Every time a metro Detroit Policeman or Fireman is injured in the line of duty, the local media promotes their “go fund me” account for their bills.
…because this is Shiny-land, where everyone gets a lecture on “personal responsibility”, instead of a helping hand, when bad things happen to good people.
Steve
One data point in the mess of American healthcare. I was on my former employer’s group plan via COBRA until 9/30. The group plan was quite good and never had any drug co-pays on the three “class A” generics that I use. I put off shopping for an individual plan until COBRA ended assuming that ANY individual plan would be vastly higher than my group rate even though I was paying 100% of that group rate.
Wrong. My COBRA rate was $704/month for what I think was a $4500 yearly deductible which really wasn’t an issue since it covered yearly preventative visits 100% and was covering the three cheap generics. When I finally shopped in September, I was expecting individual plans even with much higher deductibles to start around $790 and go up to $1000 per month. Nope. At the same carrier, individual rates ranged from $582 to $780. Since I will have to renew for the full 2024 year anyway, I opted for the cheapest “bronze” package with a $9200 max out of pocket limit per year. Picked up my first 3 year month renewal of 2 of the 3 meds and paid $5/script/month. At first I was kinda miffed – “what? I have to pay an out of pocket for drugs?” – then I did the math. I’m saving ($704 - $582) or $122 per month but only paying $15 extra per month for drugs?
Yea, the deductible is higher but I’m pretty healthy (fortunately) so I’m very unlikely to ever hit the $9200 out-of-pocket. In the mean time, the premiums are only $6984 over 12 months. For someone who KNOWS they have prescription needs or has routine non-preventative doctor visits that add to be well above a $4500 or $6500 or $9200 deductible, it seems pretty misguided to risk not buying at least a “bronze” plan. If they are NOT going to at least buy the minimum possible plan, they need to have the financial discipline to put that money aside and SAVE it for at least non-catastrophic costs that arise. If they gamble and skip insurance and come down with something requiring an extended hospitalization at $10,000 per day, there really won’t be any recovering from that financial mistake.
Oh, a second point to make about the mess that is the American “healthcare insurance” system… While SHOPPING for individual policies, something that I thought would be a VERY simple question to answer turned out to be the insurance company equivalent of proving Fermat’s Last Theorem.
I take a blood thinner so I require a routine “PT Time” test every month that is essentially identical to a stick for testing blood sugar. Curiously, the nominal billed cost of that test each month is $226 – for something that takes literally 4 minutes (1 to login, 1 minute to clean a finger with alcohol, 10 seconds to stick and capture the blood, 50 seconds to wait for a device to calculate the number, 1 minute to update the system).
My question was simple. Under my group plan with vendor X, that test has been covered for 11 years at no cost to me. Will any of the individual plans also cover that test 100% as required preventative care? If not, how much if any will they pay? If plan X1 covers it but costs $800 and plan X2 doesn’t but only costs $574 per month, then it’s a wash. I just want to know what the delta is.
That question turned out to be IMPOSSIBLE for vendor X to answer. If I talked to a person supporting my existing group plan, they have no access to policy terms on the individual sales side. If I talked to a sales person on the individual policy side, they were unable to look at the billing of my group plan. No problem, I said, I have the codes the hospital uses when they submit the test. Nope, the sales people can’t check a charge until a policy is actually present.
So much for making an informed decision as a consumer.
I also remember that my employer made attempts to help employees better optimize the plans they were choosing based upon prior spending. They found that something like 40% of employees were essentially overpaying by choosing more expensive / lower deductible plans but never coming near that deductible amount. But the insurance market is so corrupt and confusing that even those with relatively healthy families and presumably some financial savvy are so worried about getting burned by catastrophic expenses, they overpay so they can stop worrying earlier in the year about out of pocket expenses.
WTH
Right there is the gist of the fraud of the USA’s supposed “free market consumer choice” policies on health and a raft of other matters.
INFORMED choice does NOT exist, and so actual consumer power through choice in a market is null.
This is not an accident. It is the underlying reason for the enormous flow of “free speech” money to both parties to keep the scams in place.
david fb
Then you can’t buy any of their policies because they can’t give you a price quote on the actual cost of any of their policies.
You forget who is in charge.
Hint: it’s not the customer
Is there an 80% cap on major medical? Such an expensive surgery? Or a major accident that demands a lot more care? You can find a larger portion of your worth wiped out.
What I learned from 25+ years of buying individual, for-profit insurance since I retired in 1994 is that you never let the insurance company do your lab work if you have a high deductible policy. You can almost always buy the same lab test on-line at a fraction of the cost. And the work gets done at LabCorp or Quest, the same shops your personal doctor sends the blood sample to.
Now that I’m on Medicare, all the lab tests are covered 100% from day one. Medicare doesn’t even require me to satisfy the $226 part B annual deductible before covering the lab work 100%. Talk about a Luxury Health Plan.
Anyone who thinks a for-profit insurer is providing you with superior health care doesn’t understand arithmetic.
intercst
Seems to absolutely be the case. Again, the full name of the test involved here is a “Prothombrin Time Test”. It involves
This test COULD be done at home but poses another major limitation. The strips are only good for a year and test results from strips nearing two years old become significantly innacurate. Unless strips can be purchased in smaller quantities, paying for 48 strips and throwing away 36 of them would be expensive as well.
The nominal price charged by the hospital based clinic is $226. A quick Google search shows that it can also be done by Quest Health (Quest Diagnostics) for $39.00. If the new plan stops paying for the test or leaves a balanace of more than $39.00 unpaid, I will switch to the street lab approach. It would even be a shorter drive to the lab.
To Leap’s question, most plans have a deductible and and an out-of-pocket maximum. Some fees and costs aren’t covered until the patient pays the first X dollars up to their deductible limit. At that point, if other aspects of the coverage have co-pays, the patient pays that co-pay share of all incremental costs until they reach their yearly out-of-pocket maximum. As an example, a patient with a plan with
who needed over the course of a year the following services:
would wind up paying:
At this point, their out-of-pocket for the year would be 4500 + 50 + 1400 or $5950 of their $9100. The next $31,500 in non-preventative, mandatory coverage expenses would take them to their $9100 out-of-pocket limit for the year, after which insurance would pay 100%.
Note – under current regulations, all plans sold through the healthcare marketplace must provide an out-of-pocket limit and it cannot be higher than $9100 per year. This is a good safety measure to prevent firms from selling policies with deceptively low monthly rates but high co-pays and no upper limits that COULD still bankrupt someone.
Thus, for most people with limited means, the key tradeoff they need to pay attention to is any premium savings between two alternative plans versus any change in out of pocket expense. For example,
Plan A ===> $621/month, $7500 deductible, $9,000 max OOP
Plan B ===> $736/month, $6500 deductible, $8,500 max OOP
With Plan A,
With Plan B,
The two don’t appear that far apart but in fact, if you are relatively healthy and think you won’t come near to hitting the deductible or OOP limit, you could save money with the cheaper plan and not risk that much in a worst case scenario.
One key LANDMINE lurking amid all of this are pharmacy benefits. You ABSOLUTELY have to “shop” your current list of drugs and confirm how they appear in the plan’s “formulary.” A routine drug covered as Class A or Class B might not be covered at all under another plan. If you happen to need that drug and it’s astronomically expensive, you could position yourself with a huge bill that your insurance won’t cover at all. Of course, confirming the drug is on your plan’s formulary list is no guarantee the insurance company won’t alter those formulary arrangements in the middle of an insurance year or that it will be kept in the plan next year. You have to shop EVERY YEAR.
WTH
The buyer does NOT have to buy the insurance company policy. So the buyer is “the decider”.