The best way to handle it is to call to and ask for $100/month off or you'll start smoking.
"Hepatitis C costs over $100,000 to treat and will ruin your whole profit. What if you your waive the deductible without increasing the premium and I go get a clean needle?"
That definitely won't be on the Customer Service Representative's script, you asshole.
1, 3:
"Oh, that won't cut it? How about crack?"
"Are you offering....I don't mind if I do."
Anyway, I'm happy I managed to seem out without working for a health insurance company. But they were the ones sending recruiters to call me which gave me the courage to reject low offers.
Bronze-Silver-Gold - don't those apply to plans on the exchanges? Wouldn't you get your insurance through Heebie U instead of the exchanges? I am exactly as ignorant as this probably makes me seem...
oh, I just used those words for simplicity. Tier 1, tier 2, tier 3 or something.
How low does it go? Tin? Lead? Arsenic?
2. My suspicion is that they've priced these based on a bit of psychology, and that the silver plan is the worst, because it seems like the safe compromise, and thus people are most likely to reach for it when they get overwhelmed with decision fatigue.
The old "second-cheapest-wine-on-the-list" trick.
My work has something like 5 providers, with three plans each, so something like 15 potential choices. We're heavy healthcare users, so my intuition was that a gold plan would be cheapest for us. We spent a lot of time on this, and we're on a silver plan. I don't understand any of this. And when it came time to re-up, we just went with the same plan.
Yeah, I have to do mine too. I'm on the Exchange, and will probably just re-up the same plan.
Am I the only loser who picked a plan ages ago and hasn't thought about changing it since? I don't want to think about it, it is worth money to me not to think about it, as you are all saying it is not clear that being thoughtful about it would actually save me money.
We don't get a choice, which I don't mind at all because they pay the whole of the premium.
Bronze-Silver-Gold - don't those apply to plans on the exchanges? Wouldn't you get your insurance through Heebie U instead of the exchanges? I am exactly as ignorant as this probably makes me seem...
Bronze, silver, and gold have specific definitions on the exchange. Some companies use them for off-exchange plans as well, and I assume they're subject to a similar definition. (It has to do with how much of a person's likely OOP costs are paid for.)
On the exchange, silver plans have extra subsidies. People think about the subsidies just in terms of the tax credits, but for people with lower incomes, there are also subsidies to lower co-pays and deductible. If you earn less than 200% of the poverty line (which is of course laughably low) you can actually get a pretty good silver plan for very little (very very little if you're young and don't use tobacco). You can usually get a bronze plan for free. It doesn't pay for much, but it gets you your one free check-up/gyn visit a year and a flu shot and keeps you from racking up $100,000 of medical debt. Some actually pay for prescriptions before the deductible.
All of which is to say that in addition to all the other shitty aspects of our dumb system, there are a lot of people walking around without insurance who could actually afford it.
PSA related to the above: If you know anyone who doesn't have insurance, especially dumb young people who think they don't need it, beg them to at least look at heathcare.gov's estimator to see if there's something they can afford.
13: Sounds like a nice idea but between my wife and I we've changed employment statuses four times in five years (that's not as unstable as it sounds. She started her current one this past July. I started my current one in June 2016, because of this saga. My current job resulted from that co-worker's husband mentioned at the bottom of that thread) and of course having a kid changes things, so we've been obligated to at least think about it.
But, honestly, the decision fatigue in the OP seems past the point of reasonableness, even though I don't handle it well either, and some paranoia is reasonable these days. I can think of a couple different approaches to it other than treating it like a multiple choice test I didn't study for.
1. Someone should get the bronze plan if they have a lower than average amount of risky lifestyle choices or chronic medical conditions in their life, and should get the silver or gold plan if they have the average or higher than average. Cancer risk factors, diabetes, driving on icy roads because they live in a part of the country where they can't avoid that, morbid obesity, etc.
2. Think about how elastic your budget and your credit rating are. If you're living paycheck to paycheck, get the bronze plan and just try to avoid risky lifestyle choices. If you're doing fine, get the gold plan so you can worry about a catastrophe marginally less and have less inconvenience at routine visits. Get out a calculator and budgeting program and do some math, if necessary, although I haven't bothered.
We're taking the middle plan (not actually called "silver"), but personally I've experienced a lot more decision fatigue over my 401(k) maintenance and some PTA activity.
Wasn't there a thing I just saw today about Texas being especially horrible on maternal mortality because it's especially horrible on health insurance and it turns out having a baby without good medical care is dangerous?
But, honestly, the decision fatigue in the OP seems past the point of reasonableness
I personally didn't find it fatiguing so much as just clear that I don't have enough information to make the most informed decision, because of how costs fluctuate according to which plan you're on. I am also aware that I was juggling numbers that many of my coworkers would have gotten bogged down in.
One of the ways that I'm sometimes useful to the people I help enroll* is to get them to estimate their costs for the whole year, rather than just look at the premium. (See also, car payments and interest rates.)
*In case you missed it when I've trotted it out before: I'm a volunteer (certified, by virtue of some truly terrible online training) application counselor. (But the terrible online training is supplemented by fantastic training by the org. I volunteer for!)
Yes, Texas is horrible for maternal mortality overall and truly terrifying for black women, but health insurance apparently doesn't explain much of it, so several academics and orgs. are working on the why.
I certainly heard that Texas had a horribly high maternal mortality rate, when it came out a few years ago, but this interesting article says it's an artifact of sloppy record keeping and not as bad as reported.
just clear that I don't have enough information to make the most informed decision, because of how costs fluctuate according to which plan you're on
And because you're trying to predict what will happen in the lives of 6 people for an entire year, which is a REALLY, REALLY DUMB system.
Our health insurance is so weird and so good. (The only problem is that there's no actual doctors in this town and so everything has very long waiting lists, but that's not about insurance. There's only so much insurance reform is going to do for rural areas, you have to do something on the provider side.) Less than $250/month for a family with no smokers, wide network, $3K deductible, $6K out of pocket maximum, and the employer puts $2.6K into an HSA every year?! Insurance pays nothing until you hit the deductible, but you can pay costs from the HSA.
26: Huh. That's a really interesting/alarming article that I'm sorry I missed earlier. Turns out it probably has actually gone up somewhat, but by nowhere near the numbers that have been floating around.
The alarming part is that nobody actually fucking knows what's happening anywhere in the U.S.
ProPublica and NPR, in articles about maternal mortality, documented this data issue extensively in an article titled, "How Many American Women Die From Causes Related to Pregnancy or Childbirth? No One Knows." The federal government has not released an official maternal mortality rate estimate since 2007, largely because of the differing reporting methods in every state thanks to the new checkbox, the report said.
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Be the trendiest person in the room is the first sentence of the copy for this.
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Joseph and the mono-color trend coat.
I have to go round the Vatican Museum next week on a rather equivocal freebie. And I will need to be respectable. But I don't think that jacket, onesie, or whatever it is, could get here on time. So there goes my one chance to be the trendiest person in the Sistine Chapel.
30: Is that really $114,903? It kind of looks like a data entry mistake. Anyway, I wouldn't pay more than $75,000 for that.
High-waisted pants are really back.
I'm starting to think that the joke in 31 was pwned by the person who named the coat. Maybe they didn't do it on purpose, but it looks like they did.
I'm struggling to figure out how to afford a condo but I have good health insurance.
2 options at my employer only, but they keep jacking up the premiums and they'll pay me money not to take it. First dollar coverage and low copays but only if I shop at the company store. Tim's has $200 per person deductible and 10% coinsurance. Hello - welcome to facilities fees, but the combination of $3500 in premiums for 2 people, and 2k per person out of pocket max, 4K per family, is less than the effective cost of my premium.
I'm super lucky but it's all too expensive, and if I go to the general network instead of the preferred network, I.e s competitor's hospital, my out of pocket costs would be high.
They used to let us stay on the same plan but they redesigned things a few years ago and encouraged us to go with the cheaper plan - more restrictive network and higher out of pocket max but most people won't notice if they stay in the Tier 1 network.
28: is that your contribution to an employer plan? Cause that''s what Tim's is for 1 plus 1 but the out of pocket max is 4K, family is $300 something a month but still $4k out of pocket max.
Thanks for the reminder of how fundamentally broken healthcare is in the US. Every time you consider a change you need a spreadsheet to figure out how badly you are making out relative to , say the leading dozen or so countries.
On the exchange, and making just a bit too much to qualify for subsidies, I'm looking at $980 per month for my family of 3. Deductible is $16,300.
Nobody better get sick.
$25k is what family Insurance here costs so that sounds about right, Spike. Ugh.
What's the deductible on your home owner's or renters insurance?
$25k is what family Insurance here costs so that sounds about right, Spike. Ugh.
Yeah, while the cost does bother me (a lot) what I really don't appreciate is that I am paying all this money and yet still family is saddled with a financial incentive to forgo medical care except in dire situations. I feel this structure is all sorts of fucked up and I blame the neo-liberals.
I don't carry homeowners. I recognize that I should get it but it can be difficult to accept another regular bill into one's life.
Hold on wait. You carry these homeowners around and then *you* pay *them*?
There are only five English word that contain "meow". They are meow, meowed, meowing, homeowner, and domeowner.
There is only one Chrome owner.
I question whether "domeowner" is actually a word. If it is, then someone who has big thick books on their shelves is a tomeowner, and somebody who has silly little statues of bearded men on their front lawn is a gnomeowner.
And certain nation-states biomeowners.
Numerous Italians Romeowners.
I would respectfully direct your attention to 59 as the definitive clarification of ownership status in thie question. It's simpler than Schleswig-Holstein. Much simpler
Bald men may be combowners
#notall but #someowners
but all of us are proteosomeowners
possessive poly people might have co-me-owners
Our options are similar to BG. You either pay a high premium and have only copays, or you pay low premiums and then have $2k deductible followed by 20% coinsurance. Same network for both plans. On an annual basis the OOP max + premiums - employer HSA contribution of the lower coverage plan are equal to the total premiums of the high coverage plan. Technically the high coverage plan also has an OOP max but to hit it with just copays you'd have to have 200 office visits in a year or 40 ER visits.
Of course with four kids we hit the OOP max after 10 months. I'm happy to provide a data point in favor of free universal coverage that I did not in fact run out and get a recreational colonoscopy even though it's "free".
We are actually getting a lot of free necessary healthcare this month- 7yo stress echocardiogram that's been scheduled since two years ago- so came out ahead because we don't even have copays now. At a recent visit I asked the receptionist if I had to settle anything and she just shrugged which made me feel like Michael Moore when he went to the hospital cashier in England.
The thing that still scares me is balance billing which I haven't encountered yet but never know if it might happen based on the stories you hear (which I guess is why it's called surprise billing.). I've been wondering if some kind of legal text you could give to hospitals would be enforceable- something like "I only agree to be treated by in-network doctors; If an out of network doctor treats me, by doing so they are agreeing to accept only the payment my insurer offers.; If they balance bill me they also agree to pay me $500/hr for any time it takes me to resolve the unauthorized billing."
64: My husband has the option of a high deductible $1500 or $3000 w/ $500 with a $500 employer funded HSA individual $1000 family, a moderate deductible with 20% co-insurance and $500 or $1000 deductible, and a lower $200 and $400 deductible. I think there are arguments for the high deductible with HSA, but the premiums on the middle one "Core Plan" aren't enough lower than on the "Buy Up Plan"
The big thing is that they switched to Blue Cross of MA which is better than my employer's network.
Out of pocket max and balance billing. I might hit *my* out of pocket max because prescriptions are included in Tim's. My employer plan has a separate out of pocket max for drugs which varies depending on your income level.
OUT-OF-NETWORK BILLS and perverse incentives
SP - Baker is actually trying to do something out out-of-network bills. I don't know whether his proposed solution is a good one. But currently the incentives are somewhat perverse for a patient and go against the goal of encouraging people to go to lower cost community hospitals.
Right now, I get my care at an academic medical center. My doctors visits are outside of the deductible, but when I see the doctor, the hospital facility fee will get applied to my deductible and co-insurance requirements. I really have no way of guessing how high that will be.
On the other hand, a co-worker of mine was hospitalized at a community hospital, and the radiologists were out of network, so that was a $2k bill which she is paying at the rate of about $10/month. I told her she should tell the AG's office.
When I go to the academic medical center, I am (1.) paying inflated rates, and (2.) getting charged facilities fees that I wouldn't have to pay in the community, BUT I know that there is not a single person working in that hospital who could be involved in inpatient care who is out-of-network.
This thread is more fun when the Americans are asleep.
My absolute least favorite time of the year is the yearly open enrollment period, when I have to make poorly educated gambles on my family's health care and financial future based on intentionally misleading marketing material under time pressure.
I think folk vastly underestimate the magnitude of acute stressors that will just go away under a good fair public benefits plan. (Though I suppose in the United States at least it'll be replaced with the chronic stress of having to defend such plans against ideologues and grifters.)
If I were emperor the first stupid neoliberal health care kluge I'd ban is FSAs. Child care is at least somewhat predictable (and in most places the limit is well under what you're likely to spend) but for health expenses it's idiotic. Guess how much out of pocket spending you'll have! Oh you were wrong so you'll lose the money unless you waste it on something!
That's when you go for the recreational colonoscopy.
Hello this is the FSA administrator, I don't believe that purchase you made 8 months ago was eligible, please dig up your 5 foot long CVS receipt or your card will be shut off.
"FSA account administrator" has got to be high on the list of bullshit 21st century jobs.
Due to confused wording and differences between the calendar year, the plan year, and the benefits cycle, I've lost $1000 to a child care FSA. That one mistake exceeds the total gross benefits I would ever have expected to receive from marginally reducing my taxable income with FSAs.
Until Moby wakes up, and the colonoscopy jokes start.
My in-laws got a surprise bill in Ontario which was kind of a shock to them. My F-I-L has always had supplementary employer and retiree coverage that paid for care abroad, prescriptions and physiotherapy.
He was recently hospitalized for an infection and asked about his insurance coverage. He gave them the info, and was put in a semi-private room. He then got a $300 bill. If he had not had the supplementary coverage, he might have been put in a semi private room anyway, since the hospital is pretty full and might not have had space for him in a regular room with more people, but he would not have been charged.
70: My FSA has been fine. Tim's covered prescriptions easily enough, but Tim's kept saying that they could not verify that a major health system was a medical provider.
It *almost* makes me want to sign up for the high deductible plan, because the HSAs roll over from year to year. I have both 2 FSAs and money I'm putting aside in a savings account for unanticipated medical expenses.
I made some guesses as to probabilities and concluded that the tax benefit from a health FSA was about equal to the average expected loss from misestimating the amount needed, so I stopped contributing.
Saw a pollster at a conference this week note that a large majority of voters have no- to moderate-deductible health plans.
One other psychological benefit of choosing the HDHP is that you can't do both an HSA and a standard FSA so I didn't have to think about spending estimates and possible loss. The only FSA contribution I could do was for dental, and since I knew my kids would be getting braces I maxed it on that and did save several hundred in taxes. Next year we have no anticipated qualified expenses so no health FSA, and no child care FSA since the kids are all in public schools now- we could maybe get something for day camp or after school programs but just not worth the trouble.
75: My husband and I both contribute, because we will each get a physical (not free b/c they will bill for treating his hypertension) so we need to meet the deductible and cover co-pays for chronic meds. Even if you contribute less than you need, it's helpful.
When I worked at WF, I had a significant deductible on prescriptions which were then covered on the basis of co-insurance rather than a co-pay. With the FSA, I had the money to cover the deductible right away.
To illustrate the twin dangers of aging and self-employment, for the two of us the monthly premium will be 1,500, and deductible 14,400. Or we can pay 2,300 a month premium and knock the deductible down to 1,500.
Neither of us has any current prescriptions, or chronic conditions under treatment, and I would guess our 2019 medical expenses to date -- knocking wood -- as being south of $1,000. With similar luck in 2020, there's no way a higher premium low deductible plan pays off. That 14,400 deductible, though, make it just catastrophic care: ok, sure, I don't want to get cancer and lose my house.
I'm 61 and the wife will be 63 next month. I suppose I could calculate the exact number of hours until each of us is Medicare eligible.
Yes, it makes sense to contribute an amount you know you will be spending; no more though.
78: I guess the thing to do is put the $800/month difference in a savings account for healthcare every year. If you did that last year, then you have the money set aside to pay that crazy deductible.
My employer-provided coverage was $80/week for 2 people, so $360/month, but when I go on Tim's they pay me $80/week to opt out, so effective it's $720/month. For employer-provided coverage when the employer is a health care provider, that's a pretty big employee contribution vs $250 for Tim's. That's after 1 year of employment. In your first year you pay double and get a $63 opt-out if you get other private insurance. So effectively for 2 people it's $221/week or $881/month for employer-provided coverage. They have been gradually shifting the contribution from 90% employer paid to 80%.
Around here one doctor's visit and lab work could set you back $1,000 easily. A couple of years ago and last year, I had to get a brain MRI and then endocrinology labs. I think th endocrinology labs which required a visit with a nurse were billed at $10k but negotiated down to $3k or something. Still it was about $6 or $7k of expenses, because the MRI was overpriced.
79: What does that cost with part B premiums and a Medigap supplement? Do you have to pay premiums for Part D? I don't even know. $300/month each?
82 It'll be cheaper, no doubt about that.
Around here one doctor's visit and lab work could set you back $1,000 easily.
They billed me by mistake for my annual physical with blood work. It was $800.
84: I got no labs and it was billed at $800 and they paid $500. But it all depends on how things are billed. But you add in hospital facilities fees and it goes up.
I'm sure it was $125 clipboard.
Actually, they replaced the clipboard with a very expensive looking touch-screen computer. Now I don't even get to draw a mustache on the pain-scale faces.
The real treasure is the lower blood pressure I got along the way.
I'm so happy that Biden is reaching to younger voters with his slogan "No Malarkey".
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Bobcats are beating the Great Danes 47-14 in the fourth quarter. Winner plays the winner of tonight's Sacto State vs Austin Peay game. I'm hoping for AP, so the next game will be in Bozeman as well.
Griz are also winning: 58-28 over Southeastern Louisiana. Winner plays Weber, down in Utah.
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It's not been a good decade for my school. I think because too many of the fans voted for Trump.
Among the many reasons why I feel like I could never leave my (state) employer are the health insurance benefits. I have a BCBS PPO, with premiums that are something like $200/month before taxes, no deductible, and relatively reasonable co-pays. I only have co-insurance on things like physical therapy. If I were healthier or less risk-averse I could get a plan from my employer with no premium and no deductible. Granted, it doesn't cover Mr. Robot because he's eligible for his own employer-provided coverage, but my employer does provide dental and vision coverage for both of us with no premiums or deductibles. It makes me *furious* that this level of coverage isn't routinely available to everyone, much less even to other college professors! Hearing about the experiences of profs at other schools trying to afford cancer care even with insurance has been eye-opening.
Our premiums are $250 for 2 people. $125/month for the generous plan for my husband.
FWIW, where my sister lives people complained that the fees of max something like $40/mo/person was too much and a too regressive, so the government got rid of the fees entirely come January.
unless not completely obvious - 97 not USA