How to get High-Deductible health insurance?

[TopHatFox]

Turns out the low-deductible plan at work is $193/mo. Even with a $550/mo subsidy. I'll likely keep it this year for a surgery. I'll then change it afterwards.

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Curious, what's the cost range for HD health plan premiums for someone in their 20's and with top notch health habits? What range are the deductibles in?

Where does one even go to purchase insurance?

Do you personally choose a HD health plan? Why or why not? Is the health coverage around the same as low-deductible plans?

[Chris]

Curious, what's the cost range for HD health plan premiums for someone in their 20's and with top notch health habits? What range are the deductibles in?

Due to Obamacare, insurers can't discriminate based on your health, with the exceptions of 1) smoking and 2) age. And those are range-bound. States can further restrict this. I see you're in NY, which does not allow insurers to discriminate based on age at all. So a 25 year old athlete will pay the same premium as a 55 year old fat boozer. More details here.

You can play around with various plan costs with different ages and states at eHealthInsurance.

[TopHatFox]

Wow, that's bullish!t. Where's the incentive for us to have healthy habits?

[IlliniDave]

Wow, that's bullish!t. Where's the incentive for us to have healthy habits?

Well, there's your health for incentive, which when you get to be my age you'll realize is worth a lot more than a few bucks along the way. This is kind of the rub of socialized whatever. One part of the population "sacrifices more" (i.e., coughs up more money) so that another portion gets "more than they deserve" (i.e., more than they can pay for). It's arguably even more unfair because the unhealthy person with low/no income essentially gets it for nothing while the single, young, healthy, high earner gets gouged the most. But medical costs in this country are high and in order for everyone to have access many of us will have to pay significantly more in than we get out. It's the only way the math works. The choice we have is to dig deep and pay up, or accept that some portion of the population (those who can't pay) will have to be refused medical care. Neither choice is pleasant but to me one is better than the other.

One thing you might want to look for is HSA-eligible plans. They are relatively high deductible, though from what I've seen not all high deductible plans are HSA-eligible. But my research has been limited to looking at exchange plans for Illinois, and it's been more than a year since the last time I looked.

[Farm_or]

@Illinidave Well said!

When you get older and realize that you have paid so much for other people's mistakes, it puts a bitter taste in your mouth. When other people pay for your mistakes, there is an unnatural disconnect between cause and effect.

Doing costly mistakes, like living unhealthy, but not suffering the full effect of it creates more irresponsible behavior. This is the dichotomy of a free society. The more freedom, the greater the responsibility. This is why education is so paramount.

I like to think of extreme differences, like the crime rate between Singapore and the typical us city. You can walk the streets of Singapore at night with confidence for your safety. Can't do that in major American cities. One society is very strict and limiting on freedom, the other is very loose.

Absolute freedom should end at the point where your actions affect others. The people that have to pay the consequences of other's behavior should have the authority to correct that behavior. Otherwise, you are expecting responsibility without authority.

[Tyler9000]

Turns out the low-deductible plan at work is $193/mo. Even with a $550/mo subsidy. I'll likely keep it this year for a surgery. I'll then change it afterwards.

Why are you in a rush to change it? Keep in mind that while your company subsidy is $550/month, the government subsidy you will receive on the open market is $0 (because you are offered company coverage). I suspect you're going to have a very difficult time finding cheaper coverage even with a high-deductible plan.

[TopHatFox]

I'm more curious to see what to expect cost and coverage wise from open market HD health plans right now.

$200/mo + Inflation is a non-inconsequential expense to budget for over a life time.

[OTCW]

It's easy in my area. Only one plan available that meets Obama Care criteria. Shopping around for the best/cheapest/lowest deductible/highest coverage/etc/etc. literally takes no time at all.

[IlliniDave]

I'm more curious to see what to expect cost and coverage wise from open market HD health plans right now.

$200/mo + Inflation is a non-inconsequential expense to budget for over a life time.

Well, if your not going to look yourself for actual plans in your state/county, you can probably use something like $550/month as an estimate. That's about what the exchange plans I saw cost (but they were for a different state/county/year). For lower deductible plans you can just take the difference in deductibles, divide it by 12, and add it to $550 for a bogey. But it's possible there are significant price differences between where I was looking in Illinois and NYC.

[Scott 2]

My unsubsidized health care budget, including insurance, is $500/month/person. Getting enough into an HSA to offset that amount is pretty difficult. Contribution caps out around 3250 a year, per person. It's likely your employer insurance is much better than anything you would afford on your own.

With the current state of individual healthcare, the ACA insurance subsidy is critical to making an ERE approach work. If you want US based medical care, anyway.

ACA is a transfer of wealth from the young, rich and/or heathy to the old, sick, and/or poor. The contention over it creates a very real legislative risk anyone attempting to ERE has to consider. It's made me much more conservative in pulling the trigger on any sort of retirement.

When considering healthcare and insurance costs for long term planning, the shape of that price curve is relevant. It used to go up exponentially, until in your early 60's, it could be $1000+ a month. So I see some of the changes as front loading the curve, but it's still expensive.

If ACA and the subsidies survive, they are awesome for people pursuing ERE.

[Laura Ingalls]

Did your employer have other plans available?

Often there are two or three and the cheapest one is HSA compliant.

[TopHatFox]

Wow! A HDHP plan costs FIVE HUNDRED a month!? That's literally almost as much as rent!

Whatever happened to Jacob's old post about buying a HDHP for <$100/mo...

Most days I'm too tired after work to only do my own research. Maybe I'll look more thoroughly on the weekend if I'm not lost in a trail.

@Laura: Nope. They offered two LDHPs with a $550/mo subsidy. One PPO for $600/mo, and an EPO for $200/mo. Both post-subsidy.

[IlliniDave]

Wow! A HDHP plan costs FIVE HUNDRED a month!? That's literally almost as much as rent!

Whatever happened to Jacob's old post about buying a HDHP for <$100/mo...

Most days I'm too tired after work to only do my own research. Maybe I'll look more thoroughly on the weekend if I'm not lost in a trail.

At the risk of sounding divisive, ACA is what happened. ACA both upped the minimum requirements for insurance plans and forced a broadening of risk pools including the inclusion of people formerly deemed "uninsurable". That is part of the impetus behind repealing ACA, to bring back the cheaper plans that could be offered before county-wide blind pooling and the coverage requirements imposed by ACA hit the market.

[TopHatFox]

This is enough of a reason to expatriate after FI

Couldn't we just have different risk pools and benefit the already-wealthy like we do with everything else?

[Chris]

This is enough of a reason to expatriate after FI

Since ACA rules are income-based, you'd probably be eligible for a subsidy. GCC has a detailed post.

[jacob]

Most days I'm too tired after work to only do my own research. Maybe I'll look more thoroughly on the weekend if I'm not lost in a trail.

Ahhh, I think this identifies the problem as a standard Ten-T error. People who are tired or "lost" inevitable pay more #salesmanship101

Consider this a research problem with real life dollar/death consequences for correct and incorrect answers. In terms of priorities this [eventually] will be more important than a completing a work-assignment or a college essay for a rubber-stamped A. Being highly educated should allow you to read the legalese of the contract, do the math of the tax equations, and to find the answers and understand the issues wrt most of the following. Unfortunately, for all of us, the average person is not sufficiently smart && motivated to do this.

Start with these questions:

• How do you [personally] buy health insurance in your county/state? (Because the answer is different all over the country so asking people here what they pay is useless)
• What is ACA?
• Is it possible to buy non-ACA complaint plans? How? Where?
• How do the ACA subsidies vary according to income. What are the breakpoints that determine how much you pay AFTER subsidy depending on whether your salary is $100k, 75k, 50k, 25k or 0k.
• What is a pre-existing condition?
• What kind of pre-existing conditions might you acquire as a so-called "healthful" person in your twenties? thirties? .... sixties?
• If you get sick enough to lose your job and permanently acquire a pre-existing condition that leaves you unable to work that hard or simply forces you into a more median-paying or part-time or non-salaried job, what, if any, kind of health-insurance would be available to you then? What cost? (Again it varies by state and county)
• How much does a it cost to treat a broken ankle out of pocket in where you live? In NYC? In New Jersey? In Kansas? In one of those third-world tent-clinics they put up in progressive states like Virginia maybe coming to a parking lot near you soon?
• If you break your ankle, say, to which extent will you feel like hobbling around on your one good foot shopping for the best price for x-rays and a cast with your hard-earned HSA savings?
• To which degree are you an informed medical-consumer? For example, how much do you know about ankle surgery? What about head trauma?
• Same situation: Presuming they're not tired from working 16+ hour shifts to pay off a quarter mill in student loans; to which extent do you think doctors and specialists will be able or inclined to assist you in your shopping efforts by educating you or providing referrals and/or upfront costs for treatment plans around the state/country/world so you can save 15% at their competitors?

These are useful questions and might serve, not as an indication of what will be on the test, but because the process of finding out the answers would make learn enough about how the system currently works so you don't get railroaded when you wake up in ER with a potentially permanent neck-injury because a branch fell on your head when you were out lost on the trail.

[Scott 2]

500 a month is my healthcare budget, it includes actually seeing the doctor and dentist, getting medicine, etc.

Total cost of healthcare, with acceptable access, is what needs to be optimized, not the price of the insurance policy. Cheap doctors can be very expensive over time.

For my purposes, a year ago, insuring a couple with a silver PPO plan was quoted at $8k a year.

If as a couple, we keep adjusted gross income between 22268 and 24030, 1.4-1.5x the federal poverty level, the subsidy would cover $7k of that. My understanding is earn less, and we fall into the means tested (net worth tested) Medicaid pool. No subsidy, and no Medicaid, until the money runs out. Earn more, and the subsidy rapidly diminishes. The Medicaid part varies by state, I believe.

So part of optimizing the retirement plan is now hitting the income sweet spot. Good thing I didn't use that Roth 401k option, for instance. Because then I would have no AGI.

An area where this sucks for me personally, is if I want to retire, but my wife keeps working. Our finances are separate, her job offers no insurance, and her income takes us out of the subsidy pool. So I'd be paying unsubsidized prices anyway.

If this means sick people get medical care, I am ok with it, but it definitely complicates planning. Much easier to flow with the system.

[BRUTE]

doesn't Olaz have a job now? brute was under the impression that the health insurance through jobs was most often better and cheaper than the ACA plans.

[EdithKeeler]

I have a high-deductible plan at work. Cost is about $150 a month to me. Employer pays the rest. Employer also puts $800/year into my health savings account, too.

[TopHatFox]

$193/mo is sounding pretty great right about now. Hopefully, healthcare is "fixed" 5 years from now.