Sign in to follow this  
Followers 0
Clegane'sPup

Health care in the USA

21 posts in this topic

I have a question.  First a statement.

I recently received a letter stating that my health care provider has withdrawn coverage from my area.

Someone correct me if I am ignorant. The law of the land (USA) is that I must have health care or I will be penalized (attachment of my income tax).

Soooooo, under the mandate that I must have health insurance, back in yada yada, I applied.

Because the affordable care act was instituted (numerous years ago) I registered and complied with the invasive questions.

This is my question. How much do you pay for health insurance?

For 2017 I paid $109 monthly while the government paid $662.

If you don't like my questions talk about what ever you want as applies to health care. Enlighten me.


 

Share this post


Link to post
Share on other sites

109 is a pretty good out-of-pocket premium cost, all things considered. I pay $100 a month for my employer-sponsored coverage. Of course, the relative value of your premium also depends in large part upon your deductible. My current deductible is $500, which is completely doable for me, as I have Type 1 diabetes and will easily meet the deductible every year, and then some. When I was on an exchange (ACA) plan, I had to pay a $330 out-of-pocket premium per month and had a $1,000 deductible; it fucking blew. It was not affordable at all on the wage that I made, but I wasn't poor enough to get a better subsidy. 

Share this post


Link to post
Share on other sites

Lol, wrong thread!

Edited by Fragile Bird

Share this post


Link to post
Share on other sites

We're lucky in that we have two options, and my husband's British owned company offers much better insurance than my too big to fail bank.  In fact, his "low plan" was the same as the best plan my company offered.

We pay about $105 a week, for a family of three, with a $500 deductible. My company does offer an "expanded" dental plan though, that is allowing me to finally get braces...and it's only $16 a week for the whole family (the regular plan is $10 week, but only covers braces for kids, not adults - that is the same from both companies)

When we were having hard times, we did ACA and paid $274 a month for our family of 3...but I got a job half way through the year (just a temp job) and ended up have to pay a large amount of our refund (I think it was capped at $1500...or $500) as a penalty

Share this post


Link to post
Share on other sites

You don't know how good you have it.  I pay $1100 per month for my family's health insurance premiums, which is after my employer pitches in for a share of the cost.  BlueCross Blue Shield increased premiums by 40% this year in my area (Chicago).  My employer's approach to cost-sharing is skewed toward lower income colleagues, so that does drive up my cost relative to a more junior colleague with the same coverage.

And that isn't for some Cadillac plan.  This is a high-deductible health care plan.  Our annual deductible is $3k per person or $6k for the family (of three) before insurance kicks in.  So on top of my premiums, I also withhold $6750 annually into a health spending account.  That's ~$20k annually out of pre-tax income, although tax deductability now looks threatened.  Considering we're a very healthy family, the only thing insurance ever pays for us is the annual physical check-up for prevention and early detection.

My costs are so high because the employer health insurance plans are now heavily subsidizing the losses ACA exchange plans, both indirectly and directly (the requirement for employer plan premiums to not differ from ACA premiums gross of subsidy by more than a certain %, despite the employer plan population being much, much healthier on average).  This is the stealth tax embedded in the ACA.  My employer won't provide the history (I've asked) but employee premiums have been increasing at 20-40% annually for decades, despite the amount of coverage declining (higher deductibles), and all the cost is driven primarily by rare chronic conditions with extremely expensive long term medication, the obestity epidemic, and subsidizing insurance for people who only start paying premiums once they need expensive care.

How much longer do you think I, and millions of people like me, will continue paying $20k annually for health care costs despite being completely healthy?  We already have the moral hazard of people who drop coverage because they know they can restart coverage whenever they get diagnosed with a long term critical illness.  It makes more sense to just put the $20k annually into a savings account to pay for any surprise hospital visits and only start getting insurance after age 60.  We all eventually get sick and die but there are huge variations in lifestyle-driven health costs, which are not reflected in premiums either.

Share this post


Link to post
Share on other sites
5 hours ago, Iskaral Pust said:

You don't know how good you have it.  I pay $1100 per month for my family's health insurance premiums, which is after my employer pitches in for a share of the cost.  BlueCross Blue Shield increased premiums by 40% this year in my area (Chicago).  My employer's approach to cost-sharing is skewed toward lower income colleagues, so that does drive up my cost relative to a more junior colleague with the same coverage.

And that isn't for some Cadillac plan.  This is a high-deductible health care plan.  Our annual deductible is $3k per person or $6k for the family (of three) before insurance kicks in.  So on top of my premiums, I also withhold $6750 annually into a health spending account.  That's ~$20k annually out of pre-tax income, although tax deductability now looks threatened.  Considering we're a very healthy family, the only thing insurance ever pays for us is the annual physical check-up for prevention and early detection.

My costs are so high because the employer health insurance plans are now heavily subsidizing the losses ACA exchange plans, both indirectly and directly (the requirement for employer plan premiums to not differ from ACA premiums gross of subsidy by more than a certain %, despite the employer plan population being much, much healthier on average).  This is the stealth tax embedded in the ACA.  My employer won't provide the history (I've asked) but employee premiums have been increasing at 20-40% annually for decades, despite the amount of coverage declining (higher deductibles), and all the cost is driven primarily by rare chronic conditions with extremely expensive long term medication, the obestity epidemic, and subsidizing insurance for people who only start paying premiums once they need expensive care.

How much longer do you think I, and millions of people like me, will continue paying $20k annually for health care costs despite being completely healthy?  We already have the moral hazard of people who drop coverage because they know they can restart coverage whenever they get diagnosed with a long term critical illness.  It makes more sense to just put the $20k annually into a savings account to pay for any surprise hospital visits and only start getting insurance after age 60.  We all eventually get sick and die but there are huge variations in lifestyle-driven health costs, which are not reflected in premiums either.

I can emphasize with your plight. Thank you for discussing your life situation.

Part of the reason for the original post was that I was angry that in 2010 I had to give the government all of my personal information under the mandate that I would be penalized via the IRS.

I am healthy. I stay as far away from doctors as I can. The deductible that I have is 5000.

My gripe is about the culling of information.

20K is more than some people make annually. I have mixed opinions. There are some who just want to live a reasonably safe life. There are others who milk life and the system.

I complied with the ACA mandate. Now that my provider has withdrawn from my area I am questioning many things.

 

 

 

Share this post


Link to post
Share on other sites
10 hours ago, Iskaral Pust said:

You don't know how good you have it. 

Yes, I'm sure things are much worse for you than someone who needs a government subsidy to afford health insurance. 

10 hours ago, Iskaral Pust said:

. . . all the cost is driven primarily by rare chronic conditions with extremely expensive long term medication, the obestity epidemic, and subsidizing insurance for people who only start paying premiums once they need expensive care.

How much longer do you think I, and millions of people like me, will continue paying $20k annually for health care costs despite being completely healthy?

Presumably, as long as you can afford to without taking a significant hit to your quality of life. Which, from what I can glean for your posts, isn't in particular jeopardy. 

I sympathize, however, with the burden you face just so some schmuck with a "rare chronic condition" can afford to have a chance at living a barely decent life; must be tough. 

Share this post


Link to post
Share on other sites
On 11/13/2017 at 1:09 PM, Iskaral Pust said:

My costs are so high because the employer health insurance plans are now heavily subsidizing the losses ACA exchange plans, both indirectly and directly (the requirement for employer plan premiums to not differ from ACA premiums gross of subsidy by more than a certain %, despite the employer plan population being much, much healthier on average).  This is the stealth tax embedded in the ACA.  My employer won't provide the history (I've asked) but employee premiums have been increasing at 20-40% annually for decades, despite the amount of coverage declining (higher deductibles), and all the cost is driven primarily by rare chronic conditions with extremely expensive long term medication, the obestity epidemic, and subsidizing insurance for people who only start paying premiums once they need expensive care.

Isk, the two statements I've bolded are at odds with each other.  If employee premiums have been increasing that much for decades, how can you determine that the last few years of increases are due to heavily subsidizing ACA losses?

As to the OP, I have a pretty shitty HRA plan that I spend ~400 a month for my wife and myself.  I have to go to a very specific doctor to have a copay, otherwise I pay the full cost of a visit (~$400) up to the deductible ($4k) at which point my employer pays 80%.  Any kind of specialty work (MRI, CAT, PT, etc...) is all full price, to incentivize people to 'shop around' for the lowest price.  All of the out of pocket costs can be paid for out of the reimbursement account, if the funds are there.  Luckily I've saved enough in my HRA now that if something catastrophic does happen the HRA would cover most of it, but I went ~3 years w/out seeing a doctor in order to maximize the savings in that account.  

Share this post


Link to post
Share on other sites

These prices are insanneee. How many people in the US just choose not to get it? Pretty sure that is the route I would go if I was free and single.

Share this post


Link to post
Share on other sites

Just so you have it for comparison -- I'm on Medicare, and I pay $134 a month. The supplemental insurance I have beyond that literally costs me $0. It pays for my YMCA membership. So far my co-pays for doctor's visits have been no more than they were last year when I was still on my employer's plan.

Share this post


Link to post
Share on other sites

I pay $300 a month for my family (and that reminds me, open enrollment ends this Friday for next year), but we also have at least 3 plans to choose from each year. It helps to work for a company that has a large pool of employees (non-localized) which in turn helps them negotiate rates with insurance companies, I imagine. Mine is a PCP based one with ~$15 copay each time I visit the doctor, but almost negligible out of network coverage. The other two plans are low and high deductible ones. I have not seen much difference pre- and post-ACA to be honest.

It is funny to see my employer offer free gym classes, healthy eating tips, all kinds of wellness tips etc (free flu shots, for example, they probably lose more in worker sick days than the cost of the shots)..It is patently obviously they want lowered health care costs rather than an altruistic interest in the well being of employees, but those perks are nice to have.

 

 

 

Edited by IheartIheartTesla

Share this post


Link to post
Share on other sites
1 hour ago, aceluby said:

Isk, the two statements I've bolded are at odds with each other.  If employee premiums have been increasing that much for decades, how can you determine that the last few years of increases are due to heavily subsidizing ACA losses?

 

Health care inflation has been very high since the 1990s but the rate of inflation pre-ACA was ~10% annually and more like ~30% annually post-ACA.  I don't have historical data to be specific.  That differential may not seem huge but try compounding it for a few years to see.  Medical and pharmaceutical inflation have both been far ahead of CPI inflation.  In fact BLS data on CPI shows that ~90% of accumulated inflation since 1990 comes from just healthcare, pharmaceuticals, housing and education.  The Financial Times had a jaw-dropping article on this last year.  For almost three decades, those categories have seen huge price increases which offset widespread deflation in most other categories, especially manufactured goods.  Aggregate CPI of ~2% masks a huge dispersion of inflation/deflation in various categories.

My employer is unusually transparent by showing us the cost of health insurance premiums gross and net of their subsidy  because they want us to appreciate the subsidy.  Unsubsidized health insurance premiums for a family (family of three in a silver tier plan in Chicago) are close to $20k annually, before you make any deferrals to a HSA to cover the large deductibles.

Share this post


Link to post
Share on other sites

@IamMe90 the ever-popular economic theory of Other People's Money only prolongs wasteful and unsustainable policies.  Blank check public policy always crashes under its own waste and abuse.  Regardless of my personal financial capacity, this country cannot sustain a national health policy whose pre-subsidy cost is approaching half of the median household income.  No matter how soak-the-rich your politics may be, you cannot escape that math.  Healthcare is already approaching 20% of our entire economy, and growing faster than most other sectors.  Relative to other wealthy countries who spend much less, we don't live any longer or get better lifestyle for it, we just chase inefficient spending because no-one ever wants to say no.

America is alone in the entire world in paying hundreds of thousands of dollars per year per patient to address rare diseases, generally with mixed success: some offer radical life improvements, most offer hope but only questionable benefits.  Rare disease drugs have become the most aggressive area of R&D and price gouging in recent years as pharma start-ups know they can count on patients to lobby on their behalf for drug prices that would not be approved in any other wealthy, developed nation in the world.

sample NYTimes article

Share this post


Link to post
Share on other sites
2 hours ago, Iskaral Pust said:

@IamMe90 the ever-popular economic theory of Other People's Money only prolongs wasteful and unsustainable policies.  Blank check public policy always crashes under its own waste and abuse.  Regardless of my personal financial capacity, this country cannot sustain a national health policy whose pre-subsidy cost is approaching half of the median household income.  No matter how soak-the-rich your politics may be, you cannot escape that math.  Healthcare is already approaching 20% of our entire economy, and growing faster than most other sectors.  Relative to other wealthy countries who spend much less, we don't live any longer or get better lifestyle for it, we just chase inefficient spending because no-one ever wants to say no.

America is alone in the entire world in paying hundreds of thousands of dollars per year per patient to address rare diseases, generally with mixed success: some offer radical life improvements, most offer hope but only questionable benefits.  Rare disease drugs have become the most aggressive area of R&D and price gouging in recent years as pharma start-ups know they can count on patients to lobby on their behalf for drug prices that would not be approved in any other wealthy, developed nation in the world.

sample NYTimes article

You're not gonna hear an argument from me that the US healthcare industry isn't fucked up, nor that it isn't in need of massive overhaul. I agree. But, it's a little galling watching you tell someone else who's on government subsidized health insurance how "good" he has it, given (what I am, I think correctly, assuming to be) your financial situation. Snark was primarily aimed at the sentiment. 

Moving on, I'm not sure what remedial options we have in the current framework of health policy that has government in only an auxiliary role. 

Share this post


Link to post
Share on other sites
On ‎11‎/‎13‎/‎2017 at 2:09 PM, Iskaral Pust said:

You don't know how good you have it.  I pay $1100 per month for my family's health insurance premiums, which is after my employer pitches in for a share of the cost.  BlueCross Blue Shield increased premiums by 40% this year in my area (Chicago).  My employer's approach to cost-sharing is skewed toward lower income colleagues, so that does drive up my cost relative to a more junior colleague with the same coverage.

And that isn't for some Cadillac plan.  This is a high-deductible health care plan.  Our annual deductible is $3k per person or $6k for the family (of three) before insurance kicks in.  So on top of my premiums, I also withhold $6750 annually into a health spending account.  That's ~$20k annually out of pre-tax income, although tax deductability now looks threatened.  Considering we're a very healthy family, the only thing insurance ever pays for us is the annual physical check-up for prevention and early detection.

My costs are so high because the employer health insurance plans are now heavily subsidizing the losses ACA exchange plans, both indirectly and directly (the requirement for employer plan premiums to not differ from ACA premiums gross of subsidy by more than a certain %, despite the employer plan population being much, much healthier on average).  This is the stealth tax embedded in the ACA.  My employer won't provide the history (I've asked) but employee premiums have been increasing at 20-40% annually for decades, despite the amount of coverage declining (higher deductibles), and all the cost is driven primarily by rare chronic conditions with extremely expensive long term medication, the obestity epidemic, and subsidizing insurance for people who only start paying premiums once they need expensive care.

How much longer do you think I, and millions of people like me, will continue paying $20k annually for health care costs despite being completely healthy?  We already have the moral hazard of people who drop coverage because they know they can restart coverage whenever they get diagnosed with a long term critical illness.  It makes more sense to just put the $20k annually into a savings account to pay for any surprise hospital visits and only start getting insurance after age 60.  We all eventually get sick and die but there are huge variations in lifestyle-driven health costs, which are not reflected in premiums either.

I was wondering about how the local cost of living might affect the cost of insurance.

My husband's company is located in a rather low cost of living area in PA; The office of the company I work for is in an area just north of D.C. (in MD) that has become a bedroom community and the cost of living here has been steadily increasing.

When I was looking year before last, a silver plan with a $5,000 family deductible was about $1500 a month ($18,000 yr) with no employer or government subsidy – that’s less than you pay with an employer subsidy (in MD).

In a way, this kind of makes sense. I mean I probably couldn’t buy a 2 room apartment in your city for what my house costs (at least not in an area I’d want to raise my son). Everything there cost so much more than where I live.

 

 

What I wonder about is the “buy insurance across state lines” thing that some people keep harping on.  How would this effect people in current low cost of living areas? Would people in high cost areas be searching out companies/policies in from low cost areas, and would that drive up the cost of the policies there?  (making the assumption that all basic care cost more in Chicago than in Hanover, PA, which is likely true) 

 

The thing about low cost of living areas is that they also tend to pay accordingly. 

 

Which brings me to another point: controlling cost.  How can cost be controlled across such widely (I wrote “hugely” first :lmao: ) varying areas.  There would have to be some kind of COLA equation used, which makes it nowhere near as easy as many people seem to think it would be (and so many other things that vary for different areas, like cost of malpractice insurance, cost of unemployment insurance and a wide variety of other necessary things)

 

I think my point is the answers are not easy to our healthcare problems.

Share this post


Link to post
Share on other sites
56 minutes ago, Lany Freelove Cassandra said:

What I wonder about is the “buy insurance across state lines” thing that some people keep harping on. 

This is a problem not only because it might raise demand and prices in previously low cost areas but, worse still, it takes dollars out of the insurance pool that has a lot of low income people.  Insurance is expensive in Chicago because it is a relatively high cost area but also and even moreso because it has a very large pool of low income people on exchange plans who receive direct and indirect subsidies.  If I were to buy health care in Indiana instead (and trust that I can drive 2-3 hours to an ER if needed), then it's the economic equivalent of white flight to the suburbs reducing the property tax pool for city schools.

 

Share this post


Link to post
Share on other sites

I pay 80 dollars a month. No family. Perhaps because I'm in a union. No clue on the deductible yet, since I haven't had to use it.

I'm in Puget sound, so a pretty expensive area and state. However, I think Washington is one of the states where the health pools are working well.

Edited by Martell Spy

Share this post


Link to post
Share on other sites
7 hours ago, Iskaral Pust said:

 

America is alone in the entire world in paying hundreds of thousands of dollars per year per patient to address rare diseases, generally with mixed success: some offer radical life improvements, most offer hope but only questionable benefits.  Rare disease drugs have become the most aggressive area of R&D and price gouging in recent years as pharma start-ups know they can count on patients to lobby on their behalf for drug prices that would not be approved in any other wealthy, developed nation in the world.

sample NYTimes article

This is manifestly untrue. Here in Canada we certainly pay for drugs for rare diseases through a variable mixture of private insurance, compassionate release from the manufacturer, and provincially-funded drug plans (often on case-by-case bases). That doesn't mean there aren't incredible distortions in the pharmaceutical industry, but there's a difference between Soliris - which has only two rare indications for which it doesn't improve mortality - and Rituximab, a mainstay of lymphoma treatment and a safer immune therapy for pulmonary-renal syndromes. 

I hope eventually that biologics will get cheaper - and they likely will - but I don't think you can attribute escalating health care costs simply to the rare disease treatment phenomenon. In the US, the problem has been and remains a for-profit "competitive" system with gross redundancy awkwardly grafted onto myriad insurance schemes. As it stands, I deal with a single insurer with transparent fee schedules, but our system also provides no more than a patchwork of drug coverage that leaves many people out. I pay $28 per month through my employer for dental coverage and about $35 for other extended health coverage. 

Share this post


Link to post
Share on other sites
On 11/15/2017 at 10:37 AM, lessthanluke said:

These prices are insanneee. How many people in the US just choose not to get it? Pretty sure that is the route I would go if I was free and single.

Not that many, for a few reasons. First, keep in mind that health insurance payments are taken out of pre-tax money (i.e. insurance is so if you decided not to buy it, you would not receive the entirety of what you're paying because you'd need to pay tax on it. Second, the employer typically pays a fraction of the cost so if you decline to purchase it, you'll be leaving some value on the table (the insurance is mostly worthless, but nobody is proof against accidents and serious disease). And finally, there's now the "individual mandate" which means that going without insurance means you'll pay a fine to the government. It was small to begin with, but it's grown over the years and is now pretty hefty.

That said, when I took a break from work for some months, I definitely went without it -- it's way cheaper to pay the penalty and, in my experience, the insurance is pretty close to being a scam as far as most people are concerned. I currently pay around $250 per month and I haven't tried to use it yet, but at my old job, I paid around $220 per month and the one time I actually tried to use it (I needed new glasses), they paid less than 10% of the cost. Similarly, a relative of mine needed some dental work and even though he works for a large and respectable company, they only covered a third of the cost. But hey, it's better than being sick -- I think it of it as a sacrifice similar to those ancient peoples conducted to ward off misfortune.

Share this post


Link to post
Share on other sites

Not to gloat, but as an Australian, I don't pay anything. Well, I mean I do, through taxes, but Americans also provide funding through their taxes, so that's an irrelevant point. :P

You really MUST campaign for universal healthcare. It's a must to a functioning society. Everything is so much cheaper for us, since the government buys all equipment, drugs and supplies in bulk.

To say something more helpful:

There is still private health insurance in Australia and it covers additional optional things.

We used to have private health insurance, when I was pregnant, since you get five more days in the hospital after giving birth. It cost $400 per month (you have to have it for 12 months to get any obstetrics benefits). I don't know if "excess" is the same as "deductible" but we had to pay a $500 excess when becoming an in-patient. For other things, like the dentist, physio and so on there wasn't an excess. But it's not really worth it: you can only claim a maximum of services per year and it works out to be less than what you're paying anyway in monthly fees. There is an additional tax in Australia for those who don't have private health insurance but this tax doesn't apply to most families because they don't earn enough and is still considerably cheaper than private health insurance.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0