scrubbedexpat091

If you can afford Cobra coverage. Its useless for those who lose their job and have no income, they likely can't afford to pay for it.


Benefits to pay for treatment happen in countries with single payer systems as well, we see them in Canada at times, when the healthcare system wont pay for something.

kins

I agree it can be expensive. I was simply pointing out to the OP that it's an option that his friend should look into. Along with several other options worth investigating.

It doesn't actually sound like the employer was legal in dropping the employee from the plan at all if he's still working as the OP seems to be saying.

watchamacallit

Firstly thank you for the replies.
I am confused by the situation really, he works for the same company as I do. A few years back I was injured at work and spent a couple of months off, I got a very good work mans comp check every week and my insurance was kept up to date by the company. He has been told that they will pay premiums until the 20th, after that his insurance will lapse. I have tried to tell him he must have rights of some sort to ensure the premiums are kept up but he say's otherwise. Maybe in my case it was because my injury was a work related incident and the company were obligated and didn't want a law suit for damages and so the carried on paying me and the premiums ? His is not a work related injury obviously and maybe they don't care.
It's still a sad situation. Some years back a friend of mine who won a compensation case and got a few million had a serious heart condition and several operations, he eventually went bankrupt, lost everything, his villa in Pheonix, his huge coach/ RV and now lives in a sheltered retirement home.

maggot50

well there is a paradox here with these huge bills US hospitals are closing at a rate faster than for the past 30 years so someone/something must be screwing the system....is it insurance??!

also regards the NHS and roses I know someone whose relative died in the mid staffs scandal because simply they werent fed/watered. sure they didnt pay for this but for this standard would anyone?!

DebzinUS

It sounds like his FMLA benefits have been exhausted. If so, his employer is no longer obligated to hold his job and there goes the health insurance too. When this happens COBRA will kick in, but as others have already said, COBRA is expensive.

Hotscot

Can he get COBRA until A.C.A. kicks in? Would that make any difference?

DebzinUS

If he has lost his job, or even left his job for any reason, federal law requires that his health insurance is available for him to purchase at the full price for a period of 18 months.

DebzinUS

I think I need to add to this ...

COBRA covers employees of employers with at least 20 full- and part-time workers. Employees are eligible if they lose their jobs voluntarily or involuntarily, with the exception of termination for gross misconduct. Eligible employees may receive coverage for up to 18 months at the same rates that applied during their employment, although premiums may be higher since employers typically pay a portion of premiums for active employees.

Michael

Workman's comp is mandated by the government and the company has to pay 100% of the cost of medical care for the injury and is not related to normal health coverage. If he gets dropped from insurance, see if he is eligible for the government high risk pool which is very inexpensive until the Affordable Care Act kicks in on Jan 1.

If he has little income, the cost through the Affordable Care Act should either be free or minimal. The following is the cost for the California program but should similar for other states. However someone that has employer provided health insurance can't use the Affordable Care Act.

http://www.coveredca.com/calculating_the_cost.html

New York has opted into expanded Medicaid but already has a threshold level of 150% of the poverty level which is higher than the 133% for the Affordable Care Act. The difference is that the Affordable Care Act covers all families where the current Medicaid only cover families with Children and also has a higher income threshold (I believe the for current Medicaid, the minimum requirement is that income has to be below the poverty level).

http://www.advisory.com/Daily-Briefi...ap#lightbox/2/

Giantaxe

Only four states currently provide Medicaid coverage for adults without children under age 18. That will change under the ACA from Jan 1st next year for those states that have accepted the Medicaid expansion. If you're in one that hasn't, you're essentially out of luck.

bewildering

Your friend was unlucky about the health but dumb regarding insurance. with millions they should have easily afforded gold plated insurance. If you own expensive assets you must get insurance, because the state will not pay for your treatment, as the state (rightly) perceives you can afford insurance. The problem is that people try to skimp on insurance.

bewildering

Nope, it isn't insurance companies making money, nor is it hospitals. The main problem is the cost of labour in medicine. That is were the money goes.Hospitals charge ridiculous amounts for procedures to pay their ridiculous salaries. The NHS would be twice as expensive if medical salaries in the UK were similar to the USA.

HDWill

I recall reading that higher salaries in the US account for only about 10% of the higher overall cost of care in this country. I don't have the citations, but it is a multifaceted problem to be sure.

cluedweasel

Here you go;
http://www.forbes.com/sites/realspin...lthcare-costs/

Michael

That is not true. Prior to ACA, private insurers had overhead costs that were sometimes excess in of 40% the cost of premiums. Under ACA, their overhead costs can't exceed 20% for individual policies and 15% for group plans. Medicare has overhead costs of 5%.

Another major problem is that in the US if a doctor thinks a patient is terminal, he has to keep treating the patient if the patient or family requests more treatment but in other developed countries, when nothing more can be done, treatment is terminated. Hospital and doctors take advantage of the situation by treating patients for illnesses that is not related to the illness. End of life treatments cost Medicare about 25% of it's total budget.

Also less significant but still very important, the US and Switzerland are the only developed countries that don't negotiate drug prices with pharmaceutical companies typically raising the price of brand name drugs by about 40%.

Another major factor is that doctors and hospitals in the US do not share information electronically and therefore often the same test is performed over and over. Under ACA, doctors that don't keep electronic records that can be shared will be reimbursed less than doctors the do. There is a big difference between my private doctor and my VA doctor. When the VA requested my medical records, about 200 pages of hand written documents were produced but at the VA, everything is in the computer under my account including all lab tests, scans, eye pictures, x-rays, etc. I suspect my private doctor's medical records were thrown in the garbage since it would have likely taken weeks to translate, organize, and enter the information into the computer.

Trying to figure out the billing by hospitals for insurance companies is near impossible so administrative costs are high.

Finally under ACA, the insurance policies are all the same (4 plans) and what has to be covered is defined. Doctors won't have to spend time with insurance companies getting approval for procedure and patients won't have to fight with insurance companies about paying the bill if they are covered by ACA. A good example is Medicare Advantage plans which were subsidized at an additional 14% by the government are unregulated and each insurance company writes it's own plans. However insurance companies didn't have to cover the same procedures as Medicare and many low rated plans didn't and when a patient got ill, they just told them they weren't covered and during the next open enrollment period, the patient switch back to traditional Medicare. So the government got many of the sick patients back. Under ACA, one and two star plans (plans with the most complaints) were dropped from the Medicare Advantage program to try to stop that practice.