Since the Patient Protection and Affordable Care Act (also known as "Obamacare") was signed into law, many business owners have consistently complained about the increased costs of its implementation.
Because the start date of the major provisions of the Act were delayed from 2014 to 2015, most of the employees whose policies may be affected have not yet actually felt any of the alleged negative effects and instead have only heard of looming changes.
Now, as companies begin to prepare for the start of the act, employees are slowly beginning to feel these effects. UPS recently informed its employees that health care coverage for their spouses would no longer be made available.
UPS estimates that this change will effect nearly 15,000 of its employees' spouses and save the company $60 million dollars.
Similarly, the University of Virginia is dropping employees' spouses from its plan, in response to spending $7 million dollars to implement Obamacare at the University. Many employees now are questioning why their employers are targeting and dropping their spouses.
The reason is simple: the Affordable Care Act allows it. Under the act, employers are not required to provide health care coverage to an employee's spouse.
In doing so, the act altered the definition of who is a "Dependent" for purposes of offering health care coverage to employees. The term Dependent means a child under the age of 26 years old.
This includes all natural born children, adopted children, and stepchildren of the employee. The term specifically does not include the spouse of the employee.
The reasoning behind not including an employee's spouse as a Dependent is based upon the assumption that the spouse is working and eligible to receive coverage from their own employer (regardless if they are actually employed).
In essence, the Affordable Care Act only requires employers to offer health care coverage to its full-time employees and their dependents -- no one else.
Although the employer has no option with regards to insuring the employee's children, it is the employer's sole option to offer coverage to the employees' spouses.
Thus, many employers like UPS will drop spouses from their health care plan as a cost-saving mechanism.
Doing so will certainly be a cost saving mechanism for the employer, but could pose a logistical nightmare for a spouse who suddenly needs to find a new insurance plan separate from their spouse and children.
Other employers may continue to offer spousal coverage, but charge a surcharge, penalty, or other fees for spouses to be on the company plan.
Although this change may enrage employees and their spouses, the companies who have done so, and those who will follow suit, can simply contend that they are simply following the mandates of the law.
Posted by soccermama (Member # 35101) on :
Wow. I had no idea. I will have to ask my husband if his employer plans to do. They already dropped the cadillac plan because of penalties.
I do not want to go on the exchange. I heard they are mediocre.
It may determine whether someone stays with a company or not.
Posted by BuffyFan (Member # 34679) on :
oh no, that's scary. I hope my dh employer doesn't do this. I will have to ask him if he's heard anything. I am so screwed they do. I am a stay at home mom so I don't have any income besides my husband's.
Posted by surprise (Member # 34987) on :
This post stressed me out completely. Now I'm going to take a walk outside and try and let it go.
I want to say we have no idea what will change until next year. My H works for a large American corporation. If they pull healthcare on spouse,
that's it for me. I may just move to England.
Posted by surprise (Member # 34987) on :
Okay, think I get this- it's not that the spouse will have to go out and get a full time job to get insurance (because no part- time offers insurance)
but that the spouse can get the 'Obama Care' insurance- which is very cheap, yes?
I guess we will see.
Posted by Lymetoo (Member # 743) on :
I've been worried about this plan since it was passed 5 long years ago. The whole country is about to be screwed.
Posted by Pocono Lyme (Member # 5939) on :
It doesn't mean one Has to get a job unless they can't afford to pay the insurance premium, deductibles, etc.
Everyone will be forced to purchase insurance or pay penalties.
I found this. To me it's extremely sketchy. What would these unknown plans cover? How much is the deductible for each? How much are the copays?
How long before the premiums are out of reach? HMOs started out very inexpensive and covered quite well. Now?!
I got a letter from Highmark last week telling me that my health insurance plan will be discontinued at the end of 2013.
I have to select a new plan from the Health Insurance Marketplace after Oct 1.
It should be very confusing trying to figure out which one will be best for me.
Right now I pay well over $400 per month for my private pay Highmark plan which does not cover Dr visits or prescriptions.
Basically, it has only been helpful for lab and radiology costs after my deductible is met each year.
My husband's private pay Highmark plan is affordable, but we expect his premium to go way up to make up for other new plans.
Posted by jjourneys (Member # 39813) on :
right now, asking most employers what their intentions are won't help. Many employers are trying to figure it out themselves.
As others have stated, employers are sending out letters stating your insurance will end at the end of the year. Others are getting letters directly from insurance companies saying they won't be covered at the end of the year. All these people must switch over to ObamaCare.
I got the scare myself today. Hubby and I work for the same company, both of us received a letter in the mail, starts out "as the new Affordable Care Act comes into play" - WHEW - our letters state our insurance is not going away. Now we have to wait until Dec to see what the rates will be though - guarantee they'll go way up!!!!
The original poster didn't want political opinions so I'll keep them to myself. You're a FB friend of mine you know where I stand. If you want to be a FB friend send me a private message!
Posted by Lymetoo (Member # 743) on :
The reason Pocono said that is because LN does not allow political discussions.
Posted by dbpei (Member # 33574) on :
I, for one, hope that Obama Care will still be in effect by the time my husband retires in a few years. I am 5 years younger than him and this will allow me to be insured for much less $$ than we would have to pay otherwise.
A few years ago, when my daughters were just out of college, Mitt Romney put into effect mandatory health insurance for all of MA citizens. As a result, my daughters, were able to take advantage of low premium state health insurance that provided decent coverage until one got into grad school and the other got her first professional job as a teacher.
Posted by Pocono Lyme (Member # 5939) on :
Dekrator - That's a big concern. Paying premiums, maybe not cheap, and getting little coverage.
That may not be so bad for someone not requiring expensive medications or someone who is pretty healthy.
We know that's not the case for Lyme patients. When you consider a bottle of Mepron costs around $1300 for a 3 week supply and that's only one med..
We have no idea what Obamacare will or will not cover. Apparently not all states will be the same. The insurance companies that will be providing coverage haven't been revealed.
jjourneys - Good news that you will continue to have your health coverage. I believe most companies will drop spousal coverage as it will save them a lot of money.
I signed up for FB months ago yet haven't figured out what to do with it yet.
Lymetoo - Thank you. Exactly. Trying to follow lymenet rules.
dbpei - I remember something about Mitt Romney and the health care but don't know enough to comment. It's great any time it works. If this stands, I hope it works too but my gut is telling me differently.
I found this which only puts more questions in my mind.http://healthreform.kaiserpermanente.org/?kp_shortcut_referrer=kp.org/reform
Three years ago, on March 23, 2010, the Affordable Care Act, also known as the ACA, became federal law.
It initiated the most significant changes in the U.S. health care system since the establishment of Medicare in 1965.
As an integrated health care delivery system covering more than 9 million Americans, Kaiser Permanente expects that the new law will affect our organization and the members we serve in many different ways.
Some of those impacts include:
Coverage and its availability — no one can be turned down for coverage because of a medical condition, and all Americans
should be eligible for some form of coverage, whether through their employer, the new statewide Health Insurance Marketplaces, Medicare, or Medicaid.
Choice and the information to make good choices — with statewide Health Insurance Marketplaces and provisions such as the requirement for plain,
easy-to-understand language in a Summary of Benefits and Coverage, Americans will have more information and more options to choose what is best for them.
Performance — through incentive programs and payment method changes, care providers will be rewarded for their performance and efficiency, encouraging more providers to focus on quality improvement and innovation.
My questions: Are the premiums going to be really high if you do have a preexisting condition?
Under the Performance section= This is a flashback on HMOs. Physicians being rewarded for NOT ordering tests ...
I had personal experiences. Not even blood work was ordered when I first became ill. High fevers, dizziness, lightheadedness, frozen shoulder,...
I was however prescribed Xanax and later an antidepressant. For stress. Right.
Posted by Rob_h (Member # 38104) on :
I have read that the AHCA prevents charging a higher monthly purchase price due to pre existing issues.
It also, as I understand it, pays back individuals or families via the tax return for costs if mid income. Rates can be somewhat higher based on age, I think no more than twice the lowest age based rate, which is more than likely a big imp. for older folks, pre medicare.
I am not sure how companies will handle pre-existing benefit packages, part time vs full time, union based contacts, staying competitive with other related businesses in terms of attracting or retaining employees.
I have lyme for many years now, and cannot work, but if somehow lost spouse ins, I would shop the exchange to have some coverage.
My current ins has covered labs, some lyme doctor charges, ER, Rx (some with complex rules and efforts to not cover), non-lld fees, PT, psych, MRI's, so its been helpful to have.
As I understand it the ins co.'s that offer on the exchanges will have some standards but it seems unknowable for now what the co-pays, disincentives to healthcare providers will be, games, etc will be.
It would be helpful is more was known, or solidly predictable, but it depends on what ins co's offer thus before long some better info on this will become known.
I agree that it is scary, the last thing anyone needs with this insanely complicated illness is a new, non illness caused issue.
Looking back I thought it was wonderful how the fed gov stepped in to cover dialysis and transplantation for ESKD many years ago. Clearly the reverse has happened with Lyme, but a another topic actually.
I hope the AHCA works out for all of us with lyme, and folks generally.
Posted by jjourneys (Member # 39813) on :
Lymetoo - I wasn't complaining that we couldn't be political here!!! I agree completely. I come here to learn about Lyme and how to get healthy again!!! I like the fact that this forum sticks to this - that's why I'm still here.
So much useful information on this site!!! I have referred many others to this site!!!
Keep up the good work.
Posted by Pocono Lyme (Member # 5939) on :
Rob - Double the cost based on age I would imagine would be a real hardship.
Looking into this a bit. This is a little of what little I could find for PA.
Hmm (EHB) Essential Health Benefits) I wonder who determines what is essential. Are meds. essential?... You are correct. It would be helpful to have more information.
All plans offered through the Pennsylvania Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP).
The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis.
The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).
More information on the types of plans that will be available, and the carriers offering plans in Pennsylvania, is expected by late summer 2013.
I think I'll be buying the apples. Bronze, silver, gold and platinum aren't in my diet.
None pay 100%. Even 10% of some medical procedures could bankrupt a person.
I wonder how many doctors will stop accepting any insurance. I've come across quite a few over the years prior to this.
Not only LL docs. Internist, oral surgeon,...
Posted by Pocono Lyme (Member # 5939) on :
Hey jjourneys. I was typing when you posted.
I'm sure Lymetoo didn't think you were complaining. I sure didn't think you were. It just appeared that it was my rule for the post when I was trying to avoid breaking Lymenet's rule.
The moderators are great at "gently" (sometimes not so ) reminding us of the rules. Some members are aware of the rules and some aren't.
All is good friend. Posted by BuffyFan (Member # 34679) on :
Well, I just think...that if my dh is already paying for insurance...why should we have to fork over even more money for another insurance plan?? :'(
Posted by BuffyFan (Member # 34679) on :
so for our spouses that have insurance...can they take that insurance away and be forced to purchase a plan on the exchange??
Posted by Dekrator48 (Member # 18239) on :
Now today my husband got a letter saying that his private pay Highmark plan will be discontinued in a year, at the end of 2014.
We did not expect that one. He does not have a pre-existing condition and he has a high-deductible plan that was affordable.
Posted by Lymetoo (Member # 743) on :
quote:Originally posted by jjourneys:
Lymetoo - I wasn't complaining that we couldn't be political here!!! I agree completely.
- I was just making sure everyone knows that. New folks may not know!
Posted by Lymetoo (Member # 743) on :
quote:Originally posted by Pocono Lyme:
The moderators are great at "gently" (sometimes not so ) reminding us of the rules. Some members are aware of the rules and some aren't.
All is good friend.
- Posted by Razzle (Member # 30398) on :
I have private insurance (not through hubby's employer), and I received a letter from insurance stating my current plan will be discontinued at the end of this year.
They've created 3 plans to correspond with the bronze, silver & gold plans of the ObamaCare exchanges, even though the plans from my insurance co. are not available on the exchange for where I live.
So the whole industry is changing because of this. Some things will be better, but the deductible will go up (again...it went up 2 years ago) for individual, family, and a new category - a higher deductible for out-of-network providers.
My primary is a Naturopath, and even he doesn't know yet whether the insurance plans on the exchanges will cover Naturopathic office visits/treatments.
So it is NOT TRUE that we would get to keep our current plan if we like it - because all the insurance co's are changing their plans to conform with the standards of the Affordable Care Act...
Posted by Pocono Lyme (Member # 5939) on :
Buffy - I read some of what is in the link you provided.
The first thing that caught my eye was this "UPS is dropping coverage for spouses only if they can get insurance with their own employer."
They are Teamsters as are my husband's company employees. Every year we have received a letter asking if I have health insurance through an employer.
It was to determine which insurance would be primary or secondary. That would mean if I had health insurance through an employer, my insurance would be used for my medical expenses first.
Any costs not covered under my plan could be picked up by my husband's. I guess that will be out the door for those employed spouses.
The same would hold true for spouses on Medicare. The people on Medicare won't be able to depend on their spouse's insurance for Part B, dental, prescriptions,...
One point they made was it would be cheaper for some and more expensive for others. I know where we'll fall.
Razzle - Not sounding good thus far. Maybe for some. Young healthy people hopefully will benefit.
Posted by hiker53 (Member # 6046) on :
I am hoping our union fights to keep our current health care plan with the school district. This is a bargaining year and we have pretty good insurance. The school district pays my premium, but would not cover my spouse. However, I sacrifice a bump in salary to get the good insurance.
The plus is that this insurance covers the superintendent and the administrators, too, so I imagine they would want to keep it.
Hate to see what happens when I retire as the state of Illinois has major pension issues.
Hiker53
Posted by Kudzuslipper (Member # 31915) on :
This scares me too. I think it will be good though for the uninsured.
Posted by Lymetoo (Member # 743) on :
I bet a lot of them won't even sign up.
Posted by map1131 (Member # 2022) on :
I bet 90% of those that don't sign, don't have a penny to their name to be able to purchase health insurance.
The law says they must have auto insurance too. Insurance this day and time is a luxury.
I really don't know how some people make it. Every month we hear water/sewage increases, utilities increases, the price of gas jumped 40 cents over night, car/home insurance rates jump. OMG, the price of groceries!!!!
Roof, lights and food are the first priority. Then what's left? In todays world not much.
Sad state of affairs. I'm blessed that this is not my world. But my heart is heavy for the others in this life.
Pam
Posted by Rivendell (Member # 19922) on :
Here is a link to a good article about the healthcare act.
I am grateful that the law was passed. I look forward to seeing what plans will be offered. My husband and son are on COBRA which takes a huge chunk of $ each month.
If you have never been without insurance, count yourself as blessed.
I have been without insurance 1x in my life. It was very scary.
My husband was without insurance for years before we married...he had 2 jobs and worked 7 days a week. His employers didn't offer insurance and he was disqualified for a private plan because he had an allergic rash years prior. Pathetic.
Posted by Lymetoo (Member # 743) on :
Just ran across this. I have no idea on it one way or the other.
I seriously think companies are taking advantage of the new law. That way they can blame everything on it.
I just got a notice that my son and husband's Cobra rates are increasing 40% effective in Dec. There is no reason for such a change.
Posted by Lymetoo (Member # 743) on :
Probably true!!
Posted by Rivendell (Member # 19922) on :
Thanks, Laxmom.
Companies are taking advantage.
Posted by Tincup (Member # 5829) on :
Check this out...
"In every State and for the first time ever, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more and more states have the authority to reject unreasonable premium increases."
And here is another bit of good news from the same link:
"Since September 2010, approximately 3.1 million young adults have gained coverage through the provision of the Affordable Care Act that enables children up to the age of 26 to stay on their parents’ health insurance plan."
Posted by lax mom (Member # 38743) on :
I think these ACA posts are political whether people intend for them to be or not. I for one am shocked that fellow Lyme patients would have such little regard for other people who fall on hard times and need help with insurance.
It's not the end of our civilization as we know it.
I have family who will benefit from this Act...hard working family who never asked for a handout in their entire lives, who just want to have health insurance and pay the premiums without having to go bankrupt in the process.
I previously worked in Social Services pre-Lyme and know that each and every one of us is just 1 crisis away from needing to lean on the govt for help...unless you're a bazillionaire, which some of you probably are...but I am not. My family is not.
I wish everyone would watch "I Am". It's on Netflix.
I hope these ACA threads close. This is not the place.
Posted by Lymetoo (Member # 743) on :
There is a lot of good info here... I think!! I hate to close it.
Posted by randibear (Member # 11290) on :
I apologize for offemdingt anyone and have deleted all my posts regarding these subjects.
I didnt mean to sound arrogant and uncaring. I'm not really.
Again my apologies to everyone.on the board.
Posted by Pocono Lyme (Member # 5939) on :
I can see where one could take this as political or not. It's not meant to be. Personally I would like to see parties abolished.
Instead of democrat or republican, have Americans from each state represent its people in the best interest of our country and our people.
We are/were the government. For the people by the people. If anyone feels my above comments are political, I will delete or the moderators can.
Laxmom, I've been without insurance a few times and for years. The worst being after I had to stop working, didn't know what was wrong with me, no income and couldn't afford COBRA.
After eight months, I managed to get to the magistrate with much assistance of my now husband. We were married and I was then covered under my husband's insurance.
I thought I would be dead prior to being able to marry the love of my life.
I had heard "obamacare" being thrown out there but was under the impression it was to ensure "affordable" healthcare coverage for those who had none.
Since I was covered under my husband, I believed it wouldn't affect us or anyone else who had coverage.
Now I really have no idea. The letter we received is so vague but seeing now that all insurance companies are involved it makes me think I'll be without coverage under my husband.
As another poster made the analogy to auto insurance, I agree.
I believe people who are in need and are Responsible will take advantage of this and I think this can be great.
I would like to continue discussion on this so we could learn.
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) reminding us of the rules. Some members are aware of the rules and some aren't.![[bonk]](graemlins/bonk.gif)
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