5 ms·

I wish it was about catastrophic injury insurance. I'm a single, healthy 33-year-old guy with no kids, so it'd be perfect for me. My annual healthcare expenditu

by pzxc 13y ago

I wish it was about catastrophic injury insurance. I'm a single, healthy 33-year-old guy with no kids, so it'd be perfect for me. My annual healthcare expenditures are virtually zero, year after year, right now. Coverage in case of a heart attack or cancer would be awesome, because I can't afford a $100,000+ hospital bill, but otherwise I rarely even have a cold or the flu. I live in California which, as the first state to comply with ACA, has numbers available for me up at coveredca.com. The bronze plan requires me to pay a 30% deductible for the category of "High cost and infrequent care". So if I get cancer, my $200k bill (just to start, cancer treatment can go on and on) is still a $60k bill. I'm still bankrupt. The Silver 87 plan also has a percentage-based deductible. Have to go up to the normal Silver plan to have a flat rate. For my age it'll cost over $200 a month if I make $30k/yr or more. Also, all the plans, whether bronze silver platinum or anything else, include MANY MANY things other than "catastrophic injury coverage". Everything from prescription medication to preventative care visits. I really really want a "catastrophic injury only coverage" option but I don't have it. That's what insurance SHOULD be, to cover you in case of significant financial loss. Imagine how expensive car insurance would be if it covered oil changes, or homeowner's insurance would be if it covered minor repairs? For someone that's lamenting the "disinformation around ACA", I really don't think you've checked the actual costs/plans involved. Well, I have, and let's not pretend that Obamacare offers plain and simple catastrophic coverage because it doesn't. Look at the website and see for yourself. That's California only of course but I doubt the other states will be able to do much better.

vidarh 13y ago
> Also, all the plans, whether bronze silver platinum or anything else, include MANY MANY things other than "catastrophic injury coverage". Everything from prescription medication to preventative care visits. Consider that if a plan is to include many high cost "catastrophic" treatments, excluding prescription medication and preventative visits could easily make no financial sense for the insurers as it opens the door for numerous types of situations where insurance payouts rise drastically because the people insured can't or won't spend the money on drugs or preventative treatments. It is in other words not at all a given that an insure limited only to catastrophic events would actually turn out to be cheaper to you. > Imagine how expensive car insurance would be if it covered oil changes, or homeowner's insurance would be if it covered minor repairs? It would be more expensive, yes, but there is no reason it would increase your total costs unless you were irresponsible in how you treated your car yet lucky enough to escape the consequences.
_delirium 13y ago
So if I get cancer, my $200k bill (just to start, cancer treatment can go on and on) is still a $60k bill. I'm still bankrupt. The plans all have maximum annual out-of-pocket expense caps, above which you get 100% coverage, so it wouldn't be nearly as high as $60k. Checking the website, the out-of-pocket expense for the California Bronze plan is limited to $6,350/yr for an individual, or $12,700/yr for a family. This is precisely so that you can have a finite exposure that can be self-insured by keeping savings in an account. So in your example, if you were on a family plan and hospitalized, you'd pay the first $5,000 entirely out of pocket (the Bronze-plan deductible). Then you'd pay 30% of the next ~$25,650 in expenses (~$7700), which would bring your out-of-pocket expenses for the year up to $12,700. At that point you've hit your out-of-pocket cap, so if there are still bills past $30,650, the plan would cover the entirety of the remainder. The Bronze plan is essentially a high-deductible plan, but with the partial-coverage in between zone: you pay everything below $5,000, and nothing above $6,350/$12,700. The minor exception is that you get one deductible-free preventative-care visit per year.
- waps 13y ago
  How is that not a blank check to the medical industry ? I mean if this is true, it seems like it'd be trivial for the medical industry to exploit this loophole.
  - smsm42 13y ago
    Then the Congress would make another law to fix it with more regulations. And another one to fix that one with even more regulations. That's how the system works. If you don't like it, elect different people to Congress.
  - dragonwriter 13y ago
    > How is that not a blank check to the medical industry ? For one thing, because 100% coverage for medically-necessary care doesn't mean that everything that the provider would like to get paid for is medically necessary, and insurance companies are very enthusiastic (to say the least) about pursuing and denying and even clawing-back-payments-after-the-fact for unnecessary charges, even when they are only on the hook for some portion less than 100%; with 100% coverage, they are 100% motivated.

by pzxc 13y ago

vidarh 13y ago

> Also, all the plans, whether bronze silver platinum or anything else, include MANY MANY things other than "catastrophic injury coverage". Everything from prescription medication to preventative care visits. Consider that if a plan is to include many high cost "catastrophic" treatments, excluding prescription medication and preventative visits could easily make no financial sense for the insurers as it opens the door for numerous types of situations where insurance payouts rise drastically because the people insured can't or won't spend the money on drugs or preventative treatments. It is in other words not at all a given that an insure limited only to catastrophic events would actually turn out to be cheaper to you. > Imagine how expensive car insurance would be if it covered oil changes, or homeowner's insurance would be if it covered minor repairs? It would be more expensive, yes, but there is no reason it would increase your total costs unless you were irresponsible in how you treated your car yet lucky enough to escape the consequences.

_delirium 13y ago

So if I get cancer, my $200k bill (just to start, cancer treatment can go on and on) is still a $60k bill. I'm still bankrupt. The plans all have maximum annual out-of-pocket expense caps, above which you get 100% coverage, so it wouldn't be nearly as high as $60k. Checking the website, the out-of-pocket expense for the California Bronze plan is limited to $6,350/yr for an individual, or $12,700/yr for a family. This is precisely so that you can have a finite exposure that can be self-insured by keeping savings in an account. So in your example, if you were on a family plan and hospitalized, you'd pay the first $5,000 entirely out of pocket (the Bronze-plan deductible). Then you'd pay 30% of the next ~$25,650 in expenses (~$7700), which would bring your out-of-pocket expenses for the year up to $12,700. At that point you've hit your out-of-pocket cap, so if there are still bills past $30,650, the plan would cover the entirety of the remainder. The Bronze plan is essentially a high-deductible plan, but with the partial-coverage in between zone: you pay everything below $5,000, and nothing above $6,350/$12,700. The minor exception is that you get one deductible-free preventative-care visit per year.

waps 13y ago
How is that not a blank check to the medical industry ? I mean if this is true, it seems like it'd be trivial for the medical industry to exploit this loophole.
- smsm42 13y ago
  Then the Congress would make another law to fix it with more regulations. And another one to fix that one with even more regulations. That's how the system works. If you don't like it, elect different people to Congress.
- dragonwriter 13y ago
  > How is that not a blank check to the medical industry ? For one thing, because 100% coverage for medically-necessary care doesn't mean that everything that the provider would like to get paid for is medically necessary, and insurance companies are very enthusiastic (to say the least) about pursuing and denying and even clawing-back-payments-after-the-fact for unnecessary charges, even when they are only on the hook for some portion less than 100%; with 100% coverage, they are 100% motivated.