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Ask HN: Bootstrapped US founders, who do you use for health insurance?

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Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#71

Post by samaritan1 »

We use a direct medical expense sharing non-profit. Ours is called Samaritan but there are a few of them. Basically, every month we write a check for about $460 to another member, and the one time we had a hospital stay, we got a bunch of checks to cover the full amount. (It covers everything but $300, but if you negotiate the price down at all, the full amount is covered.)

That's a family plan price and we were looking at 2-3 times that with a big out-of-pocket obligation on the Exchange. So far it's saved us about $10,000 and we really like the communal model.

(Posting under an alt account to avoid giving out too much personal info)

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#72

Post by cylinder »

jbarham wrote: post #36

Do what I did six years ago: Marry an Australian and leave the US. I now pay AU $350/month for private medical insurance for my family of five, in addition to being able to access Australia's world-class public Medicare medical system. It's only when you live outside of the US that you realize it has the worst healthcare system in the developed world (unless you're very rich, in which case it's the best, which says a…

I chuckled at this being the top comment. I did the same and will be joining you soon in Melbourne!

I think the Australian system is the best model for the US to copy, not Denmark or France or what not. But it's never even mentioned here since apparently it's unpatriotic to admit other countries have figured out things we can learn from. It's got the essential public option with the private system running in parallel for those that want it or can afford it (higher incomes are tax incentivized to obtain it). The Pharmaceutical Benefits Scheme is desperately needed in America but the pharma lobby would burn the country down before they allowed that to happen.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#73

Post by mgkimsal »

Mz wrote: post #25
mgkimsal wrote: post #18

Earlier quoted context omitted.

i can't contribute to an HSA without subscribing to a high deductible plan. " basically a membership in a clinic where you pay a monthly fee in order to get cheap access to your doctor... The monthly fee is substantially less than typical health insurance premiums." But... I still need a high-deductible plan to contribute to an HSA to deal with catastrophic issues anyway. high deductible plans are putting colleagues…

Well, you are only giving me partial info here. I am not sure if you merely want to shoot down what I am saying or just what. I have found this if you actually want info: https://directprimarycarejournal.com/2014/06/08/how-does-dir...

How am I giving you only partial info?

"High deductible" plans, on their own, are very unaffordable relative to only a few years ago.

Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a high-deductible insurance plan.

You can say the HD plan is for catastrophic situations, with DPC being day to day, but for most folks I know, especially with families, the HD plan on its own has extremely high costs, and saying "let's also subscribe to a DPC service to keep our costs down!" makes 0 sense for almost all of them.

DPC alone won't deal with "crap, I just got cancer and need $180k of treatment". "regular" insurance can deal with that, but it's still extremely expensive.

Maybe I'm missing something in what you're trying to say.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#74

Post by cylinder »

gaelenh wrote: post #47

I run a bootstrapped non-profit in NYC with two employees (myself and my wife). A bronze plan for my family on the NY marketplace is about $1,200+ month with an $8k-14k deductible. I was hoping to get something through JustWorks, but since it's really just one household in our company, we can't apply for that (requires at least 3 separate insurees). Our combined family income makes us ineligible for subsidies, so I g…

This is why I can't be self employed. The situation is out of control. That's the rate for the small local carriers too with poor provider networks. The major carriers such as United go for $2,000/mo.

Don't forget the 30% coinsurance after you get past that deductible!

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#75

Post by Mz »

mgkimsal wrote: post #73
Mz wrote: post #25

Earlier quoted context omitted.

Well, you are only giving me partial info here. I am not sure if you merely want to shoot down what I am saying or just what. I have found this if you actually want info: https://directprimarycarejournal.com/2014/06/08/how-does-dir...

How am I giving you only partial info? "High deductible" plans, on their own, are very unaffordable relative to only a few years ago. Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a h…

Okay, that's valid.

Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer.

One of the ways DPC lowers costs is by helping patients stay on top of health maintenance so health problems do not escalate. For example, patients with well managed diabetes can live long, healthy lives with few complications. Patients with poorly managed diabetes see high rates of blindess, foot amputations and other horrifying, expense, life altering health complications due to diabetes.

Does that make any more sense?

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#76

Post by JoeAltmaier »

Mz wrote: post #75
mgkimsal wrote: post #73

Earlier quoted context omitted.

How am I giving you only partial info? "High deductible" plans, on their own, are very unaffordable relative to only a few years ago. Your link illustrates this even more. HSA funds can't be used for DPC monthly fees - those are out of pocket costs. You can pay service fees (for services over and above what's provided by regular DPC services) with HSA. However, you can't get money IN TO an HSA without also having a h…

Okay, that's valid. Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer. One of the ways DPC lowers costs…

Only about 40% of cancer can be controlled by our behavior. The rest are indeed random and unpredictable. Its healthy to see ourselves in control of our lives. But at some point it becomes unrealistic, or victim-blaming, or just denial.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#77

Post by vyrotek »

samaritan1 wrote: post #71

We use a direct medical expense sharing non-profit. Ours is called Samaritan but there are a few of them. Basically, every month we write a check for about $460 to another member, and the one time we had a hospital stay, we got a bunch of checks to cover the full amount. (It covers everything but $300, but if you negotiate the price down at all, the full amount is covered.) That's a family plan price and we were look…

This is definitely a starting to become a popular option. I had just commented over in another thread about it https://news.ycombinator.com/item?id=13356900

It's pretty affordable and the nicest part is most of these health shares are ACA exempt so you don't get hit by the fine of not having "normal" insurance.

Do you use a Direct Primary Health provider to cover normal doctor visits and things? I'm a fan.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#78

Post by Mz »

JoeAltmaier wrote: post #76
Mz wrote: post #75

Earlier quoted context omitted.

Okay, that's valid. Here is the thing: Catastrophic health events are not determined by some random number generator that says "Tag! You're it! We decided to fuck with you today!" Study after study after study shows that diet, lifestyle and preventive care (or lack thereof) correlate strongly with whether or not someone winds up with a catastrophic health event. This includes cancer. One of the ways DPC lowers costs…

Only about 40% of cancer can be controlled by our behavior. The rest are indeed random and unpredictable. Its healthy to see ourselves in control of our lives. But at some point it becomes unrealistic, or victim-blaming, or just denial.

I am the wrong person to tell that to. But, you know, the masses will agree with you and when I try tell my true story of overcoming a medical death sentence by changing my diet and lifestyle, every asshole within three million miles piles on to kick the shit out of me and accuse me of being insane, often while mods in various forums largely side with the lynch mob, say it is my fault I am having the shit kicked out of me and turn a deaf ear to the idea that "no personal attacks" should apply equally as much to me as it does to any other member.

So, since I am absolutely sure this is not a discussion that can be had in good faith at all, you just keep on believing whatever you want to believe. Don't let me confuse you with the facts.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#79

Post by JoeAltmaier »

Mz wrote: post #78
JoeAltmaier wrote: post #76

Earlier quoted context omitted.

Only about 40% of cancer can be controlled by our behavior. The rest are indeed random and unpredictable. Its healthy to see ourselves in control of our lives. But at some point it becomes unrealistic, or victim-blaming, or just denial.

I am the wrong person to tell that to. But, you know, the masses will agree with you and when I try tell my true story of overcoming a medical death sentence by changing my diet and lifestyle, every asshole within three million miles piles on to kick the shit out of me and accuse me of being insane, often while mods in various forums largely side with the lynch mob, say it is my fault I am having the shit kicked out…

I'm happy for you. But a personal story is not data.

And the persecution complex is probably not working out very well I imagine.

Re: Ask HN: Bootstrapped US founders, who do you use for health insurance?

#80

Post by Mz »

JoeAltmaier wrote: post #79
Mz wrote: post #78

Earlier quoted context omitted.

I am the wrong person to tell that to. But, you know, the masses will agree with you and when I try tell my true story of overcoming a medical death sentence by changing my diet and lifestyle, every asshole within three million miles piles on to kick the shit out of me and accuse me of being insane, often while mods in various forums largely side with the lynch mob, say it is my fault I am having the shit kicked out…

I'm happy for you. But a personal story is not data. And the persecution complex is probably not working out very well I imagine.

I don't have a persecution complex. Thanks so very much for hypocritically victim blaming right after telling me it is a bad thing to do to other people. Your reply is dismissive and totally in line with every shitty thing ever said to me on the subject and in no way makes good faith discussion a viable option.
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