Monday, April 29, 2013

Costing other people money

I think I have mentioned that we are extremely lucky to have great health insurance. Peanut and I each have insurance offered through our jobs, and after a lot of research 18 months ago, we went on his insurance. It's a high deductible plan, but after that costs were covered at 100% - and his employer pays the entire premium. It's a major company so almost anywhere we go is considered in-network.

It was hard to swallow the idea of shelling out a few thousand dollars before we got any coverage at all, but wow, did that wind up being a great decision when we had a child in the hospital whose stay cost almost $10,000 per day. If we had gone with my company's health insurance, we would have been on the hook for 20% of that.

This month, we got word that Peanut's employer is having to change their health insurance plan - because of us. We have cost them over $1,000,000 in health care claims since Baby M's birth.

The new situation is as follows:
Employer still pays 100% of the premiums
Deductible is $3,200 for the family before insurance kicks in at all
Co-insurance of 20% for all in-network health care up to a max out of pocket of $6,400

It basically means an additional $3,200 cost to the insured per year. Which, in the grand scheme of things, is totally awesome. (Especially because it won't really affect us until next year at the earliest - due to her birth weight, Baby M gets state medical assistance as a secondary insurance to cover out of pocket costs for her care.)

I feel bad for the other employees who now have to pony up more money for their health care. It's a risk I'm sure Peanut's boss was willing to take because he employs mainly young guys who don't go to the doctor very often. And I'm so glad it's a risk he took, because it allowed us to get the very best care for our daughter and not go bankrupt in the process.

1 comment:

  1. I'm a huge proponent of state medical assistance (mainly because I'm a caseworker). I know that some people get very persnickity about "entitlement programs", but to me, quality medical care should be a basic human right for everyone.

    A lot of states (including my own) have special policies that can help in a medical emergency situation. In my state, it's called "Spend Down". Say a 3 person household has $4000/month in income, but the income limit for medicaid for that size family is $800/month. If that family has $13,000 in hospital bills, they would end up being responsible for $3200 ($4000-800), and Medicaid would pay the remaining $9800.

    $3200 is still a huge bill, but much less painful than the full $13000


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