patrick.net

Recalling your list, if you eliminated 2,4,5,6 then I'd say most likely yes. Otherwise no

Id just as soon take the compensation as cash and tell the insurance system to suck my egg

The day I leave this job, every cent that was ever spent in my name, vanishes into thin air

I couldn't imagine a worse deal

SFace says

What's your age and known condition?. Does your employer pay for the plan fully or partially. If you do not participate, will they provide a cash replacement.

This thread is open to all situations, but in my particular situation, I'm deciding between taking the employee option or see what else is out there. My employer doesn't pay for the plan and the provider is Aetna, which I think sucks so I don't like the idea of using them.

I'm healthy, 30s, and typically spend $0.00/yr on health care. Employee heath insurance spreads the risk for insurance providers but that, of course, means that healthy employees subsidize less healthy ones, so I might do better on the market.

Evaluating a health insurance plan by Bankrate

Anyone know of a good site for picking health insurance based on your criteria? If not, that would be a good website idea.

Doing the Math on Employer Health Insurance, NYT

Our post last month on the McKinsey & Company study that suggested — but absolutely did not predict — that up to 30 percent of employers would shed the health insurance plans they now provide workers in 2014, when the Patient Protection and Affordable Care Act largely takes effect

errc says

The day I leave this job, every cent that was ever spent in my name, vanishes into thin air

I couldn't imagine a worse deal

That perfectly describes Aetna's Flexible Spending Accounts. Each year, you lose what you don't spend and you lose everything if you change jobs.

I'm thinking that a private Health Savings Account (HSA) might be the best option. From my understanding, you own the money in your HSA and it cannot be forfeited or taken away. All money left over is rolled over and you earn interest tax free.

What happens with a HSA if you die? Does it go to your estate or does the government and/or some corporation managing it take a slice or all of it?

Aetna flex spending account garbage. I have aetna through wife's provider....Deductible far lower (1/10) than what my parents pay through their business for a crappy HDHP from BC/BS NJ

7 tips for choosing a health savings account by BankRate

Excellent FAQ: Health Savings Accounts (HSA)
http://www.healthequity.com/HealthAccounts/HSA/HSAFAQ.aspx

High Deductible Health Insurance Plans for Individuals

On a national level, no employer medical insurance is dreadful, but as SFace pointed out, individual mileage may vary: if you have high covered expenses, group plans let you shift much of the cost onto other people, and there is a huge tax subsidy. Also note that employer insurance plans vary widely, some are practically illusory covering almost nothing while others are a tax dodge to cover almost everything imaginable. (Usually, low-level employees get stuck with the illusory plans, while senior executives are allowed to charge all sorts of things to their "health insurance" coverage.) As a nation, we would be better off if employer medical insurance did not exist, but some individual employees do benefit.

Found a good site for picking health insurance. Almost like using NewEgg for picking hardware.

US News Best Health Insurance Plans

I'm leaning towards BlueOptions Predictable Cost 535 from BlueCross/BlueShield. HDHP that's HSA-compatible.

Well lets see, I pay roughly $2,500 a year for me and my wife for health coverage. And on my taxes, the company I work for reported they paid $7,000 for our medical benefits, that's $9,500 total. I can't believe that any open market coverage is going to be less for better coverage. One thing you need to remember is the more employees the company has, the better deal they get from the insurance companies. The company I work for has over 300 employees.

I have a friend that was working for a company that had less then 15 employees and he was paying $600 a month for coverage for him, his wife and daughter. I don't know how much his company chipped in, but I'm sure it was at least as much as he was paying, that would make the total about $14,000 a year.

Last year my wife was working for a company that has over 5,000 employees and we were only paying $100 a month for better coverage then we have now.

Depends on the company and the situation. Mine pays a flat rate per employee to a benefit trust plan operated by my union which buys insurance for everyone at negotiated rates. I pay nothing out of pocket but a $3 copay when I visit the doctor. It's a pretty sweet deal and I know it's not usual. Medical insurance for my family of five would otherwise be a whole lotta cash.

It's only worth it in a Liberal mantra sorta way...
"It's better than nothing."

I ended up getting employer based healthcare for the company I've been contracting for. My wife got a serious test result that suggested it could be cancerous. So I went to the owner of the company and told him I had to quit and become indigent, so that I could get the best healthcare in the world. He offered me full time under their employment and insurance to begin immediately.

We went with the Cadillac plan, because at that time we weren't sure how serious her problem might get. They deduct 324 a week, or a little over 1400 a month.
While that is great for PC Doctors, and the prescriptions are dirt cheap. We realized after she had the mass removed and all of the other related procedures, and specialist visits related to her condition, that we still had to pay 20% of all of those bills. Which was the exact same amount people on the 1st tier of 4(for Florida Blue) has to pay.
The first tier is only 80 bucks a WEEK, and only covers generics for medicine. IF there is no generic then we have to pay full price.
Also the detectible per family member is 2K instead of $500.

So starting March 1st were going on the 1st tier plan. I figure for that extra 1,000 a moth we'll save, there would be more than enough to cover any specialist visit or any premium brand medicine that would hit a healthy family of 4. Also my wire finds these pharm discount cards, that in some instances have been cheaper discount than our Gold plan insurance.

Gold insurance is for people that have chronic conditions where their medicine is in the thousands a month.

The way I see it, in March 1st when the cheap plan kicks in and takes place. It will be like we've always done it. Just pay out of pocket, and the inurance will be there so we can at least get in the door and get care, if something does happen.
Doctors and Hospitals wont even look at you if you don't have insurance, even if you do have more than enough money for the proceudure. The way they look at is, they'll tell you a procedure is will be $1200. But they hope you don't have the money.
When you tell them fine, and pay them. After you've waited in the waiting room the Doctor comes out and tells you. He/She isn't comfortable performing the procedure, because anything could go wrong. And if an ambulatory emergency came up during the operation/procedure, you would be a liablity, because 10s of thousands of dollars of unforseen work could have to be done to save your life. and they would be on the hook to not let you die during the operation they were performing.

So to answer your question, while it's cheaper to just pay out of pocket, the whole damn healthcare system in this county isn't worth it. No matter what you have or don't have.

The only people who have it made in this country are the piss poor people who go the Emergency room, and get operations through social worker welfare groups.

In the last 10 years, I know about 5 people who got serious stage 1-3 cancers, and were treated and never saw one bill. They are all alive today and cured.
I know about 6 people who had cancer on employer based insurance. and 4 of those people are dead.
just because you're insured, life saving procedures and follow ups, are ofter not done because of executive decisions or if you want those done, you'll have to pay out of pocket. Like CT scans after mass removal, to make sure they got it all. Usually they are told by the ins companies to wait three months, against the Doctors suggestion. Also the waits to get procedures done or hell even diagnosed. Two of the people I'm talking about complained to their doctor for up to 6 months before they were even diagnosed.
Where as the poor people in the emergency room, they get every thorough test ran before they leave. They know they have cancer the day they complained.

See if you can get accepted into any supposedly "free market" plan, even perfectly healthy.

I had Blue Shield, may they rot in hell, which was charging me about $900/month for a family of four with an $8,000 deductible. Meaning it pays nothing until your medical charges are over $8,000 in a calendar year. And the premiums consistently rose at at least 20% per year. Nothing to do with any conditions. Those were just their published rates for families in our age groups.

So the $900 per month got me nothing at all except catastrophic event coverage. In theory I also was eligible for one annual physical, but in practice my attempt to get physical was not covered because it was mis-coded (mistake or not?). Very hard to fix that error, though I did fix it eventually.

So now I've got an employer-sponsored plan from Cigna, which in theory is $450/month from me and another $800 from my employer for complete coverage except for office copays of like $20. We will see if they actually do pay, or if there is evil tiny print that means they really don't pay.

Here is the solution, IMHO:

1. For non-essential care, all prices must be presented in advance of treatment. Every medical provider must have a publicly available price list! Yes, even if this means people make treatment decisions based on prices, which is what doctors say should never be allowed to happen.

2. For essential care, the government must set prices. There is no free market when you are not free to walk away, so prices go to infinity, and beyond.

Note that neither of these requirements has anything to do with taxes. It's just about preventing extortion.

Dan8267 says

Soliciting opinions. Is employer-provided health insurance a better or worse deal than what you can get in the free market? Do you know of a good or bad health insurance provider? If so, speak up here.

Employer coverage is often a better deal. This starts with the premiums being paid with pre-tax dollars.

I pay 28% in Federal taxes, 9.33% in state taxes, and 1.45% in Medicare which allows me to spend 63% more on employer coverage than private market for the same impact on what's left over.

If I earned less money I'd also be paying 6.2% on Social security and 1.0% California State Disability insurance which would allow me to spend 85% more on the employer plan.

Employers also pay FICA and Medicare; so in that situation they'd have to spend 2.2X as much on my pay and taxes as my employer plan ran so I could spend as much in the private market.

There's also the employer contribution. I don't pay anything for my coverage and only 80% of my wife's. It's rare that declining health coverage translates into a take-home pay increase and even then it's a fraction of the value - at my last job I could have my employer spend $400 tax free on my insurance, or give me a $100/month taxable credit of which I'd take home $63 which doesn't compare well to the $200/month I'd spend on a high-deductible plan or $300-400 such a plan would cost a 50 something person.

There's no surcharge for pre-existing conditions.

And there's no adverse market selection. 55% of Americans get our insurance through our employers, and 31% from the government. The left overs without health conditions often decide health insurance isn't worth buying meaning the risk pool is statistically sicker leading to necessarily higher rates.

This is because the game is rigged by corporatism. There's more money available when health insurance companies' premiums are paid with pre-tax dollars. There's much more money where everyone in a company gets the same plan and the plan benefits are determined by appeals to the masses who just look at deductible (I once had a choice between $250 and $500 deductibles with the same co-insurance from the same insurance company and choose the later because the premiums where $1000/year lower).

drew_eckhardt says

Employer coverage is often a better deal. This starts with the premiums being paid with pre-tax dollars.

Good point!

The $900 I was paying was post-tax.

The $450 I pay now for far better coverage through an employer is pre-tax. But then again, now I'm a wage slave.

See if you can get accepted into any supposedly "free market" plan, even perfectly healthy.

I had Blue Shield, may they rot in hell, which was charging me about $900/month for a family of four with an $8,000 deductible.

The information I found from US News on BlueOptions Predictable Cost 535 doesn't seem that bad. The page lists the following details for that plan:

U.S. News Rating 5/5 starts
Monthly Premium $125/month*
Annual Deductible $10,000
Out-of-Pocket Limit $10,000

Applicants Charged More Than Quoted Premium: 53%
Applicants Denied Enrollment: 22%

Deductible
$10,000 Individual
$20,000 Family

Out-of-Pocket Limit
$10,000 Individual
$20,000 Family

What's Included in Out-of-Pocket Limit
Deductible + Coinsurance + Co-pay

Maximum Annual Benefits Paid
No Maximum Individual
No Maximum Family

Plan Type
PPO
HSA Eligible

Office Visits
---------------
Preventive Care (Checkups, Screenings, Immunizations, etc.)
No Charge

Primary Care Visit for Illness or Injury
$60 Copay

To See a Doctor
$85 Copay

To See a Nurse, Physician's Assistant or Other Provider Specialist Visit
$85 Copay

Prescription Drugs

Generics
$10 Copay

Brand-Name Drugs on Plan's Preferred List
See drug formulary as given by provider.
$60 Copay

Brand-Name Drugs Not on Plan's Preferred List
$100 Copay

Specialty Drugs (for Specific Complex or Chronic Conditions)
$60 Copay

Hospital Care
-----------------
Inpatient Care
No Charge after deductible

Hospital Charges
No Charge after deductible

Physician Charges

Outpatient Surgery
No Charge after deductible

Hospital Charges
No Charge after deductible

Surgeon Charges
Emergency Care
Emergency Room
No Charge after deductible

Ambulance Service
No Charge after deductible

Urgent Care
$100 Copay

Tests
-------
Diagnostic X-Rays and Lab Tests
No Charge

CT Scans, MRI, Other Advanced Imaging
$200 Copay

It's a high premium plan design to protect against catastrophes rather than high use, so a lot of stuff I'm not interested in isn't covered like maternity, family, etc.

The US News ratings methodology is detailed here. Basically, it considers what actually is covered and how much the coverage cost.

This plan also lets the participant use a Health Savings Account (HSA), which I think is a very big plus. Basically, you can save a few thousand a year pre-tax in an HSA and it grows tax-free. It's FDIC protected if you invest in a savings account (although right now the interest rates are basically zero or negative after inflation), but you can also invest in anything just like an IRA or 401K if you are willing to lose FDIC and risk principle.

Plus this plan only costs about $125/month ($1500/yr). I don't get paying $450/month ($5400/yr) on a use it or lose it plan. I'd rather put the maximum contributions into an HSA ($3250 individual / $6450 family).

@Patrick

Google really likes your site. I just did a search for BlueOptions Predictable Cost 535 review and http://patrick.net/?Healthcare was the number one hit because of this thread, which is only two days old.

There has to be a way you can capitalize on this. Maybe have a form where people can fill out what health insurance they have, how they rate it, and write a review like users on Amazon.com do. Then use a nice SEO path like /healthInsurance/{InsuranceProvider}/{PlanName}. For example, http://patrick.net/healthInsurance/BlueCross/BlueOptionsPredictableCost535.

I mean, geeze, you're the number one Google search result for a specific plan just because of this one thread. You gotta take advantage of that. Marketers would kill for that page ranking.

Thanks for the suggestion Dan!

Dan8267 says

There has to be a way you can capitalize on this. Maybe have a form where people can fill out what health insurance they have, how they rate it, and write a review like users on Amazon.com do. Then use a nice SEO path like /healthInsurance/{InsuranceProvider}/{PlanName}. For example, http://patrick.net/healthInsurance/BlueCross/BlueOptionsPredictableCost535.

Yes, that's a good idea. But how would I make money from it? Ads I suppose, but ads have never worked well for me.

Dan8267 says

this plan only costs about $125/month ($1500/yr).

I don't believe it.

Certainly there is nothing like that for a family of 4 with the parents in their 40's.

Situations like this are the reason why I'm pretty darn sure I'll never accept insurance after I'm done. Based on studying insurance reimbursements from different insurance companies for various procedures, I don't think it is exactly rocket science to come up with rates that a person could reasonably afford to pay out of pocket and also present to the patient in advance.

Insurance is a noose around the neck forcing doctors to become shift-working salaried employees who are minimally concerned about doctor-patient relationships that once made medicine a highly rewarding profession, both personally and professionally.

CaptainShuddup says

just because you're insured, life saving procedures and follow ups, are ofter not done because of executive decisions or if you want those done, you'll have to pay out of pocket. Like CT scans after mass removal, to make sure they got it all. Usually they are told by the ins companies to wait three months, against the Doctors suggestion. Also the waits to get procedures done or hell even diagnosed. Two of the people I'm talking about complained to their doctor for up to 6 months before they were even diagnosed.

Where as the poor people in the emergency room, they get every thorough test ran before they leave. They know they have cancer the day they complained.

Although I know some dirtbag gunners, the vast majority want to make a good living without necessarily having to choke off those who need help. I suspect that people who are 'all about money' don't often pursue medicine, since there are far easier ways to make money, like getting an MBA at a top 5 school.

The extortionists are the insurance companies and ambulance chasing bottom feeders.

Note that neither of these requirements has anything to do with taxes. It's just about preventing extortion.

Dan8267 says

this plan only costs about $125/month ($1500/yr).

I don't believe it.

Certainly there is nothing like that for a family of 4 with the parents in their 40's.

Well, obviously ensuring 4 people is going to cost more than insuring just one. The $125/month is for an individual plan. The family plan costs more. I ran the numbers at the US News site for a family of 4 in Florida and got this result... $350/month but with a $20k deductible, which is a bit high even for just guarding against catastrophes. Of course, if you are married, there's probably other coverage you might want to get like maternity that's not covered by this plan.

Dan8267 says

7 tips for choosing a health savings account by BankRate

I love the fact that someone here is so petty that he's disliking every post I make, even if it's just a link to tips or faqs on health insurance. Every time I see such a dislike I know that I pissed off some troll so much that I'm always on his mind and ruining his day, and that puts a smile on my face.

CaptainShuddup says

So I went to the owner of the company and told him I had to quit and become indigent, so that I could get the best healthcare in the world.

CaptainShuddup says

The only people who have it made in this country are the piss poor people who go the Emergency room, and get operations through social worker welfare groups.

CaptainShuddup says

In the last 10 years, I know about 5 people who got serious stage 1-3 cancers, and were treated and never saw one bill. They are all alive today and cured.

I know about 6 people who had cancer on employer based insurance. and 4 of those people are dead.

Where as the poor people in the emergency room, they get every thorough test ran before they leave. They know they have cancer the day they complained.

I realize that you are angry - happens alot, btw - but you are over-generalizing. Can't remember who, a poster from long ago, had a mantra that "the plural of anecdote is not data." That applies in your example.

1) Many people don't qualify for Medicaid. That will change under Obamacare, but in many states one doesn't qualify for Medicaid unless they are under 18, over 65, or handicapped/disabled (such as SSI recipients). If it were as easy as quitting your job to receive medical coverage, there wouldn't be so many unfunded hospital patients. You make it sound so easy - "I'll just quit my job and then all my troubles will be over..."

2) Medicaid isn't the "best healthcare in the world." A patient whose payment source is Medicaid is assigned a hospital case manager and his costs/treatments are only provided if necessary. Even then, if the treatmens/tests can be provided in a less expensive environment, the patient will have to receive them on an outpatient basis.

3) Medicaid reimbursements to providers (including hospitals, nursing homes/rehabs, labs, physicians, etc) are shit compared to private insurance. Hospitals are paid months later at a substantially reduced rate.

4) People who are admitted through the emergency room and sent up for an operation receive the care due to medical necessity regardless of the payment source. If the treatment can wait, the patient will have to jump through all sorts of hoops but if it's medically necessary and life threatening, the patient will be sent for surgery.

5) Your anecdotal evidence about the cancer patients who were cured vs those who died is inflammatory - but every cancer is different, every patient is treated according to his disease process. That five people with stage 1-3 cancer were treated and cured (or are in remission) can't be compared to the 4/6 people who died. What stage were they? What type of cancer was it? When was it diagnosed? How was it treated?

The latter patients had insurance - so they could have made arrangements to pay the copayments. Either way, they had access to treatment.

For all we know, the first patients you described had stage 1 breast cancer or encapsulated prostate cancer, while the 4/6 had pancreatic cancer or metastatic lung cancer.

Your anger at what you perceive to be a system of free healthcare vs that for which you are paying renders your arguments useless. You are looking for cause & effect based on payment source - and although that does exist (such as the person who has no health insurance and can't access a physician, therefore a sign or symptom of a serious condition isn't caught until it seriously impedes the patient's ability to maintain his lifestyle), it doesn't exist here.

Dan8267 says

I love the fact that someone here is so petty that he's disliking every post I make, even if it's just a link to tips or faqs on health insurance. Every time I see such a dislike I know that I pissed off some troll so much that I'm always on his mind and ruining his day, and that puts a smile on my face.

I have the same problem - a trollster who dislikes me enough to stalk my posts & dislikes them. I imagine them masturbating as they do it.