[PragmaticPulp]

To help non-US people understand this plan:

> but it is the minimum $0 monthly premium plan.

The monthly premium is the cost of the insurance plan. A "$0" premium isn't actually $0, it means that Amazon is paying 100% of the monthly costs of maintaining the insurance, requiring $0 contribution from the employee. Many companies (especially warehouse type operations) are less generous, and require some monthly contribution from the employee to pay the premium. The worst health insurance I ever had required me to pay 100% of the monthly premium, with $0 committed by the company. That company lost a lot of employees.

> I pay 100% of the first $1500

This is the "deductible". The covered person is responsible for 100% of costs until the deductible is met, although there are many exceptions. For example, a routine checkup might be 100% covered ($0 cost), as well as a range of preventative care procedures described by the ACA.

> then 10% of the next $15,000

After the deductible has been met, the person is responsible for coinsurance of additional costs. An extra $5000 procedure would translate to a $500 bill for the patient.

> then 0% of anything over $16,500.

This is where the "out of pocket maximum" or OOPM is reached. In this case, the most the patient could expect to pay is $1500 (deductible) + $1500 (10% of next $15K) = $3000. After that, all excess charges are handled by the insurance company until the insurance year resets.

In short: Health care will cost between $0 and $3000 depending on how many services are used for the year (excluding fully covered benefits like annual checkup, depression screening, breast cancer screening for women, vaccinations, and other services covered for free under the ACA)

[alistairSH]

After that, all excess charges are handled by the insurance company until the insurance year resets.

This is an important point. And a related point.

- Because the OOP payments reset annually, there are perverse incentives to over consume medical care after OOP is reached within a given year. Defer preventative health care until after you have a major medical problem that runs to max OOP, then stack up on preventative care before the year ends.

- Related: Insurance is also tied to employer - if you change jobs, all those OOP values reset (to whatever policies are in place with new employer). This causes friction in the labor market - employer-provided and -subsidized health care prevents people from looking for new employment.

[elyobo]

Thanks for the explanation. Interesting to compare to Australia, which has a public health system, but where I still pay ~AUD2960/year, after government rebates (at current rates ~USD2255/year) for moderately crap health insurance for my family even with no medical usage.

In general, we wouldn't even use it to access private health care, because we would then face substantial fees to use it (I don't know exactly; it varies significantly by procedure, has a $500 deductible, substantial copay, and has maximum caps), however we're taxed heavily for not having a private policy.

Our family income has recently pushed over some thresholds in the rebate system, pushing up prices even more, might have to shop around to find an even more useless but cheaper policy.

Australia's public health system is pretty decent, but the half baked private system bolted on the side is a mess. Lots of people paying thousands for unusable insurance which is just sent directly to private companies.

[lotsofpulp]

Great write up! Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

But I assume a company like Amazon is dealing with a large insurer part of nationwide networks like BCBS.

Also, insurance companies have their own doctors and pharmacists that might disagree with the patient's doctor's treatment plans, and will not cover the healthcare costs for those items without a "prior authorization" from the insurer. There's an appeal system in place for this too. Although, this type of thing exists without health insurers too, it's just employees of the government deciding what to approve and not approve.

[kube-system]

> Only caveat is the limits only apply to in network providers (providers that have made a deal with the insurance company), so if you're on a trip and an emergency happens and you end up in a hospital that's not in network, then you're on your own.

Actually, out-of-network emergency care is an 'essential benefit' under the ACA, so most plans do cover this scenario.

I actually just screwed myself with this recently. I went to an urgent care while traveling (because that is usually cheaper when I'm at home) and it wasn't covered. An urgent care apparently doesn't count as emergency care. It turns out that I should have gone to the (typically very expensive) ER instead -- it would have been covered 100% because of the ACA!

[lotsofpulp]

Thanks for the correction, I did not know that!

Every time I dig into ACA, I find that it’s a pretty decent framework for a non taxpayer funded healthcare system.

[rightbyte]

Why do you prefer the company choosing insurance and paying x% over them paying 0%? Didn't you get the money they didn't pay? I mean what does it matter. Any tax reasons?