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.
Genuine question, because my liberal dad didn’t understand what I meant when I asked - isn’t a deductible basically just another tactic for the insurance company to further weasel out of its responsibilities? I’m pretty sure the deductible of the insurance I get through my job is higher than I already pay them yearly. If my expenses are lower than that, I’ve basically given them ~$1500 for doing literally nothing. I may as well just pay out of pocket, but I can’t since insurance fucked the system for the uninsured.
The idea with high deductible plans is that the ordinary policyholder just pays out of pocket for everything in a normal year, but they’re covered against catastrophic loss in years when they get in a $50,000 car accident or need $750,000 worth of chemo and cancer treatments. The insurance might not provide much for the 30 or 40 years of your life in which you spend less than $1,000 per year on a few doctor’s visits, but it’ll pay for itself that one year when you’re paying $5,000 instead of $1,000,000.
I have an ACA high deductable plan. It is like a no brainer for me. In my state if you pay full cost, it comes down to how you want to phase in costs. High deductable is cheaper if your healthy or if your are very sick and reach the out of pocket max. In between it will depend on your exact details.
My girlfriend just got on a high-deductible plan for the first time and it’s the worst plan I’ve ever seen due to her need for many medications. She changed jobs which is what triggered it and the new plan means her real new income is much less than her old, which we were not expecting since plan details were not available during recruitment. Feels like a bait and switch.
Kind of depends on your exact situation. If your getting a plan through a company they pay a lot of the costs.
If your having to pay for a plan yourself it costs a lot. My wife and I pay about $18000/year for the two of us if you count insurance and out of pocket. It is a good plan, but the cost is kind of scary. I like high deductible in this case because I’d rather pay lower insurance costs even though that may be partially made up by out of pocket. Your going to pay it either way presuming that your paying all the costs. On the other hand, if someone else is paying for part or all of the insurance costs, your conclusions may be different.
Also meds. Check out GoodRX and switch to the specific generic that is the cheapest of the class you need. I save almost $2K a year doing this. That is if you can. If not, drugs are just expensive.
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.
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.
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.
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 Premiumsalone.
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.
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.
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.
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.
That’s the most infuriating part. You pay for it no matter what. You’re gambling that you won’t get sick and you can keep yourself healthy. But the thing this always ignores is the human body ALWAYS breaks down over time. We all need healthcare at some point, whether it’s for a surprise tumor, a pregnancy, or just getting old. You can do everything right and at some point you will still need to engage the system, either for yourself or for a loved one. You’re still going to pay for it.
But heaven forbid you pay for it out of your (shudder) taxes.
I went for a high deductible plan this year. Unfortunately, that made the monthly cost of a single medication more expensive than my entire premium the year before. Huge mistake, since they don’t cover prescriptions AT ALL until deductible has been hit.
You call that a high deductible? I have a deductible that high and I’m being eaten alive by premiums! It never ceases to amaze me that people aren’t out rioting over this rampant thievery.
LIke 15% of the nation is working in healthcare if you include insurance and all the supporting industries. No wonder our health care costs are high. My medical bill has to keep 15% of the nation afloat and most of it ain’t going to the doctors and nurses.
Simplify the system, more doctors and nurses, fewer insurance executives. Single payer would do this.
Seriously, this is one of those topics that can head South quickly, since the legislation on its face is helpful to people with these plans because it expands coverage. On the other hand, the overall situation is ripe for abuse. I can already see the GOP pushing these on folks who can’t afford the deductible as a ‘solution’ and then use it as an excuse not to consider any real reform. It is understandable that Dems are split.
Wow, the number of comments that are just “oh, yeah, these are great, I have one” is… Wow…
No wonder you guys are fucked. Too many of y’all are spending your time supporting shit like this when you could be screaming about single payer, like the rest of the developed world has.
I mean. yeah single payer is nice, however that’s really not even on the horizon for the US. For most Americans, especially those who actually have to know how to fully utilize their insurance (if lucky enough to have it), there’s no benefit for them to worry too much about a single-payer or socialized system. They have immediate needs and immediate solutions. They need to get their prescriptions, their surgeries, and their doctor’s appointments. It’s not “supporting” it, as so much as it is the devil you know.
Practically speaking, compared to standard PPO/HMO insurance, HDHPs are pretty good. If you are low-maintenance health-wise, you don’t pay for your physical, are going to spend maybe couple hundred bucks on sick care and maintenance meds. If you have chronic illness, you will only pay the deductible before your care is 100 percent covered, so a hospital stay would be enough to meet your out-of-pocket max, and everything else is covered 100% by your insurer (whereas the traditional plans have 6-10k limits, the HDHPs are much lower at 1-2k for a person and 2-3 for a family). Especially with HSAs, which are savings/retirement accounts for medical expenses, that some employers will pay into, so basically free money to pay copays, prescriptions, even stuff like aspirin and bandages.
Are you equating ‘single payer’ with universal health care, which most of the world has, or true single payer in the sense that private insurance is effectively outlawed? The latter isn’t quite as ubiquitous, as you know, and is politically a heavier lift in the U.S. compared to the starting point of simply guaranteeing universal basic coverage through something like medicare (state insurance) expansion.
The latter approach, incidentally, has majority support here, if polls are to be believed. I share your astonishment that we have somehow been unable to successfully agitate for it. We could realistically get to where Germany or France are, but somehow … can’t.
The US has basically all 4 major healthcare insurance systems in a single country.
The Beveridge model, used in the UK for its National Health Service, is essentially socialized medicine where the government literally owns the hospitals/clinics and employs the doctors and other professionals who work within that system. It exists in the U.S., too, in the Veterans Health Administration system, and the military’s own hospitals, plus a few smaller systems like the Indian Health Service.
The Bismarck model, common in much of continental Europe, is essentially an “all payer” system where private insurance can still exist, but where all the insurers are paying the providers the same prices for services. Providers are private, but the highly regulated price structure means that private providers can’t just demand their own prices (lest they get cut out of the insurance system entirely). Insurers can be private, too, but all plans must offer specific features, in a way that ends up pushing the pricing and coverage to be fairly uniform throughout the system. This exists in the U.S. in the employer-provided health insurance system, or the “Obamacare” ACA exchanges, where most states regulate what insurance coverage there can be, what prices they can charge, and then all the providers and insurers negotiate prices that end up looking pretty similar. Realistically, someone who gets Aetna through their employer doesn’t have all that different of an experience from Blue Cross Blue Shield or Cigna or United.
The Medicare model, or single payer model, basically puts everyone on one public insurance plan and has that insurance system negotiate prices with providers as a monopsony. Doctors and other providers don’t have much room to just opt out of the system, because in a society where everyone has insurance for no or low out of pocket expenses, doctors won’t be able to charge significant out of pocket expenses for normal services. It’s what Canada has, and what the United States has for everyone over the age of 65, as well as everyone under the age of 18, and most people below the poverty line.
The chaotic market-driven model, where patients and providers essentially shop around and negotiate one-off pricing for services, is basically what remains for anyone not covered by the three models above. It might be how markets work for most other stuff in the western world, but among developed nations only the U.S. uses it in a significant way for health care markets.
Single payer, or Medicare for All, is at least something that one can envision for the United States, but I think it’s far more likely we end up with something like the German/Swiss model, which probably would be the easiest transition among the 3 major universal health care models. One disadvantage is that it doesn’t really look like what we see in other English-speaking countries (Canada’s single payer, UK’s socialized medicine), so there aren’t as many people explicitly calling on the U.S. to adopt models already implemented in other countries.
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Genuine question, because my liberal dad didn’t understand what I meant when I asked - isn’t a deductible basically just another tactic for the insurance company to further weasel out of its responsibilities? I’m pretty sure the deductible of the insurance I get through my job is higher than I already pay them yearly. If my expenses are lower than that, I’ve basically given them ~$1500 for doing literally nothing. I may as well just pay out of pocket, but I can’t since insurance fucked the system for the uninsured.
The idea with high deductible plans is that the ordinary policyholder just pays out of pocket for everything in a normal year, but they’re covered against catastrophic loss in years when they get in a $50,000 car accident or need $750,000 worth of chemo and cancer treatments. The insurance might not provide much for the 30 or 40 years of your life in which you spend less than $1,000 per year on a few doctor’s visits, but it’ll pay for itself that one year when you’re paying $5,000 instead of $1,000,000.
I have an ACA high deductable plan. It is like a no brainer for me. In my state if you pay full cost, it comes down to how you want to phase in costs. High deductable is cheaper if your healthy or if your are very sick and reach the out of pocket max. In between it will depend on your exact details.
My girlfriend just got on a high-deductible plan for the first time and it’s the worst plan I’ve ever seen due to her need for many medications. She changed jobs which is what triggered it and the new plan means her real new income is much less than her old, which we were not expecting since plan details were not available during recruitment. Feels like a bait and switch.
Always ask about benefits during recruiting imo. America is bloodthirsty to fuck over the poors if they don’t ask the right questions.
Kind of depends on your exact situation. If your getting a plan through a company they pay a lot of the costs.
If your having to pay for a plan yourself it costs a lot. My wife and I pay about $18000/year for the two of us if you count insurance and out of pocket. It is a good plan, but the cost is kind of scary. I like high deductible in this case because I’d rather pay lower insurance costs even though that may be partially made up by out of pocket. Your going to pay it either way presuming that your paying all the costs. On the other hand, if someone else is paying for part or all of the insurance costs, your conclusions may be different.
Also meds. Check out GoodRX and switch to the specific generic that is the cheapest of the class you need. I save almost $2K a year doing this. That is if you can. If not, drugs are just expensive.
I thought that high-deductible health insurance plans were already the norm.
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The best time to negotiate your medical care is in the emergency room!
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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.
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.
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 deductiblecost less over the course of the year thanPPO Premiumsalone.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.
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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deleted by creator
That’s the most infuriating part. You pay for it no matter what. You’re gambling that you won’t get sick and you can keep yourself healthy. But the thing this always ignores is the human body ALWAYS breaks down over time. We all need healthcare at some point, whether it’s for a surprise tumor, a pregnancy, or just getting old. You can do everything right and at some point you will still need to engage the system, either for yourself or for a loved one. You’re still going to pay for it.
But heaven forbid you pay for it out of your (shudder) taxes.
I went for a high deductible plan this year. Unfortunately, that made the monthly cost of a single medication more expensive than my entire premium the year before. Huge mistake, since they don’t cover prescriptions AT ALL until deductible has been hit.
You call that a high deductible? I have a deductible that high and I’m being eaten alive by premiums! It never ceases to amaze me that people aren’t out rioting over this rampant thievery.
LIke 15% of the nation is working in healthcare if you include insurance and all the supporting industries. No wonder our health care costs are high. My medical bill has to keep 15% of the nation afloat and most of it ain’t going to the doctors and nurses.
Simplify the system, more doctors and nurses, fewer insurance executives. Single payer would do this.
Oh, in that case I don’t have a comment on the American healthcare system.
Oh, you scoundrel.
Seriously, this is one of those topics that can head South quickly, since the legislation on its face is helpful to people with these plans because it expands coverage. On the other hand, the overall situation is ripe for abuse. I can already see the GOP pushing these on folks who can’t afford the deductible as a ‘solution’ and then use it as an excuse not to consider any real reform. It is understandable that Dems are split.
My immediate thought too🤣
deleted by creator
I haven’t seen a deductible that low in a very long time! As a teacher, I think our lowest deductible offered was 4 or 5K.
Wow, the number of comments that are just “oh, yeah, these are great, I have one” is… Wow…
No wonder you guys are fucked. Too many of y’all are spending your time supporting shit like this when you could be screaming about single payer, like the rest of the developed world has.
I mean. yeah single payer is nice, however that’s really not even on the horizon for the US. For most Americans, especially those who actually have to know how to fully utilize their insurance (if lucky enough to have it), there’s no benefit for them to worry too much about a single-payer or socialized system. They have immediate needs and immediate solutions. They need to get their prescriptions, their surgeries, and their doctor’s appointments. It’s not “supporting” it, as so much as it is the devil you know.
Practically speaking, compared to standard PPO/HMO insurance, HDHPs are pretty good. If you are low-maintenance health-wise, you don’t pay for your physical, are going to spend maybe couple hundred bucks on sick care and maintenance meds. If you have chronic illness, you will only pay the deductible before your care is 100 percent covered, so a hospital stay would be enough to meet your out-of-pocket max, and everything else is covered 100% by your insurer (whereas the traditional plans have 6-10k limits, the HDHPs are much lower at 1-2k for a person and 2-3 for a family). Especially with HSAs, which are savings/retirement accounts for medical expenses, that some employers will pay into, so basically free money to pay copays, prescriptions, even stuff like aspirin and bandages.
Are you equating ‘single payer’ with universal health care, which most of the world has, or true single payer in the sense that private insurance is effectively outlawed? The latter isn’t quite as ubiquitous, as you know, and is politically a heavier lift in the U.S. compared to the starting point of simply guaranteeing universal basic coverage through something like medicare (state insurance) expansion.
The latter approach, incidentally, has majority support here, if polls are to be believed. I share your astonishment that we have somehow been unable to successfully agitate for it. We could realistically get to where Germany or France are, but somehow … can’t.
The US has basically all 4 major healthcare insurance systems in a single country.
The Beveridge model, used in the UK for its National Health Service, is essentially socialized medicine where the government literally owns the hospitals/clinics and employs the doctors and other professionals who work within that system. It exists in the U.S., too, in the Veterans Health Administration system, and the military’s own hospitals, plus a few smaller systems like the Indian Health Service.
The Bismarck model, common in much of continental Europe, is essentially an “all payer” system where private insurance can still exist, but where all the insurers are paying the providers the same prices for services. Providers are private, but the highly regulated price structure means that private providers can’t just demand their own prices (lest they get cut out of the insurance system entirely). Insurers can be private, too, but all plans must offer specific features, in a way that ends up pushing the pricing and coverage to be fairly uniform throughout the system. This exists in the U.S. in the employer-provided health insurance system, or the “Obamacare” ACA exchanges, where most states regulate what insurance coverage there can be, what prices they can charge, and then all the providers and insurers negotiate prices that end up looking pretty similar. Realistically, someone who gets Aetna through their employer doesn’t have all that different of an experience from Blue Cross Blue Shield or Cigna or United.
The Medicare model, or single payer model, basically puts everyone on one public insurance plan and has that insurance system negotiate prices with providers as a monopsony. Doctors and other providers don’t have much room to just opt out of the system, because in a society where everyone has insurance for no or low out of pocket expenses, doctors won’t be able to charge significant out of pocket expenses for normal services. It’s what Canada has, and what the United States has for everyone over the age of 65, as well as everyone under the age of 18, and most people below the poverty line.
The chaotic market-driven model, where patients and providers essentially shop around and negotiate one-off pricing for services, is basically what remains for anyone not covered by the three models above. It might be how markets work for most other stuff in the western world, but among developed nations only the U.S. uses it in a significant way for health care markets.
Single payer, or Medicare for All, is at least something that one can envision for the United States, but I think it’s far more likely we end up with something like the German/Swiss model, which probably would be the easiest transition among the 3 major universal health care models. One disadvantage is that it doesn’t really look like what we see in other English-speaking countries (Canada’s single payer, UK’s socialized medicine), so there aren’t as many people explicitly calling on the U.S. to adopt models already implemented in other countries.
Great perspective. Thanks.