No Employer Supplemented Inurance - 2020 Health/Dental/Vision budget for 56 yo couple

[disneysteve]

Yes. The cost difference between medishare and Obamacare for us was about $30,000 a year back when we made the change. That’s worth a lot of oil changes and brakes

I figure we’ve saved $120-130K in premiums now, after 4-5 years.

That's great. Have you any any significant medical issues or expenses during that time?

[TexasHusker]

From their website:

Medical bills for diagnosis or treatment of a non-congenital pre-existing medical condition, defined as signs/symptoms, testing, diagnosis, treatment, OR medication for a condition within 36 months prior to membership (based on medical records), will ONLY be eligible for sharing as follows:

• Up to $100,000 per Member per year (based on effective date) once the member has been faithfully sharing for 36 consecutive months.

• Up to $500,000 per Member per year (based on effective date) once the Member has been sharing faithfully for 60 consecutive months.

High blood pressure or cholesterol that is controlled through medication or lifestyle will not be considered a pre-existing medical condition for purposes of determining eligibility for future vascular events.

[ua_guy]

there is no free market in healthcare any more, other than in the partially-self-insured space. Maybe that’s why the partially-self-insured market is exploding.

And i don’t believe your “someone” story about Medi-share. Someone is filling you full of it. They haven’t grown exponentially by acting fraudulently.

We are on Medi-Share as are a number of folks we know. No problems that I’ve heard. Even if there were issues, claims denial isn’t any sort of new thing.

Good luck with that, and I hope you never need them. I work in healthcare finance and that denial isn't the first and won't be the last. The biggest problem I see is the families can afford standard insurance but want a cheaper cost and they like the idea of a faith-based organization managing their premiums because it's not big-evil insurance. Most of them don't understand it's not a contract and it's not insurance, and isn't regulated as such. And because the families can afford insurance, they often can't qualify for financial assistance or Medicaid. So these orgs look promising, but when they deny coverage, it falls squarely on the family to foot the bill. And, usually, they end up getting sent to collections

If you're a fan of reading, this is a recent article which explains the shortfalls of paying into plans that aren't actually contracts to provide coverage:

https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html

[TexasHusker]

That's great. Have you any any significant medical issues or expenses during that time?

Yes, my wife has ACDF? neck fusion and it paid all of it. We have a friend currently with leukemia who is in treatment at MD Andersen and its paying with no issues that I know of.

[TexasHusker]

Good luck with that, and I hope you never need them. I work in healthcare finance and that denial isn't the first and won't be the last. The biggest problem I see is the families can afford standard insurance but want a cheaper cost and they like the idea of a faith-based organization managing their premiums because it's not big-evil insurance. Most of them don't understand it's not a contract and it's not insurance, and isn't regulated as such. And because the families can afford insurance, they often can't qualify for financial assistance or Medicaid. So these orgs look promising, but when they deny coverage, it falls squarely on the family to foot the bill. And, usually, they end up getting sent to collections

If you're a fan of reading, this is a recent article which explains the shortfalls of paying into plans that aren't actually contracts to provide coverage:

https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html

I was a hospital executive in finance, revenue cycle, and managed care contracts for 24 years, so I feel that I am fairly well versed on this subject.

I make a lot of damn money, but $33,000 a year for an Obummercare plan that doesn’t pay a nickel until I’ve spent many thousands of dollars ain’t exactly what I call “Affordable Healthcare”. You folks working in the ivory towers of hospitals have zero clue about reality out there.

[LivingAlmostLarge]

it's not easy answer. But this corona virus might make us take a serious look at a national system if things don't work out well.

[Fishindude77]

Appreciate you sharing. That is positively insane. It's disgusting that we allow this to be a reality in a country that is supposed to be the land of opportunity. You're paying more for annually for healthcare than many American's spend on their combined monthly expenses. Hate that employees are forced to work for a corporation just in case something were to happen and they were to need extensive medical care.

My spouse and I are both retired 57 & 60 and are paying a very similar amount per month for insurance coverage. That's just the way it is, if you have a decent income you pay dearly to subsidize those make very little and are paying almost nothing for the same coverage.
Pre ACA you could get the same insurance coverage for about half what you now have to pay.

[amarowsky]

My spouse and I are both retired 57 & 60 and are paying a very similar amount per month for insurance coverage. That's just the way it is, if you have a decent income you pay dearly to subsidize those make very little and are paying almost nothing for the same coverage.
Pre ACA you could get the same insurance coverage for about half what you now have to pay.

This is why USA healthcare system is a laughing stock globally.... We have like .0001% of US population on this forumn. And we have multiple posts about hard working 50-Before Medicare age people, who are paying a freggin arm and a leg a month, just for PREMIUMS. not even for care.... And I almost threw up when I saw the 50K out of pocket maximum....

IMO - This is our #1, solvable issue, hamstringing Americans. By: the cost, the risk to switch jobs and jeopardize insurability, the lack of entrepreneurs or self employed people w/ familys & responsibility who coudln't bare the risk of losing everything for a broken arm/leg/worse, and one of worst things.... our wasted time spent on the phone w/ insurance billing, fighting for cost, fighting for insurance to give you access to healthcare, all the bickering over any $$$ they can get out of your wallet.

Just soo wasteful... when it doesn't have to be. All in the name of preserving the opportunity for someone to make money off of investing in the system.... Just utterly wasteful and inefficient... I hope more people realize, this is one of our Bigger inefficiencies, that CAN be changed. Doesn't make a lot of sense when 40,000,000+ americans are on some kind of support, and the billing for the other 290,000,000 ish americans is different for Each employer/insurer/hospital pending what contract that were able to negotiate to preserve as much "sticker price" on health care that the Board's could.

[LivingAlmostLarge]

This is why USA healthcare system is a laughing stock globally.... We have like .0001% of US population on this forumn. And we have multiple posts about hard working 50-Before Medicare age people, who are paying a freggin arm and a leg a month, just for PREMIUMS. not even for care.... And I almost threw up when I saw the 50K out of pocket maximum....

IMO - This is our #1, solvable issue, hamstringing Americans. By: the cost, the risk to switch jobs and jeopardize insurability, the lack of entrepreneurs or self employed people w/ familys & responsibility who coudln't bare the risk of losing everything for a broken arm/leg/worse, and one of worst things.... our wasted time spent on the phone w/ insurance billing, fighting for cost, fighting for insurance to give you access to healthcare, all the bickering over any $$$ they can get out of your wallet.

Just soo wasteful... when it doesn't have to be. All in the name of preserving the opportunity for someone to make money off of investing in the system.... Just utterly wasteful and inefficient... I hope more people realize, this is one of our Bigger inefficiencies, that CAN be changed. Doesn't make a lot of sense when 40,000,000+ americans are on some kind of support, and the billing for the other 290,000,000 ish americans is different for Each employer/insurer/hospital pending what contract that were able to negotiate to preserve as much "sticker price" on health care that the Board's could.

We need to go fully socialized or fully free market. Why? because now people with covid will have pre-exisiting conditions. The government needs to decouple healthcare with employment since people are becoming more unemployed and I bet we move to a more contractor based system. So we need to allow the market to work by going free or we need to all pay in.

I prefer a single payer but I am open to free market because I know we'd make it okay. I'm okay if that's what the majority of americans want. It's that people are afraid of "giving" up their healthcare not realizing that a single payer or fully free market healthcare would allow them more choice and better access.

I have a coworker who buys insurance and her dr was out of network. So she has $1000 office visit and she wanted a mammogram but it's not covered. Her ex (a doctor) told her to wait until Medicare at 65 in 5 months (april 2021). She said she doesn't like medicare but she pay $1300/month for insurance that is crap. I pointed that out to her and she argued against a socialized system. I am going to bet in 6 months she'll never give up medicare.

[amarowsky]

We need to go fully socialized or fully free market. Why? because now people with covid will have pre-exisiting conditions. The government needs to decouple healthcare with employment since people are becoming more unemployed and I bet we move to a more contractor based system. So we need to allow the market to work by going free or we need to all pay in.

I prefer a single payer but I am open to free market because I know we'd make it okay. I'm okay if that's what the majority of americans want. It's that people are afraid of "giving" up their healthcare not realizing that a single payer or fully free market healthcare would allow them more choice and better access.

I have a coworker who buys insurance and her dr was out of network. So she has $1000 office visit and she wanted a mammogram but it's not covered. Her ex (a doctor) told her to wait until Medicare at 65 in 5 months (april 2021). She said she doesn't like medicare but she pay $1300/month for insurance that is crap. I pointed that out to her and she argued against a socialized system. I am going to bet in 6 months she'll never give up medicare.

I'm not sure what we need to do. But what we currently have, is awful... The only thing it's absolutely insuring, is profits for insurance companies... I don't know that we have been responsible stewards of a "for profit healthcare" system, when we twist in random subsidies, facing Insurance Down to patient. Maybe if we redirect the subsides from, patient Upward towards insurance? Not sure how do distribute that, but it seems more wise then giving it to insurance companies. Just spinning the pricing out of control on the current path.

I just think our healthcare system needs a serious and drastic overhaul. It's not something to be proud of as a country right now. I keep hearing how we land somewhere in the (at BEST) high teens, and (most common) in the low 30's to high 40's globally, as far as "healthcare System efficiency". The fact that we aren't focusing our efforts, as country of American's, towards getting our butts closer to top of the list, is pretty embarrassing. And hard to for me to understand why it's not more focused on. We oughta be figuring this healthcare system infrastructure out, and find a way to make it better.

[LivingAlmostLarge]

I'm not sure what we need to do. But what we currently have, is awful... The only thing it's absolutely insuring, is profits for insurance companies... I don't know that we have been responsible stewards of a "for profit healthcare" system, when we twist in random subsidies, facing Insurance Down to patient. Maybe if we redirect the subsides from, patient Upward towards insurance? Not sure how do distribute that, but it seems more wise then giving it to insurance companies. Just spinning the pricing out of control on the current path.

I just think our healthcare system needs a serious and drastic overhaul. It's not something to be proud of as a country right now. I keep hearing how we land somewhere in the (at BEST) high teens, and (most common) in the low 30's to high 40's globally, as far as "healthcare System efficiency". The fact that we aren't focusing our efforts, as country of American's, towards getting our butts closer to top of the list, is pretty embarrassing. And hard to for me to understand why it's not more focused on. We oughta be figuring this healthcare system infrastructure out, and find a way to make it better.

We spend the most internationally for the worse outcomes. Yes some of it is the fact we don't ration care. So we spend a lot on extreme cases both age and care. But we also just have terrible preventative care because we don't believe healthcare is a right. it's something we have to earn. So the average person does not have good care in the US. it's great to be super rich. It's also good to be super poverty. but the middle? Sucks. You are constantly battling the line trying to figure out cost of care and what you really need.

[disneysteve]

we don't ration care. So we spend a lot on extreme cases both age and care.

Agreed

But we also just have terrible preventative care because we don't believe healthcare is a right.

Also agreed. Until we as a nation commit to healthcare for all, the system will suffer. If you look at every other developed country and their outcomes and stats, you'll find that they all have universal healthcare. You can't have good overall results when you don't have good overall access to care.

It's also good to be super poverty.

I have to disagree with this. Care within the Medicaid system is "free" to recipients but it's not great care. The number of doctors and facilities that accept Medicaid is very limited so access is a huge problem. Long waits are typical even for the most basic care. I spent 17 years working in one of the poorest cities in America so I dealt with that first hand every day.

[LivingAlmostLarge]

Agreed

Also agreed. Until we as a nation commit to healthcare for all, the system will suffer. If you look at every other developed country and their outcomes and stats, you'll find that they all have universal healthcare. You can't have good overall results when you don't have good overall access to care.

I have to disagree with this. Care within the Medicaid system is "free" to recipients but it's not great care. The number of doctors and facilities that accept Medicaid is very limited so access is a huge problem. Long waits are typical even for the most basic care. I spent 17 years working in one of the poorest cities in America so I dealt with that first hand every day.

Maybe but i wonder if someone just above the poverty line or maybe $20k above the poverty without insurance would argue that being able to get medicaid is better than what they have? Which often times as "working" poor is nothing? Or middle class?

[amarowsky]

Maybe but i wonder if someone just above the poverty line or maybe $20k above the poverty without insurance would argue that being able to get medicaid is better than what they have? Which often times as "working" poor is nothing? Or middle class?

The "B" is as soon as you make, "enough" it costs you a huge % of your income just to pay for your own, private insurance.

I was running the numbers for a friend, who is going out to do HVAC work on his own. He quit his company (Insurance benefits started to slide, and he knows he can make 2x+ the pay working for himself).

I did some quick ACA searching for his price. As his Cobra was like $1600 a month to keep up (has a family wife + 4 kiddos, 33 year old dude). The cheapest ACA plan I could find, w/ terrible coverage was like $900 to $1100 a month. To get close to "decent" we were like in the $1250-1500 range. Still w/ a massive deductible (I want to say like 14K? or maybe higher?)

So it seems like "the sweet spot" = Say Under the limit for max subsidy (lets say under $25k per year) or a Corporate / Large-Private employer w/ a benefit plan.
"the sour spot" = You an penalized for "not working for a large employer" and making between $25.1k - $100k, Assuming 1k per month costs (you'd likely get a subsidy up to 40k income). But w/o the subsidy, your talking, at $1000 month for Premium, damn near 50% of your income, going to paying your insurance at $25k per year, to 100k per year, still paying 12% of your income towards insurance. Most people(household avg) lands around $63k annually 12k/63k = 19% tax.... Thats a lot if you chose not to work w/ someone... It's more of a Forced Tax than it is a "right to spend my money where ever". I'd imagine the MASSIVE majority of people spend money on healthcare out of necessity, instead of out of on "elective procedures and medication". Either out of cost, convenience, or other.