Author Topic: Health Insurance: Is There Any Way To Optimize?  (Read 4363 times)

Erica/NWEdible

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Health Insurance: Is There Any Way To Optimize?
« on: April 20, 2015, 01:13:10 PM »
Wondering if anyone has any suggestions for optimizing family self-insurance. Our medical insurance is the 2nd most expensive item in our budget, after housing.

In December 2012 we began self-insuring our family of four with a high-deductible insurance policy from LifeWise of Washington.
Dec 2012 the monthly price was $464.00
Jan 2013 the price increased to $572.00
Jan 2014 the price increased to $701.32
Jan 2015 the price increased to $776.44
So our annual insurance cost increased by $3737.28 in just over 2 years.

This is for a "bronze" or lower tier insurance plan that is HSA compatible (we utilize the HSA for additional tax-advantaged savings).

I'm concerned about the rapid upward cost trend here, especially as this impacts ER. Our household budget will be lower in ER, but ethically I don't think it's right to plan on utilizing a social program like Medicaid for low-cost medical insurance in ER.

I don't expect miracles, but am I missing something? Does anyone have any way to optimize insurance costs or is this just a "suck-it-up" situation? We are basically healthy, and don't use much beyond preventative care most years.

Any ideas?

ShoulderThingThatGoesUp

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #1 on: April 20, 2015, 01:19:48 PM »
This is what guaranteed issue and community rating are designed to do: raise cost for the young and healthy to lower cost for the unhealthy.

Erica/NWEdible

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #2 on: April 20, 2015, 01:27:19 PM »
This is what guaranteed issue and community rating are designed to do: raise cost for the young and healthy to lower cost for the unhealthy.
So, "suck it up," then?

jsloan

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #3 on: April 20, 2015, 01:34:40 PM »
We are struggling with the same thing with my HSA through work.  It is hard to know what things will cost because I have no idea what is wrong in order to get a good estimate.  For example, I was having knee issues so it would be difficult to call a doctor's office and ask: "Excuse me, how much do you charge to cure knee pain on the left side of a right knee?"   

My wife also has a chronic issue that will cost us about 1300.00-4800.00 per year that I'm hoping we will be able to optimize since we know more about this issue now.  We are also very healthy 30 somethings with 2 very healthy kids.  My wife's issue is genetic so lifestyle optimization doesn't matter much.  We have hit our 5000.00 deductible the last 3 years.  Thank god I didn't go with MMM's advice and get the 10,000.00 deductible. 

Axecleaver

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #4 on: April 20, 2015, 01:43:25 PM »
You didn't post details about your income, but I'll assume that you make more than 4x the FPL for your family size. If you make less, depending on the state in which you live, you may be eligible for subsidies.

If you have not done so yet, I encourage you to go to healthcare dot gov and compare all the plans available. If you don't use your benefits much, you're best off with the lowest premiums. However, many of the cheaper bronze plans have identical benefits of the silver and gold plans, but have much higher deductibles and copays. Depending on how much insurance you use, a more expensive plan may actually be less out of pocket for you.

The other big cost differentiator is provider networks. Many insurance payors are reducing their costs by squeezing providers, resulting in much more narrow networks as doctors decide not to accept the squeeze. Be sure that the plan you choose has doctors you can actually see.

Quote
ethically I don't think it's right to plan on utilizing a social program like Medicaid for low-cost medical insurance in ER.
That's certainly your choice. You should be aware, though, that if you're eligible for Medicaid and you opt out of it, you are not eligible for insurance subsidies. It could be an extremely expensive decision on your part. Medicaid no longer has an assets test (for most programs - some carve-outs continue to have them). This change was made to simplify application process, and to accommodate folks who found themselves out of work but still had assets. With this change, people who lost their jobs could immediately qualify for Medicaid without having to sell their houses and cars, which is how the plan worked prior to the Affordable Care Act.

RangerOne

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #5 on: April 20, 2015, 02:08:15 PM »
Its usually a couple hundred bucks to speak to a primary care physician. But once your in you should be able to ask what the potential cost of a specialist or test will cost before you agree to them. Then you can decide if its worth it. But I admit the prospect of paying to investigate a health issue is upsetting.

Another way to look at your HSA is to contribute enough each month, to cover the your max out of pocket expense for a full year. Then in theory you should be free to accept any necessary medical treatment regardless of cost since they will eventually be mitigated by your insurance when you hit your max for the year. And every year you will replenish the money.

Of course for this to work perfectly you need to build up about double your max out of pocket so you don't fall behind year to year in case medical needs become dire.

This could help avoid the problem of you feeling uncomfortable tapping your HSA for treatment because your worried something silly will cost too much, but it does take a lot more effort than the old fully covered low deductible plans.

I personally like HSA's but I should probably reserve judgment until I have some significant medical costs. I've so far only had to use about 1000 dollars in a year so it hasn't fully been tested yet.

I think the only real risk is some HSA covered items may not contribute toward your deductible. So maybe maxing out the HSA until you get to a nice buffer above your max out of pocket is advisable.

I think there is a real potential upside to HSA's if you stay healthy in that you can build up a lot of tax free money for medical expenses later in life for your family. And its possible to invest that money in most cases if it grows large enough to justify the risk. Where as with a normal plan you pay a lot of money every month which may never benefit you if you are healthy for many decades.

RangerOne

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #6 on: April 20, 2015, 02:12:49 PM »
We are struggling with the same thing with my HSA through work.  It is hard to know what things will cost because I have no idea what is wrong in order to get a good estimate.  For example, I was having knee issues so it would be difficult to call a doctor's office and ask: "Excuse me, how much do you charge to cure knee pain on the left side of a right knee?"   

My wife also has a chronic issue that will cost us about 1300.00-4800.00 per year that I'm hoping we will be able to optimize since we know more about this issue now.  We are also very healthy 30 somethings with 2 very healthy kids.  My wife's issue is genetic so lifestyle optimization doesn't matter much.  We have hit our 5000.00 deductible the last 3 years.  Thank god I didn't go with MMM's advice and get the 10,000.00 deductible.

Sorry to hear that. Are you not free to change plans after a year to something that maximizes the value for your cash? Deciding on a high deductible is always a risk. But if you made a mistake I would think the penalty would only last until your next sign up period. Hopefully...



Erica/NWEdible

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #7 on: April 20, 2015, 02:16:08 PM »
You didn't post details about your income, but I'll assume that you make more than 4x the FPL for your family size. If you make less, depending on the state in which you live, you may be eligible for subsidies.

If you have not done so yet, I encourage you to go to healthcare dot gov and compare all the plans available. If you don't use your benefits much, you're best off with the lowest premiums. However, many of the cheaper bronze plans have identical benefits of the silver and gold plans, but have much higher deductibles and copays. Depending on how much insurance you use, a more expensive plan may actually be less out of pocket for you.

The other big cost differentiator is provider networks. Many insurance payors are reducing their costs by squeezing providers, resulting in much more narrow networks as doctors decide not to accept the squeeze. Be sure that the plan you choose has doctors you can actually see.

Quote
ethically I don't think it's right to plan on utilizing a social program like Medicaid for low-cost medical insurance in ER.
That's certainly your choice. You should be aware, though, that if you're eligible for Medicaid and you opt out of it, you are not eligible for insurance subsidies. It could be an extremely expensive decision on your part. Medicaid no longer has an assets test (for most programs - some carve-outs continue to have them). This change was made to simplify application process, and to accommodate folks who found themselves out of work but still had assets. With this change, people who lost their jobs could immediately qualify for Medicaid without having to sell their houses and cars, which is how the plan worked prior to the Affordable Care Act.

Yes, we are in the extremely fortunate position of not qualifying for subsidies at the moment. I have looked at the Washington State insurance selection site pretty thoroughly; I'll go back and make sure, but I think the Bronze, high-deductible options are the best overall. It's worth comparing our total health care spend over the past few years to be sure.

I didn't realize opting out of medicaid meant opting out of any insurance subsidy. Thank you for letting me know, that does impact the decision making for sure.

forummm

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #8 on: April 20, 2015, 05:31:18 PM »
This is what guaranteed issue and community rating are designed to do: raise cost for the young and healthy to lower cost for the unhealthy.

The costs also reflect the fact that pre-existing conditions are not excluded anymore, and they can't boot you from your plan if you get sick, and the benefits have to meet minimum standards. So now that they have to actually cover stuff (i.e. provides better insurance), it costs more. The subsidy that a 35 year old provides to those older is less than 10%.

jsloan

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #9 on: May 30, 2015, 06:48:51 AM »
Hi Everyone,

I wanted to thank everyone for their input on this topic, our research did not have a happy ending, but I wanted to update everyone on what we have found after much discussion with our hospital and insurance.  Hopefully this information will help someone in the future if they run into the same issues.  So the bottom line is that we are on the hook for $3,400 for my Wife's doctor's visit.  This is after insurance write downs.  I still find it incredible that a single visit to the doctor in a given afternoon would cost so much.  The largest expense in our case was getting the MRI done at the same hospital that we were referred to (about 2800.00 for the scans).  MRIs are now a requirement for my wife due to genetic testing results and family history so she is required to get them 2 times a year for the next 1 year and then it will be once a year going forward.  Here are some of the things we found during the process:

1.) After talking with the hospital we tried to get the MRIs qualified as preventative care since the scans would be required going forward and even had the hospital's approval on this but it was rejected by our insurance.  Anything with an MRI cannot be considered preventative.  Apparently preventative care is more a legal term than a medical one because there are strict rules around what qualifies and what does not.   

2.) We tried to ask for better MRI pricing from the same hospital, but this was a dead end.  It was even pretty difficult to get specific pricing and reason why costs were what they were.

3.) We found we could setup a payment plan through the hospital at 0% interest, so we may just pay down the balance very slowly as we invest more money in our HSA plan tax free.

4.) We found after calling our insurance that the hospital we were referred to happens to have the highest prices for MRI scans in the state.  We did receive a list of hospitals that perform that the same scans much more cheaply (our old hospital) and will now be able to have the scans done there and then the results forwarded to my Wife's doctor.  Also our old hospital allows you to pay in cash the day of the scan for a 10% discount which is good.  This means that going forward this cost will go from around 2800.00 -> 900.00.  This will probably be the best option going forward.

So while this year will be an expensive one, we will  probably not change our health plan from the high deductible plan and we are going to make sure we call ahead about pricing before any procedures are scheduled.  In our case at least the care my Wife receive is repeatable so we can plan around it.  Our insurance company was pretty helpful and was able to provide the pricing information we needed much more readily that the hospital itself (which I found crazy).
   
So hopefully this information helps someone who has some time to research a medical issue ahead of time.           

Bearded Man

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Re: Health Insurance: Is There Any Way To Optimize?
« Reply #10 on: May 30, 2015, 10:17:54 PM »
That's good info. Shopping around seemed to be the winning ticket here.