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Comment by resto49 | Hacker News Reader

No objection that most of EU is better than the US in these regards, but Amazon warehouse workers get some of the best healthcare insurance that I’ve ever seen in the US. Similar to what the top-level-commenter pointed out, I guarantee that the warehouse jobs in Bessemer provide among the best healthcare available in the town.

The US as a whole is awful at providing healthcare, but healthcare is a particular area where Amazon actually is going way above what is normal and is provided astonishingly well for its workers.

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I'm an Amazon warehouse worker in North Carolina. As far as health insurance, I pay 100% of the first $1500, then 10% of the next $15,000 (so $3000 total), then 0% of anything over $16,500. I wouldn't call that astonishing, but it is the minimum $0 monthly premium plan. Also, I'm generally happy at work. I basically feel well paid and well treated.

Do they have upgraded plans available for purchase, and are they pretty expensive or reasonable?

Not defending insurance plans in the US whatsoever because I despise their deductible structures but that’s actually pretty good.

This is pretty much the same insurance that full-time SWEs at Microsoft receive at Redmond HQ (well, one of the two options, with the other one being tied to Kaiser specifically, but most people I know take the one that's similar to yours). 100% of the first $1.5k, 10% until you hit the total of $3k, and then everything is free. $0 monthly premium as well. That's the one I have myself at the moment.

Glad to see someone like you list the real numbers, because I keep hearing "good insurance" when it comes to Amazon warehouses, but this is the first time I saw someone actually point out the specifics. Also glad to hear that Amazon warehouse workers receive health benefits on par with full-time SWEs (not being sarcastic here, I genuinely am happy to hear this is the case).

(you didn't say this, but) nobody here should fool themselves into thinking a $3k deductible insurance is equal between an Amazon warehouse employee and a SWE at Microsoft.

$3k for a Microsoft SWE is a "dang, I wish I didn't have to go to the hospital" situation.

$3k for an Amazon warehouse employee earning $15/hr can often be a "there go my savings, I wonder if I got this injury due to the amount of physical activity my job requires" situation.

The benefit is the same, and it's far more lavish than any other $15 job offers. Employers paying for 100% of the health insurance premiums are rare.

Microsoft's healthcare plan used to pay 100% of premiums, but over time it either became unaffordable or didn't work with the ACA.

Currently it's something like "we charge you a lot for the first few months but also give you the money to pay it in your HSA", which makes you wonder why they give it to you in the first place. It's not like you can optimize your prescriptions out of your life, so it's not enabling choice.

I don't have any prescriptions or chronic health issues. My HSA is another several thousand dollars per year of tax free retirement savings (I max out 401k contributions also). Sure, I can only ever use that $ on healthcare, but when I'm older I'm sure I'll use it.

Sure, but that doesn't explain why employers contribute extra to the HSA instead of having salary deductions.

Btw, once you're 65 you can withdraw money for no reason without a penalty, so it's no worse than a traditional IRA. Too bad deposits are taxed in California.

I see your point, but to be fair, it is 10% after the first $1.5k. And it is already a much better insurance than most people working in offices I know get.

Essentially, what it means is that if an employee spends less than $1.5k/yr on medical expenses, they don't gain much benefit. If they spend over $1.5k, they essentially only spend 10% after that on all of their medical expenses. And once they hit a hard cap at $3k, they spend nothing at all. 90% off for most medical stuff is a great rate.

Not even mentioning the fact that this kind of an insurance is a godsend to people with major health problems, given that in the worst possible scenario, they would only ever spend $3k of their own money in a calendar year on medical stuff. And that's only if their actual pre-insurance-cost expenses are closer to the $16.5k, because $1.5k + $1.5k/0.1 = $16.5k.

And I am yet to see a better insurance out of any employers (not just warehouse employers). Even the "amazing" student insurance I had back in college (which I had to pay the premium for) was much worse than this.

> Essentially, what it means is that if an employee spends less than $1.5k/yr on medical expenses, they don't gain much benefit.

Nitpicking here, but they probably do, because the insurance-negotiated prices for many services are much better than the prices prices you could negotiate yourself -- and that is assuming you even have the skills and energy to do any negotiating.

I have a high-deductible plan, which on paper covers literally nothing until I hit something over $7k/yr in expenses, which I thankfully never have. However, I usually pay 30-60% less than the uninsured cash price for my appointments and procedures just because I'm on the plan in the first place.

I often (not always) check this with the provider, so it's not like I'm just blindly assuming the discount claimed by the insurance company is accurate. It's usually not, but the discount still seems to be substantial.

In exactly one case I ended up saving like 50 bucks per dermatologist appointment by paying them directly.

HDHPs are the reason for HSAs becoming a thing. I don't think most realize that the Amazon health plan mentioned is a pretty good deal. Most people only look at wage, failing to take into account what benefits are worth. In the US health benefits can account for a huge portion of overall compensation.

It’s not all equal, but I’m looking at my $7K deductible with a $1.2K/month premium (ACA Marketplace plan) and I’m thinking that plan looks like gold.

Jesus, I hope that's at least for a family of 4 or something?

I'm 38 and also have a $7k+ deductible (my plan is HDHP), costs me $275/mo.

It’s for two people over 50 with no aid from the gov’t for the premium (which means we’re in good shape financially). The “Affordable” in the ACA is not for everyone.

ACA plan costs go up pretty steeply with age, from what I've seen.

You may want to look at your options on the ACA marketplace again. The recent stimulus bill included significantly more subsidies for ACA plans and enrollment is reopened for the next few months.

They also left out the point where Microsoft gives you $1250/$2500 in your HSA to help alleviate those deductible costs (if you choose to).

That's still a remarkably good health plan being offered unless somehow people are expecting Amazon and other corporations to offer their warehouse workers a better health plan than they or Microsoft offer their own engineering staff. Even a union isn't going to get them that.

Well not quite, because Microsoft also contributes $1k to an HSA as part of the plan every year.

That said, having to pay up to $3k a year in medical costs when you're earning a Microsoft salary is a much smaller percent of your income than having the pay the same making $15/hr at an Amazon warehouse.

HSA is a separate thing that I don't even personally touch, I was talking about insurance itself.

And I agree with your point, that type of an insurance with a fixed cut-off is regressive in a similar way that a sales tax it. So please don't get me wrong, I am not trying to say that Amazon warehouse workers have it just as good as Microsoft SWEs in terms of benefits (or just in general).

They do, however, have the type of health benefits/insurance that is extremely difficult to beat by literally anyone except what other big tech companies provide to their SWEs. And afaik those benefits for Amazon warehouse workers kick-in on day 1, unlike what it's like at many other similar warehouse jobs.

Are you sure you're not confusing HSA with FSA?

The latter should absolutely be avoided, but an HSA is basically just another tax-advantaged retirement account along the lines of an IRA.

I am not confusing HSA and FSA, but my wording was likely confusing.

When I said "i don't personally touch it", I didn't mean that I avoid it. I just know that it is a part of my benefit package, i get contributions in there, but that's about it. I don't even look at it or interact with it in any way otherwise, because I am not planning to use it until much later in life.

Ah yes, sounds like you're doing it right, my apologies :)

You should at least transition it into something appreciating. By default, you make basically no interest, but you can transfer it into investments.

How much easier is it to keep a job, and thus your health insurance, as a SWE when your body breaks down?

>How much easier is it to keep a job, and thus your health insurance, as a SWE when your body breaks down?

Probably much easier than it would be for a warehouse worker. Though I have no idea how this is relevant to what was said in the message you were replying to.

I'm just pointing out that while it's great that they get pretty decent health insurance, it's a poor substitute for a societal safety net. And for a union that makes sure they're not chewed up and spit out.

I don't want to entirely discount your experience, but given that Amazon is not beneath sock puppet accounts, how do I know the post is authentic?

Reply to the sibling comment comparing to insurance of MS SWE. While the absolute values are comparable, $1500 is quite a bit more of an inconvenience at a warehouser worker pay level than at a SWE salary level.

Given the physical nature of the work, I'd consider them more enlightened if they provided a lower deductible at the $0 premium level for every warehouse worker across the board. I'm really getting tired of places treating the long term mental and physical health of workers as an unpriced externality that's later paid for by society.

Also, thanks to motardo for the data point. (I will assume you're an actual warehouse worker.)

To help non-US people understand this plan:

> but it is the minimum $0 monthly premium plan.

The monthly premium is the cost of the insurance plan. A "$0" premium isn't actually $0, it means that Amazon is paying 100% of the monthly costs of maintaining the insurance, requiring $0 contribution from the employee. Many companies (especially warehouse type operations) are less generous, and require some monthly contribution from the employee to pay the premium. The worst health insurance I ever had required me to pay 100% of the monthly premium, with $0 committed by the company. That company lost a lot of employees.

> I pay 100% of the first $1500

This is the "deductible". The covered person is responsible for 100% of costs until the deductible is met, although there are many exceptions. For example, a routine checkup might be 100% covered ($0 cost), as well as a range of preventative care procedures described by the ACA.

> then 10% of the next $15,000

After the deductible has been met, the person is responsible for coinsurance of additional costs. An extra $5000 procedure would translate to a $500 bill for the patient.

> then 0% of anything over $16,500.

This is where the "out of pocket maximum" or OOPM is reached. In this case, the most the patient could expect to pay is $1500 (deductible) + $1500 (10% of next $15K) = $3000. After that, all excess charges are handled by the insurance company until the insurance year resets.

In short: Health care will cost between $0 and $3000 depending on how many services are used for the year (excluding fully covered benefits like annual checkup, depression screening, breast cancer screening for women, vaccinations, and other services covered for free under the ACA)

Great write up! Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

But I assume a company like Amazon is dealing with a large insurer part of nationwide networks like BCBS.

Also, insurance companies have their own doctors and pharmacists that might disagree with the patient's doctor's treatment plans, and will not cover the healthcare costs for those items without a "prior authorization" from the insurer. There's an appeal system in place for this too. Although, this type of thing exists without health insurers too, it's just employees of the government deciding what to approve and not approve.

> Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

Actually, out-of-network emergency care is an 'essential benefit' under the ACA, so most plans do cover this scenario.

I actually just screwed myself with this recently. I went to an urgent care while traveling (because that is usually cheaper when I'm at home) and it wasn't covered. An urgent care apparently doesn't count as emergency care. It turns out that I should have gone to the (typically very expensive) ER instead -- it would have been covered 100% because of the ACA!

Thanks for the correction, I did not know that!

Every time I dig into ACA, I find that it’s a pretty decent framework for a non taxpayer funded healthcare system.

After that, all excess charges are handled by the insurance company until the insurance year resets.

This is an important point. And a related point.

- Because the OOP payments reset annually, there are perverse incentives to over consume medical care after OOP is reached within a given year. Defer preventative health care until after you have a major medical problem that runs to max OOP, then stack up on preventative care before the year ends.

- Related: Insurance is also tied to employer - if you change jobs, all those OOP values reset (to whatever policies are in place with new employer). This causes friction in the labor market - employer-provided and -subsidized health care prevents people from looking for new employment.

Thanks for the explanation. Interesting to compare to Australia, which has a public health system, but where I still pay ~AUD2960/year, after government rebates (at current rates ~USD2255/year) for moderately crap health insurance for my family even with no medical usage.

In general, we wouldn't even use it to access private health care, because we would then face substantial fees to use it (I don't know exactly; it varies significantly by procedure, has a $500 deductible, substantial copay, and has maximum caps), however we're taxed heavily for not having a private policy.

Our family income has recently pushed over some thresholds in the rebate system, pushing up prices even more, might have to shop around to find an even more useless but cheaper policy.

Australia's public health system is pretty decent, but the half baked private system bolted on the side is a mess. Lots of people paying thousands for unusable insurance which is just sent directly to private companies.

Why do you prefer the company choosing insurance and paying x% over them paying 0%? Didn't you get the money they didn't pay? I mean what does it matter. Any tax reasons?

What exactly do you do there?

From what I understand, order picking there must be god awful, but being the receiving clerk might not be so bad. Being on-site IT might not be so bad. Certainly being the Director of Operations for that warehouse wouldn't be bad... at least I wouldn't think.

What happens when those people stop working for Amazon?

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