Author Topic: Healthcare for my GF (Why is it SO expensive?)  (Read 5570 times)

BuckeyeFinance

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Healthcare for my GF (Why is it SO expensive?)
« on: December 13, 2015, 07:24:29 PM »
She doesn't get healthcare through her employer. She will pay $200/month AFTER her $103/month tax credit through healthcare.gov. Silver plan, $500 deductible, $1,500 out of pocket max. Copays - $30 for PCP, $50 specialist, $15 generic. This seems kind of high for someone trying to cut their expenses. Anyone have suggestions/opinions? How much insurance is too much?

« Last Edit: December 13, 2015, 07:28:37 PM by BuckeyeFinance »

maizefolk

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #1 on: December 13, 2015, 07:44:41 PM »
If she's young, in good health, and has an emergency fund saved up, why not select an HSA compatible bronze plan instead? It might save a little bit of month and gives an extra tax deferred savings basket (if her job doesn't offer health care I bet it doesn't offer a 401k plan either).

redcedar

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #2 on: December 13, 2015, 07:49:50 PM »
Ditto on HSA eligible bronze plan but make sure to check overall viability vs subsidized silver plan.

Other option is, gasp!, to forgo insurance and pay the penalty. Do note the penalty is increased in 2016 over 2015 though.

BuckeyeFinance

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #3 on: December 13, 2015, 07:56:11 PM »
Ditto on HSA eligible bronze plan but make sure to check overall viability vs subsidized silver plan.

Other option is, gasp!, to forgo insurance and pay the penalty. Do note the penalty is increased in 2016 over 2015 though.

Isn't not having medical insurance a pretty unnecessary risk?

Gin1984

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #4 on: December 13, 2015, 08:04:35 PM »
Ditto on HSA eligible bronze plan but make sure to check overall viability vs subsidized silver plan.

Other option is, gasp!, to forgo insurance and pay the penalty. Do note the penalty is increased in 2016 over 2015 though.

Isn't not having medical insurance a pretty unnecessary risk?
Yes, yes it is.  Paying less than 10% of your income towards health care is not an unreasonable cost however.  Health care, in the USA, is expensive.

NathanP

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #5 on: December 13, 2015, 08:22:49 PM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

maizefolk

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #6 on: December 13, 2015, 08:45:18 PM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

In an ideal world you're unlikely to be hospitalized with an unexpected case of childbirth in the middle of the year. But please do add that caveat to my list above:

If she's young, in good health, has an emergency fund saved up, and not planning on having a child in the next twelve months...

I think risking that extra $5000 or so in the case of unexpected health problems (or even unexpected babies although 3/4ths of the time she'd have a chance to change her insurance plan between finding out about it and delivery) by choosing an HDHP makes sense in most cases where you'd have the money to spend if you needed it. Going entirely without insurance means living with a while different world of risk. Apparently even a simple appendectomy averages more than $30,000 these days.

Exflyboy

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #7 on: December 13, 2015, 10:41:36 PM »
Why is it So expensive?.. Because we are getting screwed by corporations who the services of high paid lobbyists with direct access to the government... that's the bottom line.

Here it is graphically, I believe the US is spending nearer $10,000 per person last year.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

MDM

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #8 on: December 13, 2015, 11:58:55 PM »
Why is it So expensive?.. Because we are getting screwed by corporations who the services of high paid lobbyists with direct access to the government... that's the bottom line.

Here it is graphically, I believe the US is spending nearer $10,000 per person last year.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

^Good article and also good and varied perspectives in the comments.

See also http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf for many more reasons.

ulrichw

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #9 on: December 14, 2015, 10:06:48 AM »
We're heading off-topic, so I'll put in a quick statement to OP: I agree with all others - getting such a low deductible/OOP will cost you heavily in premiums.

My recommendation is to use insurance for what its primary purpose should be - to provide a backstop if you (or your GF, in this case) get unlucky, and end up having really large medical expenses. To figure out which insurance plan to get, figure out what the highest out of pocket (OOP) number is that you can afford without having the amount be "life changing." Then see how much cheaper the premiums are.

The Obamacare incentives change the equation a bit, but in general you'll find that if you go a few (2-3) years without a major expense, you'll be ahead with the plan with higher limits. This is true of almost any insurance - if you can afford to take a loss, you'll be better off self-insuring (the insurance companies, after all, have to make a profit somehow). The place you want insurance is where the losses will have a potentially catastrophic effect on your finances.

Now to respond to the previous two posters on medical costs:
The articles referenced do state some really good reasons why medical costs are high in our country, but in my opinion miss the mark on a comprehensive view of the problem.

The real issue, again in my opinion, is systemic - the entire way medical care is delivered is to some degree broken in this country. Here's why:
- Pricing is neither transparent nor determined by the consumers of care (us) - instead it's a complex system using Medicare prices as a baseline and then negotiated between insurance carriers and providers (doctors and hospitals). Neither party is powerless in this negotiation (contrary to the quote in MDM's article) - you'll find that both sides try to vilify the other, with providers saying the insurance companies are getting larger and larger and negotiating tighter and tighter prices, and the insurance companies saying the providers are getting bigger and negotiating higher prices.
- The real issue is that this is so much noise - neither party has a really strong interest in low prices. The insurance carriers make money by simply being good at predicting how much care their insured population is going to require and then charging a little more in premiums. Effectively they're getting a piece of the healthcare pie. So what happens if healthcare costs (as a whole) go up? The whole pie gets bigger, as does the insurance companies' slice.
- The other culprit is the consumer. For so long, a large portion of healthcare consumers has had rich plans provided by employers. Where the actual healthcare costs the consumers incurred might have been in the thousands of dollars, our out of pocket costs were comparatively miniscule (a tenth or less). Premiums were picked up by employers - so there was no perceived cost to this benefit. So where is the incentive to pick the provider and choose the care that costs the least? As a result, we let the system grow into what it is today.

The current trend of HDHPs (often called consumer-driven health plans) and more "cost-sharing" between employers and employees is going to slowly change this picture. But in the meantime, there will be a lot of pain and teeth-gnashing as the inefficiencies in the system get unravelled.

(BTW: there's a lot more to this - the main caution I'd apply is to view with skepticism any message which leaves anyone blameless - we're all to blame).

maizefolk

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #10 on: December 14, 2015, 10:18:21 AM »
- Pricing is neither transparent nor determined by the consumers of care (us)
...
The current trend of HDHPs (often called consumer-driven health plans) and more "cost-sharing" between employers and employees is going to slowly change this picture. But in the meantime, there will be a lot of pain and teeth-gnashing as the inefficiencies in the system get unravelled.

In order for the second point to have an effect, it seems like the first would need to be corrected. I haven't noticed much more transparency in pricing brought about by the HDHP trend, but I also am fortunate enough to consume very little heathcare on a year to year basis. Do others have any sense of whether it is getting easier to comparison shop to get a good deal on particular medical procedures?

I suppose the other way HDHPs could reduce costs is simply by discouraging people from seeking medical attention for less serious issues. To me, the barrier of an issue being serious enough to warrant going through the unpleasantness of dealing with doctors/hospitals is already a much higher hurdle than the barrier of an issue being serious enough I'm willing to spend money to get it fixed, but it's always dangerous to extrapolate from personal experience to the larger population.

I'm a red panda

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #11 on: December 14, 2015, 10:50:00 AM »

In an ideal world you're unlikely to be hospitalized with an unexpected case of childbirth in the middle of the year. But please do add that caveat to my list above:

If she's young, in good health, has an emergency fund saved up, and not planning on having a child in the next twelve months...

I think risking that extra $5000 or so in the case of unexpected health problems (or even unexpected babies although 3/4ths of the time she'd have a chance to change her insurance plan between finding out about it and delivery) by choosing an HDHP makes sense in most cases where you'd have the money to spend if you needed it.

Oh, if only we lived in an ideal world...  :(

However, I think a HDHP still makes sense in that non-ideal world. If you are unexpectedly hospitalized due to pregnancy (which would likely mean serious complications if you had thought you'd be delivering well into the next year), you're probably going to reach your deductible anyway.  HDHP seem to make the most sense if you plan to use very little -or- a lot of medical care.  It's the in-between that gets you.

Quote
Going entirely without insurance means living with a while different world of risk. Apparently even a simple appendectomy averages more than $30,000 these days.
There is an insane level of risk to not having insurance. I couldn't imagine anyone doing this if they were not a many-time multi-millionaire to self-insure.

reader2580

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #12 on: December 14, 2015, 10:53:36 AM »
$200 a month seems pretty reasonable to me with no employer subsidy.  Heck, I pay $105 or so a month as my portion for an employer plan that costs over $500 a month with my employer paying 80%.  I have a higher out of pocket max than $1500 too and I pay 20% of all healthcare once the deductible is satisfied.

Trudie

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #13 on: December 14, 2015, 11:47:40 AM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

This is not out of line with what we pay for single (group) coverage with a higher deductible at my work place.  I pay the company's health insurance bills, so I know the cost.  I am a fan of the ACA for many reasons (mainly access), but it has not done much to rein in costs.  That is/will be a longer term problem, but the ship won't turn quickly.

Bucksandreds

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #14 on: December 14, 2015, 01:20:40 PM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

This is not out of line with what we pay for single (group) coverage with a higher deductible at my work place.  I pay the company's health insurance bills, so I know the cost.  I am a fan of the ACA for many reasons (mainly access), but it has not done much to rein in costs.  That is/will be a longer term problem, but the ship won't turn quickly.

Only way to truly reign in cost is rationing care. That can only be accomplished through a government run program. Lowering prescription costs, limiting insurance profits, etc alone cant get us to a sustainable end result.  Raise FICA/medicare tax to include Medicare for all and ration care.  Then encourage people to buy unrationed private insurance if they want. 

Gin1984

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #15 on: December 14, 2015, 02:28:40 PM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

This is not out of line with what we pay for single (group) coverage with a higher deductible at my work place.  I pay the company's health insurance bills, so I know the cost.  I am a fan of the ACA for many reasons (mainly access), but it has not done much to rein in costs.  That is/will be a longer term problem, but the ship won't turn quickly.

Only way to truly reign in cost is rationing care. That can only be accomplished through a government run program. Lowering prescription costs, limiting insurance profits, etc alone cant get us to a sustainable end result.  Raise FICA/medicare tax to include Medicare for all and ration care.  Then encourage people to buy unrationed private insurance if they want.
Or we could stop letting insurances negotiate prices and make there be one price for all, and make that price reasonable.  No more $5 aspirins on top of room costs etc.

Bucksandreds

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #16 on: December 15, 2015, 06:55:21 AM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

This is not out of line with what we pay for single (group) coverage with a higher deductible at my work place.  I pay the company's health insurance bills, so I know the cost.  I am a fan of the ACA for many reasons (mainly access), but it has not done much to rein in costs.  That is/will be a longer term problem, but the ship won't turn quickly.

Only way to truly reign in cost is rationing care. That can only be accomplished through a government run program. Lowering prescription costs, limiting insurance profits, etc alone cant get us to a sustainable end result.  Raise FICA/medicare tax to include Medicare for all and ration care.  Then encourage people to buy unrationed private insurance if they want.
Or we could stop letting insurances negotiate prices and make there be one price for all, and make that price reasonable.  No more $5 aspirins on top of room costs etc.

If government is going to the extent of controlling prices then why use private insurance at all?  Savings with profit gone and lower administrative costs of Medicare would make private insurance extra unnecessary.

Gin1984

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Re: Healthcare for my GF (Why is it SO expensive?)
« Reply #17 on: December 15, 2015, 07:31:56 AM »
200/month doesn't seem bad considering the low deductible and relatively low out of pocket max. If it makes you feel better look up the cost of a surgery or child birth and compare it to the $1500 limit.

As others have said look at lower cost plans that have a higher deductible and max out of pocket. Treat it like any other type of insurance by asking yourself, "How much am I willing to pay assuming 'x' happens?"

This is not out of line with what we pay for single (group) coverage with a higher deductible at my work place.  I pay the company's health insurance bills, so I know the cost.  I am a fan of the ACA for many reasons (mainly access), but it has not done much to rein in costs.  That is/will be a longer term problem, but the ship won't turn quickly.

Only way to truly reign in cost is rationing care. That can only be accomplished through a government run program. Lowering prescription costs, limiting insurance profits, etc alone cant get us to a sustainable end result.  Raise FICA/medicare tax to include Medicare for all and ration care.  Then encourage people to buy unrationed private insurance if they want.
Or we could stop letting insurances negotiate prices and make there be one price for all, and make that price reasonable.  No more $5 aspirins on top of room costs etc.

If government is going to the extent of controlling prices then why use private insurance at all?  Savings with profit gone and lower administrative costs of Medicare would make private insurance extra unnecessary.
Because I don't think it requires rationing to bring the cost down, what is necessary is to stop pretending some items cost an insane amount so the insurance company can pretend they "helped" by negotiating it down to a more reasonable price.  Similar to how the ACA said that insurance companies had to spend 80% of premiums on medical care, allow for hospitals to charge X% above cost instead of pretending a band-aid costs $5.