Can't afford health insurance... Options?

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Forum -> Household Management -> Finances

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amother

Burlywood

Mon, Jun 08 2015, 10:45 pm

(we're in Brooklyn)

DH has a small business. We pay close to $2k in health insurance for the family, it's an HSA plan and the benefits are awful. On top of the premium, we're paying through the nose for everything and everything medical.

Realizing that next year with added tuition and insurance rates going up, we just can't afford it! We cannot qualify for Medicaid bc our income is way to high. It's easily over $100k, but when you look at our expenses, it's insane. Our bills just eat us up.

I'm asking if there are options re health insurance. (Please no tangents on responsible spending, let's just assume we're responsible, or cost of living in Brooklyn, etc. We just want to talk about health insurance options really...)

Any suggestions? Any amazing brokers you'd recommend (not your brother, but someone you're a customer of please).

amother

Burlywood

Mon, Jun 08 2015, 10:46 pm

BURLYWOOD?

The best color they could give me is... BURLYWOOD?!

add insult to injury...

gp2.0

Mon, Jun 08 2015, 10:48 pm

If you're under 30 you're eligible for catastrophic insurance.

amother

Jade

Mon, Jun 08 2015, 10:58 pm

Is it 2K a month or 2k a year?

My company this year offered an HSA plan. When I compared it to the standard plan (which I pay over 8K a year, employer pays the rest) I don't think it would have been as bad as it sounded.
I lined up the 2 plans side by side to do the comparison. While the HSA plan has high deductibles - if the total would have gone over 6K then I would have lost out. Because of the out of pocket limits my chances of going over were slim. I only saw a pregnancy or long extended hospital stay push it over.
Are you taking full advantage of the HSA plan - putting pre-tax money aside to play the deductibles. If doing that then you can come out ahead.
I didn't opt for the HSA plan because I was afraid of laying out the money in such large chunks up front but in some situations it makes sense and you can still come out ahead.
My accountant thought we should go with HSA but in the end I was too afraid.

I know that didn't help, but it makes sense to evaluate and compare to a standard plan to see if you are really losing before switching to another plan where the monthly out of pocket is much higher even if you don't use it.

amother

Burlywood

Mon, Jun 08 2015, 11:03 pm

I never heard of catastrophic insurance but googled it and went here. I really enjoyed reading the comments.

http://www.bankrate.com/financ......aspx

The first poster used the word "excremental" as an adjective to describe insurance nowadays and said "Worst piece of political garbage ever foisted on the American public."

DH and I are over 30 btw.

amother

Burlywood

Mon, Jun 08 2015, 11:05 pm

amother wrote:

It's actually about $1800/month. It's an oxford HSA. We do try to reimburse ourselves from the plan. Quick sort of on the topic question - do you need an RX to reimburse yourself for vitamins? Even odd vitamins? (Echinacea, etc - things I really couldn't get an rx for)

nywife

Tue, Jun 09 2015, 7:19 am

Your best bet might be to find a job that offers an insurance plan. They're usually significantly cheaper.

gp2.0

Tue, Jun 09 2015, 7:28 am

How did you get your current insurance?

Did you try signing up for the marketplace and seeing what your options are? (Can't do that until November of this year.)

Amarante

Tue, Jun 09 2015, 10:48 am

No doubt health insurance is expensive. Most people working for large corporations don't realize how expensive it is because the company generally pays all of the costs for the insured and gives a big subsidy for the rest of the family.

However, it does seem as though you can get a better rate than what you are currently paying. I am assuming that as an HSA plan, you have a high deductible and high co-payments. Depending on what your taxable income is, the ability to put money in an HSA account may or may not be economically useful. In many large corporations, there are significant benefits to the HSA account as the employer will either match it or in some way contribute and any money put in is not taxed.

I ran a pricing model in my area (Los Angeles) which is a very expensive health insurance place. NY might be higher but it's hard to believe it would be that much more. I put in a family with two parents in their 30's and three children and the HIGHEST Platinum plan was about $1500. That is a plan with NO deductibles.

You can go on the New York Exchange and plug in your own figures to see what kind of options you have. Beyond the variables of deductible and co-payments, your choice of HMO, EPO or PPO have great impact on the premium.

As others have pointed out, your choice of what type of plan to go with really depends on your medical needs and also your financial condition.

But before speaking to a broker, do your own research on the New York Exchange to see what kinds of plans are available at different price points.

amother

Linen

Tue, Jun 09 2015, 11:01 am

Libertyhealthshare.com $299/month
Not a health insurance, rather a community where health expenses are shared. Exempted from Obamacare
I am a member but I've never actually used the services

Amarante

Tue, Jun 09 2015, 11:22 am

amother wrote:

Libertyhealthshare.com $299/month
Not a health insurance, rather a community where health expenses are shared. Exempted from Obamacare
I am a member but I've never actually used the services

Be very careful of these faith based religious programs because they are not subject to any regulations.

Out of intellectual curiosity, I read about them and they really aren't suitable for most people. They don't cover a lot of stuff and there is also a very low cap on expenses so you would not be covered if you had a high medical expenses. As I understand it, you pay for the medical services and then submit the claims to the "group". I don't know how this one operates, but in some of them people mail their "donations" directly to you so that the company isn't operating an "insurance" company but a self help type of organization. In others, money is sent from the central organization.

I would NEVER place my "faith" in one of these.

gibberish

Tue, Jun 09 2015, 11:38 am

Did you try shopping around on the Marketplace/Obamacare? You may be eligible for subsidies depending on your income

amother

Burlywood

Tue, Jun 09 2015, 2:29 pm

Hi, OP (aka BURLYWOOD) here:

My husband has a very small business, that's why we feel it. Seeking a large corp to work for isn't an option that appeals to us really...

May person in LA continue to benefit from great insurance costs and all the insurance costs in CA stay low. Amen.

(We're in Brooklyn btw.)

The broker we worked with was pretty knowledgeable btw.

What would happen if we just... stopped paying premiums and decided to put the $2k/month into savings instead of insurance?

Amarante

Tue, Jun 09 2015, 2:37 pm

amother wrote:

LA poster again. I am surprised that NY insurance is that much higher than Los Angeles because my insurance costs. Not that I doubt you but I would urge you to find a good broker who can possibly do a real analysis of how to balance premiums/HSA account and how you spend your medical dollars in terms of doctor visits and prescriptions.

It really isn't wise to go without insurance because $10,000 a year saved would be nothing if you had some kind of real medical emergency - Even a broken limb or a simple appendicitis would cost more than that and if one had a real medical catastrophe, you would bankrupt yourself. My father has been in and out of the hospital the past few months and his bills are close to $250,000. This is for NO major surgery like Open Heart or cancer but just because hospitalization is so crazy expensive. Even the ambulance which took him 1/4 mile to the hospital was $1500.00

Also you would have to pay a tax penalty if you don't show proof of insurance.

amother

Seagreen

Tue, Jun 09 2015, 2:40 pm

My husband get insurance from his job and it's costing us a ton. Even with his company paying a bit into it it's our biggest expense but we do have some of us with medical needs that I don't want junk insurance so we pay. Medical is just really expensive these days and you don't want to play with your families helth .

amother

Burlywood

Tue, Jun 09 2015, 9:16 pm

So over $1800 for a family through a small business for an oxford HSA is a crazy amount? The broker came highly recommended...

I can't imagine who would do the analysis you're talking about, LA. I did my own analysis and realized that if we met the in network deductible on the HSA we'd still pay slightly less than we would on a regular plan. I just feel like that would be our job to look into, no one knows our costs like us... I guess I just didn't ask for the right options... Oxford is a good insurance company in our experience, maybe we should go with something more low end... Also I think it's a PPO.

amother

Navy

Tue, Jun 09 2015, 11:35 pm

I'm a small employer in NJ. I have Aetna with a huge deductible/HSA plan, and I pay about 1800 a month for my family plan. If I got rid of out of network benefits and took a plan that requires referrals, I could probably pay a little less, but I refuse to go that route so far. It's insane. But because I have a child with a chronic illness, we spend the deductible in the first four months of the year and then everything is covered after that (but medications are still only covered at 50% even after deductible).

When I crunched the numbers it was worth it for us. And 1800 is considered cheap. The really good plans can be much much more (no deductible, PPO, low copays etc)

Thanks Obama. Healthcare is getting more and more expensive for less and less benefits Sad

MagentaYenta

Tue, Jun 09 2015, 11:55 pm

amother wrote:

...

Thanks Obama. Healthcare is getting more and more expensive for less and less benefits Sad

I bet you hate the lack of lifetime caps, or the fact that you can't be penalized because a family member has a pre existing condition.

Raisin

Wed, Jun 10 2015, 4:04 am

amother wrote:

somebody (a professional in the field) explained to me that more illnesses are required to be covered under obamacare, which is why premiums are going up.

Amarante

Wed, Jun 10 2015, 8:23 am

Health insurance costs are going up to a large extent because medical costs are going up and those costs are passed along by the insurance companies who are in the business to make money. The reason why the American medical system provides more expensive care than any other comparable Western country is well documented - everything costs more in the US because the manufacturers and Big Pharma are allowed to charge more for the same items. It all adds up.

As Raisin and Magenta Yenta wrote, there are some things which MUST be covered - like maternity care. And you must offer coverage to anyone despite pre-existing conditions. And most people didn't realize it until they used it, but many of the less expensive policies sold in the past didn't offer coverage when push came to shove - I.e. very low caps on total payments.

But regarding OP's questions, I don't know how much a medical plan costs in NYC. I had assumed the costs would be similar to a plan in Los Angeles because Los Angeles plans are among the more expensive in the country. You can go to your New York Exchange on-line and put your family in and you should get a good idea of exactly what the options are for your own family and at what cost.

I do agree that one should be an educated consumer and not rely on a broker to just do it all. However, in my experience, I found that a broker was extremely helpful in terms of helping me decide between companies based on his knowledge of network coverage and how the company handled claims.

Again, I can't be sure of the OP's actual situation. However, in my experience dealing with getting pricing on health insurance for a small business, the pricing was actually higher than comparable policies that an individual could buy. At one time, coverage for small businesses provided an alternative for people who couldn't get insurance through the private market because you were guaranteed coverage. But with the Affordable Health Care Act, anyone can get insurance if they buy it during the Open Enrollment Period and the cost of the insurance will be the same as that price charged for anyone in the same age group - I.e. if you are 35 you will be charged the same premium (for the same plan) as every other 35 year old regardless of health or gender (had to substitute gender for s*ex.) Before the passage of the law, women were charged more and if you had ANY kind of pre-existing coverage, you could be charged a HUGE amount because essentially the insurers only wanted to insure people who they thought would never need insurance.

So the OP may (and I say may because I have no idea of premium costs in NY) find it less expensive to not get business insurance but go through the NY Exchange. Also, subsidies for insurance are available only if one buys through the Exchange. The subsidy is based on Adjusted Gross and depending on circumstances could be available to the OP because subsidies are available up to fairly high levels of Adjusted Gross - especially if one has children.

Here is a calculator to approximate the kind of subsidy available - I am not sure if you input Adjusted Gross or Gross but at $100,000 Gross with 3 children, calculated for New York City zip code, family would be eligible for $263 per month tax credit. Cost for Silver Plan (with subsidy) $797 per month. Again, I am not stating these are absolutely correct figures but people should definitely run their own numbers and speak to a broker and their tax accountant.

http://kff.org/interactive/sub.....ator/

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