Health insurance plans



  • I hope what someone just told me isn't true, but holy crap if it is. Also, those that are not part of the US healthcare system, please start a separate thread to talk about how bad we have.. thanks!

    First things first, I'm going to describe my current healthcare plan.

    My employer offers both PPO and High Deductible (HD) plans. I opted for the HD plan.

    My plan works as follows:
    Premium per month: $338
    Employer pays $282, I pay $56
    My deductible is $5350/yr which I'm 100% responsible for, after the deductible is met, the insurance company pays 100% of covered costs.

    Because I partake in a HD plan, Uncle Sam allows me to use a Health Savings Account (HSA). I can contribute a max of $3350 pretax to my HSA. This is typically done through direct deposit when I'm paid, The HSA portion going into the HSA account, and the rest goes into my checking/saving/whatever account.

    **Edited for corrected numbers



  • I consider my plan pretty OK, perhaps not great, but definitely not bad.

    Now the other plan I just heard about (and also confirmed is completely possible) is as follows:

    Premium per month: unknown
    Employer pays 100% of premium
    Deductible is $8000, after which 80% of covered costs are paid.

    HSA is the same as above as federally mandated.

    This plan seemed outrageous at first, but after an offline discussion, it is this way because the employer wanted a lower premium cost.



  • @Dashrender said in Health insurance plans:

    Premium per month: unknown
    Employer pays 100% of premium
    Deductible is $8000, after which 80% of covered costs are paid.

    HSA is the same as above as federally mandated.

    With a plan like this, the insurance seems damn near pointless with the exception of major medical.



  • When considering jobs - considering the difference between these two stated insurance plans can have sever consequences against your income.



  • Your deductible is 5350? Doesn't that mean you pay everything out of pocket, essentially every year? Unless youre going in for major surgery or a couple of MRI/CT scans every year you are paying out of your pocket, plus youre also paying for insurance. Plus you put more money in an HSA?
    Youre paying 8k/year for insurance out of pocket, plus what your company is paying the insurance company.
    That seems a bit out of control/way too much. why have employer health insurance if youre paying more than your employer every month.



  • @momurda said in Health insurance plans:

    Your deductible is 5350? Doesn't that mean you pay everything out of pocket, essentially every year? Unless youre going in for major surgery or a couple of MRI/CT scans every year you are paying out of your pocket, plus youre also paying for insurance. Plus you put more money in an HSA?
    Youre paying 8k/year for insurance out of pocket, plus what your company is paying the insurance company.
    That seems a bit out of control/way too much. why have employer health insurance if youre paying more than your employer every month.

    HSAs are for depositing pre-tax money which can later be used to pay for such expenses. So it's not $5350+$3350. His deductible is still $5350, its just a big part of it ($3350) can be paid for using pre-tax money.



  • @Kris_K
    Thanks for the clarification. I never go to the doctor so I never follow the in and outs of the insurance scam.



  • @momurda said in Health insurance plans:

    @Kris_K
    Thanks for the clarification. I never go to the doctor so I never follow the in and outs of the insurance scam.

    They all look like a big scam until something major happens. Then you're happy you don't have to file for bankruptcy.



  • This post is deleted!


  • @MattSpeller said in Health insurance plans:

    @Kris_K said in Health insurance plans:

    They are a big scam considering the system you could have

    FTFY

    Surgery this year, two hospital visit follow ups, multiple trips to the clinic for checkups and additional drugs.

    ~$50 (drug costs)

    There he goes breaking the OPs rules.



  • @coliver Apologies I didn't see that



  • @MattSpeller said in Health insurance plans:

    @coliver Apologies I didn't see that

    Canadians ... always flaunting their superior stuff.



  • @BRRABill said in Health insurance plans:

    @MattSpeller said in Health insurance plans:

    @coliver Apologies I didn't see that

    Canadians ... always flaunting their superior stuff.

    I am honestly sorry for that, I failed to read all of his post. I have to tell you though that it breaks my heart and frustrates me to no end that such an otherwise intelligent and progressive country could fail to make a system to compete with our broken, leaking and creaky health care system.



  • @momurda said in Health insurance plans:

    Your deductible is 5350? Doesn't that mean you pay everything out of pocket, essentially every year? Unless youre going in for major surgery or a couple of MRI/CT scans every year you are paying out of your pocket, plus youre also paying for insurance. Plus you put more money in an HSA?
    Youre paying 8k/year for insurance out of pocket, plus what your company is paying the insurance company.
    That seems a bit out of control/way too much. why have employer health insurance if youre paying more than your employer every month.

    You have a few things misunderstood.

    Yes, my deductible is $5350, and that does I mean I have to pay for 100% of covered expenses until I reach $5350/yr. The HSA is money I put into an account Pre-tax that I can use to pay the deductible with. So the $3350 I put into HSA is used toward the $5350, leaving me to pay $2000 with post tax dollars. Assuming I'm in a 30% tax bracket, this saves me $1005 versus paying all post tax.



  • @Kris_K

    It's a bit more than that - By $600 in premiums. So more like $6K on the first plan. Still F'd if you ask me.



  • @pchiodo said in Health insurance plans:

    @Kris_K

    It's a bit more than that - By $600 in premiums. So more like $6K on the first plan. Still F'd if you ask me.

    So to those ... oh wait.. I don't want to go and break my own request 🙂



  • @pchiodo said in Health insurance plans:

    @Kris_K

    It's a bit more than that - By $600 in premiums. So more like $6K on the first plan. Still F'd if you ask me.

    Correct, my max out of pocket for covered things in a year are $5350 + $600 = $5950



  • Now, as I mentioned my company offers a PPO plan as well.

    PPO Plan:
    Premium per month: $484
    Employer pays $343, I pay $141
    Normal office visits $50 copay, Speciality Office visits $50 copay, pharmaceuticals $5-50 ea
    Deductible $600, toward non clinic visits
    After deductible pay 20% until patient has an out of pocket expense of $2850/yr

    total max out of pocket $4542

    FYI, We do not have a FLEX plan for these plan members. For those that don't know, a FLEX plan is a bit like a HSA plan (see above). It has lower maxes, typcially $2000 I think, and what you don't use by the end of the year is forfeit to the plan holder.



  • Full disclosure - one might ask - hey wait Dash, why did you pick the HD plan when the out of pocket max is higher than your PPO plan?

    A few things, I have only met my the max spend two times in the last 5 years for pre existing conditions that are now resolved, so I don't expect anything new along these lines.

    Also, my company provides another benefit. Anyone who uses the HD plan, the company pays for the remaining deductible (remember it is $5350) after the employee pays the first $2000.

    This makes my real max out of pocket $2000 + $672 = $2672
    All of which is tax deductible.



  • I can't get healthcare in the US. The Obamacare plans don't cover people in my situation. So we are stuck without any means of getting health insurance even as American citizens.



  • @scottalanmiller said in Health insurance plans:

    I can't get healthcare in the US. The Obamacare plans don't cover people in my situation. So we are stuck without any means of getting health insurance even as American citizens.

    I'm still confused about this - mostly because I don't recall the conversation we had 2+ months ago about why you can't get insurance. But we agree that health insurance for you is pretty worthless since you spend most of your time out of the country.



  • @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    I can't get healthcare in the US. The Obamacare plans don't cover people in my situation. So we are stuck without any means of getting health insurance even as American citizens.

    I'm still confused about this - mostly because I don't recall the conversation we had 2+ months ago about why you can't get insurance. But we agree that health insurance for you is pretty worthless since you spend most of your time out of the country.

    We'd LIKE to be insured, it's just that nothing that meets the qualifications of Obamacare is required to cover us. So they don't.



  • @scottalanmiller said in Health insurance plans:

    @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    I can't get healthcare in the US. The Obamacare plans don't cover people in my situation. So we are stuck without any means of getting health insurance even as American citizens.

    I'm still confused about this - mostly because I don't recall the conversation we had 2+ months ago about why you can't get insurance. But we agree that health insurance for you is pretty worthless since you spend most of your time out of the country.

    We'd LIKE to be insured, it's just that nothing that meets the qualifications of Obamacare is required to cover us. So they don't.

    I don't understand this. Are you saying that no one carries a plan in Texas that is Obamacare compliant that you can purchase? How can that be? What is disqualifying you from the plans that the citizens of Texas I assume must have so they aren't all paying fines against Obamacare today?



  • @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    I can't get healthcare in the US. The Obamacare plans don't cover people in my situation. So we are stuck without any means of getting health insurance even as American citizens.

    I'm still confused about this - mostly because I don't recall the conversation we had 2+ months ago about why you can't get insurance. But we agree that health insurance for you is pretty worthless since you spend most of your time out of the country.

    We'd LIKE to be insured, it's just that nothing that meets the qualifications of Obamacare is required to cover us. So they don't.

    I don't understand this. Are you saying that no one carries a plan in Texas that is Obamacare compliant that you can purchase? How can that be? What is disqualifying you from the plans that the citizens of Texas I assume must have so they aren't all paying fines against Obamacare today?

    I can purchase the plan, but it won't cover me. And it's US wide, not limited to Texas. It's a known gap in the Obamacare system. Travelers in our situation are caught in a missed situation where Obamacare doesn't cover us but we still get the penalty. It's not that I'm not allowed to pay for coverage, there is just not requirement for me to be covered.



  • @scottalanmiller said in Health insurance plans:

    Travelers in our situation are caught in a missed situation where Obamacare doesn't cover us but we still get the penalty. It's not that I'm not allowed to pay for coverage, there is just not requirement for me to be covered.

    I'm lost again, first you say

    but we still get the penalty

    then you say

    there is just not requirement for me to be covered.

    If there's no requirement, then how could there be a penalty?



  • @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    Travelers in our situation are caught in a missed situation where Obamacare doesn't cover us but we still get the penalty. It's not that I'm not allowed to pay for coverage, there is just not requirement for me to be covered.

    I'm lost again, first you say

    but we still get the penalty

    then you say

    there is just not requirement for me to be covered.

    If there's no requirement, then how could there be a penalty?

    Because the penalty is for not having insurance, not for being covered. I am penalized unless I pay for insurance that doesn't cover me. There is no coverage available that qualifies for not getting the penalty. There is insurance that I'm supposed to have, but no coverage. It's 100% a tax on people in my situation to pay for everyone else's healthcare and none of our own. It's creating the exact situation they claimed the law was to fix.



  • @Dashrender

    My plan works as follows:
    Premium per month: $338
    Employer pays $282, I pay $56
    My deductible is $5350/yr which I'm 100% responsible for, after the deductible is met, the insurance company pays 100% of covered costs.

    I can't understand how in USA is so expensive.

    In Spain sanity is free and cover you anything, It's not perfect, sometimes can take month a simple scanner, but It works fine.

    If you want you can pay for a private secure but you pay about 50-70€ per month no 300€ as I read.



  • Didn't realise your healthcare insurance costs that much. Damn.



  • @scottalanmiller said in Health insurance plans:

    @Dashrender said in Health insurance plans:

    @scottalanmiller said in Health insurance plans:

    Travelers in our situation are caught in a missed situation where Obamacare doesn't cover us but we still get the penalty. It's not that I'm not allowed to pay for coverage, there is just not requirement for me to be covered.

    I'm lost again, first you say

    but we still get the penalty

    then you say

    there is just not requirement for me to be covered.

    If there's no requirement, then how could there be a penalty?

    Because the penalty is for not having insurance, not for being covered. I am penalized unless I pay for insurance that doesn't cover me. There is no coverage available that qualifies for not getting the penalty. There is insurance that I'm supposed to have, but no coverage. It's 100% a tax on people in my situation to pay for everyone else's healthcare and none of our own. It's creating the exact situation they claimed the law was to fix.

    OK I'm remembering this from before now.

    And example might be - Obama care requires that your insurance provide yearly wellness at not extra cost to you. And a plan that you would consider buying doesn't include that. And a plan that does include that is worthless to you all of your international traveling days.



  • @iroal said in Health insurance plans:

    @Dashrender

    My plan works as follows:
    Premium per month: $338
    Employer pays $282, I pay $56
    My deductible is $5350/yr which I'm 100% responsible for, after the deductible is met, the insurance company pays 100% of covered costs.

    I can't understand how in USA is so expensive.

    In Spain sanity is free and cover you anything, It's not perfect, sometimes can take month a simple scanner, but It works fine.

    If you want you can pay for a private secure but you pay about 50-70€ per month no 300€ as I read.

    Right, that's because you pay taxes to pay for these services. So you are paying, just not directly to the medical institutions.


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