I despise high deductible health insurance plans

[boston bean]

They are a deterrent built into the plan to make people ration their own healthcare.

I hate health insurance companies.

[kenny blankenship]

1. You are a decent person

with the ability to see that 2 plus 2 do not make 5, and to say so. And you will never fit in, for that reason.

[Jackpine Radical]

3. As a charter member of the Square Peg Society, I concur with the OP.

Those who can only afford the Bronze Plan will be prevented from using it in many cases by the high deductibles and copays. We need a single-payer system that provides health care, not health "insurance." Deductibles are something you should maybe pay on the coverage for your new Lexus, not for health care for your child.

[boston bean]

8. They haven't really increased access to healthcare if they make it to expensive to use.

This is a huge problem. So people pay a high premium, and still can't access healthcare because they can't afford more than the premium.

It will start to piss people off.

I see more corporations moving toward this model as well. Using the ACA as the gold standard of health insurance.

I'm not saying I hate the ACA, but there are some serious problems, that I wish would be addressed.

[Jackpine Radical]

24. It was part of the Devil's Bargain Obama made with the insurance companies

to keep Harry & Louise off his ass when he was trying to get some kind of a plan through.

The insurance cos. well understand the effectiveness of high deductibles as barriers to the use of benefits. The ultimate cynicism manifests in the fact that the highest deductibles and copays are targeted precisely at those who are least able to afford them.

There, Dammit. I said it.

[boston bean]

28. my post below, was to you...I responded in the wrong place..

[boston bean]

27. The question that comes to mind

is how is this better than the shit policies they were allowed to offer prior.

Before, High deductible, but lower premium. Now, high deductible, higher premium (if you don't qualify for subsidies).

There are some good things, like caps, 26 stay on your parents insurance, pre existing conditions. But as far as truly increasing access to healthcare for everyone, I don't see it.

The only solution as I see it, is a single payer system.

[Jackpine Radical]

93. To (slightly mis-)quote a certain notorious politician,

There's not a dime's worth of difference between us.

[Eleanors38]

94. Those high-deduct policies: I called them BA-60 plans...

Better than nothing if you hit the Bridge Abutment doing 60.

[SlimJimmy]

105. This is what happened when I compared my wife's current plan 80/20 up to

$2,700 then 100% to what was available on the exchanges. The closest plan is twice as much and has a $6,000 deductible BEFORE they pay anything, and then it's only 90%. Since we make more than the minimum for a subsidy, that won't help. So, tell me, how the hell is that a better deal for her? Her insurance is scheduled to be canceled once the employer mandate extension expires. To say that I am completely pissed off is an understatement.

I know the latest meme is that these are all *junk* plans, but I have to tell you. When she was hospitalized last year after an auto accident, the bill came to over $350,000. Since we had already met our deductible, the cost to us was zero - that's right ... zero. If that's a junk policy, then I wish junk on everyone. So please DU and MSM, stop describing all these plans that way, it just isn't accurate and is extremely misleading.

The President must find a way to allow folks that have decent policies to keep them. Even if they don't cover everything that the ACA calls for.

[Yo_Mama]

21. Some Silver plans have very high deductibles too, which makes the insurance worthless

unless you get the cost-sharing subsidy.

People don't get it, because no one is looking at the real situation of those who don't get insurance through their employer or a government plan.

[Matariki]

61. Very well said.

[treestar]

2. Me too.

I have one. So far everything that I've had to have is out of pocket. I never come near the deductible. If I did, I'd be really sick. Plus have to pay 20% of the amount over the deductible. For years I thought I was at least insured but over 50 and started to have little issues here and there - it's a lot of money and I'd still owe a whole lot.

One thing is all the cancer testing. I spent over 1500 last year determining I did not have cancer. And this was from no symptoms. I get the idea of prevention, but it too costs a lot!

In fact I have had no substantive treatment of any condition so far. Just annual screening.

[Matariki]

64. I'm in a situation where I need screening I can't afford right now

It scares the shit out of me. My job ended a few months ago and I couldn't afford the rediculously high COBRA payments so I got a short term policy. The deductible isn't even that bad but right now I can't really afford anything extra - like blood tests and so forth. It pisses me off - whose stupid idea was it to tie health care directly to employment?

[treestar]

66. That is the dumbest thing ever

And these right wingers crack me up acting like they are equal partners to a contract with an insurance company - their employer chose it for them. Wonder how they come to be so "satisfied" with it.

If you live in a blue or bluish state, they might have a program for screening for people who can't afford it. There's a "screening for life" that covers the pap smears, mammograms and colonoscopies for people who can't afford them. Though what happens if they find cancer and you can't afford the treatment who knows.

[Fumesucker]

71. Long story short

It came about during WWII, a time of intense competition for scarce workers and frozen/controlled wages/prices.

[Matariki]

87. Interesting. Do you know what folks did before that?

Paid cash? Doctors were cheaper?

[Jackpine Radical]

92. Yes, that's exactly right in terms of the history of it all.

[Igel]

4. Yes.

Anything in limited quantities needs to be rationed somehow. Otherwise there's not enough for those who are deemed--by a variety of people--to need it.

Charging money for food leads to food self-rationing.

Charging money for gasoline and energy leads to self-rationing.

Charging money for property--rent, house prices, property taxes--leads to self-rationing.

If all food were free, if energy were free, if 30k sq foot houses were free, you'd find a shortage of all of those.

That's one of the dirty secrets. In Mass., there was supply-side rationing. You'd have weeks to wait before an appt. because there weren't enough doctors. Solution? Doctors were in demand, pay went up, they moved there from other places. Same in general for doctor supply in the US--they move here from other places. This leads to more rationing in those "other places"--and we have no problem with that sort of brain drain.

In other places the decision was made to limit doctor incomes. The result is state-level rationing.

Large demand, small supply --> rationing. Just a question of how to implement it.

[leftstreet]

6. Then why isn't there a shortage of aircraft carriers?

They're basically 'free' (paid for by us) to the military contractors

[boston bean]

10. I'm not understanding what that poster wrote?

You seem to get it, can you explain it to me?

[leftstreet]

18. Er...starving people are good for profits?

If the primary motivation for growing, manufacturing, distributing food is meeting human needs, you match amounts to needs

On the other hand, if the primary motivation for growing, manufacturing, distributing food is making profits...

something along those lines

[hfojvt]

16. hard to think of a real example

since generally nothing is free in America.

But consider Black Friday at Wal-mart, where they offer special low prices on some items. Those items are not free, just priced lower than normal. And what happens? They run out of those items in the first two or three hours.

With health care though, we sort of have other options. We can, in theory, increase the supply of both a) medical knowledge and b) health professionals.

[leftstreet]

20. They run out because they understock

I think people get hung up on the word 'free'

Any social program subsidized by tax dollars is low and/or no cost

[hfojvt]

33. not to the taxpayers it is not

the question then becomes, how much MORE am I willing to pay in taxes in order to provide other people with free stuff?

But I think Ruskin had the answer, which he describes in the preface to "Unto This Last" and it was something I had suggested too - a dual economy.

Dual, dividing between needs and wants. Fresh water, for example, is a need. Mt. Dew, for some, is a want. Water is already often supplied for free, in many locations where there are bubblers to drink out of.

Basic necessities would sort of be provided for free.

Sort of, because there would be a basic work obligation as well. This stuff does not grow on trees. And even if it did, somebody would still need to go pick it.

But there would never be homelessness because you could always get basic shelter by fulfilling a basic work obligation - and those basic work obligation jobs would always be available.

There would also never be hunger, because basic food would always be available. As would basic medical care.

But that's a pipe dream, and we are not headed in that direction.

[JVS]

73. Berlin apartment shortage.

The east Germans subsidized low cost apartments. Berlin was always in short supply of housing despite the fact that the government was building huge apartment blocks constantly. After reunification not only did the shortage instantly disappear, but hundreds of thousands have moved to the city while rent prices remain lower than all the other major German metropolitan areas which is indicative of plentiful housing.

The shortage instantly dried up once people weren't given extra low rents.

[PlanetaryOrbit]

50. Huh? That doesn't even make sense.

That was a very confusing comment.

[yawnmaster]

97. The demand is low. eom

[Sirveri]

99. Because otherwise the Newport News Shipyard goes out of business.

I'm not even joking, they are the only US shipyard that can make and refit/refuel our aircraft carriers, and without the construction contracts they will face massive layoffs. Hence we get pork projects to keep their business afloat. That's also the story behind the Virginia class submarines. We make them in half's, Electric Boat up in New Hampshire makes one half, Newport News makes the other half, and they sail one end to the other and weld them together, then they switch and make the other end (even though it would be WAY cheaper to make the same half repeatedly, or to just make the entire boat and alternate boats).

I don't know if I have a serious problem with massive layoffs from defense contractors, but I'd like to have jobs for those skilled workers to transition into rather than see them hit the unemployment lines and have their houses foreclosed on and end up working at McDonalds 20 hours a week for minimum wage.

[Matariki]

65. Right, because if not for rationing everyone would be having recreational heart surgery

[laundry_queen]

106. LOL, i was going to use colonoscopy as an example. But yeah, what you said. :)

Market principles, I have learned, only work in a vacuum.

[adirondacker]

5. I worked as a medical claim dissapprover for 2 years in my youth. I got to catch a glimpse of how

the private industry worked to gain profit from the Government and Union labor. Corruption to the core.

[TBF]

7. We need single payer -

it's the best answer.

[Lex]

9. Health insurance companies make profits off sick people

and people trying to take care of their health. It's an abomination.

[hfojvt]

11. actually they are a way to reduce costs

When I borrowed money to buy a car, the lender required me to get full coverage insurance. I lowered the cost of that by raising the deductibles for comprehensive and collision up to $500.

I recently got high-deductible health insurance from work, saving $456 a year in insurance premium costs.

Especially for a young person, it is nice to have a high deductible policy.

The insurance is there, then, to cover most of the cost of a catastrophe. So you are protected if something big happens. Like a pregnancy, or a car accident, or a serious illness such as cancer or MS or Parkinson's.

But at the same time, you are not paying that extra money to cover little stuff.

Look at my own life. From the time I was dropped off my parent's policy at age 22 (and also lost whatever benefits I was getting at the University when I graduated at age 23). From then, until I was 42 I had no health insurance.

But for those 19 years, I also had very little medical expenses. Maybe $2,000 - at most, and some of those were sorta routine check-ups which would have been covered (by law now) with a high-deductible policy.

But say I saved an average of $300 a year by having a high deductible policy. I thereby saved $5,700 in insurance expenses. I am at least $3,500 ahead by having a high deductible policy.

[boston bean]

13. I see it just the opposite.

People who don't seek care when they should are create additional expenses.

Decreasing access to healthcare by making it to expensive to access, is criminal imho. Actually the thought of it make me want to puke.

[Ms. Toad]

32. hfojvt did not avoid seeking care when s/he should.

Neither did I when I used a high deductible plan.

It was a very deliberate, informed choice.

I had two options - better coverage at a cost of ~$16,000 - $20,000 a year (with some out of pocket expenses I didn't explore the policy enough to be able to repeat), or catastrophic coverage at a cost of $200/year which would exclude coverage for pre-existing conditions.

I had a pre-existing condition which resulted in every risk-based policy I looked at refusing coverage. At the time we believed was not likely to repeat itself, and I was otherwise was very healthy and taking no medications.

If the condition did manifest itself again, I could enroll in the costly policy as long as I was not hospitalized at the time of enrollment.

So I could choose to pay $16,000 - $20,000 a year, every year, and receive a couple hundred dollars of benefits - or I could spend a couple hundred dollars on catastrophic coverage, and a couple hundred dollars on care (up to $5000 - which I think was the out of pocket maximum for all but pre-existing conditions) , and save the larger (insurance) expense until the time I actually needed it.

I had regular doctor's appointments during that period, and saw the doctor whenever my health indicated I needed to see a doctor. It was a very good decision for me - and would have been even if a catastrophe had struck the two options would have been no more than $5000 - or the price of the insurance if the catastrophe was a recurrence of the pre-existing condition which prevented me from obtaining reasonably priced insurance in the first place.

So while I strongly prefer single payer - as long as we are stuck with an insurance based program, high deductible options should be available for those who choose them, because they can be part of a well thought out plan to minimize health care expenses without sacrificing care.

Our current health situation is such that we will hit any out of pocket maximum a plan has every year - so it would not be a good option for us at the moment. But if our regular expenses were low, I would buy a high deductible, high out of pocket plan and use the difference in premiums to fund an HSA to make sure the money is available (at a tax advantage) to cover the out of pocket expenses for the medical care which is necessary. My former employer found it so much cheaper to purchase high deductible/high out of pocket cap insurance, that it was able to fully reimburse all of our out of pocket expenses more cheaply than it could purchase a low deductible/low out of pocket maximum plan. My current options are flipped - because of the delay in the merged medical/prescription cap - but the following year it will be cheaper for me to have a high deductible/high out of pocket and pay the maximum than to buy up to a low deductible/low out of pocket.

Those plans also get people into the insurance pool who would otherwise not be there (and reduce overall losses by institutions who might otherwise have to pick up the remainder of the bill for uncovered people. And they also cover regular preventative care visits.

Insurance will never be the ideal solution, but as long as it is part of providing access to health care, high deductible/high out of pocket maximums have a role to play as a responsible option for people who can afford plans with more complete coverage - but whose regular expenses are low. And choosing that kind of plan - as hfojvt and I both did, for different reasons, doesn't mean we are not seeking care when it is appropriate to seek care.

[boston bean]

37. People will purchase what they can afford, hope for the best

And pray nothing happens that they can't afford. And will decide not to see a doctor based on costs not need.

Does this mean that some people can't manage a high deductible plan. And that it might be a good option for a young healthy person? No. You had enough money to manage the risks you were taking based on the plans available to you at the time.

Glad the pre existing barrier is gone, but other problems still persist.

[Ms. Toad]

38. I'm not saying they don't -

Just that high deductible plans are not inherently evil. They should be a responsible choice - not just what is affordable. Although having a high deductible plan which covers (typically) three preventative care visits without charge is still better than what any low income person with pre-existing conditions could afford before the ACA.

But anyone who is stuck with a high deductible plan because it is all they can afford should be aware that if they are eligible for subsidies, those subsidies also reduce out of pocket costs.

[boston bean]

41. That is your opinion. Insurance companies offer them for the reasons state.

People who find themselves paying a higher premium with high deductibles won't find themselves in a better position than they were before. The only difference will be that they the patient will deny themselves healthcare not the ins co.

Are there some good things about the ACA, yes.

[Nye Bevan]

12. They can work very well for people in good health.

What you save in premium you can put in an HSA, which is tax-deductible, so instead of all the money going to the insurance company each month a lot of it stays with you. The HSA money rolls from year to year, so you can build up a big cushion against illnesses or accidents (and you can also use the money for eyeglasses, orthodontics, etc.) I agree that they are not so good for people with chronic or expensive conditions; these folks are better off with traditional plans.

[boston bean]

14. I would like to see proof of this HSA rollover year after year.

As far as I know only $500 can be rolled over. If you have more than that left, it goes bub bye...

[Nye Bevan]

17. No, you're thinking of a "Flexible Spending Account" which is something different.

http://en.wikipedia.org/wiki/Flexible_spending_account

A FSA does indeed have the "use it or lose it" clause. Until very recently you lost everything left in the account at year-end, but this has been changed to allow you to roll over up to $500. I have had one of these in the past, and a lot of times had to spend down the money in a hurry at the end of December on stuff like eyeglasses.

A Health Savings Account, on the other hand, is entirely different (except that the contributions are still tax-deductible). There is no "use it or lose it"; if you end up never needing the funds for medical expenses you can use them for your retirement (once you turn 65, the account effectively becomes the same as a Traditional IRA).

http://en.wikipedia.org/wiki/Health_savings_account

[boston bean]

19. well, maybe it's just the company i work for

that does this. They said due to the ACA you could now roll over $500 whereas before you could roll over nothing. I'm not confusing it with the FSA. or maybe i am. thanks for the info.

[Nye Bevan]

25. Your company gave you bad information. The $500 rollover is not in the ACA;

it was announced only recently.

http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/FSA-Lose-It-Rule-Modified.aspx

Of course, this is not the first time that someone has incorrectly attributed something to the ACA.

[Lars39]

30. Employers' choice as to whether they let

employees roll that $500 to the next year.

[Ms. Toad]

36. That is NOT an HSA.

More likely an FSA. In an HSA, the money remains in your account until you spend it for eligible medical expenses.

I currently have an FSA - we can use ours for eligible expenses through March 15 of the following year. (Another option, at the employer's choice.)

[ay.ayron]

112. Interesting how this topic is still so relevant with Trump favoring HSAs

Definitely right. It's completely different.
Seeing as there seems to be some confusion, here's a clearer explanation of health savings accounts.

[Ms. Toad]

34. Here:

Q. Does the money I have in my HSA roll over from year to year or do I lose the money at the end of the year?
A. Your HSA balance will roll over from year to year. You don’t lose the money left in your HSA, or the interest it’s earned, at the end over the year like some other health accounts. It’s your money.

http://www.healthequity.com/en/HealthAccounts/HSA/HSAFAQ.aspx

What are the benefits of an HSA?
You may enjoy several benefits from having an HSA.
You can claim a tax deduction for contributions you, or someone other than your employer, make to your HSA even if you do not itemize your deductions on Form 1040.
Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income.
The contributions remain in your account from year to year until you use them.
The interest or other earnings on the assets in the account are tax free.
Distributions may be tax free if you pay qualified medical expenses. See Qualified medical expenses , later.
An HSA is “portable” so it stays with you if you change employers or leave the work force.

http://www.irs.gov/pub/irs-pdf/p969.pdf

If you lose the money in the account, it is NOT an HSA.

[boston bean]

42. See post 19.

[Ms. Toad]

43. Your company cannot change the law regarding HSA accounts

If it is an HSA account, you are entitled to keep the entire amount from year to year. HSAs are tax favored plans which have to comply with the applicable IRS regulations.

You likely have a different tax favored account - likely an FSA, which is forfeited at the end of the year, unless your employer chooses an IRS reg allowed means of permitting you to keep it.

[boston bean]

67. Did you read my post!

Your response doesn't make sense f you did.

[Ms. Toad]

69. I read it earlier -

when you were assuring us that you were not confusing the two. I recognized it as the one you were pointing me to, and didn't notice you have modified it.

[boston bean]

75. I modified it well before you responded to me, but that is neither here nor there.

I understand.

[shadowrider]

15. One of the things I shake my head at

is people who are AMAZED at how low their PREMIUM is (with a subsidy - which they don't get until they do their taxes, and then, it's only a tax credit) otherwise, without the subsidy, they wouldn't be able to afford it.

My head shaking comes in when these same people don't realize, haven't looked, or simply don't care, that that low premium comes with a $6350 deductible. If they can't afford the premium, they're sh*t out of luck when they go in for care and are told, "How do you plan to pay your deductible BEFORE we treat?".

The shock, for many, will come when they actually go in for care.

[Yo_Mama]

22. Yes, and that's when the trouble starts

because many families will not have the money to get the care, which makes them effectively uninsured for early treatment of remediable conditions.

Diabetics won't be able to access the routine care we now normally provide. Heart patients or those with suspected cancer won't be able to pay for the diagnostic tests. Some won't be able to get treatment if they do get diagnosed.

This is a heartbreaking situation.

[boston bean]

23. and if they are spending 3-500/month on insurance premiums.

They gonna get pretty pissed off..

[NoOneMan]

26. I despise all deductibles and copays

Its all about self rationing. Why these things are legal blows my mind

[boston bean]

29. instead of the ins company denying a claim, people will deny care for themselves.

[JNinWB]

31. Deductibles and annual out-of-pocket are two different things.

Each person has access to an annual well-care visit and a long-list of associated tests at no cost. Many chronic conditions can be diagnosed and addressed during this consultation. Medications and treatment plans can be prescribed. Depending on the plan selected, future doctor visits and Rx drugs may only require co-pays.

Individuals selecting plans with $2000 deductibles have to pay this full amount before additional visits (after the annual well-care), or Rxs, are available with co-pays. If you are diagnosed with a serious condition, paying the deductible for further appointments and medications may be an important "investment" in your over-all health.

In the future, as the functioning of the ACA becomes more fully understood, HSAs as mentioned above will become far more appealing. Or, perhaps lower income individuals will have to reserve a credit card for health care deductibles and annual out of pocket expenses. CC companies may offer cards specifically for health-related charges.

Anyone, who is not entitled to a exchange subsidy, should probably seek help selecting a plan from an Ins broker. We use a broker for our employer small group---her job was to help us understand how the various plans work in the contest of individual health care usage.

I fully support Single-Payer but that's not what we are dealing with.

[historylovr]

35. K & R

They should have been lined up and staked through their miserly hearts instead of being locked in as the gateway to health care.

[ErikJ]

39. Vermont 2017 is hope

They will put a public option into Obamacare and then watch the other states adopt it.

[Matariki]

90. +1

I really really hope that works out superlatively and serves as a shining example!!!

[brewens]

40. I've been saying things eventually have to shake out so that people get health care for

what they can afford to pay. As a blood center employee, I know I want to keep working as does everyone in the medical field. Even before the ACA, it was clear something has to give. As a guy with more of a regular Joe type job in the industry, I know they can't get someone to do what I do for a whole lot less. I drive the bus and work at blood drives. As long as people need transfusions, I keep working. I just hope they keep getting those transfusions.

So who gets cut back? I'd say it has to be the health insurance people. Hopefully the good ones end up working for our national health care system when we finally get it. Maybe some of the higher paid people in the industry have to take a little hit too. I'll bet we'll still have doctors and nurses that are paid quite well even if it's not as much as they hoped getting into the field.

Almost two years ago we did a blood drive at a medical insurance company. The customer service women behind the counter in the lobby were discussing a meeting they had just attended with their CEO. All of them are no longer with the company btw. They closed that down. Those women were talking about how the big boss had explained that people were just going to have to accept the high deductible policies. None of them voiced any objections. I suspect they still had good coverage and didn't dream that would apply to them. I translated what their CEO told them as,"I need more money so we can't actually afford to pay out for anything anymore."

I'll eventually run into one of those women. I'd suspect she will blame "Obamacare" on her job loss but maybe not. But WTF did they THINK was gonna happen? Where did big medical insurance companies come from in the first place? I'm pretty sure the labor movement forced that. The last thing big corporations wanted to do was give all their workers health care. The workers organized and made them want to! So then people like these women, who all sound pretty conservative to me, go along with beating down workers everywhere for thirty years or so by voting Republican. I've been around that place for that long and know two of them had worked there that long too. Never mind anyone else, they had their good job and benefits! Their days were numbered even without the ACA. Fewer people with good insurance every year was going to get them sooner or later.

[Major Nikon]

44. They have their place

If you are single, healthy, and just need a plan to keep you from going bankrupt in the event of a catastrophic illness or injury, a high deductible health care plan may make sense if it lowers your premiums significantly. It can also make sense for some if you have an HSA or FSA.

The problem is that predatory health care insurers often couple high deductibles with little to no catastrophic coverage which virtually insures they win no matter what happens.

[BlueStreak]

48. PLUS heavy co-pays

I serious question the proposition that most people with HD policies can actually pay in the event of a catastrophic illness. Let's say a person gets a brain tumor that includes a stroke, some brain damage and a total cost of $250,000 the first year, and $120,000 every year after that. The person probably loses their job, and would rely on Social Security and Disability insurance.

If they have a $11,000 deductible plus an HSA that has $4000 in it, they are probably still $70K underwater after the first year, maybe a lot more than that. Unless they had about a half million in savings, they would be wiped out pretty quickly if they can't return to work and still have to fight the remnants of the brain tumor.

These HD policies only work if you are very well off or fortunate enough to not get an expensive illness. The idea that it covers a catastrophe is just plain bullshit. None of them cover that very well. Anybody who believes they are covered probably has not read their policy.

[Nye Bevan]

52. No, it's impossible to be anything like "$70k underwater", whatever the policy.

The highest out-of-pocket maximum allowed under the ACA is $6350 for an individual. Once you have spent this, on deductibles and copays, you do not have to pay anything else. So even if you run up a million bucks in medical bills, the most you can be "underwater" is $6350 plus whatever you paid in premiums.

http://www.uhc.com/united_for_reform_resource_center/health_reform_provisions/essential_health_benefits.htm

(The only caveat is that I am assuming that the patient stays in-network).

[BlueStreak]

54. The thread is talking about high-deductible non-ACA policies, not ACA policies

And those often have no limits whatsoever on out-of-pocket costs. The deductible is often just the point when you stop paying 100% and start paying 30% or 40%..

[Nye Bevan]

56. Well, those are genuinely crappy plans which quite rightly have been banned under the ACA.

There are plenty of people for whom a high-deductible ACA-compliant plan is an appropriate choice.

[BlueStreak]

63. Possibly, but I don't think that is what the OP is talking about

But let's think this through. You can only buy an ACA HD plan if you are under 30. Unlike the earlier HD plans, they must cap total out-of-pocket, which is a good thing. But how many people under 30 have enough money sitting in the bank to pay for that total out-of-pocket, and also cover the rest of their expenses assuming they don't have a job for 6 months because of the illness?

Ideally a person should have to demonstrate they have a net worth of at least $250,000 before being allowed to buy an HD policy. And if that were the case, then why limit it to people under 30?

The under-30 thing is a purely political concession. They knew that most people under 30 can't afford real insurance, but most people under 30 don't get terribly ill. In other words, we allow them to buy what we know is inadequate coverage because we know that only 25,000 of them (or so) will actually go bankrupt because of it, and we can live with that.

[Ms. Toad]

80. You only need the out of pocket max in the bank -

You can't get dinged for $250,000 (or anything even near that) - the out of pocket caps are in the range of $6500.

For the most part, the under 30 crowd will not have any years in which they hit the out of pocket max, absent chronic illnesses. It really is pretty hard to run up medical expenses that high on a regular basis.

Ideally, you contribute the difference between your HD premium and a LD premium to an HSA. As long as you continue to have good health, you use very little of the account each year and it remains to cover the few years in which your expenses are actually high.

(Unfortunately, in our family that doesn't work - we hit the cap every year; the last two years in February, but that is the theory. In my 50s, it would still work for me - I typically have one bad year in 10. But not for the rest of my family - including my under 30 daughter)

[BlueStreak]

98. You need enough savings to live on if you lose your job or else

you will go bankrupt and not pay those medical bills. That's the whole point. Most people under 30 don't have the financial means to adsorb a major illness, and are highly likely to default.

One of the primary goals of the ACA is to get out of the situation where people default on their HC bills, causing the costs to be shoved onto the people who have good insurance. I think it is irresponsible to offer that kind of policy to anybody with less than a $250K net worth because they will default if they have a bad illness.

If they had proper insurance, they would still probably go bankrupt if they have to go without a job for a year. But the HC bills will be paid by the insurance, which is the whole point of this ACA business.

[Ms. Toad]

102. A bad illness costs $6500, not $250,000

That is the point of an out of pocket cap.

Unless you are counting all the other things which go along without being able to work for a significant period of time - all of which apply to everyone, not just those who make a responsible choice to use their premium savings to stock up an HSA so they have the money available to pay the maximum if they have a bad health year.

You don't seem to understand that once you hit roughly $6500, you don't have to pay a penny more that year - even if your bad illness costs $10 million dollars - and when the next year rolls around, if you had a bad year - and are unemployed because you are so ill you can't work - you can switch to a better plan (chances are at $0 or low cost - with $0 or low out of pocket costs).

It is ridiculous to expect people to have a net worth of $250,000 to cover a maximum bill of ~ $6500.

[Ms. Toad]

77. I have actually not seen plans without an annual cap

(other than prescription plans ).

Plans usually have a deductible AND and annual out of pocket maximum I have seen lifetime maxes - which is a different thing.

[Hoyt]

78. Medicare - no out-of-pocket cap.

[Ms. Toad]

82. The original model is not an insurance plan.

And - in support of what I said - Medicare Advantage plans (most similar to the ACA plans) are required to have out of pocket caps.

[Hoyt]

83. And that's why those who support Medicare for all, are supporting insurance companies.

And that's why those who support Medicare for all, are supporting insurance companies. A prescription for bankruptcy.

You asked the question, I gave you an answer. Then, you said Medicare is not insurance. It sure acts that way though.

[Ms. Toad]

85. There are two forms of Medicare -

One is an insurance plan (Medicare Advantage) - AND has out of pocket maximums

The other is the original Medicare - single payer - with no out of pocket caps.

Based on that, when it acts like an insurance company (Medicare Advantage) you have the benefits of caps.

(I'm not advocating that model - just noting that on this single issue, traditional Medicare-for-all would be worse than standard insurance policies.)

[Hoyt]

89. Medicare Advantage plans are offered by cigna, blue cross, and other insurance companies

I suspect I'll enroll in an Advantage plan. From what I can tell, it's cheaper than traditional Medicare with a supplement and drug plan. Of course, you have to put up with networks, drug formularies, etc. But, that really doesn't bother me.

[Ms. Toad]

91. I would not be surprised if I make that choice, as well

Because there is typically better coverage (and a stop loss) at an equivalent (and sometimes better) cost. I have a few years to make that decision.

[BlueStreak]

81. An annual cap for the INSURANCE COMPANY?

I'm getting confused with all the different situations being discussed.

I think this thread is discussing pre-ACA high-deductible policies, including those with HSA.

I have never seem one that talked about maximum "out-of-pocket" at all. Maybe there are some, but it seems to me the normal case is a DEDUCTIBLE, which is not the same thing as out-of-pocket.

Typically you pay 100% of the costs until you hit the deductible. And then you pay some non-zero percentage copay with no limits how far that can run up on you. If there is an annual limit it is more likely to be a limitation on how much the INSURANCE COMPANY will pay in a year.

That's what I have seen, but I am not an expert and I am dealing with a small sample.

[Ms. Toad]

84. Every single insurance plan I've ever had -

probably a dozen, some employer, some short term insurance, some privately purchased, had both a deductible (what you pay before insurance starts picking up anything - mine have ranged from $0 to $6000) an annual out-of-pocket maximum (mine have ranged from a few hundred dollars to $10,000), and (until recently) a lifetime cap (the total the insurance company will pay on your behalf - (typically in the $.5 million to $2.5 million range).

Most people don't pay any attention to the out of pocket maximum, because most people don't ever hit them. Since I just ran the numbers - so you have an idea of what it takes - we are billed around $65,000 a year for medical care (average from the last 20 months) - on a relatively standard 80% plan we hit the cap; on a 90% plan we don't (we miss it by around $500)

The companies I've been covered by range from standard big names, to self-insured employer plans, to relatively obscure small insurers.

[BlueStreak]

96. I have NEVER had a policy that stated a max out-of-pocket

I had one that had zero copay after deductible. In that case, you can calculate your max out-of-pocket, EXCEPT that it had an annual cap on what they would pay, so in effect there was NO CAP AT ALL on what I might have to pay.

99% of the pre-ACA individual policies (not corporate group policies which are negotiated by professionals) are set up to turn the customer into the insurance company and to greatly limit the company's risk. I don't even think you can accurately call it insurance. It is a high priced payment administration system did does pool some risks for you -- but only up to a point. Comprehensive insurance? No. Never.

I realize that is a generalization, but unless you have read the fine print in great detail and are yourself an insurance expert, I do not believe any claims that any of these pre-ACA policies are as people are describing them. I'm not saying anybody is lying. It is just that the consumer had no leverage and the insurance companies were in business to make sure they didn't take too much risk.

[Ms. Toad]

103. We have ~$65,000 a year in medical expenses.

So, yes - I have read the fine print in detail, and yes I am pretty much an expert.

I have had policies with at least a half dozen companies, as an employee, as a student, several outside the standard market in short term policies, and two individual "regular" policies. The policies included PPO, POS, and HMO. I have at least one major fight with insurance companies a year over their incompetence or refusal to live up to their contract. I have never lost a fight with an insurance company over coverage, aside from two I decided it was not worth it to fight (ironically both over the same injury - because we needed the cooperation of a doctor who refused to cooperate (and whom we fired shortly thereafter)). Those include coverage for two experimental treatments, approval of medication outside the formulary, merging of two single plans into a family plan (because the single plans they insisted were our only option would have cost us $3000 more a year - and violated their contract), approval of full coverage for anesthesiologists for emergency surgery (which are often out of network, even when you go to a hospital which is in network), and excision of a mole (which is typically rejected as cosmetic - even when the reason for the excision is to test for cancer). I have had to appeal, but I have never had to go to court to win.

I have had two insurance companies change the state-wide implementation of their policies because the way they implemented them did not comply with their contract, the most recent requiring a rewrite of their software (treating a family headed by a same gender couple the same as one headed by a mixed gender couple - rather than as two separate families).

And every single plan I have had has had an out of pocket maximum for the year. So either I am an extreme aberration - across all kinds of plans and companies. Or you are mistaken.

[Major Nikon]

53. What you describe is a problem with lack of catastrophic coverage

Per your scenario a person with no deductible would still be underwater. Good health care plans cap the out of pocket expenses one may incur in a given year.

[Nye Bevan]

55. Under the ACA, *all* plans are required to cap out-of-pocket costs,

at $6350 per person, and $12,700 per family.

[BlueStreak]

58. I don't believe the OP is talking about an ACA policy.

Under the ACA only people under 30 can buy a HD policy.

[Major Nikon]

68. Exactly

That's a great feature of ACA. One of many.

[BlueStreak]

57. Many HD policies have no hard caps on the insured

They have hard caps on the out-of-pocket FOR THE INSURANCE COMPANY. They call that the annual cap or the lifetime cap. But they usually have no limits on how much YOU could pay.

Don't confuse deductible with out-of-pocket cap. It is not usually the same thing. The deductible is usually just the point when you stop paying 100% and you start paying a lower co-pay rate, but not zero.

People who haven't been sick often believe a bunch of garbage about the coverage they think they have. But they learn real quick once the bills start flowing in.

[Nye Bevan]

62. Such lifetime and annual caps are also banned under the ACA.

If the true point of this thread is that some pre-ACA policies were really crappy, then I concur. But as far as I can tell, the OP is talking about HD policies in general (both pre-ACA and ACA-compliant).

[Ms. Toad]

88. Annual caps actually aren't banned

Which is silly, because a series of annual caps is - effectively - a lifetime cap (unless you have an infinitely long life).

[BlueStreak]

95. If they state a max out-of-pocket, they cannot apply an annual cap

I'm not positive every ACA policy states a max out-of-pocket. If you don't see max out-of-pocket, run -- don't walk -- the opposite direction. If they don't cap your max, then YOU are the insurance company and they are just a payment clerk.

[Ms. Toad]

104. ACA policies are required to have a maximum out of pocket.

Capped at $6350 for an individual, $12,700 for a family.

I haven't tracked down the language in the law recently. Early on, the law permitted annual caps on insurance expenditures but prohibited lifetime caps. It appears to have been changed in the final law - continuing to be permitted only for policies issued before 1/1/2014, and caps can still exist on non-essential functions. But - I have not gone back to the law to confirm that it was changed from earlier versions.

[BlueStreak]

109. I know I have seen policies with no out-of-pock max on the exchange

but those were probably data entry problems. I haven't seen that recently.

[Ms. Toad]

111. I haven't been on the exchange -

But it is fairly typical for what is available on an on-line insurance shopping venue to be an incomplete statement of the plan. I suspect you just didn't go far enough into the plans you were looking at.

Short term insurance currently works that way (it is the insurance marketplace I have shopped several times). You get to an initial screen with the basics, but if you poke around long enough you can find the rest of the details. Out of pocket caps are not necessarily the thing people are most interested in, so it isn't what companies with limited grab your attention space tend to put front and center.

For example on www.ehealthinsurance.com, it takes 3 screens (once you get a list of plans) to get to the annual out of pocket maximum. The first screen gives a list of available plans. If you click on Show Plan Details you get a slightly larger list of details, and on the second screen you can click "Show All Plan Details" and you get a pop up screen with more details - including, for each of the half dozen (out of 59 available to me) which I relatively randomly clicked on - an Annual Out-of-Pocket Limit ranging between $2000 and $5000.

(And, FWIW - I have searched short term marketplaces for friends several times in the last decade, and the out of pocket maximum has always been part of every plan I have looked at.)

And, I do know what the ACA requires - which is that the max out of pocket be no more than (this year - it is keyed to a value which can change over time) $6350 single/$12,700 family, which I recited in my last post.

[Major Nikon]

70. I'm not confused

What you describe is a shitty feature of shitty plans which are going away under ACA. That's why some people are getting their plans cancelled and are seeing their rates increase. The reality was they were never fully insured at all and were at risk of losing everything they have. The insurance companies rigged the game to guarantee they would never lose.

[BlueStreak]

72. I agree the ACA HD policies are better, but I still think that is crappy coverage

It is fine if a person has enough money in the bank to cover the max out-of-pocket plus 1-2 year's worth of income. But if they don't then they are probably going belly up if they get a really expensive disease.

And most people under 30 don't have such financial means. So basically we're letting them roll the dice because statistically not very many people under 30 get really expensive diseases or have really expensive accidents. It is a political compromise. It is not good coverage for most people who will be taking it, but the ACA rightly puts more emphasis on getting the older folks into good coverage.

[Major Nikon]

76. The best solution is what Vermont is trying to do

Premiums will be based on income and will come out of your paycheck like FICA. Coverage is universal.

[BlueStreak]

79. I hope they are successful

They got off to a good start, but as the rubber starts to meet the road, it is getting tougher.

If they can make this work, that is potentially a game changer down the road. The best we can say about the ACA is that it is better than the horrendous system we had before. But it still leaves the crooks mostly in charge and still has this completely absurd idea of having most people get their insurance through employer plans.

The ACA is just bad enough that every health care problem will be blamed on the ACA. A few years down the road, we'll find ourselves teetering on the edge of a HC implosion again. If the Vermont plan is working by then, that is our chance.

[Ms. Toad]

86. They are not the same thing -

but insurance plans typically have both (deductible and out of pocket max).

[questionseverything]

45. i keep asking this

when did we have a national discussion about what percentage of income is correct to pay for healthcare?

the aca costs of premiums plus out of pocket run from 25-35%

who among us has that kind of disposable income?

the cost is the problem

[BlueStreak]

46. People have been brainwashed into thinking HD policies are somehow a good thing

No. They are not a good thing. That may have become a necessary evil -- the last step before no insurance at all. But this is because out HC system has been completely out of control with a cost spiral that would eventually have bankrupted the whole nation -- yes, it would even have hurt the 01%-ers.

It makes me crazy to hear teabagger types talk like a $12,000 deductible policy is one of the great American rights -- year, as if any of them could pay off their $12,000 deductible PLUS all the co-pays that would come along in that deal with these junk policies.

But any rational discussion about this must start with the premise that we are not immortal, nor are we impervious to any accident or disease. And you can't even get that much out of the right-wingers.

But most of them also believe in protective fairies in the sky too, so good lock having any rational discussion.

[EC]

47. They're also a waste of money

since we pay for the luxury of having nothing covered.

[maindawg]

49. deductibles are bullshit

I dont know much about the new ACA laws. I do not buy health insurance because for 100 or 150 dollars a month you get nothing. And if I have a bad month and cannot pay then I have literally nothing anyway. I am self employed, and some months are ok, some are bad,no work. I am 54, no one will hire a 54 year old finisher. There are no jobs for me.I also work as a sub for the Schools. That pays 54 dollars a day. So I am poor. Below the poverty level poor. [it was not always that way] so I will be eligible for medicaid anyway now, as long as the state of Ohio accepts the ACA which it has not. Our legislature is wholly owned by the Kochs. So I learned a secret a few years ago.When you need to go to the hospital, you ask for H-cap forms, and you owe nothing.zero. Except for the 'Imaging' bill that is a scam being perpetrated by someone I dont really know who.But insurance does not pay Imaging,medicare/medicaid does not pay them either.So they are harassing me now.
If we have single payer I would sign up for that. I would pay according to my income and be pleased to be a good citizen.

[Drunken Irishman]

51. My deductible is $2,000.

But it's free insurance through my employer. I took it because I'm in my 20s and haven't been to a doctor in years. I don't need to pay for a low deductible plan.

[thesquanderer]

59. In defense of high deductible plans

About a year ago, I compared two plans from the same company...

Low $1500 deductible, $603 a month
High $6000 deductible, $376 a month

There were some differences in the plans, but for the most part, the bottom line was that the low deductible only ended up saving you money if you needed roughly between $6000 and $12000 worth of health services over the year. If you needed less than $6k in services, you came out ahead by having paid the lower deductible all year. If you needed more than $12k in services, since both plans paid essentially all your bills from that point on, you again came out ahead on the plan where you had paid the lower monthly premium. The only time the low deductible plan made sense was in that small window where you could take advantage of the lower deductible to an extent that more than made up for the higher premiums you paid.

Essentially, a plan that charges you $2700 more a year for a plan that has a $4500 lower deductible is forcing you to pay that $2700 whether you need the care or not, whereas if you get the low deductible plan, you only pay that $2700 if you need the service. The "better" plan in this case only made sense for that "gap" between the $2700 and $4500 figures, that's the only place you were getting some extra protection and coming out ahead by getting more service without having to pay for it in some way. This "gap" is, in fact, the only piece of insurance you are paying for with your higher premium, and I would say that paying $2700 for $4500 worth of extra coverage is a pretty bad deal. Or, a pretty good deal for the insurance companies.

I agree with your premise that a deductible prompts people to ration their own health care... people don't want to go to the doctor at all as long as they see the money coming out of their pocket directly as a consequence of making that choice. But that's equally true whether they have a $1000 deductible or a $10k deductible. On Jan 1, people in either plan will still avoid seeing a doctor unless they "really need" to. All the $1k plan does is, if someone is unlucky enough to unavoidably need $1000 worth of medical care, once they hit that figure, they will stop being hesitant to go that much sooner. But at the start, either plan essentially rations health care equally.

Personally, the only plans I would personally want to choose would be zero deductible or high deductible. Everything in between prompts self-rationing, and anything short of a high deductible will tend to favor the insurance company over most possible ranges of coverable expenses. It is those in betweens where the insurance company almost always come out ahead. And these are the plans most people pick. Believe me, the insurance companies know what they are doing.

[Matariki]

60. And THAT is precisely what the previously uninsured will be getting

while we all applaud the 'success' of the ACA. Personally, I think it's a double insult to have to pay for something that a person can't actually afford to use.

Blah. I want single payer healthcare system and get fucking insurance companies out of the equation altogether.

[LWolf]

74. +10,000 nt

[madville]

100. A high deductible plan costs the same as a low deductible plan

The way you pay is just different.

I would rather have the high deductible plan because there is potential to save money there. A simple example would be a $200 a month Bronze plan with a max annual out-of-pocket of $6400 compared to a $400 a month Platinum plan with a max annual out-of-pocket of $4000.

If you use them a bunch, both plans will cost the customer $8800 a year max. The deductible is basically a tool to get a lower monthly payment to the consumer. One way it benefits the consumer is if they are healthy that year with a high deductible Bronze plan they just saved $2400 in premium over a Platinum plan.

Both plans cost the same amount of money, it is just collected in different ways.

[Lydia Leftcoast]

101. Most countries don't even have deductibles and

as recently as twenty years ago, it was possible to get a no-deductible policy.

I actually went without insurance for nearly a year because I suffered an injury that was expensive but didn't quite reach the level of my $5000 deductible (and a 20% copay after that). Paying my insurance premiums was making it impossible to pay my medical bills, so I dropped the policy.

I went without until I inherited a small nest egg, and my financial advisor said that I needed to have SOME insurance to protect the money. So I got the cheapest policy I could find with a $10000 deductible and no copays after that.

Now the insurance company has said that my deductible is lowered to $4000, but the monthly premiums have risen by $175. It would actually be a great price if I could get first-dollar price.

The rationale behind deductibles--that otherwise hypochondriacs would clog up the health care system--is bogus. How many people actually enjoy getting medical attention? Some do, but it's a tiny percentage of the population.

[CFLDem]

107. Especially when the deductible is raised

to seven grand and excludes Rx coverage. You know because the company was spending too much on employees and not enough on shareholders.

Just a larger trend of companies moving towards dumping everyone onto the exchanges... which may actually be good in the long run since I think it will increase demand for single payer.

[laundry_queen]

108. I think any deductible and copay is criminal

I'm in Canada and over the last month or so I've been very sick, and so have 3 of my 4 kids. We all needed the doctor. There's no way I'd have been able to afford all of the copays and deductibles as a single parent if I was in the US with basic insurance. I'm not sure how I would've decided which kid I would take, or how I wouldn't be able to go myself (I was very sick, sicker than any of my kids) and still function and go to school and pass my classes. Normally we don't all get sick at the same time like this (at least not bad enough to need to see a doctor) and it would've been a major hardship to pay for so many doctor's appointments. I am thankful everyday that I don't have to worry about that.

I do still hate insurance companies though because I still have to deal with them for all my prescriptions as Canadians are not covered for dental, eyecare or drugs. I'm lucky to pay next to nothing in premiums through my school, but coverage for my kids is just far too expensive, their dad covers all their medical expenses thankfully. I looked into getting my own plan through a private insurance company and it was a total rip off. $100/month for 70% on SOME services (some were only 50%) plus a cap, large copay and large deductible. Plus they wouldn't cover my asthma and GERD meds because it was 'preexisting'. Fuck that, what is the point then? I sure hope I get a decent job after graduation so I have a decent plan. It gives me a (super teeny tiny) taste of the despair so many Americans must feel. Single payer for ALL (And everything!)!!!

[OwnedByCats]

110. After living a decade in a country with

single payer, I also despise insurance companies. I despise our entire system.