Insurance cost and the Affordable Care Act

it’s why I am leaving self employment and becoming Mr. Mom.

I don’t doubt it. Health plan options for people vary tremendously. Some of us have amazing options through an employer and some of us can’t get full-time work because the employer has to offer health insurance. I agree with you that everyone should have a stake and I think it would be better to completely sever health insurance from employment and that Congress should have to use the same health care market as everyone else. In your case, I doubt your options in the individual market as self-employed person would have been any better even before ACA.

On the one hand, with the ACA I can get health coverage and so can my husband ( a cancer survivor).

One way to offset some of the costs of things like Dexcom, is to find out if your healthplan covers it elsewhere. IF so, you get your Rx, you get proof of coverage by the healthplan in your area, and then your payment is reduced to what healthplans pay. I save 50% by doing this. The fact that healthplans only have to pay 50% is a whole different issue.

Granted the costs are high. In KY a T1 person was uninsurable prior to the ACA. If we got rid of the ACA how much do you think your premiums would decrease? Would your coverage get better? The problem is Wall Street profiteering on our health issues.

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For many years now, you don’t need a prescription for Humulin or Novolin R and NPH, at least here in the US. Walmart sells for about $25 per vial, their discount agreement sometimes shifts between Humulin & Novolin.
I have a micro sized corporation and have a Group Policy for 2. Last year my insurance company wanted to raise my rates significantly because I cost them more than what they charged me (likely primarily d/t my incorporating Dexcom into my supplies), so I selected a different plan of theirs, slightly different but very close to same price. Intended to renew our policy for 2016 BUT Assurant decided to get out of the Health Insurance business - and so did my Agent!!

The mere thought of that stuff makes me shudder. 20 years on it was far far too long, and if I had to go back to it… I guess I’d have to. But damn.

Anyway, the real question is: why is it that, unlike virtually all other advanced technology, pharmaceuticals like Lantus, Levemir, Novolog, Humalog escalate in price over time instead of decreasing? I swear there are times when I feel like the main benefit of a cure for T1 would be to put these #@*^%$s out of business.

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I too have a small company that employees low wage workers. I have to supply them with insurance, which they all…100% of them…signed the waiver to deny it. I offered to pay 50% of their coverage-and that is a stretch for the business. Thirty percent of my employees are young adults still covered be their parents insurance.

Here is the problem: No insurance company will write me plan because I don’t have any employees that want insurance, therefore, I am fined by the government because I can’t provide my employees insurance because NONE of them want it.

The irony…the fines are cheaper than providing insurance.

Now I just got a call from my Dexcom supplier that Assurant is not covering my Sensors under the Pharmacy Plan as they have for over 2 years. Will see what my Assurant contact comes up with as an excuse.

This thing was doomed from the start. Those of us with any understanding of insurance coverages realized this BEFORE it even became law. The goal was to make it affordable for everyone and to bring coverage to the 30 or so million not covered.

Well, as we can all agree it has not become more affordable. The first year our plan premium doubled (1750 per month) and deductibles increased. This was a plan offered by a large national insurance company for employees and agents… We tried the lower plans and still it was over $1200. We now have a Bronze plan with premiums close to, but higher than our old plan. We have higher co pays, less prescription coverage and our deductible id $10,500.00! Yes, no typo. Bronze plan = $10,500 deductible.

As for insuring the uninsured 30 mill, it may be that they now have insurance. BUT, that is of little comfort to the 30+ million now uninsured by this piece of pork fat crony crap.

Its not all bad though. We now have pediatric, obstetric and contraception coverage. These are must haves for couples near sixty years old when they are both sterile.

Something important to remember when determining what is actually coming out of D.C. is the 180 rule. Listen closely to what is said. With that in mind, re-think the information 180 degrees off the given message and you will be VERY close to understanding the real world outcome. Try it. You will be shocked at how accurate this really is. OH, and you can keep your plan while you save $2500!

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OK, so now with only 2.5 months until they bailout of health insurance, Assurant claims that they should have been rejecting my Dexcom supplies as Pharmacy Benefits. Odd since they have been considered Pharmacy Benefits for over 2 years. How can something that lasts 7 days at most, be considered Durable Medical Equipment? I considered my wife’s wheelchair as Durable until it required repairs. Guess I’ll need to start re-calibrating old sensors to get a few extra days out of each.

Before the ACA, my employer based insurance plans cost me zero. I had two, very high quality insurance plans covering my entire family… Out of pocket costs to me was zero. Each plan had a $250 deductible, which didn’t apply for prescription drugs.

Post-ACA, one plan remains the same but I now pay $110/ month for it. The other plan was replaced by a far inferior plan, while raising its out of pocket costs from zero to over $800/month… The employers reasoning was that they would continue to pay the same Premium that they did before the ACA and pass the remainder on to the employee… (Keep in mind, this is for an inferior plan.)

So of course we are counting he days until we can drop this secondary coverage because it’s expensive, shoddy coverage, and just creates a lot more headaches with coordination of benefits.

The ACA has not benefitted my family. Because of it we are actually less insured, at a higher cost.

exactly what I’m using now, R and NPH. I have a relion meter as well.
The issue I have with r and NPH is I have to eat low carb and use massive doses to even to have half decent numbers.
Problem will be solved after 11/25/2015.

To me, the root of the insurance premium rises and deductible increases has to do with the requirement that the coverage can’t be picking and choosing what they will pay for, and that in the US health plans are largely for profit entities - so of course the bulk of the premiums we pay got to the shareholders. Because health plans now have to cover Peds, OB/GYN., preventive care, their costs have gone up. To make up for that they raise the rates, and raise the deductible. And for a lot of people in the US, getting what they need to stay healthy or manage a chronic disease will only bring benefits in the long term - ie no expensive complications. To our health care insurance execs, if that happens we will be Medicare’s problem so why worry. The theory behind ACA was to build the revenue from premiums, so that claims would be paid. Unfortunately many decide to , as an example, pay the fine rather than have coverage. Of course that might bite them in the end since these are the same young people who do stupid things and aren’t immune. Hey, I was Dx’d with rapid onset type 1 when I was 30,. I certainly expect that. Nor did I expect that my employer provided insurance would drop me as fast as the Dx happened.

We also have to remember that in addition to anything we pay for our own healthcare, we (as taxpayers, and covered indoividuals) pay for the ER and hospital costs for the uininsured. Hospitals have to make ends meet somehow. Kinda like p[rices go up to cover costs to stores from shoplifting, so do the cost of medical services.

These four insulins are produced via recombinant DNA techniques. I don’t know about the other two, but the patent for Novolog export in a few years while Levemir patents expire much later. So … we may see price reductions as generics enter the market.

http://www.drugpatentwatch.com/ultimate/tradename/NOVOLOG
http://www.drugpatentwatch.com/ultimate/tradename/LEVEMIR

NOTE: Drug research and develop is a financial risky business. The successful drugs help offset the financial losses from the failed drugs. Typically prices do not come down until after patents have expired and generics enter the market. The cost of the successful drug is set to ensure profit during patent protection as well as provide capital for further investment. Without this, pharmaceutical companies are not financially viable.

http://www.phrma.org/sites/default/files/pdf/2015_phrma_profile.pdf

Yes. But I paid those sunk costs before ACA when insurance premiums were lower.

That is one problem I have with ACA. My wife is personal witness to this. Two young women work in the office with my wife. One is 25 and covered under her parents and is oblivious to the cost and is a big defender of ACA for all the typical reasons. The other is 27, no longer eligible for coverage under her parents plans and is experiencing first hand how ACA works and she’s not happy at all.