Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
He is flat our wrong about this too...sure, maybe in the dental field this is the case, but I can tell you exactly how much we will get paid for every procedure we bill from each insurance company...not to mention you COULD go off past experience as well.
What are you talking about? Who's "we"? You are not a provider. Or, have you changed jobs?
Further, toofache talks directly to past experience, here:
Quote:
So the provider increases their billed fee for that code to capture more of what the insurance company is willing to pay. This continues until the billed amount is higher than the allowed amount.
Except the self-employed people on this forum that constantly complain about how much they pay and how high their out of pocket costs are
Because they are paying HIGH PREMIUMS and HIGH DEDUCTIBLES. I think many would be thrilled to have low premiums with high deductible plans. That is what the self employed on this forum have been complaining about because that is what many used to have and they want to have it back again.
Single Payer was the original plan which the Republicans were against. The compromise got us Obamacare. It will also just go back to status quo of what it was before.
The ACA depended on young, healthy people signing up to offset the older, sicker, population did not work. Younger, healthier people just decided to pay the penalty and not have health insurance at all. It is very similar to we younger Seniors on Medicare subsidizing the older, sickly, Medicare Beneficiaries. The entire concept is exactly the same. Forget if anyone over 65, healthy or not, has to compete with a 25 year old in an insurers mind.
Universal Healthcare, like in other countries which was originally proposed, is the way to go, but that it not in the for profits agenda of the Republicans. No PROFITS and Insurance Companies would go out of business not selling to the Public.
Preventive Care is going out the door, including vaccinations Suzy, when people have to go back to deductibles and copay for it.
That's why there can be no option to opt out, just as you cannot opt out of paying the payroll taxes for Social Security and Medicare.
People paid for preventive services before the ACA when they had to pay co-pays and deductibles for it. They paid for preventive services under the ACA with higher premiums and deductibles, even if there was no additional out of pocket cost at the time the service was received. Preventive care has never been "free" and never will be.
The question is what is the sweet spot for premiums, co-pays, and deductibles. Young, healthy people can opt for higher deductibles and co-pays and lower premiums, knowing that many years they would not meet their deductibles. Pair that with a health savings Account and set aside money for years in which you have higher expenses, say those associated with having a baby or the need for surgery.
Quote:
Originally Posted by Qwerty
Group plans actually cost more than individual plans. With the individual plan, you are lumped into a "group" with everyone else that has that plan. The only deep "discounts" are what your employer pays for you. A large group is usually self-insured and the premiums collected pay the claims and the insurance company gets a small administration fee to administer the paper work/claims, etc. They have their own ratings and their claims experience is unique to their company.
I could get an individual plan off the market place for about half of what the full premium my company pays for our plan, less than half if I get family coverage off the exchange. My employer pays about 90% of the premium for our higher out of pocket plan, your "employer" could do the same thing.
If your employer is paying more, it sounds as if whoever negotiated the contract did not do a very good job. Whatever the subsidized portion of the premium is actually is additional compensation to the employee. A self employed person is paying both the employer's share of the premium and the employee's share.
I still think that where you work should not determine the premium you pay for health insurance.
Essentially, insurance companies are not obligated to disclose ahead of time to providers what they will pay for a procedure - and vary provider reimbursements depending on how aggressively the provider bills.
Read this carefully - more than once - from an actual provider:
Everyone has to pay into health care or it can't work. But the typical issues are that no one wants higher taxes, no one wants to pay for someone else, no one wants co-payments. The list goes on. In reality, nothing comes for free and health is a right, not a luxury. Everyone will need it sooner or later.
Many years ago when my husband was doing IT consulting work, he decided to form his own corporation. He employed nobody but himself. Besides all the tax benefits to a "corporation", he was able to get Health Insurance rates as a corporation. I was never an employee of his corporation, and certainly our Minor children weren't, but we had health insurance from his corporation. I do not know all the legal in's and out's of this. There are fees involved to incorporate. Is this still available today? Perhaps many of the "self employed" should look into this option if still available. You might call it working the system. You don't have to be a billionaire like Donald Trump to work the system.
Edit: The Public School District I used to work for dropped their national health insurance company, and self-insured. They still do today in 2016 long after Obamacare. Preventive Care? Um, that was not only free to employees, but just about mandatory, or they would penalize you in your premiums. Major reason I quit. I don't like being told I am in "non-compliance" for anything health related. I like my Original Medicare. They leave me alone, unlike my former employer.
Many years ago when my husband was doing IT consulting work, he decided to form his own corporation. He employed nobody but himself. Besides all the tax benefits to a "corporation", he was able to get Health Insurance rates as a corporation. I was never an employee of his corporation, and certainly our Minor children weren't, but we had health insurance from his corporation.
We had the same thing, although I imagine that states differ w/ what policies are--and were--offered. But that was back when health insurance was much more affordable. We had a deductible for each family member of $250, and I though that was high then.
The cost of health insurance, like college tuition, has increased astronomically in the past 15 years.
Because they are paying HIGH PREMIUMS and HIGH DEDUCTIBLES. I think many would be thrilled to have low premiums with high deductible plans. That is what the self employed on this forum have been complaining about because that is what many used to have and they want to have it back again.
The premiums you pay are much, much less than the full premium cost of a group plan and that is the point you keep missing. You want to pay nothing and get everything and it just doesn't work that way. You are under this delusion that people are paying these low, low premiums and that is all the plan costs. Sure, I only pay a few bucks a month, but the individual plan cost is over $600/month on our plan and over $2000/month for the family coverage....
Quote:
Originally Posted by suzy_q2010
That's why there can be no option to opt out, just as you cannot opt out of paying the payroll taxes for Social Security and Medicare.
People paid for preventive services before the ACA when they had to pay co-pays and deductibles for it. They paid for preventive services under the ACA with higher premiums and deductibles, even if there was no additional out of pocket cost at the time the service was received. Preventive care has never been "free" and never will be.
The question is what is the sweet spot for premiums, co-pays, and deductibles. Young, healthy people can opt for higher deductibles and co-pays and lower premiums, knowing that many years they would not meet their deductibles. Pair that with a health savings Account and set aside money for years in which you have higher expenses, say those associated with having a baby or the need for surgery.
If your employer is paying more, it sounds as if whoever negotiated the contract did not do a very good job. Whatever the subsidized portion of the premium is actually is additional compensation to the employee. A self employed person is paying both the employer's share of the premium and the employee's share.
I still think that where you work should not determine the premium you pay for health insurance.
Exactly, if you look at your insurance as a work expense vs a personal expense, you can have the same set up, not to mention that you get to write off your full premium amount.....so, you can have an employer plan where your "company" pays half or more of the premium and you pay the rest. So, if your premium for your family is $1200, your "company" pays $600, you pay $600, which is WAY less than a family plan at our company.....You also have the option of getting a group plan where you have more say in the deductible amounts, which has been suggested here over and over again, but then reality sets in that its way more expensive to do that....
Quote:
Originally Posted by CA4Now
Exactly. Some of us are paying two and three times what those who are covered under an employer's policy pay.
That is because the employer pays for at least half of that cost for an employee. If you choose to be self-employed, that is part of the choice, but your plan is still less expensive than what the FULL cost of the group plan is. See above, you can get a group plan...and then pay more. Not to mention, again, that you are NOT paying the full price of that plan because you are also writing off the cost of those premiums, unless you are not making a profit, in which case, you aren't paying taxes anyway so you just made how much money and didn't have to pay taxes on that...
Quote:
Originally Posted by CA4Now
We had the same thing, although I imagine that states differ w/ what policies are--and were--offered. But that was back when health insurance was much more affordable. We had a deductible for each family member of $250, and I though that was high then.
The cost of health insurance, like college tuition, has increased astronomically in the past 15 years.
Like college tuition, the portion that employers contribute has decreased over the years as well. Back when we were first married, our monthly premiums were $212 with a $1100 deductible, working for a company that had about 10,000 employees at the time, about 30 years ago. There was no such thing as a Co-pay back then, you went to the doctor, you got bills for your services until you met your deductible, then you paid a percent of that bill until you reached your out of pocket max. Our co-insurance was 85/15 which was good back then. Once the HMO model was adopted and co-pays were the "thing" this all changed and created the mess we are in now. People need to move away from the thinking that they should only pay $15 or $20 to see a doctor because that just encourages overuse and unnecessary visits--driving up costs. It would be like filing an auto insurance claim for a door ding or a homeowners claim for a broken window pane....
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
