Health insurance

[donnyj08]

Originally Posted By: zzyzzx
Upfront pricing for standard procedures would be a huge improvement.



+1 do away with most insurance and make clinics compete on a price/quality basis like the rest of the market.

 

[Doog]

Originally Posted By: Joe_Power
You're probably the same guy that is anti Union. Your employer says they'll take take of you, and you believe it. Keep telling yourself that. I'm Union, pay ZERO for health insurance.


That will change soon.

 

[JHZR2]

Originally Posted By: Nyogtha
Originally Posted By: JHZR2
I have an hdhp. So I pay the first few thousands out of pocket, which is how insurance should be. It has made us emphasize cost (yes you can ask for pricing and you can negotiate), and planning, as well as being smart about not expecting something so stupid as all other insureds paying your bill to have the doctor tell you that you have a cold.

Reality too is that many doctors are overpaid, many provide low value, and if the insurance companies are changing formats to provide lower cost approaches, market forces will make the doctors come in line. Plenty of them have loans, debts, and like to eat too. Sure I have multiple friends who have started over $300k/yr, but if in the new scheme they play tough and don't see enough patients, they won't have billable hours and they won't earn their money.


Thankfully for those of us with chronic health issues (including my wife who has never smoked and doesn't drink but developed breast cancer at an early age), there are choices without a high deductible. I'm all for choices rather than dictating to everyone how things "should be". We don't go to Dr.'s for colds either.

Less choice, less freedom. But clearly not everyone believes in freedom of individual choice. There are always those who believe everyone should be free to ONLY choose the same choice they make.


Actually, I did some research for you. The federal government, as a huge employer, so there's a lot of data out in the open. You can see plan costs for all sorts of plans in every state here:

https://www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums/2016/nonpostal-hmo.pdf

So, your location says Ohio, so let's do an example... The Ohio AultCare HMO. I selected this one because they offer a "high" coverage level ( which is the sort of plan with minimal out of pocket), and an HDHP as their only two offerings. Page 55. So the high family plan is $1464/mo, while the HDHP is $719/mo.

If that HDHP is anything like mine, it returns premium to the hsa at a rate of around $125/mo, making its effective price let's say $600/mo. A full 60% less per month. And at somewhere around $3000 out of pocket, 90% insurance kicks in, so the insured pays only 10% of the negotiated price.

So for a year, the outlay in premiums for the high end plan is $17568, while the HDHP is $8628, but is net around $7128/yr with the return of premium into the HSA. Yes, the HDHP has to pay $3000 out of pocket, so the effective prices are $17568 vs. ~$10128.

So the real question is if one needs to have chronic meds or other recurring costs paid for at a level of more than $7k/yr (which is the delta in total max outlay per year). If so, year after year, then one is better. If not, the other is better.

Notionally everyone can do math and figure what's best for them. And that may change over time.

Doesn't mean that insurance is any less pooled risk as the prime intent, and all that I said above.

 

[JHZR2]

Originally Posted By: donnyj08
Originally Posted By: zzyzzx
Upfront pricing for standard procedures would be a huge improvement.



+1 do away with most insurance and make clinics compete on a price/quality basis like the rest of the market.


+1

 

[CT8]

It is all the hope and change the majority of voters wanted to receive.

 

[The motor guy]

Originally Posted By: JBinTX30
Same issues here. The HMO is only taken by two offices here, and one of them is the community clinic where its reduced/free to see the doctor anyways.

Need to see a specialist and have the HMO? better be ready to drive 1.5hrs to be seen.


Do you think since insurance companies dropped PPO plans for individuals their will be more doctors accepting HMO plans for 2016? It's still a little early yet, but maybe when they start losing patients they will. Then again it's hard to say how many people have to pay for their own insurance so if it's a small percentage they may not even care.

 

[Nyogtha]

Originally Posted By: JHZR2
Originally Posted By: Nyogtha
Originally Posted By: JHZR2
I have an hdhp. So I pay the first few thousands out of pocket, which is how insurance should be. It has made us emphasize cost (yes you can ask for pricing and you can negotiate), and planning, as well as being smart about not expecting something so stupid as all other insureds paying your bill to have the doctor tell you that you have a cold.

Reality too is that many doctors are overpaid, many provide low value, and if the insurance companies are changing formats to provide lower cost approaches, market forces will make the doctors come in line. Plenty of them have loans, debts, and like to eat too. Sure I have multiple friends who have started over $300k/yr, but if in the new scheme they play tough and don't see enough patients, they won't have billable hours and they won't earn their money.


Thankfully for those of us with chronic health issues (including my wife who has never smoked and doesn't drink but developed breast cancer at an early age), there are choices without a high deductible. I'm all for choices rather than dictating to everyone how things "should be". We don't go to Dr.'s for colds either.

Less choice, less freedom. But clearly not everyone believes in freedom of individual choice. There are always those who believe everyone should be free to ONLY choose the same choice they make.


Actually, I did some research for you. The federal government, as a huge employer, so there's a lot of data out in the open. You can see plan costs for all sorts of plans in every state here:

https://www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums/2016/nonpostal-hmo.pdf

So, your location says Ohio, so let's do an example... The Ohio AultCare HMO. I selected this one because they offer a "high" coverage level ( which is the sort of plan with minimal out of pocket), and an HDHP as their only two offerings. Page 55. So the high family plan is $1464/mo, while the HDHP is $719/mo.

If that HDHP is anything like mine, it returns premium to the hsa at a rate of around $125/mo, making its effective price let's say $600/mo. A full 60% less per month. And at somewhere around $3000 out of pocket, 90% insurance kicks in, so the insured pays only 10% of the negotiated price.

So for a year, the outlay in premiums for the high end plan is $17568, while the HDHP is $8628, but is net around $7128/yr with the return of premium into the HSA. Yes, the HDHP has to pay $3000 out of pocket, so the effective prices are $17568 vs. ~$10128.

So the real question is if one needs to have chronic meds or other recurring costs paid for at a level of more than $7k/yr (which is the delta in total max outlay per year). If so, year after year, then one is better. If not, the other is better.

Notionally everyone can do math and figure what's best for them. And that may change over time.

Doesn't mean that insurance is any less pooled risk as the prime intent, and all that I said above.


Nope, I never said anything about paying the same premium. Thankfully my wife's employer offers freedom of choice for a lower deductible but higher premium plan. But neither of us believe everyone should be forced to that option.

There is a high deductible option with a higher premium as well.

We know the math for our selections. We're both degreed engineers.

More choice, more freedom. It's that simple. Clearly not everyone agrees with that being beneficial.

We've hit stop-loss multiple years, including this one.

FWIW it now appears my wife is cancer free (at this point). Off the cancer preventive meds this year. Multiple surgeries for several prior years though.

What does that do to your research?

 

[Nyogtha]

Originally Posted By: JHZR2
L
Originally Posted By: Nyogtha


Thankfully for those of us with chronic health issues (including my wife who has never smoked and doesn't drink but developed breast cancer at an early age), there are choices without a high deductible. I'm all for choices rather than dictating to everyone how things "should be". We don't go to Dr.'s for colds either.

Less choice, less freedom. But clearly not everyone believes in freedom of individual choice. There are always those who believe everyone should be free to ONLY choose the same choice they make.


Wow...

So let me get this straight. Your wife is reliant on meds perhaps due to treatments or to keep a cancer at bay? Your costs to the pool of insureds will be statistically higher, and you want to pay the same premium, regardless of type of plan, as all other insureds. Sounds like another play on redistribution of wealth to me.

Insurance should pool risk, not recurring cost, IMO. But here's where your attack on me backfires - obviously a breast cancer finding and the appropriate treatment to get to the best possible outcome is a catastrophic event, and should be covered.

Insurance should also be for catastrophic conditions, not chronic/recurrent ones, which was my point in saying how it should be. We need to segregate redistribution of wealth for the betterment of people who may need it, because of chronic issues, handicaps, whatever, from pooled risk (of catastrophy or at least relatively major events/expenses) which is the point of insurance.

With an HDHP, one still pools risk, but one also pays the first few thousand out of pocket in return for a lower premium. If I pay $200/mo for an HDHP, or $500/mo for a zero deductible plan (made up numbers), and the HDHP pays 90% after $3k out of pocket, one can come out ahead with the HDHP, even if they incur a lot of costs, because of the lower premiums. It looks worse because as opposed to no deductible. You have to pay "out of pocket" a good chunk of change before coinsurance kicks in. But you pay a lot less premium. It covers catastrophy well, which again, is the point of pooling risk via insurance.

Do you expect your car insurance to pay for oil changes? Homeowner's insurance to pay for gutter cleaning? Malpractice insurance to pay for your continuing education classes and professional development? If no, then why would we expect pooled risk (insurance) to pay for routine needs, even if they are unfortunate?

YOU are paying more in to get more out, with your plan. Great. No place did I say that people should be starved of choice.

But INSURANCE should be for catastrophe.


Clearly your choice of terms is in the eye of the beholder.

So when something transitions from acute to chronic you don't think it should be insurable.

How about asthma? Epilepsy? Lots of things are chronic / recurring. No problem if you're not afflicted though.

Eugenics by lack of coverage for recurring / chronic health conditions, so it's not affordable to treat this generation, much less pass that along to someone else who had no choice in their genetic makeup?

 

[Gasbuggy]

Originally Posted By: Cutehumor
it's open enrollment time for me. I work for a health insurance company in the top fortune 20. We have high deductible health plans. there are three plans to pick from. I am going with the cheapest plan. With employee and children, it will be $123.48 dollars a month for me. My deductible will be $3,200 per individual and $6,400 deductible per family.

There is a $150 per month surcharge if your spouse has access to insurance, but enrolls with my employer/health insurance company. that made alot of people mad.



This is confusing. You are talking about the portion your employer has you pay, not the actual cost of the plan per month. I'm healthy and in my 20's, I could not a get a [censored] ACA approved plan for anywhere near something less than $285 a month.

 

[Al]

Originally Posted By: Mr Nice
Government
Unions have good benefits. funded by taxpayers


Fixed that for ya.

 

[JHZR2]

Originally Posted By: Nyogtha


Nope, I never said anything about paying the same premium. Thankfully my wife's employer offers freedom of choice for a lower deductible but higher premium plan. But neither of us believe everyone should be forced to that option.

There is a high deductible option with a higher premium as well.

We know the math for our selections. We're both degreed engineers.

More choice, more freedom. It's that simple. Clearly not everyone agrees with that being beneficial.

We've hit stop-loss multiple years, including this one.

FWIW it now appears my wife is cancer free (at this point). Off the cancer preventive meds this year. Multiple surgeries for several prior years though.

What does that do to your research?


Clearly your comprehension is lacking despite being a "degreed engineer". No place did I say choice was bad. I did say that insurance should be for catastrophic loss only, not benign items. Only you decided to go on an attack due to your apparent offense at that comment, which, by the way, is consistent with how insurance is implemented and used for every other application of it in peoples' daily lives.

There are lots of options still out there. You did your math, what do you want, a prize? Sorry, you did what you should do - an analysis of the costs. Wonderful. Hooray.

I do think that you do not understand HDHPs though. I don't care to be a salesman for them, but they have worked for us. Do realize that there is an annual max out of pocket for them. In my case it is $8k/year, including deductible, coinsurance at 10% once past the deductible, and prescriptions. So it's realistically $5000 of out of pocket once past the deductible (half of which is automatically covered by return of premium). That $5k, at a 10% rate (Aetna covers 90% once past the deductible) means $50k worth of services. Beyond that we pay $0 for other care and prescriptions for the rest of the year.

The $6500 of pre tax money worst case out of my pocket, if all I considered was my premium, not the employer's share, would be more out of pocket if used consistently. But we don't use it consistently. So there's a major net savings that benefits us.

That is choice. You can pick your plan - you did amongst multiple. If you get lumped with other higher cost people because there are multiple plans out there that people can choose, and because of the plans you choose and the costs you incur, your premiums go up wildly, that's the free market - also choice based. I can choose to pick a lower cost plan that is more focused upon catastrophic loss, again, the way that insurance is implemented across the insurance industry as a whole, and likely lump with overall less risky people, and have a lower cost out of pocket. That's choice. . If it so happens that the pool of risk of folks that use HDHPs is lower, so premiums stay low, while those of higher recurring risk choose the other plans where the premiums skyrocket, that's the market. Or would you prefer that absolute wealth redistribution occurs, where there is a single insurer and a single payer, and everyone pays in and everyone pays out? Doesn't sound like choice then to me... But your premium might drop.

I'm really sorry to hear of your wife's issue, and I get it that it makes you sensitive to these things. I'm glad you did the math to see what choice works for you.

 

[Alfred_B]

Originally Posted By: motor_oil_madman
So it appears that health insurance providers dropped the ppo plans that doctors would only take. There are only like 2 doctors in all of Houston who accept HMO plans. So it seems like people who don't have insurance from their employer are sol now? Now we get to spend 200 bucks on an office visit. The insurance guy I talked to on the phone said more doctors will be likely to accept HMO for 2016 since all the insurance companies no longer provide that PPO plan to individuals. The only people who can provide the PPO plans are employers giving insurance to their employees. [censored]?


It looks like the HMO plan in question could not contract with many doctors.

Get another insurance through the exchange if your employer doesn't offer one. Or if your state expanded Medicaid, you might qualify for that, too.

 

[GGorman04]

JHRZ2,
I have a few friends in the medical profession(doctors) who make this kind of money but are crying now. In addition to their massive student loan debt, they all see the future writing on the wall of lower pay for more time worked.

 

[OVERKILL]

Originally Posted By: OneEyeJack
Where did the cash reserves go? Do you know.

The Obamacare bill was inserted into a gutted bill by Dingy Harry that had already passed and one of the provisions is that the government is the guarantor of debts for healthcare and now healthcare companies do not have to maintain anything like the reserves they did before all this reinvention of healthcare took place. The whole process was a fraud that would not stand the scrutiny of a sunny day.



IMHO, the whole Obamacare fiasco was just a different spin on an already crooked and broken system. The whole thing should have been tossed and something similar to what Canada and the European nations have adopted.

 

[stockrex]

Originally Posted By: OVERKILL
Originally Posted By: OneEyeJack
Where did the cash reserves go? Do you know.

The Obamacare bill was inserted into a gutted bill by Dingy Harry that had already passed and one of the provisions is that the government is the guarantor of debts for healthcare and now healthcare companies do not have to maintain anything like the reserves they did before all this reinvention of healthcare took place. The whole process was a fraud that would not stand the scrutiny of a sunny day.



IMHO, the whole Obamacare fiasco was just a different spin on an already crooked and broken system. The whole thing should have been tossed and something similar to what Canada and the European nations have adopted.


Amen, we in US act like this is a new concept, we give is names like socialized health care, Obama care. Many nations around the have figured it out like Canada, one payer, what a concept.

 

[stockrex]

Originally Posted By: jmsjags
I am in the military and qualify for Tricare Reserve Select- $200 a month for my wife and I. The health insurance plans offered through my employer start around $300/mo for a high deductible and go up from there. I really do sympathize with the people paying exorbitant amounts of money each month for health insurance. It is my hope that a single payer system will be adopted soon so that people will not need to stress over this anymore.


Amen bro, maybe the politicians can grow some gonads and stop pimping their mothers out.

 

[stockrex]

Originally Posted By: OneEyeJack
A single payer system means government control. Has the government ever done anything on budget and on time?

The cost for my coverage doubled, has lower limits everywhere and went from no deductible to $6K per year. Also my new plan does not cover any of my cancer drugs at all and very few lab tests required for me because I'm defective. My healthcare did not need "fixing". Everything was moving along just fine but my plan was not Obamacare compliant so that was then end of that.

So, all the money I've paid into healthcare coverage is gone and a new system starting from scratch is taking over. I wonder where all those cash reserves went when Obamacare took over. Someone some where got greased and those reserves that disappeared were in the range of thousands of billions of dollars in cash and other liquid assets much of which is in offshore banks.

Usually when you get greased like this you find some candy, flowers or a nickel in the palm of your hand when you wake up in the morning. At this point the only thing left to do is change the sheets.






Your healthcare cost did not increase, your coverage increased hence the increased cost plus the PROFIT you are paying to the middlemen.

I am guessing you will NOT claim any social security or medicare in future?

 

[Al]

Originally Posted By: OVERKILL

IMHO, the whole Obamacare fiasco was just a different spin on an already crooked and broken system. The whole thing should have been tossed and something similar to what Canada and the European nations have adopted.

No disrespect but those countries have massive waits in many cases for life saving interventions. The U.S. has the best facilities on the planet. Obviously down sides have down sides. I can't deny that.

Very few Americans travel to Canada for life threatening treatment.

 

[stockrex]

Originally Posted By: Al
Originally Posted By: OVERKILL

IMHO, the whole Obamacare fiasco was just a different spin on an already crooked and broken system. The whole thing should have been tossed and something similar to what Canada and the European nations have adopted.

No disrespect but those countries have massive waits in many cases for life saving interventions. The U.S. has the best facilities on the planet. Obviously down sides have down sides. I can't deny that.

Very few Americans travel to Canada for life threatening treatment.


True, cuz we can't afford to go to Canada, we go to india/Thailand/south America.

 

[MikeHigg]

There is so much mis-information regarding Healthcare, some as seen in many of these posts, its sad really. We pay twice what someone in Belgium or Germany pays and we have a shorter life expectancy, that's how economist view our system anyway. Our doctors are no better than theirs, but they do exert a lot control over the system that is supposed to control them, at least in my state legislature, they own it. If you think market forces drive the medical care industry, dream on. The only thing that will bring reasonable healthcare costs is Universal Healthcare and get the insurance companies out of it, and that's a ways off. Obamacare policies don't bring you second rate care as one unknowledgeable poster asserted, you can get first rate care with it, I have. But if you hate Obama, then by all means dont get one of those policies. You just have to look intelligently at all your options and determine the best for you. No one is going to do your footwork and thinking for you, especially no one on TV or the radio.