[jitl]

After I left Airbnb, I paid $680 a month to keep my previously employer-paid health insurance. Very cool, loved to have the “freedom of choice” to “participate in the market”. Insurance feels like another little way businesses seek to own people in the US. Want to own yourself? Gotta pay the lease… on your own body.

[koheripbal]

Most businesses would very much prefer NOT to have to deal with employee health plans. Forgetting the cost to them - it's a massive annoying overhead and nightmare to manage.

[lotsofpulp]

Big businesses would prefer it. They already have the huge HR departments to manage it, and it serves as price obfuscation so the worker cannot accurately compare alternative employers’ offerings.

It also works against small businesses that cannot afford to offer health insurance, because the small businesses’ employees cannot purchase health insurance with pre tax money, while the big businesses can compensate people with pretax health insurance that they subsidize.

[acdha]

It’s also a huge disincentive to switching jobs: I’ve known people who took or stayed at jobs they didn’t love just for the benefits who would have preferred to be independent or at small companies but had families, various conditions which didn’t prevent working normally but would have made individual insurance prohibitive. The ACA helped, but not enough and not in every state — especially because large group plans can mean less pushback on every charge.

[sidlls]

That may be true, but it’s not annoying enough for them to prioritize doing anything about it. We’d see them forming coalitions to counter the insurance lobby were it otherwise.

Also I’m skeptical that they don’t actually want it, per the sibling commenter’s remarks. I think bigger businesses are all too happy to have another lever of informational asymmetry to pull to manage their actual biggest cost: salary.

[ChrisRR]

I'm not clued up on US healthcare, but is $680 a lot, average, low?

Does it cover all procedures? Is there an excess? Value of coverage?

[bingidingi]

$680 is probably somewhat typical, I pay $1000/mo for family coverage.

It only covers "medically necessary" procedures as deemed by the insurance company (there are some laws requiring certain procedures to be covered). You have to use specific doctors and facilities.

Typically you have a deductible as well. I have to pay $4,000 out of my own pocket before insurance kicks in. Preventative care (check-ups) are usually covered by a co-pay, mine is $30.

There's usually an out-of-pocket maximum you can pay every year (mine is $9,000). That's the real value of the insurance... if you're in a catastrophic event hopefully it caps your costs (but it doesn't always depending on facility, procedures, etc).

Not sure what you mean by excess or value of coverage, but the answer is probably no.

This does not include dental or vision services.

[ChrisRR]

Medically necessary is still a rule in the UK NHS. It doesn't cover cosmetic surgery unless there's a very good reason (like something affecting a person's quality of life)

I think excess is what you call a deductible, as in if I have an accident in my car, I pay for the first £250 and that's the excess.

The value of the coverage is the maximum amount they'll pay out. I don't know if I have that on my car, but my house contents insurance is insured up to a certain value

[gambiting]

I have insurance with Hastings Direct(because they were cheap) and their 3rd party liability maximum is 25 million pounds. When I was with Aviva last year theirs was 20 million.

I pay £300/year to insure my car.

And yeah, excess in US can be crazy I think. We have private health insurance from work and when I had to use it there was a £100 deductible for the year - I thought that was quite steep.

[martin_a]

> I don't know if I have that on my car

This should be fairly standard around the EU. In Germany this is capped at around 1 million, I think.

Which sounds a lot, but bigger accidents can ramp up a lot of costs...

[handrous]

Low-cost-of-living (that is: undesirable) US state here.

~$1800/m for bad family (married couple + kids) health insurance on the HCA Marketplace. There are no providers beyond the two on there still selling individual insurance to anyone in this state. Other providers are only interested in selling group insurance. Check with insurance providers directly, check with insurance brokers, that's what you hear. No, no-one sells individual insurance in this state except those two providers you've never heard of. Other providers will only deal with businesses or other organizations.

How is the insurance bad? Well, for one thing, it still leaves you with ~$25,000 of risk exposure per year. That is, if things go very poorly (two family members get very sick, basically—nb, because US healthcare is actually, no-joke, insane, "gets very sick" includes "gets pregnant"), you could potentially have to pay $25,000, total, in a given year, on top of the monthly premiums. For another, US insurance plans have a concept of a "network", that is, particular places (hospitals, clinics, testing centers) where the insurance applies. For most insurance, you'll pay most or all costs if you go "out of network". These two providers each have very different networks, such that, for our location, one must choose between having the only children's hospital in the area "in network" (and of course said hospital is itself a "network" of locations and they've bought up everydamnthing related to children's healthcare in our city, because healthcare in the US is batshit insane) or having either of the two nearest normal hospitals to us be in-network.

Oh, and get this: US healthcare plans like to restrict coverage geographically. I think they all have to cover emergency room visits anywhere, but I wouldn't want to see what happens if you get in a bad car wreck, or have a heart attack, or whatever, in another state and can't be moved and are transferred out of the ER to any other part of the hospital. My guess is you get hit with five to six figures of bills that insurance won't touch. That's right: it's probably advisable to get travel healthcare insurance to travel in your own goddamn country. Further, lots of people live within tens of miles of a state border and might routinely travel—even just to commute to work—outside the area their insurance covers. Hope they never need anything but ER care while doing that!

US healthcare: fucked top-to-bottom, and we pay a huge premium for the "privilege" of "enjoying" it, because freedom or something.

[ddingus]

+1 similar scenario here

[lotsofpulp]

Here is a good pdf where you can calculate it for your age:

https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...

Basically, the metal levels are as follows: bronze, silver, gold, platinum are priced so that you the insurance company pays 60%, 70%, 80%, 90% of the healthcare costs.

Of course, this is an actuarial calculation, so it’s only true over a large population over a long timeline. But healthcare is a pretty certain need for everyone, so the cost for healthcare for everyone from age 0 to 65 (when government starts offering it called Medicare) is amortized into health insurance premiums for all of the 0 to 65 years.

The ACA law of 2010 requires a few things which cause the premiums to be adjusted such that younger people subsidize older people. The age rating factor table at the bottom of the linked pdf shows that the riskiest person (64 year old) must cost at most 3x what a 21 to 24 year old costs.

Also, healthy people subsidize unhealthy people because your health condition cannot be taken into account when determining premiums, and men subsidize women since gender cannot be taken into account (due to birthing).

As far as I know, smoking is the only activity that causes one’s premium to be higher.

Let’s take a silver HSA plan for example:

https://www.horizonblue.com/qhp/files/2021/2021_IHC_OMNIA_HS...

The out of pocket maximum for in network providers is $6,550. The premium is $350 per month. So $4,200 premium plus $6,550 out of pocket means a 21 to 24 year old pays at most $11k per year for healthcare if they get into trouble (most will only pay the $4.2k premiums since they are 21 to 24 and probably will not need healthcare).

A complication to these calculations is when employees pay, they can pay with pretax money, and HSA plans allow you to invest your HSA contributions tax free (max of a few thousand dollars per person per year).

[ChrisRR]

Wait, so insurance doesn't even cover 100% of the costs?

So when you hear about those people who get lumped with $100k medical bills they still have to pay like $20k of that on top of your insurance?

What happens if you can't afford the remaining percentage?

[wincy]

You just get the care anyway and get a bill later. It’s all pretty weird.

My wife got a medical bill for $100k after being hospitalized with a life threatening illness years ago called and told them she’d send them $6,000. They said fine and considered it paid in full. The whole system is really bizarre.

My uncle has cancer and no insurance and is on Medicare so all his costs are covered.

My daughter is disabled and is also on Medicare, which is a weird mix of private and public where Medicare pays her primary insurance deductible so if she gets a surgery any surgery or doctors visits we might need after that in the year are going to be free.

I was unemployed when my disabled daughter was born so it didn’t cost us a dime, if I’d been employed it would have cost at least several thousand dollars. I started a job a week later but that didn’t retroactively change the cost owed.

When my disabled daughter was in the NICU for six months while a recruiting firm was technically my employer, she ruined their health insurance plan by racking up a million dollars in fees because they only had 60 or so employees, so the cost was extreme and their health insurance renewal rates were more expensive for a worse plan. I left the plan and used a Health Insurance marketplace plan instead which was cheaper and better than what their organization was offering for the following year.

[rightbyte]

> she ruined their health insurance plan by racking up a million dollars in fees because they only had 60 or so employees

That is really bad. The gov or insurance providers (whoever is responsible) are essentially discouraging employing people with sick family members.

[lotsofpulp]

There was a lot of uproar from middle and upper middle class people when the original healthcare reform proposals in 2009 involved getting rid of all employer sponsored health plans.

Many leaders at that time did want to dump everyone into one insurance market so all healthy people subsidized all sick people, but there was tons of politics blowback from people who already had access to good healthcare who would see their costs rise because until then, they only had to share costs between healthy, employed workers.

Even today, you will read people lamenting how the ACA increased their health insurance premiums. Nevermind that it enabled millions more to actually get healthcare, so obviously the money was going to have to come from somewhere.

[lotsofpulp]

Insurance in general typically has deductibles (auto, home, renters, etc). for which you are responsible for first before the insurance kicks in. This is beneficial since it allows for lower premiums and lets customers pay out of pocket for expenses that they can afford. As a concept, it only makes sense to purchase insurance for expenses that you cannot afford.

>So when you hear about those people who get lumped with $100k medical bills they still have to pay like $20k of that on top of your insurance?

It depends if the person was insured or not, and if the care was provided by healthcare providers who have contracts with the insurance company or not (referred to as being in network).

In the US, when you go to a healthcare provider, the first thing they will ask you to sign is a form acknowledging you know you are responsible for anything your insurance company does not pay for (unless you go to a vertically integrated healthcare / health insurance company like Kaiser Permanente). In fact, health insurance companies are better referred to as managed care organizations (MCOs) in the US.

What happens is people are not capable of knowing what healthcare services they need or do not need. They have no way to determine if they are being ripped of or not. So the MCOs employ legions of doctors and pharmacists and whatnot to double check the doctors performing the services. They also have enough knowledge about pricing healthcare procedures that they are more able to determine a "good" price to pay.

Anyway, after the ACA law, there is an out of pocket maximum for in network providers, so you would not get a $100k bill. the out of pocket maximum for individual / family is $8,550 / $17.1k in 2021:

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

So you would only be liable up to that amount at most in a calendar year for all healthcare you receive from an in network provider. Everything else is paid for by insurance.

>What happens if you can't afford the remaining percentage?

The healthcare provider can choose to go after you for it, since you signed the form that says you will pay them if insurance does not. If you feel your insurance denied the doctor inappropriately, you can appeal to a third party to determine if insurance is obliged to pay it (if it is evidence based medicine, then they most likely have to pay it).

[ghaff]

Decent insurance plans typically have an out of pocket maximum--at least for what they cover.

[lotsofpulp]

All US health insurance plans have an out of pocket maximum, by law per ACA of 2010.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

And they have to cover all non elective procedures.

[PeterisP]

Medical bills are considered to be the most frequent reason for personal bankruptcies in USA.

[ghaff]

Medical illnesses are the most frequent reason. Which can include bills of course. But also includes inability to work, a requirement for ongoing home help, etc.

[bsenftner]

It covers the basics, and very little beyond that.