Fed up with health insurance situation

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SeekingAPlan
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Re: Fed up with health insurance situation

Post by SeekingAPlan » Tue Sep 25, 2018 9:44 am

LiterallyIronic wrote:
Tue Sep 25, 2018 9:40 am
theplayer11 wrote:
Tue Sep 25, 2018 9:22 am
LiterallyIronic wrote:
Tue Sep 25, 2018 9:12 am
sergio wrote:
Mon Sep 24, 2018 2:06 pm
This year it's $900/month for the three of us, going up to $1040/month in 2019

Anyone ever find themselves in a similar situation?
Frankly I have not ever found myself in that situation, but if I did, I would "nope" right on out of the there. Those prices would make health insurance my highest expense. $1040 is pretty much the mortgage and groceries combined for our family of three. At that price, you could pay cash for someone to go to the emergency room like every other month. I feel like, at $1040/month, there's about 99.999% chance you don't come out ahead by using the insurance. Now, obviously, it's expected that some people come out ahead with insurance and most don't, but I don't think that it should be tipped that far.

In that situation, I'd either change jobs, look for coverage outside of the employer, or drop coverage altogether (except for the kid).
and what would you do if you were self employed making a good living? I don't think you understand what procedures cost, and what hospitals charge..People need insurance.
I would do exactly what I just said - get a new job, buy insurance through Humana directly, or drop coverage. I'm aware what hospitals charge (we paid $12k for our baby to be delivered (insurance paid $0, despite us having maternity coverage, so I'm pretty jaded)). I'm also aware that there's a 99.999% chance that I won't need a kidney transplant or have a heart attack and I'm not going to give up 25% of my income to cover that 0.001% chance that I do. Even 10% of my income would be too high. 5% would be more like it.
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.

ralph124cf
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Re: Fed up with health insurance situation

Post by ralph124cf » Tue Sep 25, 2018 9:50 am

michaeljc70 wrote:
Mon Sep 24, 2018 9:35 pm
sergio wrote:
Mon Sep 24, 2018 5:06 pm
Artsdoctor wrote:
Mon Sep 24, 2018 2:51 pm
Sergio,

Clearly, your description echoes the national sentiment.

One thing you can take a little solace in: your premiums are run through your corporation (correct?). Consequently, at least you're paying premiums with pre-tax dollars.

I realize that that is little solace but I can tell you that many people are paying those same premiums with post-tax dollars . . .

And, if you keep all of those medical receipts, you can reimburse yourself in the future with funds from your HSA if you're inclined to do so.
Correct - all premiums are thru payroll so we dodge all taxes. And I definitely realize there are people out there that have it worse.

As a small business co-owner, not only do I pay the high premiums and deductibles myself, but I also have to partially deal with the fallout (keeping employees happy) and doing whatever I can to help solve the problem. The thing that irritates me the most is how much stress, uncertainty, and distraction this injects into our small company. Employee morale tends to be lower around this time since everyone is awaiting how much premiums will increase. Normally I would not post this on Bogleheads but we're seriously starting to run out of options.

We'll look into health insurance associations, and at the very least, consider an HSA contribution to help tide things over for another year.
It can definitely be challenging. As a contractor, I was often paid on a W2 meaning I couldn't deduct my premium (on a 1099 I could). Not to get too much into the tax code, but I could deduct the interest on my boat but not my health insurance premiums. You still cannot deduct health insurance premiums even if all paid out of pocket after tax.
This is ONLY in reference to the deductibility of health insurance premiums.

Medical expenses are deductible to the extent that they exceed 7.5% of AGI. Medical (and dental and vision) insurance is considered part of medical expenses. Yes, this can be a pretty high bar.

Ralph

michaeljc70
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Re: Fed up with health insurance situation

Post by michaeljc70 » Tue Sep 25, 2018 10:03 am

ralph124cf wrote:
Tue Sep 25, 2018 9:50 am
michaeljc70 wrote:
Mon Sep 24, 2018 9:35 pm
sergio wrote:
Mon Sep 24, 2018 5:06 pm
Artsdoctor wrote:
Mon Sep 24, 2018 2:51 pm
Sergio,

Clearly, your description echoes the national sentiment.

One thing you can take a little solace in: your premiums are run through your corporation (correct?). Consequently, at least you're paying premiums with pre-tax dollars.

I realize that that is little solace but I can tell you that many people are paying those same premiums with post-tax dollars . . .

And, if you keep all of those medical receipts, you can reimburse yourself in the future with funds from your HSA if you're inclined to do so.
Correct - all premiums are thru payroll so we dodge all taxes. And I definitely realize there are people out there that have it worse.

As a small business co-owner, not only do I pay the high premiums and deductibles myself, but I also have to partially deal with the fallout (keeping employees happy) and doing whatever I can to help solve the problem. The thing that irritates me the most is how much stress, uncertainty, and distraction this injects into our small company. Employee morale tends to be lower around this time since everyone is awaiting how much premiums will increase. Normally I would not post this on Bogleheads but we're seriously starting to run out of options.

We'll look into health insurance associations, and at the very least, consider an HSA contribution to help tide things over for another year.
It can definitely be challenging. As a contractor, I was often paid on a W2 meaning I couldn't deduct my premium (on a 1099 I could). Not to get too much into the tax code, but I could deduct the interest on my boat but not my health insurance premiums. You still cannot deduct health insurance premiums even if all paid out of pocket after tax.
This is ONLY in reference to the deductibility of health insurance premiums.

Medical expenses are deductible to the extent that they exceed 7.5% of AGI. Medical (and dental and vision) insurance is considered part of medical expenses. Yes, this can be a pretty high bar.

Ralph
And it is going up to 10% for 2019. With the new raised standard deductions, the bar is very high.

Rupert
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Re: Fed up with health insurance situation

Post by Rupert » Tue Sep 25, 2018 10:15 am

LiterallyIronic wrote:
Tue Sep 25, 2018 9:40 am
I'm also aware that there's a 99.999% chance that I won't need a kidney transplant or have a heart attack and I'm not going to give up 25% of my income to cover that 0.001% chance that I do. Even 10% of my income would be too high. 5% would be more like it.
I'm genuinely curious: Why are you so certain that there's a 99.999% chance you won't need a kidney transplant or have a heart attack? And why do you think 5% of your income is a reasonable percentage to spend on insurance?

I love that we have these healthcare threads so often, and I keep thinking that in one of these threads someone is going to propose a brilliant solution to our healthcare problem. But more often than not, the threads just leave me more convinced that there is no solution to the problem. My observations, based on reading dozens of healthcare threads at Bogleheads and elsewhere, are this: First, people in general tend to engage in magical thinking re what is likely to happen to them and their loved ones health-wise. Second, people tend to have some sort of gut feeling as to what health insurance (and healthcare, for that matter) should cost and that number seems to always be just a little bit below their mortgage payment. (Why the cost of health insurance should be constrained by the cost of one's home is never explained.) Third, people tend to want a health-insurance option, such as the ACA, available to them should they (or someone they love) get sick. They just don't want to pay for that option until they get sick. And, fourth, when people do get sick unexpectedly, they not only want an ACA-like heath insurance option to exist, they also expect to have the option of receiving care immediately at a top-notch tertiary care center, such as the Mayo Clinic or MD Anderson Cancer Center.

It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).

3feetpete
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Re: Fed up with health insurance situation

Post by 3feetpete » Tue Sep 25, 2018 10:18 am

The root problem is that we are spending too much on healthcare. Healthcare is something like 18% of our economy or about 10k per person per year. That is unsustainable. Someones got to pay that. Insurance companies have to take in more than they pay out to cover their overhead and profit. The federal government tends to have a huge overhead on anything they do so I doubt nationalising the healthcare industry will accomplish much. Cutting costs is difficult but lets say we could cut costs by 15% that still leaves us with $8,500 per year per person to cover. I am afraid the only solution is to cut costs where possible but also reduce usage.

The way to do this is to eliminate the low deductible plans. When I was a kid, health insurance was meant to cover hospital costs and other catastropic costs. Not day to day medical costs. Somehow this changed to where companies are now expected to provide medical insurance that covers almost all of their costs. There is no disincentive to go to the doctor and so everybody goes more often.

michaeljc70
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Re: Fed up with health insurance situation

Post by michaeljc70 » Tue Sep 25, 2018 10:22 am

3feetpete wrote:
Tue Sep 25, 2018 10:18 am
The root problem is that we are spending too much on healthcare. Healthcare is something like 18% of our economy or about 10k per person per year. That is unsustainable. Someones got to pay that. Insurance companies have to take in more than they pay out to cover their overhead and profit. The federal government tends to have a huge overhead on anything they do so I doubt nationalising the healthcare industry will accomplish much. Cutting costs is difficult but lets say we could cut costs by 15% that still leaves us with $8,500 per year per person to cover. I am afraid the only solution is to cut costs where possible but also reduce usage.

The way to do this is to eliminate the low deductible plans. When I was a kid, health insurance was meant to cover hospital costs and other catastropic costs. Not day to day medical costs. Somehow this changed to where companies are now expected to provide medical insurance that covers almost all of their costs. There is no disincentive to go to the doctor and so everybody goes more often.
It has also turned into a "discount" scheme with the networks. I had a $30k outpatient surgery and the insurance company's discount was $24k. That is 80% off! They inflate the price to astronomical levels so you need insurance to get the discount. Otherwise many people could get a cheap catastrophic plan (if it were allowed).
Last edited by michaeljc70 on Tue Sep 25, 2018 10:25 am, edited 1 time in total.

SeekingAPlan
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Re: Fed up with health insurance situation

Post by SeekingAPlan » Tue Sep 25, 2018 10:23 am

3feetpete wrote:
Tue Sep 25, 2018 10:18 am
The root problem is that we are spending too much on healthcare. Healthcare is something like 18% of our economy or about 10k per person per year. That is unsustainable. Someones got to pay that. Insurance companies have to take in more than they pay out to cover their overhead and profit. The federal government tends to have a huge overhead on anything they do so I doubt nationalising the healthcare industry will accomplish much. Cutting costs is difficult but lets say we could cut costs by 15% that still leaves us with $8,500 per year per person to cover. I am afraid the only solution is to cut costs where possible but also reduce usage.

The way to do this is to eliminate the low deductible plans. When I was a kid, health insurance was meant to cover hospital costs and other catastropic costs. Not day to day medical costs. Somehow this changed to where companies are now expected to provide medical insurance that covers almost all of their costs. There is no disincentive to go to the doctor and so everybody goes more often.
I remember those days as you do. That said, I believe the change was meant to encourage people to see a doctor before a small thing became a big expensive thing.

Rupert
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Re: Fed up with health insurance situation

Post by Rupert » Tue Sep 25, 2018 10:27 am

It's actually a myth that Americans see doctors more often than citizens of comparably-developed countries. Americans do receive more tests, some of arguable utility, but that's not entirely a consumer problem, i.e., the patients aren't ordering their own tests.

JBTX
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Re: Fed up with health insurance situation

Post by JBTX » Tue Sep 25, 2018 10:52 am

Over past 10 to 20 years, total health care costs of increased at mid to sometimes high single digits - on a per person basis.

https://www.healthsystemtracker.org/cha ... t-quarters

I think if you were to look at a large employer's health care costs, they typically have for a while had full coverage policies, and they are typically self insured, and typically have a mix between young and old, and my guess would be the company paid per person cost probably generally follow the above macro trend - that's generally what I saw a few years ago when working at Megacorp.

As to small businesses and individuals, pre ACA, they often had more skeletal plans that excluded certain coverages, so they were generally cheaper. The premiums have gone up more, because

1. ACA pretty much mandated full coverage, closer to what Megacorps provide. You could no longer issue ACA compliant insurance and not have maternity care, mental health care, drug rehab coverage, etc. That increased premiums more. Smaller employers passed more on to consumers.

2. Initially insurance companies jumped in using certain assumptions. Reality showed that more older people go into ACA policies and less young people than planned. Insurance companies were losing money, so either they dropped out, or increased premiums. This increased premiums even more

3. Initially in ACA Feds provided subsidies directly to insurance companies (in additional to ACA direct subsidies to consumers). Those subsidies have been phased out, so not insurance companies have to charge more to stay even (or more drop out). This increased premiums more

At this point, your typical ACA plan (and cost) is comparable to what megacorp has offered for years.

4. Going forward - Now the individual mandate is being phased out. More sick will jump in and out of the ACA pool, and healthier people will drop out because there is no requirement. This will increase premiums more, and may end up ultimately blowing up the ACA market. On the flip side, with no mandate, non ACA compliant policies will probably crop up, that will be cheaper, but will have less comprehensive coverage.

So there are really 2 issues here

1. Overall health care inflation, which continues to exceed overall inflation at a significant but not hyperbolic pace.

2. Premiums of individuals and small companies going up even more, because of mandated more comprehensive coverage, elimination of ins company subsidies, and elimination of individual mandate have gone up much more than health care costs in general.

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bottlecap
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Re: Fed up with health insurance situation

Post by bottlecap » Tue Sep 25, 2018 11:39 am

Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
What you describe is not really a commons dilemma, no less a classic one. It is a heavily subsidized option the use of which costs very little (to the user) that creates a commons dilemma.

There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.

These are the "selfish" interests faced in the commons dilemma.

JT

Topic Author
sergio
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Re: Fed up with health insurance situation

Post by sergio » Tue Sep 25, 2018 11:58 am

bottlecap wrote:
Tue Sep 25, 2018 11:39 am
Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.
From what I've seen as a business owner, the biggest winners from this whole overhaul are (1) frugal people wanting to retire early, between 55-60 and (2) people with pre-existing conditions that don't have employer coverage but have the means to pay for their own policy.

We recently had someone retire in their late 50s. Paid off house, no debts, very frugal, huge 401k balance, and so on. Him and his spouse plan to live off of $40k or so until they are eligible for medicare - gives them something like a $1100/month tax credit for health insurance :shock:

michaeljc70
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Re: Fed up with health insurance situation

Post by michaeljc70 » Tue Sep 25, 2018 12:05 pm

sergio wrote:
Tue Sep 25, 2018 11:58 am
bottlecap wrote:
Tue Sep 25, 2018 11:39 am
Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.
From what I've seen as a business owner, the biggest winners from this whole overhaul are (1) frugal people wanting to retire early, between 55-60 and (2) people with pre-existing conditions that don't have employer coverage but have the means to pay for their own policy.

We recently had someone retire in their late 50s. Paid off house, no debts, very frugal, huge 401k balance, and so on. Him and his spouse plan to live off of $40k or so until they are eligible for medicare - gives them something like a $1100/month tax credit for health insurance :shock:
The insurance companies got millions of new customers, many of them government subsidized.

JBTX
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Re: Fed up with health insurance situation

Post by JBTX » Tue Sep 25, 2018 12:11 pm

bottlecap wrote:
Tue Sep 25, 2018 11:39 am
Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
What you describe is not really a commons dilemma, no less a classic one. It is a heavily subsidized option the use of which costs very little (to the user) that creates a commons dilemma.

There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.

These are the "selfish" interests faced in the commons dilemma.

JT
Any time a cost is subsidized, via insurance, govt, or otherwise, cost tends to escalate. Thus what is needed concurrently are some sort of cost control mechanism, rationing, allocation etc. Our cost control mechanisms are pretty weak. Cost control / rationing mechanisms are not popular however.

feh
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Re: Fed up with health insurance situation

Post by feh » Tue Sep 25, 2018 12:14 pm

sergio wrote:
Mon Sep 24, 2018 2:29 pm
aristotelian wrote:
Mon Sep 24, 2018 2:13 pm
Thread locking in 3...2...

Without getting into politics, I will say that I checked my year end pay stub last year and noticed a line for my employer health coverage contribution. We only pay $100/mo fornour HSA because the employer is picking up something like $15K. If your company can't shoulder that burden, it all falls on employees. Agreed, the system is out of control.
I didn't mean to get political at all. For 2019 we'll probably end up making an employer HSA contribution approximately equal to the premium increases our employees will face ($500/year for single, $1000/year family - roughly). At least that's the easiest proposal (read: bandaid) on the table. Right now, owners are not taking any large dividends and instead most of our profit is reinvested in growth - more $$ towards health insurance means less towards the parts of the business that cause growth (R&D, marketing, sales etc.) It's just frustrating as a small company, but the worst part is the uncertainty in years 2020, 2021 etc...
You may want to consider a PEO: https://en.wikipedia.org/wiki/Professio ... ganization

Your health insurance costs may be reduced as part of a larger pool of employees.

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GoldStar
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Re: Fed up with health insurance situation

Post by GoldStar » Tue Sep 25, 2018 12:19 pm

Yes - I spent 12 years at small companies / start-ups. I never "hit it big" although got some significant lump sums along the way.

Now I enjoy just working for a large profitable company that can afford to take care of its employees. I still have equity (skin in the game) which provides a little extra income but will never provide huge gains. On the other hand - I am pretty confident my company won't be shutting its doors in 6 months either.

Rupert
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Re: Fed up with health insurance situation

Post by Rupert » Tue Sep 25, 2018 12:20 pm

bottlecap wrote:
Tue Sep 25, 2018 11:39 am
Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
What you describe is not really a commons dilemma, no less a classic one. It is a heavily subsidized option the use of which costs very little (to the user) that creates a commons dilemma.

There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.

These are the "selfish" interests faced in the commons dilemma.

JT
I think they're both commons dilemmas. I agree that whoever decided to base eligibility for ACA subsidies on income, rather than assets, is a dunderhead. But I'm not sure which is the bigger problem -- early retirees manipulating their income to qualify for subsidies or young healthy people (usually men, I've observed just from reading threads here at Bogleheads) opting out entirely because they just don't want to pay for it (maybe because they think they'll never get sick or they can't empathize with the sick or they just don't like being told what to do, I don't know). In any event, we really should be focused more on the cost of healthcare, which always seem to get lost in the argument over access to care. Although I'm not much of a conspiracy theorist in general, I really do believe there are forces that benefit financially from the present system that are actively employing access-to-care arguments (the very ones we address in our respective commons dilemma examples) to distract us from the cost problem.

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sergio
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Re: Fed up with health insurance situation

Post by sergio » Tue Sep 25, 2018 12:21 pm

feh wrote:
Tue Sep 25, 2018 12:14 pm
sergio wrote:
Mon Sep 24, 2018 2:29 pm
aristotelian wrote:
Mon Sep 24, 2018 2:13 pm
Thread locking in 3...2...

Without getting into politics, I will say that I checked my year end pay stub last year and noticed a line for my employer health coverage contribution. We only pay $100/mo fornour HSA because the employer is picking up something like $15K. If your company can't shoulder that burden, it all falls on employees. Agreed, the system is out of control.
I didn't mean to get political at all. For 2019 we'll probably end up making an employer HSA contribution approximately equal to the premium increases our employees will face ($500/year for single, $1000/year family - roughly). At least that's the easiest proposal (read: bandaid) on the table. Right now, owners are not taking any large dividends and instead most of our profit is reinvested in growth - more $$ towards health insurance means less towards the parts of the business that cause growth (R&D, marketing, sales etc.) It's just frustrating as a small company, but the worst part is the uncertainty in years 2020, 2021 etc...
You may want to consider a PEO: https://en.wikipedia.org/wiki/Professio ... ganization

Your health insurance costs may be reduced as part of a larger pool of employees.
Someone else suggested this earlier - I'm going to look into our options ASAP. Thanks!

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 12:25 pm

3feetpete wrote:
Tue Sep 25, 2018 10:18 am
The root problem is that we are spending too much on healthcare. Healthcare is something like 18% of our economy or about 10k per person per year. That is unsustainable. Someones got to pay that. Insurance companies have to take in more than they pay out to cover their overhead and profit. The federal government tends to have a huge overhead on anything they do so I doubt nationalising the healthcare industry will accomplish much. Cutting costs is difficult but lets say we could cut costs by 15% that still leaves us with $8,500 per year per person to cover. I am afraid the only solution is to cut costs where possible but also reduce usage.

The way to do this is to eliminate the low deductible plans. When I was a kid, health insurance was meant to cover hospital costs and other catastropic costs. Not day to day medical costs. Somehow this changed to where companies are now expected to provide medical insurance that covers almost all of their costs. There is no disincentive to go to the doctor and so everybody goes more often.
I agree with your description of the "problem". However, simply eliminating the low deductible feature/plans is a real challenge - because of the high costs/charges. Many folks would then either 1. avoid treatment of things that really need doing OR 2. be significantly financially challenged to get treatment. There are some conditions where early diagnosis and treatment can prevent very serious and expensive conditions from developing.

Yes, to a degree, with no financial incentive - some folks do go to the doctor more often and unnecessarily. Getting the "balance" right is the challenge.

In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.

To control costs, "we" (patients) must be willing (or be forced) to give up something. Maybe unlimited access to specialists, or more copays, or longer waits for some things, etc.

The other aspect that is unpopular to most folks (but what I believe in) is lifestyle changes to reduce the epidemic of hypertension, obesity, type 2 diabetes, heart disease, kidney failure, etc.

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 12:26 pm

I agree that whoever decided to base eligibility for ACA subsidies on income, rather than assets, is a dunderhead.
A puzzle to me as well.

lukestuckenhymer
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Re: Fed up with health insurance situation

Post by lukestuckenhymer » Tue Sep 25, 2018 12:27 pm

I'm fortunate to have an ER that pays 100% of my Anthem HDHP with HSA (+ER contributes $1,800/yr)... Costs them $10,611, which is not bad compared with others.

Still the unsustainability (premiums going up 14-30% year to year) is staggering. No matter whether you advocate for single-payer or not, you must see the writing on the wall. 18% of GDP. It's all going to come crashing down, one way or another.

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JoeRetire
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Re: Fed up with health insurance situation

Post by JoeRetire » Tue Sep 25, 2018 12:29 pm

SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Very Stable Genius

JBTX
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Re: Fed up with health insurance situation

Post by JBTX » Tue Sep 25, 2018 12:36 pm

dm200 wrote:
Tue Sep 25, 2018 12:26 pm
I agree that whoever decided to base eligibility for ACA subsidies on income, rather than assets, is a dunderhead.
A puzzle to me as well.
Likely for the same reasons (right or wrong) we tax based on income, not so much on assets. Some assets are illiquid (primary home with heavy price escalation, retirement accounts, etc) and you may not otherwise have that much free cash to make large annual payments.

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wabbajack
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Re: Fed up with health insurance situation

Post by wabbajack » Tue Sep 25, 2018 12:37 pm

sergio wrote:
Tue Sep 25, 2018 11:58 am
bottlecap wrote:
Tue Sep 25, 2018 11:39 am
Rupert wrote:
Tue Sep 25, 2018 10:15 am
It's a classic "commons dilemma," where people's short-term selfish interests (low insurance premiums) are at odds with long-term group interests and the common good (having an ACA-like health insurance option available for everyone who needs it).
There is a heavy incentive to "cheat," for example, by keeping your income low, retiring early, etc..., while using a disproportionate amount of the benefits.
From what I've seen as a business owner, the biggest winners from this whole overhaul are (1) frugal people wanting to retire early, between 55-60 and (2) people with pre-existing conditions that don't have employer coverage but have the means to pay for their own policy.

We recently had someone retire in their late 50s. Paid off house, no debts, very frugal, huge 401k balance, and so on. Him and his spouse plan to live off of $40k or so until they are eligible for medicare - gives them something like a $1100/month tax credit for health insurance :shock:
Commons dilemma hits the nail on the head. The winners win at the expense of the losers. In this case, the losers happen to be OP and people in a similar situation.
Have we reframed the argument? If we add the cost of health insurance to the salary of the small business employee, is it comparable to the equivalent compensation for the megacorp employee? Adjusting for talent, productivity, etc (which is impossible), of course.

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Re: Fed up with health insurance situation

Post by JBTX » Tue Sep 25, 2018 12:41 pm

dm200 wrote:
Tue Sep 25, 2018 12:25 pm


In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.
I agree, there is definitely the potential for technology to disrupt the whole model, largely for the better. What I am not sure is if the current incentives and "infrastructure" (current providers, insurance companies, etc) will allow this, at least not rapidly.

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Re: Fed up with health insurance situation

Post by HereToLearn » Tue Sep 25, 2018 12:46 pm

JoeRetire wrote:
Tue Sep 25, 2018 12:29 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Are you saying that the premium on your ACA plan w/o subsidies is half the cost of your prior COBRA premium?

Were you covered as part of a larger group that had a lot of employees living in HCOL areas, and do you now live in a LCOL area? I am intrigued by this.

HereToLearn
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Re: Fed up with health insurance situation

Post by HereToLearn » Tue Sep 25, 2018 12:48 pm

JBTX wrote:
Tue Sep 25, 2018 12:41 pm
dm200 wrote:
Tue Sep 25, 2018 12:25 pm


In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.
I agree, there is definitely the potential for technology to disrupt the whole model, largely for the better. What I am not sure is if the current incentives and "infrastructure" (current providers, insurance companies, etc) will allow this, at least not rapidly.
Are Kaiser physician's salaried? I haven't looked at this in decades, but I recall years ago that some of the CA plans were group practice HMOs. The theory then was that they could control all care costs in one closed network. I have no idea how successful that was.

I agree that something must change, and that even if we were to move to single payor, the reimbursement and access to delivery needs to be addressed also, but I have no idea how we effect that painful structural change.

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Re: Fed up with health insurance situation

Post by whodidntante » Tue Sep 25, 2018 12:51 pm

Small businesses and their employees feel it more, but it seems to me that large businesses also carry an enormous burden to provide medical coverage for their employees.

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Re: Fed up with health insurance situation

Post by SeekingAPlan » Tue Sep 25, 2018 12:52 pm

HereToLearn wrote:
Tue Sep 25, 2018 12:46 pm
JoeRetire wrote:
Tue Sep 25, 2018 12:29 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Are you saying that the premium on your ACA plan w/o subsidies is half the cost of your prior COBRA premium?

Were you covered as part of a larger group that had a lot of employees living in HCOL areas, and do you now live in a LCOL area? I am intrigued by this.
I am curious as well. ACA is much higher than Cobra for me as I do not qualify for a subsidy and am 60 yrs old.

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Re: Fed up with health insurance situation

Post by oaks » Tue Sep 25, 2018 12:58 pm

bottlecap wrote:
Tue Sep 25, 2018 7:09 am
The new law crushes the self-employed and small businesses.
I would edit your post to say that the "Obamacare" or "Affordable Care Act" law crushes the self-employed and small businesses. It isn't new in the normal sense meaning that it just came out. It has been around for years and everyone who is self employed has felt the absolute horror and pain since ACA, aka Obamacare was passed.

I'm in the same boat as the op. Reaching near $1,000 a month for catastrophic health insurance that the average citizen doesn't even have enough savings to pay for my deductible before the insurance company pays a single penny. It is outrageous, but there are no good alternatives. There are some "minster"/church related insurance TYPE plans but I wouldn't bet my life on them so I pay the $1k a month nonsense.

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Re: Fed up with health insurance situation

Post by kd2008 » Tue Sep 25, 2018 1:08 pm

I have stated this on this forum before: Your best bet is to eat the first year cost (and pay the non-subsidized price) arrange your assets such that you qualify for subsidy in subsequent years. You know the rules of the game. Whining about them does not resolve your problem.

If you are going to pay for insurance, then at least get something that is worth it. Share ministry or 3 month plans or catastrophic plans are not real deal and everyone knows it. They are just less expensive alternatives and they cost less because they guarantee less.

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Re: Fed up with health insurance situation

Post by bottlecap » Tue Sep 25, 2018 1:19 pm

Rupert wrote:
Tue Sep 25, 2018 12:20 pm
I think they're both commons dilemmas.
I've cut out the rest of the post for brevity, not for any other reason.

If you based subsidies on wealth, you have the same problem. People would hide wealth or store it in other forms that did not fit the ACA definition of wealth.

The problem is that when you give something away to some but not all, there is no limit to the ingenuity of those who seek to benefit without paying proportionately. There's no way around that.

JT

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 2:14 pm

The whole US based health insurance primarily done through employers is, in my opinion, a really bad way to fund and support healthcare. BUT - that is a long and sad story - for lots of folks.

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 2:16 pm

SeekingAPlan wrote:
Tue Sep 25, 2018 12:52 pm
HereToLearn wrote:
Tue Sep 25, 2018 12:46 pm
JoeRetire wrote:
Tue Sep 25, 2018 12:29 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Are you saying that the premium on your ACA plan w/o subsidies is half the cost of your prior COBRA premium?

Were you covered as part of a larger group that had a lot of employees living in HCOL areas, and do you now live in a LCOL area? I am intrigued by this.
I am curious as well. ACA is much higher than Cobra for me as I do not qualify for a subsidy and am 60 yrs old.
My guess is that big difference is that your COBRA premiums may not be age related, while the ACA ones (for your older age) may be higher because of age. BUT - it could be worse - prior to ACA - the individual plans for this age group were much higher.

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 2:24 pm

HereToLearn wrote:
Tue Sep 25, 2018 12:48 pm
JBTX wrote:
Tue Sep 25, 2018 12:41 pm
dm200 wrote:
Tue Sep 25, 2018 12:25 pm
In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.
I agree, there is definitely the potential for technology to disrupt the whole model, largely for the better. What I am not sure is if the current incentives and "infrastructure" (current providers, insurance companies, etc) will allow this, at least not rapidly.
Are Kaiser physician's salaried? I haven't looked at this in decades, but I recall years ago that some of the CA plans were group practice HMOs. The theory then was that they could control all care costs in one closed network. I have no idea how successful that was.
I agree that something must change, and that even if we were to move to single payor, the reimbursement and access to delivery needs to be addressed also, but I have no idea how we effect that painful structural change.
Yes - my understanding is that Kaiser physicians are, to a degree at least, salaried. Kaiser is still the "captive" HMO model. Over the decades, being with Kaiser and other types of insurance (including several types of HMOs) - some things work and some things do not. I assume that since Kaiser advertises heavily (employer based, individual based and Medicare) in this area -- it must be "profitable" to cover all of these types of patients.

In several other areas, I notice that Kaiser was not able to make their system "work" and they withdrew from those markets. On two occasions many years ago, we were insured by other plans that ended up merging into Kaiser. At the time, I was hoping that this "hybrid" system would or could be the best of both worlds, BUT Kaiser could not (or would not) make it work. We had to go back to only all Kaiser physicians.

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Re: Fed up with health insurance situation

Post by HereToLearn » Tue Sep 25, 2018 2:47 pm

dm200 wrote:
Tue Sep 25, 2018 2:24 pm
HereToLearn wrote:
Tue Sep 25, 2018 12:48 pm
JBTX wrote:
Tue Sep 25, 2018 12:41 pm
dm200 wrote:
Tue Sep 25, 2018 12:25 pm
In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.
I agree, there is definitely the potential for technology to disrupt the whole model, largely for the better. What I am not sure is if the current incentives and "infrastructure" (current providers, insurance companies, etc) will allow this, at least not rapidly.
Are Kaiser physician's salaried? I haven't looked at this in decades, but I recall years ago that some of the CA plans were group practice HMOs. The theory then was that they could control all care costs in one closed network. I have no idea how successful that was.
I agree that something must change, and that even if we were to move to single payor, the reimbursement and access to delivery needs to be addressed also, but I have no idea how we effect that painful structural change.
Yes - my understanding is that Kaiser physicians are, to a degree at least, salaried. Kaiser is still the "captive" HMO model. Over the decades, being with Kaiser and other types of insurance (including several types of HMOs) - some things work and some things do not. I assume that since Kaiser advertises heavily (employer based, individual based and Medicare) in this area -- it must be "profitable" to cover all of these types of patients.

In several other areas, I notice that Kaiser was not able to make their system "work" and they withdrew from those markets. On two occasions many years ago, we were insured by other plans that ended up merging into Kaiser. At the time, I was hoping that this "hybrid" system would or could be the best of both worlds, BUT Kaiser could not (or would not) make it work. We had to go back to only all Kaiser physicians.
Thanks for the explanation.

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 2:59 pm

HereToLearn wrote:
Tue Sep 25, 2018 2:47 pm
dm200 wrote:
Tue Sep 25, 2018 2:24 pm
HereToLearn wrote:
Tue Sep 25, 2018 12:48 pm
JBTX wrote:
Tue Sep 25, 2018 12:41 pm
dm200 wrote:
Tue Sep 25, 2018 12:25 pm
In my opinion, technology can offer a way of addressing this, but the providers would need to be compensated and not penalized. If, for example, a five minute phone call with a Physician or nurse could replace a 20 minute in person office visit - then that would be a good thing. However, the doctor or nurse would need to be compensated for that five minutes - and that is a challenge for most types of insurance. With our Kaiser plan, they (Kaiser) has figured out (not sure how) ways of offering (no charge to patient) telephone appointments, email back and forth and "virtual" house calls (2 way audio and visual) on a smartphone or similar. They also offer (no charge to patient) 24x7 telephone access to advice nurse.
I agree, there is definitely the potential for technology to disrupt the whole model, largely for the better. What I am not sure is if the current incentives and "infrastructure" (current providers, insurance companies, etc) will allow this, at least not rapidly.
Are Kaiser physician's salaried? I haven't looked at this in decades, but I recall years ago that some of the CA plans were group practice HMOs. The theory then was that they could control all care costs in one closed network. I have no idea how successful that was.
I agree that something must change, and that even if we were to move to single payor, the reimbursement and access to delivery needs to be addressed also, but I have no idea how we effect that painful structural change.
Yes - my understanding is that Kaiser physicians are, to a degree at least, salaried. Kaiser is still the "captive" HMO model. Over the decades, being with Kaiser and other types of insurance (including several types of HMOs) - some things work and some things do not. I assume that since Kaiser advertises heavily (employer based, individual based and Medicare) in this area -- it must be "profitable" to cover all of these types of patients.
In several other areas, I notice that Kaiser was not able to make their system "work" and they withdrew from those markets. On two occasions many years ago, we were insured by other plans that ended up merging into Kaiser. At the time, I was hoping that this "hybrid" system would or could be the best of both worlds, BUT Kaiser could not (or would not) make it work. We had to go back to only all Kaiser physicians.
Thanks for the explanation.
In this area, one (to me) somewhat puzzling change Kaiser made about ten years ago was to hire a lot more Primary Care Physicians (for adults Board Certified in Internal Medicine or Family Practice/Medicine) AND eliminate Registered Nurses, Nurse Practitioners, etc. from the Primary care "team". The seems contrary to the overall trend of Primary Care in the US. Now, when I have an appointment with my Primary Care Physician, she is the only medical professional I see. [A technician takes my blood pressure, weight, tells me to undress or not]. Since Physicians (MD or DO degree) are paid more than nurses or nurse practitioners, somehow Kaiser here is able to make it work financially. In this transition, as well, it seems that in person appointments with Primary care physicians are more readily available - even on short notice. So, Kaiser is not controlling costs (from everything I see) by restricting or delaying appointments.

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Re: Fed up with health insurance situation

Post by randomguy » Tue Sep 25, 2018 3:08 pm

SeekingAPlan wrote:
Tue Sep 25, 2018 12:52 pm
HereToLearn wrote:
Tue Sep 25, 2018 12:46 pm
JoeRetire wrote:
Tue Sep 25, 2018 12:29 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Are you saying that the premium on your ACA plan w/o subsidies is half the cost of your prior COBRA premium?

Were you covered as part of a larger group that had a lot of employees living in HCOL areas, and do you now live in a LCOL area? I am intrigued by this.
I am curious as well. ACA is much higher than Cobra for me as I do not qualify for a subsidy and am 60 yrs old.

Both cases seem very likely to me. Here are a couple of ACA quotes for my zip code.

25 year old - 267/month
60 year old - 802/month

A group plan might charge like 500-600 bucks (depending on the age distribution of their employees). So basically the young employee subsidizes the old. It makes a lot of sense for the old person to stay on the plan where they are subsidized by the young and for the young to switch to plan where they are not subsidizing (as much) the old.

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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 3:13 pm

Both cases seem very likely to me. Here are a couple of ACA quotes for my zip code.

25 year old - 267/month
60 year old - 802/month


A group plan might charge like 500-600 bucks (depending on the age distribution of their employees). So basically the young employee subsidizes the old. It makes a lot of sense for the old person to stay on the plan where they are subsidized by the young and for the young to switch to plan where they are not subsidizing (as much) the old.
In most states, the federal age ratio limits apply. The oldest tier cannot be charged more than three times the youngest tier. So 1/3 of 802 is 267.

Prior to the ACA limits, that ratio was higher - so this is much better for those in the older tier than prior to the ACA.

furikake
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Re: Fed up with health insurance situation

Post by furikake » Tue Sep 25, 2018 3:38 pm

sergio: you may want to also check into partially self-funded Small Group plans in your area. I'm in TX, depending on the group size, if the employer has 10 or more employees participating and they're young and healthy, the self-funded rates are much much better than the fully insured rates.

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Re: Fed up with health insurance situation

Post by furikake » Tue Sep 25, 2018 3:49 pm

wabbajack wrote:
Tue Sep 25, 2018 9:33 am
Interesting discussions - particularly those from the employer (buyer's) side of the equation. Someone mentioned association health plans (AHPs), which allow small business to band together for the purpose of obtaining insurance. I seem to recall my old actuarial study material saying something about how employers cannot band together for the sole purpose of obtaining insurance. Again - this is old material - rules have changed since then.

Does anyone have actual experience using AHPs?
I have a client years ago on a co-op plan, similar to an association plan. The employees from different companies were relatively healthy at the beginning. Then people got sick, the sick people from different companies wanted to stay on, the healthy people were fleeing because the rates got higher and higher because of the sick people. At the end, the insurer quit that plan because they could not pay out the claims anymore. And then soon after that, that insurer went under. They're no longer in business.

Then, I had another client (doctor's office) who was asked to join an association, some broker paid to have the association registered and everything, took a long time. The whole office building of medical professionals of about 500 people wanted to participate. The street rates were good, and then when it came time to actually submit the application, out of the 500, only 9 people (all sick) submitted their applications. They did get final rates back for the 9. Out of the 9, only 1 (I believe that was the one with ongoing cancer treatment) wanted to participate. So after wasting time and money, the association (or co-op?) never materialized.

Yes, small businesses banding together for the sole purpose of buying group insurance was illegal, but it looks like it is legal now and it is encouraged like it's a brand new idea.

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JoeRetire
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Re: Fed up with health insurance situation

Post by JoeRetire » Tue Sep 25, 2018 3:53 pm

HereToLearn wrote:
Tue Sep 25, 2018 12:46 pm
JoeRetire wrote:
Tue Sep 25, 2018 12:29 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 9:44 am
This may work for you but I wonder how old the OP's employees are. I am 60 and currently using Cobra. An ACA plan for just me would cost more than what OP says he pays for 3 people. My Cobra is a little lower because many members of my former employer group were much younger.
Yup, everyone is different.

My current ACA plan is less than half what I paid for COBRA through my Megacorp a few years ago. Same doctors, far lower deductibles, much lower cost.
Are you saying that the premium on your ACA plan w/o subsidies is half the cost of your prior COBRA premium?

Were you covered as part of a larger group that had a lot of employees living in HCOL areas, and do you now live in a LCOL area? I am intrigued by this.
No. We get subsidies.

We are currently paying $262/month for better insurance than we got for $702/month on COBRA about four years ago. We currently have much lower deductibles, and overall better coverage now. We do get ACA subsidies. And while on COBRA, we paid both the employee's and the employer's side plus 2% administrative costs. The Megacorp I retired from has employees around the world, both young and old. I know their employees are currently paying even higher premiums, but I don't know by how much. We continue to live in a HCOL area - we haven't moved.

I am currently 64 years old. Many folks who retire will find themselves in a similar situation. But everyone's mileage may vary.
Last edited by JoeRetire on Tue Sep 25, 2018 4:02 pm, edited 6 times in total.
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dm200
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 3:54 pm

I think this "situation" may have gone away, but about 15-20 years ago, my small company employer faced much higher costs because one dependent spouse of an employee had huge medical bills - and that caused our premiums to go up a lot.

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Re: Fed up with health insurance situation

Post by SeekingAPlan » Tue Sep 25, 2018 3:55 pm

dm200 wrote:
Tue Sep 25, 2018 3:13 pm
Both cases seem very likely to me. Here are a couple of ACA quotes for my zip code.

25 year old - 267/month
60 year old - 802/month


A group plan might charge like 500-600 bucks (depending on the age distribution of their employees). So basically the young employee subsidizes the old. It makes a lot of sense for the old person to stay on the plan where they are subsidized by the young and for the young to switch to plan where they are not subsidizing (as much) the old.
In most states, the federal age ratio limits apply. The oldest tier cannot be charged more than three times the youngest tier. So 1/3 of 802 is 267.

Prior to the ACA limits, that ratio was higher - so this is much better for those in the older tier than prior to the ACA.
Prior to ACA many of us got turned away for having a pre-existing condition. In my zip code ACA is more than $802. Cobra is $600 for a.single adult on company self funded plan. While one could say that the young subsidize the old, could not one also say that my childless self is subsidizing pregnancy care? Isn't that the point of insurance and care for all?

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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 3:59 pm

SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
dm200 wrote:
Tue Sep 25, 2018 3:13 pm
Both cases seem very likely to me. Here are a couple of ACA quotes for my zip code.
25 year old - 267/month
60 year old - 802/month

A group plan might charge like 500-600 bucks (depending on the age distribution of their employees). So basically the young employee subsidizes the old. It makes a lot of sense for the old person to stay on the plan where they are subsidized by the young and for the young to switch to plan where they are not subsidizing (as much) the old.
In most states, the federal age ratio limits apply. The oldest tier cannot be charged more than three times the youngest tier. So 1/3 of 802 is 267.
Prior to the ACA limits, that ratio was higher - so this is much better for those in the older tier than prior to the ACA.
Prior to ACA many of us got turned away for having a pre-existing condition. In my zip code ACA is more than $802. Cobra is $600 for a.single adult on company self funded plan. While one could say that the young subsidize the old, could not one also say that my childless self is subsidizing pregnancy care? Isn't that the point of insurance and care for all?
Yes - DW and I had to scramble when my employee insurance was cancelled abruptly - cost a lot to get individually insured.

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Re: Fed up with health insurance situation

Post by JoeRetire » Tue Sep 25, 2018 4:05 pm

SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
Prior to ACA many of us got turned away for having a pre-existing condition.
That is one of the big worries for many of us - being uninsurable due to pre-existing conditions should the ACA go away.
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Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 4:41 pm

JoeRetire wrote:
Tue Sep 25, 2018 4:05 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
Prior to ACA many of us got turned away for having a pre-existing condition.
That is one of the big worries for many of us - being uninsurable due to pre-existing conditions should the ACA go away.
While I support the ACA and oppose efforts for it to "go away", a return to the pre-ACA rules would not completely eliminate the situation. Prior to the ACA, if/when you had certain kinds of coverage (such as employer based) - when coverage was continued under another plan/insurer - pre-existing conditions could not be excluded. [Not sure of all the details]

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Re: Fed up with health insurance situation

Post by furikake » Tue Sep 25, 2018 4:50 pm

dm200 wrote:
Tue Sep 25, 2018 4:41 pm
JoeRetire wrote:
Tue Sep 25, 2018 4:05 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
Prior to ACA many of us got turned away for having a pre-existing condition.
That is one of the big worries for many of us - being uninsurable due to pre-existing conditions should the ACA go away.
While I support the ACA and oppose efforts for it to "go away", a return to the pre-ACA rules would not completely eliminate the situation. Prior to the ACA, if/when you had certain kinds of coverage (such as employer based) - when coverage was continued under another plan/insurer - pre-existing conditions could not be excluded. [Not sure of all the details]
This only applied in some states, not all. My state did not have this, but we had a risk pool - people with pre-existing conditions who couldn't get coverage could join the risk pool run by the state from the tax money from corporations. You still had to pay a premium, it was expensive, but the coverage was there, and it was subsidized by corporations' tax money. Now the ACA rates are like the risk pool rates, and the whole ACA is like a big risk pool.

User avatar
dm200
Posts: 22912
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Fed up with health insurance situation

Post by dm200 » Tue Sep 25, 2018 5:17 pm

furikake wrote:
Tue Sep 25, 2018 4:50 pm
dm200 wrote:
Tue Sep 25, 2018 4:41 pm
JoeRetire wrote:
Tue Sep 25, 2018 4:05 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
Prior to ACA many of us got turned away for having a pre-existing condition.
That is one of the big worries for many of us - being uninsurable due to pre-existing conditions should the ACA go away.
While I support the ACA and oppose efforts for it to "go away", a return to the pre-ACA rules would not completely eliminate the situation. Prior to the ACA, if/when you had certain kinds of coverage (such as employer based) - when coverage was continued under another plan/insurer - pre-existing conditions could not be excluded. [Not sure of all the details]
This only applied in some states, not all. My state did not have this, but we had a risk pool - people with pre-existing conditions who couldn't get coverage could join the risk pool run by the state from the tax money from corporations. You still had to pay a premium, it was expensive, but the coverage was there, and it was subsidized by corporations' tax money. Now the ACA rates are like the risk pool rates, and the whole ACA is like a big risk pool.
Thanks for the added information. I had thought this was a universal requirement. You know you are "old" when you remember when employer provided health insurance:

1. Began on your first day of employment
2. Was 100% funded by the employer
3. Had no network, referral requirements, etc. AND paid almost all (or all) expenses as submitted
4. Covered all dependents fully and at no charge to employer

danaht
Posts: 621
Joined: Sun Oct 18, 2015 11:28 am

Re: Fed up with health insurance situation

Post by danaht » Tue Sep 25, 2018 5:36 pm

OP - I was self employed earlier this year- but it was costing me $560 a month for an ACA one person plan. At least your $1040/month plan is cheaper per person than mine was. It's an outrageous cost anyway. And, I did exactly what you suggested - I joined a megacorp. I am enjoying a $18 a month premium payment instead. It also has a much smaller deductible for that $18. The megacorp self insures and pays about $200 of the monthly cost - and the employee pays only 18 per month.
Last edited by danaht on Tue Sep 25, 2018 5:41 pm, edited 1 time in total.

SeekingAPlan
Posts: 168
Joined: Sat Dec 12, 2015 1:03 pm

Re: Fed up with health insurance situation

Post by SeekingAPlan » Tue Sep 25, 2018 5:40 pm

furikake wrote:
Tue Sep 25, 2018 4:50 pm
dm200 wrote:
Tue Sep 25, 2018 4:41 pm
JoeRetire wrote:
Tue Sep 25, 2018 4:05 pm
SeekingAPlan wrote:
Tue Sep 25, 2018 3:55 pm
Prior to ACA many of us got turned away for having a pre-existing condition.
That is one of the big worries for many of us - being uninsurable due to pre-existing conditions should the ACA go away.
While I support the ACA and oppose efforts for it to "go away", a return to the pre-ACA rules would not completely eliminate the situation. Prior to the ACA, if/when you had certain kinds of coverage (such as employer based) - when coverage was continued under another plan/insurer - pre-existing conditions could not be excluded. [Not sure of all the details]
This only applied in some states, not all. My state did not have this, but we had a risk pool - people with pre-existing conditions who couldn't get coverage could join the risk pool run by the state from the tax money from corporations. You still had to pay a premium, it was expensive, but the coverage was there, and it was subsidized by corporations' tax money. Now the ACA rates are like the risk pool rates, and the whole ACA is like a big risk pool.
There was a wait list for the state's risk pool. Everyone who needed it could not just apply & be approved. It was much more expensive than ACA. I would also ask why the unfortunate sick people should pay more for insurance than everyone else. Most people will eventually become the sick person. It is just that many will not be that sick until that have reached Medicare age. Isn't insurance supposed to cover everyone? We all buy auto insurance even tho we do not plan to have an accident.

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