5 ms·

Is health insurance not an option?

ryanSrich 12y ago
I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure). I understand that my coverage is not all that common, although most providers do an 80/20 split. So for a procedure costing $100k (an ambulance ride and a few nights in the hospital would easily run this high) you'd have to pay $20k out of pocket.
- pcl 12y ago
  Many health insurance plans have a yearly cap on how much you pay out of pocket. So you might pay 20% up to a few thousand dollars, and then get 100% coverage after that.
  - refurb 12y ago
    Actually, with the passage of the ACA, the limit is a requirement for all health insurance plans (a few were grandfathered in, but they will disappear over the next few years). It goes up each year (adjusted for inflation), but as an individual, your maximum out of pocket (includes everything: deductible, co-pays, co-insurance, etc) is ~$6,750.
    - zaroth 12y ago
      See: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
  - justanother 12y ago
    I'll never forget the year I had laproscopic surgery to remove my gallbladder, not because of the experience (although being asked for $3000, in cash, before they'd let me into the OR, was interesting, but welcome to America), but because I ended up hitting my $5000 or so out-of-pocket maximum, between that and co-pays for a few other visits. For the remaining 6 months of the year, I joked that I was living it up Canadian style, and actually visited the doctor to get regular exams and to get medicated for influenza, you know, the things everyone should do, but a large double-digit percentage of Americans can't. Ahh, the good life...
- deleted 12y ago
  [deleted]
- morgante 12y ago
  > I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure). Actually, it's the opposite. For the vast majority of insurance plans, there's an annual limit to your copay. To be honest, if there weren't that limit there would be no purpose to insurance at all.
  - ryanSrich 12y ago
    Do you mean the insurance company has a limit for what they pay? [1]? I can't find a source for the limited co-pay that I think you're suggesting. 1.http://www.hhs.gov/healthcare/rights/limits/ http://www.hhs.gov/healthcare/rights/limits/
    - zrail 12y ago
      It's called "out of pocket limit". After you meet your deductible the insurance company will pay for every covered cost except for the copay and coinsurance. Once you've met your out of pocket max they will pay for every dollar of every covered cost.
      - Tenhundfeld 12y ago
        Except prescription drugs. I am not fully informed on how the ACA affected this, but it used to be that insurance plans could exclude certain classes of prescription drugs from out of pocket max. This is how many people are financially ruined by long-term chronic illnesses. For some less common diseases, medications can easily cost >$10,000 per month – which might not be covered by your health insurance for various reasons or only partially covered. Read the fine print.
  - UrMomReadsHN 12y ago
    A few years ago there was no annual limit on my plan. Not with co-pays, just co-insurance. I ended up needing outpatient treatment almost every day for over a month. Each day was a $25 co-pay. I then moved on to a once a week treatment for close to the next year. I could afford that, many people cannot. I was also lucky to be able to collect my pay while I was getting treated because my employer provided me disability. The cost just skyrocketed beyond belief and while I already maxed out my co-insurance my treatment was billed like an office visit so co-pays are treated differently.
- mikeash 12y ago
  Don't "suspect," know. Your insurance will have an extensive description of their coverage. You should go read it, and if you find it to be inadequate, you should go shopping for new stuff. This is really important and not something to ignore.
gcb4 12y ago
you just have to step in the wrong hospital to break the agreement and end up with massive bill
- mikeash 12y ago
  Any vaguely decent insurance will cover emergency procedures in any hospital.
jianshen 12y ago
There will be things that your insurance plan will just randomly decide not to cover or worse, you just don't have the right kind of insurance for what you need. Both my parents have suffered strokes. My father had to go to a step down unit which requires Long Term Care Insurance, something that I'm willing to bet most people aren't familiar with. Even that, due to changing regulations, your LTCI that you purchased decades ago most likely no longer covers today's prices. Unfortunately you just can't prepare for everything.

I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure). I understand that my coverage is not all that common, although most providers do an 80/20 split. So for a procedure costing $100k (an ambulance ride and a few nights in the hospital would easily run this high) you'd have to pay $20k out of pocket.

pcl 12y ago
Many health insurance plans have a yearly cap on how much you pay out of pocket. So you might pay 20% up to a few thousand dollars, and then get 100% coverage after that.
- refurb 12y ago
  Actually, with the passage of the ACA, the limit is a requirement for all health insurance plans (a few were grandfathered in, but they will disappear over the next few years). It goes up each year (adjusted for inflation), but as an individual, your maximum out of pocket (includes everything: deductible, co-pays, co-insurance, etc) is ~$6,750.
  - zaroth 12y ago
    See: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
- justanother 12y ago
  I'll never forget the year I had laproscopic surgery to remove my gallbladder, not because of the experience (although being asked for $3000, in cash, before they'd let me into the OR, was interesting, but welcome to America), but because I ended up hitting my $5000 or so out-of-pocket maximum, between that and co-pays for a few other visits. For the remaining 6 months of the year, I joked that I was living it up Canadian style, and actually visited the doctor to get regular exams and to get medicated for influenza, you know, the things everyone should do, but a large double-digit percentage of Americans can't. Ahh, the good life...
deleted 12y ago
[deleted]
morgante 12y ago
> I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure). Actually, it's the opposite. For the vast majority of insurance plans, there's an annual limit to your copay. To be honest, if there weren't that limit there would be no purpose to insurance at all.
- ryanSrich 12y ago
  Do you mean the insurance company has a limit for what they pay? [1]? I can't find a source for the limited co-pay that I think you're suggesting. 1.http://www.hhs.gov/healthcare/rights/limits/ http://www.hhs.gov/healthcare/rights/limits/
  - zrail 12y ago
    It's called "out of pocket limit". After you meet your deductible the insurance company will pay for every covered cost except for the copay and coinsurance. Once you've met your out of pocket max they will pay for every dollar of every covered cost.
    - Tenhundfeld 12y ago
      Except prescription drugs. I am not fully informed on how the ACA affected this, but it used to be that insurance plans could exclude certain classes of prescription drugs from out of pocket max. This is how many people are financially ruined by long-term chronic illnesses. For some less common diseases, medications can easily cost >$10,000 per month – which might not be covered by your health insurance for various reasons or only partially covered. Read the fine print.
- UrMomReadsHN 12y ago
  A few years ago there was no annual limit on my plan. Not with co-pays, just co-insurance. I ended up needing outpatient treatment almost every day for over a month. Each day was a $25 co-pay. I then moved on to a once a week treatment for close to the next year. I could afford that, many people cannot. I was also lucky to be able to collect my pay while I was getting treated because my employer provided me disability. The cost just skyrocketed beyond belief and while I already maxed out my co-insurance my treatment was billed like an office visit so co-pays are treated differently.
mikeash 12y ago
Don't "suspect," know. Your insurance will have an extensive description of their coverage. You should go read it, and if you find it to be inadequate, you should go shopping for new stuff. This is really important and not something to ignore.

gcb4 12y ago

you just have to step in the wrong hospital to break the agreement and end up with massive bill

mikeash 12y ago
Any vaguely decent insurance will cover emergency procedures in any hospital.

jianshen 12y ago

There will be things that your insurance plan will just randomly decide not to cover or worse, you just don't have the right kind of insurance for what you need. Both my parents have suffered strokes. My father had to go to a step down unit which requires Long Term Care Insurance, something that I'm willing to bet most people aren't familiar with. Even that, due to changing regulations, your LTCI that you purchased decades ago most likely no longer covers today's prices. Unfortunately you just can't prepare for everything.