Bipartisan legislation aims to get more Americans into high-deductible insurance, but perils would remain.

For thrifty consumers, there’s a lot to like in high-deductible health insurance. The plans offer low monthly premiums and those fees fully cover preventive care, including annual physicals, vaccinations, mammograms and colonoscopies, with no co-payments.

The downside is that plan participants must pay the insurers’ negotiated rate for sick visits, medicines, surgeries and other treatments up to a minimum deductible of $1,500 for individuals and $3,000 for families. Sometimes deductibles are much higher.

Let’s keep it civil.

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snooggums
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131Y

The best time to negotiate your medical care is in the emergency room!

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The only gap is paying the deductible which is no problem if you have a funded HSA.

Wouldn’t a fair amount of people *not *have a funded HSA? The savings power of Americans is not so great; it seems logical to me that a good percentage of people choosing low premium/high deductible plans are doing so because they already can’t afford a large monthly expense, not because they’re flush with cash to fund a savings account.

It sounds like you are able to fully fund your HSA, so it works out great for you, but I’m not convinced that would be the case for most people on these plans.

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That’s the thing about HDHPs…they aren’t really great unless you are also actively funding your HSA. Which, unlike an FSA, doesn’t lose its balance at the end of the year.

At my employer, it also worked out that HDHP Premiums + Funding HSA to cover the whole deductible cost less over the course of the year than PPO Premiums alone.

That, to me, makes the HDHP the best option no matter how you look at it…as long as the HSA can cover your deductible.

And even then, it allows the balance over a certain amount to be invested in funds similar to a 401k, so not only do you not lose the funds at the end of the year, you are also keeping it invested instead of losing value to inflation.

snooggums
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81Y

Car insurance that was universal would set maintenance prices in a way that was cheaper than paying on your own, as proven by every single payer country in the world.

You think that because you are wheeling and dealing that you are getting a good deal, but that is just the impression they want you to have. Countries with single payer or comparable universal medic coverage spend far less (like 6k a year on average) and people pay proportional rates based on income. That isn’t what they pay in taxes, that is the cost averaged out an includes cancer patients and is far lower for lower income earners and higher for high income earners.

You have fallen for the desire to have choice over a working system that benefits everyone and most likely would cost you less.

@tburkhol@beehaw.org
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21Y

Car insurance is to pay for the damage your accident does to other people. You probably have the optional coverage that also pays for damage to your own car, but that’s not why insurance is legally required. You can get repair insurance, but it’s generally ‘not worth it,’ because no one gets it, leading to a small premium pool and minimal risk spread. Kind of like low premium, high deductible plans do for health insurance.

@tburkhol@beehaw.org
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131Y

I think the HSA is a big attraction for the GOP - tax advantaged encouragement to get more people investing more money in stocks. Practically, though it also means more people effectively self-insuring. My deductible is $6500, but I’m allowed to put $3500 into HSA, so 2 years’ HSA savings covers the deductible. Fine, for individuals that are reasonably healthy, but it reduces the pool of money that insurers have to pay benefits to people who do have claims.

Essentially incentivizing individuals to sabotage the system.

The maximum contribution for self-only coverage is $4,150. The maximum contribution for family coverage is $8,300. Those age 55 and older can make an additional $1,000 catch-up contribution.

Are you on a family plan or individual? $6500 seems high for an individual plan, but in either case, you aren’t limited to $3500.

Individual, ACA. $7000 annual premium, $6500 deductible, $6700 max out-of-pocket, so it really only covers catastrophic care. 2023 HSA limit is $3850, up from 3650 in 2022 because of inflation. Please excuse me for rounding - that $350 makes all the difference.

Yeah, that’s rough buddy.

I didn’t realize Max OOP limits were so high. I’d say it’s bullshit that HSA contribution limit isn’t tied to the max annual OOP.

My family OOP is lower than family contribution limit. Hadn’t realized that it could be any other way.

It’s not a hardship, though. I’m healthy with no chronic conditions, and I’ve made the specific choice to go with a HDHP to get the HSA, which I treat like a pre-tax Roth IRA. If some catastrophe happens, it’ll be easier to pay for surgery out of the HSA than a real Roth, but I don’t expect to see doctors until Medicare. I don’t even pay for glasses out of the HSA, because its future value is too great.

This is a perfectly rational individual choice to maximize my personal benefit, but it is terrible policy at the population level. It means there are less resources available for the small minority of people who do have expensive health issues, because I’m diverting my insurance premiums into a retirement fund. This is a recurring theme in right wing policy - it’s fine for people whose lives have no major complications, and people with special circumstances are too few to consider. You have to look out for yourself, and a few people will fall through the cracks, which is a borderline sociopathic attitude.

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