Author Topic: Health Insurance Choice Help  (Read 4079 times)

FarmFam

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Health Insurance Choice Help
« on: July 17, 2015, 01:37:22 PM »
It is that time when we need to pick an option.

Family of 4: married with 2 kids

We have accident insurance which covers accidents: $12 per paycheck.  This will stay and no insurance is needed to have this.  We live on a farm and accidents happen more frequently in rural areas!  They actually have studies about this...LOL

Healthcare options:

1) No insurance =  penalty ($93,000 income before taxes and deductions) We are confused at what the penalty would be
2) Christian Medical Share program = Bronze at $145 per month, no preventive, $5,000 deductible (no penalty with this option)
3) High deductible Insurance from job = $94 biweekly, covers preventive 100%, $5,000 individual deductible

I am healthy, kids are healthy for the exception of a yearly epipen purchase ($700) which means he needs a visit to a "regular" doctor for the prescription yearly, husband has high blood pressure which has been controlled through diet and exercise.  We prefer holistic natural care which the insurance doesn't pay for.

Thank you for all the great information and advice!

lsalinas

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Re: Health Insurance Choice Help
« Reply #1 on: July 17, 2015, 02:12:46 PM »
I don't have any advice, but to help with the numbers:

The penalty for 2015 is the higher of
•   2% of your yearly household income (but the penalty is only calculated on the income above the tax filing threshold, which is 20,300 for married filing jointly in 2015)
•   $325 per adult and $162.50 per child

If your income is 93k then you would be penalized 2% of 73k, or $1,460.  Then you add the cost of at least one doctor’s visit without insurance to see the total cost of this choice.

FarmFam

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Re: Health Insurance Choice Help
« Reply #2 on: July 17, 2015, 03:08:09 PM »
Thank you for helping with that Isalinas!

So it looks like my options between 1 and 3 is about $600 per year and having preventive covered and possibility of something really costly happening over $5000 covered.  Although, one night in the hospital can easily cost tens of thousands.

This may seem like weird reasoning but it seems since I would have to pay $1,460 no matter what as a tax of living in the US of A, then it seems that my only cost for disastrous health insurance is $600 per year.

$600 doesn't seem to much for peace of mind of ending up with tens of thousands in hospital bills.

Does this sound mustachian?

forummm

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Re: Health Insurance Choice Help
« Reply #3 on: July 17, 2015, 07:49:09 PM »
For #2, if that's a nongrandfathered plan, it *does* include preventive care, and they can't charge copays or deductibles when you get that care in-network. And if the only thing you get it preventive care during the visit, they can't charge for the visit either. The list of preventive services that are included is available at
www.cdc.gov/prevention

I think it has to be nongrandfathered if you aren't getting it through work and don't have it already. All new individual plans, including all plans on healthcare.gov are nongrandfathered.

Regardless, I don't think #1 is a responsible or mustachian choice--especially with a family. If your opportunity cost is only $600 (or $300 with #2), that's incredibly good value to safeguard yourself against the possibility of giant medical bills.

Rural

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Re: Health Insurance Choice Help
« Reply #4 on: July 17, 2015, 09:22:37 PM »
For #2, if that's a nongrandfathered plan, it *does* include preventive care, and they can't charge copays or deductibles when you get that care in-network. And if the only thing you get it preventive care during the visit, they can't charge for the visit either. The list of preventive services that are included is available at
www.cdc.gov/prevention

I think it has to be nongrandfathered if you aren't getting it through work and don't have it already. All new individual plans, including all plans on healthcare.gov are nongrandfathered.

Regardless, I don't think #1 is a responsible or mustachian choice--especially with a family. If your opportunity cost is only $600 (or $300 with #2), that's incredibly good value to safeguard yourself against the possibility of giant medical bills.


#2 isn't insurance but a religious loophole in the ACA.

etselec

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Re: Health Insurance Choice Help
« Reply #5 on: July 17, 2015, 10:09:36 PM »
The price gap between #2 and #3 may be smaller than you think, since #3 would be pre-tax money and #2 would (I presume) be post-tax. For further savings with #3 you can look into whether you qualify for an HSA, so the $700 Epi-Pen and any other health care costs you have up to your $5000 would also be pre-tax money. And with #3 you actually get a guarantee that bills will be paid in the event of a big health crisis — I am skeptical that those sharing plans would be able to deal with the hundreds of thousands of dollars a serious medical condition could cost in a worst-case scenario.

ShoulderThingThatGoesUp

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Re: Health Insurance Choice Help
« Reply #6 on: July 18, 2015, 05:41:40 AM »
Check how many hospitals and doctors are available with these plans. My understanding is that this is a problem with marketplace plans, exacerbated by ACA mandates and in rural areas.

forummm

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Re: Health Insurance Choice Help
« Reply #7 on: July 18, 2015, 07:00:10 AM »
For #2, if that's a nongrandfathered plan, it *does* include preventive care, and they can't charge copays or deductibles when you get that care in-network. And if the only thing you get it preventive care during the visit, they can't charge for the visit either. The list of preventive services that are included is available at
www.cdc.gov/prevention

I think it has to be nongrandfathered if you aren't getting it through work and don't have it already. All new individual plans, including all plans on healthcare.gov are nongrandfathered.

Regardless, I don't think #1 is a responsible or mustachian choice--especially with a family. If your opportunity cost is only $600 (or $300 with #2), that's incredibly good value to safeguard yourself against the possibility of giant medical bills.


#2 isn't insurance but a religious loophole in the ACA.

Oh, it's one of those ones where people pay each others bills? I would stay far away from that! It obviously varies, but at least with a real insurance plan you have the benefit of the negotiated prices from a large entity with market power. And since you have a large deductible, you will be paying whatever those prices are--so you want the negotiated ones.

Axecleaver

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Re: Health Insurance Choice Help
« Reply #8 on: July 18, 2015, 07:10:37 AM »
Quote
Check how many hospitals and doctors are available with these plans. My understanding is that this is a problem with marketplace plans, exacerbated by ACA mandates and in rural areas.
It's a good point - before buying an insurance plan, make sure the provider network includes the doctors you want to see.

The reason it's happened is not what I would call a "problem" or directly attributable to ACA mandates, not exactly. It's because insurance companies have been trying various ways to reduce the cost of care, and one way they do this is by squeezing the providers to agree to lower fees. As the provider networks get squeezed, the larger, more successful, and more powerful ones decide not to sign contracts, and they get excluded from the provider network. So a lower-cost plan may be lower-cost precisely because it has a narrow provider network.

Two ACA mandates have contributed to this problem, sort of. The ACA implemented "essential health benefits" which are required for all plans to be sold on the marketplace. It includes 10 things like hospitalization, ambulatory care, maternity care, etc. Details here: https://www.healthcare.gov/glossary/essential-health-benefits/ Some states, through their insurance departments, implemented EHB's for all plans sold in the state. This raised the cost of care, because the benefit plans were larger.

The other contributor to the issue was Medical Loss Ratios. Another ACA rule, this one said "no more squeezing your customers; insurance companies have to actually spend the majority of what they collect in premiums on actual care." So, in a post-ACA world, an insurance company can't cut your benefits, and they have to actually use 85% of the money you give them to provide benefits to you. I know, how awful! Stupid Obamacare! The net effect was to squeeze providers because they couldn't squeeze their customers as easily.

TL;DR: Insurance companies lost some of the levers they used to have available to drive P&L, so now provider networks are more narrow than they used to be.

forummm

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Re: Health Insurance Choice Help
« Reply #9 on: July 18, 2015, 08:10:51 AM »
I think you're close, Cleaver, but I see it a little differently. In the days of yore, employers were competing with tax-free dollars to have the better health plans to attract the better employees. So the cost of the plan (tax-free dollars) was less important than having a huge network to attract a wide variety of employees with differing interests. But the Marketplace now makes the focus on price. Every plan is sorted by price. So in order to be competitive, plans are doing everything they can to bring the premiums down. The easiest way to do that is to pay the providers less. And certain providers won't take the lower rates yet, so they don't join the networks.

ShoulderThingThatGoesUp

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Re: Health Insurance Choice Help
« Reply #10 on: July 18, 2015, 10:57:21 AM »
The reason it's happened is not what I would call a "problem"...

It's not a problem in the sense that individual health insurance market consumers who can afford insurance are not the intended beneficiaries of the ACA. If you are one of those people, getting your medical options restricted is a problem.

...or directly attributable to ACA mandates, not exactly. <snip>
TL;DR: Insurance companies lost some of the levers they used to have available to drive P&L, so now provider networks are more narrow than they used to be.

This seems self-contradictory.

ACA (1) increased demand for health insurance, (2) raised the cost of providing health insurance, and (3) did nothing to increase the supply of health care providers. Obviously this will increase cost and reduce the quality of what's produced for your average market participant. It may very well be more fair, but that doesn't mean it's wrong to say it creates problems for some or most people.

goatmom

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Re: Health Insurance Choice Help
« Reply #11 on: July 18, 2015, 12:30:13 PM »
I think you need the health insurance in case something catastrophic happens.  I know with high deductible plans and many doctors opting out - it is easier just to pay cash to see the doctors that you want to see for many things.  I know I pay cash for my pediatrician and my son's therapist.  Not going to go to the lowest bidder there.  I will still stay under my family deductible for the year.  Ouch.  But if someone gets cancer or in a car wreck - I have the back up insurance.

Mrs.LC

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Re: Health Insurance Choice Help
« Reply #12 on: July 18, 2015, 12:32:02 PM »
$700 annually for an epipen is quite high. I suggest you shop around for a better price. The insurance plan (#3 option) might have prescription coverage that could bring that cost way down. Your physician may very well write the prescription for it during a wellness visit erasing the cost of a visit.

Cpa Cat

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Re: Health Insurance Choice Help
« Reply #13 on: July 18, 2015, 12:44:51 PM »
That's expensive for an epipen.

If you choose not to get real insurance, you might be able to get a discount with Goodrx. Also, supposedly Epipens will be able to go generic in Sept of this year. So watch out for that and make sure your doctor indicates that generic is ok on your prescription.

With insurance, you'll likely benefit from a lower contracted rate for the Epipen, and may be able to get even lower by mail-ordering through your insurance's preferred mail-order pharmacy.