I am especially curious what freelancers in the NYC area are doing.
Thanks!
I had 3 options:
1. Obama Care - I qualified for a $16 subsidy...
2. Individual plan from a health care provider in state
3. Health Share plan (think Credit union for health care)
Obama care cost 2x as much as an individual plan, and almost 3x as much as a health share plan, so even after the subsidy, this was not an option.
Health share plan was very affordable, however it only worked with the health care providers on the east side of the state(I live on the west), it had a low yearly deductible, much lower then the individual High deductible HMO, however it had a 20% copay for all health services, including routine physicals and checkups.
Individual Plan from an instate health care plan costs slightly more each month, but all routine check ups, generic brand pharmaceuticals proscribe from my doctor, and any specialist (Chiropractor, Knee Doctor, etc) visits are 100% covered IF I am referred by my primary care physician.
I went with an individual plan for about $140/m and $28/m for dental coverage.
A political side note: this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play. (edit: Health Care cost, not Heath + Dental)
3. http://www.healthshareplan.org/ When I contacted them, they only paid out to UoM and Mercy Health networks, not spectrum health. Since I live in Spectrum health land, this wouldnt work well for me. however if you live in East MI, you may consider this.
I cant say much more then that because im pretty sure its what they would call a trade secret... I am only aware of it because I worked for them and was involved in supporting this from an IT perspective.
On a side note for all of you people looking for a change of pace. Health care is IMO the most fascinating place to be as far as IT is concerned, I would have never left the health care industry except that I wanted the benefit of working from home full time. When I left, I told my boss and a few other managers to let me know if a full time work from home position became available.
(I got stuck having to get a normal job because of a pre-existing condition.)
And maybe in part because you're spending that $84 now someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious.
You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it.
yes i am aware that the 26 rule is an obama care result. However, if I am nice, and I am, I pay my parents the extra cost per month to go from a spousal plan to a family plan, which is $85/m, shocker.... However if my parents had other kids younger then me that required a family plan it would have saved me money, yes. in my response to another post, i noted that this was really the only positive to Obama care that I experienced.
>And maybe in part because you're spending that $84 someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious.
I dont think it is fair that I have to pay for someone elses health care expenses. ESPECIALLY since that someone else doesnt take the time of day to shop around for the best coverage for the cost, care to look at success rates to avoid re-works, or heaven for bid, self diagnose themselves and go directly to a specialist that can result in more expensive care. If people actually had to pay for the coverage they used, they would take the time to shop around and make informed decisions, and do things like exercise and eat well, avoid smoking and recreational drugs, then people with pre-existing conditions, and low incomes wouldnt have to pay so much for their care. Its called capitalism, and the health insurance industry would look VERY different. Obama care only gets us farther from where we need to be, and makes the entire situation worse. I know I sound like a jack ass right now because some people would suffer in the short term, but if you eliminated obama care, and the health insurance industry, we would be better off in 10 years. keep medicare for the poor, old, and disabled if you want, keeping it will have very little affect as its an income tax and not a premium subsidy.
>You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it.
If the government allowed care providers to go after uninsured individuals assets and not eat the costs. AND if the government allowed back charging for care given to qualified medicare/medicaid individuals, there would be no need to increase the burden on me to help pay for everyone else who goes in for care un covered. over 75% of the uncovered costs pre-ACA are people treating the ER like their PCP anyways. If we allowed capitalism to work, those individuals who go to the ER for a cold would eventually go to a PCP and only pay $25 for the visit and $15 for the generic meds.
I'm almost 40 and never had use of my health insurance - if you are like me you can save 124$ per month !
Think of all those years I would have been able to save. Same thing for my car (never stolen, no accident), house insurance (no theft), professional liability insurance, travel insurance (no problem so far), life insurance (still alive), payment protection insurance (still employed), critical illness insurance on the mortgage (thanks god).
Don't be bitter about it. I don't regret it for a second all that money spent. I feel lucky every day if the little premium I pay prevent me to see a friend in misery. And by the time you get my age, you will have seen a lot of stuff happening around you (to me it started around age 28, shit happening somewhere is sadly too common nowadays).
ACA had good intentions, just very poor execution.
What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know.
> this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play
How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc.
EDIT: Remove something that I think was overly provacative, (even if not meant that way).
Ironically a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. This is for a couple reasons:
On the market place, a qualifying plan must meet ALL ACA requirements. This includes a capped deductible, bundled Dental, vision coverage, prenatal coverage/birth control coverage. Also, ACA plans are held to a higher standard then individual plans purchased on the open market. I have fewer options to choose from, and those fewer options all come with lower deductibles and more coverage then I need/want. This means higher monthly premiums.
>Were you pricing insurance 2 years before you need it? Many years ago (before Obama was elected), when I was pricing individual insurance the price was several times more. Insurance companies seemed uninterested in individual consumers.
I had the wonderful experience of working at Priority Health from 2011-mid 2014. I got to see ALL sorts of chaos unfold as they tried to meet all the requirements and deadlines (They did just fine, but there certainly wasn't much cushion on time). This increase in coverage was literally over night, as in 12/31/2013 Individual Plan A (The actual name...) was $84/m, on 1/1/2015 Individual Plan A was $136/m (Priority Health did grandfather in the pre-ACA prices for anyone already on the plan for 1 year, however any new members paid the new price)
>How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc
Overall ACA has negatively affected my coverage and most people I know. However to be fair, I was in the Goldilocks zone for health care coverage. Young, white, healthy athletic male, no pre-existing conditions, never smoked, and located in a relatively low health care area when compared to LA, NY, Chicago, etc. Pre-ACA my health care costs would have been as low as low could be.
I do think that coverage until age 26 is a good additional, however I wish it was through the entire year they turn 26 in, and not just until the month they turned 26, (For me June and I had to find coverage within 30 days of my birthday).
I do like the fact that it give subsidies to the individuals who cannot afford even a $84-$150 monthly premium pre ACA, however I wish that they just expanded the medicare program to give these subsidies as these people only represent about 1/3 of 1% of Americans, and in many cases a large portion of this small percentage would have been covered under medicare anyways
I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.)
I think it is stupid that my obama care plan purchased through the open market also includes Dental, Vision, Prenatal care, and Birth Control coverage. I think its a smart marketing move to bundle these together into one plan for certain females, however it is not possible to unbundle this. And yes that means all you males out there, and all you women after menopause have prenatal and birth control coverage...
I think its stupid that as a male i am REQUIRED to purchase prenatal care and birth control coverage for myself even though i will NEVER use this. why do i have to purchase this? All US Citizens are required to purchase a plan that meets the affordable care acts requirements, it does not mean i must purchase a plan on the open exchange, but yes that mean individual buyers must purchase coverage they will not use in an attempt to make health care for everyone good. If I dont purchase prenatal care, I will qualify for the penalty at tax season.
Those young women who made the decision to have sex not knowing if the individual they "Tangoed" with would help with any costs or work will soon learn that it was a poor decision. Sheltering the consequences of ones actions is not an affective way to direct behavior for the masses. That young girls friends will see that it was hell, and their parents will learn it was an expensive decision, and then those other girls and their parents will do a better job being responsible citizen. I shouldnt have to pay for coverage that is ultimately needed because of poor parenting.
And yes, with any statistical examination there will be a small percentage of people that statistics work against, IE. the less the 1% of pregnancies due to rape.
Also, if a female can go from no prenatal care to prenatal care then there going to swap from one to the other when they decide to have kids which would distort the market. In the end it's the same reason you can't get insurance with and without support for specific diseases.
If you are a single guy with no kids, do you also complain about property taxes funding public schools? After all you have no kids, you are paying for something you don't use. If you go single or DINK, then it is something you will never use.
Really, this is why I think single payer or just full-on nationalized health would work better in the end. Insurance is just another tax now, and there is no point to put private companies in the middle of it.
How about diabetes or mental health care, should you be allowed to opt out of that coverage it you're sure™ it's not going to happen to you? Can women opt out of most everything to do with the prostate?
On top of all of this, as another commenter explained, the marginal cost of prenatal/pregnancy/postnatal coverage isn't even all that high. The cost of managing the opt-out would probably destroy any savings you were hoping to realize.
I have never used my health insurance for any reason in the last 15 years, I eat well, exercise, get plenty of sleep, etc. - so the whole situation makes me mad every time I see the bill.
The problem is that insurers try to deny claims based on a patient having a pre-existing condition that they weren't paying for.
This would have been a much better overall option vs entire ACA mess. Is the issue access to health insurance or access to health care service? I feel like the two got mixed together quite often (not sure how much was actual intentional deception vs truly not grokking the difference) but... insurance is not the same as care, and moving towards universal health care vs universal health insurance... I don't know when we'll ever get to the former. :/
Doesn't the ACA require all insurance plans to meet its standards? If there wasn't that requirement, why would insurance companies offer ACA-compliant plans?
> I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums.
That isn't really subsidy, it is almost the definition and purpose of insurance. The total cost of medical care is the same, but we spread the risk (and therefore the cost) evenly over everyone in the insurance pool. Or another way of looking at it is we all subsidize each other; you are subsidized too, for your own unique risks and costs.
That way, when something bad happens and your costs spike, you will receive the medical care you need and won't go bankrupt. If we all simply paid for our own costs (and didn't 'subsidize' each other), we wouldn't be insured.
None of this is a judgement, just the raw math of the situation.
Here's one sample but the problem is nationwide:
"“Our enrollees generated 24 percent more claims than we thought they would when we set our 2014 rates,” said Nathan T. Johns, the chief financial officer of Arches Health Plan, which covers about one-fourth of the people who bought insurance through the federal exchange in Utah. As a result, the company said, it collected premiums of $39.7 million and had claims of $56.3 million in 2014. It has requested rate increases averaging 45 percent for 2016."
Ref: http://www.witn.com/home/headlines/-Health-Insurance-Compani...
Why is that a problem? I'm not sure why a less diverse risk pool is inherently better than a more diverse one. Certainly I want very ill people to receive medical care, and it seems as broad as possible a risk pool facillitates that.
> it turns out that many healthy people have continued to opt out and many of the new enrollees are people who couldn't get coverage elsewhere.
Don't opt-outs have to pay the fine, which funds medical care regardless (or do those funds go elsewhere)? The fines might be less than insurance payments, but I'd assume they are all profit. The opt-outs consume generate zero claims and costs from insurers.
The paragraph you quote doesn't say healthy people are opting out; it says the insurance company is claiming higher costs than they expected and wants a rate increase. Their expectations could have been wrong, or they simply might want to raise rates and are making a case for it (or their claim could be legitimate, of course); I'd guess reality is some mix of the three.
After ACA, it got a lot better. Currently we have PPO through HMSA in HI. About $650/mo for me, my wife and one kid. Kind of high ded ($1500/$3000), but drugs are covered and also with basic vision and dental.
http://www.target.com/pharmacy/generics-condition
http://www.walmart.com/cp/4-Prescriptions/1078664
(you have to click around more to get the list on Walmart)
86% of people who sign up with Obamacare received a subsidy1 from the government for low income. Without that, I don't understand how anyone could afford the rates posted there.
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1 http://www.nytimes.com/2015/03/11/us/11-7-million-americans-...
And you should also learn the generic drug names or IUPAC chemical names for the commonly prescribed antibiotics.
I'm not saying those two suggestions are in any way related, other than the possibility that doing both could save you a great deal of money, in certain situations. Otherwise, grocery stores and big-box stores with embedded pharmacies often sell generic antibiotics at prices below your drug co-pay, but you would still need a prescription, and therefore an office visit co-pay. It pays to shop around.
Based on his experiences I'd rather go directly to an insurer like Oscar.
But with the Affordable Care Act, individual plans are no longer medically underwritten, so how are those groups helpful?
The Affordable Care Act has really taken the pain out of insurance when working for yourself. Things like Freelancers Union were almost a necessity before the ACA. Now individuals can buy insurance at competitive rates and without worrying about "pre existing conditions".
Personally, I went with a plan from Oscar (http://hioscar.com). Oscar offers reimbursements for gym memberships, free unlimited access to Teladoc (http://www.teladoc.com/), and Amazon gift cards if you take enough steps per day (tracked by a free Misfit Flash).
Pre-2015, I had insurance with Freelancers Union (https://www.freelancersunion.org/). Their plans are not subsidized, but with some of them you get free, unlimited access to doctors at Freelancers Medical (https://www.freelancersmedical.org/). They have two offices, one in Downtown Brooklyn, and one in the Financial District.
I am married and have 2 kids. I got a gold plan through the marketplace for $1250 a month. I got no subsidies since I make more than is required. It's a pretty good plan but expensive.
My last job which was pre-obamacare they were deducting $450 a month every 2 weeks for just my wife and I. So nothing really changed for me.
On a sidenote my cousin is low income and she got a killer plan through obamacare for 75 a month. So now she can afford to go to the doctor and not "walk it off" :-)
> deducting $450 a month every 2 weeks
That is confusing/doesn't make sense.
Prior to ACA, we had my wife and kids on a COBRA plan out of Maryland from when we lived there (God bless Maryland for making COBRA last as long as you want, and making it last even when you leave the state) and me on a separate individual policy. Together they were about as expensive as our current plan, and they had higher deductibles/OOP max and poorer coverage.
Still grateful for the Maryland coverage, though, as I would have had to have a normal job once we moved to FL otherwise.
When you applied for insurance, did they acquire your medical history?
1. http://kff.org/health-reform/perspective/how-buying-insuranc...
2. http://blog.rmhp.org/2013/12/sticker-shock-obamacare-and-the...
Some areas of the country seem to have been better served with the passage of ACA, but much of NC seems in the dark ages. I think we've got one other company that's now serving our county this year, and they're ... 20% more expensive, IIRC.
ACA has basically made this a non-issue. Figure out how big of a deductible you can absorb, walk through your state's exchange and find something reasonable. Then (this is the most important part), raise your rate to compensate for your newly legitimate business expense.
PS I haven't noticed much effect due to ACA, except that some services that used to require a co-pay became free. It will be nice not having to worry about pre-existing conditions, too.
I am firmly in the (b) camp, and see yearly medical expenses as the deductible plus premiums. And so, I pay $1500 a month in health insurance premiums, but have a $1500 deductible and $4000 out of pocket max. Yearly cost: $22,000.
So, depending on your health and tolerance for rick, go for a high deductible cheap premium plan OR a high premium low deductible plan.
As a freelancer, premiums CAN be tax deductible (see a CPA to make sure).
If he has a healthy family who does not need coverage outside of basic physicals, then its likely he purchased this plan to only cover catastrophic events, I know I would rather purchase the $500/m with 23k deductible rather then the $1000/m 13k deductible if I only planned on using coverage in the event of a horrible catastrophe.
I started freelancing in 2012 with BCBS of MI. Being young-ish and healthy with no kids, just a spouse, I was paying something around $200/mo for a PPO with an HSA (side note: get an HSA and save - it's your best option for not being screwed as a freelancer). 3 years later and the AHA has left me at $400 a month for a HMO (downgrade), higher deductable (downgrade), but thankfully I still am allowed to use an HSA (HSA compatibility is complete bullshit, BTW).
Everything is out of pocket except some bare minimum prevention stuff. Everything trip to the doctor involves me wondering if it's really worth the money and the hassle (thanks to the HMO I can no longer see my old family doctor).
Those of you bound to say that I should shop around using the marketplace - yup, I did. This was the best deal. Insurance is dependent on geography. I'd love to see an app that told me which address would give me the most reasonable insurance. Any takers?
My suggestion - budget something like $500/mo/person. Half for insurance and half for saving in the HSA. As a freelancer you'll likely make too much money to have any of your insurance covered by the government. It's outrageously expensive, but if you have serious health problems, a $12.7k deductible is way less than potentially ten times that in hospital bills.
As an aside - I do believe the AHA did some good. I had friends in states without a non-profit insurance provider like BCBS who simply could not leave their jobs due to pre-existing conditions. That no longer happens, thankfully. However - we can do better. It's insane that I have to weigh the monetary cost of going to the doctor in my decision to go. Of course we all go for an acute illness, but I believe there are millions with minor chronic illness that are simply not getting treated because they cost of even the most common diagnostic tests is astronomical.
See https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
I had a BCBS/MI family plan through the marketplace up until last month. (Silver Multi State) It cost $1,000/month and had a $6,000 (family) deductible, after which BCBS pays 80% of all costs until you hit that out of pocket max. It also allows you to bank $6,500 a year in an HSA pre-tax, which basically covers the deductible.
[edit] Forgot to mention that this plan included medical, dental, and vision.
It's still about double what we were paying before the ACA, but it's a far cry from the $1500+ premiums some others here are paying.
It may be worth seeing if such a program exists in NYC, and if it would be worth the membership costs.
My first suggestion: Keep the health insurance through your wife if you can and if she is still working. It is hard to beat the plans sponsored by employers as they get subsidized group rates to offer to employees.
But if you absolutely need to buy your own, you have 2 options:
Option 1: Use Obamacare [0] and see your options. You can try healthsherpa.com [1] which is a unofficial wrapper on top of obamacare and you can compare the various plans.
Option 2: You go and buy health insurance directly from an insurance company without the extra layer of obamacare in between. You can use sites like ehealthinsurance [2] to get some quotes.
Option 3: Use an insurance broker. Find someone locally in your area. Sometimes brokers can get you good deals.
All options have benefits and problems. I personally hated obamacare as it was too much bureaucratic crap to deal with and now you have 2 layers to work with. The only advantage of obamacare is that if you are considered poor by obamacare standards, you can get subsidy on your premiums if you enroll through obamacare. But if you don't care about these things or are not applicable to you, then just go buy insurance directly and not even bother about obamacare.
Monthly Costs depend on a few factors:
In-network vs Out-Network: Very important factor. You can only go to certain doctors/hospitals etc that are "in-network". Some plans only allow in-network. Some plans have both but have higher premiums. Also, out of network coverage is very limited usually.
Co-Payment: This is the amount (usually $10-$30) that you will pay for every visit to a doctor. Some plans have no co-payment while most have the range as I mentioned.
Deductible: This is the amount that you will pay first for any medical expenses before your insurance company pays anything. So if you go for a plan with "high deductible", then your premiums may be lower and so on.. I will say that for a family specially with kids, I personally prefer zero deductible as it can save you more over a year since kids visit doctors frequently. But if you think you won't visit the doctors as much in a year, then go for high deductible. Again, just a choice and no right answer here.
Co-Insurance: This is the portion that you will pay after your insurance company has paid the remaining portion. For example, if your co-insurance is 30%, then the insurance company will pay the 70% for the medical expenses and you take care of the rest. Again, to get here, you will have met your deductible first.
Out of Pocket limit: This is the total amount you may pay for an entire year. Anything over this, the insurance company pays regardless. For example, lets say your deductible was $500, co-insurance 30% and out of pocket limit is $5000 for the family and you end up with a bill of 14,000 on your very first visit during a calendar year. In that case, you will pay upto the total of $5000 (including deductible+co-insurance) and insurance company will pay the remaining balance of $9000. After that, you will not pay anything for that whole year (except copays). Plans with higher out of pocket limit may have lower premiums by logic.
PCP (Primary Care Physician) required: THis may not affect cost but important factor to know. Some plans require you to choose a PCP and only use that PCP as your well, PCP. You have to let the comnpany know if you change PCP.
Specialist Referral required: Some plans require you to get referral from your PCP before you can visit a Specialist. This is critical as you cannot go to a specialist on your own in that case.
Hope this helps. Happy to give you more inputs if you need.
[0] https://www.healthcare.gov
Medical underwriting is no longer a thing industry-wide and hasn't been since the beginning of 2014. No matter where you buy your plan, they will not ask about pre-existing conditions.
It's true that the only reason why you'd actually buy through an exchange is to get the subsidies, even if you don't it's worthwhile to check. They offer a pretty comprehensive survey of the companies that offer insurance in your state and roughly how much you'll pay, and you can go to those companies separately and check into their plans they don't offer on the exchange.
Another idea is to find a local insurance broker in your area. They're free to you (the insurance companies pay them) and they'll find you a good plan that fits your needs.
It has vastly improved the health care the poor receive.
I'm not a huge fan of Obamacare, but it is all he could get past the Rebublicans at the time. He tried to push for a sensable solution, but Republicans fought it. I am waiting for anyone to propose a better solution to Obamacare, but keep bill's core requirements.
As to what how for-profit insurance companies have explioted us, while blaming Obamacare; I hope there's a special place in hell for these heathens! In the original Obamacare bill there were measures that would limit rate increases, and out of pocket fees--the Republicans got rid of all of them. I recall them saying, 'Get ride of this language/requirement and we might pass it?"
What I am trying to say is get rid of Obamacare, but replace it with something better. I haven't heard any real alternative plans proposed by the Rebublicans? I though the the Rebublican Doctor(Bobby Jindal) would have a thoughtful, pragmatic plan--yea, he has a plan, but it just sounds like basically going back to the free market system we had before? That worked so well?
The new system is the same, except now there's no pre-existing conditions and the individual is forced to buy a plan. The plans themselves are the same crappy plans with a few tweaks.
The consumer of healthcare is still completely disconnected from the price of the goods sold, completely screwing up market signals and making sure prices stay astronomically high. This is not a free market by any measure.
Granted the deductibles look high, but unless you have ongoing heath issues your generally better off using a higher deductible and putting the difference into a savings account.
PS: Don't forget the high ROI part of health insurance is simple negotiating power, the risk mitigation part is less useful.