So $5,520 a year for health insurance! Ridiculously expensive. I'm looking for any other options, perhaps plans geared toward small businesses with less subsidies.
It's only when you live outside of the US that you realize it has the worst healthcare system in the developed world (unless you're very rich, in which case it's the best, which says a lot about the US political system).
I think the Australian system is the best model for the US to copy, not Denmark or France or what not. But it's never even mentioned here since apparently it's unpatriotic to admit other countries have figured out things we can learn from. It's got the essential public option with the private system running in parallel for those that want it or can afford it (higher incomes are tax incentivized to obtain it). The Pharmaceutical Benefits Scheme is desperately needed in America but the pharma lobby would burn the country down before they allowed that to happen.
As an Australian who moved to the US, this * 1000.
Yes, no healthcare is free. But a 1-1.5% increase in income taxes to pay for healthcare is a whole world away from the US situation:
- hospital stay in Melbourne, 9 days. Out of pocket, $36 for in room TV rental (this was 15y ago), including take-home meds
- kidney stone in Seattle, $8,000+ out of pocket AFTER insurance (and this was good insurance, but admittedly more complex than average kidney stone - surgical removal attempted, infection found, stenting, lithotripsy a week later)
How does your average person come up with $8K to deal with a kidney stone? Something many people might have to deal with multiple times in their life, if not annually?
Our combined family income makes us ineligible for subsidies, so I guess my option is to pay $14k a year for an $8k deductible with little coverage. I guess now all plans are HDHP, but with 3-5x the premium.
Don't forget the 30% coinsurance after you get past that deductible!
That's a family plan price and we were looking at 2-3 times that with a big out-of-pocket obligation on the Exchange. So far it's saved us about $10,000 and we really like the communal model.
(Posting under an alt account to avoid giving out too much personal info)
It's pretty affordable and the nicest part is most of these health shares are ACA exempt so you don't get hit by the fine of not having "normal" insurance.
Do you use a Direct Primary Health provider to cover normal doctor visits and things? I'm a fan.
Also is there any guruntee you wouldn't go bankrupt for a major medical issue? Are they very reliable?
No guarantees. You can't take anyone to court to make them pay your bills. However, if you don't make your monthly payment, you've effectively cancelled your membership and the person who was supposed to receive your check gets it from someone else so they're still made whole. Personally, I am more comfortable with the risk of a long-running voluntary system failing than I was with the risk of insurance deciding to screw me on coverage, accidentally getting out-of-network care, etc. But I looked into it for a couple of years before I reached that conclusion.
What would taxes be if we compared the US to Canada?
Using the following two tools: https://simpletax.ca/calculator https://smartasset.com/taxes/california-tax-calculator
For 50k a year in British Colombia for Canada and California for the US I get the following:
BC: $8,372 CA: $11,112
At 100k with 18k contributed to 401k/RRSP the numbers are 17.5K and 25.8k for BC and CA.
Unless I missed typed something because it's late we Americans are getting a raw deal. I realize Canada has VAT, but CA has very high sales taxes and I did not include the cost of an exchange plan. What you are looking is the Income and FICA taxes alone.
So for your hypothetical $50k/year worker, the tax burdens are pretty similar; BC+Canada sales taxes come to 12% which I believe is a bit higher than California's sales taxes, but of course the BC resident has government medical coverage.
Two important caveats however:
1. Depending on your income, BC is the lowest-tax or very close to the lowest-tax jurisdiction in Canada. Someone earning $50k in Quebec would pay around $13k of income taxes instead of $10k.
2. Salaries in Canada are vastly lower than San Francisco / Silicon Valley salaries.
That is disappointing. I̶ ̶w̶i̶l̶l̶ ̶a̶m̶e̶n̶d̶ ̶m̶y̶ ̶c̶o̶m̶m̶e̶n̶t̶.̶ (Can't amend, the above post is too old.)
> someone earning $50k in BC pays just over $10k... plus another $900/month (more if you're not single) of mandatory tax-but-not-called-a-tax government medical premiums.
$900 a month? Are you certain of that? That seems very high, unless it is paid by the employer. Is that a fixed amount or is it dependent on income?
> 1. Depending on your income, BC is the lowest-tax or very close to the lowest-tax jurisdiction in Canada. Someone earning $50k in Quebec would pay around $13k of income taxes instead of $10k.
I chose BC because it seemed to be having it's own tech boom in Vancouver and has very mild weather in that area. I felt that would be relevant to alot of people here.
As cbowal noted, the $900 is per year, not per month. I'd fix it above, but apparently my comment is also too old to be corrected now...
I chose BC because it seemed to be having it's own tech boom in Vancouver and has very mild weather in that area. I felt that would be relevant to alot of people here.
Oh, I entirely agree -- the Vancouver area is the only part of Canada I would want to live in. (Well, maybe Victoria, but that has the same weather and tax rates.) My point was simply that Canada's reputation for being a high-tax jurisdiction isn't entirely undeserved when you consider that most of Canada has significantly higher taxes than BC.
This, so much this. As a Canadian (living in Edmonton, AB moving to CA in a few days) the difference in pay is simply staggering. Since a lot of our prices are CAD/USD exchange adjusted (essentially buying, for example, a GTX 1080 is the same in USD, but costs "300" dollars more in here) the difference is compounded even further. Its not unheard of making 2-3x in the Valley compared to what you make up North. So then the tax situation becomes moot, because we're talking about the amount of cash that you take home which after all the taxes, and even the living expenses, is still significantly higher.
More importantly, besides VAT (actually called GST in Canada) there's all the employer-side taxes that aren't advertised in a job posting. Try using the self-employment box in your Canadian calculator; for $66,820 CAD in self-employed income in BC, you end up with $48,229 CAD after tax, or only $36,378 USD on $50,000 USD.
That's not really fair or useful either, because the same situation will have all kinds of tax implications in CA as well. My point is more than simply looking at "this is what income tax is in jurisdiction A vs jurisdiction B" is not necessarily reflective of what the tax burden's actually like.
Many people believe that despite it being a statement which is entirely a fiction.
I'd recommend checking out your local professional associations. IEEE and ACM have some options:
https://www.ieee.org/membership_services/membership/discount...
If you want a better health care deal you'd need to leave the USA or maybe become a member of congress.
A small group health plan isn't likely to be much less expensive, if any, and the small business health exchange SHOP (CoveredCA, Healthcare.gov, etc), the plans are pretty much the same individual plans.
The Affordable Care Act defined Essential Health Benefits (EHBs) which are basically a way to ensure that common and critical types of health care are guaranteed to be covered, along with a variety of other market making aspects (individual mandate, pre-existing conditions, etc). Prior to this, people could sell "health insurance" which covered few services, had strict amount limits, and could deny claims for various unclear reasons.
If you're going to earn less than $50k in 2017, then you'll qualify for a subsidy on your plan. If not, your options are going uninsured (potentially getting a tax fine at the end of the year), or enrolling in an individual market plan.
Stride Health, https://www.stridehealth.com helps consumers enroll in plans through CoveredCA and Healthcare.gov, as well as directly through the health plans. * Prices are the same you'll find anywhere else (they're set by law). I'd encourage you to try it, and hopefully it will take some of the headache out of it. * There's a support line with a very knowledgable staff if you have more questions about the impact of your income earning for the next year, or any more questions about your health care needs. * We'll also be there to help you throughout the year, and make sure to close the loop with your taxes the following year.
A couple of years ago a snafu caused my insurance to go unpaid. When it got cancelled, I couldn't pay for a policy anywhere due to enrollment rules, and I think the monthly penalty on my taxes ended up being $230 or so per month my wife and I were uncovered.
I initially purchased insurance via CoveredCA (no subsidy) and they just acted as a middleman between my family and Blue Shield without providing any benefit.
It'll take a bit more research and possibly some extra filing but you may benefit from it. In exchange for moving your income to a more employee like arrangement you'll be able to move things like this directly above the fold in some cases.
Or LLC filing as SCorp for federal tax purposes. Although that's the sort of thing you'll want to look at the 1040 rules for.
That's how I do it, but this probably puts me in the "lucky" category...
They have children so there was mutual interest in making sure all family members were cared for.
Your coverage is essentially $X higher until you sign the waiver saying "I affirm that my spouse has no other coverage options from another employer". That's how you're obligated to the policy.
HIPAA also doesn't prevent an employer from finding out if your spouse has insurance options elsewhere.
We just signed up for JustWorks, a PEO, primarily because their healthcare plans are much cheaper than going direct to brokers as a 3 person company. They require 2 people though so if you are solo I don't think this is an option for you.
cheaper and the model is more efficient. yes you give up some choice but there's a reason it is cheaper
before you poo poo it I would give it a try with an open mind
Assistance is for those who need it, not those who willingly choose to live in a high COI area. It is possible to live in CA on $50k/year.
Would you pay that assistance back if you had a liquidity event? Probably not.
Also, you think it's fair that somebody who makes $55,000 pays the same amount for health insurance as somebody that makes $500,000 a year?
At your income level, you're not getting subsidies. You can either pay the IRS penalty, around $2k at what I'm estimating your income at, and cash for whatever health expenses come up, or you can seek out a religious organization who will give you a waiver if you join their program (note: the healthcare that can be provided through such a financial program is probably not what you're going to prefer when the time comes for your healthcare needs to be addressed, caveat emptor).
Another option is to move out of the country before the end of the month; you're not required to be insured if you live outside the US at least 330 days/year.
You could also look at a cheaper bronze HDHP plan instead.
EDIT:
> Also, you think it's fair that somebody who makes $55,000 pays the same amount for health insurance as somebody that makes $500,000 a year?
Not at all! I'm just telling you your options. Don't like it? Quit your startup and go into politics. Good people need to grind day and night to fix things like this. Your fight is not with me. The situation in general sucks, and I am genuinely sorry about your frustration with your healthcare insurance costs.
I thought we weren't getting into politics though (re: your edit adding the last line).
I don't think you've fully grasped the concept of "insurance".
" basically a membership in a clinic where you pay a monthly fee in order to get cheap access to your doctor... The monthly fee is substantially less than typical health insurance premiums."
But... I still need a high-deductible plan to contribute to an HSA to deal with catastrophic issues anyway. high deductible plans are putting colleagues of mine in to $1000/month premiums already - saying "spend even more $ each month on a membership plan" isn't going to cut it for most people I know.
5 year ago a 'high deductible' plan cost my family <$300/month. Today it's close to triple what I paid just a few years back.
https://directprimarycarejournal.com/2014/06/08/how-does-dir...
"High deductible" plans, on their own, are very unaffordable relative to only a few years ago.
Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a high-deductible insurance plan.
You can say the HD plan is for catastrophic situations, with DPC being day to day, but for most folks I know, especially with families, the HD plan on its own has extremely high costs, and saying "let's also subscribe to a DPC service to keep our costs down!" makes 0 sense for almost all of them.
DPC alone won't deal with "crap, I just got cancer and need $180k of treatment". "regular" insurance can deal with that, but it's still extremely expensive.
Maybe I'm missing something in what you're trying to say.
Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer.
One of the ways DPC lowers costs is by helping patients stay on top of health maintenance so health problems do not escalate. For example, patients with well managed diabetes can live long, healthy lives with few complications. Patients with poorly managed diabetes see high rates of blindess, foot amputations and other horrifying, expense, life altering health complications due to diabetes.
Does that make any more sense?
So, since I am absolutely sure this is not a discussion that can be had in good faith at all, you just keep on believing whatever you want to believe. Don't let me confuse you with the facts.
And the persecution complex is probably not working out very well I imagine.
And the thing I found hardest to swallow about that job was that many of the totally random, shit happens claims from good people not milking their policy for money got damn little money out of us. It seemed incredibly, horribly unjust to me.
You could not entice good employees by offering them a pay raise because it was illegal [0]
This passage also reflects a possible misunderstanding of how marginal income tax brackets work. In no situation does bumping someone into a higher tax bracket result in lower net pay.
I am frustrated and not sure what I need to do differently to get that across effectively.
Edit: Feel free to nitpick this version: http://micheleincalifornia.blogspot.com/2017/01/direct-prima...
Maybe I shall eventually get it right (just in time for the law to change under Trump).
Thank you.
I agree that separating disaster/catastrophic coverage (ie: insurance ) from routine things like doctor visits (ie: health care ) is a good thing. I was aware of HDHP and HSA for the former but I did not know about DPC until you brought it to my attention with this comment thread.
Thank you.
I don't know why I seem to inspire this kind of reaction in people, and maybe it isn't "me" per se, but I seem to get this a lot. And I am genuinely interested in figuring out if it is really something I do that I can somehow change.
Thank you for engaging me in meaty discussion.
Best.
http://micheleincalifornia.blogspot.com/2017/01/direct-prima...
Also submitted: https://news.ycombinator.com/item?id=13354383
I assume it will get no traction.
Best of luck in resolving your problem.
Also the plan that you claim was comparable before the ACA was probably not comparable at all because it had a lifetime coverage cap. So it was objectively worse because if you got a serious and expensive medical condition you would have been cut off at some point.
I have a pretty expensive PEC and my state had a high risk pool that was much less expensive than what I pay now. (To be clear, I think the preexisting condition exclusion ban is wonderful, just adding a data point to the conversation)