Author Topic: Health insurance  (Read 7685 times)

Fiddler Nick

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Health insurance
« on: August 11, 2016, 08:34:43 PM »
Not really sure if this is the right place for this, but what do mustachians do for health insurance?  I read an old post about a high deductible plan, I used to have one and I loved it, but they have gone the way of the mammoth where I am.  Sorry to you lovers, but Obamacare plans are pretty awful.  I pay a fortune for crap insurance that's not much good out of state and my income keeps creeping up, because I can't stop saving money.  It's going to get to the point where I pay $900 bucks a month for this crap plan.  Whole family lives off $36000 so nearly a third of that going to insurance seems bogus.  Enough bitching, I'm not here to complain, I want to know what the clever self-employed or unconventionally retired people are doing to cover their asses?  I would love a cheap ass policy with a $50000 out of pocket limit.  Is there any way to still get one? I would forget it completely, I'm just scared of a $1000000 bill.  Also interested in unconventional thoughts on how to deal with this problem.  Anybody health share?  Anybody self pay and negotiate the balls off of bills?  Whatever you've got let's hear it.
To avoid a few reasonable but off topic replies: No, I don't have any access to employer based coverage.  I make a lot more than 36,000, that's what I spend, so subsidies are limited and I hate taking other people's money anyway.

Roland of Gilead

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Re: Health insurance
« Reply #1 on: August 11, 2016, 08:55:41 PM »
Pretty much the only thing you can do is bitch and pay up until you retire and can.control your MAGI such that you get a subsidy.  We were spending $35k and paying $60k in federal tax alone while we were working.  Even had to pay several hundred in ACA tax back then.

LeRainDrop

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Re: Health insurance
« Reply #2 on: August 11, 2016, 09:20:36 PM »
Sorry, Fiddler, I feel your pain.  I'm ponying up a high premium for COBRA because I checked out all of the ACA plans in my state, NONE of my doctors are in ANY of the provider networks for these plans, and I'm not willing to change doctors right now.  My mom is a nanny, so she is reliant on the ACA plans, and they are high premium and high deductible, again forcing her to change doctors from when she previously was on a COBRA plan through my dad's former employer.

Fiddler Nick

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Re: Health insurance
« Reply #3 on: August 12, 2016, 06:28:15 AM »
At 10,000+ a year for the next 30 years until Medicare, with the loss of reinvestment of dividends and growth from investment, it works out to somewhere around $1,000,000 dumped into the healthcare system.  Craziness!  I know the standard answer, "pony up." Now that's definitely not bad advise, but surely there are some mustachians taking alternative routes?  I hate doing things that are nonmathematically fear based, but that's what I'm currently doing on the tiny chance that somebody in the family will rack up a life wrecking bill.

Roland of Gilead

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Re: Health insurance
« Reply #4 on: August 12, 2016, 07:37:58 AM »
In a nine month period at age 53 my dad racked up $1,200,000 in medical expenses.  So there is your million wasted in premiums and lost compounding.

Fiddler Nick

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Re: Health insurance
« Reply #5 on: August 12, 2016, 07:59:37 AM »
Indeed, I am perfectly aware that it can happen.  That's the crux of the problem.  The rarity of it happening is what made high deductible plans so much cheaper.  I am not arguing against the possibility of destruction!  Indeed that's the only reason anybody with significant savings should have insurance.  Out of curiosity, were the bills 1.2 million or was that what insurance ended up paying?  Often insurance ends up paying about %10-%15 percent of what the hospital charges. That would be 120-180,000 in payout.  Of course they have a lobbying arm, makes it much easier for them to negotiate prices.

Roland of Gilead

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Re: Health insurance
« Reply #6 on: August 12, 2016, 10:47:56 AM »
Indeed, I am perfectly aware that it can happen.  That's the crux of the problem.  The rarity of it happening is what made high deductible plans so much cheaper.  I am not arguing against the possibility of destruction!  Indeed that's the only reason anybody with significant savings should have insurance.  Out of curiosity, were the bills 1.2 million or was that what insurance ended up paying?  Often insurance ends up paying about %10-%15 percent of what the hospital charges. That would be 120-180,000 in payout.  Of course they have a lobbying arm, makes it much easier for them to negotiate prices.

No, those were the actual payouts.  He had 17 operations and was in a hospital room for 7 months.  All because of a stupid gallstone.

Fiddler Nick

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Re: Health insurance
« Reply #7 on: August 12, 2016, 12:34:22 PM »
Damn!

cj25

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Re: Health insurance
« Reply #8 on: August 12, 2016, 12:52:14 PM »
If you are a Christian and attend church, there are health co-ops.  Basically, you pay a base rate every month and that goes to pay the claims of the others in the co-op.  Meanwhile, you pay any claim under $300.  Anything over $300 for a single "issue" can be submitted for reimbursement.  Then there are additional premiums that can be made to cover claims into the hundreds of thousands/millions.  You negotiate and pay cash prices for everything and decide your own healthcare.   And being in the co-op is an exemption under the ACA.  Not sure if other non-religious groups also offer anything similar.

Fiddler Nick

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Re: Health insurance
« Reply #9 on: August 12, 2016, 02:14:24 PM »
Yes, I've seen those.  Liberty Health share does not require a statement of faith.  I'm Episcopalian, so some of the others I could apply for as well.  I'm highly interested in those, but I have two problems with them.  First, no contract! That makes me nervous. Second, lots of them have a 1,000,000cap.  As a recent poster noted, it's possible to break that cap these days with the ridiculous prices hospitals charge.   However, if you are a mustachian who uses a health share option, please share your opinions about it!  I want to hear everything, good, bad and ugly.

Spork

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Re: Health insurance
« Reply #10 on: August 12, 2016, 02:41:27 PM »
Back to the original question...

We're using an ACA bronze plan that is high deductible and HSA compatible.  The HSA compatibility allows us to reduce MAGI by $6750 (2016 numbers) while investing that money in Vanguard funds.


edit:  Just googled and that $6750 is also true for 2017.
« Last Edit: August 12, 2016, 03:19:27 PM by Spork »

LeRainDrop

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Re: Health insurance
« Reply #11 on: August 12, 2016, 02:55:05 PM »
Yes, I've seen those.  Liberty Health share does not require a statement of faith.  I'm Episcopalian, so some of the others I could apply for as well.  I'm highly interested in those, but I have two problems with them.  First, no contract! That makes me nervous. Second, lots of them have a 1,000,000cap.  As a recent poster noted, it's possible to break that cap these days with the ridiculous prices hospitals charge.   However, if you are a mustachian who uses a health share option, please share your opinions about it!  I want to hear everything, good, bad and ugly.

You may be interested in reading this article by Holly Johnson at Club Thrifty:  http://clubthrifty.com/liberty-healthshare-review/

Fiddler Nick

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Re: Health insurance
« Reply #12 on: August 12, 2016, 03:13:54 PM »
Interesting on the HSA MAGI thing.  Will have to look that up.  Interesting also the Liberty article.  Would love to see a candid review of big bill "Health share pony's up a gazillion dollars for patient's new flux capacitor."Thanks to all commentors thus far.  Keep that info rolling in!

Monkey Uncle

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Re: Health insurance
« Reply #13 on: August 13, 2016, 05:18:27 AM »
Yes, I've seen those.  Liberty Health share does not require a statement of faith.  I'm Episcopalian, so some of the others I could apply for as well.  I'm highly interested in those, but I have two problems with them.  First, no contract! That makes me nervous. Second, lots of them have a 1,000,000cap.  As a recent poster noted, it's possible to break that cap these days with the ridiculous prices hospitals charge.   However, if you are a mustachian who uses a health share option, please share your opinions about it!  I want to hear everything, good, bad and ugly.

You may be interested in reading this article by Holly Johnson at Club Thrifty:  http://clubthrifty.com/liberty-healthshare-review/

I'm quite intrigued by the healthshare concept.  It's basically cutting through all the crap and going back to old-school fee-for-service insurance.  But the cap on payouts per incident would probably scare me away.  If you get cancer, you're fucked.

Fiddler Nick

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Re: Health insurance
« Reply #14 on: August 13, 2016, 06:24:10 AM »
That fear of the cap is what has kept me from making that leap thus far.

Spork

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Re: Health insurance
« Reply #15 on: August 13, 2016, 12:30:38 PM »
That fear of the cap is what has kept me from making that leap thus far.

The fear of them canceling me because they passed moral judgment on me would keep me from leaping.  If you make a big claim and they start deciding whether your moral fiber meets their coverage...  This seems like a good way out of paying big bills.

Richie Poor

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Re: Health insurance
« Reply #16 on: August 16, 2016, 10:50:41 AM »
Yes, I've seen those.  Liberty Health share does not require a statement of faith.  I'm Episcopalian, so some of the others I could apply for as well.  I'm highly interested in those, but I have two problems with them.  First, no contract! That makes me nervous. Second, lots of them have a 1,000,000cap.  As a recent poster noted, it's possible to break that cap these days with the ridiculous prices hospitals charge.   However, if you are a mustachian who uses a health share option, please share your opinions about it!  I want to hear everything, good, bad and ugly.

You may be interested in reading this article by Holly Johnson at Club Thrifty:  http://clubthrifty.com/liberty-healthshare-review/

I'm quite intrigued by the healthshare concept.  It's basically cutting through all the crap and going back to old-school fee-for-service insurance.  But the cap on payouts per incident would probably scare me away.  If you get cancer, you're fucked.

I have used a healthcare sharing ministry for about 2 years. I pay $405 for my family but that might go up a bit soon. I think there could certainly be a risk of bills going over $1 million but the odds seem low for healthy people under 50. What also mitigates the risk is that if it is a drawn out health problem that last months you can likely just switch over to an ACA plan during enrollment periods. It is doubtful it would ever come to that however. There are people participating in healthcare sharing that get cancer and people that have brain surgery and they do just fine. I read about them in the monthly newsletter.

I personally would have a hard time paying an extra $500 a month (the difference between my plan and yours) because I worried about the cap. $6k a year can make a big difference to my FIRE plans. I might have a higher risk tolerance than some though. I can understand why some people don't make the change though. I waffled myself for months.

Monkey Uncle

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Re: Health insurance
« Reply #17 on: August 17, 2016, 04:34:46 AM »
Yes, I've seen those.  Liberty Health share does not require a statement of faith.  I'm Episcopalian, so some of the others I could apply for as well.  I'm highly interested in those, but I have two problems with them.  First, no contract! That makes me nervous. Second, lots of them have a 1,000,000cap.  As a recent poster noted, it's possible to break that cap these days with the ridiculous prices hospitals charge.   However, if you are a mustachian who uses a health share option, please share your opinions about it!  I want to hear everything, good, bad and ugly.

You may be interested in reading this article by Holly Johnson at Club Thrifty:  http://clubthrifty.com/liberty-healthshare-review/

I'm quite intrigued by the healthshare concept.  It's basically cutting through all the crap and going back to old-school fee-for-service insurance.  But the cap on payouts per incident would probably scare me away.  If you get cancer, you're fucked.

I have used a healthcare sharing ministry for about 2 years. I pay $405 for my family but that might go up a bit soon. I think there could certainly be a risk of bills going over $1 million but the odds seem low for healthy people under 50. What also mitigates the risk is that if it is a drawn out health problem that last months you can likely just switch over to an ACA plan during enrollment periods. It is doubtful it would ever come to that however. There are people participating in healthcare sharing that get cancer and people that have brain surgery and they do just fine. I read about them in the monthly newsletter.

I personally would have a hard time paying an extra $500 a month (the difference between my plan and yours) because I worried about the cap. $6k a year can make a big difference to my FIRE plans. I might have a higher risk tolerance than some though. I can understand why some people don't make the change though. I waffled myself for months.

Yeah, I didn't think about the fact that you can just switch to an ACA plan if things go bad.  I'm so used to the old health insurance model that I keep forgetting that pre-existing conditions don't matter any more for regular insurance policies.

Not sure I'm ready to jump on board with the "statement of shared beliefs," though.  I mean, I know Liberty isn't going to check up on you to see if you're actually going to church and reading the bible, but the references to "God of the Bible," "biblical duty," etc. make me uncomfortable.  And from what I've seen, Liberty is probably the most lenient healthshare when it comes to enforcing a religious code.

Quick searches for "atheist healthshare" and "non-religious health care sharing" just produced more links to Liberty.

Richie Poor

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Re: Health insurance
« Reply #18 on: August 17, 2016, 10:37:41 AM »
The group I belong to is Samaritan Ministries and I didn't have a problem with the statement of faith. I can understand some people that do though. You may look into Altrua Healthshare as they have a "Statement of Standards" as opposed to a statement of faith. Those standards may or may not fit you. I have no experience with Altrua so can't vouch for how well they operate as an organization.

In your original post you also asked about negotiating bills. I have found that being self pay will generally get around a 20-25% discount with most doctors. I was able to negotiate my wife's anesthesiologist bill 50% (had to pay it off right away). Being self pay it becomes important to shop around for the best prices on things like MRIs. They can vary a good bit. I've never used it but I understand there are "medi-bid" tools that allow you to get bids on procedures. Medical tourism starts looking pretty viable too. I know others have written on the MMM forums about dental tourism and I will likely follow suit in a few years.


Axecleaver

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Re: Health insurance
« Reply #19 on: August 17, 2016, 10:58:41 AM »
Hi Nick, are you saying that there are no HDHP health plans available where you are? What state are you in, if you don't mind me asking? Are you not eligible for subsidies, or is your subsidy simply lower than it was, because you make more money now? Most markets have HDHP options available, typically as an HDHP version of another non-high deductible plan.

Sometimes they are sold on the open market, not on the Exchanges. If you don't get a subsidy or cost sharing, it's fine for you to buy off-exchange. But if you do get a subsidy, you will be limited to plans sold through the Exchange.

My understanding of health sharing ministries is that they typically pay providers higher rates, because their ability to negotiate provider discounts is limited. I have very little experience with them other than what is defined in the ACA. No new healthsharing ministries can be formed, only ones that existed prior to the ACA's passage, due to how the legislation was written.

Monkey Uncle

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Re: Health insurance
« Reply #20 on: August 18, 2016, 04:39:46 AM »
In your original post you also asked about negotiating bills. I have found that being self pay will generally get around a 20-25% discount with most doctors. I was able to negotiate my wife's anesthesiologist bill 50% (had to pay it off right away). Being self pay it becomes important to shop around for the best prices on things like MRIs. They can vary a good bit. I've never used it but I understand there are "medi-bid" tools that allow you to get bids on procedures. Medical tourism starts looking pretty viable too. I know others have written on the MMM forums about dental tourism and I will likely follow suit in a few years.

My understanding of health sharing ministries is that they typically pay providers higher rates, because their ability to negotiate provider discounts is limited. I have very little experience with them other than what is defined in the ACA.

Can anyone with healthshare experience address these two somewhat contradictory posts?  I always assumed that self-pay patients (which would seem to include healthshare members) pay higher prices due to the lack of an insurance company negotiating "in network" prices.  Every time I get a statement of benefits from my insurance company, it shows the price the provider tried to charge, which is always higher (sometimes substantially higher) than the negotiated price that the insurance company actually paid.  I presume the provider is charging self-pay patients that higher price.  How much leverage do self-pay patients have to negotiate that down?

bmiles62

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Re: Health insurance
« Reply #21 on: August 18, 2016, 07:07:07 AM »
I currently am using a health share program for my wife and have had no problems however the cap does linger in the back of my mind. I am hearing that some people are buying insurance outside of the ACA and even with paying the penalty it ends up being cheaper better coverage. Of course when you buy outside of ACA you have to qualify and not have any major preexisting conditions. I am not exactly sure how to buy insurance outside of ACA. Ha s any one here done it? If yes who did you go through to get it?

Richie Poor

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Re: Health insurance
« Reply #22 on: August 18, 2016, 07:28:46 AM »
In your original post you also asked about negotiating bills. I have found that being self pay will generally get around a 20-25% discount with most doctors. I was able to negotiate my wife's anesthesiologist bill 50% (had to pay it off right away). Being self pay it becomes important to shop around for the best prices on things like MRIs. They can vary a good bit. I've never used it but I understand there are "medi-bid" tools that allow you to get bids on procedures. Medical tourism starts looking pretty viable too. I know others have written on the MMM forums about dental tourism and I will likely follow suit in a few years.

My understanding of health sharing ministries is that they typically pay providers higher rates, because their ability to negotiate provider discounts is limited. I have very little experience with them other than what is defined in the ACA.

Can anyone with healthshare experience address these two somewhat contradictory posts?  I always assumed that self-pay patients (which would seem to include healthshare members) pay higher prices due to the lack of an insurance company negotiating "in network" prices.  Every time I get a statement of benefits from my insurance company, it shows the price the provider tried to charge, which is always higher (sometimes substantially higher) than the negotiated price that the insurance company actually paid.  I presume the provider is charging self-pay patients that higher price.  How much leverage do self-pay patients have to negotiate that down?

They are contradictory but keep in mind there are different healthsharing organizations out there and each one operates a little differently. Some operate extremely similar to insurance company that have networks of doctors. The group I belong to doesn't get that involved. I pay my own medical bills as a self-pay patient and then submit them to the group and I am reimbursed. The big benefit for me is I have absolute control over the doctors I see. I can choose based on the cash discount they give or I can just pick the best specialist doctor in the country. I think it is rare for self pay patients to pay the "list price". Doctors offices tend to really value patients that don't use insurance but still pay right away.

Buying insurance outside the ACA sounds interesting. I didn't know it was possible. A a true catastrophic plan would be awesome.

Fiddler Nick

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Re: Health insurance
« Reply #23 on: August 18, 2016, 07:31:01 AM »
Cool, lots of great replies.  I hadn't checked in a few days because I thought the thread had died. Thanks for not letting it do so. I'll try to respond to each of you, but let me know if I forget someone.  First, yes I am familiar with Samaritan.  They are pretty finicky about who they let in, or at least their information packet seems that way. I do like the fact that practically nothing goes to administration, that's cool.  I do not like the fact that there is practically no deductible, I feel like that encourages less care about prices and will eventually drive the price up. Have you been satisfied with them? Have you ever had a big bill?  How did it work out?
For Monkey Uncle, Liberty is as loose as it gets in the statement of faith.  I can see how an atheist,agnostic or non Judeo/Christian religious adherent would hesitate to sign on. There will be no new ones, they have been frozen to these five:samaratin, CHM, Medishare, altrua, liberty.  In order of hardcore religiosity they seem to be from lax to tight: liberty, altrua, chm, Medishare/Samaritan(these two seem about the same).  CHM and Medishare have policies that would run about $175 a month for the whole family, but the have low caps.  I think the idea is that you can pick up aca if the shtf.
Axecleaver(love the name, sounds like a viking)
I live in Mississippi in the heart of anti aca country, lots of docs don't take the exchange plans and few exchange plans are available.  I have taken the subsidy, but my income creeps up every year and my deduction gets less.  I should correct my initial post, I am rushing toward $900 a month.  I am subsidized less every year. ETA three years, full price. Plus, I hate taking the subsidy anyway. I wish I had my old $200 a month policy back, but it's dead.  I could try to make less money, but since I enjoy making money and I hate taking oher people's money that seems like a bad option.  I could buy a plan off exchange, but I'm very frugal.  So I'm looking at all options and I appreciate all the things people have said thus far.
Monkey Uncle
I have personally negotiated an %80 reduction in hospital bills.  My old policy didn't cover maternity.  It doesn't mean all hospitals will do it, but often if you offer to pay the negotiated balance right now!! They will take it.  If they decide to be jackasses about it, you don't have the power that insurance companies do.  Some hospitals list their policies on cash online. I'll find a link for one of those hospitals.

Roland of Gilead

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Re: Health insurance
« Reply #24 on: August 18, 2016, 08:04:16 AM »
Curious why you hate taking the subsidy?

When we were pulling in $260k a year and having to pay a few thousand extra in Obama tax for the ACA on our investments, I hated that.  I like the subsidy we get now, kind of a payback.

Fiddler Nick

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Re: Health insurance
« Reply #25 on: August 18, 2016, 08:42:59 AM »
First of all, down here the amount to disqualify for aca subsidy is far less.  At around $90,000 a year for a family of four, the tap shuts off entirely. Actually, above about $80,000 it dwindles to almost nothing, so when I talk about making too much money, I'm not talking about hauling in a mother load, I doubt I will get to the point where I am paying back into the pool like you did, isn't that over $200,000?  So, when I take the subsidy, I am taking money out of your pocket, right?  I don't want your money, I have my own.  Plus, I am paying money to increasingly sleezy health insurance companies,  Not only paying my money, but yours too.  I guess I was paying the jerks before, but it was less and I wasn't compelled to do it.  So yes, there is some guilt involved.  I think I have plenty of money,yet I will probably never repay your contribution.  At the same time, I'm frugal(read cheap) so I don't want to pay a fortune to take the high moral ground and buy a policy that costs 1\3 of what we live off of.

Spork

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Re: Health insurance
« Reply #26 on: August 18, 2016, 09:10:43 AM »
In your original post you also asked about negotiating bills. I have found that being self pay will generally get around a 20-25% discount with most doctors. I was able to negotiate my wife's anesthesiologist bill 50% (had to pay it off right away). Being self pay it becomes important to shop around for the best prices on things like MRIs. They can vary a good bit. I've never used it but I understand there are "medi-bid" tools that allow you to get bids on procedures. Medical tourism starts looking pretty viable too. I know others have written on the MMM forums about dental tourism and I will likely follow suit in a few years.

My understanding of health sharing ministries is that they typically pay providers higher rates, because their ability to negotiate provider discounts is limited. I have very little experience with them other than what is defined in the ACA.

Can anyone with healthshare experience address these two somewhat contradictory posts?  I always assumed that self-pay patients (which would seem to include healthshare members) pay higher prices due to the lack of an insurance company negotiating "in network" prices.  Every time I get a statement of benefits from my insurance company, it shows the price the provider tried to charge, which is always higher (sometimes substantially higher) than the negotiated price that the insurance company actually paid.  I presume the provider is charging self-pay patients that higher price.  How much leverage do self-pay patients have to negotiate that down?

I do not have healthshare experience, but nonetheless I will try to explain the contradiction.  I have gone into doctors offices and asked if there was a discount for paying cash in full.  There almost always is one.  I have gone in with an insurance card and seen the same thing -- a significant discount pre-negotiated.  The common factor is this: You're telling them up front, "Yes, you are going to get paid."  They love that.  Hospitals and doctors pretty much expect a very large number of people to walk in, get services and walk away without paying.  That amount is written off at "full price".  They are minimizing their losses by maximizing the write off expenses.

LeRainDrop

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Re: Health insurance
« Reply #27 on: August 18, 2016, 11:59:16 AM »
Can anyone with healthshare experience address these two somewhat contradictory posts?  I always assumed that self-pay patients (which would seem to include healthshare members) pay higher prices due to the lack of an insurance company negotiating "in network" prices.  Every time I get a statement of benefits from my insurance company, it shows the price the provider tried to charge, which is always higher (sometimes substantially higher) than the negotiated price that the insurance company actually paid.  I presume the provider is charging self-pay patients that higher price.  How much leverage do self-pay patients have to negotiate that down?

I do not have healthshare experience, but nonetheless I will try to explain the contradiction.  I have gone into doctors offices and asked if there was a discount for paying cash in full.  There almost always is one.  I have gone in with an insurance card and seen the same thing -- a significant discount pre-negotiated.  The common factor is this: You're telling them up front, "Yes, you are going to get paid."  They love that.  Hospitals and doctors pretty much expect a very large number of people to walk in, get services and walk away without paying.  That amount is written off at "full price".  They are minimizing their losses by maximizing the write off expenses.

I went to my doctor recently while I was still in the window where I could elect COBRA or not elect it from my last job.  I had not yet elected and wanted to find out what the cost would be if I just paid the doctor's bill myself.  So, when I registered at the front desk, I told them that background, and they said that I would get registered as "self-pay" and that I get a 60% discount.  (Ultimately, I elected COBRA anyway, so my final payment was made as an insured patient.)

jim555

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Re: Health insurance
« Reply #28 on: August 18, 2016, 12:11:24 PM »
The ACA is easy to optimize once you know the ins and outs of how it runs.  Pre ACA was a nightmare and I would probably still be working if it didn't exist.  Some states are much better than others.  In my state you can have income of <200 FPL and only pay $20 a month.  Under 150 FPL and it is $0 a month.  So I now pay $0 a month and have a max yearly OOP of $200.  That is like a super platinum plan.  The key is location and MAGI control.

I have NO problem with this.  I worked 28 years and have paid huge amounts of taxes, this is a small recovery compared to what I have paid in.

Fiddler Nick

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Re: Health insurance
« Reply #29 on: August 18, 2016, 12:32:55 PM »
Wow, that is amazingly cheap.  I hear you on the tax thing.
Good info from all, keep it rolling in.