The cheapest Bronze HSA plan we can get on the exchange would cost us over $13,000 in premiums in 2017 for 2 adults. When you consider the over $11,000 deductible and over $13,000 OOP max, we could pay almost $27000 on healthcare.
DH and I are in our early 60’s, are self-employed, and fairly healthy. I dread how expensive this could get before we qualify for Medicare.
The policies off-exchange are even more expensive for similar coverage.
@“Cardinal Fang” I agree with you and I do not think those with pre-existing conditions should pay more but my family is healthy not only because we are lucky, but also because we eat well and exercise, do not smoke, etc. Additionally, we do not run to the doctor for every ache and pain like many that we know seem to do. For me that is the reason paying the ever increasing premiums is so frustrating.
Rolling a moral dilemma up into what was has always been a voluntary system doesn’t seem to be working. Probably because it isn’t hiding the costs of the solution. That and the fact there’s an enormous amount of nuance to the dilemma, which lends wiggle room for the conscience of the healthy.
A long gone poster stated several times, back when ACA passage was being amicably worked out, that the only thing that was going to trim healthcare costs was ‘ruthlessly driving down pay in the healthcare industry’. Don’t recall that he was really advocating that, just stating what he saw as a fact.
Anyone who believes increasing government regulation is going to do the job, without denying service to the pre-existing segment, the ‘too old for the expense’ segment, to someone… is delusional.
Some people have preexosotng conditions and not through any fault of their own. I have two kids…not smokers, eat healthy, exercise. Neither would be have insurance because if their preexisting conditions.
Regardless of the cost, I am glad they can get health insurance. Neither has employee sponsored health insurance.
@thumper1 and I am also glad they have health insurance that is affordable, it is the folks that do not attempt to monitor their health that frustrates many
I never said it was. Ffordable! I said I was glad they have it! Both will see increases from $275 a month to $375 a month.
@yearstogo --your family is healthy because you are lucky - not because you have a healthy lifestyle. It is true that your healthy lifestyle improves your odd of staying healthy – but previously healthy people develop cancer and other serious, expensive diseases; and healthy and athletic people sustain physical injuries that are expensive to treat.
The advantage healthy people have is that they can opt for low cost, high deductible bronze plans and shouldn’t have a problem with an HMO, given that they rarely need to see any doctor.
Maine already had a law requiring insurance companies to cover pre-existing conditions. So that’s why I’m annoyed with ACA. You can’t blame premium increases in Maine on the pre-existing condition coverage requirement.
I don’t consider $1,309/month for three healthy people to be “low cost.” “High deductible” is certainly correct, though!
http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ has some information on Medicare spending. Looks like government spending on Medicare parts A+B+D is $12,744 per person (figure 6). Note that the payroll tax almost covers part A spending, but parts B and D must be paid for mostly from general revenue (plus some from the premiums).
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html has some more medical care spending statistics. In 2012, per person spending was $18,988 for age 65+, $6,632 for working age people, and $3,552 for children.
Even those of us with chronic health conditions may have many years of very low health expenses, especially when our conditions are under good control.
I know that in our family, most years our total medical expenses are fairly modest, but in the years where we are trying to get evaluations and improve treatment, costs may spike.
Studies have shown that A LOT of VERY expensive (futile) care is given to elders in their last year and month of life. This is one of the many reasons people are encouraged to have advanced directives–so people can come together with loved ones and choose how they want to live and die.
Around here…it’s $10,000 a month for individual coverage per person off exchange. On exchange, it depends on the age of the person. But for a 20 something…it’s $350 plus a month.
I know $1300 a month is a lot, but really…per person, that isn’t awful.
$10,000 per month for individual coverage? ($120,000 annually in premiums?) Where is that, and for whom? Seems implausibly high.
In looking over options for my daughter’s insurance I noted that the ACA has one category for children ages 0-20. Mine is 19. Once they hit 21, the insurance for nearly every plan goes up more than $100 a month, at least with the Blue Cross company we have. The PPO gold plan (which is too expensive already) goes up nearly $160 a month to $430. Those rates look like they stay steady until age 25, when they start to rise each year.
High costs in medical care and medical insurance may seem to be a surprise to many people because:
a. Most people do not directly pay the costs of their medical care beyond small co-payments and deductibles (paid by medical insurance).
b. Most people do not directly pay most of the costs of their medical insurance (subsidized by their employer or the government).
Of course, this also tends to cause people to be price-insensitive when it comes to selecting between courses of action or shopping for the best value (in non-urgent/emergency/monopoly situations). That is likely one of the drivers of upward pressures on cost of medical care in the US. Another likely driver for upward pressure on cost is financial pressure on physicians graduating with $300,000 in medical school debt. Monopoly situations for drugs are another driver of upward cost pressure (and individual differences in drug reaction could result in you facing a monopoly even though the general market may not be a monopoly for drugs targeted to the condition).
Insurance company limitations on reimbursements are the main cost controls that exist today, but they are also the cause of greatly increased bureaucracy (and its costs) and are also extremely unpopular with both patients and physicians who want the procedure with unlimited cost paid by insurance. Most people do not want to self-ration like they do when they are paying for something directly themselves, but resent it when someone else (insurance company) makes rationing decisions that apply to them.
All of the above have been features of the US medical care system for decades. ACA did not change the basic structure of how it all worked (poorly in terms of cost control).
Mentioned upthread was dermatologists emphasizing cosmetic procedures. This is not surprising, since such things are optional procedures paid directly by the patient, creating a much more normal (in terms of economics) market for such things. However, self-pay for regular medical care is likely only to be an option for the very wealthy, due to the high costs that prevail now.
A big symptom of people not knowing that health insurance is expensive is COBRA. I can’t count how many times I’ve heard someone say “COBRA is so expensive.” They act as if COBRA is some kind of super-expensive government plot to rip you off.
They don’t realize, COBRA is how much insurance costs. Under COBRA, you pay what your employer would pay for you. If you’re paying some huge amount for COBRA this year, your employer was paying that same huge amount last year when you worked there. Yeah, it’s a lot of money-- and that same huge amount of money is still what your old employer is paying for all your former colleagues who still work there. Health care costs in the US are astronomical. This is not a plot, it is a fact.
The premium ratio for children 1-20 versus 21-year-olds is set by state law. Children pay one rate, and once a person turns 21 they start paying the higher adult rates, which go up about 2.5% per year of age*.
*except for New York and Vermont where all adults pay the same premium
Re: price insensitivity. In our experience, both sides of the equation, provider and patient, experience this price insensitivity or perhaps it’s suffering from a lack of transparency in pricing?
It’s almost impossible to discuss your next step, weighing medical need and costs, with a provider. No one seems to know what the out of pocket cost will be, and some providers are very uncomfortable discussing what to do within the framework of a budget.
Yes, there is lack of transparency in pricing, since the amount paid by the insurer and amount paid by the patient depends on the pre-negotiated rate between the provider('s organization) and insurance company. These rates can vary based on insurance company and which plan the patient is on. The provider can quote his/her list price, but that is likely to be an artificially inflated price used as a starting point in yearly negotiations with insurance companies (this also means that self-pay patients will either pay inflated list prices, or depend on negotiating discounts themselves, though some providers may offer some amount of discount off the list price to begin with).
Of course, if the patient has high coverage insurance, both the patient and provider have an incentive to disregard costs when choosing which course to take. Indeed, a provider (possibly thinking about his/her medical school debt) may have incentive to recommend the more costly course, even if it does not lead to better medical outcomes.
When there is no transparency, it is really difficult for patients and providers to intelligently discuss costs because neither one knows the costs – list or out-of-pocket until after processing by insurer which may take some time. Even when I get an arc filled, they can’t tell me what I owe until they process my claim or a dummy claim with my insurer.
When friends tried to get price estimates for evaluations at a med center out of state, the estimates were pretty far from the final prices, partly because what is done depends upon the results of testing and partly due to convoluted pricing that keeps being renegotiated.
My husband recently saw the dr and he requested some tests (all appropriate give my husband’s symptoms). My husband called the lab and also our insurance co to find what these tests would cost him. After several phone calls and hours of his time, he learned that he simply could not learn what the cost to him would be. This is just crazy!! There is no transparency whatsoever in our current system. How can anyone make a responsible decision if you can’t know what it will cost in advance?! This system must be changed.