Comment by demondemidi | Hacker News Reader

Comment by demondemidi | Hacker News Reader

Parent Full thread

In the US there is the affordable care act from ~2013, where anyone can purchase insurance from a pooled market subsidized by the government up to a certain income (50k I think). But that is also impacted by the state you live in, as the states negotiate the contracts paid by federal dollars (I know it's effed up). So the ACA is cheaper on the west coast than it is in Alabama. Today, a "gold" policy for a single man in his 40's is about $900/month through the ACA. The cheaper "emergency" plans (aka "trash" plans) appended by Trump are still a few hundred dollars, but cover almost nothing.

I now pay $120 for me and my wife for a plan that is better than the $1000 plan through the ACA in Oregon because I'm no longer self employed.

That's almost a 10x difference.

After working for myself for 12 years, hustling consulting and contracting gigs, I'm way happier working for a company that pays well, has great benefits, and I always know I have a paycheck coming.

I have a feeling your employer is paying the difference, so basically you're paying one way or another.

Exactly this. People feel like wages have not been increasing. In reality wages have been increasing, but employers are passing most of the increase over to health insurers.

No feeling that is the reality. But corporations get steep discounts. They pay about half to a quarter of what I would pay on my own.

> I now pay $120 for me and my wife for a plan that is better than the $1000 plan through the ACA in Oregon because I'm no longer self employed.

Look at box 12 code DD on your W-2. That is the total amount you are paying for your health insurance (it’s just that your employer is paying it directly). It’s still counted in the cost of employing you though, obviously.

Assuming you have a silver or gold level plan, total cost to insure you and your wife is the same on healthcare.gov or if your employer buys it.

The only broad savings are if your employer is self insuring and their risk pool (employees and their families) are disproportionately low risk (young and single).

It is much lower than what I would pay on ACA.

I wonder if your employer sponsored plan is not ACA compliant.

Health insurance has a 2% profit margin, and premiums are tightly regulated by state insurance commissioners. So a wildly different premium indicates a change in coverage, or a change in the underlying risk pool.

For an annual out of pocket maximum of $10k to $18k and age rating factors capping age 64 premiums to 3x age 21, the minimum bronze/silver monthly premium should be somewhere in the ~$400 to $1,200 depending on age. For example, see NJ’s premiums here:

https://www.nj.gov/dobi/division_insurance/ihcseh/ihcrates20...

This is very informative. I am investigating. Thank you!

You're probably not reading this, but I didn't include what I pay out of pocket to 12d DD ... turns out it is MORE than than the most expensive ACA plan, but I have way more coverage at my job. E.g., I can go out of network, where the ACA plans do not allow that; and the deductibles are less than 1/3 of the lowest deductibles on the ACA. Thanks for that nudge.

Where did you get that 2% profit thing? I've been googling for that too and insurance profits and all I can find is that ACA only allows 20% admin costs. Non ACA plans indicate that their profit is ~15-20% of their revenue.

Search UNH/Elevance/CVS/Cigna/Humama/Molina/Centene profit margins on macrotrends.

These are all publicly listed health insurers, so all their financials are public. It is not a very profitable business, as pretty much all insurance business.

Reply on news.ycombinator.com