Insurance woes

My wife works for a small company and they never got around to getting onto the exchange health care plans last year. That left us with the worst health plan we have ever had in our lives as I navigated this cancer crap. We were extra screwed because we got to pay all of last year's out of pocket costs for lab work, biopsies and consults. Then this year, we got the surgery. I have a huge bill coming my way, but at least we were done with out of pocket expenses for the year (Cialis and TriMix excluded because insurance won't consider paying for them).

Now, my wife's company has decided to move to the exchange. My wife is the only user of health insurance in her small company and had made it clear what plan would work best for us and what plans would really hurt. Despite that, the owner chose a plan that makes our current plan look like a good deal. We got no say in the matter. I'm not even sure how it's legal that my wife was simply transferred to this crappy plan with no say in the matter. But, since my company offers zero benefits, we'd be idiots to not take any coverage at all. It still seems illegal to deduct pay from my wife's check for a plan she did not agree to use.

Our out of pocket maxes have soared. If my PSA tests don't come back as undetectable this year, I will get to choose between keeping our house or getting treated. I've pretty much already decided that I will skip any further treatments so my family doesn't lose their home. I have decent life insurance (purchased on the open market because my own employer offers no benefits at all), so at least my family would be well taken care of if I'm gone.

This is not a PPACA issue. The good plans are there. It's a tone deaf employer not willing to work with the only employee who uses a benefit. We were going to pay the extra amount. The cost change to the employer was zero.

I'm ready to just give up on it all right now. The last six months have been too much already. I simply can't absorb another hit like this.

I guess it's time for me to consider finding a different job, despite the fact that I love the work I do at my current job. Or, just call it a day and give up. I don't think I've ever been so angry and frustrated in my entire life.

Are you possibly qualified for Medicaid? See eligibility requirements given at the government website:

www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html

There are also state and sometimes even local assistance programs available, as well as private programs that can help. There is help out there!

If you would like to share some more specifics of your financial situation (family income, whether both of you work. etc.) and where you live we might be able to offer more specific advice to you.

You should absolutely not ever have to choose between treatment and keeping your home! There is a better way!

Please, don't feel that you have to give up. There is something out there to help you!

DM:

Pardon my ignorance. Can't your wife take the work plan and YOU take the ACA exchange plan?

Mel

If we buy separate plans (we have two kids to cover as well), the sum exceeds the current costs. My wife could take the plan at work (which is still an ACA plan - just a bad one) and cover herself, the kids and contribute the HSA money. That would save $375/month. I could then pay about $600/month to cover myself. We would then be subject to two different deductibles for the year, which would exceed the single deductible I have now. Plus, the $375 savings exceeds what she could add to her HSA so her taxable income would increase. I would have to pay the $600 pre-tax, so there is no tax break at all for those premiums. So, our total costs would go up, our taxable income would go up, and the laws on HSA limit things by family not individual, so I couldn't do my own account to make anything else pre-tax.

And, if my wife or kids had any appreciable health care expenses, it would get out of control quickly.

I've been through it dozens of time already and haven't found a way to make it better at all. We went from the worst care we've ever had to substantially worse care, and it wasn't the law, but the decision of one person that put us there.

I wonder if it might be cheaper if we got divorced? In that scenario, I'm afraid our income taxes would go up in a way that offset the ability to have two distinct HSA accounts.

If anyone has any ideas (I'll pay a financial planner who can get me out of this h*llhole), I'd love to hear them.

dmlvt

I would go to an insurance broker who should know how to get you out of the mess you're in if it's possible.

Your story is tragic; I hope someone can help you out!!

Bob

Thanks for all of the suggestions. No military service. Not Medicaid eligible. Not ACA-subsidy eligible.

I know how the HSA and FSA stuff works and we are maximizing that. It's just the change that more than doubled our out of pocket maxes and also changed from a "stacked" scenario to "aggregate" max that hurts. Under our older stacked plan, my out of pocket was high enough that we were done with script costs as well for the year. Now, everything costs money again until we've paid thousands more.

Now, we get to pay thousands more out of pocket, with much of it post-tax. This is just a bizarre system.

My wife makes under $40K per year and our health care costs will exceed over 60% of that this year. One of us needs to find a new job with better benefits.

If its a small company go to owner and ask them to adjust to the plan u want and pay the difference. They will go fir this unless the are a holes.

Reason being its a writeoff and doesnt hurt them.

Having to deal with ACA for several comoanies I know its doubked the cost and lowered the level of coverage.

Plus all the low income folks going on plans will be wiped out when they get sick and find out their deductible = 40% of their annual income.

Give ur employer a shot. If its a net 0 they should bite.

Also act like its a totally normal request because it is!!!

Good luck

Check out this thread and the link within the thread

www.healingwell.com/community/default.aspx?f=35&m=2860628

malecare.org/advancedpcabookV2.1klgfg0e4w8e4fgjfguifgeiu.pdf

particularly pages 39-41 of this 53 page document that specifically address sources of financial assistance, albeit back in 2012.

It dated 2012 but the whole document is pretty good. I could not find a more currrent version when I scanned the parent site.

LupronJim

@Gothicarch - My wife's employer initially told us she would pay a fixed amount and we could buy any plan we wanted. She then kept the old plan for the first three months of the year, and then unilaterally moved to the even worse plan, and won't let us buy up even at a net zero cost to her. It's either "take what I say" or nothing at all, which puts us in the open market with no subsidy options. So, I say she is an a-hole.

@LupronJim - Hopefully no more significant costs for me, but if the PSAs don't come back at zero, there will be more costs. Part of the problem is another family member who also uses the health care system extensively for mental health issues. If we had kept our old plan or been allowed to move to the plan we wanted, those would have had no additional impact on our financial situation. Also, because that person is covered by us but not a legal dependent any more, we can't even use pre-tax money there - weird laws around HSAs.

@Octorobo - I respectfully disagree. An acceptable plan is there on the exchange for us - a more expensive plan that would allow us to control our total expenditures at a much lower level than they will hit now. We have not asked the employer to pay an extra penny - only to allow us to buy up to the better plan. If my wife's employer did not pay anything at all (the company is small enough that she does not need to offer anything at all), we would simply buy the plan we want in the open market. It would hurt a lot to buy it that way. But, after everything is factored in for this year, including taxes and higer out of pocket costs, we might have been about break-even if we had simply purchased the higher level plan on our own.

Lastly @F8, I agree. I am a C-level officer in a small start-up company. I've accepted that level of risk/reward for a number of years. even though I've had a good salary with zero benefits. This entire incident has me re-thinking my commitment to the tiny company where I've worked for a number of years.

Thanks to everyone for the thoughts and suggestions. I was mostly venting and never really expected anyone to chime in with so many well thought out suggestions.

Things may be that way in other states, but here, companies can buy their insurance through the exchange for their employees. This is done when the company can't negotiate a better deal outside of the exchanges, but still wants to pay or subsidize the cost of insurance for the employee. It's mostly small firms doing that here. The larger firms self-insure or have better deals with the insurance companies.

Legally, they don't even have to offer insurance, (such as my company, which doesn't - about the same size as my wife's company), but they can offer to subsidize plans through the exchange. But, they can also then limit the exchange plans available to employees. Some plans require companies to set up HSAs, others to set up FSAs, etc. My wife's company already has an HSA plan (our old and new plans were high deductible plans), and they have an FSA for medical and vision, so those were not limitations.

We wanted to "buy up" to the platinum plan which would have kept our costs much more controlled, while I deal with cancer and another family member deals with some other health issues. But, my wife's company basically offered to subsidize only a single plan through the exchange for its employees. And, it picked a plan that more than doubled our out of pocket expenses. The plan cost went down, helping the company, but our costs, as consumers, went up. I know that the mandates for companies to provide insurance have been delayed, and my wife's company is not legally required to provide insurance, but they always have done that for their employees. They simply downgraded the available plan options at a time when my family was most vulnerable. If they had simply said "we will pay X, you can pay the rest toward any plan you like", we would have been fine. Instead they chose a plan that simply doesn't work well for our current situation.

The end result is that one or both of us will likely be looking for jobs. This is a place where the ACA is really not doing what was promised (For the record, I don't hate the ACA. I'm one of those people who wish we'd gone all the way to single payer). If we were paying for our plan completely on our own, we would have complete job portability. But, having a company subsidize a single plan leaves very few options. Changing jobs partway through a year means changing plans, even if you end up leaving and re-joining the same plan. That re-starts the out-of-pocket and deductible calculations. So, after paying $5K out of pocket already this year, we are at a potential financial disadvantage to even change jobs. And our plan is potentially portable, meaning that another company might offer it, but we don't want it anyway. If we had single payer, or some sort of system where all companies contributed the same amount or percentage (it could even be nothing and be equitable), job portability would exist. But, with most firms still providing some insurance benefit to full time salaried employees, that job portability promised in the PPACA does not yet exist.

Because my company offers no insurance at all, we could have bought our own insurance on the exchange. We are not subsidy eligible, and while some of the premium cost (the part exceeding 10% of family AGI) would have been tax deductible, in our current situation, the company contribution towards benefits and an HSA would have been left on the table, further increasing our out of pocket expenses.

The way I see it right now, our total health care costs for the year, after premiums, HSA and FSA contributions, and out of pocket expenses will exceed $20K. Remaining on my wife's policy allows a fair amount of that to be pre-tax money. Doing it on our own through the exchange would have allowed us to tax-defer a lot less money on top of paying more total. So, our plan is expensive, but better than going it alone. Just not by much.

I seem to remember someone declaring "elections have consequences ".

it certainly did with previous administrations but are you sure you wanna go there?

ed

Dmlvt, it sounds complicated. There may be subsidies with bronze plans that don't apply to higher grade plans, which might have something to do with your company's actions. I know many people in my state (Washington) where the ACA has been a lifesaver, given them insurance that they wouldn't have been able to get. Just getting rid of the pre-existing condition issue has been huge.

I agree with you about single payer. One of the advantage of getting older will be getting on Medicare. It's not perfect--the drug plan is a complicated mess--but the hospital and doctor part are more simple and flexible than commercial insurance, especially if you are not in one of the Advantage plans. During all the politicking that went on back in 2009, the idea of moving Medicare age down to 60 was floated, and quickly got shot down in congress. I think they should move the Medicare eligibility age down to 0. Of course, that would bankrupt the health insurance industry, overnight.

very sorry to hear of this situation, talk about being stuck being a rock and a hard place. feel bad for any one in that scenario.

I agree with a suggestion from above, a really good general insurance broker should be able to help you out. I handle all my insurance needs that way, from home-auto-health-medicare, etc. the good ones have access to all the markets, and should be able to help negotiate a better deal than any of the ones described thus far in this thread.

There has to be a better answer out there. Good luck, and don't give up, I realize its very frustrating, an your employee is a total "A"-hole for putting you into this mess.

David