IronWing
No Lifer
- Jul 20, 2001
- 70,250
- 28,976
- 136
There have been a lot of numbers shown about in a rather loose fashion for what health insurance costs so I'll put my actual costs on the table. This is for a family plan (in my case this is my wife and myself but the group rate would cover any number of children.
Prior to 2009 I was on an HMO, cadillac plan, with no deductible, 10/25/50 copays for Rx, 30 for office visits, 200/day hospital, 50/ER visits, $2000/yr out of pocket cap. The total premium for this plan for 2009 is $13666.90/yr with my company picking up ~67% of the premium.
I tracked all our expenses, asked providers what things actually cost, and based on these costs and our history, I switched to a "consumer-driven" high deductible plan this year. This is a donut plan where the first $2500 of any medical expenses are 100% covered, the next $1500 is entirely out of pocket, then a traditional 80/20 plan kicks in but also includes a 10/25/50 copay for Rx. $4000/yr out of pocket cap in network, $6000/yr cap out of network for out of pocket costs. The total premium was $9682.66/yr with my employer picking up ~75% of the premium.
For this year we saved ~$1200 in premiums by switching to the high deductible plan. If our expenses had stayed in line with past years, we would have ended up saving ~$1200 overall, which is why we switched.
We use an FSA to pay the out of pocket costs (copays/coinsurance) on a pretax basis and plan that out based on past expenses.
A benefit to the consumer driven plan is that we do see all the bills and see what providers charge. We also see the insurance company's negotiated rates which are much lower than what the providers bill, so much lower that one realizes that those billing rates are total bullshit.
Now to the point. This wasn't a normal year. We did have much higher expenses than in years past (two trips to the ER via ambulance and one overnight hospital stay) that blew out our projections. Months after these events, the bills for this are still coming in (due to grossly inefficient, private hospital billing procedures) so we still don't have a clear picture of what the care cost us. Note: consumers can not make reasoned decisions about level of care desired when providers simply will not provide cost information at the time of service. Based on the bills received so far we estimate that we will hit the out of pocket limit for the year and likely already have done so. Until the final bills come in, I can't say whether or not the switch to a high deductible plan has paid off financially but I do know the risk premium should not be considered trivial when selecting a plan.
Edit: I should add that even though we have a chronic condition in the family requiring four daily maintenance meds and no foreseeable cure, even with these med costs and even with the ER visits mentioned above, the insurance company will still make money off us this year as they have every year.
Prior to 2009 I was on an HMO, cadillac plan, with no deductible, 10/25/50 copays for Rx, 30 for office visits, 200/day hospital, 50/ER visits, $2000/yr out of pocket cap. The total premium for this plan for 2009 is $13666.90/yr with my company picking up ~67% of the premium.
I tracked all our expenses, asked providers what things actually cost, and based on these costs and our history, I switched to a "consumer-driven" high deductible plan this year. This is a donut plan where the first $2500 of any medical expenses are 100% covered, the next $1500 is entirely out of pocket, then a traditional 80/20 plan kicks in but also includes a 10/25/50 copay for Rx. $4000/yr out of pocket cap in network, $6000/yr cap out of network for out of pocket costs. The total premium was $9682.66/yr with my employer picking up ~75% of the premium.
For this year we saved ~$1200 in premiums by switching to the high deductible plan. If our expenses had stayed in line with past years, we would have ended up saving ~$1200 overall, which is why we switched.
We use an FSA to pay the out of pocket costs (copays/coinsurance) on a pretax basis and plan that out based on past expenses.
A benefit to the consumer driven plan is that we do see all the bills and see what providers charge. We also see the insurance company's negotiated rates which are much lower than what the providers bill, so much lower that one realizes that those billing rates are total bullshit.
Now to the point. This wasn't a normal year. We did have much higher expenses than in years past (two trips to the ER via ambulance and one overnight hospital stay) that blew out our projections. Months after these events, the bills for this are still coming in (due to grossly inefficient, private hospital billing procedures) so we still don't have a clear picture of what the care cost us. Note: consumers can not make reasoned decisions about level of care desired when providers simply will not provide cost information at the time of service. Based on the bills received so far we estimate that we will hit the out of pocket limit for the year and likely already have done so. Until the final bills come in, I can't say whether or not the switch to a high deductible plan has paid off financially but I do know the risk premium should not be considered trivial when selecting a plan.
Edit: I should add that even though we have a chronic condition in the family requiring four daily maintenance meds and no foreseeable cure, even with these med costs and even with the ER visits mentioned above, the insurance company will still make money off us this year as they have every year.
The plan seems like it's for people who DON'T go to the doctors. It encourages you to NOT go to regular checkups.
ebaycj
Diamond Member
- Mar 9, 2002
- 5,418
- 0
- 0
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTMl
Just activate and pay your COBRA coverage every month, and there will be no gap.
No these plans are oerfect for alot of young and healthy people. There is no point for a young and healthy person to spend hundred in premiums every month when they rarely need to go to a doc. THey could pay annual checkup out of pocket and still be way ahead in cost.
I was unemployed from 2Q08 - 1Q09. While I had severance (which included health care coverage) thru year end 2008, I can tell you the one thing that scared the crap out of me was not having insurance before I found a job. I have a wife and 2 kids under the age of 6, so not carrying insurance is NOT an option.
And Cobra isn't a viable option either. Those clowns actually wanted to charge me $2048 per month. How can anyone afford that? I was prepared to go to Blue Cross / Blue Shield for a $800/mo family plan (which was nothing more than catastrophic care when you really get down to it).
Well, thankfully I found work 2 months after my severance period ended, but I have a new appreciation for the apprehension some folks go thru. It isn't so simple a choice for people with a family, as it is for you single people. Luckily for us, I was employed again when my daughter had to go to the emergency room 2x unable to breathe (before she was officially diagnosed with asthma). No insurance would have meant a $10k bill between both treatments -- as I'm looking at both bills and what was disallowed/negotiated due to insurance. Both incidents occured at 3am over the weekend when our pediatrician wasn't around so the ER was the only option. It should not cost $10k for this treatment though -- how the fvck can unemployed people or those below my personal means afford that?
Now I'm not sure universal health care is the answer, but allowing people to buy insurance without state restrictions on choice, and/or letting them keep their insurance when they leave employers probably makes some sense. But that means substantially restructuring the incentives/tax breaks that currently exist (since your employer and you pay 1/2 each of the much more favorable group rate).
Complicated system we have but way too expensive too. Without insurance, it's scary for those with families as you are one broken bone, one kid's illness, or one car accident away from financial ruin. But the cost of Cobra or on-your-own sufficient coverage can also mean financial ruin too.
And Cobra isn't a viable option either. Those clowns actually wanted to charge me $2048 per month. How can anyone afford that? I was prepared to go to Blue Cross / Blue Shield for a $800/mo family plan (which was nothing more than catastrophic care when you really get down to it).
Well, thankfully I found work 2 months after my severance period ended, but I have a new appreciation for the apprehension some folks go thru. It isn't so simple a choice for people with a family, as it is for you single people. Luckily for us, I was employed again when my daughter had to go to the emergency room 2x unable to breathe (before she was officially diagnosed with asthma). No insurance would have meant a $10k bill between both treatments -- as I'm looking at both bills and what was disallowed/negotiated due to insurance. Both incidents occured at 3am over the weekend when our pediatrician wasn't around so the ER was the only option. It should not cost $10k for this treatment though -- how the fvck can unemployed people or those below my personal means afford that?
Now I'm not sure universal health care is the answer, but allowing people to buy insurance without state restrictions on choice, and/or letting them keep their insurance when they leave employers probably makes some sense. But that means substantially restructuring the incentives/tax breaks that currently exist (since your employer and you pay 1/2 each of the much more favorable group rate).
Complicated system we have but way too expensive too. Without insurance, it's scary for those with families as you are one broken bone, one kid's illness, or one car accident away from financial ruin. But the cost of Cobra or on-your-own sufficient coverage can also mean financial ruin too.
The cost of medial care is complete and total BS. We need a Walmart in the hospital business to shut out all those other over-priced hospitals. Do hospitals fix prices or something? There needs to be some govt regulation of these things or there needs to be some competition that actually looks out for the needs of the people. Hospitals are just another business. If there could be a hospital started by some altruistic businessmen maybe things could change. I am not sure if we can squeeze those 2 words together though..
Are you talking about the large number of hospitals then that are funded via church/charity? Already being done on a huge scale.
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