I haven't had health insurance since 2005.
I'm an American.
Healthcare premiums
Healthcare premiums
Would this include the $2184 I'm paying for Medicare?
I'm an American.
At 65 you'll get Medicare. Until then it sounds like you may qualify for Medicaid. Depending on the state it should cover all your needs until 65.
I'm 56 and will not make it to 65. DES already denied my claim for disability because they don't recognize my condition and say I am able to work, in large part because a doctor on their payroll who saw me for five minutes also never bothered to understand my condition. It also didn't help that the neurosurgeon who was going to (temporarily) fix my primary spinal issue threw me under the bus after I canceled the surgery due my health insurance expiring.
I was lucky enough to use AHCCCS to cover my appendectomy in 2003 when we didn't have coverage, but they told me I'd never be able to use it again.
Corporate Plan (2017) | Current Plan (2020) | |
Type | Gold, HSA PPO, | Bronze, HSA PPO, |
Individual in company policy | Individual in marketplace | |
Total Monthly Premium | $625 | $452 |
My Monthly Premium | $110 | $452 |
Yearly Deductible | $5500 | $7650 |
CoPay | $0 | $0 |
In Network CoInsurance | 20% | 20% |
Out of Network CoInsurance | 40% | 40% |
Yearly OOP Maximum In Network | $24,000 | $33,500 |
Yearly OOP Maximum Out of Network | $24,000 | No Limit |
TLDR; I think most people on corporate & individual plans, don't realize how much they will actually pay for health insurance/care. Everything is good as long as you are reasonably healthy, everything breaks loose when you have an emergency.My guess is insurance companies won't offer these plans in states where they would be on the hook for some or all of the balance billing money. I would like to check though. Would you PM me the name of your plan, I'd like to check. Totally understand if you don't want to.
Costs = premiums, deductible, copay, coinsurance, balance billing amount (Usually we can't figure out coinsurance accurately until we get an EOB let alone balance billing (unless you are lucky and live in a state that has made balance billing illegal) ). EOB = Explanation of Benefits
Here is a comparison of what I had when I was at a large corporation vs what I currently have (I don't qualify for subsidies. Health insurance companies sell the same individual plans on healthcare.gov and directly through their website. If you don't get any subsidies, it doesn't matter where you get it from)
Note: Both plans are ACA compliant Medical only plans. Difference being corporate plan is an individual plan under company's group policy and the 2020 plan is individual plan on the marketplace. Vision and Dental costs are not listed below.
Corporate Plan (2017) Current Plan (2020) Type Gold, HSA PPO, Bronze, HSA PPO, Individual in company policy Individual in marketplace Total Monthly Premium $625 $452 My Monthly Premium $110 $452 Yearly Deductible $5500 $7650 CoPay $0 $0 In Network CoInsurance 20% 20% Out of Network CoInsurance 40% 40% Yearly OOP Maximum In Network $24,000 $33,500 Yearly OOP Maximum Out of Network $24,000 No Limit
OOP Maximum = Out of Pocket Maximum i.e. once policy holder has paid the amount listed in total of deductibles, copays, coinsurance for the year, 100% of the costs are paid by the insurance company.
Balance Billing = Out of network providers have no pre-arranged agreed upon rates with insurance company. Provider bills their rate, the insurance company pays whatever they want to pay - you are on the hook for the rest of the balance. Few states have laws in place to make Balance Billing illegal.
My guess is insurance companies won't offer these plans in states where they would be on the hook for some or all of the balance billing money. I would like to check though. Would you PM me the name of your plan, I'd like to check. Totally understand if you don't want to.
I know a lot of people don't bother trying to help themselves before they seek help from others, but that is not the case with me. I have always been the one offering help rather than the one seeking it. If I ask for advice or help it's because I've already exhausted every avenue known to me.
I applied. I spoke with a disability attorney who told me I had no case because of the lack of physician recognition and my condition being too rare. I sought help with an advocacy group for my condition. I had a neurosurgeon conclude I was not able to work without spinal surgery until I had to cancel the surgery and he suddenly proclaimed me fit to work. I had a formal letter from my personal doctor which they wouldn't accept. Most doctors I spoke with had never head of it, including the quack they assigned to assess me, and I can't afford to see another, independent doctor.
Do you really believe I lack perseverance when I've been able to write, format, create art for, and publish six books even though the simple act of sitting uptight is extremely painful and exhausting for me? See my profile image? I was on my knees in front of our library because I couldn't stand unaided long enough to have the photo taken. That's why it looks like I'm in pain.
I assume the question is actually for what self-employed authors are paying? That's not me but...
Currently mine is covered by an employer.
But if it wasn't, because I'm a single guy who is extremely healthy with no medical issues and so therefore shoulders a disproportionate share of the cost of those who actually use healthcare, under the ACA an 80/20 co-pay with a $5000 annual deductible would cost me $1100 per month?! So... I'd be $18200 in the hole in one year to get 80% of costs covered. The fork?!?!
The ACA is a redistribution of costs that subverts the actuarial model insurance is based on, not an actual cost reduction.
Were I to go self-employed I'd join one of the Christian cost-sharing programs like Medi-Share because conventional insurance has been destroyed in the US except for those in the high risk pool.
Not knocking your efforts, and I'm sorry that you are in such pain. Disability is harder to get than Medicaid--although, depending on your state, not so.
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.
I assume the question is actually for what self-employed authors are paying? That's not me but...
Currently mine is covered by an employer.
But if it wasn't, because I'm a single guy who is extremely healthy with no medical issues and so therefore shoulders a disproportionate share of the cost of those who actually use healthcare, under the ACA an 80/20 co-pay with a $5000 annual deductible would cost me $1100 per month?! So... I'd be $18200 in the hole in one year to get 80% of costs covered. The fork?!?!
The ACA is a redistribution of costs that subverts the actuarial model insurance is based on, not an actual cost reduction.
Were I to go self-employed I'd join one of the Christian cost-sharing programs like Medi-Share because conventional insurance has been destroyed in the US except for those in the high risk pool.
The Slack self-published writing group I'm a part of talks a lot about health care, and I think the cost you're talking about would be a little high based on what they say unless you're in a state where the ACA has been horribly mismanaged (which happens, sometimes intentionally). One of them is a 29 year old healthy male in MA and he pays something like 600 a month. ...
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.
Health care is not a mess in the US. It's just expensive, sometimes a lot more expensive than it should be.
The ACA is a flawed system, certainly, but health care in America was a horrible mess long before it came about, and in certain states it has improved things.
Health care is not a mess in the US. It's just expensive, sometimes a lot more expensive than it should be.
Well, I mean, Americans pay far more per capita than any other developed country for far less comprehensive coverage and worse results. That's because we prioritize industry profits over the actual well being of those that use the system. That seems like a mess in my book
And now, for the counterpoint ...
And now, for the counterpoint ...
If you'd watch the Oliver video, you'd know what you posted was by no means a counterpoint. It was rightwing propaganda.
I watched it. That guy is an idiot. He doesn't even begin to engage with the actual reasons for cost reduction and relies on his dismissive, sneering attitude that resonates with right wing sheep.
One example: One of the reasons total health care costs would be projected to go down under a medicare for all type system is the decrease in paperwork and administrative bloat. There are layers upon layers of middlemen between Americans and their healthcare right now, which of course leads to substantial administrative costs. Removing these private insurance company layers will reduce overall costs, full stop. That's the reason why every other developed country spends far, far less per capita on administrative healthcare costs (like 200, as opposed to 800 per American). But instead of actually engaging with this argument he sneeringly dismisses it by claiming 'reduce paperwork? The federal government reduce paperwork? Ha!' Raw red meat to his base, ignoring the actual argument to strum those gubmint hating bones in his listener's bodies.
Pathetic.
Anyone that believes that the paperwork load will go down if the government takes over the entire healthcare system is .... well ... there's no helping you.
It doesn't have to be this way. The U.S. could actually learn something from how other countries handle medical care instead of being pigheaded.
Except the US has learned from other countries and that is why we don't want a government monopoly of our health care services.
Doctors have complained bitterly to me about the immense hassle and cost of dealing with the insurance companies. The typical medical practice has one or more employees who deal with this full time. (Look at all those people behind the glass windows. What are they doing? They aren't delivering medical care, that's for sure.) A common training course offered to people looking for part-time or work-from-home employment is to become medical coders. Those people look up the codes and apply them to any medical visit or procedure. Codes change all the time, and insurance companies commonly reject a large number of medical claims from doctors--not just from you or me.
Doctors have employees who spend all day filing and re-filing the claims and navigating their way through an immense sea of paperwork. But who pays for those extra employees--people who provide no direct patient services? You and me, with ever increasing bills, either from the doctors directly or from the insurance companies.
And let's not get started on the gouging big pharma does with meds. The profits are immense despite the costs of getting a new drug through the FDA. Yet many people die because they can't afford the meds that are priced absurdly high. Do you eat this week, or take this pill? That's what it comes down to for too many people.
It doesn't have to be this way. The U.S. could actually learn something from how other countries handle medical care instead of being pigheaded.
Sure, they might have gripes about their health care system, but they are absolutely horrified when conversation turns to how our system operates.
They are aghast, every time, at the barbarity of taking a basic human need like health and making the overriding concern the amount of profit corporations can extract.
What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.
Except the US has learned from other countries and that is why we don't want a government monopoly of our health care services.
The real problem with the US health care system is over insurance. Americans go to doctors for every little thing when they are insured for it. This causes the cost of insurance to go up.
I'm not an expert, but if the government negotiates the price, the incentive to create more products may not be there, because the profit may not be there. Not like in the current environment.What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.
I think it actually works the other way around. Broadly speaking, earning loads off of ten products reduces the incentive (urgency) to create more products. When those ten products begin earning less, there's an incentive to create more products to restore revenue/profits, despite their development costs.
Are they as angst at corporations making profit from food production? Food is an even more basic human need.
Because your life is unlikely to depend on possessing an Apple smartphone. Your life might depend on the quality of healthcare you can receive.Are they as angst at corporations making profit from food production? Food is an even more basic human need.
That was one of the things Crowder got on about in his little rant. He showed the healthcare sector brought in $100 billion in profits in 2018. Then he showed that Apple had brought in profits to equal almost 60% of that. Just one tech company brought in over half what the entire healthcare sector brought in. Where's the outrage over Apple's overpriced smartphones?
Your argument is sound, but there is one way to short-circuit that connection between research funds and profit margins--government-financed research.I'm not an expert, but if the government negotiates the price, the incentive to create more products may not be there, because the profit may not be there. Not like in the current environment.What if the US negotiated prices with the pharmaceutical companies? First, we'd get cheaper drugs. Second, globally, drug manufacturing would become less profitable. Then, R&D budgets would fall.
I think it actually works the other way around. Broadly speaking, earning loads off of ten products reduces the incentive (urgency) to create more products. When those ten products begin earning less, there's an incentive to create more products to restore revenue/profits, despite their development costs.
Any way you slice it though, it would be an interesting experiment if the US would start negotiating drug prices.