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Employees Start to Feel the Squeeze of High-Deductible Health Plans

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Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#61

Post by rockinghigh »

johnnyletrois wrote: post #12
tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

Not all employers offer HSAs to go along with their HDHPs. Mine doesn’t and it’s very frustrating. I want to save pretax money in an HSA but I can’t.

That's not true. You don't need your employer participation to open an HSA.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#62

Post by pastor_elm »

rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

Ok, but what if your doctor says you need an MR enterography because there is something really suspicious going on in your stomach? The problem is many people just say, "that's all out of my deductible. I'll take my chances."

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#63

Post by xenospn »

rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

Whenever people ask me what's the biggest difference about living in the US vs. where I'm from, I always say the same thing: "People have to think twice before going to the doctor". It's just so damn weird. I think it's the equivalent of being a woman in Saudi Arabia and having to ask your husband's permission before going outside. Both scenarios can result in your life being completely ruined.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#64

Post by chadash »

rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

In theory, I think it's true that healthcare costs are high because most people aren't paying them, their insurance companies are. And then the insurance companies just turn around and charge more, so they aren't really (enough) incentivized to lower costs either.

In practice, the current system screws a lot of people at the bottom. We live in a world where by-and-large, the people with the most clout are also the most likely to have better insurance with lower deductibles. If you work at Google, McKinsey or JP Morgan, you probably have the option to get a low-deductible plan with 80%-100% of premiums covered. Work at Walmart? Your lowest deductible for a family is $3,500 with an annual out-of-pocket maximum of $13,700 [0]. And Walmart actually has better insurance than many low-paying companies, presumably because they are a behemoth with a lot of negotiating leverage.

> So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry.

Yeah, but there are two big issues here:

1) Sure, it prevents some people from going in when something isn't really an emergency. But it also prevents people from going in when something really is an emergency. I recently heard a story of a poor family whose toddler accidentally drank something poisonous. They knew that they couldn't afford to go to the ER, so they drove to it and waited outside to monitor the kid and see if she started having seizures or other side effects from the poison. She luckily ended up being okay, but that's a horrible decision to have to make. I'm personally very lucky to be in a financial situation where a few thousand dollars is significant to me, but not significant enough to take chances with my child's health.

2) Why is that bill $2K in the first place? I once had some chest pain and went to the ER. They took an EKG, everything was fine and they discharged me. Bill was a few thousand bucks. EKG machines are ubiquitous, not very costly to purchase (given how much they are used) and the test takes less than 10 minutes to administer and look at. In almost any other developing country, they'd be able to do exactly the same set of tests for a few hundred dollars, insurance or not.

[0] https://smartguide.walmartone.com/smartpages/Media/Default/L...

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#65

Post by rockinghigh »

goobynight wrote: post #29

While I am satisfied with my HDHP + HSA, I'd be a lot more worried if it were my only option (I'm only young for now) or if I didn't make/save as much. People are getting hit with HDHP only and no HSA? That's rough.

Anyone with an HDHP plan can get an HSA. Whether it's through your employer or through another plan provider like Fidelity or Vanguard.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#66

Post by stronglikedan »

jdoliner wrote: post #55

I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of people insured, but that doesn't really capture how well insured they are. Life expectancy seems to be the only well known (at least to me) stat that begins to capture the health of the nation. We've now had 3 straight years of declining life expectancy in the…

A good metric is - did it do what it was designed to do? I think the answer is yes. It was designed to be an unsustainable failure, in order to trick people into thinking single-payer was the next best thing. In that regard, it has been a resounding success.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#67

Post by bliblah »

sithlord wrote: post #57
tptacek wrote: post #38

Earlier quoted context omitted.

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did tha…

>> just needs to be actually thought through,

It's impossible because you both political parties want exclusively mutual results

You can't have cheap insurance without making it mandatory since only the sick will get it

You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs

You can't have good insurance if you aren't willing to pay the market price which happens to be very inflated in the US

You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts

Overall, it's a shitshow that will keep being patchworked every time the administration changes between parties.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#68

Post by qqqwerty »

sithlord wrote: post #57
tptacek wrote: post #38

Earlier quoted context omitted.

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did tha…

lol, You might want to take in account who you are replying to. tptacek is one of the more prolific commenters on HN. And just to be clear, he was talking about 'rate of growth` in costs, not absolute costs.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#69

Post by jseliger »

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

But it's been tough for people who were already covered by employer insurance.

Yes. The only word I disagree with in the headline is "start." The squeeze started years ago. One way to look at the problem is this way: http://seliger.com/2018/11/11/health-insurance-security-fqhc...:

In Northern Virginia, for example, the cheapest 2019 Obamacare individual market Silver plan for a family of four (mom and dad age-40) making a subsidy eligible $65,000 a year costs $4,514. That plan has a $6,500 deductible meaning the family would have to spend $11,014 on eligible health care costs before collecting other than nominal first dollar benefits.

I am not a fan of the word "unsustainable," but it seems to apply here.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#70

Post by kxyvr »

For those of us who are self-employed, I'll mention that low or no deductible health plans may provide better value.

When they sort of work, health deductible health plans are nice because: (1) monthly premiums are low and (2) they give access to a health savings account (HSA) where some amount of money can be stored pre-tax and then used for health related expenses. Of course, none of this saves someone that gets hammered with a $5000 bill like those in the article.

Anyway, the pre-tax HSA account seems to be an attractive to many, and it may be benefit some. However, if you're self-employed, you can deduct your premiums off your income through the self-employed health insurance deduction:

https://www.irs.gov/taxtopics/tc502

This means that there may be higher tax benefit for a high-premium, but low or no-deductible plan. Personally, I find it much easier to handle than going through the trouble of an HSA.

All that said, it's pretty much all the same in a catastrophic case. Just take the premiums x 12 + out-of-pocket max to figure out the "maximum" yearly liability. At least on the ACA exchanges, this number is typically $11-15k on what I've seen from either high or low-deductible plans. If you can't make this number, you're not fully covered for catastrophic. Alternatively, if the hospital sends a bill to an out-of-network operator, you're probably screwed as well.

Anyway, this is not to detract from the article. This is a huge problem. Mostly, I wanted to pass on some information that I had to sort through when picking and choosing plans over the years.

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