Health Insurance

[TLO]

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.

[Chief Roundup]

Originally Posted by KCUnited

SOCIAL INFLATION

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.

[BigRedChief]

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.

[Hoover]

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

[Chief Roundup]

Originally Posted by BigRedChief

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.

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

[BigRedChief]

Originally Posted by Hoover

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

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.

[Hoover]

Originally Posted by BigRedChief

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.

[blake5676]

Originally Posted by Hoover

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

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.

[Chief Roundup]

Originally Posted by Hoover

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.

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.

[blake5676]

Originally Posted by Chief Roundup

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

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.

[penguinz]

Originally Posted by Chief Roundup

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

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

[Chief Roundup]

Originally Posted by blake5676

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.

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.

[Chief Roundup]

Originally Posted by penguinz

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

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

[BigRedChief]

Originally Posted by Hoover

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.

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.

[Buehler445]

Originally Posted by notorious

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.

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.

Originally Posted by notorious

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.

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.

Originally Posted by KCUnited

SOCIAL INFLATION

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.

[Buehler445]

Originally Posted by BigRedChief

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.

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.