The decision not to buy health insurance: is it rational?

[AimeeM]

It can seem that way for some families.

 

Purchasing it outright, with no company to chip in/subsidize your premiums? It can seem that way.

My younger cousin is in this position. She has two children; one of whom has food allergies and other medical issues. 

When she did the calculations, even if she had paid out of pocket for all doctor's appointments, hospital, etc, she still would have saved thousands at the end of the year, when compared to the premiums, deductibles to be met, and co-pays she had to pay HAVING insurance. 

 

We've certainly found health insurance worth it - primarily because we have one kiddo with somewhat serious medical issues, who sees several specialists, and undergoes several diagnostic/preventative/"keeping an eye on things" visits with radiology and labs yearly. Even when DH's company only subsidized half of the cost of premiums, it was worth it to us (specifically when DS had a major surgery, then another procedure when there were complications from the first, and then a month long hospitalization). 

That said, since he's been stable and only "maintenance" regarding his specialists and labs/radiology, I haven't done the numbers. DH's current company pays almost all of our monthly premium, though, and we pay very, very little in deductibles. If DS were stable and we were paying full-price, or even half, for premiums, and standard deductible costs? I'm not sure because, as I said, I haven't done the numbers. I would have to figure the full price for echos, x-rays, labs, and the prices for each specialist's "regular check-ups" vs. their "sick visit" prices. 

 

Anyway, rational or not, I can see how (to some) it may make sense to just pa out of pocket. Most hospitals offer significant discounts for "self pay" patients, and many even have the funding to completely "write off" certain procedures (a friend of mine has his appendix removal, and hospitalization for it, paid for out of a special fund in the hospital for the uninsured). 

 

So, all that to say that I can't really speak on it, lol. We find it worth it to have insurance, but everyone has different circumstances.

[Frances]

I know what I'm about to say sounds horrible.

 

I think we need to get more comfortable with death.

 

My 63yo aunt had a stroke a month ago. She was in the hospital a few days when she had another massive stroke. It was pretty evident that it was a terminal event. It took half a day to stabilize her blood pressure so she could be air lifted to a bigger hospital where it was confirmed that this was a terminal event. She languished in the hospital for 10 days waiting for her brain to finish shutting down. At no point after the second stroke did anyone think she would recover. Not that long ago, she would have been sent home to die in her bed. Instead, she died hooked to machines with nurses checking on her every hour.

 

My sister is a doctor with Hospice and she sees it every day. People want to "do everything you can for Mom" when Mom has had terminal cancer for 5 years and her organs are failing. There is no coming back from that but some doctors (not my sister) will try everything to make the family feel better. Which is great but very expensive.

 

I get that watching people die is hard. But people did it for thousands of years and still do it in most countries. Death is a natural part of life and shouldn't always have to cost more than a 3-bedroom home.

I think we might be finally starting to get there, as soon Medicare will start reimbursing for advanced end of life counseling. Google La Crosse, Wisconsin if you want to know more about an area of the country where more than 95 percent of individuals have made plans. Their approach started with one ethicist at one hospital and has slowly spread. Sarah Palin unfortunately delayed the movement for many years, but hopefully with Medicaid on board, it will become readily available throughout the whole country very soon.

 

Having watched both my dad and my father-in-law die from cancer at home with wonderful hospice care and no heroic measures, everyone in my immediate family wants something similar.

[bettyandbob]

To the poster who said insured people shouldn't have to subsidize uninsured. How do you handle ER treatment? The cost of ER treatment must be paid by someone and it's not being paid by uninsured people. Until ERs are permitted to refuse all treatment until proof of insurance is verified, uninsured people will be subsidized by insured people.

 

Do we want that to happen? No. I do not want a child to die because his parents decided not to get insurance. Nor do I want an adult to die because of a convergence of financial and life decisions.

 

It would be fairer if we all paid in for universal coverage. That would take the ethical decision of who gets care out of it. No one would wait until an injury got worse, an illness got worse, avoid preventative care due to copays and deductible costs. We do ration healthcare in the country. We ration by cost/ability to pay. There has got to something unethical about that.

 

If one can afford insurance, as the OP described, and is still risk for disease, I don't think it is rational not to have coverage. The person is probably missing out on preventative care and early detection. Unless the person is feeling fatalist about developing the conditions, I'm not sure it makes sense.

[Carrie12345]

What stands out to me in this thread is the giant differences in policy cost in different states.  I can't imagine paying 2k/mo with a 10k deductible. I'm frustrated that my choices for next year are worse than what I've had, but they're nowhere near that.

[Alessandra]

However flawed the system is, you still need insurance, imo. One big reason is insurance company discounts. A hospital stay with a sticker price of $50,000 is billed to insurance at $17,000, actual example btw. If you are self pay, you would have to start asking for discounts.

 

Also, my impression is that you are covered for pre-existing conditions after six months of coverage.

[Alessandra]

I was disappointed to see that the exchange plans have far less coverage and higher oop than what local government and the school district, thru local property taxes, provides their employees. I wonder that it would be more cost effective to make everyone a part time employee just for health insurance...we could all do local govt or school district chores saturday morning from 10 to whenever we have made enough to pay our premiums.

In my state, the teachers' health plans have $100 deductibles, $400 max, ten times better than what I have. Teachers are angry that they now have to pay larger percentage of premiums. I pay 100%. They have out of network coverage, I have none. But my taxes help pay for their plans.

 

But, on the side of teachers, they do not have lower cost plan options, at least I did not find anything comparable to gold, silver, bronze when I checked government website.

 

The system is utterly dysfunctional.

[Jane in NC]

To the poster who said insured people shouldn't have to subsidize uninsured. How do you handle ER treatment? The cost of ER treatment must be paid by someone and it's not being paid by uninsured people. Until ERs are permitted to refuse all treatment until proof of insurance is verified, uninsured people will be subsidized by insured people.

 

Do we want that to happen? No. I do not want a child to die because his parents decided not to get insurance. Nor do I want an adult to die because of a convergence of financial and life decisions.

 

It would be fairer if we all paid in for universal coverage. That would take the ethical decision of who gets care out of it. No one would wait until an injury got worse, an illness got worse, avoid preventative care due to copays and deductible costs. We do ration healthcare in the country. We ration by cost/ability to pay. There has got to something unethical about that.

 

If one can afford insurance, as the OP described, and is still risk for disease, I don't think it is rational not to have coverage. The person is probably missing out on preventative care and early detection. Unless the person is feeling fatalist about developing the conditions, I'm not sure it makes sense.

 

Again, let me state that I believe in universal coverage.  I do not wish for people to be turned away from the ER.

 

But the question of funding of rural/community hospitals hits close to home.  An article in the Washington Post last spring addresses financial issues of rural hospitals.

 

https://www.washingtonpost.com/national/health-science/rural-hospitals-beset-by-financial-problems-struggle-to-survive/2015/03/15/d81af3ac-c9b2-11e4-b2a1-bed1aaea2816_story.html

 

The ER at my community hospital has been the first stop for the uninsured who are missing out on preventative care.  I do not want to see people turned away--I want to see different health care and funding models.

 

I also want to note that I believe we should emphasize palliative care over heroic measures for the elderly or terminally ill but this too requires a different mindset than how Americans see and use medicine.

 

 

[Butter]

What stands out to me in this thread is the giant differences in policy cost in different states.  I can't imagine paying 2k/mo with a 10k deductible. I'm frustrated that my choices for next year are worse than what I've had, but they're nowhere near that.

 

YES!  We have a plan where we get the first $1,000 of medical costs covered straightaway.  Then we pay a $1,000 deductible.  And then our co-insurance is 10%.  Our family deductible max is $2,000 (these are for in-network, out-of-network are higher of course, but we live in a city so we have plenty of in-network choices for everything we need).  We pay a $25 co-pay for our primary care doctor and $45 for specialists.  $175 for our ER co-pay.  Urgent Care like the type in CVS or similar standalones we pay as if we were seeing a primary care doctor.  Well visits, shots, etc. are covered 100%.  Allergy shots are a $5 co-pay each time.  Our out of pocket max per person per year is $6,500 or $13,000 for the whole family.  Crazy that our out of pocket family max is similar to some people's deductibles.  We pay $152 every two weeks for our insurance, so just under $4,000 a year.  The federal government (which is my husband's employer) kicks in a few times as much as we do.  The total cost of premiums is over $20,000 a year when you count our part and the government's part (insurance coverage is one of the major benefits of working for the federal government; really, federal employees usually exchange a lower pay than they could be in the private sector for job security and really good benefits - not as good nearly as they were for people who started federal positions before 1986, but still better than most private sector jobs).

 

Even when we had a high deductible health plan, we had an $8,000 deductible and we paid $79 every two weeks, but $125 of that per month was put into our HSA.  We never met the deductible, but after the deductible it would've paid most of our costs.  It included well dental from the start for everyone.  That plan costs a little more more now (around $100 every two weeks), but still includes well dental and also includes well medical.  When we had it it did not.

 

If everyone had options like ours at costs like ours it would be completely irrational not to have health insurance.  The thing is, most people do not have those options.  Mandating people buy health insurance when they can't afford it is useless.  You can't make money from nothing.  I do think this is one place Congress was out of touch with society as a whole.  I think they assumed everyone had good employer provided and subsidized health insurance like they did when that is not the case at all.  (For the record, the Congresspeople, at least before AHA, had the same exact health insurance options as every other federal employee.  I think that might have changed after AHA due to backlash of rumors that were not quite true.  They were never making themselves exempt from the rules of AHA.  They were simply going to be allowed to not use the exchanges because they already had employer provided health insurance just like everyone else who has employer provided health insurance.  People latched on to the "not use exchanges" part, however.)

[DawnM]

Cancer isn't the only thing insurance is for. If you have a heart attack, you can't get coverage that goes back to start the day before.

 

Or a car accident, or any accident, or any attack (gall bladder, appendix, etc....)

[Haiku]

It's not rational, and furthermore, it's selfish. Everyone else gets to assume the cost of the uninsured person's treatment in the case of a catastrophic event (think car accident that leads to emergency room visit). You don't get get retroactive coverage for that.

 

If the person in question is hoping to get health insurance through an employer, you can only do that during open enrollment. If said person is planning to get insurance through the exchange, he or she may end up with a less-desirable plan with high deductibles/low benefits.

 

Health insurance in this country is a mess and a travesty, I grant you that, but when people choose (not can't afford) to go without it, I tend to view them as selfish people who are more concerned with making a statement than being responsible.

[Lady Marmalade]

However flawed the system is, you still need insurance, imo. One big reason is insurance company discounts. A hospital stay with a sticker price of $50,000 is billed to insurance at $17,000, actual example btw. If you are self pay, you would have to start asking for discounts.

 

Also, my impression is that you are covered for pre-existing conditions after six months of coverage.

 

Uh, I've seen the pricing sheets at my ob/gyn.  Everything is grossly inflated price-wise for those with insurance.  Self pay actually gets a very hefty discount.

 

Any person can absolutely negotiate with a hospital/medical office to have a rate reduced- you don't need the insurance company to do that for you. 

[Haiku]

break your wrist falling on ice, or get a concussion playing sports.

 

I broke my wrist last July by falling on ice (I was taking a skating class). Even with insurance, the whole deal cost me >$1200.

 

My dh got a concussion last week from falling down the stairs. It was 4 a.m., he was groggy, and he thought he was at the bottom step, but he wasn't.

 

He chose not to go to the ER because we have an 8k deductible. We did go to Urgent Care. Luckily my husband was able to be off work for a week and is mostly healed now. We will still have bills from the Urgent Care visit and follow-up with out doctor. Had his concussion been more severe, we would have even huger bills.

 

I understand cost being a limiting factor in people's health care decisions. My husband works for a big company, makes a decent salary, and has decent insurance, but we still pay a lot out of pocket. Healthcare in this country is broken.

 

But had my husband ended up with a truly traumatic brain injury, no insurance would have retroactively covered that.

[Guest]

It can seem that way for some families.

 

Purchasing it outright, with no company to chip in/subsidize your premiums? It can seem that way.

My younger cousin is in this position. She has two children; one of whom has food allergies and other medical issues.

When she did the calculations, even if she had paid out of pocket for all doctor's appointments, hospital, etc, she still would have saved thousands at the end of the year, when compared to the premiums, deductibles to be met, and co-pays she had to pay HAVING insurance.

 

We've certainly found health insurance worth it - primarily because we have one kiddo with somewhat serious medical issues, who sees several specialists, and undergoes several diagnostic/preventative/"keeping an eye on things" visits with radiology and labs yearly. Even when DH's company only subsidized half of the cost of premiums, it was worth it to us (specifically when DS had a major surgery, then another procedure when there were complications from the first, and then a month long hospitalization).

That said, since he's been stable and only "maintenance" regarding his specialists and labs/radiology, I haven't done the numbers. DH's current company pays almost all of our monthly premium, though, and we pay very, very little in deductibles. If DS were stable and we were paying full-price, or even half, for premiums, and standard deductible costs? I'm not sure because, as I said, I haven't done the numbers. I would have to figure the full price for echos, x-rays, labs, and the prices for each specialist's "regular check-ups" vs. their "sick visit" prices.

 

Anyway, rational or not, I can see how (to some) it may make sense to just pa out of pocket. Most hospitals offer significant discounts for "self pay" patients, and many even have the funding to completely "write off" certain procedures (a friend of mine has his appendix removal, and hospitalization for it, paid for out of a special fund in the hospital for the uninsured).

 

So, all that to say that I can't really speak on it, lol. We find it worth it to have insurance, but everyone has different circumstances.

Why does she not have an ACA plan with a subsidy? Or whatever her state offers in free care for the children? She sounds like the kind of person who could be bankrupted by a broken arm or other kid thing.

[Butter]

Uh, I've seen the pricing sheets at my ob/gyn.  Everything is grossly inflated price-wise for those with insurance.  Self pay actually gets a very hefty discount.

 

Any person can absolutely negotiate with a hospital/medical office to have a rate reduced- you don't need the insurance company to do that for you. 

 

This is another thing that is totally broken about our health care system.  The providers HAVE to charge a grossly inflated price in order to get paid a reasonable amount.  It's so ridiculous.  I used to work for a psychotherapy office.  I did billing.  There was a point when we were informed by several insurance companies we'd have to increase our rates in order to keep getting paid the same amount because they do some sort of calculation to get the usual and customary rate in your area and if a certain percentage of the providers don't raise rates at some point the insurance companies can and will reduce the usual and rate.  It's ridiculous.  So we increased rates from $80-$100/hour (depending on type of provider - we had counselors with varying degrees) to $90-$110/hour.  This did not increase what the providers got paid.  The UCR was still $40-60 depending on insurance company.  We still charged the self-pay people the same average we'd get from insurance ($50).  But on paper it looked like everyone got a raise.  (BTW, from that average of $50 an hour, the providers had to pay 40% for overhead - electricity, phones, office staff - and then they had to pay their own taxes because of the way the practice was set up.  So after paying overhead they were getting about $30/hour before taxes.  And that's assuming people showed up.  We often had no-shows.  We charged $25 for a no show, but often people didn't pay it and we just wrote them off.  We never sent people to collections for a no show or two.  I can't even tell you the number of people who would look at the grossly inflated dollar amount and comment about how much the therapists were getting paid.  That grossly inflated dollar amount is meaningless to everyone except the insurance companies and their weird UCR calculations.)

[QueenCat]

What stands out to me in this thread is the giant differences in policy cost in different states.  I can't imagine paying 2k/mo with a 10k deductible. I'm frustrated that my choices for next year are worse than what I've had, but they're nowhere near that.

 

Me either! We have a $5000/family deductible next year, premiums for next year are going up but will only be $250ish a month. No copays after deductible is met. And our coverage is excellent. I do realize that this is only because dh's company pays for the bulk of the premium. Most people I know irl don't pay crazy prices for health insurance. Only on here do I hear of crazy amounts.

[Plateau Mama]

How about cutting down the ER load? Opening more urgent cares has been helpful. On our last ER visit, our nurse was spending more time calling for taxis for people that should be at a clinic,doctors office, or urgent care than attending to the patients. That job could be done by a clerk. People the police had brought in from breaking up fistfights were being observed...that could be done at the station house with someone qualified to triage.Adding more hours to community clinics instead of using the ER would also be helpful.

We have ugent cares all over the place here. Every time we go to the urgent care they send us downstairs to the ER. That would be 3x this year. Yes, it's been a bad year for our family. The first time they took my temperature and put the oxygen thing on my finger, said I was too sick to be there and walked me downstairs to the ER. I was billed $1000 for that. I then spent 4 hours in the ER and had IV Fluids and other drugs, X-ray etc. my total bill was $3000. The ER was the much better deal.

 

I'm done going to urgent care. My pediatrician has weekend hours and as an adult if I can't wait to get into my Dr. I'm going to the ER.

[JFSinIL]

Wish we could use urgent care - we used to use one run by Advocate, and we can still take our son with autism there since they accept his Medicaid...but the rest of us, with a Blue Cross plan, can not use it. The hospital in town we can use does not run any urgent cares in the area any longer. So we have to use the ER if the doctor's office is unavailable. Annoying. Note, the urgent care we can not use also has an x-ray machine, does blood draws - none of which we can use now. Note, too, that before our plan was changed, a co-pay for urgent care was $30. Now, for ER visit, it is $500. :-(.

[goldberry]

My BIL had an accident that involved a life flight, ICU, and therapy for a head injury and broken back.

Uninsured.

It took him 10 years to pay off the bills.

 

I've had kids with head CT's and illnesses that required surgeries and week long hospital stays. A parent with an emergency surgery from a fall.  A cousin who had a stroke.

 

 

 

I would be terrified to be without insurance.

 

Yes.  I am without insurance for the first time in years, because I can't afford it, and I am terrified.

 

 

To the poster who said insured people shouldn't have to subsidize uninsured. How do you handle ER treatment? The cost of ER treatment must be paid by someone and it's not being paid by uninsured people. Until ERs are permitted to refuse all treatment until proof of insurance is verified, uninsured people will be subsidized by insured people.

 

Do we want that to happen? No. I do not want a child to die because his parents decided not to get insurance. Nor do I want an adult to die because of a convergence of financial and life decisions.

 

.

 

 

I agree with you here and that is why I think we should have a universal coverage that everyone pays into.  This experiment with having everyone required to have coverage but no way to control costs, shows that the only way to GET everyone coverage affordably is to have a system that can negotiate costs enough to keep the costs down.

[goldberry]

​..

 

This is all just to say we're screwed.

 

We could always socialize medicine and control the production of some key drugs that are causing the lifetime expenditures to be so high. Just sayin'.

 

Tsuga, I get what you are saying now.  I see it more as a problem with the costs themselves though, that has been allowed to continue because it has been "invisible" to a certain extent. 

 

Your point is correct that it is an unsustainable system.

[goldberry]

Me either! We have a $5000/family deductible next year, premiums for next year are going up but will only be $250ish a month. No copays after deductible is met. And our coverage is excellent. I do realize that this is only because dh's company pays for the bulk of the premium. Most people I know irl don't pay crazy prices for health insurance. Only on here do I hear of crazy amounts.

 

I am a bookkeeper for a reasonably small company with 17 people covered.  They have probably a pretty representative mix of single, employee/spouse, and full family.   I have been watching the health insurance costs start to become a real strain on them.  It's insane.  The monthly bill is over $20,000.  MONTHLY.   Here is what the bill is like:

 

Employee Only $701

Employee Spouse $1400

Family $2259

 

I would guess most of the employees feel the same as you though, that "it's not too bad" because they pay something similar to you. 

The owner is a great guy.  I have seen him take cuts in his own pay when times were lean, rather than lay off or cut benefits.  But he make have to start making some tough choices soon.

[Erica in OR]

How about cutting down the ER load? Opening more urgent cares has been helpful. On our last ER visit, our nurse was spending more time calling for taxis for people that should be at a clinic,doctors office, or urgent care than attending to the patients. That job could be done by a clerk. People the police had brought in from breaking up fistfights were being observed...that could be done at the station house with someone qualified to triage.Adding more hours to community clinics instead of using the ER would also be helpful.

 

Agree with this. We are in a location with no urgent cares at all. We had to pay for an ER visit over a holiday weekend once when one of the kids appeared to have strep and couldn't have waited until the doctor's office (no weekend hours) opened Tuesday due to the pain on swallowing. Urgent care could have handled that, no sweat, at a lower cost.

 

Erica in OR

[QueenCat]

I am a bookkeeper for a reasonably small company with 17 people covered.  They have probably a pretty representative mix of single, employee/spouse, and full family.   I have been watching the health insurance costs start to become a real strain on them.  It's insane.  The monthly bill is over $20,000.  MONTHLY.   Here is what the bill is like:

 

Employee Only $701

Employee Spouse $1400

Family $2259

 

I would guess most of the employees feel the same as you though, that "it's not too bad" because they pay something similar to you. 

The owner is a great guy.  I have seen him take cuts in his own pay when times were lean, rather than lay off or cut benefits.  But he make have to start making some tough choices soon.

 

I don't think that "it's not too bad" when it comes to our nation's healthcare. I know it costs too much for many. I was saying that I realize that we're fortunate that his employer pays more most of it. Bigger company than yours but less than 150 employees so not a giant company by any means.

[Carrie12345]

Me either! We have a $5000/family deductible next year, premiums for next year are going up but will only be $250ish a month. No copays after deductible is met. And our coverage is excellent. I do realize that this is only because dh's company pays for the bulk of the premium. Most people I know irl don't pay crazy prices for health insurance. Only on here do I hear of crazy amounts.

 

If we took dhs' employer's plan, we would be around the 2k/10k point, which is why we purchased our own.  Last year, we paid about $1,100/mo with $1,000 family deductible (family of 7) for 100% coverage.  No copays, no co-insurance, no usage limits.  That's still not affordable for everyone, but it was a heck of a lot better than what some are seeing.

[AimeeM]

Why does she not have an ACA plan with a subsidy? Or whatever her state offers in free care for the children? She sounds like the kind of person who could be bankrupted by a broken arm or other kid thing.

She doesn't qualify for medicaid and she doesn't qualify for a subsidy. I believe it has something to do with that her company does offer health insurance (not that that makes it affordable, kwim?). So, she pays what she pays for insurance, and then still has to pay the deductibles and co-pays. Don't get me wrong - she didn't drop her insurance, but she is questioning how rational it is for her to carry it.

 

I do believe she looked into the subsidies. She was very excited about the healthcare reform initially. 

 

Why would you think she'd be bankrupted by a broken arm? Most hospitals (at least around here) are more than happy to set up payment plans based on what a person can afford monthly. A broken arm? I don't think that would bankrupt her if she paid on it monthly. Something much more serious and chronic? That would break her insurance or not... but, frankly, that would break (or come close to breaking) many people with the exception of the very wealthy, even with insurance.

[Guest]

She doesn't qualify for medicaid and she doesn't qualify for a subsidy. I believe it has something to do with that her company does offer health insurance (not that that makes it affordable, kwim?). So, she pays what she pays for insurance, and then still has to pay the deductibles and co-pays. Don't get me wrong - she didn't drop her insurance, but she is questioning how rational it is for her to carry it.

 

I do believe she looked into the subsidies. She was very excited about the healthcare reform initially.

 

Why would you think she'd be bankrupted by a broken arm? Most hospitals (at least around here) are more than happy to set up payment plans based on what a person can afford monthly. A broken arm? I don't think that would bankrupt her if she paid on it monthly. Something much more serious and chronic? That would break her insurance or not... but, frankly, that would break (or come close to breaking) many people with the exception of the very wealthy, even with insurance.

I'm not sure I understand your last paragraph. Our insurance has a 10k deductible with 100% paid after that. So, if one of my children needed $100k in cancer treatment, my exposure is capped at 10k/year. If her uninsured child needed the same treatment, would she really be able to make the payments? Medical bills are the #1 cause of bankruptcy.

[TX Native]

I'm not sure I understand your last paragraph. Our insurance has a 10k deductible with 100% paid after that. So, if one of my children needed $100k in cancer treatment, my exposure is capped at 10k/year. If her uninsured child needed the same treatment, would she really be able to make the payments? Medical bills are the #1 cause of bankruptcy.

I'm not the poster who wrote, but I think what she means if she has something like a 10K annual deductible, it will bankrupt her the same as something like a $100,000K medical bill would. We don't have an ongoing $8,000-$12,000/year to spend in premiums as well as $12,000/year OOP max were something dreadful to happen and need medical follow up year after year. For some a 10K OOP max annually might as well be a $100K annual OOP max, because if one doesn't have an extra $10K/year for medical care after expensive monthly premiums they just don't have it.

[Guest]

I'm not the poster who wrote, but I think what she means if she has something like a 10K annual deductible, it will bankrupt her the same as something like a $100,000K medical bill would. We don't have an ongoing $8,000-$12,000/year to spend in premiums as well as $12,000/year OOP max were something dreadful to happen and need medical follow up year after year. For some a 10K OOP max annually might as well be a $100K annual OOP max, because if one doesn't have an extra $10K/year for medical care after expensive monthly premiums they just don't have it.

That makes sense. It is a terrible spot, all around.

[kroe1]

I have been thinking about this question for two days. It feels quite irrational that I have purchased insurance for 35 years and never used it. Yet, I do not have the guts to go without. If I had been disciplined enough over the years to put all those premiums into a savings account, I would easily have enough money now to cover many catastrophes. But, statistically speaking, one spends 90% of his healthcare dollars in the last 5 years of life.

 

So, I think it is rational to go without for a young, healthy, non-risk taking family who is not having more children, and can afford the penalty better than they can afford the premiums. In addition, there must not be any genetic anomalies in the family, i.e. diabetes, hypertension, etc. But, this same family must be disciplined enough to set aside, and not spend, a significant amount to be used in a future catastrophe. Every family gets some, it is just a matter of when.

[EmseB]

I'm not sure I understand your last paragraph. Our insurance has a 10k deductible with 100% paid after that. So, if one of my children needed $100k in cancer treatment, my exposure is capped at 10k/year. If her uninsured child needed the same treatment, would she really be able to make the payments? Medical bills are the #1 cause of bankruptcy.

I don't think that last sentence is exactly accurate.

 

http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/

 

Buried in the study is the fact that only 27 percent of the surveyed debtors had unreimbursed medical expenses exceeding $1,000 over the course of the two years prior to their bankruptcy. … Nobody likes to pay $1,000 in medical expenses even when they get two years to do it in, but for most Americans (particularly those with enough at stake to seek the protection of bankruptcy) it is not catastrophic.

[AimeeM]

I'm not sure I understand your last paragraph. Our insurance has a 10k deductible with 100% paid after that. So, if one of my children needed $100k in cancer treatment, my exposure is capped at 10k/year. If her uninsured child needed the same treatment, would she really be able to make the payments? Medical bills are the #1 cause of bankruptcy.

She isn't uninsured, first.

Second, her deductible doesn't pay 100% after meeting it - and I've never seen a plan that is, actually. I mean, I believe they exist, but we've never been on one that pays 100% after deductible.

I absolutely believe that medical bills are the number 1 cause of bankruptcy - but that is generally for major medical and/or chronic/serious illness, no? Not a broken arm.

[QueenCat]

She isn't uninsured, first.

Second, her deductible doesn't pay 100% after meeting it - and I've never seen a plan that is, actually. I mean, I believe they exist, but we've never been on one that pays 100% after deductible.

I absolutely believe that medical bills are the number 1 cause of bankruptcy - but that is generally for major medical and/or chronic/serious illness, no? Not a broken arm.

 

Mine pays 100% after meeting the deductible. And that includes prescriptions.

[Tsuga]

Tsuga, I get what you are saying now.  I see it more as a problem with the costs themselves though, that has been allowed to continue because it has been "invisible" to a certain extent. 

 

Your point is correct that it is an unsustainable system.

 

Yes, absolutely. We have gone without insurance for my husband and even for me when they refused to pay. I totally get it.

 

I just think that the thought that it should be cheaper... well, I don't know. Medicine should be cheaper, but it's not, so given that, we are screwed.

 

Also, insurance requires the healthy to pay without using it. Everyone pays in the average cost and those who are sicker are takers and those who are healthier are givers. That's how it works.

 

Some believe that is not fair and it's not. But I'd rather be healthy and paying in than sick and taking out so I just try to keep that in mind.

[AimeeM]

Mine pays 100% after meeting the deductible. And that includes prescriptions.

Is your deductible 10K, though?

I'm tired and I'm probably rambling in a million different directions, so I apologize ahead of time. I spent my day cleaning up hay bales from a Halloween party, lol. 

 

If my cousin's deductible is higher than she can afford to pay, and much higher than they generally spend on medical, it makes sense to me that she's frustrated that she's essentially losing a LOT of money (a lot to her) - if her family doesn't incur, say, 10K (not sure if that's her deductible; just working with others' numbers) worth of medical expenses, on top of the monthly premium, she isn't "getting anything from" the insurance even if it WOULD pay 100% after she meets the deductible.

 

Our insurance only pays 80/20 after deductible is met, I think - but our family deductible is only a few hundred dollars. 

 

100% coverage after deductible is met sounds great... but if your deductible is much more than your family usually spends in medical, it would seem fairly off-putting.

[Guest]

Is your deductible 10K, though?

I'm tired and I'm probably rambling in a million different directions, so I apologize ahead of time. I spent my day cleaning up hay bales from a Halloween party, lol.

 

If my cousin's deductible is higher than she can afford to pay, and much higher than they generally spend on medical, it makes sense to me that she's frustrated that she's essentially losing a LOT of money (a lot to her) - if her family doesn't incur, say, 10K (not sure if that's her deductible; just working with others' numbers) worth of medical expenses, on top of the monthly premium, she isn't "getting anything from" the insurance even if it WOULD pay 100% after she meets the deductible.

 

Our insurance only pays 80/20 after deductible is met, I think - but our family deductible is only a few hundred dollars.

 

100% coverage after deductible is met sounds great... but if your deductible is much more than your family usually spends in medical, it would seem fairly off-putting.

I get what you are saying and it is expensive. But, I don't get upset when a year without a car accident goes by and I essentially lose money. Or home owners. Or life insurance. Insurance, if you're lucky, will always be a loss financially.

[QueenCat]

Is your deductible 10K, though?

I'm tired and I'm probably rambling in a million different directions, so I apologize ahead of time. I spent my day cleaning up hay bales from a Halloween party, lol. 

 

If my cousin's deductible is higher than she can afford to pay, and much higher than they generally spend on medical, it makes sense to me that she's frustrated that she's essentially losing a LOT of money (a lot to her) - if her family doesn't incur, say, 10K (not sure if that's her deductible; just working with others' numbers) worth of medical expenses, on top of the monthly premium, she isn't "getting anything from" the insurance even if it WOULD pay 100% after she meets the deductible.

 

Our insurance only pays 80/20 after deductible is met, I think - but our family deductible is only a few hundred dollars. 

 

100% coverage after deductible is met sounds great... but if your deductible is much more than your family usually spends in medical, it would seem fairly off-putting.

 

No, $5,000/family. I do understand what you're saying, I'm just pointing out that there are people who  are paying less. And we pay far less than we paid 10 years ago. Too tired to explain my thoughts on the whole issue more, though... just about ready to go to sleep.

 

[Joker]

Our family deductible is $4200 (then insurance pays 80%) and our family out of pocket maximum for the year is $8400 (then they pay 100%). Our monthly premiums for four are less than $100/month. Insurance is definitely worth it for us and we won't be going without unless those figures change drastically.

[Guest]

I did the math for us, and while I would never go without insurance, because you *never know,* I did get the $10,000 deductible "catastrophic" insurance.  ONE year, we met the deductible so I went in for every procedure I needed, counseling, chiropracty, you name it.  

 

I treat it like "insurance," not "coverage."  We pay regular maintenance and tune-ups out of our pocket...but it has *never* equaled what I would have paid in insurance bills.  And, at any rate, some of the stuff I pay for, insurance doesn't cover anyway.  And two of my practitioners give a deep discount for paying out of pocket (it saves them time so they can do more of the work they do, not paperwork for insurance....so they encourage that.)  I'm talking 40% less, paying out of pocket.  

 

Our monthly bill for a family of 3 is $630.  And we are oldish, so that makes a difference.  It was $430 until the Affordable Care Act kicked in.  

 

So, no, I would not go without INSURANCE.  I do go without COVERAGE, if that distinction makes sense.  

 

 

[ktgrok]

I get what you are saying and it is expensive. But, I don't get upset when a year without a car accident goes by and I essentially lose money. Or home owners. Or life insurance. Insurance, if you're lucky, will always be a loss financially.

 

The difference is, I pay that money in premiums all year (12,000 dollars) and then when I get sick, I STILL pay out of pocket, because we haven't met the deductible (just found out that is 6k per person for up coming year). So it's not that I'm upset I paid in and then didnt get sick or injured. I'm upset that I paid in, got sick or injured , and still had to pay out of pocket. If I'm paying a grand a month, I shouldn't have to still pay another $100 to see if my daughter has an ear infection. 

[vonfirmath]

Mine pays 100% after meeting the deductible. And that includes prescriptions.

 

You've got a great plan. Ours pays 80% after meeting the deductible.

 

[TX Native]

Our family deductible is $4200 (then insurance pays 80%) and our family out of pocket maximum for the year is $8400 (then they pay 100%). Our monthly premiums for four are less than $100/month. Insurance is definitely worth it for us and we won't be going without unless those figures change drastically.

This is a wonderful plan. I am curious what you would consider a drastic figure change? If the premiums were to increase, what would be the max you would pay for that same coverage? We had decent coverage that didn't cover a lot of routine things, but enough to be worth it. After ACA, the rates kept increasing and increasing to the point we were paying more for medical insurance than we were for housing. That is when we just couldn't keep paying.

[Guest]

Our family deductible is $4200 (then insurance pays 80%) and our family out of pocket maximum for the year is $8400 (then they pay 100%). Our monthly premiums for four are less than $100/month. Insurance is definitely worth it for us and we won't be going without unless those figures change drastically.

But that isn't a purchased plan, right? Meaning, it is a plan in which an employer is kicking in the lion share of the expense, right?

[NicksMama-Zack's Mama Too]

My best friend pays $1575 a month for insurance (more than her mortgage payment). She is self-employed, so she pays 100% of it. The true cost of insurance premiums is rarely felt for those that have generous employee compensation plans.

[Guest]

My best friend pays $1575 a month for insurance (more than her mortgage payment). She is self-employed, so she pays 100% of it. The true cost of insurance premiums is rarely felt for those that have generous employee compensation plans.

Yep. DH is self-employed. Before ACA, we paid $2k/month for mediocre coverage. Half that feels like a bargain.

[AimeeM]

I get what you are saying and it is expensive. But, I don't get upset when a year without a car accident goes by and I essentially lose money. Or home owners. Or life insurance. Insurance, if you're lucky, will always be a loss financially.

Absolutely - I would imagine she counts her blessings that she doesn't *need* to use the insurance in such a way that it would mean meeting the deductible. 

I will point out that that life insurance premiums and HO insurance premiums are very, very, very small potatoes compared to many health insurance premiums (and deductibles). 

[creekland]

Also, insurance requires the healthy to pay without using it. Everyone pays in the average cost and those who are sicker are takers and those who are healthier are givers. That's how it works.

 

Some believe that is not fair and it's not. But I'd rather be healthy and paying in than sick and taking out so I just try to keep that in mind.

 

Even health share works this way.  If anyone disagrees with the bolded, I'd love to see if we could trade positions...

 

 She is self-employed, so she pays 100% of it. The true cost of insurance premiums is rarely felt for those that have generous employee compensation plans.

 

We switched off insurance (and on Healthshare) when hubby opted to leave his workplace and go in business for himself.  Insurance costs/coverages are astounding.  I've often wondered if more people knew about the true costs... would that lead to more insistence that our country get something affordable for all?

[DawnM]

My best friend pays $1575 a month for insurance (more than her mortgage payment). She is self-employed, so she pays 100% of it. The true cost of insurance premiums is rarely felt for those that have generous employee compensation plans.

 

For an individual?

 

We have a family who paid less than that and were self employed.  

[DawnM]

Even health share works this way.  If anyone disagrees with the bolded, I'd love to see if we could trade positions...

 

 

We switched off insurance (and on Healthshare) when hubby opted to leave his workplace and go in business for himself.  Insurance costs/coverages are astounding.  I've often wondered if more people knew about the true costs... would that lead to more insistence that our country get something affordable for all?

 

Creekland,

 

Do you not get health benefits at your job?

[The Girls' Mom]

I'll never go without health insurance if I can help it.  

Dh had a completely out of the blue life threatening event about 5 years ago.  He went from no pain to a colon rupture in under 12 hours.  The emergency surgery, home health care for a colostomy, and a follow up surgery would have cost us everything.  We would have had to declare bankruptcy and would have lost our home.  As it was it still quite a stretch to pay for what the insurance didn't cover.

So now we keep paying premiums that get higher and higher, and watch our deductible grow.  Dh and dd are both on medications that cost us as much as our mortgage payment each month, that insurance doesn't touch.  We don't come even close to our deductible most years, so every illness is paid out of pocket.  This Christmas season I have a hefty ER bill to pay for my self.  Fun times.  But, I'm still going to pay because if something horrific happens again, I will likely won't lose my house over it.  I do miss the days of co-pays and decent prescription coverage though.

I honestly don't know how families with lower incomes do it.  

[Hikin' Mama]

I have health insurance which covers nothing routine and has a HUGE ($15,000 family) deductible and is still very expensive. I am very thankful we can pay it, because we have it in case a horrible event would occur that we could not pay for. I will absolutely not judge someone else as irrational who is not making the choice to have health insurance which is the price of a house payment. I know many people for whom that kind of expenditure is not possible.

 

I will add that because of the ACA, yearly well-woman checks and mammograms are now covered by insurance even if you haven't met your deductible. However, when the insurance premium goes up every year, that really doesn't provide me, or any other insured person any financial benefit. And for those uninsured, I'm not sure how that helped them either.

[NicksMama-Zack's Mama Too]

For an individual?

 

We have a family who paid less than that and were self employed.

Family.