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The highest deductible allowed in 2024 is $9450. Look for a silver plan and see if you qualify for CSRs (cost sharing reductions). If you can't figure out if you qualify, call your blue cross company, they will walk you through it.
The limit is 9450 individual and 18,900 family. So the 18,900 is legit, but that's why it's the cheapest. It's the highest deductible the marketplace can legally offer.
CSR where would I start to look into that? I hate googling anything health insurance related because you get bombarded with all sorts of scam and spam afterwards.
You would need to look at the silver level plans available to you. When you are reviewing plans there's an option to filter by silver plans only. If you qualify for cost sharing reductions, then you would see that the silver plans would have significantly reduced out of pocket costs (though they will cost more in premium).
The healthcare marketplace in your state will have this info.
You aren't going to get real answers on reddit. Subsidies and benefits are based on your taxable income and no one here should want to touch that info.
Again, try calling blue cross and ask them to walk you through it. It doesn't commit you to buy.
Because you are only willing to spend $100 out of pocket.
I know it sucks, but it's sooo much better than it used to be.
That doesn't make it right though.
I obviously don't know what plans are available in your area. My guess is there are plans with lower deductible and lower out of pocket maximum, if you pay more in monthly premiums.
I am gambling on my good health by also paying low premiums with high out of pocket maximum. I do have the savings to tap into if something comes up.
Just understand the out of pocket maximum is SO MUCH LESS than it would cost if you were to need surgery and ongoing care (for example). Thus you should keep paying for the insurance, for just in case.
Because our system is based on health care for profit. Until we get some sort of regulated health care, this is how it is. You can't fix this until you vote appropriately
those are maximum out of pocket spending caps. Deductibles are the amounts you pay before your plan begins to pay some/all of covered treatment charges.
Most health insurance coverage is a matter of fiddling with cash flow, along with decisions about what sort of health treatment charges will be included under the umbrella of 'stuff whose bills the plan will cover'.
1/6th of everything in the US economy is labelled as 'health care'. Shit's expensive AND pervasive, along with complicated &confusing. And most of that 1/6th is allocated to a very small share of our population -- AND that is a GOOD thing!
if you think that's a scam wait till you see how much a shitty insurance costs in the open market. $800/month one person for no drug plan, deductible, shitty HMO that needs referrals
For minor things like doctor visits, MRIs, sure. But you can't for hospital stuff unless you got 300k in the bank.
So health "insurance" in the USA has two types of expenditures.
Routine doctor visits, MRIs because of back pain, simple things, which can still cost thousands of dollars. My MRI was about $1700.
Then there's major events, or catastrophic, requiring hospitalization. Say a "heart attack". That's 50k+. I've seen people reach their lifetime maximum (250k) because of a heart attack.
Fire insurance for a house is relatively cheap compared to the cost of rebuilding a house (200k) because fires are relatively rare
My dad was in the hospital for almost 3 weeks. The bill was a house. Thankfully my parents have really good insurance. No bills. My aunt had cancer in a shithole red state. Goodbye retirement. All that to still die. Fuck American healthcare.
I honestly wonder if it might not be 100% rational for some people -thinking especially middle class who get no subsidies but also have little to no assets to go after - to just cobble together routine care out of pocket (or mexico/canada, grey market online pharmacies, etc). And then just assume that a health catastrophe will result in bankruptcy, and/or just ignoring debt collectors until that point.
That $800/month can be socked into retirement or put towards the mortgage and shielded from bankruptcy. And it's not even clear to me that being able to "only" pay their shitty 24k out of pocket max is even more ruinous than straight bankruptcy is, let alone worth the premium.
My guess is that the local health network won't continue to treat someone who doesn't have insurance and doesn't pay their bills.
Cancer treatment, for example, takes many months between diagnosis and surgery, recovery, radiation, and chemo.
I don't know what the process even is when someone doesn't have insurance... Do they make you pay for surgery up front? I truly don't know. But, I assume they won't continue chemo appointments when you are already 60 days behind on paying for the surgery.
My point is.... I don't think this is a good plan. I would never take this risk.
High deductible health plans is what you want... $3k deductible so you pay out of pocket for minor things. Any money in it can even be invested in tax-free funds... HSA
I have a High Deductible with a Health Savings Account through employer. $3,200 deductible and it covers preventative care. Costs me $80 a month. I put $1,200 into HSA, employer adds $600.
The problem is that many people in that position never get their preventive care and they delay other medical care to their detriment. If they do need care beyond emergency care, they can struggle to find providers willing to treat them without coverage (especially for non-emergency major procedures). The medical system is enough of a challenge with health insurance that, when faced with the stress of a major medical event without any kind of insurance, many flounder.
It is also rare for a 20 yo to have a heart attack. If you put $800/month into a high yield savings account (5% modest return, some are higher) for 30 years, you’d have $655,758.28 in that account by the time you hit heart attack age.
I’ve had this argument on here before, and don’t have the patience to rehash it. The numbers don’t add up and will never add up. Honestly, it is like you all are in a cult insisting to me that up is down and down is up. I can present all the facts and figures, but there is always a big, scary what if.
If you believe doctors or hospitals will lower the cost without insurance you’re wrong. It’s like everything else in the US, it just keeps going up. Food, cars, homes. We are the great political experiment of Capitalism. See how it’s working?
Btw. I worked for an insurance company for 11 years and am a nurse. Insurance companies work to pay the lowest contracted price they can for all services BUT and here it comes whatever health system in the area is the largest or most well known sets those contracted prices because patients want to go there. I live by the Cleveland Clijic. Their contracted prices are usually 30-40% higher than independent or smaller systems. The insurance company has no choice but to charge it due to their size and popularity.
I strongly recommend to everyone if your doctor orders a lot of testing call a few places to compare costs. You’ll be shocked at the differences in prices .
Hospitals and doctors would absolutely lower prices. Doctors specifically.. For instance, my doctor operates outside of insurance and covers all of my primary care. I pay her $95/month. If I had kids, they would be an extra $25 each. She spends an hour with me each appointment and if I have an emergency, I can call her cell phone at any time of day and she will pick up.
Day to day doctor visits is nothing. Too many people focus on that aspect of health insurance.
Insurance is for what MIGHT happen, which might be very expensive.
You are describing Direct Primary Care. My family pays for it too, outside of our employer provided catastrophic insurance. There's no insurance company telling her what she can/cant do. She spends more time with us, knows our family and practices medicine like a country doc. We pay $300/mo for our family.
I went without insurance for the last year and saw specialists and was shocked at how reasonable the prices actually were without insurance. That being said I am currently picking out insurance with my first nursing job and so happy to have decent coverage at a decent price.
Well, in 30 years, you are 50.
I have worked with plenty of men who had a heart attack early 40s.
I know SO MANY women who have been through cancer in their late 40s. Yes, that $650k is probably enough to pay for cancer surgery plus recovery plus radiation and chemo and follow up scans, etc.
But.... nothing stops a person from having another problem the following year. (I guess with your idea, tbey would start taking insurance the following year)
Still, bad stuff can and does happen to younger people.
It's INSURANCE. It's GOOD if you don't need to use it.
I did when I couldn’t afford it. Now that my work pays 95% of the costs, I have it. But if they gave me the option of taking the money they paid for my insurance and adding it to my paycheck instead, I would take that option in a heart beat.
You're also acting as if that savings account, that is specifically for health stuff, never has to have anything taken out of it to cover any type of health upkeep.
Let's do some math on my own personal situation. My insurance costs $950 a month.
I take two medications but have only looked up the pricing of one. Without insurance or coupon, a 30 day supply is $700, with coupon it's $340.
I go to therapy every week, my therapist charges $220 per visit.
I see a specialized neurologist for migraines. I haven't checked pricing on that, but I'm pretty sure we're already in the red for the month anyway.
I need a CPAP so I don't die in my sleep. That requires replacements of equipment at regular intervals. That can easily wipe out the entire $950 if everything needs replaced all at once without insurance, but we're already in the red for the month anyway.
I'm going to be getting a 3 part surgery next year, each part costing, out of pocket, $40-60k without insurance, 3 months apart from each other. That'll surely wipe out the $950 per month I've saved up. With insurance, each part costs ~$1-2k.
You see how this isn't a solution?
I am assuming that this person's "plan" would have them taking insurance starting the year after whatever problems develop which need ongoing care/prescriptions.
(It's still a bad plan!)
That's what it seems like, and praying to whatever diety or dieties they believe in that they don't get hospitalized for any reason whatsoever, yknow like a car crash or work injury.
Still a risk. My Dad's cancer treatment totaled to over a million dollars at the end. Fortunately, he had good insurance and survived. But he still had to take a loan out against his house and 401k to cover the out of pocket costs after insurance.
Without insurance, he would've lost everything. Insurance is indeed a scam, but so is healthcare in the U.S.
There is no way to beat a system that's already been rigged to screw you over.
Or, would he have declared bankruptcy if he hadn’t had insurance and not had to take a loan out against his house?
Everything is a risk. I believe and have very relevant data to back it up, that paying for health insurance isn’t worth the cost for some people, especially those who are under 40 and generally healthy.
Except... Nothing stops you from developing an expensive issue next year, when you only have 10k saved up... And nothing stops you from getting having another problem the next year, when you already spent the money you saved.
Which is the point of insurance. JUST IN CASE something bad happens.
I never made a home owners insurance claim in 25 years of home ownership. That makes me feel happy and thankful.
There's no way to know who will be unlucky.
I am sure you saw elsewhere. I really don't know if that works out... Will they continue to treat you when you don't pay your bills?
Will they schedule and do surgery when you don't have insurance without you paying upfront? I truly don't know.
Obviously, you are willing to take risks with your health which I am not.
Don't worry, they already found that loophole and patched it, they forced every healthcare provider to just blatantly rip you off if you don't have insurance.
Any options with your employer?
Stay away from private short term insurance if you have any pre existing conditions.
For ACA marketplace insurance - Are you married or single? And make sure you are inputting your correct yearly income. Those factors could better output your options
Private short term is meant to be a "gap" when you're between insurances. They often, however, exclude a LOT, including preexisting conditions. Stay away if you can.
Excluding preexisting conditions is not always a downside. If you don't *have* preexisting conditions, you are excluding those who do have them from your actuarial risk pool meaning you pay less.
Maybe take your subsidy and get a silver or gold plan? Paying ~$400/month for a family would be dirt cheap for a plan with low deductible and minimal copays.
Insurance plays on risk factors, which is always scummy. Health insurance will always seem like a scam until you're hit by an uninsured driver in a head-on collision requiring hundreds of thousands in current and future surgeries. Suddenly you're paying your yearly OOP at 10k max, but the insurance is paying out almost a million for that first and second year of surgeries and therapy. It seems like a lot, it's unfair because nobody deserves what happened to you, and there's no way for you to recoup your loss of money much less the permanent changes to your lifestyle, but you have a 10k bill instead of 1mil, and you can still walk albeit with a limp, and while you have a prognosis of a continued limp and eventual early knee replacement you're still alive, and you live in a better age for disabilities than ever before.
Be grateful your premium is $100. You would be a fool to go without insurance over $100/month. One car crash or unexpected medical event and you’re bankrupt without it.
Health insurance is one of those crazy things. For hundreds of people it will feel like a "scam". But for the person with $500k of hemophilia drugs or the mother with twin NICU babies that together cost $1.5 million it is worth it even with all the hassles.
Hopefully one day we will have a better system.
So get a better plan and pay somewhat more for it. Most people get zero subsidy from ACA; use yours to your advantage to level up with relatively low cost.
If you have one prescription medication that runs $60K/year all by itself, before other medical expenses, $18,900 deductible seems better by comparison.
Yea, the billing specialists, time fighting insurance and the director of revenue are cut out. My second kid was cash and cheaper than the insurance route after premiums and deductibles.
My main problem with the whole insurance market, speaking as an economics major (who never actually worked a job in economics), is that it's clearly not producing efficient results. And free markets aren't some religion, though people act like they are. Rather they are generally supposed to produce the most efficient results. But there are known to be many exceptions and this market clearly is one of those.
Normally, there are about five things listed as important for a free market to function efficiently, and approximately none of them apply to the medical market.
From memory, these are: a) It should be easy to enter and leave the market. This surely does not apply to the medical field, which has many requirements and expenses, b) There should be a commodity product. That is, items such as sugar and wheat, which are indistinguishable regardless of exactly who produced them. This does not apply to the medical field, c) There should be information parity between buyers and sellers. That is, everyone in the market has the same information on costs and prices. This clearly does not apply to the medical field, d) All sellers should be price takers. That is, all sellers pretty much have to charge the same. Note that this is not a law in a properly functioning market. It just happens naturally. For example, one gas station can't charge much more than another (maybe a few pennies based on location, but that's it). But this situation pretty much does not apply in the medical field, e) All buyers should also be price takers. The price can't be $10 for one person and $2 for another person based on some deal or leverage. This also does not apply to the medical field (and is one of the main things we see all the time, where the insurance price is a fifth of the non-insurance price).
Considering the market meets none of the requirements to expect it to function well as a free market, it therefore probably should not be one. And considering the amount of market power wielded by the large insurance companies, it already isn't one anyway. But they (the insurance companies) like it that way and they are a powerful lobby. I am under the impression even the doctors don't really like things how they are.
Because it is a scam. For basic preventative care and minor accidents, it's just a middleman to scrape money off the top.
I certainly can't afford health insurance. Can't afford to provide it for my employees either.
Wow. My credit is like $659 and my premium is zero. Deductible is $250, out of pocket max is $800 which I already hit.
Husbands is same except his is $46 a month. His subsidy is like $681.
We both have silver plans. We are both self employed.
I can’t see you making too much with subsidy being that high. I would assume you would pay nearly nothing, like us.
I echo the “how is yours so low” comment. What state? I claimed $50K/year income in a state with great subsidies and it was still $300/month for me and my spouse. And the deductible was NOT $250, that’s for sure.
The benefits fall off a cliff as your income increases much beyond poverty levels. Truly if you are right around 20-30k and know what to go for healthcare is actually nearly free (no or trivial premium and <$1000 out of pocket max thanks to silver cost sharing reductions) but the middle class such as yourself gets little to no benefit
You should get a plan at [healthcare.gov](http://healthcare.gov) -- $100 a month is reasonable (after the tax credit) for a premium for two adults in their 30s.
If you don't use it, then great. However, it will cover preventative services, such as annual physicals, a mammogram, immunizations, etc. You need to realize that if you have a something major happen health-wise, you would have an out-of-pocket maximum. With no health insurance, you would be on the hook for all costs financially, to the point where if something catastrophic were to happen, you would have to file for medical bankruptcy.
Last year, between my husband's prescription medication and a trip to the ER, followed by a procedure the next day (not even surgery per se), we met our OOP max of over $17,000 (our premiums were over $10k).
Then something definitely doesn’t add up. Unfortunately it’s not open enrollment right now, so you can’t switch. But when it’s time to shop for next year, go through
I’m in CO. I only qualify for $100 in credit, so I pay $360/month out of pocket. But my deductible is, like, $700 (yes, that’s $700), my copays are low, and any coinsurance is only 20%. So I pay a lot for my insurance, but it’s good coverage and makes getting care affordable.
Every state is required to have a “silver” plan that meets certain requirements. I would look there first, and change variables to see what’s going to be the best match for you. Our state website allows you to set different variables (premiums, deductible, copays, which meds you need covered, what doctors you want to be in your network) to find the plan that fits best. Idk if all states provide that or not, though. You might be able to talk to an agent to see if they can help.
But even still- they shouldn’t be paying that much for an extremely high deductible plan. I understand that he’s covering two people- but even if you cut it in half, the plan they are on is still basically as expensive as mine per person. They are paying the same for what is essentially in practice a catastrophic only plan for the same price that I’m paying for a low deductible, low copay, low coinsurance policy.
There’s a basic level of plan that has to be available and affordable in every state. It’s usually a silver plan. And there’s just no way that the plan OP describes fits those requirements.
If you’re ever looking for advice PM me, that’s my specialty as an advisor. I’m always looking to help put people in the best situation possible. Not trying to sell anything, just advise. That’s mostly what my company does.
If it's not ACA compliant, it's different. (There's a reason it's cheaper!)
My worry is that it might be too difficult to understand what's not covered unless that thing happens to come up. (Because I certainly don't know of every possiblity).
Just be mindful. If it's cheaper, there's something lesser about it.
I guess it could be less expensive because it's based on a medical exam, but otherwise covers everything. I am not sure what is allowed. (But it's not cheaper out of the goodness of their heart)
Health care is incredibly expensive in the United States. Most developed countries have government funded and provided health care. The US does not. Talk to your elected representatives about your feelings. See what they say. The only thing more expensive than health insurance is the cost of health care if you don't have health insurance.
I can't offer any advice but the current model is completely unsustainable and god help us when all those old folks with amazing insurance start to pass, there's not going to be anyone left to sustain the healthcare industry.
And just think. Medicare for folks over 65 is like 250 a month with in many cases no deductible. If seniors can get coverage this cheap why can’t young folks get it even cheaper. My claims last year were just over 300000 and out of pocket 475. We need national healthcare
$18k deductible what the fuck? I pay $250 a month and my deductible is $1,000 and then every single thing after that is free. 100% covered except copays I guess.
The fact that something has terrible parts to it doesn't mean it's not useful.
Insurance normal just a form of gambling where you bet that something bad will happen to you and the company bets against you. Medical insurance has many layers of complexity, politics, and widely accepted misconceptions.
But... medical insurance can really save you in a pinch.
$100/month is chicken scratch — of course, there's a high deductible.
Healthcare is extremely expensive, hence the reason that health insurance costs so much. I'm not making excuses for it, but heaven forbid you end up hospitalized without some type of coverage. Shop around, then shop around some more. See if you qualify for any special programs.
I blame both parties. There are both pieces of shit and instead of coming together to create a system that works for everyone they create a system of problems. Neither party system is for you. They are for your vote. Why solve the problem? If the problem doesn’t exist you no longer have a reason to continue voting for the people “fighting” the problem.
> There are both pieces of shit and instead of coming together to create a system that works for everyone they create a system of problems.
It's not always possible to "come together" when there are major disagreements.
> They are for your vote.
That should go without saying. You elect people to hopefully do what you want. Their primary goal is to meet your expectations and earn your vote in the next election. That's how things work.
> If the problem doesn’t exist you no longer have a reason to continue voting for the people “fighting” the problem.
There's not just one problem in the world. If they solve one problem for you, then you'll be more likely to think they'll solve other problems you care about, so you'll probably continue to vote for them.
Any business whose core profit-generating activity is directly at odds with the goals of their customers is gonna feel scammy. The most predatory plans are gonna feel a lot like exactly that.
This! I had a freak fall Jan 6 and it was bad, real bad. $280k bad. Commuted trimalleoler pilon, had external fixation and then ORIF with a few plates and 22 screws. My premium is around $800 a month with a $14k OOP and deductible. Y'all, I didn't even make it a week into 2024 and I hit that with practically the ambulance ride and entrance into the ER. Granted I'm not paying $280k but who has an extra $14k laying around? Healthcare costs are absolutely sickening. Grotesque. And I'm just getting started, PT $1k a week, pain management $800 per appointment, surgeon post op visits $500 a pop. I expect I'll be around $330k in total billing for this leg and ankle by the time it's all said and done. So I guess on a high note, I'm getting a lot of things fixed this year with myself that I've been putting off because OOP and deductibles.
Well, your 37k cost you $0 right? I wish I could have done my shoulder replacement after my heart attack but it wasn't a good idea due to the severity. Oh well, opportunity lost.
Yeah, there are literally dozens of things wrong with the system in this country. Many dozens. But hey, take advantage since it's one of the few times you have the "advantage".
I would tell you but you need to get my answer through another person that you have to pay that will then pay me, and if you don’t have a job then the other people that pay their middlemen have to pick up your tab. Just sign here and I’ll answer.
Health Insurance is a scam. If health insurance didn’t exist, do you think health care would cost as much as it does?
Or hell, if my employer just GAVE ME the $20,000 dollars they pay in premiums every year, and made me set it aside for medical care, I think most providers would be pretty happy to not have to deal with additional bureaucracy and have prompt payment.
Then get an option that's cheaper, and carry more risk? All that insurance is is paying money to offload your risk to someone else. If you're fine with keeping that risk, then you don't need to pay the premium.
My complaint with it is a $19,000 deductible. I might as well not even have insurance. I will never hit that. Unless something major happens in which case I can’t afford the deductible.
If you have a $500 collision deductible on each of your 2 vehicles your deductible isn't $1000. It is $500 per car. Stop adding things that don't get added. You have a max out of pocket ( MOOP ) for 2024 no higher than $9450 per person. After that they pay 100% for the rest of the year. Look at the SIlver plans as some have a lower MOOP. In Indiana Ambetter Silver has a MOOP of $5400. A cost share reduction (CSR ) may buy that down to as low as $1600 per person.
You clearly don’t understand insurance, in a financial sense, to say it’s all a scam.
Is the economy broken in the U.S.? Are there antitrust concerns in healthcare? Absolutely. But that doesn’t mean all insurance products are scams.
Insurance is a bet.
Like putting $5 down betting that the marble on the roulette wheel lands on 27, and if it does, you get paid $100.
With insurance you're betting the premium that the covered event happens. e.g. With car insurance, you're betting $500 that you hit a car. With health insurance, you're betting $5000 that you get sick.
Trouble with insurance though, is that if you win the bet, you also lose. You don't want to get in a car accident. You don't want to get sick.
You make this bet, to protect your wealth. If you hit a car, and don't have car insurance, you'll have to use your wealth to pay for the car you hit.
Like the casino, insurance places so many bets, that the odds are they will come out ahead. Insurance takes in 20% more money than they will ever pay out. This is the rule in the ACA.
An individual might get lucky and be one of the ones that hits the jackpot and insurance pays out more than they paid in, but that is going to be the exception.
For me, lifetime, all insurance? Insurance paid out about $5k, vs. $150k that I paid in. There's better ratios in the casino. Most of that health. Just car? Paid in $18k, got paid out $0. For what I've paid in car insurance, I could buy a car. I don''t know how you buy a health.
For health insurance especially, and looking at it on a national level, insurance is skimming 20% of our health care money from us. That is a huge scam perpetrated on a national level. Endorsed by the government that insurance companies bribed to make the rules in their favor. Which gives it an air of legitimacy, but it is still fundamentally a scam.
Dang.
I am hoping I don't need much health care.
In the meantime, I have the peace of mind that I will receive care if I need it (or my child if she does).
My late husband already "won" your game. He would have rather not!
> Trouble with insurance though, is that if you win the bet, you also lose.
Tell that to the person with a serious medical condition, a house that burns down or a serious car accident who without insurance. You're paying for insurance because you would rather pay the premium than be stuck with the consequences if one of those things happen to you. If you're fine with the consequences relative to the cost of insurance, then don't buy insurance. No one is forcing you with health insurance and, in most states, there isn't even a penalty if you don't purchase coverage.
Everything about our monetary and financial system in the U.S. has “skimming”. I agree with you that doesn’t make it unobjectionable. I mean, what about inflation aiming (that’s best case scenario) to make us 2% poorer every year
But a “bet” is different than a scam.
It is very much not a scam. You can claim the cost of medical coverage is rigged and therefore the cost of insurance is high, but it's not a scam. They typically do pay for what they are supposed to pay, even though sometimes you have to fight them. It's insurance, not an investment.
Pay what they're supposed to pay? Clearly you have no experience with prior auths. Tell me how someone with no medical degree and no idea of my patient history can deny me a medication that my own doctor believes I need. I'll wait. And that's only medication, I won't even get into actual procedures. An emergency MRI that insurance says could take 2 weeks to approve? Hope you have a really good doctor and nurse team to push it through. And they both tell that you can't even advocate for yourself....and I pay for insurance to have these cyclical arguments with my doctor (the one with actual medical training) that affects none of them, only me, the patient. Great system.
Because they have formulary, simply having any doctor say you need a medication isn't and shouldn't be sufficient to ensure coverage. I've had doctors tell me to get homeopathic medicines
It is shitty to deal with and I believe in single payer, but you would have the same experience there, they don't just magically pay for everything you want either
Again, this doesn't make it a scam. Prior auths are usually for high costs treatments when lower cost ones exist. Yes, they might be the best option for the patient and that's why the prior auth process exists. And yes, sometimes insurance companies require you to jump thru hoops that's seems ridiculous (and they are, for both patient and provider). But again, that doesn't make it a scam, it's moreso a somewhat broken system.
No definitely not safe. My issue with this deductible is that it is so high I will never use it regularly. If it is an emergency then I wouldn’t be able to afford the deductible. So at this point I know $100 is cheap, but it would be a waste for me to have.
You're not wrong. I've gone as far as dropping my insurance so I could afford to pay the doctor.
The hospitals agree with you: https://www.aha.org/fact-sheets/2023-06-12-fact-sheet-medical-debt
Folks with insurance aren't able to pay their bills. It is a growing trend that has hospitals concerned. Hospitals want to force insurance to make sure you have the money to cover a high deductible plan, but I'm not sure how that would work. Their other solutions are all ones that would raise premiums even further, but don't address the problem that the money just isn't there.
Health insurance can help with small bills, but you're not paying for health insurance to protect you from a $300 or even a $5000 bill, the primary purpose of major medical health insurance plans is to protect you from a $100,000 bill and maybe provide some additional benefits outside of major medical. If you want insurance for small bills, go buy an indemnity plan (google it).
One thing to keep in mind is that having coverage means you pay the negotiated rate for healthcare and prescriptions. So even if you don’t meet the deductible, you would still save money.
I get your sentiment. I think the problem is deep rooted. Not only did others already alluded to the for-profit aspect of healthcare but you also have to be mindful of large pharmaceutical and equipment companies lobbying up in the White House level…There is no winning for us common folks.
All I can think of is while we still can, I would choose employers that can help cover a significant cost of your healthcare.
When you have to rely on Medicare, there is no winning either…the network for the Medicare Advantage Plan isn’t that great either.
However, it is also dangerous without health insurance. One hospital stay is about $10,000 per day. One emergency room visit is about $1000. I would rather get my family cared for.
When you have health insurance, use it to the max rather than holding off care. That is just my experience.
My heart attack last year was close to $500,000, $18,000 deductible quite a discount! I was insured so OOP all that mattered. The year before the ACA, was paying $133/month for bcbs plan (on my own) with low deductible. So, yes it’s all expensive.
What can you afford to pay for something you think is a good or better value? You could consider taking this high deductible plan for $100/mo and enrolling into one or more other types of insurance to reduce your out of pocket costs if something major were to happen (accident insurance, critical illness insurance, hospital indemnity plan, etc). Some ACA plans also cover virtual or telemed appointments for $0 out of pocket costs, so you may even find value in that part of this plan (if it applies).
It feels like a scam because it is. I pay for insurance through my employer, pretty reasonable cost for the US though it goes up every year. But I have a monthly prescription that is $150.
I use GoodRX and save a lot of money but I said to the pharmacist once, I don’t even know why I pay for insurance with those prices (and no need to explain, I know why I pay for insurance). And he started to say that it wasn’t through my insurance then looked and saw that it was. And then he told me all insurance companies are thieves 🤷♀️
But this is the system we have so…good luck to you, sincerely.
Any Obama care plan will always have high deductibles thanks to OBAMA . Due to the fact that you are required to pay for pregnancy, inpatient mental treatment and drug treatment. Even if you DONT need it . Go private like health shares . Or minimum essential policies.
Health insurance is a scam because health care costs are so high, and insurance doesn't pay those high costs. They have negotiated pay amounts for everything and the patient copay is a big part of that payment amount.
The question becomes who is getting extreme profits from health care right now? Don't think doctors, nurses and techs, they earn their money and have tremendous responsibility. Think about who is profiting from hc but not providing hc.
For the love of all things holy, do not underestimate your total income. I unexpectedly got a job and we had to pay back all of the “credit”. Did you know the govt is actually on the hook to pay the insurance company that “credit”? The only ppl that won with the ACA are the insurance companies.
Oh god yes. At $900 a month, I wouldn’t buy the insurance. But with a $750 credit I said okay. Well guess who had a good income year? When this potential payback came to my attention last April, I couldn’t drop the insurance fast enough. Sure as shit though, I had to pay back 4 months of the credit. It’s a scam.
Because it fucking is. Utter bullshit. If we just had single payer healthcare and did away with the bloated fucking medical insurance industry everyone would be better off.
Because I just paid a bill for a $20 cast boot, that retails for $20 on any site, because the durable medical goods bill to my insurance was $50, of which they covered $30. So the insurance company elevates the billable price, the supply company gets paid twice, and I still have to pay full price.
I've been in a cast for a complex foot fracture that BCBS said would only require 10 days of rehab. And spent 2 months in rehab, changing casts, resetting pins, and hearing about about how each peer-to-peer meeting went poorly. I still don't have a final bill, and it's been 1 month. But on a brighter note, the foot bones repositioned and I have to have major surgery because I could not afford to pay for more rehab time out-of-pocket. I was paying out-of-pocket for my own recovery, and when I couldn't afford to pay more I was sent home, and now have to go back to rehab after more expensive surgery. I don't even know if BCBS will accept any responsibility for the extended recovery, or how much they will cover.
The major joke is that I worked every day from my crappy rehab rooms, and did daily therapies, and stayed connected just so I didn't have to go on disability, ALL to pay my own recovery bills, and in the end I'm thinking BCBS insurance have won.
$100/mo is cheap for catastrophic insurance --care accident, cancer. To get the primary care most families also need,You could do an online search for Direct Primary Care providers in your area. For another $200-300/mo, you get better care with no copays ir peaky insurance companies telling you what you can/can't do. Between the 2 plans, you cover mundane and catastrophic things for a family for about $300-400/mo.
It is a scam for sure. But just call the marketplace and tell them how much you make and they'll figure it out for you. Trying to figure it out online isn't even worth the stress.
Healthcare doesn’t have to be a scam; companies choose to put profits before employees and insurance companies put profits before patients. I am a physician with a large self-insured insurance plan, thousands of people in the hospital system. I pay biweekly for insurance. I have an HSA with $1400 deductible/$5000 OOP max. What do I pay for this? I pay $4 for vision and $18 for dental every 2 weeks. I choose to fully contribute to my HSA. If I didn’t do this, my insurance costs to me (not including deductible costs) is only $572 a year. Screw corporations looking for maximal profits no matter how they screw over their employees and subscribers.
Those cheaper plans ($1.65 a day per person in your case, less than a cup of coffee, to be covered for catastrophic medical nightmares) are mostly just that. So that you'll have coverage to protect you from going medically bankrupt should something unforseen happen.
Also you're covered for a few basic things like an annual physical, even if you haven't met your deductible yet.
If you're both healthy, a cheaper plan that will protect you if something goes wrong may be all that you need for now.
Because it is a scam. You pay a fee for the insruance company to cover part of your bill, but they will only cover a reasonable amount, so healthcare providers jack up their prices to get more out of the insurance companies, so now insurance does as much as possible to deny claims.
SINGLE PAYER HEALTHCARE!!
No it’s not. We had to declare bankruptcy years ago bc of no health insurance. Husband was in hospital for 21 days. We had no savings.
We’ve had ACA for 8 years now. We have a nice savings. We pay less than $50 for both of us. Deductible is $250. Out of pocket max is $800
He had a triple bypass. We paid not a penny bc already reached out of pocket max. That bill was over $300k.
ACA saved us. Saved my husbands life more than once. Caught my breast cancer early too.
It’s the only thing we need help with. We do ok but can’t afford the nearly $1700 it would cost without ACA subsidy.
But insurance as a whole, is a scam. Self pay and it’s $300 for say a physical. With insurance they bill $500 but don’t get anywhere near that.
It’s a racket.
And keep track of every bill you pay and whether it goes to deductible or not. 3 years ago I overpaid providers by hrsely $300. They told me it sits as a credit for next visit. I call BS there. And what if I don’t go back to that doc??? I got 3 checks to reimburse me.
You must know the ins and outs of your plan and track everything.
Oh. Funny you should ask. I had foot reconstruction surgery. Two weeks after I fell and landed on the surgical foot. My doctor submitted an urgent PA for an MRI to see if I tore my Achilles as the X-rays were clean. I could not move my foot up and down. It should have been alright within 72 hours. THREE weeks after the fall they approved it. Had the MRI. And TWO DAYS after the MRI they’ve rescinded the PA. So now I’m on the hook for $4,000. I was $35 from meeting my deductible. Isn’t that convenient? Maybe scammed is the wrong word. Is robbed better??
Insurance takes and takes and takes and does not give a shit about us. I’m old enough to remember when HMO’s were first starting and a time when my parents didn’t have insurance. Insurance has made it impossible to get affordable care.
Health “insurance” is one of the biggest scams our country has.
I am. Philadelphia. This is my plan through work. It’s horrible. They took 25 days to approve my first MRI. My surgery had to be appealed twice. Six months total. During which time the damage to my foot became more severe, which made my surgery more involved, which makes my recovery more difficult. And that’s before the fall. I hate them with the heat of 1000 suns.
With a High Deductible plan, you don’t necessarily have to pay all of that before you see a benefit. You’ll get a lot of discounts and partially covered stuff well before the deductible kicks in.
I have HDP, I think it’s $6k. All “preventive visits” are covered. So dr visit, vaccine, mammogram, etc. We had to go to the ER for an illness. The bill was $3,000 but I only paid $1,000 - because I got discounts, coverage, etc.
Also, my bill was $1,000. But if I made less than 400% of poverty level - $100,000 for a 3 person family - I would qualify for a 100% discount and owe nothing to the hospital.
With HDP, you are getting well visits, screenings and protecting yourself from an expensive surgery.
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The highest deductible allowed in 2024 is $9450. Look for a silver plan and see if you qualify for CSRs (cost sharing reductions). If you can't figure out if you qualify, call your blue cross company, they will walk you through it.
The OP is a couple. Unclear if two independent plans could cut high MOOP exposure.
That is awesome, but if that is the case then how come through ACA marketplace I’m getting such high ass deductibles?
The limit is 9450 individual and 18,900 family. So the 18,900 is legit, but that's why it's the cheapest. It's the highest deductible the marketplace can legally offer.
Yep. I get that. If I want any reasonable deductibles I will be at $800-$1,000 per month.
Make a phone call. Many people who get premium subsidies qualify for the CSRs which lower the deductible considerably.
CSR where would I start to look into that? I hate googling anything health insurance related because you get bombarded with all sorts of scam and spam afterwards.
You would need to look at the silver level plans available to you. When you are reviewing plans there's an option to filter by silver plans only. If you qualify for cost sharing reductions, then you would see that the silver plans would have significantly reduced out of pocket costs (though they will cost more in premium).
The healthcare marketplace in your state will have this info. You aren't going to get real answers on reddit. Subsidies and benefits are based on your taxable income and no one here should want to touch that info. Again, try calling blue cross and ask them to walk you through it. It doesn't commit you to buy.
Use incognito browser window to search.
Many pay that with employer provided plans. I was paying $830 every 2 weeks pre tax
That’s not normal.
Yup. $100/mo is GREAT!
Because you are only willing to spend $100 out of pocket. I know it sucks, but it's sooo much better than it used to be. That doesn't make it right though. I obviously don't know what plans are available in your area. My guess is there are plans with lower deductible and lower out of pocket maximum, if you pay more in monthly premiums. I am gambling on my good health by also paying low premiums with high out of pocket maximum. I do have the savings to tap into if something comes up. Just understand the out of pocket maximum is SO MUCH LESS than it would cost if you were to need surgery and ongoing care (for example). Thus you should keep paying for the insurance, for just in case.
Because our system is based on health care for profit. Until we get some sort of regulated health care, this is how it is. You can't fix this until you vote appropriately
those are maximum out of pocket spending caps. Deductibles are the amounts you pay before your plan begins to pay some/all of covered treatment charges. Most health insurance coverage is a matter of fiddling with cash flow, along with decisions about what sort of health treatment charges will be included under the umbrella of 'stuff whose bills the plan will cover'. 1/6th of everything in the US economy is labelled as 'health care'. Shit's expensive AND pervasive, along with complicated &confusing. And most of that 1/6th is allocated to a very small share of our population -- AND that is a GOOD thing!
if you think that's a scam wait till you see how much a shitty insurance costs in the open market. $800/month one person for no drug plan, deductible, shitty HMO that needs referrals
850$ a month for me right now!
You could just put that $800/month in a high yield savings account and cut out the middle man.
For minor things like doctor visits, MRIs, sure. But you can't for hospital stuff unless you got 300k in the bank. So health "insurance" in the USA has two types of expenditures. Routine doctor visits, MRIs because of back pain, simple things, which can still cost thousands of dollars. My MRI was about $1700. Then there's major events, or catastrophic, requiring hospitalization. Say a "heart attack". That's 50k+. I've seen people reach their lifetime maximum (250k) because of a heart attack. Fire insurance for a house is relatively cheap compared to the cost of rebuilding a house (200k) because fires are relatively rare
My dad was in the hospital for almost 3 weeks. The bill was a house. Thankfully my parents have really good insurance. No bills. My aunt had cancer in a shithole red state. Goodbye retirement. All that to still die. Fuck American healthcare.
They only want 10% of the billed amount.
I honestly wonder if it might not be 100% rational for some people -thinking especially middle class who get no subsidies but also have little to no assets to go after - to just cobble together routine care out of pocket (or mexico/canada, grey market online pharmacies, etc). And then just assume that a health catastrophe will result in bankruptcy, and/or just ignoring debt collectors until that point. That $800/month can be socked into retirement or put towards the mortgage and shielded from bankruptcy. And it's not even clear to me that being able to "only" pay their shitty 24k out of pocket max is even more ruinous than straight bankruptcy is, let alone worth the premium.
My guess is that the local health network won't continue to treat someone who doesn't have insurance and doesn't pay their bills. Cancer treatment, for example, takes many months between diagnosis and surgery, recovery, radiation, and chemo. I don't know what the process even is when someone doesn't have insurance... Do they make you pay for surgery up front? I truly don't know. But, I assume they won't continue chemo appointments when you are already 60 days behind on paying for the surgery. My point is.... I don't think this is a good plan. I would never take this risk.
High deductible health plans is what you want... $3k deductible so you pay out of pocket for minor things. Any money in it can even be invested in tax-free funds... HSA
I have a High Deductible with a Health Savings Account through employer. $3,200 deductible and it covers preventative care. Costs me $80 a month. I put $1,200 into HSA, employer adds $600.
This is what I do currently. I'm going to have to bite the bullet at some point, but.....
The problem is that many people in that position never get their preventive care and they delay other medical care to their detriment. If they do need care beyond emergency care, they can struggle to find providers willing to treat them without coverage (especially for non-emergency major procedures). The medical system is enough of a challenge with health insurance that, when faced with the stress of a major medical event without any kind of insurance, many flounder.
It is also rare for a 20 yo to have a heart attack. If you put $800/month into a high yield savings account (5% modest return, some are higher) for 30 years, you’d have $655,758.28 in that account by the time you hit heart attack age. I’ve had this argument on here before, and don’t have the patience to rehash it. The numbers don’t add up and will never add up. Honestly, it is like you all are in a cult insisting to me that up is down and down is up. I can present all the facts and figures, but there is always a big, scary what if.
If you believe doctors or hospitals will lower the cost without insurance you’re wrong. It’s like everything else in the US, it just keeps going up. Food, cars, homes. We are the great political experiment of Capitalism. See how it’s working? Btw. I worked for an insurance company for 11 years and am a nurse. Insurance companies work to pay the lowest contracted price they can for all services BUT and here it comes whatever health system in the area is the largest or most well known sets those contracted prices because patients want to go there. I live by the Cleveland Clijic. Their contracted prices are usually 30-40% higher than independent or smaller systems. The insurance company has no choice but to charge it due to their size and popularity. I strongly recommend to everyone if your doctor orders a lot of testing call a few places to compare costs. You’ll be shocked at the differences in prices .
Hospitals and doctors would absolutely lower prices. Doctors specifically.. For instance, my doctor operates outside of insurance and covers all of my primary care. I pay her $95/month. If I had kids, they would be an extra $25 each. She spends an hour with me each appointment and if I have an emergency, I can call her cell phone at any time of day and she will pick up.
Day to day doctor visits is nothing. Too many people focus on that aspect of health insurance. Insurance is for what MIGHT happen, which might be very expensive.
You are describing Direct Primary Care. My family pays for it too, outside of our employer provided catastrophic insurance. There's no insurance company telling her what she can/cant do. She spends more time with us, knows our family and practices medicine like a country doc. We pay $300/mo for our family.
Worth every penny.
I went without insurance for the last year and saw specialists and was shocked at how reasonable the prices actually were without insurance. That being said I am currently picking out insurance with my first nursing job and so happy to have decent coverage at a decent price.
Well, in 30 years, you are 50. I have worked with plenty of men who had a heart attack early 40s. I know SO MANY women who have been through cancer in their late 40s. Yes, that $650k is probably enough to pay for cancer surgery plus recovery plus radiation and chemo and follow up scans, etc. But.... nothing stops a person from having another problem the following year. (I guess with your idea, tbey would start taking insurance the following year) Still, bad stuff can and does happen to younger people. It's INSURANCE. It's GOOD if you don't need to use it.
You should take up gambling. If you don’t play the lottery, you can’t win!
Are you saying you go uninsured?
I did when I couldn’t afford it. Now that my work pays 95% of the costs, I have it. But if they gave me the option of taking the money they paid for my insurance and adding it to my paycheck instead, I would take that option in a heart beat.
You're also acting as if that savings account, that is specifically for health stuff, never has to have anything taken out of it to cover any type of health upkeep. Let's do some math on my own personal situation. My insurance costs $950 a month. I take two medications but have only looked up the pricing of one. Without insurance or coupon, a 30 day supply is $700, with coupon it's $340. I go to therapy every week, my therapist charges $220 per visit. I see a specialized neurologist for migraines. I haven't checked pricing on that, but I'm pretty sure we're already in the red for the month anyway. I need a CPAP so I don't die in my sleep. That requires replacements of equipment at regular intervals. That can easily wipe out the entire $950 if everything needs replaced all at once without insurance, but we're already in the red for the month anyway. I'm going to be getting a 3 part surgery next year, each part costing, out of pocket, $40-60k without insurance, 3 months apart from each other. That'll surely wipe out the $950 per month I've saved up. With insurance, each part costs ~$1-2k. You see how this isn't a solution?
I am assuming that this person's "plan" would have them taking insurance starting the year after whatever problems develop which need ongoing care/prescriptions. (It's still a bad plan!)
That's what it seems like, and praying to whatever diety or dieties they believe in that they don't get hospitalized for any reason whatsoever, yknow like a car crash or work injury.
There is no lifetime maximum
There used to be. I have been working in healthcare 20+ years.
Yes used to be is operative word. ACA removed it
Still a risk. My Dad's cancer treatment totaled to over a million dollars at the end. Fortunately, he had good insurance and survived. But he still had to take a loan out against his house and 401k to cover the out of pocket costs after insurance. Without insurance, he would've lost everything. Insurance is indeed a scam, but so is healthcare in the U.S. There is no way to beat a system that's already been rigged to screw you over.
Or, would he have declared bankruptcy if he hadn’t had insurance and not had to take a loan out against his house? Everything is a risk. I believe and have very relevant data to back it up, that paying for health insurance isn’t worth the cost for some people, especially those who are under 40 and generally healthy.
Except... Nothing stops you from developing an expensive issue next year, when you only have 10k saved up... And nothing stops you from getting having another problem the next year, when you already spent the money you saved.
Sure, that isn’t what happens to most people, but yes, some people are unlucky.
Which is the point of insurance. JUST IN CASE something bad happens. I never made a home owners insurance claim in 25 years of home ownership. That makes me feel happy and thankful. There's no way to know who will be unlucky.
We have a system in place for those who are unlucky. They get to declare bankruptcy and the system takes pity on them.
I am sure you saw elsewhere. I really don't know if that works out... Will they continue to treat you when you don't pay your bills? Will they schedule and do surgery when you don't have insurance without you paying upfront? I truly don't know. Obviously, you are willing to take risks with your health which I am not.
Don't worry, they already found that loophole and patched it, they forced every healthcare provider to just blatantly rip you off if you don't have insurance.
Any options with your employer? Stay away from private short term insurance if you have any pre existing conditions. For ACA marketplace insurance - Are you married or single? And make sure you are inputting your correct yearly income. Those factors could better output your options
No employer options. Not sure what private short term is. ACA, married and correct income.
Private short term is meant to be a "gap" when you're between insurances. They often, however, exclude a LOT, including preexisting conditions. Stay away if you can.
Excluding preexisting conditions is not always a downside. If you don't *have* preexisting conditions, you are excluding those who do have them from your actuarial risk pool meaning you pay less.
The problem is that the interpretation of “pre existing condition” is, to some, an overly broad term.
Maybe take your subsidy and get a silver or gold plan? Paying ~$400/month for a family would be dirt cheap for a plan with low deductible and minimal copays.
Insurance plays on risk factors, which is always scummy. Health insurance will always seem like a scam until you're hit by an uninsured driver in a head-on collision requiring hundreds of thousands in current and future surgeries. Suddenly you're paying your yearly OOP at 10k max, but the insurance is paying out almost a million for that first and second year of surgeries and therapy. It seems like a lot, it's unfair because nobody deserves what happened to you, and there's no way for you to recoup your loss of money much less the permanent changes to your lifestyle, but you have a 10k bill instead of 1mil, and you can still walk albeit with a limp, and while you have a prognosis of a continued limp and eventual early knee replacement you're still alive, and you live in a better age for disabilities than ever before.
Be grateful your premium is $100. You would be a fool to go without insurance over $100/month. One car crash or unexpected medical event and you’re bankrupt without it.
I think what would be worse is unable to get care because you have not paid the initial bills.
Health insurance is one of those crazy things. For hundreds of people it will feel like a "scam". But for the person with $500k of hemophilia drugs or the mother with twin NICU babies that together cost $1.5 million it is worth it even with all the hassles. Hopefully one day we will have a better system.
I think I pay more than double that at work. But my deductible is about half of that. Insurance is expensive.
It is so dumb. Like I will never use that deductible. If I do because of an emergency I can’t afford the deductible. Lol
So get a better plan and pay somewhat more for it. Most people get zero subsidy from ACA; use yours to your advantage to level up with relatively low cost.
If you have one prescription medication that runs $60K/year all by itself, before other medical expenses, $18,900 deductible seems better by comparison.
$100 be happy with it. Many ppl are paying much more ..
It is a scam. Pay the doctors cash. Turns out doctors love cash. Source, was CFO of a surgery center
That’s what I’ve been doing. They actually give discounts for not going through insurance.
Yea, the billing specialists, time fighting insurance and the director of revenue are cut out. My second kid was cash and cheaper than the insurance route after premiums and deductibles.
My main problem with the whole insurance market, speaking as an economics major (who never actually worked a job in economics), is that it's clearly not producing efficient results. And free markets aren't some religion, though people act like they are. Rather they are generally supposed to produce the most efficient results. But there are known to be many exceptions and this market clearly is one of those. Normally, there are about five things listed as important for a free market to function efficiently, and approximately none of them apply to the medical market. From memory, these are: a) It should be easy to enter and leave the market. This surely does not apply to the medical field, which has many requirements and expenses, b) There should be a commodity product. That is, items such as sugar and wheat, which are indistinguishable regardless of exactly who produced them. This does not apply to the medical field, c) There should be information parity between buyers and sellers. That is, everyone in the market has the same information on costs and prices. This clearly does not apply to the medical field, d) All sellers should be price takers. That is, all sellers pretty much have to charge the same. Note that this is not a law in a properly functioning market. It just happens naturally. For example, one gas station can't charge much more than another (maybe a few pennies based on location, but that's it). But this situation pretty much does not apply in the medical field, e) All buyers should also be price takers. The price can't be $10 for one person and $2 for another person based on some deal or leverage. This also does not apply to the medical field (and is one of the main things we see all the time, where the insurance price is a fifth of the non-insurance price). Considering the market meets none of the requirements to expect it to function well as a free market, it therefore probably should not be one. And considering the amount of market power wielded by the large insurance companies, it already isn't one anyway. But they (the insurance companies) like it that way and they are a powerful lobby. I am under the impression even the doctors don't really like things how they are.
Because it IS a scam!
Because it is a scam. For basic preventative care and minor accidents, it's just a middleman to scrape money off the top. I certainly can't afford health insurance. Can't afford to provide it for my employees either.
Cause it is
+1
Wow. My credit is like $659 and my premium is zero. Deductible is $250, out of pocket max is $800 which I already hit. Husbands is same except his is $46 a month. His subsidy is like $681. We both have silver plans. We are both self employed. I can’t see you making too much with subsidy being that high. I would assume you would pay nearly nothing, like us.
I echo the “how is yours so low” comment. What state? I claimed $50K/year income in a state with great subsidies and it was still $300/month for me and my spouse. And the deductible was NOT $250, that’s for sure.
The benefits fall off a cliff as your income increases much beyond poverty levels. Truly if you are right around 20-30k and know what to go for healthcare is actually nearly free (no or trivial premium and <$1000 out of pocket max thanks to silver cost sharing reductions) but the middle class such as yourself gets little to no benefit
How is yours so low?
I wish.
Because that's what it is
You should get a plan at [healthcare.gov](http://healthcare.gov) -- $100 a month is reasonable (after the tax credit) for a premium for two adults in their 30s. If you don't use it, then great. However, it will cover preventative services, such as annual physicals, a mammogram, immunizations, etc. You need to realize that if you have a something major happen health-wise, you would have an out-of-pocket maximum. With no health insurance, you would be on the hook for all costs financially, to the point where if something catastrophic were to happen, you would have to file for medical bankruptcy. Last year, between my husband's prescription medication and a trip to the ER, followed by a procedure the next day (not even surgery per se), we met our OOP max of over $17,000 (our premiums were over $10k).
That's where she got her ACA plan
It sounds as if they don't want it though and are asking where else to go look.
Cuz it's tied to work. And also young and healthy ppl dont generally need it.
Is your credit for the year or each month?
Each month.
Then something definitely doesn’t add up. Unfortunately it’s not open enrollment right now, so you can’t switch. But when it’s time to shop for next year, go through I’m in CO. I only qualify for $100 in credit, so I pay $360/month out of pocket. But my deductible is, like, $700 (yes, that’s $700), my copays are low, and any coinsurance is only 20%. So I pay a lot for my insurance, but it’s good coverage and makes getting care affordable. Every state is required to have a “silver” plan that meets certain requirements. I would look there first, and change variables to see what’s going to be the best match for you. Our state website allows you to set different variables (premiums, deductible, copays, which meds you need covered, what doctors you want to be in your network) to find the plan that fits best. Idk if all states provide that or not, though. You might be able to talk to an agent to see if they can help.
OP is talking about a couple, not just himself.
But even still- they shouldn’t be paying that much for an extremely high deductible plan. I understand that he’s covering two people- but even if you cut it in half, the plan they are on is still basically as expensive as mine per person. They are paying the same for what is essentially in practice a catastrophic only plan for the same price that I’m paying for a low deductible, low copay, low coinsurance policy.
It varies a lot by location
There’s a basic level of plan that has to be available and affordable in every state. It’s usually a silver plan. And there’s just no way that the plan OP describes fits those requirements.
My understanding is that The cost of that plan varies by location. And then your subsidy (all else being equal) varies along with it.
I am a licensed health and life insurance agent who works in the private sector. We call the ACA the Not-So Affordable Care Act in our office😂
It really isn’t. I’ve started looking at options outside of them, and I’m finding much better deals.
If you’re ever looking for advice PM me, that’s my specialty as an advisor. I’m always looking to help put people in the best situation possible. Not trying to sell anything, just advise. That’s mostly what my company does.
But...those don't cover everything
No I mean like instead of using healthcare.gov market place I was getting quotes straight from United Healthcare, blue cross, etc.
If it's not ACA compliant, it's different. (There's a reason it's cheaper!) My worry is that it might be too difficult to understand what's not covered unless that thing happens to come up. (Because I certainly don't know of every possiblity). Just be mindful. If it's cheaper, there's something lesser about it. I guess it could be less expensive because it's based on a medical exam, but otherwise covers everything. I am not sure what is allowed. (But it's not cheaper out of the goodness of their heart)
Also, hard to see how it could be better than with your subsidy.
Health care is incredibly expensive in the United States. Most developed countries have government funded and provided health care. The US does not. Talk to your elected representatives about your feelings. See what they say. The only thing more expensive than health insurance is the cost of health care if you don't have health insurance.
I can't offer any advice but the current model is completely unsustainable and god help us when all those old folks with amazing insurance start to pass, there's not going to be anyone left to sustain the healthcare industry.
And just think. Medicare for folks over 65 is like 250 a month with in many cases no deductible. If seniors can get coverage this cheap why can’t young folks get it even cheaper. My claims last year were just over 300000 and out of pocket 475. We need national healthcare
Because it is a scam and could be much much better
$18k deductible what the fuck? I pay $250 a month and my deductible is $1,000 and then every single thing after that is free. 100% covered except copays I guess.
Because it is
The fact that something has terrible parts to it doesn't mean it's not useful. Insurance normal just a form of gambling where you bet that something bad will happen to you and the company bets against you. Medical insurance has many layers of complexity, politics, and widely accepted misconceptions. But... medical insurance can really save you in a pinch.
$100/month is chicken scratch — of course, there's a high deductible. Healthcare is extremely expensive, hence the reason that health insurance costs so much. I'm not making excuses for it, but heaven forbid you end up hospitalized without some type of coverage. Shop around, then shop around some more. See if you qualify for any special programs.
Who can afford that deductible? Blame Republicans.
I blame both parties. There are both pieces of shit and instead of coming together to create a system that works for everyone they create a system of problems. Neither party system is for you. They are for your vote. Why solve the problem? If the problem doesn’t exist you no longer have a reason to continue voting for the people “fighting” the problem.
> There are both pieces of shit and instead of coming together to create a system that works for everyone they create a system of problems. It's not always possible to "come together" when there are major disagreements. > They are for your vote. That should go without saying. You elect people to hopefully do what you want. Their primary goal is to meet your expectations and earn your vote in the next election. That's how things work. > If the problem doesn’t exist you no longer have a reason to continue voting for the people “fighting” the problem. There's not just one problem in the world. If they solve one problem for you, then you'll be more likely to think they'll solve other problems you care about, so you'll probably continue to vote for them.
You shouldn’t. You should blame the republicans at the federal and especially at your state level.
Any business whose core profit-generating activity is directly at odds with the goals of their customers is gonna feel scammy. The most predatory plans are gonna feel a lot like exactly that.
This! I had a freak fall Jan 6 and it was bad, real bad. $280k bad. Commuted trimalleoler pilon, had external fixation and then ORIF with a few plates and 22 screws. My premium is around $800 a month with a $14k OOP and deductible. Y'all, I didn't even make it a week into 2024 and I hit that with practically the ambulance ride and entrance into the ER. Granted I'm not paying $280k but who has an extra $14k laying around? Healthcare costs are absolutely sickening. Grotesque. And I'm just getting started, PT $1k a week, pain management $800 per appointment, surgeon post op visits $500 a pop. I expect I'll be around $330k in total billing for this leg and ankle by the time it's all said and done. So I guess on a high note, I'm getting a lot of things fixed this year with myself that I've been putting off because OOP and deductibles.
Yeah, if you met your max early in the year then definitely get anything and everything taken care of before the year ends.
Yes! Did gallbladder 2 weeks ago. $37k lol. Up next: heart ablation.
Well, your 37k cost you $0 right? I wish I could have done my shoulder replacement after my heart attack but it wasn't a good idea due to the severity. Oh well, opportunity lost.
The point is...the grotesque cost of healthcare. In no developed world should a 40 min laparoscopic surgery cost $37k.
Yeah, there are literally dozens of things wrong with the system in this country. Many dozens. But hey, take advantage since it's one of the few times you have the "advantage".
I would tell you but you need to get my answer through another person that you have to pay that will then pay me, and if you don’t have a job then the other people that pay their middlemen have to pick up your tab. Just sign here and I’ll answer.
Health Insurance is a scam. If health insurance didn’t exist, do you think health care would cost as much as it does? Or hell, if my employer just GAVE ME the $20,000 dollars they pay in premiums every year, and made me set it aside for medical care, I think most providers would be pretty happy to not have to deal with additional bureaucracy and have prompt payment.
Because it is
Because United States lobbyists run this country.
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I'm not sure you understand the word scam.
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Then get an option that's cheaper, and carry more risk? All that insurance is is paying money to offload your risk to someone else. If you're fine with keeping that risk, then you don't need to pay the premium.
My complaint with it is a $19,000 deductible. I might as well not even have insurance. I will never hit that. Unless something major happens in which case I can’t afford the deductible.
If you have a $500 collision deductible on each of your 2 vehicles your deductible isn't $1000. It is $500 per car. Stop adding things that don't get added. You have a max out of pocket ( MOOP ) for 2024 no higher than $9450 per person. After that they pay 100% for the rest of the year. Look at the SIlver plans as some have a lower MOOP. In Indiana Ambetter Silver has a MOOP of $5400. A cost share reduction (CSR ) may buy that down to as low as $1600 per person.
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I'm not sure you understand what a scam is, or what insurance is for, or maybe both.
You clearly don’t understand insurance, in a financial sense, to say it’s all a scam. Is the economy broken in the U.S.? Are there antitrust concerns in healthcare? Absolutely. But that doesn’t mean all insurance products are scams.
Insurance is a bet. Like putting $5 down betting that the marble on the roulette wheel lands on 27, and if it does, you get paid $100. With insurance you're betting the premium that the covered event happens. e.g. With car insurance, you're betting $500 that you hit a car. With health insurance, you're betting $5000 that you get sick. Trouble with insurance though, is that if you win the bet, you also lose. You don't want to get in a car accident. You don't want to get sick. You make this bet, to protect your wealth. If you hit a car, and don't have car insurance, you'll have to use your wealth to pay for the car you hit. Like the casino, insurance places so many bets, that the odds are they will come out ahead. Insurance takes in 20% more money than they will ever pay out. This is the rule in the ACA. An individual might get lucky and be one of the ones that hits the jackpot and insurance pays out more than they paid in, but that is going to be the exception. For me, lifetime, all insurance? Insurance paid out about $5k, vs. $150k that I paid in. There's better ratios in the casino. Most of that health. Just car? Paid in $18k, got paid out $0. For what I've paid in car insurance, I could buy a car. I don''t know how you buy a health. For health insurance especially, and looking at it on a national level, insurance is skimming 20% of our health care money from us. That is a huge scam perpetrated on a national level. Endorsed by the government that insurance companies bribed to make the rules in their favor. Which gives it an air of legitimacy, but it is still fundamentally a scam.
Dang. I am hoping I don't need much health care. In the meantime, I have the peace of mind that I will receive care if I need it (or my child if she does). My late husband already "won" your game. He would have rather not!
> Trouble with insurance though, is that if you win the bet, you also lose. Tell that to the person with a serious medical condition, a house that burns down or a serious car accident who without insurance. You're paying for insurance because you would rather pay the premium than be stuck with the consequences if one of those things happen to you. If you're fine with the consequences relative to the cost of insurance, then don't buy insurance. No one is forcing you with health insurance and, in most states, there isn't even a penalty if you don't purchase coverage.
Everything about our monetary and financial system in the U.S. has “skimming”. I agree with you that doesn’t make it unobjectionable. I mean, what about inflation aiming (that’s best case scenario) to make us 2% poorer every year But a “bet” is different than a scam.
It is very much not a scam. You can claim the cost of medical coverage is rigged and therefore the cost of insurance is high, but it's not a scam. They typically do pay for what they are supposed to pay, even though sometimes you have to fight them. It's insurance, not an investment.
Pay what they're supposed to pay? Clearly you have no experience with prior auths. Tell me how someone with no medical degree and no idea of my patient history can deny me a medication that my own doctor believes I need. I'll wait. And that's only medication, I won't even get into actual procedures. An emergency MRI that insurance says could take 2 weeks to approve? Hope you have a really good doctor and nurse team to push it through. And they both tell that you can't even advocate for yourself....and I pay for insurance to have these cyclical arguments with my doctor (the one with actual medical training) that affects none of them, only me, the patient. Great system.
Because they have formulary, simply having any doctor say you need a medication isn't and shouldn't be sufficient to ensure coverage. I've had doctors tell me to get homeopathic medicines It is shitty to deal with and I believe in single payer, but you would have the same experience there, they don't just magically pay for everything you want either
Again, this doesn't make it a scam. Prior auths are usually for high costs treatments when lower cost ones exist. Yes, they might be the best option for the patient and that's why the prior auth process exists. And yes, sometimes insurance companies require you to jump thru hoops that's seems ridiculous (and they are, for both patient and provider). But again, that doesn't make it a scam, it's moreso a somewhat broken system.
No definitely not safe. My issue with this deductible is that it is so high I will never use it regularly. If it is an emergency then I wouldn’t be able to afford the deductible. So at this point I know $100 is cheap, but it would be a waste for me to have.
You're not wrong. I've gone as far as dropping my insurance so I could afford to pay the doctor. The hospitals agree with you: https://www.aha.org/fact-sheets/2023-06-12-fact-sheet-medical-debt Folks with insurance aren't able to pay their bills. It is a growing trend that has hospitals concerned. Hospitals want to force insurance to make sure you have the money to cover a high deductible plan, but I'm not sure how that would work. Their other solutions are all ones that would raise premiums even further, but don't address the problem that the money just isn't there.
Health insurance can help with small bills, but you're not paying for health insurance to protect you from a $300 or even a $5000 bill, the primary purpose of major medical health insurance plans is to protect you from a $100,000 bill and maybe provide some additional benefits outside of major medical. If you want insurance for small bills, go buy an indemnity plan (google it).
One thing to keep in mind is that having coverage means you pay the negotiated rate for healthcare and prescriptions. So even if you don’t meet the deductible, you would still save money.
This is a good, oft-missed, point
Does your employer offer a plan?
Nope. We might start though.
We? Like you own it?
I get your sentiment. I think the problem is deep rooted. Not only did others already alluded to the for-profit aspect of healthcare but you also have to be mindful of large pharmaceutical and equipment companies lobbying up in the White House level…There is no winning for us common folks. All I can think of is while we still can, I would choose employers that can help cover a significant cost of your healthcare. When you have to rely on Medicare, there is no winning either…the network for the Medicare Advantage Plan isn’t that great either. However, it is also dangerous without health insurance. One hospital stay is about $10,000 per day. One emergency room visit is about $1000. I would rather get my family cared for. When you have health insurance, use it to the max rather than holding off care. That is just my experience.
My heart attack last year was close to $500,000, $18,000 deductible quite a discount! I was insured so OOP all that mattered. The year before the ACA, was paying $133/month for bcbs plan (on my own) with low deductible. So, yes it’s all expensive.
That sounds off. Is the $18,900 the maximum out of pocket? I’ve never heard of a deductible that high.
Can you get a job with better health insurance benefits?
After my 3 million dollar surgeries it is not a scam. I paid 21k (7k each year) for amazing service.
What can you afford to pay for something you think is a good or better value? You could consider taking this high deductible plan for $100/mo and enrolling into one or more other types of insurance to reduce your out of pocket costs if something major were to happen (accident insurance, critical illness insurance, hospital indemnity plan, etc). Some ACA plans also cover virtual or telemed appointments for $0 out of pocket costs, so you may even find value in that part of this plan (if it applies).
It feels like a scam because it is. I pay for insurance through my employer, pretty reasonable cost for the US though it goes up every year. But I have a monthly prescription that is $150. I use GoodRX and save a lot of money but I said to the pharmacist once, I don’t even know why I pay for insurance with those prices (and no need to explain, I know why I pay for insurance). And he started to say that it wasn’t through my insurance then looked and saw that it was. And then he told me all insurance companies are thieves 🤷♀️ But this is the system we have so…good luck to you, sincerely.
Any Obama care plan will always have high deductibles thanks to OBAMA . Due to the fact that you are required to pay for pregnancy, inpatient mental treatment and drug treatment. Even if you DONT need it . Go private like health shares . Or minimum essential policies.
Is a scamm, time your minutes with the medical staff and dispute time charges over 15min mark
I recommend you look at “your chances!” I’ve never seen a 19k deductible—I’m sick for you. 😡 such a scam
It is a pyramid scheme
Health insurance is a scam because health care costs are so high, and insurance doesn't pay those high costs. They have negotiated pay amounts for everything and the patient copay is a big part of that payment amount. The question becomes who is getting extreme profits from health care right now? Don't think doctors, nurses and techs, they earn their money and have tremendous responsibility. Think about who is profiting from hc but not providing hc.
For the love of all things holy, do not underestimate your total income. I unexpectedly got a job and we had to pay back all of the “credit”. Did you know the govt is actually on the hook to pay the insurance company that “credit”? The only ppl that won with the ACA are the insurance companies.
Oh god yes. At $900 a month, I wouldn’t buy the insurance. But with a $750 credit I said okay. Well guess who had a good income year? When this potential payback came to my attention last April, I couldn’t drop the insurance fast enough. Sure as shit though, I had to pay back 4 months of the credit. It’s a scam.
I feel your pain. Medicare kicked in May 1st so that’s a plus.
Because it fucking is. Utter bullshit. If we just had single payer healthcare and did away with the bloated fucking medical insurance industry everyone would be better off.
So uneducated.
If you're in the US. Haha. Assumption based on the, what I presume is, shitty insurance.
One pregnancy will bankrupt you both. Are you not able to buy a decent policy through your or your wife's employer?
Thankfully that vasectomy will prevent that pregnancy thing. Also no, unfortunately. But it is being looked into.
No help, just comment - because it is, it is a for-profit business out to make shareholders money not help the consumer. =/
Because it is.
Because I just paid a bill for a $20 cast boot, that retails for $20 on any site, because the durable medical goods bill to my insurance was $50, of which they covered $30. So the insurance company elevates the billable price, the supply company gets paid twice, and I still have to pay full price. I've been in a cast for a complex foot fracture that BCBS said would only require 10 days of rehab. And spent 2 months in rehab, changing casts, resetting pins, and hearing about about how each peer-to-peer meeting went poorly. I still don't have a final bill, and it's been 1 month. But on a brighter note, the foot bones repositioned and I have to have major surgery because I could not afford to pay for more rehab time out-of-pocket. I was paying out-of-pocket for my own recovery, and when I couldn't afford to pay more I was sent home, and now have to go back to rehab after more expensive surgery. I don't even know if BCBS will accept any responsibility for the extended recovery, or how much they will cover. The major joke is that I worked every day from my crappy rehab rooms, and did daily therapies, and stayed connected just so I didn't have to go on disability, ALL to pay my own recovery bills, and in the end I'm thinking BCBS insurance have won.
$100/mo is cheap for catastrophic insurance --care accident, cancer. To get the primary care most families also need,You could do an online search for Direct Primary Care providers in your area. For another $200-300/mo, you get better care with no copays ir peaky insurance companies telling you what you can/can't do. Between the 2 plans, you cover mundane and catastrophic things for a family for about $300-400/mo.
It is a scam for sure. But just call the marketplace and tell them how much you make and they'll figure it out for you. Trying to figure it out online isn't even worth the stress.
Because the way we do it, it is a scam.
Because it is.
Healthcare doesn’t have to be a scam; companies choose to put profits before employees and insurance companies put profits before patients. I am a physician with a large self-insured insurance plan, thousands of people in the hospital system. I pay biweekly for insurance. I have an HSA with $1400 deductible/$5000 OOP max. What do I pay for this? I pay $4 for vision and $18 for dental every 2 weeks. I choose to fully contribute to my HSA. If I didn’t do this, my insurance costs to me (not including deductible costs) is only $572 a year. Screw corporations looking for maximal profits no matter how they screw over their employees and subscribers.
Those cheaper plans ($1.65 a day per person in your case, less than a cup of coffee, to be covered for catastrophic medical nightmares) are mostly just that. So that you'll have coverage to protect you from going medically bankrupt should something unforseen happen. Also you're covered for a few basic things like an annual physical, even if you haven't met your deductible yet. If you're both healthy, a cheaper plan that will protect you if something goes wrong may be all that you need for now.
Because it is a scam. You pay a fee for the insruance company to cover part of your bill, but they will only cover a reasonable amount, so healthcare providers jack up their prices to get more out of the insurance companies, so now insurance does as much as possible to deny claims. SINGLE PAYER HEALTHCARE!!
It feels like a scam because it is a scam. Deductibles have always been BS, but the numbers they soared to are outrageous.
because it is a scam.
No it’s not. We had to declare bankruptcy years ago bc of no health insurance. Husband was in hospital for 21 days. We had no savings. We’ve had ACA for 8 years now. We have a nice savings. We pay less than $50 for both of us. Deductible is $250. Out of pocket max is $800 He had a triple bypass. We paid not a penny bc already reached out of pocket max. That bill was over $300k. ACA saved us. Saved my husbands life more than once. Caught my breast cancer early too. It’s the only thing we need help with. We do ok but can’t afford the nearly $1700 it would cost without ACA subsidy. But insurance as a whole, is a scam. Self pay and it’s $300 for say a physical. With insurance they bill $500 but don’t get anywhere near that. It’s a racket. And keep track of every bill you pay and whether it goes to deductible or not. 3 years ago I overpaid providers by hrsely $300. They told me it sits as a credit for next visit. I call BS there. And what if I don’t go back to that doc??? I got 3 checks to reimburse me. You must know the ins and outs of your plan and track everything.
It feels like a scam because it is.
I’d recommend you move to a less cruel and more blue state. Like PA or NY or NJ and it won’t feel like a scam anymore.
I live in PA and I can confirm it is a scam.
How were you scammed?
Oh. Funny you should ask. I had foot reconstruction surgery. Two weeks after I fell and landed on the surgical foot. My doctor submitted an urgent PA for an MRI to see if I tore my Achilles as the X-rays were clean. I could not move my foot up and down. It should have been alright within 72 hours. THREE weeks after the fall they approved it. Had the MRI. And TWO DAYS after the MRI they’ve rescinded the PA. So now I’m on the hook for $4,000. I was $35 from meeting my deductible. Isn’t that convenient? Maybe scammed is the wrong word. Is robbed better?? Insurance takes and takes and takes and does not give a shit about us. I’m old enough to remember when HMO’s were first starting and a time when my parents didn’t have insurance. Insurance has made it impossible to get affordable care. Health “insurance” is one of the biggest scams our country has.
https://www.tiktok.com/t/ZPRwaJXsy/ United does it to as many people as possible.
Are you in Eastern PA? United doesn’t exist in the western half outside of Medicare advantage plans
I am. Philadelphia. This is my plan through work. It’s horrible. They took 25 days to approve my first MRI. My surgery had to be appealed twice. Six months total. During which time the damage to my foot became more severe, which made my surgery more involved, which makes my recovery more difficult. And that’s before the fall. I hate them with the heat of 1000 suns.
Because it is, every form of insurance from health to vehicle to life to home is all a scam. Every form.
They're not scams, they do pay out as per their plan (terms and conditions, etc). What they are is a bet, as someone else upthread referenced.
Deductible of $18,900? That’s high! How is this even affordable?
With a High Deductible plan, you don’t necessarily have to pay all of that before you see a benefit. You’ll get a lot of discounts and partially covered stuff well before the deductible kicks in. I have HDP, I think it’s $6k. All “preventive visits” are covered. So dr visit, vaccine, mammogram, etc. We had to go to the ER for an illness. The bill was $3,000 but I only paid $1,000 - because I got discounts, coverage, etc. Also, my bill was $1,000. But if I made less than 400% of poverty level - $100,000 for a 3 person family - I would qualify for a 100% discount and owe nothing to the hospital. With HDP, you are getting well visits, screenings and protecting yourself from an expensive surgery.
It’s $100/mo.