3 ms·

This. I've actually worked with some large payers and they are just literally not set up organizationally, technically, and systematically to work with individu

by mbesto 10y ago

This. I've actually worked with some large payers and they are just literally not set up organizationally, technically, and systematically to work with individuals or even very small businesses for that matter (less than 5 employees). Furthermore not only are they not setup to help individuals, they can't even figure out whether it's financially viable for them or not.

tptacek 10y ago
A big problem with the individual market is that it isn't financially viable to serve the individual market at reasonable prices, because in the US market, not holding a job with adequate health insurance is a huge adverse selection marker. Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full time job elsewhere until Matasano had group coverage.
- mbesto 10y ago
  My wife (startup founder) is under my insurance (I'm a full time employee that gets $12k per year towards UHC healthcare). Even if she paid the same from her company (~15 employees), her deductible would be double what it is currently. If she went under her own company health insurance, we would have to pay at least an extra ~$2,000 this year out of pocket for various health related services she incurred. From a macro lens there is definitely a huge disincentive to start a company in this country.
  - tptacek 10y ago
    I think a lot of 20-somethings think that they'll have the same access to health insurance they get now when they're in their 30s and starting a family.
    - toomuchtodo 10y ago
      Well won't that be a surprise when they see their premiums with a partner and children. I know I was certainly surprised to find I went from paying $300/month for myself to $1300/month for a family.
      - tptacek 10y ago
        I think they're going to be a lot more surprised when they let their insurance lapse for a few months and find out that the ACA amendments provide guaranteed issue only if you've had continuous coverage --- without continuous coverage, you can be uninsurable without first working a full-time job for a year. Not "expensive to insure". Uninsurable, at any cost.
        toomuchtodo 10y ago
        You can skip coverage for up to 3 months a year ("Short Gap" exemption). If you do this at the end of a year, you can get back in Jan 1st of the next year without penalty. You could, depending on risk level, only be insured 9 months each year to save on costs. https://marketplace.cms.gov/technical-assistance-resources/exemption-gap-in-health-coverage.pdf https://marketplace.cms.gov/technical-assistance-resources/e...
        tptacek 10y ago
        That's under the current ACA. The most likely repeal/replace bill replaces the individual mandate with a far stricter continuous coverage rule.

by mbesto 10y ago

tptacek 10y ago

A big problem with the individual market is that it isn't financially viable to serve the individual market at reasonable prices, because in the US market, not holding a job with adequate health insurance is a huge adverse selection marker. Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full time job elsewhere until Matasano had group coverage.

mbesto 10y ago
My wife (startup founder) is under my insurance (I'm a full time employee that gets $12k per year towards UHC healthcare). Even if she paid the same from her company (~15 employees), her deductible would be double what it is currently. If she went under her own company health insurance, we would have to pay at least an extra ~$2,000 this year out of pocket for various health related services she incurred. From a macro lens there is definitely a huge disincentive to start a company in this country.
- tptacek 10y ago
  I think a lot of 20-somethings think that they'll have the same access to health insurance they get now when they're in their 30s and starting a family.
  - toomuchtodo 10y ago
    Well won't that be a surprise when they see their premiums with a partner and children. I know I was certainly surprised to find I went from paying $300/month for myself to $1300/month for a family.
    - tptacek 10y ago
      I think they're going to be a lot more surprised when they let their insurance lapse for a few months and find out that the ACA amendments provide guaranteed issue only if you've had continuous coverage --- without continuous coverage, you can be uninsurable without first working a full-time job for a year. Not "expensive to insure". Uninsurable, at any cost.
      - toomuchtodo 10y ago
        You can skip coverage for up to 3 months a year ("Short Gap" exemption). If you do this at the end of a year, you can get back in Jan 1st of the next year without penalty. You could, depending on risk level, only be insured 9 months each year to save on costs. https://marketplace.cms.gov/technical-assistance-resources/exemption-gap-in-health-coverage.pdf https://marketplace.cms.gov/technical-assistance-resources/e...
        tptacek 10y ago
        That's under the current ACA. The most likely repeal/replace bill replaces the individual mandate with a far stricter continuous coverage rule.