I don’t pay anything weekly/monthly for the plan offered by my employer. Our family deductible is $4000. The company very generously covers the final $2000 of the deductible for employees. I still pay every claim from $2001-$4000, but I submit those claims to HR and they cut an expense check to cover it. After $4000(really $2000) for the family I don’t pay for anything beyond co-pays and medication. It’s been like this for the 26 years I’ve worked here, though the deductible has risen every five years. I don’t know if they’ll be able to sustain this through my entire career, but I’m hopeful costs will stay relatively low.
Premiums are high for students, but for us out-of-pocket remains very high since our kid has type 1 diabetes. Insulin, needles, meter, strips, glucose tabs, pump, pump supplies, CGM, CGM sensors, CGM transmitters. Her university health plan doesn’t being to cover her expenses. We tried Med-Cal but the United plan put so many road blocks on the path that it ended up costing more because we had to purchase things for cash that were life-sustaining, while United wanted yet another authorization (we sent preauth for 3 things finally and then they denied because they only asked for one.) So we are back to $4k out of pocket per year PLUS the premium.
This is very true, almost exactly my situation. My Fortune 500 company where I worked for 28 years picked up the tab for the majority of it. My portion, including dental was $6k.
DH now pays through his company for family coverage, which is not subsidized. We pay over $20k a year.
@GKUnion You are very lucky! And a good incentive to stay there. My employer - we are self insured, meaning our premiums must cover our group’s expenditures, though we do have a stop gap loss coverage policy. We are an older and generally unhealthy group. Something like 90% of us are either obese, high BP, and/or have high cholesterol. At our annual employee wellness check to get a premium discount, the nurses love me… Thus, our health insurance rates have always been a challenge. Every year, since 97 at open enrollment, they go over all of the numbers and explain why it’s increasing and what they’ve done to try to minimize the increase for us. It’s never pretty, but I appreciate their openness.
Another piece to the ACA was that the rate had to be “affordable” to employees. Affordable was based off of a certain percentage of the lowest paid employee’s salary. We have lots of people making $8-10/hr, so our individual policy rates are really low now, and the employer must eat the difference. After the ACA was passed, the individual premiums were lower than I paid in '97! However, affordable doesn’t extend to other plans (family, spouse, one child, etc). So, they try to make up some of the loss there. But now that requirement has either been dropped or lessened, so I expect our rates will rise again. How fast and by how much will remain to be seen.
My policy only costs $16,000/year (I pay $4000 in premiums), but we have a $5000 per person deductible, $10K family. The kicker is that we must pay 100% of all drug costs until we hit that deductible. Then it goes to the $10/50 tier system. Hardly anyone in our company chooses this plan because of that. Everyone is on so many medications. We are on none. except for S19’s random albuterol inhaler.
Our company’s $1500 deductible, normal drug tier plan i want to say is around $25,000/year and I want to say the employee portion is $750/month… H’s school system has always been horrible for families. Even in '98, it was $850/month and it didn’t cover ANY wellness, nor did those costs go toward your deductible. All of those 1 week, 2 week, 1 month, etc. baby visits and shots? Good luck. All on you. Nowadays, the plan covers wellness, but is $1800/month. The individual rates are pretty good, because of the ACA requirement.
Forty or so years ago there were no MRI’s, CT Scans etc. Until recently a double room was standard in hospitals, now most new hospitals are built with all single rooms. Technology and patient demands are major drivers of health care cost increases.
YUP! Learned that 10 years ago when I forced the High Cost Provider to give me the cost for H’s colonoscopy. That was just the facilities fee. Did a bit of calling around. Same Doc did procedure at a different facility. The cost was 1/3 of the High Cost Provider.
I and my family refuse CT scans and MRIs frequently. X-rays too.
Seems to me that his main point was to shop around.
No doubt, but most studies show that defensive medicine only adds 1-2% of the total costs. (Yes, it’s still a whole lot of money, but OTOH, not responsible for the annual increases…)
A month ago I stepped in a hole in a parking lot while looking for my car (don’t ask) and rolled my ankle/foot pretty badly. A week later it still hurt to put my weight on my foot.
I remembered hearing on the radio an add for urgent care orthopedic centers. I went and it was great-no waiting for hours in an ER, immediate xrays and diagnosis. Diagnosed with a stress fracture and soft tissue injuries,I’ve been in a boot for a month and have a second follow up appointment next week. Perhaps I could have gotten the boot cheaper through a traditional MD office visit or by ordering through Amazon. I didn’t check or think about it at the time.
Overall, though, I was satisfied with the Ortho urgent care clinic vs. the way I would have done it otherwise (hospital ER to avoid having to wait weeks to get in to see a doc).
Healthcare costs were rising sharply long before ACA came along. For those blaming it on ACA, you might want to look at historical healthcare cost increases.
I do think the pricing - especially being price takers without often having the ability to know costs upfront - is a huge issue and contributor. I can’t think of other industries that work that way.
We pay almost $10k/year for our family of 4 on my husband’s state health plan. And we pay for dental and vision on top of that. 
One of the biggest problems with healthcare is the total lack of transparency in pricing. Most of us don’t know what a certain procedure or medication is supposed to cost, and we can’t comparison shop either.
When you go to an in-network facility for your insurance, expecting to have your treatments covered, but unexpectedly the providers are out of network, the technical term is “surprise bill.” The worst offenders for surprise bills are emergency room docs, but anesthesiologists are also offenders.
Congress is working on dealing with this problem. The House Energy and Commerce Committee has been working on bills. Who knows if anything will happen, but there is some bipartisan consensus that surprise bills ought to be constrained. California has already outlawed them.
Patients being price takers is probably at least partly due to historically patients being price insensitive, since they may not be directly paying for the care (their employer or the government medical insurance is). Of course, as deductibles increase, patients are now more worried about costs, but the price opacity rooted in history now makes it difficult to shop around. Also, shopping around for urgent or emergency care is more difficult than for scheduled procedures (and purely elective procedures like cosmetics and LASIK appear to function more like normal markets).
But then patients may not be that price sensitive, in that (along the lines of the “overtreatment” angle) many will, for example, choose the twice as expensive option that may be only 10% better, especially when the cost is still heavily paid for by someone else.
@Happytimes2001 I hear you. I don’t work for any employer, so I know what you are saying. Paying $1k per month for a lousy plan for me and my spouse. Put our kid under college plan because even if it’s expensive it covers all year and is a lot better than any in private market. Under that insurance, he had a little surgery that was billed $30k and he paid only $200. The cost was BS because a private doc was willing to do it for $8k. The system is so broken I don’t even care anymore. I just consider my payment as helping to subsidize other Americans.
I did a quick calculation, and basically, it costs me around $35k per year for healthcare, real property tax, utilities, car insurances etc, even before buying any foods.
INO US system encourages one to earn less money and get Medicaid coverage.
I’ve also had hospitals/healthcare providers, when I question costs, tell me, “don’t worry, it won’t cost you anything” meaning I personally am not paying for it, the insurance company will. But, in actuality, yes we are all paying for it in higher costs. Lots of unnecessary CYA testing, little transparency.
Even when you try to pin them down, it’s difficult. My spouse was getting his knee looked at. Doctor (supposedly the best around) ordered an MRI. My spouse asked for a cost estimate. It took many calls and several weeks for the doctor’s office to come back with a quote. The practice required full payment upfront. The quote wound up being over $1K MORE than the negotiated rate with our insurer. We get the insurance statement over 1 month after the MRI. Of course, the provider made no effort to pay us back the $1K+ until my husband called the office to request reimbursement and to complain about their lousy estimate. I doubt they would have called or refunded at all if we hadn’t been proactive about it. So, even when you try very hard to pin down a price, you get the run around and bad info. And, we are healthy and educated people. I always wonder what happens to those who are older, more confused, not feeling well. It’s a shambles of a system, IMO.
I had a procedure done for which a full knock-out was recommended. I asked the doc if it could be done with a local shot - of course! I happily agreed. My insurance was billed $1500 for the anesthesia I refused to get, so I called them and alerted them to the fact that I was never under any of that anesthetic. It did not make a difference for me financially one way or the other, so I suspect many folks would simply ignore this kind of overcharging if it did not come out of their pocket.
We moved from PA to MD when I was 32 weeks pregnant with S1. New OB in DC billed my insurance for an entire 40-week pregnancy. I called the insurance to complain and was told, "Why do you care? Maternity care is covered at 100%!
They actually only took care of me for five weeks, as I was early. Nevertheless, it burned me that the DC doc made a tidy profit on me.
And then the insurance company just passes the cost on to your employer (either directly, if the insurance company just does claims processing for a self-insured employer, or indirectly through higher premiums the next year). Or to you if it is your own individual or family policy.
I called insurer to complain that the soft boot I was issued at urgent care was too short and the ortho urgent care issued me a knee length longer boot.
Of course I got a bill for the short boot and complained. Also it was significantly more than I could have purchased the same wrong boot for online. Insurer said we had to pay—they did and I did. Argh! I was fortunate the ortho urgent care never billed me for the longer correct boot! Insurer said it would pay for that as well.