty hard this year with medical costs. I feel like we're always at the doctor. This year we paid $600-$700/mo. in health insurance on top of maxing out our $3,000 deductible, and I think that's ludicrous.

Btw, our benefits advisor came in this week to meet with all of our employees and she was clearly not happy with the ACA. That's fine and all, but I found it incredibly unprofessional that she passed her judgments along to our employees because they were misleading and not always correct. Please, if this is your line of work, keep your opinions to yourself when you're presenting the material.

Your benefits adviser has probably had enough of people venting on her about the change in benefits and rising costs.

Not like the ACA made her job any easier

jnealet · October 2013

Our plans haven't changed all that much. Our costs may have gone up a little but nothing sinificant.

jf198400 · October 2013

OctBride-2005 said:
My employer has a "Cadillac plan" currently. In order to avoid the 40% excise tax, they are increasing our cost to decrease theirs to avoid the tax. They are doing this slowly over the next couple years until 2018 when the law takes effect. Currently my employers pays 100% of premiums for employees that make under a certain yearly amount. They will no longer be able to do this come 2018.

This is similar to DH's company. They used to pay 100% of premiums for all employees. Last year and this year the employees have to contribute. But if you get a health evaluation then they will waive it for the year.

aglenn · October 2013

To clarify - the "Cadillac plan" tax is based on the total cost of coverage and it does not matter how much of that cost is paid by employees vs. the company. The only way to reduce the company's liability for that tax is to cut benefits. They may be adding to employee contributions to offset costs in general, or to partially offset what they expect to pay due to that tax, but the tax is based on the total premium (if anyone cares).

I have spent waaaaay too much time learning about and discussing ACA in the past couple of years. It is a very convoluted set of regulations.

jf198400 · October 2013

aglenn said:

To clarify - the "Cadillac plan" tax is based on the total cost of coverage and it does not matter how much of that cost is paid by employees vs. the company. The only way to reduce the company's liability for that tax is to cut benefits. They may be adding to employee contributions to offset costs in general, or to partially offset what they expect to pay due to that tax, but the tax is based on the total premium (if anyone cares).

I have spent waaaaay too much time learning about and discussing ACA in the past couple of years. It is a very convoluted set of regulations.

Thanks for the explanation!

chicagobride_07 · October 2013

DHs company just announced the plans. Premiums went up a lot, especially for the lower deductible PPO option. They are also charging a spousal surcharge. All in all, it is costing us 200 more a paycheck for the same benefits.

mae0111 · October 2013

My plan went up about $30, from what I'm paying now, but they changed the options a bit for next year. This year the options were self, self +1, and self + family. So I put DD2 on my plan, and DH put DD1 on his high deductible plan. With both of them on his plan, his company doubled their annual contribution to the HSA.

This year, the options are self, self + spouse, self + kids, and family. They also introduced additional salary tiers. To put DD1 and DD2 on my plan will increase the cost by $30 for the year. DH will stay on his high deductible plan and build up the HSA for retirement.

driveshorses · October 2013

Mine is close to the same as yours, except I have a $5k deductible to meet. I kicked DH off of my insurance because the working spouse fee has gone from $2400 to $3600 per year. He can go back to his own insurance because that's just not happening, even though my insurance is better than his. I currently pay $190 per month with VSP vision, dental, health, LTD and extra life insurance on myself, DH and kids. My open enrollment starts on Monday so hopefully there isn't too much of a change. I expect it will go up some, but my car insurance premium went down so it will balance out I imagine.

jmjb2008 · October 2013

I am paying $1200/month for my family with a $1650 deductible and $3300 out of pocket, and that's on a teacher's salary so the majority of my paycheck is going to insurance. We rarely go to the dr, but oops I got pregnant!

WBMom · October 2013

Our insurance is very high in cost. We have the choice between a HDHP and non-HD but I swear I cannot tell the difference in prices. Not a significant change for us this year - just get so frustrated overall with it - my out of pocket costs so far for a ER visit for my son in July are nearing $1900.

Standard: $730/month for premiums for family coverage. $5000 family deductible. $8000 maximum out of pocket.(the deducible is included in the out of pocket maximum). I pay 20% of costs after we have met the deductible. Well visits are covered at 100%.

HDHP: $530/month for premiums for family coverage. $3000 family deductible. $10000 maximum out of pocket (the deducible is included in the out of pocket maximum). I pay 20% of costs after we have met the deductible. Well visits are covered at 100%.

Meery82 · October 2013

Unless we switch to a sky high deductible, our monthly cost will more than double. Not so "affordable".

Mrs.AllyH · October 2013

The ACA is directly impacting me. As much as we were told "if you like your current plan, you can keep it." And "I will not raise taxes on middle class families." It was all BS (as many expected). I had incredible coverage. I mean incredible- I was covered at 100% by my employer, DH at 90% for premiums. That has changed to 85% for both. So our monthly cost is going up greatly. On top of that- we have to pay a fee (directly related to ACA) because my husband could get crappy insurance through his company. So our options are DH goes with a crappy plan (therefore not keeping the good plan we have) OR we pay a fee (I would consider this a $600 increase a tax for keeping our good plan) politicians are liars. They should not keep their jobs-not one of them! And BTW, we're not even "upper middle class," so we could really use that extra money elsewhere In our budget.

notreal2 · October 2013

My Insurance has gone up every year. I firmly believe most companies are usng ACA as a scapegoat to hide the fact that they themselves are saving money by changing plans. And for the last 5 we have had a spousal fee if our spouse could be covered by their own employer but we chose to put them on our insuramce, so that's not ACA related.

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