Friday, October 18, 2013

Well, there goes affordable health insurance

This month we are paying two health insurance premiums... SCB will be going on his employer health insurance plan and they require you to pay a month in advance before coverage begins. We are so incredible grateful that he was able to find this amazing job with benefits... and he loves working there.

Why all the fan fair and love? Because his employer thankfully isn't sending employees to the exchanges.

I hate to say this because I don't talk politics on this blog, but because of the Affordable Care Act... AKA, Obama Care, his current plan with Kaiser will be eliminated... not because it doesn't meet the new standards as the booklet we got in the mail claims (which it does as you can see from below), but because they won't make enough money on my husband when they have to pay to help care for those that are not as well as he is for the same price. So they got rid of his plan.

The suggested new "KP CA Bronze" plan that is not sufficient for his needs and would cause our family a great financial mess. Plus, it's more expensive. Yup you read that right, more money for less medical care... in fact, 15% more money for less benefits.

His old plan was $178 a month. 

  • $3,000 Deductible
  • $6,000 out of pocket maximum
  • 1 physical exam free
  • Office visits $40 
  • Inpatient care 20% after deductible
  • Emergency room visits were $200 after deductible
  • and his prescription coverage was $10 Generic, $35 for Brand after a $250 brand deductible. 
What was great about this plan was his doctors visits were affordable since he has to go in a few times a year to renew his maintenance medications... we have generic prescription coverage from day one, and worst case, we had to pay $3k from our emergency fund before insurance kicked in to help us cover bills.

What Kaiser was trying to sell him for $204.87 a month.
  • $5,000 Deductible
  • $6,350 out of pocket maximum
  • 1 physical exam free
  • First 3 office visits $60
  • Inpatient care, 30% after deductible
  • Emergency Room, $300 after deductible
  • Prescription Coverage: $19 Generic, $50 brand.... all after deductible.
Despite the obvious other problems like a $5k deductible, on a practical day to day basis we'd have to pay 50% more to see a doctor from day one... and we wouldn't have any prescription coverage until we payed $5,000 out of pocket. Hubby needs his pills and while they are thankfully all generic now that singular is generic, that's still crazy. That gives us nothing and they would be charging him more money for it from the get go.

His new work plan is a little hard to read since I don't have the cheat sheet anymore but we pay 20% after a $1,000 deductible, $30 office visits, and more things are included like x-rays and there are standard fees for emergency rooms ($75) etc. Prescriptions only have $125 out of pocket before insurance kicks in (75% of the cost so we pay 25%)... which is way better than having to pay $5k out of pocket with no coverage help. 

Since we pay for it with pre-tax dollars and he also has dental taken out too, after taxes it only costs us $197.20 a month for both medical and dental for him.

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