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Employer Health Insurance Options are getting worse and worse

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iamwhatiseem

iamwhatiseem

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But if you actually do start needing enough medical treatment so that you are no longer profitable to the insurance company, they drop you.
So then all the money you paid in the past is lost.
The insurance company took off the profit but then avoids paying their share of any costs.
All the money you paid in while you did not need any treatment is gone once you change jobs, move out of state, actually get injured or a condition, etc.
Insurance companies are actually useless and essentially just a scam, with promises they have no intentions of keeping.
Depends on how you look at it.
Buying health insurance has always been a betting game.
Like I said, you are betting you get sick... they are betting you don't. And like gambling, you don't get any money unless you "win".
The difference today is the ever increasing deductibles, ever increasing max out-of-pocket, and then also increasing copays.
Before ACA, 70/30 plans were almost unheard of. Only the crappiest plans left you with holding 30% of the bag.
Today, 70/30 is very common.
The average deductible years ago was anywhere between as little as $250 to $1000 max. With max OOP around $2500.
Today... deductibles average $4000 - $7000, many with max OOP as high as $14,000.
Meanwhile... premiums just keep rising above inflation. Especially after ACA
 

Rigby5

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Or patients. You're premise is a false dichotomy.
It's the presumption that patients shouldn't be responsible for their own health care costs that is causing the problem. We're chasing delusion.

It's exactly the opposite. If you don't like what your insurance company is doing, you can fire them. Today. You don't have to ask permission, you don't have to convince the majority to agree with you.

You have no such recourse with government. Best case scenario, you can vote for someone else in the next election. But that only works if the rest of the country agrees with you. If they don't, you're shit out of luck.

I disagree.
Almost no individual can afford health care on their own any more.
The potential costs are way too high.
And due to insurance companies deliberately over paying, doctors won't even take patients who don't have insurance any more.

And you most definitely can NOT fire your insurance company because you prepaid.
They already have your years and years of premiums.
 

Rigby5

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Depends on how you look at it.
Buying health insurance has always been a betting game.
Like I said, you are betting you get sick... they are betting you don't. And like gambling, you don't get any money unless you "win".
The difference today is the ever increasing deductibles, ever increasing max out-of-pocket, and then also increasing copays.
Before ACA, 70/30 plans were almost unheard of. Only the crappiest plans left you with holding 30% of the bag.
Today, 70/30 is very common.
The average deductible years ago was anywhere between as little as $250 to $1000 max. With max OOP around $2500.
Today... deductibles average $4000 - $7000, many with max OOP as high as $14,000.
Meanwhile... premiums just keep rising above inflation. Especially after ACA

I don't mind the high deductible, and I always select catastrophic if allowed.
That is not the problem.
The problem is I change jobs often enough and often work as an independent contractor, so I don't get insurance from work usually.
Individuals pay much higher rates than big corporations can negotiate.
It is the opposite of progressive.
 

dblack

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I disagree.
Almost no individual can afford health care on their own any more.
That's simply not true. It's just a question of how much health care. Most people can afford basic health care services, even now. The myth that we can't afford health care without health insurance is simply an insurance company sales pitch.

But it is true that health care prices are far higher than they need to be, and the irony is - that's BECAUSE very few people are paying for their own health care. If they were, prices, and less expensive health care options in general, would be in demand again. The market would rebalance. But of course you're not interested in fixing the market, you want to eliminate it and put health care rationing under government control.
The potential costs are way too high.
You're conflating emergency insurance that covers "potential costs" with paying for regular health care expenses. The problem is that we are, quite stupidly, trying to use insurance for our routine health care needs. That's wasteful. There's no reason to funnel every health care transaction through insurance companies.
And due to insurance companies deliberately over paying, doctors won't even take patients who don't have insurance any more.
I haven't tried it recently, but ten years ago, when I still had an HSA and was paying most of my health care out-of-pocket, doctors were more than happy to take cash. They even gave me discounts for not having to deal with insurance.
And you most definitely can NOT fire your insurance company because you prepaid.
They already have your years and years of premiums.
LOL - you're kidding yourself. It makes exactly NO difference how long you've been paying premiums. They'll cancel your policy in a heartbeat if it suits them. You have the same right. And, in my view, you're a sucker if you don't take advantage of it.

Also, to clarify, since you seem poised on this equivocation, I'm not advocating for getting rid of insurance altogether - just bailing on the "full-service" bullshit. The best approach is to have as little insurance as you can get away with. If you have 10k in the bank, the best strategy is to get catastrophic insurance with $10k deductible. If you have more, go for a higher deductible. If you have no savings, you are poor. You don't need insurance. You need money.
 
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iamwhatiseem

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Everyday, that's what I do. But it does depend on platinum, gold, silver or bronze and subsidized vs non subsidized.
READ: The lowest income don't worry about it because it doesn't cost them anything, or little to nothing at all. Which is why I don't acknowledge that insurance for 80% of the population is $1,000s more a year after Obamacare
 

debbiedowner

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Have you negotiated a personal policy for yourself and/or others?
Policies cost way above what most people can afford.
You don't negotiate a policy you pay what it is. The affordability does depend on your income and this and next year the tax credits will be higher. FPL at 400% not really this and next year. Nope, I don't have to price a plan for myself and wife we're both over 65. My grown kids have 100% paid group health from their employer's.

I do agree off exchange is way too high for a good majority of people but if you're around 150% of FPL you might be pleasantly surprised as an individual and as a family even better. I'm in a non medicaid expansion state and no one (except kids and a pregnant woman) under 100% of FPL qualifies for a subsidy or medicaid and go without. If you have, let's say a couple with 2 kids and right at 250% of FPL then the marketplace will shoot the kids to your state medicaid. I am discussing Florida only. States that did expand medicaid and states with their own exchange do vary.
 

debbiedowner

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READ: The lowest income don't worry about it because it doesn't cost them anything, or little to nothing at all. Which is why I don't acknowledge that insurance for 80% of the population is $1,000s more a year after Obamacare
After obamacare? Unless your employer is self funded then you're on obamacare. The little or nothing on an individual plans depends on whether or not your state expanded medicaid if below 100% of FPL. I do agree an individual making around $15,000 per year in the state of Florida pays a couple of bucks for premium or nothing depending on their age.
 
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iamwhatiseem

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You don't negotiate a policy you pay what it is. The affordability does depend on your income and this and next year the tax credits will be higher. FPL at 400% not really this and next year. Nope, I don't have to price a plan for myself and wife we're both over 65. My grown kids have 100% paid group health from their employer's.

I do agree off exchange is way too high for a good majority of people but if you're around 150% of FPL you might be pleasantly surprised as an individual and as a family even better. I'm in a non medicaid expansion state and no one (except kids and a pregnant woman) under 100% of FPL qualifies for a subsidy or medicaid and go without. If you have, let's say a couple with 2 kids and right at 250% of FPL then the marketplace will shoot the kids to your state medicaid. I am discussing Florida only. States that did expand medicaid and states with their own exchange do vary.
You are still avoiding the fact that exchange ACA is not even health insurance. It is a catastrophic plan CALLED health insurance. If you want an actual decent plan on ACA - you are going to pay out the ass for it. A 70/30 plan with a deductible of $5000 - $7000 per member, with an OOP of $14,000 is not health insurance. PERIOD. It is a catastrophic plan that before AVA only cost $125 - $150/mo
Now cost 5 times that or more.
 

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As long as the actual costs of medical services are hidden from the consumer the medical and insurance industries will have all the power because they are actually insulated from consumer and market pressures.
 

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I have said it before, but far and away the best benefit of being a retired Marine is the health insurance via TriCare.
 

debbiedowner

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You are still avoiding the fact that exchange ACA is not even health insurance. It is a catastrophic plan CALLED health insurance. If you want an actual decent plan on ACA - you are going to pay out the ass for it. A 70/30 plan with a deductible of $5000 - $7000 per member, with an OOP of $14,000 is not health insurance. PERIOD. It is a catastrophic plan that before AVA only cost $125 - $150/mo
Now cost 5 times that or more.
On or off exchange if you do not qualify for a tax credit it's going to cost you out the ass. I don't know what state you're in or what you're looking at on the marketplace but each insurance company and actually damn near every county has different premium's and plans for different prices. You're income level (not in every case) determines you deductible and moop. Most of the times when you see deductible $5000 per member it's usually just for 2 even though you may have 6 kids on the plan and moop $14,000 is either one member or a whole family.

If you make $18 an hour and one person and assuming you work 52 weeks at 40 hours per week then your gross is $37,440, you would qualify for a tax credit, now add a spouse and kids even more but most likely with the kids it would put you under 250 of FPL in Fl and your kids would be placed either on healthy kids or medicaid.

Look, most of us in the business had high hopes Trump administration would change this, but nope and we all have to live with it now unless you totally self insure.

If you think that we're all pro obamacare in the business you're wrong. It's not fun even telling someone off exchange this year with 2 kids and yes she make's a little over $200,000 per year that she will be paying almost $40,000 premium next year. The rates have skyrocketed this year because of claims for Covid. The woman in this scenario is 62, spouse 64 and her 2 kids. Her and spouses age does not help. In a few months her husband will turn 65 and and lowering her premium a lot.

Oh and btw it is health insurance on the exchanges.
 
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iamwhatiseem

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On or off exchange if you do not qualify for a tax credit it's going to cost you out the ass. I don't know what state you're in or what you're looking at on the marketplace but each insurance company and actually damn near every county has different premium's and plans for different prices. You're income level (not in every case) determines you deductible and moop. Most of the times when you see deductible $5000 per member it's usually just for 2 even though you may have 6 kids on the plan and moop $14,000 is either one member or a whole family.

If you make $18 an hour and one person and assuming you work 52 weeks at 40 hours per week then your gross is $37,440, you would qualify for a tax credit, now add a spouse and kids even more but most likely with the kids it would put you under 250 of FPL in Fl and your kids would be placed either on healthy kids or medicaid.

Look, most of us in the business had high hopes Trump administration would change this, but nope and we all have to live with it now unless you totally self insure.

If you think that we're all pro obamacare in the business you're wrong. It's not fun even telling someone off exchange this year with 2 kids and yes she make's a little over $200,000 per year that she will be paying almost $40,000 premium next year. The rates have skyrocketed this year because of claims for Covid. The woman in this scenario is 62, spouse 64 and her 2 kids. Her and spouses age does not help. In a few months her husband will turn 65 and and lowering her premium a lot.

Oh and btw it is health insurance on the exchanges.
$18 an hour??? Hells fire... who said I made that little??
Ohh... I see now... I make decent money so I should "pay my share"
Why didn't you say so at the beginning?
You have done nothing but avoid what people are saying, and constantly try and deflect the point to something else.
Good riddance
 

sealybobo

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It's like being a teacher. Perhaps there is a better way. Someone with a little less training, let's say a nurse checks you out. Then they have 10 doctors in Washington that the nurses can consult. This low cost government option may not be for everyone, but it's good for someone who's been denied by a private insurer for having a pre existing condition.
Yesterday an english woman was explaining how here in America we do education all wrong. We only let people who are really smart at Reading, Writing and Arithmetic into our top universities. At Oxford, if there is someone who is exceptionally good at one thing, they will allow that person in to focus on that one thing.
 
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iamwhatiseem

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Yesterday an english woman was explaining how here in America we do education all wrong. We only let people who are really smart at Reading, Writing and Arithmetic into our top universities. At Oxford, if there is someone who is exceptionally good at one thing, they will allow that person in to focus on that one thing.
Totally agree with that
 

debbiedowner

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$18 an hour??? Hells fire... who said I made that little??
Ohh... I see now... I make decent money so I should "pay my share"
Why didn't you say so at the beginning?
You have done nothing but avoid what people are saying, and constantly try and deflect the point to something else.
Good riddance
ACA is not health insurance it is a law. Obamacare is not health insurance it is the law. The exchange is not health insurance it is where one goes if they so choose to purchase a health insurance plan from an insurance company.

I have said that people that don't qualify for a tax credit are paying through the nose. Is that not the point of your fucking thread? What the fuck am I avoiding. Oh, BTW in one of your posts you didn't say you made $18 an hour but rather said if someone makes $18 an hour and used an example. So that is where I got $18 an hour from.

The point of your thread was bitching what you're going to have to pay in premium's next year and you never said if it was just you or a family. I did address that.
 

dblack

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As long as the actual costs of medical services are hidden from the consumer the medical and insurance industries will have all the power because they are actually insulated from consumer and market pressures.
It's gonna take more than transparency. Patients need a reason to care about prices. If insurance is picking up the tab, the patient has every incentive to choose the most expensive options at every decision point, and exactly no incentive to seek bargains.
 

Unkotare

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Yesterday an english woman was explaining how here in America we do education all wrong. We only let people who are really smart at Reading, Writing and Arithmetic into our top universities. At Oxford, if there is someone who is exceptionally good at one thing, they will allow that person in to focus on that one thing.
Why did you post this same thing in two different forums?
 

Blues Man

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It's gonna take more than transparency. Patients need a reason to care about prices. If insurance is picking up the tab, the patient has every incentive to choose the most expensive options at every decision point, and exactly no incentive to seek bargains.
Insurance companies can give a break on premiums as a rebate at the end of the year if people choose the most affordable options
 

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