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Health Insurance Options when leaving employer

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jwhanke

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Hello all,

In Q1-Q2 in 2021 I will be quitting my W2 job. I am planning for worst-case scenarios for health insurance costs. If I keep my employer's insurance, it will be around $450.
  • Is there any cheaper options or am I better off keeping it? I have savings for high deductibles, I just want insurance for catastrophe (accident, cancer, etc.).
  • Should I expect the costs to be around $400 dollars a month or in your experience any cheaper options?
  • Any recommendations on how to find options?
I am a late 20s male with no recurring prescriptions and healthy. I also have no dependents. Any options that take account savings/net worth, I will not be eligible.

I also will be vagabonding for around 6 months in Argentina Q3-Q4 if that is a factor. My goal is to eat into my net worth as little as possible. I have some rental/dividend income from my portfolio, to cover some costs.

Thanks for taking the time to read and appreciate any suggestions. Hope it helps anyone else in the future in a similar situation!

PS I know 100% focusing on a true fastlane business before would be ideal, but I want to take the trip first. I'm on the forum and understand that's an option :) It could take 3-5 years of full-time attention. I want to cross the trip off my bucket list before. The future is uncertain and may have more responsibilities then.

(Until I started looking, I had no clue how expensive insurance would be. It's the biggest expense!).
 

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FierceRacoon

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You may be able to buy a "catastrophic" Obamacare-type plan if you are under 30, which is cheaper. There are also Christian ministry-type cost-sharing options, though they don't really promise you anything, so theoretically they may end up not paying for something like cancer Hard to say as it also happens with traditional insurance. There're also lots of unregulated ones on the Internet, off-marketplace; rumors say that they similarly don't like to pay, but like to charge you a (lower) fee while nothing happens.

My hope is that the coronavirus will be the last drop, and we will finally get "Medicare for all".
 
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jwhanke

jwhanke

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You may be able to buy a "catastrophic" Obamacare-type plan if you are under 30, which is cheaper. There are also Christian ministry-type cost-sharing options, though they don't really promise you anything, so theoretically they may end up not paying for something like cancer Hard to say as it also happens with traditional insurance. There're also lots of unregulated ones on the Internet, off-marketplace; rumors say that they similarly don't like to pay, but like to charge you a (lower) fee while nothing happens.

My hope is that the coronavirus will be the last drop, and we will finally get "Medicare for all".
I appreciate the response! I am US based; it seems the best option will be looking into Obamacare options (like the policy or not if I can take advantage of it seems like the best option). Thanks for the heads up on the options over the internet, I would rather go with a more certified company.
 

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Hello all,

In Q1-Q2 in 2021 I will be quitting my W2 job. I am planning for worst-case scenarios for health insurance costs. If I keep my employer's insurance, it will be around $450.
  • Is there any cheaper options or am I better off keeping it? I have savings for high deductibles, I just want insurance for catastrophe (accident, cancer, etc.).
  • Should I expect the costs to be around $400 dollars a month or in your experience any cheaper options?
  • Any recommendations on how to find options?
I am a late 20s male with no recurring prescriptions and healthy. I also have no dependents. Any options that take account savings/net worth, I will not be eligible.

I also will be vagabonding for around 6 months in Argentina Q3-Q4 if that is a factor. My goal is to eat into my net worth as little as possible. I have some rental/dividend income from my portfolio, to cover some costs.

Thanks for taking the time to read and appreciate any suggestions. Hope it helps anyone else in the future in a similar situation!

PS I know 100% focusing on a true fastlane business before would be ideal, but I want to take the trip first. I'm on the forum and understand that's an option :) It could take 3-5 years of full-time attention. I want to cross the trip off my bucket list before. The future is uncertain and may have more responsibilities then.

(Until I started looking, I had no clue how expensive insurance would be. It's the biggest expense!).
If you are coming to Argentina just hit me up!
 

Beerbread

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My hope is that the coronavirus will be the last drop, and we will finally get "Medicare for all".
That or cheaper prices on the exchange. Once in a blue moon, I check the exchange prices and since Covid, the one I wanted went down by $40. To have close to what I have, I would have to pay $560 a month and I'm single with no kids. I don't mind incorporating the cost in my expenses, but it's so crazy how much of a trainwreck this is.
 

wanttogofaster

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We've had the Christian Share one (mychristiancare) for over three years now.

Yes, the don't cover a few things (like annual physicals) but they just paid for my wife's prenatal check ups our daughter's birth and so far, all her well child office visits.

When we signed up, it was about $400 cheaper than the next insurance option (Kaiser), right now, it is about $300 cheaper than the next option (Aetna) for a family of three.

I would look into it if I were you. I think it less than $100 a month for singles. They do offer reimbursement options if you incur any medical expenses overseas, which should be a couple hundred in Argentina, anyway.

Happy to answer any questions.
 

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I get mine through our local Blue Cross / Blue Shield franchise. A lot of good plans there. We have company benefits that we offer to employees, but we've kept our personal BCBS plan because we like it.
 

Iwokeup

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Hello all,

In Q1-Q2 in 2021 I will be quitting my W2 job. I am planning for worst-case scenarios for health insurance costs. If I keep my employer's insurance, it will be around $450.
  • Is there any cheaper options or am I better off keeping it? I have savings for high deductibles, I just want insurance for catastrophe (accident, cancer, etc.).
  • Should I expect the costs to be around $400 dollars a month or in your experience any cheaper options?
  • Any recommendations on how to find options?
I am a late 20s male with no recurring prescriptions and healthy. I also have no dependents. Any options that take account savings/net worth, I will not be eligible.

I also will be vagabonding for around 6 months in Argentina Q3-Q4 if that is a factor. My goal is to eat into my net worth as little as possible. I have some rental/dividend income from my portfolio, to cover some costs.

Thanks for taking the time to read and appreciate any suggestions. Hope it helps anyone else in the future in a similar situation!

PS I know 100% focusing on a true fastlane business before would be ideal, but I want to take the trip first. I'm on the forum and understand that's an option :) It could take 3-5 years of full-time attention. I want to cross the trip off my bucket list before. The future is uncertain and may have more responsibilities then.

(Until I started looking, I had no clue how expensive insurance would be. It's the biggest expense!).
You should look into plans like Christian Share (as noted above by @wanttogofaster) or something "non-secular" like Sedera Medical Cost Sharing (Sedera Medical Cost Sharing - A refreshing healthcare alternative.). If you wanted to contract with a local direct primary care doctor in your home state then that would be an option. Otherwise, depending on where you're living, an arrangement can be made with a doctor (such as myself) to do Telehealth. It depends on your state, licensing, etc. Feel free to DM with questions.
 
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jwhanke

jwhanke

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@Iwokeup , @wanttogofaster , @Rabby, @Beerbread Thank you for taking the time to respond. Having a place to start looking is invaluable. Google just led to more questions.

@Iwokeup , I like the idea of finding an arrangement with a doctor. I'll be taking you up on the offer for more details closer to next year!
(Also, @Iwokeup & @Vigilante the case and point mystery is killing me).

@Lucky Lu Sorry missed your response earlier, will do! (assuming the border is open...................)

Hope everyone had a good fourth of July (even the non-Americans ;))!
 

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AAR2972

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Hi, health insurance expert here. When you say keeping health insurance through your employer is $450, do you mean that is the monthly cost while you're employed? Or is that the cost to continue coverage when you lose your job through COBRA?

In your situation, a Marketplace plan (Obamacare) or COBRA will be your best options. However COBRA coverage only lasts 18 months, so if you're looking for something permanent the Marketplace is your best option.

I have not personally looked into medi-share options, so I won't comment on that. I would forget about direct provider contracting - good luck. Also, a direct primary care arrangement will be useless when you need any form of care that goes beyond an office visit. You will have no coverage if you need significant care like an elective outpatient procedure.

Also, if you're going to be outside the U.S. for a significant period of time, why purchase domestic health insurance at all? You should be aware that most health insurance plans specifically exclude health care provided outside the United States. Instead, you should look into purchasing travel insurance. I've never looked into it, but given that healthcare is significantly cheaper in other countries, the policies are not too expensive.

This questions are usually far more complex than they need to be...so much that I make a living out of it. That's health care in the United States for ya.
 

pumpking

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Hi all,

I’m also looking to leave my employer this year (woop woop!) but instead of being an under 30 single, I’m a 40 year old family guy with a wife and two kids to see to. One of my kids suffers from OCD, the other has mild anxiety and so both need some special attention (our health insurance does a so-so job of covering this today... it’s Allways). Then of course there will always be dental and vision stuff.

@AAR2972 thanks for chiming in on this thread. Can you make a recommendation that is more appropriate to my situation? At the minimum I can continue with my employers plan under COBRA (I believe that’s an option even if you chose to end employment yourself) and it will come out around $1000 a month (I think). But after the 18 month period is up we’ll need something else (hopefully sooner considering cost).

Thanks in advance, hopefully this will be helpful to someone else too
 

AAR2972

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Hi all,

I’m also looking to leave my employer this year (woop woop!) but instead of being an under 30 single, I’m a 40 year old family guy with a wife and two kids to see to. One of my kids suffers from OCD, the other has mild anxiety and so both need some special attention (our health insurance does a so-so job of covering this today... it’s Allways). Then of course there will always be dental and vision stuff.

@AAR2972 thanks for chiming in on this thread. Can you make a recommendation that is more appropriate to my situation? At the minimum I can continue with my employers plan under COBRA (I believe that’s an option even if you chose to end employment yourself) and it will come out around $1000 a month (I think). But after the 18 month period is up we’ll need something else (hopefully sooner considering cost).

Thanks in advance, hopefully this will be helpful to someone else too
So again, I operate in the more traditional healthcare space and I'm ignorant of new alternative solutions such as medi-share plans or some system of direct provider contracting. But I would say stay away from them if you want comprehensive, reliable coverage. Especially true in your case, as a man with a family who actually uses their health coverage (as opposed to a younger guy who never sees a doctor and just needs catastrophic coverage), you'll want to avoid plans that do not provide "minimum essential coverage" (i.e. plans that do not provide the full spectrum of health services you'd expect out of a health plan like mental health, inpatient/outpatient care, Rx, etc.). Thus, this really only leaves you with two reliable options: 1) COBRA through your employer and 2) Federal/State Marketplace Coverage.

(There are also public plans available (e.g. Medicare, Medicaid, TRICARE, etc.), but I assume you and your family do not qualify for any of those? I'm also assuming that other employer-sponsored coverage is not attainable through you or your spouse?)

The choice between COBRA and Marketplace coverage is contingent on each individual's situation. Depending on your income, you may qualify for a subsidy when purchasing Marketplace coverage, which may or may not render it more affordable than COBRA coverage. But I'll say that without a subsidy, these plans are pretty expensive in my location.

You're right that COBRA must be offered to you whenever you terminate employment (and lose healthcare coverage as a result), whether the termination was voluntary or not. It typically lasts only 18 months (though it can be extended for your spouse/dependents in certain circumstances up to 29 months) because COBRA is designed to be a temporary solution until you find your next source of healthcare coverage. Therefore if you're looking for something long-term, Marketplace might be your only option in absence of you or your spouse getting coverage through another employer (or public health coverage).

Some insider nuggets of info for everyone: One thing to note about COBRA is that due to the pandemic, most (but not all ) plans/insurers are required to extend COBRA deadlines. This means that you can technically hold off on electing (paying for) COBRA until 60 days after the end of this national emergency period. So if you don't have any immediate healthcare needs, you could go months without paying premium, and then elect COBRA when you actually need the coverage (up until 60 days after the government announces the end of the national emergency). If you're a younger, healthy person who doesn't need to see a doctor or get prescriptions filled any time soon, and you just lost employer coverage, consider going bare for as long as you can. **But make sure your health plan is complying with these deadline extension regulations - not all employers are required to do so. Ask your benefits/HR staff or insurance company**

**Note there may be a COBRA subsidy coming shortly in the stimulus bill being debated by Congress right now. Since many people are losing their jobs and coverage, the feds may be providing some relief. Keep an eye on that.

Also: This is a good thing to know about COBRA regardless of the pandemic. In normal circumstances, you have 60 days to elect COBRA from the date you lose employer insurance, and then a 45 day grace period to pay the first month's premium. So you technically have 105 days that you can go bare without coverage if you're a healthy person with no short term healthcare needs; defer your COBRA election as long as possible if you find yourself terminated/resigning/retiring from employment.
 
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pumpking

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@AAR2972 WOW, thanks so much for this awesome, "above and beyond" reply. I really appreciate it and I'll be able to action on the info this coming January (My planned quitting month). I trust others who are more similar to me will find it helpful as well.
 

jaminson

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Hi, health insurance expert here. When you say keeping health insurance through your employer is $450, do you mean that is the monthly cost while you're employed? Or is that the cost to continue coverage when you lose your job through COBRA?

In your situation, a Marketplace plan (Obamacare) or COBRA will be your best options. However COBRA coverage only lasts 18 months, so if you're looking for something permanent the Marketplace is your best option.

I have not personally looked into medi-share options, so I won't comment on that. I would forget about direct provider contracting - good luck. Also, a direct primary care arrangement will be useless when you need any form of care that goes beyond an office visit. You will have no coverage if you need significant care like an elective outpatient procedure.

Also, if you're going to be outside the U.S. for a significant period of time, why purchase domestic health insurance at all? You should be aware that most health insurance plans specifically exclude health care provided outside the United States. Instead, you should look into purchasing travel insurance. I've never looked into it, but given that healthcare is significantly cheaper in other countries, the policies are not too expensive.

This questions are usually far more complex than they need to be...so much that I make a living out of it. That's health care in the United States for ya.
thank you very much for that answer
 

eliquid

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I went through a lot of this, just trying to reduce premiums and also because my situation changes sometimes and I like to be informed.

Anyways, the only options I ever was able to find ( for someone that makes money ) was:

1. Medi-share type plans ( religious or not )
2. Marketplace/Obamacare type plans
3. Private insurance ( basically catastrophic )
4. Insurance from a job
5. COBRA - If you had a job and lost it
6. Travel Insurance, Travel Health Insurance - if you travel outside the US
7. Direct provider - you pay a Dr a monthly fee, although this is hard to find
8. Medicare/Medicaid/CHIPS/Medi-CAL - You have to have some special qualifications to get into these

So if you are not traveling, didn't just lose a job, make enough to not qualify for help/assistance, and trying to go on your own, the only real options are:

1. Medi-share
2. Marketplace
3. Private plan

I would have gone Medi-share myself, but right before I elected into it my wife had a colonoscopy and we found a polyp. A large one.

That was enough to keep me on my Marketplace plan. A private catastrophic was looked into with some riders, but it was damn fishy I ended up passing on it. It was like between Medi-share and Marketplace for my specific situation.

If I was single or married with no health issues, I'd prob do Medi-share though. The private catastrophic can be good too actually, depends on plan and the riders you get.

One tip though, buy for the marketplace coverage.

Meaning, you buy into the insurance for the discount they provide, not really what they "cover".

I'll give you an example ( making some numbers up here, but this actually happened to me ):

My wife went in and did her colonoscopy. This was fully paid for as routine ( yeah! ). They found the polyp and scheduled her back again after a sample was taken to have it removed.

The lab that did the testing on the sample was not fully covered. The removal of the polyp was not fully covered. The anesthesia was not covered.

But we paid almost nothing for it all. Not because the insurance covered it, but because what the doctors charge and what they contractually get paid are 2 different prices. They might have charged us $12,000, but contractually they were only going to get paid $800 total for everything.

The insurance paid 80% of that, which left us only paying $160.

That's what's important about insurance. The discount in the network. Not what they pay/cover, although that is a huge help too.
 

MHP368

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So again, I operate in the more traditional healthcare space
Couldn't a bunch of entrepreneurs throw together and form a "group" and bargain for a health plan that way? , or would that sort of be moot (since the "employer" usually pays the lions share of the cost)

I was thinking even if you we're still looking at 500+ a month per person just having hundreds of people grouped together would make it a juicy enough sale for a decent discount from a bigger carrier then what the normal marketplace offers.
 

AAR2972

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One tip though, buy for the marketplace coverage.

Meaning, you buy into the insurance for the discount they provide, not really what they "cover".

I'll give you an example ( making some numbers up here, but this actually happened to me ):

My wife went in and did her colonoscopy. This was fully paid for as routine ( yeah! ). They found the polyp and scheduled her back again after a sample was taken to have it removed.

The lab that did the testing on the sample was not fully covered. The removal of the polyp was not fully covered. The anesthesia was not covered.

But we paid almost nothing for it all. Not because the insurance covered it, but because what the doctors charge and what they contractually get paid are 2 different prices. They might have charged us $12,000, but contractually they were only going to get paid $800 total for everything.

The insurance paid 80% of that, which left us only paying $160.

That's what's important about insurance. The discount in the network. Not what they pay/cover, although that is a huge help too.
Not to rip this, but there are some misstatements here. I'm sure you're an intelligent person so this just displays how ignorant the majority of educated people are about how healthcare operates in this country. I'm an expert and I still struggle sometimes as a healthcare consumer.

I'm not sure what you mean by "That's what's important about insurance. The discount in the network. Not what they pay/cover, although that is a huge help too." You absolutely do buy coverage for what it pays/covers because "coverage" is technically synonymous with "discounts". For example, if your plan completely excludes coverage of acupuncture, you are getting a 0% discount on the provider's billed charge for that service from your insurance plan. If your plan provides 80% coverage of acupuncture in their network, you are getting an 80% discount on the price the insurer negotiated with the in-network provider (called the "allowed charge").

So using your example, the doctors have a certain list price of some unknown amount for those services called a "billed charge". However, because you used providers (doctors) contracted with your Marketplace insurance plan's network, those doctors are only allowed to bill you a negotiated amount of $12,000 for those service (called an "allowed charge"). Your plan then provides 80% coverage of those services, meaning they apply an 80% discount of that allowed charge.

So, the combo of labs, polyp removal, and anesthesia may have a list price of (billed charge) of say $30,000 by those providers (this number can be anything the providers want because...this is how the U.S. healthcare economy works). Then the insurer negotiates an allowed charge of $12,000. Because the plan provides 80% coverage (discount) of that allowed charge, it results in total patient cost-sharing of $800 to you. However if your plan did not provide coverage of polyps/anesthesia/labs, then you could be hit with that $30,000 billed charge by the provider.

And this is why Marketplace coverage as well as COBRA coverage are the ideal options for those who actually need some degree of healthcare. As I explained in my other response, these forms of coverage provide "minimum essential coverage", meaning that they provide coverage for the full spectrum of health services you'd expect out of a health plan like mental health, inpatient/outpatient care, Rx, etc. at or above a certain actuarial value.
 

eliquid

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Not to rip this, but there are some misstatements here. I'm sure you're an intelligent person so this just displays how ignorant the majority of educated people are about how healthcare operates in this country. I'm an expert and I still struggle sometimes as a healthcare consumer.

I'm not sure what you mean by "That's what's important about insurance. The discount in the network. Not what they pay/cover, although that is a huge help too." You absolutely do buy coverage for what it pays/covers because "coverage" is technically synonymous with "discounts". For example, if your plan completely excludes coverage of acupuncture, you are getting a 0% discount on the provider's billed charge for that service from your insurance plan. If your plan provides 80% coverage of acupuncture in their network, you are getting an 80% discount on the price the insurer negotiated with the in-network provider (called the "allowed charge").

So using your example, the doctors have a certain list price of some unknown amount for those services called a "billed charge". However, because you used providers (doctors) contracted with your Marketplace insurance plan's network, those doctors are only allowed to bill you a negotiated amount of $12,000 for those service (called an "allowed charge"). Your plan then provides 80% coverage of those services, meaning they apply an 80% discount of that allowed charge.

So, the combo of labs, polyp removal, and anesthesia may have a list price of (billed charge) of say $30,000 by those providers (this number can be anything the providers want because...this is how the U.S. healthcare economy works). Then the insurer negotiates an allowed charge of $12,000. Because the plan provides 80% coverage (discount) of that allowed charge, it results in total patient cost-sharing of $800 to you. However if your plan did not provide coverage of polyps/anesthesia/labs, then you could be hit with that $30,000 billed charge by the provider.

And this is why Marketplace coverage as well as COBRA coverage are the ideal options for those who actually need some degree of healthcare. As I explained in my other response, these forms of coverage provide "minimum essential coverage", meaning that they provide coverage for the full spectrum of health services you'd expect out of a health plan like mental health, inpatient/outpatient care, Rx, etc. at or above a certain actuarial value.
You basically made my point. Not sure where you thought you were ripping me.

Doctor bills $30k, but in my example ( discount ) there is a discount since you are under X plan and the doctor is only allowed to collect say, $4k. Then the insurance pays 80% of $4k and I pay 20% of 4k.

In what I present above, I pay only $800. Why? the largest chunk was discounted, like I said above. The why in buying the insurance.

I go to same doctor and they bill $30k with no discount, I'm stuck paying $30k. Lets say some insurance "covers/pays" 80% and I pay 20%, I'm paying 20% of $30k, which is $6,000.

So yes, you buy insurance 110% for the discount, not what they pay. What they pay is basically icing on the cake as I'd rather pay 100% of a huge discount, than 20% of little or no discount depending how the math works out.

Even me paying 100% of the discount ( in my example, $30k to $4k, and me paying 100% of the $4k ) is still less than me paying the $6k example above.
 

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AAR2972

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Couldn't a bunch of entrepreneurs throw together and form a "group" and bargain for a health plan that way? , or would that sort of be moot (since the "employer" usually pays the lions share of the cost)

I was thinking even if you we're still looking at 500+ a month per person just having hundreds of people grouped together would make it a juicy enough sale for a decent discount from a bigger carrier then what the normal marketplace offers.
Yes, this is already being done if I'm understanding you correctly. Small businesses who share some type of commonality (e.g. profession, line of business, geographical location) can pool together to form an "Association Health Plan" (AHP) to get the savings of large group medical coverage rates for their employees. But if by "entrepreneurs" you mean some self-employed people to form a group health plan for other self-employed people to join, it's not clear to what extent that can be done right now.

The Trump administration attempted to expand the types of groups that could form an AHP with new a Dept. of Labor rule, including expanding the definition to allow self-employed individuals with no employees to form AHPs. The rule also removed the "commonality of interest" requirement, as well as avoid some Obamacare coverage requirements. However a federal appellate court blocked the rule from going into effect. But a bunch of states are ignoring the court ruling, so it's a mess.
 

AAR2972

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Doctor bills $30k, but in my example ( discount ) there is a discount since you are under X plan and the doctor is only allowed to collect say, $4k. Then the insurance pays 80% of $4k and I pay 20% of 4k.
Ok, when you say there is a "discount" you mean there is a negotiated price between the insurer and the doctor, called the "allowed charge" of the insurer for a given service. Aetna can contract with a doctor who bills $30k for a service and say "We are only going to reimburse you $4k for this service". Then the plan charges you 20% of the allowed charge of $4k, resulting in $800 out-of-pocket cost-sharing to you.

In what I present above, I pay only $800. Why? the largest chunk was discounted, like I said above. The why in buying the insurance.

I go to same doctor and they bill $30k with no discount, I'm stuck paying $30k. Lets say some insurance "covers/pays" 80% and I pay 20%, I'm paying 20% of $30k, which is $6,000.
This is where you are misunderstood because you don't understand how the healthcare economy works. The billed charge for the exact same hip surgery on the exact same patient can range anywhere from $15k to $70k in Dallas...the exact same procedure. Why? Because private healthcare prices set by providers are imaginary and are based on nothing in the U.S. Therefore, you don't buy health insurance based on the discounts negotiated between insurers and providers as you're suggesting. You buy healthcare based on the monthly premium / cost-sharing (80%/20%) that the insurance charges you for comprehensive health coverage. The negotiated rate between providers and insurers factors zero into your buying decision because you don't even know what the true discount is.

A doctor can charge $15k for a hip surgery, and an insurer negotiates down to $10k (a 33% discount) and covers the surgery at 80%, resulting in $2,000 charge to the patient.

or

Another doctor can charge $50k for a hip surgery, and that same insurer negotiates it down to $5k (a 90% discount), but only covers the surgery at 50%, resulting in $2,500 charge to the patient.

The discounted/negotiated billed charge between provider and insurer means nothing. All that matters is how much you pay out-of-pocket per month in relation to the level of coverage you receive in return. Period. You can't get your terms straight so it's difficult to even correct you.

As someone that has been buying insurance for years and paying out of my pocket, I know this as a fact.

But thanks though.
k
 
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eliquid

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This is where you are misunderstood because you don't understand how the healthcare economy works. The billed charge for the exact same hip surgery on the exact same patient can range anywhere from $15k to $70k in Dallas...the exact same procedure. Why? Because private healthcare prices set by providers are imaginary and are based on nothing in the U.S. Therefore, you don't buy health insurance based on the discounts negotiated between insurers and providers as you're suggesting. You buy healthcare based on the monthly premium / cost-sharing (80%/20%) that the insurance charges you for comprehensive health coverage. The negotiated rate between providers and insurers factors zero into your buying decision because you don't even know what the true discount is.

A doctor can charge $15k for a hip surgery, and an insurer negotiates down to $10k (a 33% discount) and covers the surgery at 80%, resulting in $2,000 charge to the patient.

or

Another doctor can charge $50k for a hip surgery, and that same insurer negotiates it down to $5k (a 90% discount), but only covers the surgery at 50%, resulting in $2,500 charge to the patient.

The discounted/negotiated billed charge between provider and insurer means nothing. All that matters is how much you pay out-of-pocket per month in relation to the level of coverage you receive in return. Period. You can't get your terms straight so it's difficult to even correct you.
Not true.

I don't need to know the wording, the process, the intimate details of how something works or is set up.

Just like a business owner doesn't need to understand finely tuned details of Google Adwords and the algo and other processes. They just need to know, is this helping my business or not.

They ( and myself ) just need to understand money in and money out. Money is what matters in the end ( besides care, quality of care in a medical situation.. which we are not talking about here ).

However, I have been buying insurance for decades. I also worked in healthcare ( Humana in Louisville, KY ) and I have been under group plans and also bought my own plans way before Obamacare. I've shopped around a lot. I've paid a ton of money, I've reviewed a lot of plans.

Money in and Money out.

If Aetna provides better allowed charges ( the discount ) than Humana, the price I pay for the premium or % covered is almost second thought. Depending on the allowed charges ( again the discount ) which sets the base price, the premium or % I pay could either be great, or horrible.

The base price sets the foundation. The base price comes from the allowed charges ( or discount that was negotiated ). The premium and % influence past that and that influence could be tiny or nothing at all.

Hence see my examples again above on $30k procedure.

It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides.

Everyone runs to see what their premuim is. Everyone runs to see what their Dr visit is or their % in-network after deductible. All of that is shit if the allowed charges ( again the discount ), is NULL.

Its math in and math out. Very simple.
 
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levijean

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I am trying to navigate this right now. I am covered by an employer but I dont do much work for them anymore so they want me to secure my own coverage. The plan I have with them costs me like $800/mo for my family for a very good plan. The closest to the same benefits I can find in the open market are around $2,600/mo. This is f'in crazy and is making me reconsider if I should just do the bare-minimum few hours/week for my employer to maintain my existing health coverage.
 

levijean

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The negotiated rate between providers and insurers factors zero into your buying decision because you don't even know what the true discount is.
So how do you account for this when shopping for coverage?
 

AAR2972

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I don't need to know the wording, the process, the intimate details of how something works or is set up.

Just like a business owner doesn't need to understand finely tuned details of Google Adwords and the algo and other processes. They just need to know, is this helping my business or not.
Perhaps. The problem is that you're ignorant of even the basics. It's one thing to overcomplicate something to the point where it provides no benefit to your understanding. It's another thing to dumb down something out of ignorance in an attempt to convince yourself that you understand it. The healthcare simply economy does not follow the basic supply and demand principles you learned in Econ 101 . Throw everything out the window when it comes to pricing of healthcare goods and services.

However, I have been buying insurance for decades. I also worked in healthcare ( Humana in Louisville, KY ) and I have been under group plans and also bought my own plans way before Obamacare. I've shopped around a lot. I've paid a ton of money, I've reviewed a lot of plans.
Look, I'm not an expert in most things. But I called myself an expert in health coverage because I am one. I am a niche health benefits attorney with almost a decade of experience reviewing insurance plan documents and provider contracts. Not only do I review plans, I DRAFT the plan documents and their reimbursement terms. This is what I do for a living.

If Aetna provides better allowed charges ( the discount ) than Humana, the price I pay for the premium or % covered is almost second thought. Depending on the allowed charges ( again the discount ) which sets the base price, the premium or % I pay could either be great, or horrible.
And this statement alone shows your ignorance. Do you understand that these reimbursement rates are proprietary, so even if you wanted to know what the "base price" is for a service, you wouldn't be able to know? You also realize that Aetna negotiates reimbursement rates with each individual provider for each individual service? So tell me, how do you obtain the fee schedule of payments between providers and insurers to make this evaluation on which insurer provides better discounts on a whole across all providers for all services? You don't, and you're pretending like you somehow do which is comedic. What if Aetna negotiated excellent reimbursement rates for outpatient surgery but terrible ones for physical therapy? Which insurer is "better" there?

It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides.
When people use information that is actually available to them (i.e. upfront costs) rather than the imaginary analysis you're pulling out of your a$$ is when people have any hope of getting value out of their healthcare. Pretending like you know what you're talking about when you don't is how you leave people confused in threads.

When determining health coverage to purchase, the main question is 1) how much health coverage do I need and 2) what plan will help me reduce my out-of-pocket costs the most. You need to look at 1) the range of services covered and the level of coverage for each service, 2) the cost-sharing split between patient and insurer (i.e. copays and coinsurance for a given service), and 3) the overall monthly premium. Not much more should be going into the average person's analysis.

Everyone runs to see what their premuim is. Everyone runs to see what their Dr visit is or their % in-network after deductible. All of that is shit if the allowed charges ( again the discount ), is NULL.
Absolute ignorance. I'm not going to respond to anything further you say at this point.
 
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AAR2972

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I am trying to navigate this right now. I am covered by an employer but I dont do much work for them anymore so they want me to secure my own coverage. The plan I have with them costs me like $800/mo for my family for a very good plan. The closest to the same benefits I can find in the open market are around $2,600/mo. This is f'in crazy and is making me reconsider if I should just do the bare-minimum few hours/week for my employer to maintain my existing health coverage.
Depending on which employer you work for, employer-provided coverage is commonly less expensive than any plan you'd find on the individual market because the employer subsidizes a portion of the premiums as an employment benefit. So I would say if there's any way to hang on to your employer coverage while still pursing your entrepreneurial goals then definitely do that.
 

AAR2972

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So how do you account for this when shopping for coverage?
You just don't. You estimate what your health needs are going to be and then shop for a plan based on the combination of monthly premiums, scope of coverage of services (i.e. what types of services are covered), and level of coverage (i.e. how much does the plan pay after you met your deductible / copays).
 

eliquid

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Blah blah blah
Fine, I dont "have" to be right. Seems you try very hard to though.

Here is what I do know... You say I wouldn't know the fee schedules ahead of time.

Wrong.

I've called my doctor before to find out typically what they charge for X procedure and then have called my insurance ( Humana ) to find out if procedure was covered. When told yes, I was also told what I was going to pay/owe as breakdown.

If the doctor's office told me the fee is typically $500 for this procedure, and the insurance tells me I will owe $40 ( this was not an office visit ), You telling me I can't figure out the discount when I'm responsible for 20% to make that $40?

20% of the $500 is $100... so there is discount I can calculate to figure out how the insurance got to $40 that I will owe. It's math.

Of note, I've been able to call other insurance networks and do the same while "shopping". I've done this with 2 other networks in the past month. Over the last decade I've done it with more that I didn't bother to count as I didn't know I would have to prove something like this on a forum.

While I can not call every provider about every possible procedure on this green earth, I can very well call about the medical conditions my family has routinely and ask about those and get a general idea of where things are laid out.

Money in and money out.

So please tell me again, with your drafting plan expertise how I was able to pull this off and know?

Drafting documents does not equal knowing or not knowing how to figure out discounts/allowed rates on the consumer end.

Have a nice day.
 
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