The day before Xmas, --three days after QCOM requires that you actually choose a provider, we received the news that "effective January 1, 2016, Qualcomm will replace its current health plan with a qualified deductible health plan." A qualified deductible health plan is just another way of saying you're getting screwed by a "high deductible health plan" ["HDHP") that your employer is probably using as a profit center. For one employee + spouse the deductible is now $3,450. Not counting copays and coinsurance. Oh, and the deductible applies to prescription drugs. And the formulary has changed--so you may be paying several hundred dollars per month for medications that cost you $20 per scrip last year. Since the average person under 40 (who does not have either an unforeseen life-threatening emergency or an expensive pre-existing condition--) uses approximately $1,000 of medical care and Rx drugs per year, someone is making out--and it isn't just the insurance companies. If you and your spouse have a gross income under $140,000, HDHPs are a DISINCENTIVE to purchase health insurance and choose to pay the penalty--which in 2016 is the greater of 2.5% of your gross income, or $695 per adult. Also, for certain specialists, or chronic and pre-existing conditions, you may get better coverage by paying out of pocket--if only because you don't have to pay the added co-pay and add-ons for out-of-plan physicians. Do the math. And bitch frequently to benefits@qualcomm.com
52 replies (most recent on top)
welcome to 2016. the trend is for companies to pay less health insurance. Also your analysis omits the possibility you could end up in the hospital with a huge bill. In that case you will be happy you have insurance assuming you do not have to pay beyond your deductible.
@F8MbaJY-kws. Kaiser works only if you don't need to see a specialist that isn't in the kaiser system. Otherwise, you're pretty much limited to what kaiser has. For most people ,that's probably ok.
@F8MbaJY-zqx. I consider a person abusing his/her health plan if the plan didn't have a co pay or a very low copay (like $10) with very little co-insurance, and the first day you get a slight cough or slight fever, you visit the Urgent Care or ER facility thinking you are going to die. And despite the doctor at teh Urgent Care or ER telling you just have a simple cold, and just wanting to send you home telling you to stay home from work and get some rest and drink lots of fluids, you insist that the doctor runs a throat culture to make sure you don't have strep throat, take an xray to make sure you don't have pneumonia, run a blood test to make sure you don't have avian flu or ebola or lyme disease, and request that the doctor give you a prescription to CiPro antibiotics "just in case"....And then when the doctor does that, you only pay maybe $20 out of pocket, with the rest of the cost mostly being covered by your insurance plan...And that $500+ CiPro antibiotics you end up throwing away in the trash a week later, because you got over your common cold and didn't need to take it afterall....
@F8MbaJY-tch. If you're in a financial situation called "bankruptcy" or "bill collector". I hardly consider that a negotiation strategy of strength from your part. I call that debtor's prison. And considering it takes 7 years to wash off your credit report, good luck finding affordable housing, when either landlords won't want to deal with you or will make you pay an arm and length because your credit is shot.
That said, for non-emergency medical treatment, it is possible for you to call your provider and try to negotiate with your provider up front, and if you are good a negotiating, you might do as well as an insurance company. But practically speaking, if you or your loved one is in a medical crisis, or in the trauma hospital because you're in an accident, I serious doubt the first thing you would be doing is spending the time and energy to be negotiating your hospital bills while you or your loved one is in ER. Again, you aren't in a position of strength at that time to be negotiating.
This is common sense. If you think otherwise, clearly you or your loved ones never have experienced anything major, including giving birth, and for example, requiring an emergency c-section that had it not been done would have jeopardized both the pregnant spouse and/or your unborn child...Or you have never been hit by a uninsured drunk driver and ended up in ER...Or you have never come down with something like cancer, or never had a sports injury, such as a concussion/bone/limb surgery. etc,etc,etc. And hopefully you are one of the lucky ones that were blessed with good luck of not having to deal with anything major that happens to your health beyond your control to worry about it. Because if you did, you would have experienced at looking at what a "retail" hospital bill would look like (for example, $3000-4000 PER NIGHT for ER stay), and then see the "negotiated" insurance bill of being 1/10 of that, of which you were responsible for maybe a maximum of $3000 of it, with the rest being paid by either your insurance plan or being eaten by the hospital itself. An MRI scan, for example, would by itself set you back by $20,000 roughly, uninsured and if you weren't in a position to negotiate that MRI up front, which in most cases, you wouldn't be.
Some of you people seem to have interesting ideas regarding the "abuse" of health care, and "industry norms." How many visits do you get before it's considered "abuse?" And is that per person insured under the plan, or total? With the exception of preventive care and certain other mandated conditions that MUST be covered, the "industry norms" are all over the map. You are eligible for aid if your premiums exceed 9.5% of your gross household income, if married. The plan offered by QCOM costs a little over $500 per month per adult, which is actually pretty good. Employees are covered for free. So the cost of premiums is in line. Deductibles are about mid-range. (Blue Cross and some other Brand X that I can't recall of the"use-it-and-lose-it-variety" were among the worst, with deductibles over $6,000.) Many of you also seem to think that people with medical conditions are in worse health than YOU are. Guess what; some of us could wipe the floor with you--because nothing makes you decide to improve your health faster than a brush with death! Some of us don't see doctors more than once or twice per year. I have paid out of pocket to see the doctor of my choice, so that's not an issue. But the scheme for changing the payment tiers in the Rx drug formulary from copays only to copays plus a differential, AND making the differential part of your deductible before your insurance kicks in, AND knowing that the insurance will NOT kick in, EVER, if the drug is not listed in the formulary--that's the part that is problematic. The medications that are used to treat certain chronic and pre-existing conditions are often branded pharmaceuticals--which can cost hundreds of dollars per prescription each month, or have been repackaged in new "delivery systems" that can up the price from your Albuterol (asthma) to close to $200 per inhaler, or raise the price of injectables for certain allergies, cancer treatments, or diabetes medications to over $1,200 per "pen." I would save $4,000 under this 2016 HDHP scheme by NOT having insurance, and paying for everything out of pocket. I have a feeling I'm not alone. So essentially, an HDHP is exactly what the ACA was designed to prevent: A situation where the people who need affordable health care the most will be able to afford it the least.
Qualcomm seed money and wellness cash cover the deductible in the first year and most of it the 2nd year. The sky doesn't fall until year 3.
uyg: Where do you get the idea that the only people who have leverage to negotiate are insurance companies? The word "bankruptcy" generally makes them more willing. And medical liens are also one reason why wealthy geezers own big-ticket items like real estate through trusts, and park their cash in off-shore accounts. With the money you save on health care, maybe you too can afford a "therapy pony!"
Choose Kaiser.
Well. Making people actually pay something to go see a doctor will discourage people who use to abuse going to see a doctor for every tiny thing such as a cold, when there was very little financial disincentive to see a doctor anytime you wanted to without paying s lot of money. If at all, this will make more people thing twice about spending money on a doctor's visit for really stupid things.
how much will these fees add to EPS for FY2016, and is it already priced in?
just say no to Rx drugs
Um... I hate to break the news to you. But this healh plan looks more in line with what the industry norm is now. Some plans offerhave no insurance premiums like my current employee, but have an 20% copay that you are responsible for paying up to a maximum out of pocket expense of $3000-4000.
And lets face it, if you or someone in your household isn't in great health, you should be paying more for healthcare versus someone that is healthy and doesn't use their insurance as much. Everyone else that is healthier is subsidizing the health care cost that you or the person in your family that needs extensive medical treatment. And having a high deductible plan is still better than having no insurance. The hospital bill you get is drastically different simply when you have insurance versus if you don't have it. Because insurance companies will negotiate the rate for treatment versus if you have no insurance you will end up with a retail priced hospital bill. If you want to be oisses, blame god for your health misfortunes and blame the medical industry for making health care so unaffordable.