Thought this was interesting because I didn't know the definition of a cadillac health plan as it pertains to proposed national health care.


How do I know if my insurance plan is a "Cadillac plan"? Look at the cost. The finance committee defines high-cost or "Cadillac" as any plan with premiums higher than $8,000 for individuals or $21,000 for families. Keep in mind that these figures include everything you and your employer spend on health care except for the deductible: premiums for medical (the portions paid by you and by your employer), dental, and vision coverage, as well as any money you put into a flexible spending account, which allows you to set aside pretax money to cover medical costs. Since your pay stub may show only your personal contribution—not that of your employer—the best way to find out the total cost of your plan is to ask your human resources liaison. Many companies already list their employees' total premiums on their W-2 tax forms. The bill passed by the finance committee would make that mandatory.

What does a "Cadillac plan" offer? The top-of-the-line plans—say, the $40,000-a-year plan offered to Goldman Sachs CEOs—likely have no copayments, no deductibles, few limits on how much you can spend, and no need for prior authorization, i.e., to get special permission before you get treated.

But many not-so-fancy plans also qualify as "Cadillacs" under the finance committee's definition. That's because the term refers to total cost—not a particular set of benefits—and many factors—like the state you live in, the size of your company, and the makeup of that company's work force—can affect costs. Premiums tend to be significantly higher in Massachusetts than in Idaho, for example. (The employer/employee contribution also varies by state.) The smaller the business, the fewer employees who go into the pool, the less leverage the organization has to negotiate lower premiums. And if the workers have an average age of, say, 54, their premiums are going to be a lot higher than if the average is 25.

A lot of basic benefits packages, then, can still qualify as "Cadillacs." (The Senate finance committee has made exceptions for workers with high-risk jobs like firefighters, whose premiums tend to be high.) The Joint Committee on Taxation has estimated that the tax would hit 14 percent of family health policies and 19 percent of individual policies in 2013, when the legislation would take effect. Those numbers would rise to 37 percent and 41 percent, respectively, by 2019, since premiums are expected to rise faster than inflation.



If I have a "Cadillac plan," will I have to pay the proposed tax myself? No. The 40 percent tax will be charged directly to the insurer. That is, the insurance company has to pay 40 cents on every dollar spent above the $8,000 or $21,000 cutoff. Some portion of that tax, however, is likely to get passed onto the consumer.

I guess I was paying for a cadellac plan. Cheapest plan avialable for me and my family was $1,900 a month, $20 co-pays, $250 per subscriber co-pay, no vision, or dental, and a prescription plan that was more expensive than walgreens. I have no doubt it will just be passed on, at one hundred percent.

Every side of this debate is full of it. Just was listening to a conservative lament on the fact that insurance companies only average a 2% profit. That was just after the fact he said most companies are non-profit. The number he was ranting about could be horribly low or outrageously insane, depending on what the 2% margin was based on. Is it based on the total profits of non-profits and for profits together? Is it based on leverged assets or actual cash invested? Is it based on total revenue? Imagine for a moment that each month you paid me a $1000 premium and I handed $980 over to an HMO. At the end of the year I would have collected $12,000 in premiums and only earned $240.00, a measily 2% profit on revenue. But, if I only spent 50 cents a month on stamps, then my return on investment would be 5000%.

A freind worked at a store that was averaging less than a 2% profit margin. They would actually turn it over more than once a month and were making a killing. The margin means nothing unless it is in context. I hate this entire debate. There are easy solutions. They just don't make anyone money.

Well, I looked at the numbers at our company today, and here's the summary:

Census is 58 people between 22 and 48. Median age is about 30, about half are married, and about 2/3 of the married folks have families.

Our plan covers ALL FAMILY MEMBERS and employee premiums at 100%, for health, dental and vision ... Yes there are $20 copays for visits, and an annual deductible, but it's a very comprehensive plan. Fully PPO (no referrals to see specialists, etc).

Our *most expensive* employee (and his family), per year of these benefits? $11,500/yr.

So if the line is $21,000 for a family -- we're a zillion miles from bumping up against that with our very comprehensive plan. Holy cow, we'd have to either be offering crazy other health benefits (annual full body scans?) to get over the $21K line. How the $40K/yr plans get there is totally beyond me.

IR--- The plan costs that employee 958 a month? That seems like a killer deal. Are your single workers under $8,000?

Looks like my employer is paying $663.60 a month and I'm paying $82 a month.

I can go anywhere I wish and have no co-pay. Once I meet the deductible (2K a year per family), 90% of everything is covered. No premiums for Dental

It cost the employee nothing. We fully fund the plan, and yes, the most expensive employee (+ his whole family) totals out to just under $1k/mo.

Our single workers are *WAY* under $8K.

Parker, that's for you + family, or just you alone?

We have dental($2,000 a year), vision and medical with $500 deductable and the cost is around $1300 a month for me and the dependant wife. We have 35 employees ranging from the mid 20's to 82 years old. Our health care costs have been negociated out of the wage pie plus the $125 a month that is deducted from my check.

I'm not sure why ours is 30% less than yours, Jerry... It's possible our guys are just more boring and less likely to end up in the hospital (grin). It's a big difference tho... I can say that shopping around is awfully important, because there are massive differences in price and coverage and as benefits are one of the three major expenses for us, we worked hard on getting a good plan/deal.

And even with your costs, you're still well below the "cadillac" line, right?

Me and family...even with the wife working here as well. Was cheaper for her to just drop insurance and for me to be the primary w/family.