I was very pleasantly surprised, yesterday, to learn that our healthcare insurance (which changes rates every February) will actually be decreasing in February of 2012. True, it is for a negligible amount--just $1.56 per month (from $431.60 to $430.04)--but I had really expected it to increase at the typical 10-12 percent level. Has anyone else here experienced a similar surprise lately? Or have we just been fortunate, in this regard?
Doctors are not paid a wage. Nurses are; but I am unaware of any decrease in this regard. (For the record, my wife was an RN; although she retired in 1995.) In any case, our healthcare-insurance plan is a PPO; in-network providers (who are utterly ubiquitous, where I live) are required, by contractual agreement, to accept far less than the Submitted Charges as payment in full. (For instance, when my wife visited her hemotologist on 12/2/11, the Submitted Charges came to $1,144.00; BC/BS paid $472.44; we paid another $101.30; and the remaining $570.26--about half the total--was written off, as an insurance adjustment.)
That's a big surprise. Hopefully I'll see the same on my next round of premiums. The typical 12-14% annual increase is depressing.
Apparently, some holders of TriCare healthcare insurance are also experiencing a price reduction: http://www.govexec.com/dailyfed/1111/112311kl1.htm (Note: My mother-in-law has TriCare. My wife and I have Blue Cross/Blue Shield.)
Are your benefits the same? Some plans try to keep premiums down by reducing benefits or toying with deductible and copay amounts.
Fair question. Each December I scour our new Service Benefit Plan booklet (which takes effect every January 1, even though premium changes don't start for another month beyond that), for changes in the terms and conditions. This year, there were seven changes to Standard Option only (which we have; it is a PPO), plus another nine changes plan-wide (which includes both Basic Option--which is an HMO--and Standard Option). Some of these changes were actually additions (e.g. the plan now pays for "specific blood and marrow stem cell transplants when performed in a facility accredited by the Foundation for the Accreditation of Cellular Therapy"). Others were subtractions (e.g. the plan "no longer provide benefits for lobar lung transplants performed at Blue Distinction Centers for Transplants"). However, an increase in prescription-drug copays, from $10 to $15 for a 90-day supply of generic drugs, is the only one that would appear to affect us. (Oddly, the $10 will remain in effect for all who have Medicare Part B--which my wife and I do not--even though Part B is entirely unrelated to prescription-drug coverage.) (Note: This rather benign set of changes has not always been the case. Between 2009 and 2011, for instance, we have taken several hits: As one example, our copay for ambulance service has doubled within this time frame, from $50 to $100. Our coinsurance, among in-network providers, has increased by 50 percent, from 10 percent of the Plan Allowance to 15 percent of it. Copays for specialists have also increased by 50 percent within this time frame, from $20 to $30. And our annual out-of-pocket, catastrophic cap has increased from $4,000 to $4,500, and then to $5,000. Oh, and deductibles no longer count toward that total--just coinsurance and copays. And the per-person deductible has increased by 40 percent, from $250 to $350. )
List of drugs and procedures covered by insurance might be reduced and you don't even know about that.
Well, there is a change to the prescription-drug program: It will be administered by Caremark this year (instead of Medco); and it will include a formulary--which is new to the plan--with four tiers. As for the medical procedures that are covered, there are a few additions and a few subtractions, as I noted earlier; but nothing that would appear to impact us (or most other plan members).
Yes, your coverage has changed, and in my observation, the change in drug plan is significant. The formulary/tiers plans are a pain.....
I agree with you as concerning the disagreeable nature of formularies. I really do not care for them. Still, the most significant change appears to be the 50 percent increase in the copay for a 90-day supply of prescription drugs, from $10 to $15. (I believe that all the brand-name drugs my wife and I take--for which there is no generic equivalent--will remain at $70. "Non-preferred" brand-name drugs will increase to $95; but I don't believe that will affect us.) Note: If I have any significant concern, as regarding changes in the plan, it is the fact that the definition of the term, "medical necessity," has been revised a bit. It seems a bit more subjective than I would prefer. But chances are that this will not come into play.
