The only way our country will ever be able to get control of it's health care costs which is at the heart of the whole crisis.

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

Dreamsglore wrote:

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

What do you think Obamcare is about,Bob? The insurance exchanges are going to have to compete for participants.Thought you might want to know.

Dreamsglore wrote:

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

What do you think Obamcare is about,Bob? The insurance exchanges are going to have to compete for participants.Thought you might want to know.

Dreamsglore wrote:

What do you think Obamcare is about,Bob? The insurance exchanges are going to have to compete for participants.Thought you might want to know.

PACEDOG#1 wrote:

Dreamsglore wrote:

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

What do you think Obamcare is about,Bob? The insurance exchanges are going to have to compete for participants.Thought you might want to know.

Really? Why is it then that the cheapest Obamacare plan in 2016 is 20,000 per year? HUH? Damn ditz. That's over 1600 per month. WTF is wrong with you? Is math not your strong suit? Who the hell can afford that premium? Nobody on this forum I would guess.

Bob wrote:There's a reason why I'm getting free medications from Publix. Why I'm getting $4 drugs from Walmart, Target and other sources.
I'm actually no longer even bothering to use the drug plan that comes with the health insurance policy I pay for. Unbelievably, even though I am paying the insurance company to subsidize the drug costs with that plan, the net cost of buying my medications is less when I completely ignore the plan and buy all my medications without any insurance involvement.
Additional to the free drugs and $4 drugs, I buy a K-Mart plan for $10/year which gives me one of my blood pressure meds for $12 (90 pills) that would cost a lot more if bought through the drug plan.
And the only med I can't get from those sources I get from a Canadian pharmacy for a fraction of what I would pay otherwise.
And I'm not alone on this. My friend just got on Medicare. If she uses the drug plan that comes with the Medigap policy she's buying, one damn drug out of the many she's prescribed is going to put her in the "doughnut hole".
The retail value of that drug is $3500/year. The doughnut hole starts at $2900. If you're not Medicare and don't know what the doughnut hole is you can google that.
We've figured out that she can buy the drug from Canada for $171 (for 90 pills) which is only about twice what her co-pay would be using the medigap drug plan. BUT since she won't be adding a retail value of $3500 to the running total for the doughnut hole, buying the drug from Canada could save her into the thousands.

There is one word which explains all this. Competition. These corporations are having to compete and that's what's lowered the price of these meds.
Walmart started this to attract customers to the store. Target had to compete and follow suit or they would lose customers to Walmart. And then other retailers had to do the same.
That is what brings the costs down.

But it shouldn't have to end with medications. These same corporations could be in the business of delivering primary medical care and if they were doing so, the same scenario of competition would occur.
Instead of doing nothing to control these skyrocketing costs, the government should be fostering that as a partial solution.
Private enterprise engaged in full-out competition is the ONLY way to get control of these costs. Period.

Smart thinking but insurance companies don't use retail price to figure donut hole, they have contracted prices with the pharmacies that are lower than retail. But still probably would have hit donut hole by 4th quarter of year. If you hit your donut hold say around May then you probably would hit catastrophic by sept and then all generic no more than $2.60 and brand $6.60 but then that would have meant a total of $4700 out of pocket.

doubtingthomas wrote:.
I can see now that this is designed to fail so a single payer system will be in place down the road.

Chrissy wrote:

doubtingthomas wrote:.
I can see now that this is designed to fail so a single payer system will be in place down the road.

I agree. Some people dont agree with your comment here. Would you mind sharing why you said that?

Thanks

Bob wrote:

Dreamsglore wrote:

What do you think Obamcare is about,Bob? The insurance exchanges are going to have to compete for participants.Thought you might want to know.

Lack of competition could hike costs in health insurance exchanges

http://news.wustl.edu/news/Pages/23936.aspx

PkrBum wrote:There will also be stress applied to the employer... by design I believe. Who will pick up that subsidy if biz opts out?

doubtingthomas wrote:but insurance companies don't use retail price to figure donut hole, they have contracted prices with the pharmacies that are lower than retail.

doubtingthomas wrote:

Chrissy wrote:

doubtingthomas wrote:.
I can see now that this is designed to fail so a single payer system will be in place down the road.

I agree. Some people dont agree with your comment here. Would you mind sharing why you said that?

Thanks

Well, let me see. It will begin Oct 1 open enrollment, all the regs have not been put into place and the govt is behind (no surprise) insurance companies cannot get their act together down until the govt does, state regulators OIR is scrambling to approve all the plans insurance companies are submitting with rates and how many plans can be under each metal plan, Yes the state's department of insurances still have to approve the plans. Many people (I know this is hard to believe) still think they are going to receive for FREE. The states who did not put their own exchange in and did not except the Medicaid (Florida) will have thousands of people below 100% poverty level not qualify for anything including medicaid, so therefore they are still uninsured. Dr's and hospitals who are going to receive larger reimbursements for Medicaid really won't see this.

Now if the govt is behind you don't think that their people as the end user who approves all applications coming in across the nation in thousands starting Oct 1 know what the hell they are doing. Many will still go without and pay the penalty tax. Individual insurance plans will go sky high in the next couple of years and the ones that did not qualify for a subsidy will no longer be able to afford insurance for a family, even if their income is $100,000. The government doesn't have the money to subsidize the people who will qualify. Insurance agents after the first year will be dropping like flies, navigators won't be licensed insurance agents and no nothing about insurance. There are just so many reason's this was designed to fail.

The whole sad thing about this is if republican congress really wanted to do something I believe they could. I think that at the end of the day they are all working together in D.C. to put everyone on Medicare, but this may not be bad either if they age band premiums and the younger people paying a little more than seniors. Say age 0-10 $125.00 a month premium, 11-20 $175.00 monthly premium, 21-30 $250, 31-40 $350, 41-50 $400, 51-55, $475, 55-65 $550 and then at 65 plus fall back into line. Now there is a flaw to even this plan the low income would still have to be subsidized. There really may be no solution.

The cost of health care started going up many years ago when HMO's and PPO's came on the scene. Why not go back 40 years to the health plans. It was simple: a deductible then 80/20 up to a max out of pocket. Now that I have rambled and not really answered your question.

The reason I feel single payer is meant to be is my thought after trying to sort this whole bs out. There is just too many variables to tear this whole thing a part.

doubtingthomas wrote:Here ya go:

http://ifawebnews.com/2013/01/24/wal-mart-considers-role-in-exchanges-selling-small-group-health-plans/?utm_source=streamsend&utm_medium=email&utm_content=17901267&utm_campaign=IFAwebnews%253A%2520Latest%2520Pennsylvania%2520Insurance%2520News

doubtingthomas wrote:Below are the plans apparently approved already in Texas by Humana:

A family of 4 - parents both age 40, 2 kids ages 6 & 10, zip code 78708

Platinum - $0 deductible - $2852 monthly
Gold - $0 deductible - $2576 monthly
Silver - $0 deductible - $1656
Bronze with a $6,250 deductible - $1034 monthly
Bronze HSA - $4,250 deductible - $925 monthly
And those all say "HMO" on them, and the prescriptions must be filled at Wal-mart.


Contrast that to current traditional plans with a much larger network:
Enhanced Copay 80% plan - $1000 deductible - $788 monthly
Enhanced HSA 100% plan - $5,000 deductible - $516 monthly


On the Bronze at $1034 monthly, the brief summary of benefits says:
Annual deductible of:
$6,250 - you pay $1,034.91/month

Diagnostic illness/injury office visits are included with your plan for a copay for the first 6 visits; there is a $35 copay for a primary care physician visit and a $60 copay for a specialist, $60 for an urgent care visit to a Concentra Clinic and $100 for an urgent care visit to a Non-Concentra Clinic. The plan pays 100% after you pay your deductible for all additional visits
100% coverage for preventive care office visits for primary care physician

Inpatient and outpatient hospital services are paid at 100% after deductible for covered expenses

Prescription coverage included with separate deductible and copays (see details below)


What's the medical deductible?

Individual coverage annual medical deductible: $6,250
Family coverage annual medical deductible: $12,500
Copays do not apply to the deductible
Expenses applied to the medical deductible won't apply to the prescription drug deductible
What’s the coverage for preventive care services?

Plan pays 100% on all in-network preventive care services provided by your primary care physician before you have met your deductible. This includes preventive office visits, lab and X-rays.

What's the coverage for diagnostic illness or injury office visits?

For the first 6 visits the plan pays 100% of covered expenses after your $35 copay for office visits to your in-network primary care physician. Copays for in-network urgent care visits to a Concentra Clinic are $60 and Non-Concentra Clinics are $100. Copays for in-network specialists visits are $60 and require a referral from your primary care physician. After your first 6 visits the plan pays 100% after you pay your deductible.

What's the coverage for lab and x-rays?

For diagnostic labs or X-rays during an office visit or urgent care visit the plan covers the first $500 per person then 100% after you pay your deductible.

What's the coinsurance percentage for hospital services?

For in-network inpatient services, once you meet your annual deductible, this plan pays 100% coinsurance for most covered medical expenses from in-network providers. For in-network outpatient services your plan covers the first $500 per person for labs and X-rays and then pays 100% after you pay your deductible.

What's the coverage for emergency room services?

Your plan pays 100% of covered expenses, once you meet your deductible.

Does the plan include prescription drug coverage?

Yes prescription coverage is included with the coverage outline below.

There is a $1,500 deductible which is separate from your medical deductible. The prescription drug deductible does not apply to Level One drugs.
Prescriptions must be filled at Walmart pharmacies or through mail-order service at RightSourceRx.com
If you use an out-of-network pharmacy, there is no coverage
Prescription drug deductibles and copays apply to the plan out-of-pocket maximum
Plan pays 100% for covered services after the plan out-of-pocket maximum is satisfied
Drug levels and copays
$5 copay for Level One: Preferred generics
$25 copay for Level Two: Non-preferred generics
$65 copay for Level Three: Preferred brands
50% for Level Four: Non-preferred brands
50% for Level Five: Specialty drugs
To find out what level your prescription is in, visitHumana.comand select Drug List under Insurance for Individuals

doubtingthomas wrote:Here ya go:

http://ifawebnews.com/2013/01/24/wal-mart-considers-role-in-exchanges-selling-small-group-health-plans/?utm_source=streamsend&utm_medium=email&utm_content=17901267&utm_campaign=IFAwebnews%253A%2520Latest%2520Pennsylvania%2520Insurance%2520News