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So the way it works is that the insurance covers X% of something up to some pre-set limit which doubles or triples if you have a family. This is called co-insur

So the way it works is that the insurance covers X% of something up to some pre-set limit which doubles or triples if you have a family. This is called co-insurance. So if you have a 50% co-insurance then you are responsible for 50% of the cost of treatment up to the yearly limit for your insurance. If your yearly limit is $9,000 then that means you rack up a $9,000 bill from $18,000 of medical treatment. Where it gets complicated is that if you add another person to your insurance then your yearly limit goes from EG $9,000 to $16,000 which can bankrupt most people. And this is for a "high-quality" plan. And what's worse, because it's a yearly limit it resets in December. This means that if you get sick in December, you can rack up $9,000 of bills from December, then roll over into January and rack up another $9,000 worth of bills. Or $32,000 as a family. This is strangely still sold as insurance.

lotsofpulp 6y ago
You can buy platinum level health insurance that covers 90% of your expected healthcare costs and has out of pocket maximums of a couple thousand dollars. Most people just can’t afford the monthly premiums for it. It’s just a simple result of the actual healthcare itself costing a ton more in the US than in other countries, since all up and down the healthcare business a lot more people make a lot more money than in other countries.
- erentz 6y ago
  We helped a friend through this last year. Where she lived there was only two insurance providers providing ACA plans. And both were HMO only. And both only offered Silver and Bronze plans. I also checked this out in a couple of other counties and it was the same situation. (I didn’t find a single gold plan in my search.) So for a lot of people they can’t buy better plans even if they could afford it.
  - lotsofpulp 6y ago
    That’s a result of the political compromises that had to be made in order to pass ACA, which is people didn’t want to give up their silo’d white collar employer based health insurance, and insurers can’t compete across state lines. If there was a single marketplace for health insurance where everyone had to go, there would be sufficient lives for health insurance companies to be able to offer more options.
    - erentz 6y ago
      I’m 100% for single payor as IMO it’s the best compromise in the US system to achieving universal healthcare, but I do agree with you. The employer provided healthcare plans are a huge distortion and abolishing that and making people buy their own plans would be preferable to the status quo for a multiple reasons. PS. I don’t have it handy but there was a great chart breaking down changes in how people were covered over the years I saw a few months back and what was most startling was just how little coverage is from ACA plans. It’s puny. Like 10% or something. Better for those 10% than before they didn’t have it, and some things like not disqualifying for preexisting conditions were important changes, but the ACA really wasn’t this revolutionary thing many people hold it up to be. It’s more of a blip.
      - lotsofpulp 6y ago
        I disagree that pre existing conditions was revolutionary. It enabled people to get healthcare that they simply couldn’t before, because payers had the ability to decline them. Also revolutionary was capping insurance premiums for old people as a multiple of young people, thereby instituting a wealth transfer from the young to the old. This is necessary because there is no incentive for a young person to purchase insurance, and without universal taxpayer funded healthcare, this mechanism serves as a tax. It’s all one and the same, except universal taxpayer funded healthcare is unpalatable to sufficient voters, so the best we could do is this system where instead of taxes paying for other people’s healthcare, you have insurance premiums paying for other people’s healthcare.
        lotsofpulp 6y ago
        Oops, in the above comment, I meant “I disagree that removing pre existing conditions was NOT revolutionary”.
- aidenn0 6y ago
  I would be suspicious of that still; usually the "maximum out of pocket" has a lot of footnotes.
  - lotsofpulp 6y ago
    The footnote is that it has to be in network providers and it has the treatment has to be justified (e.g. have supporting data of efficacy).
panzagl 6y ago
$9000 /year is not 'high-quality', that sounds more like a high deductible plan that would have relatively low premiums. Higher premiums would lower the deductible.
- jschwartzi 6y ago
  Lol it's been about what I got at all the jobs I've had. It's pretty comparable to the Silver plan I was on as a contractor.

lotsofpulp 6y ago

You can buy platinum level health insurance that covers 90% of your expected healthcare costs and has out of pocket maximums of a couple thousand dollars. Most people just can’t afford the monthly premiums for it. It’s just a simple result of the actual healthcare itself costing a ton more in the US than in other countries, since all up and down the healthcare business a lot more people make a lot more money than in other countries.

erentz 6y ago
We helped a friend through this last year. Where she lived there was only two insurance providers providing ACA plans. And both were HMO only. And both only offered Silver and Bronze plans. I also checked this out in a couple of other counties and it was the same situation. (I didn’t find a single gold plan in my search.) So for a lot of people they can’t buy better plans even if they could afford it.
- lotsofpulp 6y ago
  That’s a result of the political compromises that had to be made in order to pass ACA, which is people didn’t want to give up their silo’d white collar employer based health insurance, and insurers can’t compete across state lines. If there was a single marketplace for health insurance where everyone had to go, there would be sufficient lives for health insurance companies to be able to offer more options.
  - erentz 6y ago
    I’m 100% for single payor as IMO it’s the best compromise in the US system to achieving universal healthcare, but I do agree with you. The employer provided healthcare plans are a huge distortion and abolishing that and making people buy their own plans would be preferable to the status quo for a multiple reasons. PS. I don’t have it handy but there was a great chart breaking down changes in how people were covered over the years I saw a few months back and what was most startling was just how little coverage is from ACA plans. It’s puny. Like 10% or something. Better for those 10% than before they didn’t have it, and some things like not disqualifying for preexisting conditions were important changes, but the ACA really wasn’t this revolutionary thing many people hold it up to be. It’s more of a blip.
    - lotsofpulp 6y ago
      I disagree that pre existing conditions was revolutionary. It enabled people to get healthcare that they simply couldn’t before, because payers had the ability to decline them. Also revolutionary was capping insurance premiums for old people as a multiple of young people, thereby instituting a wealth transfer from the young to the old. This is necessary because there is no incentive for a young person to purchase insurance, and without universal taxpayer funded healthcare, this mechanism serves as a tax. It’s all one and the same, except universal taxpayer funded healthcare is unpalatable to sufficient voters, so the best we could do is this system where instead of taxes paying for other people’s healthcare, you have insurance premiums paying for other people’s healthcare.
      - lotsofpulp 6y ago
        Oops, in the above comment, I meant “I disagree that removing pre existing conditions was NOT revolutionary”.
aidenn0 6y ago
I would be suspicious of that still; usually the "maximum out of pocket" has a lot of footnotes.
- lotsofpulp 6y ago
  The footnote is that it has to be in network providers and it has the treatment has to be justified (e.g. have supporting data of efficacy).

panzagl 6y ago

$9000 /year is not 'high-quality', that sounds more like a high deductible plan that would have relatively low premiums. Higher premiums would lower the deductible.

jschwartzi 6y ago
Lol it's been about what I got at all the jobs I've had. It's pretty comparable to the Silver plan I was on as a contractor.