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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?

#101

Post by mrfusion »

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…

Is it hard to get the aca exception with these? Any risk of having to pay the penalty?

Also is there any guruntee you wouldn't go bankrupt for a major medical issue? Are they very reliable?

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

#102

Post by mrfusion »

joezydeco wrote: post #70
ThrustVectoring wrote: post #60

Earlier quoted context omitted.

This is actually a pretty significant incentive issue with health insurance. Companies are encouraged to not choose the most comprehensive plan, so that their dual-income married employees choose to use the other company's insurance.

My company actually adds a surcharge to the family plan if your spouse works and is offered health insurance through their employer.

How would they know?

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

#103

Post by samaritan1 »

mrfusion wrote: post #101
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…

Is it hard to get the aca exception with these? Any risk of having to pay the penalty? Also is there any guruntee you wouldn't go bankrupt for a major medical issue? Are they very reliable?

No issue getting the exception. These programs are explicitly mentioned in the ACA regulation and tax prep software supports them.

No guarantees. You can't take anyone to court to make them pay your bills. However, if you don't make your monthly payment, you've effectively cancelled your membership and the person who was supposed to receive your check gets it from someone else so they're still made whole. Personally, I am more comfortable with the risk of a long-running voluntary system failing than I was with the risk of insurance deciding to screw me on coverage, accidentally getting out-of-network care, etc. But I looked into it for a couple of years before I reached that conclusion.

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

#104

Post by joezydeco »

mrfusion wrote: post #102
joezydeco wrote: post #70

Earlier quoted context omitted.

My company actually adds a surcharge to the family plan if your spouse works and is offered health insurance through their employer.

How would they know?

Not quite sure. I suppose it's an honor system until they find out otherwise. Lying on an insurance application is an incredibly effective way to lose your coverage completely.

Your coverage is essentially $X higher until you sign the waiver saying "I affirm that my spouse has no other coverage options from another employer". That's how you're obligated to the policy.

HIPAA also doesn't prevent an employer from finding out if your spouse has insurance options elsewhere.

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

#105

Post by tptacek »

WillPostForFood wrote: post #100
nradov wrote: post #99

Earlier quoted context omitted.

I don't think you understand how insurance works. What do you think would have happened to you if you got a serious chronic medical condition and exceeded your lifetime coverage limit on the old (pre ACA) policy?

I would happily trade a lifetime coverage limit for a reasonable deductible so I can afford healthcare today for myself and my family. Your arrogance is astounding - ACA is a disaster for the vast majority of self insured people, and there were cheaper easier solutions for the small number of people who have chronic issues and lifetime coverage caps.

There are no serious chronic medical conditions in my family and the ACA has been a lifesaver for us, the only reason we were able to start our last company. That's because before the ACA, no individual health insurance plans were available to our family at any cost, due to "do-not-cover" lists (for instance: our daughter, now a teenager, had an unexplained seizure when she was 4 years old). There were millions of families in the same situation.

Further: as an employer, I'm aware that what I pay for an ACA silver plan is ballpark comparable to what we paid as employers for family coverage in our small group plan. The ACA plan is more expensive, but nothing resembling twice as expensive.

The ACA has not been a disaster for individual entrepreneurs. It has been anything but.

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

#106

Post by sethev »

tptacek wrote: post #105
WillPostForFood wrote: post #100

Earlier quoted context omitted.

I would happily trade a lifetime coverage limit for a reasonable deductible so I can afford healthcare today for myself and my family. Your arrogance is astounding - ACA is a disaster for the vast majority of self insured people, and there were cheaper easier solutions for the small number of people who have chronic issues and lifetime coverage caps.

There are no serious chronic medical conditions in my family and the ACA has been a lifesaver for us, the only reason we were able to start our last company. That's because before the ACA, no individual health insurance plans were available to our family at any cost, due to "do-not-cover" lists (for instance: our daughter, now a teenager, had an unexplained seizure when she was 4 years old). There were millions of fa…

I'll throw another anecdote in there. The small consulting company I worked for up until 2014 switched over to reimbursing us for a portion of what we paid for an ACA plan. Before that we had a (very small) group policy that was incredibly expensive because of health problems that one person had. The ACA saved thousands of dollars in that case (without subsidies) just by having access to a larger risk pool.

I've heard people complain about ACA wrt to small business but it's always very vague general terms whereas the specific cases I know about were all positive.

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

#107

Post by WillPostForFood »

tptacek wrote: post #105
WillPostForFood wrote: post #100

Earlier quoted context omitted.

I would happily trade a lifetime coverage limit for a reasonable deductible so I can afford healthcare today for myself and my family. Your arrogance is astounding - ACA is a disaster for the vast majority of self insured people, and there were cheaper easier solutions for the small number of people who have chronic issues and lifetime coverage caps.

There are no serious chronic medical conditions in my family and the ACA has been a lifesaver for us, the only reason we were able to start our last company. That's because before the ACA, no individual health insurance plans were available to our family at any cost, due to "do-not-cover" lists (for instance: our daughter, now a teenager, had an unexplained seizure when she was 4 years old). There were millions of fa…

In California, for an individual, the ACA is minimally 3 times as much, for substantially less coverage.

Pre-ACA, we paid $400 a month for $2000 deductible PPO plan. We now pay $1200 a month for $12,000 deductible PPO, and had to switch doctors.

Go check the numbers for a bronze plan (for 3) for yourself: http://www.coveredca.com/

It is ridiculous is to say a good solution to pre-existing conditions and "do-not-cover-lists" is raising rates and deductibles 3x. It is grossly wasteful, inefficient, expensive solution.

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

#108

Post by tptacek »

WillPostForFood wrote: post #107
tptacek wrote: post #105

Earlier quoted context omitted.

There are no serious chronic medical conditions in my family and the ACA has been a lifesaver for us, the only reason we were able to start our last company. That's because before the ACA, no individual health insurance plans were available to our family at any cost, due to "do-not-cover" lists (for instance: our daughter, now a teenager, had an unexplained seizure when she was 4 years old). There were millions of fa…

In California, for an individual, the ACA is minimally 3 times as much, for substantially less coverage. Pre-ACA, we paid $400 a month for $2000 deductible PPO plan. We now pay $1200 a month for $12,000 deductible PPO, and had to switch doctors. Go check the numbers for a bronze plan (for 3) for yourself: http://www.coveredca.com/ It is ridiculous is to say a good solution to pre-existing conditions and "do-not-cover…

What year, how many people, and what provider? We insured California employees and I have some idea of how much we paid to do it.

For instance: are you comparing individual market PPO premiums from 2009 to 2016 ACA individual market PPOs? That 2009 PPO didn't have guaranteed-issue, meaning that your insurer got to cherry pick you out of the population. Your number is a more accurate comparison if it's from the small group marketplace (where we had to buy insurance from), because small group coverage had guaranteed issue.

Also worth mentioning: California premiums had double digit growth in 2009 and 2010, both prior to ACA.

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

#109

Post by WillPostForFood »

sethev wrote: post #106
tptacek wrote: post #105

Earlier quoted context omitted.

There are no serious chronic medical conditions in my family and the ACA has been a lifesaver for us, the only reason we were able to start our last company. That's because before the ACA, no individual health insurance plans were available to our family at any cost, due to "do-not-cover" lists (for instance: our daughter, now a teenager, had an unexplained seizure when she was 4 years old). There were millions of fa…

I'll throw another anecdote in there. The small consulting company I worked for up until 2014 switched over to reimbursing us for a portion of what we paid for an ACA plan. Before that we had a (very small) group policy that was incredibly expensive because of health problems that one person had. The ACA saved thousands of dollars in that case (without subsidies) just by having access to a larger risk pool. I've hear…

Look at the data then - ACA plans are going up 22% in just this year. And that doesn't account for the skyrocketing deductibles that effectively make the plans worthless except for catastrophic illness. It may have bailed out a some people with pre-existing conditions, but in totality, it isn't a money saver, it is crushing people that have to buy individual plans, and that's not an anecdote, it is clear from the data on the cost of plans.

http://abcnews.go.com/Health/health-care-premiums-rising-oba...

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

#110

Post by tptacek »

WillPostForFood wrote: post #109
sethev wrote: post #106

Earlier quoted context omitted.

I'll throw another anecdote in there. The small consulting company I worked for up until 2014 switched over to reimbursing us for a portion of what we paid for an ACA plan. Before that we had a (very small) group policy that was incredibly expensive because of health problems that one person had. The ACA saved thousands of dollars in that case (without subsidies) just by having access to a larger risk pool. I've hear…

Look at the data then - ACA plans are going up 22% in just this year . And that doesn't account for the skyrocketing deductibles that effectively make the plans worthless except for catastrophic illness. It may have bailed out a some people with pre-existing conditions, but in totality, it isn't a money saver, it is crushing people that have to buy individual plans, and that's not an anecdote, it is clear from the da…

Non-ACA plans went up by a comparable amount in the years just prior to ACA; that was one of the reasons the ACA had the urgency it did at the time.

Our Non-HDHP non-HSA-qualifying premiums today are more expensive, but not nearly twice as expensive, as the small group market was in 2009. But the trajectory we were on prior to the ACA was double-digit annual premium increases, so it's tough to say how much of that is ACA.

Remember also that these "regulations" we're talking about are primarily things like actuarial value, spending caps, community rating, and guaranteed issue. That's not red tape!

Obviously, if you're 25 years old and buying insurance, the ACA is not a particularly great value to you (unless you have a "pre-existing condition", which I'll remind you there's no due process for adjudicating --- an unexplained seizure 10 years ago is a "do-not-cover" pre-ex). But that's part of the point!

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