7 ms·

my company pays 2000 dollars a month for our insurance premiums. This is a plan with a 2k individual/6k family deductible per year. We are saving 1.37% next ye

my company pays 2000 dollars a month for our insurance premiums. This is a plan with a 2k individual/6k family deductible per year. We are saving 1.37% next year by going to a plan with 3k individual 9k family deductible. If we didn't do that premiums were going to rise by 10.4% next year. Our rates have gone up every year since I've been working here. The total EOB (Explanation of Benefits) costs value for the medical care my family got last year was under 6k. This was unusually high because we had two minor surgeries. The two years prior were much closer to our baseline of about 3-4k of medical care. This includes shots for the young kids, regular checkups, the occasional prescription and one semi-emergent emergency. One year a kid broke her arm, the other my wife needed an MRI. I know I represent a young family with relatively few health problems but so far, just since being on my current plan, we have paid 90,000 dollars (costs were slightly lower than our current premiums in prior years if you are doing the math) and received (at the high end) 18,000 dollars worth of medical care. I have paid 72,000 over just 4 years for insurance against catastrophic illness, disease or trauma. As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it? I don't know. I think that question is ridiculous but I don't know what other question to ask.

cylinder 10y ago
Yes, many people are asking that question now. Those who work for a company and receive a W-2 form can look at Box 12 on the W-2 to see how much their employers paid for their side of their health insurance policy (coded with "dd"). You might think "who cares" but that's money that could have gone towards your salary.
- spoonie 10y ago
  To which they would then have to spend on their own, more expensive health insurance plans?
  - digikata 10y ago
    One should also question why an individual healthcare purchase should be charged more than a work based group plan. Shouldn't the operative "group" of patients basically be everybody who is a customer of the insurance company (or at least everybody at some tier of the insurance plan).
    - ghaff 10y ago
      The historical (and continuing--hence the controversial Obamacare mandate) problem is adverse selection. If you know you'll be using a lot of expensive insurance coverage you'll buy insurance--probably the most comprehensive you can get. If you're a 20-something who doesn't think he will ever get sick or injured (or just doesn't think about future events a lot), you may pass on insurance entirely. Outside of health care specifically, this is also why disability plans tend to be relatively inexpensive for large companies to offer but are pretty pricey--when you can even get them--for individuals.
      - digikata 10y ago
        I'm not sure I follow. Healthcare is mandated, or you'd be paying some penalty on your taxes. So charge a startup fee for some entrance check of taxes, but otherwise why would an individual getting insurance be any riskier than a group? (It does make me start to think of farfetched scenarios like people joining a front-company to get group insurance rates...) Same with disability, examine the individual coming in to make sure they don't already have a disability that's being covered, but after that why would the individual odds be any different than accepting a whole group? If you do an actual exam, they might actually be better.
        ghaff 10y ago
        The mandate is weak enough that there are still healthy individuals who aren't covered by company plans who are choosing not to buy insurance. [ADDED: And there's a fair bit of concern that the number of these individuals will rise as rates go up, driving further rate increases, in what's often called a "death spiral.] There are non-employer group plans for certain types of insurance e.g. through something like the IEEE but generally not for healthcare AFAIK. With respect to disability--leaving aside that an exam won't find all pre-existing conditions such as joint problems--there's still adverse selection. The people who would even apply for disability insurance are a higher risk pool (probably older for one thing) than the working population as a whole or all employees working at a large company.
- iamthepieman 10y ago
  oh I know. That's why I said "we have paid 90,000 dollars" Even though the insurance premiums are all covered by my employer I still count it as coming out of my salary.
  - radley 10y ago
    My understanding is that beginning this year, obamacare premiums paid by your employer are now considered income and are subject to taxes.
    - ghaff 10y ago
      I assume you're talking about the "Cadillac tax" on more generous insurance plans. Its implementation has already been pushed back to 2020 and there's a pretty decent chance that it will never see the light of day.
      - JonFish85 10y ago
        The problem there is that the subsidy money has to come from somewhere, and the longer that tax gets pushed back, the more we have to do other shenanigans to come up with the money: borrow more, raise taxes elsewhere, etc. As it is, the subsidies don't really help folks as much as was planned, and even with the subsidies, the costs are rising quickly. It's a runaway train at this point: costs rise, making the subsidies insufficient, so the politically expedient thing to do is to expand the subsidies, which means that taxes must rise to pay for them.
        cmdrfred 10y ago
        >As it is, the subsidies don't really help folks as much as was planned, and even with the subsidies, the costs are rising quickly. I don't think this is in spite of subsidies but beacuse of them. Just like the epipen mess, the less of a bill the customer sees the more you can raise it.
ceejayoz 10y ago
> As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it? Well, it's insurance. It's there so if you have twins in the NICU for two months because they were born in the second trimester (like I did) you don't wind up with a multi-million dollar bill to pay. Most people will incur more premiums than benefits. That's normal.
- existencebox 10y ago
  Let me ask the relatively cruel question though for the purposes of prompting further discussion: At what point does subsidizing other people's outlier events become unacceptable? I will never have kids (biological issues). I will likely die from a one off critical heart failure (also genetic in my family) rather than anything that will cost me significant amounts of money. I do not drive, leave the house much, or do any risky activities, yet as the parent said, I pay _hilarious_ amounts of money each year for insurance. And the real kicker for me, I've developed some conditions related to stress-side effects, sedentary behavior, and joint issues because of my work. So the insurance money would be BETTER SERVED being reinvested so I could stop working in such a way that damages my body. Now, you can say this is selfish, but as I said, I'm taking an intentionally selfish point of view for this argument. At what point do we draw the line of "I need this money for me now" or "someone else needs the net effect of re-balancing costs across a society?" I will openly admit that as I've gone through a decent chunk of my career without incurring any major events, but while incurring major costs, where I sit on being OK with the current arrangement has shifted.
  - ceejayoz 10y ago
    That question is pretty close to home for me. Our family's highest yearly billing was about $3M, and we've hit $100k every year in the last 8. If you were writing a textbook about healthcare outliers, we'd be in it. The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes. I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/ http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).
rgbrenner 10y ago
we have paid 90,000 ... and received 18,000 But have you seen how they gouge the uninsured? I was in a minor bike accident last year and I had a 5k deductible. Just had an ambulance ride and got checked out at the emergency room. The bill was $6000 without insurance, which was reduced to $1500 with insurance. Hospitals have such poor cost accounting.. they basically make something up if you're uninsured. It completely eliminates going without insurance. The charges would be outrageous. Edit: The 4x multiple in my bill isn't anywhere near the worst. There are hospitals that charge up to 12x (so 1500 turns into 18000): https://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html https://www.washingtonpost.com/national/health-science/why-s... Add to that, hospitals won't tell you what something will cost up front... so you get to find out when they send you the bill.
- PaulHoule 10y ago
  It's also an issue for meds. There are plenty of generic meds that cost less than $10 with the discount negotiated by the insurance company but cost upwards of $100 if you don't get the discount. The calculation that "you get nothing with a high deductable plan" is not entirely accurate if you take these into account.
  - deleted 10y ago
    [deleted]
  - maxerickson 10y ago
    There are free pharmacy benefit managers that will get you similar negotiated discounts. There are also store programs like Walmart's $4 drugs https://www.walmart.com/cp/1078664 https://www.walmart.com/cp/1078664 . (that's what lots of drug discount cards are, you get a negotiated price instead of the cash price) So having a PBM price is an included detail of insurance plans, I'm not sure how useful it is (I expect the formulary used by cheap insurance ends up similar to the free stuff).
- germinalphrase 10y ago
  I had a similar experience. Burned the sole of my foot. Twenty minutes talking to a nurse at the hospital - two pain pills and the assurance that it was below the threshold for a third degree burn - and I walked out with a $3000 bill. They eventually knocked it down to $2500 and gave me a no-interest payment plan.
losteverything 10y ago
Twelve years $158,000. Orthopedic replacement $23,000 one year. Other years combined $2600 Not worth it. But plan your surgeries and up the coverage for that year. That strategy can work (not dental) Even with a high out of pocket it is smart.
taurath 10y ago
Unfortunately the interests of the industry trumps the interest of affordable healthcare. We need someone to come in and dismantle all the middlemen in healthcare. The Healthcare Industrial Complex is just a machine to move money around.

cylinder 10y ago

Yes, many people are asking that question now. Those who work for a company and receive a W-2 form can look at Box 12 on the W-2 to see how much their employers paid for their side of their health insurance policy (coded with "dd"). You might think "who cares" but that's money that could have gone towards your salary.

spoonie 10y ago
To which they would then have to spend on their own, more expensive health insurance plans?
- digikata 10y ago
  One should also question why an individual healthcare purchase should be charged more than a work based group plan. Shouldn't the operative "group" of patients basically be everybody who is a customer of the insurance company (or at least everybody at some tier of the insurance plan).
  - ghaff 10y ago
    The historical (and continuing--hence the controversial Obamacare mandate) problem is adverse selection. If you know you'll be using a lot of expensive insurance coverage you'll buy insurance--probably the most comprehensive you can get. If you're a 20-something who doesn't think he will ever get sick or injured (or just doesn't think about future events a lot), you may pass on insurance entirely. Outside of health care specifically, this is also why disability plans tend to be relatively inexpensive for large companies to offer but are pretty pricey--when you can even get them--for individuals.
    - digikata 10y ago
      I'm not sure I follow. Healthcare is mandated, or you'd be paying some penalty on your taxes. So charge a startup fee for some entrance check of taxes, but otherwise why would an individual getting insurance be any riskier than a group? (It does make me start to think of farfetched scenarios like people joining a front-company to get group insurance rates...) Same with disability, examine the individual coming in to make sure they don't already have a disability that's being covered, but after that why would the individual odds be any different than accepting a whole group? If you do an actual exam, they might actually be better.
      - ghaff 10y ago
        The mandate is weak enough that there are still healthy individuals who aren't covered by company plans who are choosing not to buy insurance. [ADDED: And there's a fair bit of concern that the number of these individuals will rise as rates go up, driving further rate increases, in what's often called a "death spiral.] There are non-employer group plans for certain types of insurance e.g. through something like the IEEE but generally not for healthcare AFAIK. With respect to disability--leaving aside that an exam won't find all pre-existing conditions such as joint problems--there's still adverse selection. The people who would even apply for disability insurance are a higher risk pool (probably older for one thing) than the working population as a whole or all employees working at a large company.
iamthepieman 10y ago
oh I know. That's why I said "we have paid 90,000 dollars" Even though the insurance premiums are all covered by my employer I still count it as coming out of my salary.
- radley 10y ago
  My understanding is that beginning this year, obamacare premiums paid by your employer are now considered income and are subject to taxes.
  - ghaff 10y ago
    I assume you're talking about the "Cadillac tax" on more generous insurance plans. Its implementation has already been pushed back to 2020 and there's a pretty decent chance that it will never see the light of day.
    - JonFish85 10y ago
      The problem there is that the subsidy money has to come from somewhere, and the longer that tax gets pushed back, the more we have to do other shenanigans to come up with the money: borrow more, raise taxes elsewhere, etc. As it is, the subsidies don't really help folks as much as was planned, and even with the subsidies, the costs are rising quickly. It's a runaway train at this point: costs rise, making the subsidies insufficient, so the politically expedient thing to do is to expand the subsidies, which means that taxes must rise to pay for them.
      - cmdrfred 10y ago
        >As it is, the subsidies don't really help folks as much as was planned, and even with the subsidies, the costs are rising quickly. I don't think this is in spite of subsidies but beacuse of them. Just like the epipen mess, the less of a bill the customer sees the more you can raise it.

ceejayoz 10y ago

> As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it? Well, it's insurance. It's there so if you have twins in the NICU for two months because they were born in the second trimester (like I did) you don't wind up with a multi-million dollar bill to pay. Most people will incur more premiums than benefits. That's normal.

existencebox 10y ago
Let me ask the relatively cruel question though for the purposes of prompting further discussion: At what point does subsidizing other people's outlier events become unacceptable? I will never have kids (biological issues). I will likely die from a one off critical heart failure (also genetic in my family) rather than anything that will cost me significant amounts of money. I do not drive, leave the house much, or do any risky activities, yet as the parent said, I pay _hilarious_ amounts of money each year for insurance. And the real kicker for me, I've developed some conditions related to stress-side effects, sedentary behavior, and joint issues because of my work. So the insurance money would be BETTER SERVED being reinvested so I could stop working in such a way that damages my body. Now, you can say this is selfish, but as I said, I'm taking an intentionally selfish point of view for this argument. At what point do we draw the line of "I need this money for me now" or "someone else needs the net effect of re-balancing costs across a society?" I will openly admit that as I've gone through a decent chunk of my career without incurring any major events, but while incurring major costs, where I sit on being OK with the current arrangement has shifted.
- ceejayoz 10y ago
  That question is pretty close to home for me. Our family's highest yearly billing was about $3M, and we've hit $100k every year in the last 8. If you were writing a textbook about healthcare outliers, we'd be in it. The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes. I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/ http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).

rgbrenner 10y ago

we have paid 90,000 ... and received 18,000 But have you seen how they gouge the uninsured? I was in a minor bike accident last year and I had a 5k deductible. Just had an ambulance ride and got checked out at the emergency room. The bill was $6000 without insurance, which was reduced to $1500 with insurance. Hospitals have such poor cost accounting.. they basically make something up if you're uninsured. It completely eliminates going without insurance. The charges would be outrageous. Edit: The 4x multiple in my bill isn't anywhere near the worst. There are hospitals that charge up to 12x (so 1500 turns into 18000): https://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html https://www.washingtonpost.com/national/health-science/why-s... Add to that, hospitals won't tell you what something will cost up front... so you get to find out when they send you the bill.

PaulHoule 10y ago
It's also an issue for meds. There are plenty of generic meds that cost less than $10 with the discount negotiated by the insurance company but cost upwards of $100 if you don't get the discount. The calculation that "you get nothing with a high deductable plan" is not entirely accurate if you take these into account.
- deleted 10y ago
  [deleted]
- maxerickson 10y ago
  There are free pharmacy benefit managers that will get you similar negotiated discounts. There are also store programs like Walmart's $4 drugs https://www.walmart.com/cp/1078664 https://www.walmart.com/cp/1078664 . (that's what lots of drug discount cards are, you get a negotiated price instead of the cash price) So having a PBM price is an included detail of insurance plans, I'm not sure how useful it is (I expect the formulary used by cheap insurance ends up similar to the free stuff).
germinalphrase 10y ago
I had a similar experience. Burned the sole of my foot. Twenty minutes talking to a nurse at the hospital - two pain pills and the assurance that it was below the threshold for a third degree burn - and I walked out with a $3000 bill. They eventually knocked it down to $2500 and gave me a no-interest payment plan.

losteverything 10y ago

Twelve years $158,000. Orthopedic replacement $23,000 one year. Other years combined $2600 Not worth it. But plan your surgeries and up the coverage for that year. That strategy can work (not dental) Even with a high out of pocket it is smart.

taurath 10y ago

Unfortunately the interests of the industry trumps the interest of affordable healthcare. We need someone to come in and dismantle all the middlemen in healthcare. The Healthcare Industrial Complex is just a machine to move money around.