What Should we do? Health Insurance Question

amother

Wed, Feb 08 2023, 9:41 am

NotInNJMommy wrote:

Are you sure it's only 5-10 days in hospital max per year or the copays max out after 5-10 days?

When I was on an HMO, the daily copay for hospital max'd out after a week or so, but th ehealth insurance kept paying.

Similarly, my mother in law now on a medicare HMO was recently in the hospital for over two weeks and her copays max'd out as far as what she had to pay---but the health insurance didn't stop paying.

Positive.
Repeated everything, wrote all down

amother

Oxfordblue

Wed, Feb 08 2023, 9:50 am

amother OP wrote:

Not correct.

If it's not Obamacare, they can. And they do.
Did my HW on this

Their web page explicitly states they are NOT insurance. LOL

Now whether you think that is important is a different issue. Insurance is highly regulated in many aspects even without regulations of Obamacare. For example, they are required to have certain capital to ensure they actually have the ability to pay claims based on their subscribers. You also do not fill out a medical application which is why actual health insurance is required to cover pre-existing conditions.

Wolfsbane

Wed, Feb 08 2023, 9:51 am

NotInNJMommy wrote:

Yup. But again, that's why people go into certain careers/employers---for the bennies...many people do this.

I wouldn't work for an employer with bad bennies cvs.

But yes, not everyone plans for that, for various reasons.

Affordable healthcare really shouldn't be a special privilege that only some people have access to.

Healthcare in America is incredibly expensive, and health insurance is a for-profit industry whose actions are not motivated by concern about the health and well-being of their customers. It's the system that's at fault, and I don't think anyone should feel like they're doing something wrong because they don't have a job that will subsidize high-quality insurance for them.

amother

Oxfordblue

Wed, Feb 08 2023, 10:03 am

I would not even consider the third plan because the purpose of health insurance is to protect you against extreme medical problems like needing to be hospitalized for more than five days. Most people don't need this protection but it is also the reason why people really need the protection because that kind of health emergency or crisis could wipe someone out - ruin them financially for years.

Regarding the first and second, the best way to proceed is to add up the TOTAL amount you would probably pay each year assuming that your child had the same medical issues as the year before. In other words, the cost of the premium, the co-payments and the deductible. There is generally an annual out of pocket cap for each plan. Determine what that annual cap is.

Most people would be able to pay the annual out of pocket cost if the worst happened - it might be difficult but it wouldn't be a financial catastrophe and it is highly unlikely that a relatively healthy 26 year old is going to need that kind of medical attention unless they are pregnant.

The reason I am discussing one year out of pocket is that next January you can switch to another plan which might suit your needs better. For example, it might make sense to move to a higher tier like Platinum. Again, you run the numbers and estimate how much each plan would probably cost based on anticipated medical usage for the upcoming year.

Also consider how you want to access medical providers. An HMO is generally the least expensive but has the most restrictive networks. And even the same insurance company might have different networks depending on the tier - I.e. Platinum might have wider networks than the Bronze plan.

However NO ONE can anticipate some kind of extreme medical crisis which is why the plan which limits hospitalization and visits is completely unacceptable. You can be in a bad accident and need care or you can be like my friend's daughter - a healthy 28 year old who developed a rare lymphoma - required bone marrow transplant and was hospitalized for weeks as well as requiring frequent medical visits of all kinds. The family would have been bankrupt without good health insurance and this a disease out of the blue - nothing in her medical history would have led anyone to think she would have developed cancer that year so young. Sad

NotInNJMommy

Wed, Feb 08 2023, 10:25 am

Wolfsbane wrote:

Thousands of people do have access to it.

Also, many employers, including mine, are self insured. While I carry a common name "insurance", they just do the admin, etc. They do not actually underwrite the expenditures.

I'm not saying anyone is doing anything wrong. If someone doesn't want to pay exorbitant $$$ for health insurance, then they need to plan to have a job that also comes with good health insurance as part of their compensation. Especially when providing for a family, it should be part of the considerations when seeking parnossah, in addition to the pay rate. We can argue all day if it "should" be the case... but for the time being, it has been and will continue to be the case.

Many couples davka ensure at least one is employed with a job that gives good benefits, even if the other makes a better rate of pay elsewhere for this reason.

It's a good and important idea. And someone in their 20s (like OPs DC) is probably in an optimum position in life right now to try to plan for those things with fewer constraints than someone already in the grind of making a family, etc.

Wolfsbane

Wed, Feb 08 2023, 10:29 am

NotInNJMommy wrote:

A 26-year old might already be finished with grad school, and thus locked into a field, if not a specific job. "Just get a better job" is easier said than done for most people.

NotInNJMommy

Wed, Feb 08 2023, 10:34 am

Wolfsbane wrote:

A 26-year old might already be finished with grad school, and thus locked into a field, if not a specific job. "Just get a better job" is easier said than done for most people.

It's not about a better job. It might be a cut in salary, but better benefits.

If people just chase pay rate, and not the big picture, then that's what they get.

There are loads of jobs that may not be in one's initial degree path that they may be qualified for and provide a decent compensation. If one works in NYC, there are loads of state and city jobs, and even federal jobs.

A degree is a tool not a crutch. One uses their skills and qualifications as tools to find the parnossah Hashem has in store for them. One either needs to plan for high deductibles, premiums, etc. or plan for finding ways to use their skills for pay in a situation with good benefits.

If one wants to work a specific job, with a specific type of company, in a specific place, with specific people, well, then, one may not get their pick of ideal compensation packages. It's not wrong. It may mean something else is lacking--and if health insurance benefits as part of the compensation package isn't a significant priority, it may be that. So, folks need to plan for it.

amother

Oxfordblue

Wed, Feb 08 2023, 10:36 am

Wolfsbane wrote:

A 26-year old might already be finished with grad school, and thus locked into a field, if not a specific job. "Just get a better job" is easier said than done for most people.

I think the point is that thinking about "benefits" is part of what people should do when considering how to structure their lives so that they can "afford" things.

Prior to Obamacare it was impossible for many people to get ANY health insurance except through a corporation so people did in fact select jobs or go into fields to get health insurance.

I am not sure what fields don't offer options. In general you can find some kind of job with a government department and those jobs offer excellent health insurance in general. No different than thinking about salary when choosing a field or thinking about different employers.

Wolfsbane

Wed, Feb 08 2023, 10:39 am

OP, DC doesn't have the option of signing up for an Obamacare catastrophe plan? It's usually accessible to people under 30. The premiums should be pretty low. Deductibles are high, but the out of pocket maximum is not unreasonable, so it's a good option for someone who isn't expecting to seek a lot of health care but it still provides protection against extremely high medical bills in the event of a medical emergency ch"v. (Probably not a good idea if DC is female and planning to get pregnant this year, though).

Wolfsbane

Wed, Feb 08 2023, 10:42 am

amother Oxfordblue wrote:

I understand the calculation. I just think there's something inherently broken about a system in which people's access to reasonably priced healthcare is still so tied to their specific employer.

But also, a lot of people will apply to a lot of jobs and not get an abundance of job offers. A lot of people can't pick and choose.

amother

Oxfordblue

Wed, Feb 08 2023, 10:51 am

Wolfsbane wrote:

I am the LAST person on imamother who would defend the US health care system. LOL

However it is what it is and for the foreseeable future, people need to work within its inherent limitations.

I think the only point that is being made is that kids need to be taught the hard realities of life including that medical care in the US is expensive just like they should be taught that "living" itself is expensive and they should be thinking about how they will earn enough to support themselves and their family at the level they want.

Part of the "total" picture for deciding how much you are actual paid are the benefits offered by your employer - and government and large corporations tend to have better benefit packages.

One reason large corporations have better health insurance is because it is less expensive for them PER EMPLOYEE than for a smaller employer but that is just a side issue.

The time for thinking about the economics of life is not when one is 26 and has locked oneself into dead end jobs but growing up.

For example, although I wasn't explicitly given my parents' finances growing up, it was taken for granted that I was going to work and that I needed to factor in salary when making career decisions. Not to the exclusion of all other factors but I did understand that if I wanted a certain lifestyle, then I would have to consider certain fields

Wolfsbane

Wed, Feb 08 2023, 11:05 am

amother Oxfordblue wrote:

I am the LAST person on imamother who would defend the US health care system. LOL

I don't know...in my community I see so many college kids aiming for the same three or so fields (jobs in those fields have generally high income, good benefits, minimal post-college education), and I feel kind of sad for our future.

Wolfsbane

Wed, Feb 08 2023, 11:14 am

OP, I'm not really qualified to give advice, but plan #3 sounds kind of sketchy. In terms of plan #1 vs. #2 - it's about a $2k difference in premiums vs a $3k difference in deductible. (Don't have details on other parts of the plan.) It might make sense to go for the lower-premium plan. In the event that you would have to make use of more expensive medical care, do you/DC b'dieved have the financial ability to pay the deductible's worth in medical costs?

amother

Oxfordblue

Wed, Feb 08 2023, 11:29 am

Wolfsbane wrote:

What fields are those? And why are you sad.

There are certain fields which many college kids go into because of the economic benefits.

On a certain level it is sad if they aren’t suited and would hate the jobs but it is what it is. My experience is that most people aren’t passionate about their jobs but do it because they need the money. If they didn’t need the money they would quit. Not that your job should be absolute torture every second but realistically work is work. 🤷‍♀️