Twinkle0927

Even with high premiums there is still a deductible and a co-pay to pay when you go to the doctor or hospital or dentist. Insurance doesn’t cover every penny.

Pulaski

I think that is a red herring, and would only apply if the business had at least 50 full time employees.
The deductible is what you pay before the insurance pays anything, so if your family insurance has $3,000 individual deductibles and a family deductible of $12,000 then if three members of the family got sick or injured, and incurred $2,500 of medical expenses each, you would have to find $7,500 to pay those bills, because insurance wouldn't pay anything. If a fourth family member got sick or injured and incurred $3,500 of medical expenses you would pay the first $3,000, and your insurance would pay $500. If the fifth family member got sick or injured and incurred $2,200 of medical expenses you would pay the first $1,000 and your insurance would pay $1,200 because 3×$2,500 + $3,500 + $1,000 = the family deductible of $12,000. Obviously all the deductibles reset each year on January first.

You can put upto $6,800, IIRC (and half as much again for a working spouse), of pre-tax income into a Health Savings Account (HSA) and use that to pay qualifying medical expenses each year.

As Twinkle said above, even with higher premiums you would still have a copay, typically $20-$30 to visit a GP and $50-$100 to visit a specialist, and a lower deductible, which might be $1,000/person, $4,000 for the family.

We decided to switch to HD insurance when we realized that we were never reaching the low deductible figure, so we're getting no actual benefit from paying the high insurance premiums. So we switched to HD insurance and put the maximum into our HSA's, so about $6,800 for me each year, and per IRS limits, half as much for my wife, and as we don't have more than two visits to the GP per year, which cost us about $200 including a small amount for prescription (most common drugs are fairly cheap), and on average every other year a visit to urgent care for a fall or bump my daughter had, costing around $400-$500, we are sitting on quite substantial balances in our HSA accounts to meet future medical expenses.

GeoffM

Our copays are as follows (payment at point of service):
Family doctor: $25
Specialist: $45
Urgent care: $25
ER: $100, waived if admitted
Generic prescription: $10 or less
Brand prescription: not covered
Labs: no cost
All the above is dependant on the insurer even agreeing to cover the cost. You can have a doctor say something is medically necessary yet have in untrained minion in Timbuktu decide if your insurance is going to cover it.

Twinkle0927

And it's well and good if your health costs are spread evenly over the year. A doctor visit here. A prescription there. Helps with budgeting. But life doesn't always go like that. Last June I was taken into the hospital by emergency ambulance with yet another TIA and spent a few nights in the hospital. The ICU was $12,000 a night so my entire yearly out-of-pocket was reached in a few hours. That meant I had nothing to pay for the rest of the year but also meant I had to find a good chunk of money at once. In other words, in a few hours I racked up bills that many people don't see if they add up everything from the year together.

Rete

So true. There are some plans that do, however, as mine does. I never have had to shell out a penny for any medical expense from either a doctor, hospital, urgent care or pharmacy other than my copay and this was for both employer sponsored healthcare and at present with medicare and my supplemental healthcare/pharmacy plan.

I count my blessings. Healthcare today is a mine field to navigate and shows the world just how deep politicians are in the pockets of the healthcare and pharmacy business. Everyone should be given the same wonderful healthcare policies that are given to our politicians.

Pulaski

Once you get an established HSA, with some funds in it, the budgeting takes care of itself - the money is just there, waiting for an unfortunate event that creates a medical bill.

We put in money from each paycheck, and get the tax benefit, and the account balance just rolls up each year. We could pay the maximum family deductible every year for probably six years from our HSA's even if we stopped making any additional contributions. Alternatively it could easily absorb the copay on a hospital bill for something as severe as a heart attack.

tom169

Also use mine to pay for dental and vision. Having a wisdom tooth out in a couple weeks.

kins

We have a choice between high deductible HSA (family deductible of $6k then everything covered) or low deductible policy ($250 deductible) with much higher premiums.

We go through a load of scenarios with a spreadsheet each year, and each year we go high deductible.

Typically we hit our deductible each year, but all that means is that we spend the same as what we'd have spent on premiums for the low deductible policy.

In the occasional year where we don't hit our deductible we have money left in our HSA for next year.

kins

Yes - we preload our HSA somewhat at the start of each year just in case, but it wouldn't cover big bills like this. In this case I guess I'd negotiate a payment plan with the various providers. Not a stress you'd need after a big medical event. Sorry to hear you have been having TIAs.

Pulaski

That was the fundamental discovery for us, that the worst case scenario was that we were out of pocket by approximately the same amount whether we chose the traditional or HD policy.

Once we realised that, given our typical medical expenses each year, we were facing a one-way bet - we either break even (with the cost of traditional health insurance), or accumulate upto around $8k tax free in our HSAs, the decision pretty much takes itself.

scrubbedexpat099

Never pays or should never pay to swop money with an Insurance Company.

jcampo

Is there a Kaiser in your area? If you are purchasing health insurance directly, they usually have the most competitive premiums.

Kapan

I recently got married to a US citizen and my AOS is pending. I am also waiting on authorisation to work letter to be approved so i can get a SSN. Should I apply for health insurance now? and if so how do i go about it. It seems to be too complicated to even start. Help please

tom169

Does your spouse have coverage, e.g. through an employer?

If that is the case then the cheapest option is likely to be added to that. Probably get in touch with HR.

If not take a look at a state marketplace.

Kapan

No he doesn't as he is self employed and infact his own cover ran out. He is looking for a new one