My healthcare choices

[Foil]

In a week or so, my employment status will be changing. I've been working a full-time-plus-benefits position, but in a week I will become a contractor for a different company, which means I will have to handle my own benefits.

Since healthcare costs/benefits/etc. has been the most popular topic as of late, I figured this might be an opportunity to explore an actual healthcare decision - mine.

So here are the parameters:

• Coverage will be for myself (36), my wife (36), and our son (5)
• Given some known health issues (including one very serious diagnosis), we're looking heavily at quality of coverage
• Particular attention is being paid to coinsurance percentage and max-out-of-pocket amount

And here are the primary options I've seen:

• COBRA / continue my existing plan - [Have not yet seen costs on this, but the coverage is pretty decent]
• ACA / Obamacare - [Have not yet researched pricing or coverage]
• Plan offered by the company I will be contracting through - [Prices on this are steep, have not yet seen the coverage details]

I'll post more details when I get them. In the meantime, any predictions on which one will prove out?

[callmeslick]

will be interesting to see the comparison, Foil. I was still doing the COBRA thing(at least in my cases, price was pretty steep, but it was the lazy option), and the ACA platinum option was cheaper.

[Tunnelcat]

My husband and I looked into COBRA at one time years ago. I think it's the most expensive option you can choose, and it tends to stay expensive because of the extensive coverage, lower deductibles and great options it offers because it continues what you already have seamlessly. The only reason that you'd want to choose COBRA over anything else is because of that preexisting bad diagnosis you've got. That "detail" may hinder you when trying to get a good quality of coverage with a lower deducible for a decent rate outside of COBRA.

Now the ACA is "supposed" to require coverage for families even in the face of preexisting conditions or diagnoses. The rates? You'd have to compare between private insurance and what the exchanges offer in your state before you lose the ability to obtain COBRA. Us, we opted out. We wanted a higher deductible and a much lower rate when we made the decision.

[callmeslick]

in my case, doing what you said above, TC: Non-ACA exchange plan cost was around 100 bucks per month more than the same(for all intents and purposes) ACA plan. Now, Aetna(non-ACA) offered me a couple plans that the exchange did not, and here were the plans and prices(hold onto your seats for sticker shock):
Covering me(58) and wife(56), with minor, but still somewhat ongoing health issues, that would have be excusionary before the ACA, Aetna offered one plan that had 0 Deductable, and $35 copay with meds at $10-50 for a 90 day script and out of pocket cap of $2000---price was $2130 per month
The second plan had a $500 per person deducatable, but 0 copays and the same med price structure--that cost $2370 per month.

My current COBRA offers $500 per person deductable, $35 copays, meds from $0-60, total out-of pocket of $2000 per person, and costs $1643 per month, with an extra 100 bucks for minimal dental. The ACA plan I chose offers $500 per person deductable, $35 copays, meds from $20-100, out of pocket cap of $3000 per person and costs $1280, with a dental plan added on for around $140.

[callmeslick]

update, for the sake of honest disclosure:
I was contacted today by the folks at Healthcare.gov, with some adjustments and options I originally did not have. First off, my daughter HAS to go onto my family policy,as she is currently under 26 years old(24), and is on a government subsidized policy from the state of Delaware. Second, as she and grandkids(3) are ALL on my tax return for 2013, the ceiling to NOT get subsidies goes from $56,000 to $116.000, rendering me eligible for a $600 monthly subsidy, where I previously did not qualify for anything. Finally, Blue Cross/Blue Shield in Delaware offered a new Platinum option which I could choose. The net result:
I have a policy which covers myself, my wife and daughter. The GROUP deductable is $600, copay is 10% with a GROUP out-of-pocket cap of $2500. After that, I have 100% coverage. Primary Dr visits have a 10 dollar copay, specialists $20, meds range from $8-30. My monthly tab for this plan will be a bit over $1100, a savings of 600 from my current plan. Thank-you, ACA. I can only wonder what deals will emerge as more people sign up. I note that 250,000 went to the website yesterday morning alone. Some liability!!

[Spidey]

Great, the ACA saved the rich guy money….wow, who am I to complain.

[callmeslick]

Great, the ACA saved the rich guy money….wow, who am I to complain.

wonder how much it saves folks who aren't so well off? Like, folks getting by on no-benefit jobs, or working a couple of part-times to survive. Or, maybe single moms with the ever-more-popular 'contract' position?

[Spidey]

I don’t really give a damn, because it isn’t doing a damn thing for me…but I’m sure I will have to pay for some of the great stuff for other people.

[CobGobbler]

Good thing it's not all about you then Spidey. You've been doing the second part you're entire life, so stop ★■◆●ing whining about it and grow up. Don't like taxes? Then put a ★■◆●ing gun in your mouth and give everyone else a break from your woe-is-me mentality. 80% of the world lives on less than ten bucks a day, you probably waste more than that on beef jerky and orange drink you awful jackass.

[Spidey]

Well it would have been nice if “health care reform” had actually done something to help someone who consumes a moderate amount of health care pre year.

But hey…slick got a nice break.

But you are right, I have no right to complain.

[Will Robinson]

Great, the ACA saved the rich guy money….wow, who am I to complain.

wonder how much it saves folks who aren't so well off? Like, folks getting by on no-benefit jobs, or working a couple of part-times to survive. Or, maybe single moms with the ever-more-popular 'contract' position?

I wonder how it is going to save 'everyone' money AND cause everyone to have more coverage than they had....
Magic?

[callmeslick]

Well it would have been nice if “health care reform” had actually done something to help someone who consumes a moderate amount of health care pre year.

but it does, for millions

But hey…slick got a nice break.

a far better break will be gotten by millions who have no insurance, or crappy insurance

But you are right, I have no right to complain.

but, that won't stop you.

[callmeslick]

Great, the ACA saved the rich guy money….wow, who am I to complain.

wonder how much it saves folks who aren't so well off? Like, folks getting by on no-benefit jobs, or working a couple of part-times to survive. Or, maybe single moms with the ever-more-popular 'contract' position?

I wonder how it is going to save 'everyone' money AND cause everyone to have more coverage than they had....
Magic?

no magic, largely offset by an influx of younger people, and the deep slashing of wasteful hospital based primary care treatments. Add that in to the drop in uninsured and some efficiencies in Medicare delivery, plus those small taxes noted elsewhere, and it all adds up. Nicely, from all studies.

[Spidey]

Well it would have been nice if “health care reform” had actually done something to help someone who consumes a moderate amount of health care pre year.

but it does, for millions

Well it would seem to have missed a few…

I’m speaking of sub deductible…IE: the actual cost of health CARE…and I think you already knew that, because the cost of actual health CARE, seems to be something no one wants to talk about.

[callmeslick]

Well it would have been nice if “health care reform” had actually done something to help someone who consumes a moderate amount of health care pre year.

but it does, for millions

Well it would seem to have missed a few…

so, unless it works, perfectly, out of the gate, it's some sort of failure? Get real.

I’m speaking of sub deductible…IE: the actual cost of health CARE…and I think you already knew that, because the cost of actual health CARE, seems to be something no one wants to talk about.

over time, the ACA will contain SOME of those costs, but unless we go to the same model as the rest of the civilized world(Single-Payer), we won't reduce those costs dramatically, I will agree.

[Spidey]

Well it would have been nice if “health care reform” had actually done something to help someone who consumes a moderate amount of health care pre year.

but it does, for millions

Well it would seem to have missed a few…

so, unless it works, perfectly, out of the gate, it's some sort of failure? Get real.

No it has nothing to do with being perfect or not…it has to do with not dealing with the real health care crisis in the country…the ACTUAL COST OF HEALTH CARE!

The fact is…many (millions?) people with insurance do without basic care because the out of pocket costs are too high…if you need proof, look up an old PBS NewsHour article on the issue. (it was one of many they did during the ACA debate) And the ACA does nothing to address this…in fact at first glance, with more people getting coverage, and the higher deductibles on the exchanges…there will probably be even more people in this situation. (only my opinion tho)

The ACA is just a (political) bandage on a more systemic problem. (Pun intended)

Sure you can keep throwing that straw man around concerning single payer…but that is not the point here...the point here is the ACA…

[callmeslick]

speaking of the topic, Spidey, I am looking forward to what Foil discovers, because to date, exactly ONE of us has actually utilized the exchange to get coverage, and his experience was a good one.

[Tunnelcat]

Well, my experience was not so good. Not only were the plans through our exchange more expensive than what I already had, I'm now getting an added tax put on my plan that wasn't there before the ACA came into existence, our own Oregon website hasn't worked properly since IT went live, and we even have a liberal governor who wants it to work. They're STILL working on it too.

[callmeslick]

TC, how much money are you bringing in? Did the website display the exchange plan costs AFTER rebates? You should be eligible for some sort of rebate, one would think. At any rate, on the Delaware exchange, the raw price of the plan I got was nearly $200 cheaper than the cost of nearly the exact same plan from Aetna(non-exchange)

[Foil]

...I am looking forward to what Foil discovers...

It's looking like I may not have all the numbers until well into next week, at the earliest. I haven't received the COBRA info yet, and won't have the detailed pricing for the contractor-group coverage until next week, either.

I'll keep you guys posted.

[flip]

If I was rich, why would I bother getting health insurance? Insurance is just for those that cannot pay upfront. Then I keep all my money, and if the need arises, I either pay the costs or thanks to the ACA, go get insurance!

[callmeslick]

If I was rich, why would I bother getting health insurance? Insurance is just for those that cannot pay upfront. Then I keep all my money, and if the need arises, I either pay the costs or thanks to the ACA, go get insurance!

because most people, no matter what the financial status don't want financial surprises. The insurance pays for itself over time for most people insofar as (to use my example) paying $15,000 per year for 10 years offsets is better than having to suddenly fork over $50,000 in one shot for some serious medical condition. And, at my age, people routinely encounter things that can cost upwards of 50K to fix.

[Spidey]

If you put 15,000 into a bank account for ten years you could afford to get a 50,000 dollar illness 3 times.

The more typical example:

You pay insurance over your life…you get one of those 50,000 dollar illnesses, your insurance pays 60% of it. (ok you’re not rich)

So…

50,000 x 40% = 20,000
Deductible = 4000

Your total cost = 24,000

God forbid you get one of those 500,000 dollar illnesses, because you would probably become bankrupt as Krom has pointed out because your out of pocket costs would be…

204,000

The average person would be far better off putting a meager 2000* or so bucks away starting at the age of 20 or so, then when you get to the illness ages…say 50 or so…you would have something close to…70 grand in the bank.

*5,000 a year would get you $150,000

And I fully understand all of the implications of savings vs. insurance…so don’t even bother…just look at that out of pocket cost…even if you have insurance and think about it.

[snoopy]

Bottom line: You're either betting on your own health or letting the insurance companies do it for you..... except that insurance companies use their buying power to also lower your cost.

If you think your lifetime healthcare costs will be below average and you have the capital to absorb the downs, why wouldn't you keep your capital for the ups? The window in which you come out losing isn't even all that big; If your healthcare costs end up being too far enough above average the insurance companies make sure that it comes out of your pocket via adjusted rates and lifetime maximums anyways.... So you really only lose if your costs are a bit above average, but not very much so.

[callmeslick]

It's that gambling part that most people, wealthy or otherwise, don't wish to engage in. Better, to my mind, to pay for insurance rather than take some huge hit that NO ONE ever really sees coming. A perfect example for young people(who always view themselves as not needing insurance) is car accidents, which the young are most prone to be involved in. A major accident injury can easily run towards 6 figures at a time in life when one can least afford the cost.
Now, to get back to the 'wealthy' who, presumably, wouldn't be driven into bankruptcy by much of anything, it's a matter of capital preservation and predictable cash flow more than anything else.

[flip]

Still doesn't make sense to me. I'd probably go more the route that Spidey suggests, if I had say 50 million, even 25 million. I figure most people's healthcare wouldn't cost more than 2 million over their lifetime. That's a gross exaggeration too, but if you had the money, wouldn't it be better to at least invest that money or at best like Spidey suggests, take that 2 million and put it in an account that gains over time. You could over 30 years probably make in interest what your costs would be. I have found prices considerably different than what Snoopy sees. If my insurance paid the MRI costs were between 1200-1600 dollars, if I paid it ran half of that.

[callmeslick]

I figure most people's healthcare wouldn't cost more than 2 million over their lifetime.

I'd like to know the real numbers......but I suspect this figure might be low.

That's a gross exaggeration too, but if you had the money, wouldn't it be better to at least invest that money or at best like Spidey suggests, take that 2 million and put it in an account that gains over time. You could over 30 years probably make in interest what your costs would be. I have found prices considerably different than what Snoopy sees. If my insurance paid the MRI costs were between 1200-1600 dollars, if I paid it ran half of that.

I don't know, but I'll continue to buy insurance. The predictable nature of my costs works for me. I'll invest other money, elsewhere.

[Tunnelcat]

If I was rich, why would I bother getting health insurance? Insurance is just for those that cannot pay upfront. Then I keep all my money, and if the need arises, I either pay the costs or thanks to the ACA, go get insurance!

because most people, no matter what the financial status don't want financial surprises. The insurance pays for itself over time for most people insofar as (to use my example) paying $15,000 per year for 10 years offsets is better than having to suddenly fork over $50,000 in one shot for some serious medical condition. And, at my age, people routinely encounter things that can cost upwards of 50K to fix.

I've got news for you Slick. Even with insurance, people still get surprised with unexpected charges. Insurance companies are notorious for contesting something, or not paying for something and sticking it to their customers, AFTER THE FACT. It's happened to us many times even WITH insurance. But even if you wanted to forgo insurance all together flip, you'd get a nasty surprise. Cash customers really get the shaft when paying out of pocket for medical care. Our system is so expensive, corrupt and unfair, it's going to eventually fail, or start a revolution.

[callmeslick]

I've got news for you Slick. Even with insurance, people still get surprised with unexpected charges.

no news for me. Insurers are big on fine print, and a lot of people are too lazy or stupid to read it. Hence the nasty surprises. If you know where you stand with the contract, going in, and know the number of your State Insurance Commissioner's office, you will face far fewer surprises, in my experience.

[Tunnelcat]

I'll bet you even read the EULA's that come with the software you buy. I try to read it, but it's so long and convoluted, it's impossible. You'd spend most of your time reading the EULA and not using the software. There otta be a law........

But WHY should there be all that fine print? Why obfuscate your services? The only reason I can think of is to rip off your customer, protect your ass from lawsuits because your doing something illegal or immoral, and make more profit for your company. For the average person, contracts should be in PLAIN ENGLISH, period. No hidden clauses or agendas and no more legaleez.

[flip]

That's not been my experience Tc. Consistently the cash price was significantly lower. I used the 2 million dollar figure only because our first policy capped us at 2 million over our lifetime. I'm not sure of our current limit but I still figure that's a worst case (read 5 years or less scenario.

I had a friend 25 years or so ago, get right at a half mill in a malpractice suit. I'm not entirely sure of the type account, but he claimed to be making $660.00 dollars a week in interest. If I ended up with a large sum of money, that ★■◆● is going to work next day .

[Tunnelcat]

That's not been my experience Tc. Consistently the cash price was significantly lower. I used the 2 million dollar figure only because our first policy capped us at 2 million over our lifetime. I'm not sure of our current limit but I still figure that's a worst case (read 5 years or less scenario.

I had a friend 25 years or so ago, get right at a half mill in a malpractice suit. I'm not entirely sure of the type account, but he claimed to be making $660.00 dollars a week in interest. If I ended up with a large sum of money, that **** is going to work next day .

Well, in many hospitals, they charge cash customers way more in order to make up for the deadbeats. But you're right, I have found that some doctors and dentists will give you a discount if you pay in cash. It's not much, but it's better than nothing.

http://www.jhsph.edu/news/news-releases ... arges.html

[callmeslick]

likely my final update: got the bill, paid the bill, am now listed as a Highmark member, with ID # and effective date of Jan 1. In short, despite much naysaying and admittedly lingering issues, the site works, the ACA will work, eventually, for everyone. I suspect that, as time goes on, the silliness that has been spread about the ACA is going to make a lot of folks look rather foolish.



Aside--when I logged onto the site, the first message I got from Highmark was for a 10% discount on pet insurance. Joy, after I just shelled out $1200 for abcessed molars on the family dog..........

[Will Robinson]

... . I suspect that, as time goes on, the silliness that has been spread about the ACA is going to make a lot of folks look rather foolish. ...

Yea but in Obama's case the media is reluctant to point out how foolish he was.
And silly isn't the word I would choose to describe the bullcrap he's been shoveling about it either!

Oh... wait... you meant to leave him and his team out of that didn't you?!?

[callmeslick]

Will, I think they HAVE been made to look foolish, on both the website rollout and the 'keep your insurance' overreach. But, in time, I think the 'ACA will kill people', 'Death Panels', 'bankrupt the people and the country' arguments will look sort of precious and simpleminded.

[Will Robinson]

Will, I think they HAVE been made to look foolish, on both the website rollout and the 'keep your insurance' overreach. But, in time, I think the 'ACA will kill people', 'Death Panels', 'bankrupt the people and the country' arguments will look sort of precious and simpleminded.

I think the death panel accusation has already been beta tested by Sebelius and her intended victim survived only by virtue of a judge over ruling the panel-of-one's decision to let the little girl die!
So you shouldn't go counting those chickens...they aren't going to hatch the way you want them to.

It is inevitable that when you put the government accountants in charge of what gets covered, and what doesn't, you will have 'death panel' results.

[callmeslick]

Will, I think they HAVE been made to look foolish, on both the website rollout and the 'keep your insurance' overreach. But, in time, I think the 'ACA will kill people', 'Death Panels', 'bankrupt the people and the country' arguments will look sort of precious and simpleminded.

I think the death panel accusation has already been beta tested by Sebelius and her intended victim survived only by virtue of a judge over ruling the panel-of-one's decision to let the little girl die!

has nothing to do with the ACA.....those transplantation priority rules were in effect for over a decade. And, for the record, I think the decision to change them reflected emotions and not practicality, and was wrong.

It is inevitable that when you put the insurance company accountants in charge of what gets covered, and what doesn't, you will have 'death panel' results.

reflects the long-standing US healthcare system.

[Krom]

We have had a name for death panels for a very long time already: "Board of review". Nothing new.

[Tunnelcat]

We have had a name for death panels for a very long time already: "Board of review". Nothing new.

The other market-based death panel is; "Have no money? You get no treatment, tough sh*t". Never heard Palin comment on that one.

[Will Robinson]

So now under ACA we STILL have the same system of insurance providers and medical review boards trying to steer our decisions on care but we had options in many cases....competition, etc. AND now we add the mother of all bureaucracies, the federal government to Influence those decisions to protect its interest!
However, unlike the insurance companies vying for our purchasedollars, the FED has no competition and instead uses the law enforcement division to FORCE our decisions to meet their requirements!

The FED who specialized in mucking things up on a scale never conceived of by those private entities!!

And this somehow proves there are no 'death panels' under the Obamacare plan?!? Yea, right, and you can keep your old plan too...

All it proves is the old death panels are to the new ACA one like an air freshener is to a nerve gas attack!!