Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

npr.org

Post reply on HN
Print view View original

111–120 of 387 posts

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

#111

Post by loeg »

kasey_junk wrote: post #53
johnnyletrois wrote: post #12

Earlier quoted context omitted.

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.

There is no requirement for your employer to provide the HSA. Frequently the employer can get better deals on the HSA than you can individually (like no waived maintenance fees and the like) but you can for sure open your own. In fact once you have enough money in there that you are moving out of liquid investments then you definitely want to shop around for HSA much like you would for an investment account.

Can you actually fund a non-employer HSA with tax-deductible funds, or is that a benefit that only applies to payroll HSA contributions? If not, a lot of the benefit of an employer HSA disappears.

(FWIW, I have an HDHP, employer HSA, and an individual HSA that I roll my employer funds to annually for lower-fee investing.)

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

#112

Post by bhupy »

ip26 wrote: post #50
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…

The fundamental problem is when you cover emergency care but not preventative care, you get more emergency care. Because emergency care is more expensive, this is worse for everybody in the long run, except for profitable hospitals and insurance companies who enjoy the increased revenues.

This is only a problem if preventative care is expensive to begin with...

In India, a visit to the doctor for a general checkup can cost anywhere between Rs. 100-1000 out of pocket, with no insurance whatsoever. For reference, this is basically the price of a movie ticket.

What if preventative care cost $15-30 a pop out of pocket?

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

#113

Post by tptacek »

mieseratte wrote: post #72
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.

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits o…

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree.

If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

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

#114

Post by delecti »

LarryDarrell wrote: post #60

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room. I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

I happen to agree that the system is broken and getting worse, but that's not necessarily a good metric for whether you should change any given system now.

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

#115

Post by lotsofpulp »

maxxxxx wrote: post #107
lotsofpulp wrote: post #102

Earlier quoted context omitted.

401k are tied to employers, but I don’t see what HSA has to do with employers since they’re just as easy to have without an employer. It’s just a savings account with tax advantages for people with HDHP.

are you saying that if your employer offers a high deductible plan without HSA you can open one for yourself? I don’t think many people know that.

Yes.

https://www.fidelity.com/open-account/all-accounts (best option, it's free and has access to great investment options)

https://healthaccounts.bankofamerica.com/individuals-familie...

I'm sure there are others.

Edit: In fact, the employer's HSA custodian (unless it's Fidelity), probably charges you a few basis points for investing your HSA funds, so it's actually much better for you to transfer the funds out into your own Fidelity HSA immediately.

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

#116

Post by lotsofpulp »

kxyvr wrote: post #101
lotsofpulp wrote: post #81

Earlier quoted context omitted.

The tax savings on the difference in premium between high deductible health plans and low deductible health plans is probably $2k at most ($6k in extra premiums @30% tax rate). That’s for single coverage, but even for family total year tax savings can’t be more than $5k. In either case, triple tax advantage of HSA is far more, especially due to compound growth. If you have the cash to be able to deal with $10k of med…

This is not to say that you're wrong, but I don't completely understand your numbers. My understanding of the triple-tax advantage of HSAs are that 1. Money going into the HSA is pre-tax 2. Investment gains from the HSA are not taxed 3. Money used from the HSA for qualifying health expenses is not taxed That said, there are many restrictions and two of these benefits seem to be included for self-employed individuals.…

If you save your receipts for any medical care you or anyone else has received that you paid for, you can withdraw from your HSA to "reimburse" yourself at any point in time, including the future.

Q39 at bottom of page 18 of following IRS document:

https://www.irs.gov/pub/irs-drop/n-04-50.pdf

Have a baby? Save that receipt showing payment for $5k from your post tax dollars, and let the money in your HSA grow tax free for however long you can, and then when you need it (e.g. in retirement), reimburse yourself for the birthing expenses.

It's the first place your savings should go. It's easiest to just model the HSA as a triple tax advantage savings account as long as you pdf receipts for payments for medical expenses. Which you might not in 20s and 30s, but surely will into 40s and definitely 50s, and you can use it for payments you made for other people's medical expenses too. And even if you need to withdraw from it for an emergency, the penalty is only 10%.

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

#117

Post by WrtCdEvrydy »

LarryDarrell wrote: post #60

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room. I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

Individualism in America is the main cause... if you just got taxed and didn't have to worry about healthcare, people wouldn't care, but they all think that it could never happen to them.

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

#118

Post by WrtCdEvrydy »

chadash wrote: post #64
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 mo…

It's because there's nothing to gain by lowering costs.

If you get a bill from a ER for $36 dollars, you'd be less likely to buy a $200 insurance plan, so we have to make ERs as expensive as possible so we can guarantee customers for the poor insurance companies. They won't pay that full 2K anyways.

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

#119

Post by anonKeepMyJob »

anonKeepMyJob wrote: post #45

One of our company's primary products "helps employees make an informed decision when choosing their health insurance plan". Basically, during open enrollment they are presented with their choices of plans and the "expected total cost" of each plan over the course of the year as calculate based on either, if we have their consent, their historic data or, if we don't have their consent, the historic data of a represen…

I tell you all that my company works with employers to move their employees to HDHPs based on sketchy data, sketchy calculations, no transparency, and based on profit motive, and,,,, nothing.

Interesting.

Side note: The chances that some HN readers have used our software are, very good.

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

#120

Post by ameister14 »

tptacek wrote: post #40
mdorazio wrote: post #16

Earlier quoted context omitted.

The parent comment is exaggerated, but I think the point is that prior to ACA, employer-provided plans tended to be cheaper and have lower deductibles largely because insurance companies were able to drop or deny coverage whenever they felt like it for individual plans to keep their margins up. While logically true, this is roughly equivalent to hearing from an old coworker that South Africa was a great place to be w…

Yes: if you go back in time, health care costs go down, because they've been rising rapidly over the past 20 years. But the only thing that happens at the point in time when the ACA passed is that the rate of growth in cost falls .

That's not really true, though. Costs as a % of GDP went down from '05-06 and went up slightly from '06-07.

In real numbers, in 2008-2009, the increase in overall cost per year was actually lower than in 2014-2015, when the exchanges opened.

You're right that the rate of growth in Medicare cost fell after the ACA passed, but that's much more specific than overall cost delta.

Post reply on HN