Individual health insurance?

[Whiteroom_Guardian]

So I emailed back and forth with our companies broker. COBRA is stupid expensive, and something changed just this spring where brokers can no longer quote for individuals. Carriers cut them out of the loop unless it for groups/businesses.

[mcski]

Cobra has always been expensive. You're just continuing on a company policy without the company's subsidy (that they get a tax break on). In the old days, the expensive cobra was the only option if you got laid off w a pre-existing condition until you got a new gig.

As currently unemployed you could get an ACA policy w a decent subsidy for not much or maybe even qualify for Medicaid.

[Whiteroom_Guardian]

Well I won't get any good deals because for tax year 2017 I will have made way too much money to qualify for any type of aid. First world problem.

I just talked to Horizon BCBS about an individual plan. The "Bronze" plan is only $287 per month. $3k deductible. $7150 out of pocket max.

Honestly have no idea really what that all means totally. Like if I broke my arm and needed surgery I would basically end up paying $3k right off the bat? Assuming I actually made my way to a BCBS network hospital/doctor (which is fucking super confusing to figure out using their network site)....

[mcski]

287 seems reasonable. 3k is probably not bad these days as a deductible. Yes, that's what you pay out of pocket until reached. If you plug in what you expect to earn(ed) in 17, the ACA tool will tell you plan costs and subsidy if any. Not sure about the Medicaid part, but youre not working now so you might even qualify even though u made money earlier this year

[tom tuttle from tacoma washington]

Well I won't get any good deals because for tax year 2017 I will have made way too much money to qualify for any type of aid. First world problem.

I just talked to Horizon BCBS about an individual plan. The "Bronze" plan is only $287 per month. $3k deductible. $7150 out of pocket max.

Honestly have no idea really what that all means totally. Like if I broke my arm and needed surgery I would basically end up paying $3k right off the bat? Assuming I actually made my way to a BCBS network hospital/doctor (which is fucking super confusing to figure out using their network site)....

That price isn't very out of line.

[Whiteroom_Guardian]

I honestly was expecting like $500+ monthly.

[bobz]

Also:
- Deductible doesn't apply to a number of things, so you do a $20 copay or whatever, and that's it, even though the deductible hasn't been reached.
- Where you do pay out of pocket (towards a deductible that you may or may not eventually reach), you typically pay all of or a portion of the insurance company's negotiated rate (with in-network providers anyway), which can sometimes be a fraction of the listed rate that they're prepared to send out for collection if the patient was uninsured. Like those hospital bills, which famously include charges for $20 Band-Aids and so on; insurance companies don't pay any of that crap, and when an insurance company gets back to the hospital about the part of the bill you need to cover, you don't either... but if you're uninsured, the hospital will go after your salvaged assets to pay for every one of those Band-Aids, or nail your ass to the wall trying.

[uglymoney]

Couple of reasons for that. Chances are that while the new plan has a higher deductible your current plan covers a lot more stuff--that's regulation, whether you think it's good or bad is another issue. Part of it is that there is now a woman of child-bearing age on the plan. A big part is that Congress hasn't made the necessary adjustments to the subsidies the insurance companies get to keep rates low. A big part of it is that Obamacare introduced community rating--everyone pays the same whether healthy or sick, and no one is excluded for pre-existing conditons, so you're paying a big part of the premiums for those sick people. It's the same as the FICA tax you pay for SS and Medicare. You're supporting the elderly for health care and a modest pension even though you're too young to retire and healthy. The problem is that the penalties for not being insured aren't high enough to induce enough healthy people to buy insurance to pay for the sick people, so the healthy people who do buy pay a lot more.

Part of the problem with Obamacare is that a lot of people saw it as a takeaway--we're taking away your choice of what kind of insurance to buy or no insurance at all. People don't like takeaways. Now that Congress is threatening to take away health care from a lot of people, people like that even less.

Obamacare is a structurally flawed plan that could be tinkered with if Congress were willing, but it will always be plagued with problems. The big thing it does is that it has gotten people to start seeing health care as a right and that will some day open the door for single payer.

Yep. Yes. Hopefully. Great post.

Covering pre existing conditions has a cost and the cost is magnified when young healthy people simply don't buy and choose to pay the much cheaper penalty because they can't or don't want another mortgage payment. That is a big reason why the individual market is blowing up. But nobody wants to get rid of the pre existing condition mandate because we are all only an accident or illness away from being uninsurable without it.

So something has to give. As a country we aren't ready for single payer sadly. We are still in the scapegoating and simple answer to complex problem phase.

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[bobz]

But nobody wants to get rid of the pre existing condition mandate because we are all only an accident or illness away from being uninsurable without it.

For me, that's not even the main reason. Here are some others:

- Rescission: In an individual policy and you get some disease that's going to cost six figures to take care of? The insurer gets to look for ways to avoid covering you, and the most fertile ground for that is to look at your 15-page application and disclosure and see if you left something out (doesn't even have to be connected to what you want them to cover); since they have access to more accurate records than you probably did when you filled it out, it might not be too hard. Michael Moore's "Sicko" (one of his better works, where he managed to minimize his obnoxious trolling story-telling style) covered this issue in detail. Want to sue them? Great, if you live long enough to win, they'll end up saving money anyway, on account of you being so frugal with medical care while not knowing if they'd pay.

- It's not just big-ticket illnesses. My wife had a bear of a time getting insured on account of some knee surgery she had not long before (us skiers think of that as a pretty routine shit-happens-gotta-see-doctor kind of thing). Hasn't had problems in the decade or so since, but for a while there it looked like she might have been locked out of getting (individual market) health insurance.

- There's a game insurance companies used to play. Me: "Why is my insurance premium about to go way way up?" Agent: "Oh, look at that, you should apply for this other plan from the same company that's just about exactly the same, and is only modestly more expensive than you were paying before." Me: "Great, I'll fill out the 15-page application, good thing I'm still healthy!"

[uglymoney]

No I completely agree. We have to cover pre existing conditions. I had acl surgery so I know that I would be fucked without it in the individual market because they don't want to cover my knee. My point is simply that covering everybody comes at a cost and if healthy working people skip out on coverage because it costs too much or they simply don't want it for whatever reason we end up in a cost prohibitive death spriral. Everybody has to play to make it work.

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[Danno]

Also:
- Deductible doesn't apply to a number of things, so you do a $20 copay or whatever, and that's it, even though the deductible hasn't been reached.
-.

Depends on the type of insurance. I have a HDHP, free annual exam but everything else I pay 100% until I hit my deductible.

[Mazderati]

287 seems reasonable. 3k is probably not bad these days as a deductible. Yes, that's what you pay out of pocket until reached. If you plug in what you expect to earn(ed) in 17, the ACA tool will tell you plan costs and subsidy if any. Not sure about the Medicaid part, but youre not working now so you might even qualify even though u made money earlier this year

That price isn't very out of line.

For what level of care? $300-500/month is bullshit if you still have to fight for coverage or pay some ridiculous deductible.

[tom tuttle from tacoma washington]

Well yeah. Given our current system and the challenges so well presented above, that is a decent quote and is reality.

And probably cheaper than his Cobra without all the potential problems with that.

[old goat]

For me, that's not even the main reason. Here are some others:

- Rescission: In an individual policy and you get some disease that's going to cost six figures to take care of? The insurer gets to look for ways to avoid covering you, and the most fertile ground for that is to look at your 15-page application and disclosure and see if you left something out (doesn't even have to be connected to what you want them to cover); since they have access to more accurate records than you probably did when you filled it out, it might not be too hard. Michael Moore's "Sicko" (one of his better works, where he managed to minimize his obnoxious trolling story-telling style) covered this issue in detail. Want to sue them? Great, if you live long enough to win, they'll end up saving money anyway, on account of you being so frugal with medical care while not knowing if they'd pay.

- It's not just big-ticket illnesses. My wife had a bear of a time getting insured on account of some knee surgery she had not long before (us skiers think of that as a pretty routine shit-happens-gotta-see-doctor kind of thing). Hasn't had problems in the decade or so since, but for a while there it looked like she might have been locked out of getting (individual market) health insurance.

- There's a game insurance companies used to play. Me: "Why is my insurance premium about to go way way up?" Agent: "Oh, look at that, you should apply for this other plan from the same company that's just about exactly the same, and is only modestly more expensive than you were paying before." Me: "Great, I'll fill out the 15-page application, good thing I'm still healthy!"

Is all this true under Obamacare with community rating (sick and healthy people pay the same) and no exclusion for pre-existing conditions? Sicko came out in 2007.

[bobz]

My understanding is that ObamaCare addressed the rescission issue; thus, Sicko mainly addresses a problem that is no longer a problem now... but which could easily return if we move back to a system that discriminates based on pre-existing conditions.

[Todds]

If you'll be away from your official place of residence and are only interested in coverage for emergency care, you should look into travel insurance. IIRC it's cheap and the medical coverage is generally pretty good. Injuries have to occur a certain distance from "home" but I think the minimum distance is usually around 100 miles.

That said, think very carefully before you voluntarily create a gap in your medical coverage. Rates really should not be that bad for a young single person.

I think emergency care is covered if you are away from home, but follow up care might not be. There have been lots of articles written about this. It is tricky stuff.

[NoPostholio]

So I emailed back and forth with our companies broker. COBRA is stupid expensive, and something changed just this spring where brokers can no longer quote for individuals. Carriers cut them out of the loop unless it for groups/businesses.

How expensive - north of 700?
I have to get into this next week (cobra 60 day election period) so will report back. I am using it as a bridge until I can establish something when I make a landing hopefully via a remaining ACA.

[TBS]

How expensive - north of 700?
I have to get into this next week (cobra 60 day election period) so will report back. I am using it as a bridge until I can establish something when I make a landing hopefully via a remaining ACA.

For comparison, I'm paying north of $1k. Central Oregon is wicked expensive.because there isn't any competition.

[spindrift]

I don't understand the problem. There was an interview with some guy in the NYT the other day. He said you just pay twelve bucks a year and you are good to go....

[hutash]

If you have a high income, and therefore high tax bracket, look at the bronze HSA.Put thr max in the HSA and stay healthy. If you need to pay medical bills you get upward of 40% discount because of the tax savings. Worked great for the thousands of dollars of dental work my wife had last year.

[old goat]

If you have a high income, and therefore high tax bracket, look at the bronze HSA.Put thr max in the HSA and stay healthy. If you need to pay medical bills you get upward of 40% discount because of the tax savings. Worked great for the thousands of dollars of dental work my wife had last year.

Like a lot of things--401K's, mortgage and state income tax deductions, capital gains tax rate, and on and on--HSA's are great for people with money. For the average American living paycheck to paycheck and most likely not managing to save anything for retirement HSA's are useless.

[hutash]

All true, but the OP made a comment about making too much money for subsidies, so he may be able to take advantage of an HSA.

I agree that HSA are just another way to give tax breaks to rich people and don't do si
hit for most people. Imagine that, one of the big parts of the GOP health plan favors the rich. I'm shocked, shocked I tell you.

[Danno]

Eh, I'm far from rich, and I make good use of an HSA. My employer offers a PPO or an HDHP that's much cheaper, so I went the HDHP route and put the premium savings (and some extra) into the HSA every month.

I realize that you have to have some money to use one, but it's a huge stretch to say you need to be rich. You do, however, need to have the discipline to put money in there.

[MontuckyFried]

I about lost my cool when I saw this commercial not too long ago showing these people dancing cause they're stoked about their super awesome health care plans. I wish I could get those sorts of rates! Instead, I'm literally days away from losing my coverage because I can't afford my crappy plan any more.

[old goat]

Eh, I'm far from rich, and I make good use of an HSA. My employer offers a PPO or an HDHP that's much cheaper, so I went the HDHP route and put the premium savings (and some extra) into the HSA every month.

I realize that you have to have some money to use one, but it's a huge stretch to say you need to be rich. You do, however, need to have the discipline to put money in there.

I didn't say rich. I said people with money. Plenty of people who aren't rich take advantage of the mortgage interest deduction, the property and state income tax deductions and have 401K's and capital gains--but the richer you are the more valuable those deductions are. Re HSA's --a large percentage of Americans who are too "rich" for subsidized health insurance still don't have spare cash to put into an HSA. The other problem with HSA's is that the program assumes you will have time to accumulate a substantial amount before you get sick. Saving for retirement works because you know about when you will retire and can plan your retirement contributions accordingly. No one knows when they'll get sick.