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As employers switch to High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars, many people ar
by bryan11 7y ago
As employers switch to High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars, many people are delaying health care in general. A doctor's visit that once cost a co-pay of $30 is now frequently a cash price from $130 to $400, plus more for lab work. With higher costs and much of them unknown in advance, many skip getting things checked until it seems absolutely necessary.
- JumpCrisscross 7y ago> High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars HDHPs are a great deal for anyone who can set aside the deductible’s value in cash. They are a bad default. But a good thing to consider if you can set aside some cash. (The problem with HSA-compatible plans is they have a maximum deductible. They’re thus almost as expensive as non-HDHP plans.)
- maxxxxx 7y agoThere is definitely a psychological problem. When I had a high deductible plan I always set the max aside but considering the potential cost of a doctors visit I often hesitated. 1000 dollars is still 1000 dollars even if you have set them aside beforehand.
- mgkimsal 7y agowhy is it a problem to have a maximum deductible? Relatedly, it seems like there's roughly some 'max' insurance expects you to pay each year, and you can decide whether to take the risk using a high deductible plan, and potentially not have many expenses, but lower premium, or have higher premium up front. 8 years ago, our HDHP was ... $280/month. It's now north of $800, and the deductible went up. Yes, we're a bit older, too but it's still a bit crazy. $280/month, with high deductible, meant that, in a bad year, we might have $15k in expenses before the insurance covered everything else. Now, it's more like $10k per year in premiums, and another $10k+ before insurance really would kick in. Catastrophic need? It's fine - I don't want to have to face a $400k bill. Day to day? This stinks.
- learc83 7y ago8 years ago insurance was allowed to have yearly and lifetime policy limits. They could deny coverage for preexisting conditions and increase your premiums if you developed new conditions. You were also 8 years younger, which makes a big difference despite being only a few years. Many people had policies with $100k yearly limits, any serious condition and they basically didn't have insurance.
- rootusrootus 7y agoAnd these are the folks who complain now that they weren't allowed to keep their plan. So many people had (and have) no idea that they had basically no real coverage, just a policy that looked good on paper.
- JumpCrisscross 7y ago> why is it a problem to have a maximum deductible? Because it means I get to choose between $500 a month with a $6,500 deductible, and HSA-compatibility, and $150 a month with a $8,000 deductible. The latter is a better fit for my risk profile.
- mgkimsal 7y agothose are just deductibles - i didn't understand what "maximum deductible" meant in that context. Unfortunately, my experience, at least in my state, is such that none of the premium options are remotely affordable now. $2000/month with a $1000 deductible per year, or $1300/month with an $11000 deductible. Neither of these are anywhere near 'affordable' in my book.
- peteradio 7y agoI paid 400 dollars to have a doctor tell me to neti pot my nose after having sinus infection for 3 months. Might not be rational but fuck everything about this system. Who is pocketing all this goddamn money?
- lurkertroll 7y agoThe Dr and the insurance company... who else would it be?
- colechristensen 7y agoMalpractice lawyers and insurance, administrative juggling of data and insurance claims, medical equipment manufactures and certification, doctors (by proxy medical schools and loan providers), practices recovering unpaid bills, and real estate owners.
- sexyflanders 7y agoNot to mention pharmaceutical companies charging astronomical prices for prescription meds.
- brudgers 7y agoThrough no fault of the author, this comment thread explains the trick. The article talks about US health care access but the discussion quickly goes off into the weeds of the US health insurance market. As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. All that money is pocketed by businesses run for profit. It's pocketed because it can be. It can be because untreated a sinus infection can kill you. Not a bad business to be in by the standards of business.
- samirillian 7y agoYou make it sound like the business isn't run by humans. Do you consider price gouging sick people and ethical business to get into? If not, please make that a bit more clear in your comment.
- usaar333 7y ago> many skip getting things checked until it seems absolutely necessary True, but isn't that the entire point of hdhps, to minimize unnecessary visits? They still provide no additional cost annual physicals, so you'll get the required yearly screening. Additionally, many offices have no cost phone or email advice. I'm personally quite happy with my family HDHP - and it is nice to have additional retirement savings. But you have to have a savings mindset; many people don't which is what leads to medical spending increases when a refund comes in.
- rootusrootus 7y ago> They still provide no additional cost annual physicals, so you'll get the required yearly screening. Well, until you find out that you can only get the physical for free, and physicals are really not worth much. If you discuss anything at all with your doctor that is outside a routine physical, ask any questions, get any advice, and he codes it when he submits the bill -- it won't be free at all, it'll cost you a couple hundred bucks. So there is incentive not to bother.
- usaar333 7y agoIf that happens, honestly it is time to get a different doctor. :) Good primary care doctors should be incentivized not to do that as it is a great way to churn patients.
- rootusrootus 7y agoThat is a good point. My current doctor hasn't yet done this to me. Past doctors for sure, but my current GP is pretty laid back.
- JonGarfield 7y agoJust because something is minor does not mean it isn't urgent or best tended to sooner rather than later. Strangely enough, those of us with universal health care don't make it a hobby to go to the doctor's office because it is "free" at point of use. We only go when necessary, we just don't have to weigh the possible trade off of food, shelter or savings in the equation that turns minor, easily treated conditions into major, life threatening ones.
- stevenwoo 7y agoThe co-pay was $10 for me in 1989. I had outpatient arthroscopic knee surgery in 1993 and it cost me nothing including X-Rays/MRI/CAT scan (the ortho was having trouble diagnosing it). All the pricing stories I hear today scare the heck out of me.
- exabrial 7y agoActually I find that with my high ductable Health Plan, my visits did not change price. And you failed to mention how you get to save/grow/spend your money tax free. I made 12% on my HSA last great and didn't pay a dime of tax.
- usaar333 7y agoA lot of folks are in California on this board which hurts the investment case for HSAs (state taxes investment and contributions). New Jersey similarly doesn't recognize HSAs.
- chaosbutters314 7y agoI'm even researching medical tourism. The unknown financial risks are too high
- derblitzmann 7y agoAnd if I am wrong please correct me, but I recall high deductible health insurance became more common/prominent since "obamacare". Which i viewed as at best a half measure at the time.