Health Insurance
 

My company is changing up providers for the health insurance they offer this upcoming year, and the options are pretty lackluster.

I know diddly dick about trying to find private health insurance, but surely someone on here has some knowledge to share.

Where do I look? What would constitute "good coverage" in your opinion?

Any suggestions welcome.

Don't bother. The private options will either be shit or too expensive to seriously consider.

Always hate when an employer changes providers

They usually try to tell the employees its for their benefit but it's always for the benefit of the company

These guys are helpful and a better option than the gub'ment run exchanges (gub'ment = ****tards) IMO
They rank/rate based upon options customers really care about, then link you directly to the providers

https://www.nerdwallet.com/blog/health-insurance/

Bend over and provide thy anus

Oh wow!!! Look at this really good plan... For $686 a month!!!! WTF is this shit?????

Health insurance is just like football. You have to pay for the fatties because that's the market.

Somebody has to pay for all the free shit

company provided plans are usually better bargains than private. You can compare coverage and cost including out of pocket and deductibles against your company provided coverage

If they’re supplementing it at all it’s likely better than you can get elsewhere. There is some non-insurance group cost sharing stuff that sounds a little too good to be true ish, but no way I’m doing that.

If it’s bad enough start looking for a better job.

Ehhh. I just got a pretty massive promotion. I'll stick it out with shit health insurance if needed. :D

It's all a racket

Don’t get Aetna. They are the worst

As others have said, you're very unlikely to find a better deal than your company-provided insurance.

Are you in good health? You might want to consider (if they offer it) a high deductible HSA plan. A lot of companies contribute to their employees' HSAs annually and your contributions can be pre-tax. If you can swing it, an HSA provides multiple tax benefits. And it typically comes with lower premiums.

This, and only this.

Unless your company has zero employer cost share (very doubtful), you simply are not going to find a better product/price on your own. For what it’s worth, you can see how much your employer pays vs. what you pay on your W-2.

Source: while I currently work in forecasting/reserving, I used to work in health insurance pricing.

100% do not get Coventry. When I was working at a local hospital we switched from BCBSKC to Coventry and the place I worked at wouldn't even take them for a lot of things.

I'm going to be going on my girlfriend's insurance this year. I didn't even know I could do that. She can claim me as domestic partner lol. Instead of $31 a month at a $3,000 deductible it's $51 a month at a $3,000 deductible instead of Obamacare.

Eat right and exercise and don't smoke and go with the employer option.

And get that 4th booster, TLO,.

Looks like I'm going to have to go back to The Marketplace to get Health Insurance. My girlfriend got laid off a while back and she can't even get an interview so can't get healthcare through her right now once Cobra runs out. Can't wait to get ripped off and pay $1200 a month.

Looked into part time jobs that offer benefits but you have to work like 23+ or 28+ hrs plus. I would do 10 lol but that is about it.

Maybe becoming a Canadian citizen so I can get healthcare is an option

Damn, didn’t know you had a girlfriend. Sorry for her.

Well, it is for the employees benefit, directly or indirectly. You have to be competitive for whatever product you sell and non revenue producing cost like employee benefits need to be competitive to gather and retain employees, but they also need to be cost effective. If you aren't looking for more economical options on a yearly basis, you are doing your employees and company a disservice.

It's over $600 a month for just me through my work. I've been to the doctor twice in the last 15-20 years. I just can't justify it

Not sure on your age? but that's relatively high for a work sponsored plan assuming you don't have some "cadillac" super plan with almost no deductible and super low out of pocket max.

If it's just an average plan with a medium to high deductible (4-8k) then I'm guessing that you're either paying the vast majority of the premium and your employer isn't paying much OR you have a small group with a poor health rating pool of employees.

You could likely find a similar premium plan on the individual marketplace, but those plans are usually only a good deal for someone earning a low enough income to get a subsidy to cover the majority or all of the premium. If you are above that threshold, you're probably paying that same premium for a shit plan with an $6k deductible in a relatively narrow network or with a "new" insurance company you've probably never heard of that may or may not be around for another few years.

The insurance game really is a shitty proposition these days. You can't just self insure at a reasonable rate anymore.

Go talk to your doctor/his secretary. They know who pays the bills. I've lived long enough to get most of the basics free these days, but I paid out the wazoo when I spazzed out a time or two before the geezer-rates kicked in. FWIW, eat less beef, walk more (push a cart around Walmart then get what you came for) and let your girlfriend do most of the work. Buy a pair of 10 lb dumb bells or kettle bells - and use 'em 3 days a week. Read up on 'indian clubs' and buy or make yourself a pair. They're designed to make you a better swordsman. Turns out - you don't need to stab people to benefit.

I've had Aetna for over a decade through the wifes work. $500 a month for both of us. PPO plan, Vision, Dental also. Go wherever we want. See any specialist etc. $2500 out of pocket max per year. No complaints here.

I had Coventry when I had knee surgery about 20 years ago. Cost me $50 out of pocket for the surgery and PT.

First follow up with the ortho I mentioned I couldn't believe it was so cheap.

His response was the Coventy was great for patients because it was very inexpensive.

It sucked for doctors because Coventry was very bad about paying out if the did at all.

He said usually when a patient has Coventry he would be lucky to break even on his costs.

I like the plans that have high max out of pocket costs per year so I can self insurance myself but they still have a discount each year for regular doctor exams etc. Seems like I would be a pretty cheap person to insure. Single, no kids, etc. I don't really care about a low co pay on everything. If I get a terrible disease or saw my leg off I'm perfectly fine paying $10,000 max as long as I don't have to pay $150,000 and I save money on my monthly premium.

Do they offer a high-deductible health savings account option?

US insurance needs to develop a "Health Care SR-22" so the rest of us don't have to sacrifice our retirement goals for the Big Gulp chugging, smoke-a-pack-just outside-the-building's-front-door, no-walking, buffet-busting, lil' Debbie crowd. It's such a scam that drivers are rated, life insurance purchasers are rated, but they don't group the healthy and the morbidly obese/high risk people in their own groups. Doing so would GREATLY enhance the habits of those that are trying to get into or maintain their membership in the "healthy pool".

Then why would he choose to be in the Coventry network?

I thought the same as well. All I can think is that it was because he was younger his name wasn't on the building so he had less say into what networks the practice was in.

If people had to pay outside of work they would shit their pants.


46 non smoker married to a 42 female with great tits non-smoker. Healthy, I've been to the doctor one time in 20 years to get a thumb stitched up.

1400/month. Small business owner.

Yap I'm gonna be in same boat. Although a friend of mine who is a poker dealer says he makes less than 19k a year and it's only $280 a month for him.

Healthcare.gov saves a lot of money with subsidies if Uncle Sam thinks that you don't make much.

I'm going to leave it at that.

That's not exactly how it works but honestly most doctors don't know a thing about health insurance. There's probably a few that are solo offices or independent from a hospital, but you ask you're average family physician or and ortho how much X company pays and they won't have a clue. But they probably do hear from management or billing that one company is better than the other for their specialty.

Coventry doesn't exist anymore, they were acquired by Aetna about a decade ago and slowly completely phased out into Aetna plans, but they were not unlike any other "big" insurance company. They each have their own fee schedule for the services provided. For example, Blue Cross may pay me $48 for doing one procedure yet United Health only pays me $31 for the exact same thing. I certainly have insurance companies I like better than others, but it mostly boils down to what they pay for services rather than ease of dealing with. Sure, some can be cumbersome at times but they all have to approve or deny claims w/in 30 days of submission and you basically know what you're getting paid before you send it.

So on that note, when people say one insurance company they had was SO MUCH BETTER than a different one they had another time, it usually actually means they had a better plan/contract and not that the insurance company was better. In your example, you didn't only pay $50 because Coventry kicked ass. You paid that amount bc you were either close to hitting your out of pocket max or you had a really good plan with killer copays or cost sharing.

Where people run into trouble with actual insurance companies is when they or their employer use one of the smaller guys that have narrower networks and more stringent pre-authorization requirements. If you have one of Aetna, UHC, Blue Cross, Medicare, Humana, etc, then your insurance company is basically as good as the plan you're signed up for. Not a ton of difference between them other than that, with some mild caveats.

Self-insuring is absolutely insane these days. If you fall in "middle class" where you make more than the level where you get a subsidy but you're not making 2 or 300k per year, it's gonna be a dagger. And unfortunately you can be as healthy as possible and you're still gonna get bent over.

I'm luckily on my wifes plan, but it would cost me $7-800/month for a plan with a high deductible and narrow network to insure just myself at 41 years old. And then I'd have to pay about $5k more before the insurance would even kick in. So you're basically looking at $15k out of pocket with the deductible and the monthly premium before actually getting any benefit.

I don't mean to make this political, but prior to the ACA (and getting married and being on my wifes plan) I used to pay about $70/month for a $2500 deductible with the largest local insurer and network in KC. Obviously I'm 10 years older now and inflation, but it would cost 10 times as much for a shittier plan if I were out there on my own again. The individual marketplace is HORRIBLE if you're not receiving subsidies for having a lower income.

This isnt a health insurance thing only. My wife got rear ended sitting still at a stop light. Totaled the car. Paid the money to us. Except.....Now we have to pay $400 more over 6 months because she had a wreck that no one thinks was her fault.

Florida is a no fault state. Two cars have a wreck. Police say and give a ticket to one driver of the car that caused the wreck. But, Both cars are flagged as if they were both at fault because there is this no fault insurance law.

They raised my house insurance rates in Lees Summit in the mid 90's because a hurricane happened in Florida.

I had not idea...that needs to be fixed asap. People think about food, gas, utilities, and property taxes going through the roof over the past three years, but insurance costs are sneaky and just as bad. There are no "no-wait" medical sharing orgs out there that may be the best deal on health for the self-employed

SOCIAL INFLATION

Absolutely disgusting.

Ugh, I work in Healthcare for a profit and even I suggest we'll move to a government supplemented program soon. Hopefully.

Before you jump down my throat, please note this is not a political perspective, its economic.

Approx 55% of hospitals in the US are failing to make a profit post covid. Reminder to everyone that they are business, for profit, and will cut services and employees if they can't continue to profit. At least 5 hospitals in FL shut down 1st qrt last year.

The trends relate to the increase in cost from vendors (medical and pharma companies), stagnant wages and decrease in headcount at hospitals due to less profit, YOY increases in cost of insurance, etc... Ultimately, run away capitalism requires some taming in key industries that act as the pillars of our society.

I'm also a lifelong sales person, but even I can see that there are industries where we allow unnecessary middle men to profit just to give useless folks a job. Specifically, car sales, mortgage sale, and insurance sales could all be easily purchased online now but we inflate the ins industry bc it's powerful in the US and many folks depend on it for jobs and it would have ramifications on our economy to evolve to a new system.

Don't let politicians feed you anti-american BS when it comes to offering citizens better value in healthcare is my .02c, they're paid to keep the status quo.

The entire model is broken beyond repair IMO. I'm not smart enough to know the answer. And it goes against my inclination towards letting businesses and the market figure things out on their own. But I lean towards agreeing on some sort of drastic change or expansion of Medicare for All.

Costs are simply out of control. Changing the health insurance landscape with the ACA helped insure more people on net, but it skyrocketed spending and the cost of insurance.

Hospitals are a big problem. They charge 2-4x to private insurers when compared to what they get from Medicare. They get away with it bc they've gobbled up every doctor possible from primary care to specialists. And then hospitals have boards and administrators making tens of millions of dollars that aren't in any way involved in patient care.

We pay more for pharmaceuticals than any other country in the world, by multiple factors. Sometimes 10-fold for the same drugs. They always scream that if we didn't pay more and subsidize the cost for everyone, research money goes down the drain and we are no longer innovators.

And then you flip the script and wonder how getting the govt MORE involved would ever even help anything. Half the reason costs are the way they are is due to burdensome regulation, lobbied loopholes for certain industries and the list goes on.

I truly believe disassociating health insurance from employment could only be a good thing and a start to changing the landscape. But that will be a seismic change that I don't know anyone has balls to pull off.

Hell, I'm getting more depressed about the prospect of any solution just typing this out! I'm saying more govt involvement on one hand while reminding myself that scenario typically only makes things worse. I think we're all just pretty much ****ed when it comes to healthcare spending. Maybe when it hits 25% GDP something will change?

Your Bias and ignorance of everything that comes into the situations is showing.
Most of the people you are referring to are poor. Those people have to eat cheap. Do you know what is cheap? Food that is bad for you. There are many other factors. I will stop here as they will get into an area that is political and all of that other stuff that gets people mad.

Dude, how old are you?
This will never be changed. Insurance companies have been doing this forever. It is an agreement that they all made with each other to save themselves money. Also to get coverage for all vehicles in a large accident situation, otherwise drivers and others would not have been covered.

What about just regular ole inflation? You know the price of goods to everyone. When inflation hits several levels that all pertain to one entity it makes that one entity struggle due to being hit with several price increases to complete one task because of inflation.

Try to build something now. The electrician is more expensive, the plumber, the HVAC, the carpenter, etc. The one entity, owner/builder, in this scenario, is getting hammered.
It is no different in most everyday situations including medical insurance or the costs of operating a hospital, rural health clinic, nursing home, procedure space, doctor's office, etc.
All those price increases must be spread out to all parties and individuals or they could not be absorbed and survived.

Having profit in healthcare is the demon in all this. It should not be a business.

Somehow, someway we should figure out how to deliver healthcare to all of us without the government involved and profit not being involved. There has to be a way. We need some out of the box thinking.

It’s ****ed up because government is involved. If it was just a business providing a product it would work much better. It’s government mandates that drive prices up. It’s a giant ****ing mess

I am curious about how many people know that a large majority of hospitals are completely tax-exempt and not for profit.

We have for profit hospitals and insurance plans. They are no better.

Businesses will deny healthcare just to keep their profit margins. You got an expensive cancer? Heres the phone number for Hospice.

You can keep the same system we have now and everything would be great if you face where most of the money goes, end of life. We will spend on average 45% of our total healthcare expense in our whole lifetime in the last 6 months of our lives.

Families cant just let mom or granny go. All the expensive care is covered so lets spend a million or more giving her another 3-6 months of life. If we could just let the elderly at the end of life die instead of spending treasure to give our 87 year old grandma another 3-5 months. But, thats never going to happen.

You are missing my point.

State and federal governments mandate that insurance companies cover all sorts of things. So even if it’s impossible for my wife and I to conceive a child, our health coverage has to contain coverage for pregnancy. All the mental heath issues? Mandated to be covered. Some dude thinks he’s a woman trapped in a dudes body. ****ing covered.

Let the consumer decided what coverage they actually want or need and it would be more affordable. The Shia broken because it’s required to cover all things for all people.

In most industries I'd agree with you, but healthcare is somewhat different. And I'm certainly not an advocate for burdensome and unnecessary regulation, but I personally think health care is somewhat different.

And as far as government involvement goes, the first example of it being a GOOD thing in health care is Medicare. Hospitals and doctors bitch and moan that Medicare pays like crap. But Medicare pays a pretty reasonable and fair rate for the majority of services it provides. For example, getting a cervical MRI with Blue Cross might cost you $1,300 out of pocket. Medicare only allows $430 for the same test. An MRI shouldn't cost $1,300. Medicare can do that because they 65 million customers and the hospitals have to accept their rates. Your local Blue Cross doesn't have the same patient base, so they get stuck paying 3, 4, 5 times the amount Medicare does for the same procedures.

This post is not entirely accurate.
You or your employer can and does choose various options of what their plan will or will not cover.
Cancer, mental/nervous, specialists is generally an add-on/rider policy and not covered unless you pay extra.
The hospital that I work at does not cover specialists, basically anything with an 'ologist in the title until you hit your max out of pocket.

Honestly, what does that really even mean these days? I obviously know that it technically means they're not paying SALT, but the non-profit hospitals still have insane expenditures and aren't having to be as cost conscious as the for profit hospitals. BOTH have tens of millions of dollars in salaries getting paid to administrators and boards and business analysts etc.

I don't think there's an appreciable difference in quality of care received at one type vs the other. But saying a hospital is non-profit certainly doesn't mean they're running tight margins bc they don't bring in much money.

This is quickly going the other direction. More and more are for profit and the big ones are buying others.

No, what it means is that they get even more tax advantages.
All businesses have to be making money. If they do not then they would not be able to give raise increases, expand their business or even purchase new equipment.

Someone back in the comments hit the proverbial nail on the head the government mandates. Anything used in the medical field is extremely more costly than it would be for any other business.
The other part of those mandates is that they are required because of some hospitals, Dr., nurses, or staff members doing something unethical that resulted in harm to an individual. Those things happen far too often because of the drive to make or remain profitable.

As of January 2024 64% of all hospitals are not for profit. These businesses are not going to give up those advantages.

Ala Cart would never work. This isn’t streaming. People would select the absolute cheapest option.

What happens when they get sick with something that wasn’t covered and they don’t have the money to pay for the treatment? We just tell them you are SOL pal?

Should have paid for better insurance. That’s never happening. They will just go to the hospitals that have to take anyone. Me and you will pick up the bill.

This, right here, is why the wife won't ever quit working. It's just not feasible. Even her having to pull out almost a large for the family plan coverage.

There are some real gotchas that can happen here. I did taxes for a dude that had picked up a policy on the marketplace, got a big subsidy, paid the premiums all is well. Right? RIGHT? Well, he had mis-estimated his income by a bit - I don't remember how - doesn't matter. Did the return, entered the shit, well, the IRS said he undrestated his earnings, the subsidy will be substantially less, and you have to pay the difference with the return (and there might have been a penalty I don't remember). So he owed a pile of cash, and obviously if he was getting a subsidy, he was low income, so my guess is it was a substantial hardship for him.

It's a thing. In Kansas they pulled removed the cap for pain and suffering on a liability claim, so the shitheel lawyers of the world have come out of the woodwork to plaster ads all over everything. Barf.

Not me.

The wife's plan raised rates and the company lowered the coverage, which is nice, so they rolled out some lower cost plans. It took all of 5 minutes to figure out that if you use the plan at all for anything other than an annual checkup, the premium savings wouldn't outperform the coverage.

But you're right, if you're going to roll with lower coverage, you need to keep the jack available to cover medical expense. I don't remember where I saw it, but somewhere I saw the percentages of bankruptcies that were attributable to hardship from medical was pretty staggering.

Uh, yeah they would.

36 non smoker, 38 wife non smoker, no health issues for either of us.

3 kids 10 and under.

2200 a month.

I've listened and read about as much as I can with regards to health insurance. It's a multifaceted issue that I think we all look at wrong.

We want a solution. It's not a problem that is gonna have a "this fixes it" solution.

It's more "this is economically the best option for the biggest faction of people".

Reality bolded above. One of the reasons I had such an issue with the ACA. There was a small % of the population that couldn't get insurance on their own due to health conditions. But they changed insurance for 100% of the population for the sake of that small percent of people. Coverage increased, yes. But cost skyrocketed for EVERYONE.

No actual answer that solves everything. Only measures that could make things slightly less painful. And again, I'm not smart enough to know the best options. But I do strongly believe unwinding insurance from employment would do wonders, even if that prospect is unrealistic.

Yes

I've never figured out health insurance. I have a good plan that I pay about 10% of the premium.

As an example of recent cataract surgery here is the breakdown:

Retail price of surgery on 2 eyes: $12,500
Insurance agreement with surgery center: $4800
Additional cost of anesthesia: $650
Six office visits: $350

My total cost: $550 per eye.

The strange thing? I have $2500 max out-of-pocket and this surgery only used $229 of the $2500. I thought I would be responsible for much more because of the max out-of-pocket.

Probably have a deductible, once that is met then a co-pay, co-pay up to out of pocket max then everything is "free"

To be clear: your premium is what you pay for your insurance...

Without trying to get political, you want people to chase their dreams and entrepreneurial spirit. Its hard to do that in this country because of no socialized health insurance. If you try to be self employed you pay out the ****ing ass for health insurance.

As it is in the current system since you cannot refuse care, you are looking at a huge portion of costs that simply go unpaid by the poor, illegals, or people at rhe end of life. Those costs are passed on to paying customers and their insurance rates are higher because of it.