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What Startups Need To Know About Health Insurance in 2013

blog.simplyinsured.com

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Re: What Startups Need To Know About Health Insurance in 2013

#151

Post by cdmoyer »

tricky wrote: post #81

I got the green light to work on my startup full time. BUT, i have to figure out health care for my wife and infant before I can quit my job. We've been spoiled with a tremendous insurance for so long. Can anyone offer any advice or give helpful anecdotes about their experiences (good or bad) going solo with a family?

This is going to really depend on your state and your needs.

Many states add some rules to the providers, often to your benefit.

If you have any pre-existing conditions, having continuos coverage is really important in many states, as it prevents companies from denying coverage for those conditions... in many states even if you change providers, as long as you have some coverage.

In New York, where I am, after a lot of research, I ended up joining a chamber of commerce with my company and enrolling my company (me) in a group HMO plan.

This cost me 1535 a month last year, and will cost 1680 a month this year. This covers basically everything, most prescriptions, numerous tests and treatments my family has needed because of pre-existing conditions. (I pay $300 a year to be in the chamber, as well.)

Note: If my company had an employee and I wasn't a sole proprietor, these rates would be 10-15% less.

If I didn't know we would hit the deductible, I would have been on a high deductible plan. If you hit the 10k deductible on the plans I looked at, it costs the same as the plan we are on, you just may end up paying the whole thing up-front.

So, in short, New York, family comprehensive co-pay plan, 20k a year.

(Do COBRA as long as you can, first, if you can. COBRA will almost always be cheaper because your former employer will be a group and have better rates.)

Re: What Startups Need To Know About Health Insurance in 2013

#152

Post by anigbrowl »

tptacek wrote: post #116
anigbrowl wrote: post #40

Earlier quoted context omitted.

1. Oh please, this is just a truism expressing your general political views. Government does lots of things well. Every time there's a relevant accident, the NTSB is on the spot within 24 hours. The FAA does an amazing job. I could go on with many other examples; and where government is slow to respond, it's often because the rules require government to engage in a lengthy public consultation process or make it easy…

It is especially amusing to see people suggest that the government can't competently administer health care given that Medicare customer satisfaction exceeds that of private health insurers. It's weird how easily people "forget" that the federal government is already an extremely accomplished health management administrator. But I take issue with your argument about the health market not clearing. In fact, consumers…

I see your point, but I think it's very hard to gauge what the appropriate level of insurance is, because the risk factors are opaque and the likely cost of treatment unpredictable.

The other reason I'm strongly in favor of socialized healthcare is because of the insane administrative burdens it imposes on patients, whether or not they have insurance. Every medical decision a person makes about their own health in the US suddenly takes on administrative and financial dimensions that are quite poorly correlated with the clinical considerations.

Re: What Startups Need To Know About Health Insurance in 2013

#153

Post by anigbrowl »

MichaelSalib wrote: post #86
tptacek wrote: post #57

Earlier quoted context omitted.

Give me a break. Republicans are anti-public health care because public care sets in motion a process that moves care decisions into federal bureaucracies, which is absolutely a problem that Canada and the UK have. Also, health care is ineluctably two things: a vital necessity and a commercial service. With a single payer, the commercial service objective is warped: patients and doctors are motivated to make care dec…

There is a big difference between single-payer and a nationalized healthcare system. In the latter, doctors are government employees. The UK and Canada work that way, and choose to spend very little money on healthcare. But most peer nations have single-payer non-nationalized healthcare systems and choose to spend more than Canada and the UK, but much much less than the US. With a single payer, the commercial service…

The UK and Canada work that way, and choose to spend very little money on healthcare.

And yet going to the doctor or the hospital in the UK is a relatively painless experience, other than in the clinical context.

Re: What Startups Need To Know About Health Insurance in 2013

#154

Post by grecy »

run4yourlives wrote: post #125
grecy wrote: post #32

Earlier quoted context omitted.

I don't suggest you model it after Canada's system. It's good, but it could be better. I moved to Canada from Australia, so I'll compare the two systems for you. Canada: "healthcare for all" provides basic coverage of everything you need. Works pretty well. Even homeless / out of work people are fully covered. Things like dental and chiropractor are not covered, so you pay for those. Employers give "health care" whic…

Disclaimer: In Employee Benefits in Canada. Canada's private health care insurance is very broad, and while you aren't necessarily incorrect about anything you are only giving part of the picture. The "Employer sponsored" extended health coverage you are referring to is Group Insurance. It is a form of insurance that can be offered to all people aligned to an entity (employer, trust, association, etc) that removes th…

Thanks for the detailed and thoughtful reply.

> It is an effective enticement to have a good benefit plan, hence the interview question.

A better enticement is to divorce health coverage and employment 100%. They should have absolutely nothing to do with each other.

Imagine if the employer in Canada dictated where I can live, or what goods I can buy... that's how it feels for me when the employer dictates(or in fact has anything what-so-ever to do with) my health care.

> Keep in mind that self management also presents a fair amount of improperly covered people.

Those people are covered by Canada's public health care, which is exactly what it is there for.

> At least under an employer sponsored plan a trained professional is designing a plan that meets as many of the needs of the employer's workplace as they feel is required.

You are still not even accepting the option of no extended plan at all.

The number of people in Australia that opt for extended private care is small, because the public option is sufficient.

Re: What Startups Need To Know About Health Insurance in 2013

#155

Post by prostoalex »

run4yourlives wrote: post #136
prostoalex wrote: post #135

Earlier quoted context omitted.

Net cost of what? Pregnancy with complications, chemotherapy, spinal surgery or teeth cleaning is all <$1,000 with deluxe package?

Pregnancy - Covered by national plan, all in. chemotherapy - Ditto spinal surgery - Ditto Your $1000 is getting you a nicer room, name brand meds, etc etc. teeth cleaning - This would be offered under Dental Coverage, which is completely private in Canada.

This is indeed a pretty sweet deal. In the US anything outside of teeth cleaning might result in personal bankruptcy, depending on employment situation.

Re: What Startups Need To Know About Health Insurance in 2013

#156

Post by protomyth »

grecy wrote: post #150
protomyth wrote: post #101

Earlier quoted context omitted.

"1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that." Given this theory, explain Indian Health Service. Point 1 is bad reasoning and demonstrated to be false. On point 2, rules are not inherently socialist (Capitalism actually requires a strong rule of law).

I have no idea what Indian Health Service is. I know rules are not inherently socialist, what I was saying is you already live with a ton of them, and thinking that adding a few more will drastically decrease your "freedoms" is delusional at best.

Indian Health Service is the currently running, government health care for a small fraction of the population. If they cannot get that right, they cannot get it right for the rest.

Adding a few more rules is the dictionary definition of loosing freedom. Adding the wrong rules will.

Re: What Startups Need To Know About Health Insurance in 2013

#157

Post by beagle3 »

IanDrake wrote: post #146
beagle3 wrote: post #139

Earlier quoted context omitted.

> As it is there is a shortage of nurses and doctors. Partly because it costs a lot of money and effort to enter that profession. In the not-so-distant-past (less than 10 years ago!) mostly because the AMA tightly controls the influx of new people to the field, in an attempt to make sure that the salaries remain high: http://skeptics.stackexchange.com/questions/4561/does-the-am... (Although now they are trying, so fa…

>And yet, the US system is the most expensive system for what it gives... I was making a generalized comment. As you said, the US healthcare industry is extremely regulated, which is what I believe is the root of the problem we face. People who want a the government to control health care are pointing at a system with a ton of government interference and saying "Look that isn't working well, we must need more governm…

> People who want a the government to control health care

No one wants the government to control healthcare. Many people want the government to run healthcare, and accept that as a result it will be government controlled . You might consider this a distinction without difference, but it paints supporters of public health care in a light they do not deserve. An analogy:

You seem to want my health care to be controlled by people whose own profit is their motive -- in fact, by corporations who are required by law to maximize shareholder profit at the expense of my health.

> "Look that isn't working well, we must need more government."

Most are saying "look, that isn't working well. But e.g. NHS in England is working extremely well. Let's copy that". And after looking at the NHS, it turns out that you need more (and especially, a very different kind) of government involvement.

Can you point to a working example of a system that you believe in? Because if you can't, I think the NHS and government involvement carry a LOT more weight as arguments.

Re: What Startups Need To Know About Health Insurance in 2013

#158

Post by run4yourlives »

prostoalex wrote: post #155
run4yourlives wrote: post #136

Earlier quoted context omitted.

Pregnancy - Covered by national plan, all in. chemotherapy - Ditto spinal surgery - Ditto Your $1000 is getting you a nicer room, name brand meds, etc etc. teeth cleaning - This would be offered under Dental Coverage, which is completely private in Canada.

This is indeed a pretty sweet deal. In the US anything outside of teeth cleaning might result in personal bankruptcy, depending on employment situation.

Yup. In Canada, hard-core health care is quick, cheap and amazingly efficient. Any thing that can seriously screw with you is covered 100%. People with a cancer diagnosis get started on treatment within days. Pregnancies are smooth and straightforward, even more so if there are complications. Trauma is just the same as an American hospital.

The Canadian system slips a little when it comes to non life threatening issues that could be considered "quality of life" concerns. Knee and hip surgeries, elective procedures, chronic conditions, non serious specialist procedures (dependent on field)

There is a movement here to expand private health care into these areas. Personally, I support such a move but in Canada we have a group as pig headed about "no private health care" as you do about "no public health care" which makes things a little difficult.

Re: What Startups Need To Know About Health Insurance in 2013

#159

Post by run4yourlives »

grecy wrote: post #154
run4yourlives wrote: post #125

Earlier quoted context omitted.

Disclaimer: In Employee Benefits in Canada. Canada's private health care insurance is very broad, and while you aren't necessarily incorrect about anything you are only giving part of the picture. The "Employer sponsored" extended health coverage you are referring to is Group Insurance. It is a form of insurance that can be offered to all people aligned to an entity (employer, trust, association, etc) that removes th…

Thanks for the detailed and thoughtful reply. > It is an effective enticement to have a good benefit plan, hence the interview question. A better enticement is to divorce health coverage and employment 100%. They should have absolutely nothing to do with each other. Imagine if the employer in Canada dictated where I can live, or what goods I can buy... that's how it feels for me when the employer dictates(or in fact…

>They should have absolutely nothing to do with each other.

Says the healthy young guy. :-) Many people receive extended benefits at a significant cost advantage through group insurance.

Also most employers pay a significant portion (if not all) of the premium of these benefits! You and I may see a health questionnaire as a simple form where you answer "no" to everything and sign it, but many, many people not much older than you aren't able to do that.

>Imagine if the employer in Canada dictated where I can live, or what goods I can buy...

Um, your employer does dictate where you can live, since most roles expect you to come to a structure of the employer's choosing, and what you can buy through your paycheck. Regardless, there is no dictation here at all. You are being offered benefits, often paid at least in part by the employer as a condition of employment. It's like being offered a cell phone or a car allowance.

>You are still not even accepting the option of no extended plan at all.

As I already stated, this option does exist and IS USED. In almost any company of significant size (i.e. above 10 employees or so) you can refuse all coverage. All you have to do is do so with a written form. You can do so for Health and Dental in ALL cases if you are expected to pay the premium and have coverage elsewhere, inclusive of personal coverage.

Why in god's name you would turn down what in many cases is free money is beyond me, but that is your prerogative. To suggest you are unable to do so in Canada is incorrect.

Re: What Startups Need To Know About Health Insurance in 2013

#160

Post by grecy »

run4yourlives wrote: post #159
grecy wrote: post #154

Earlier quoted context omitted.

Thanks for the detailed and thoughtful reply. > It is an effective enticement to have a good benefit plan, hence the interview question. A better enticement is to divorce health coverage and employment 100%. They should have absolutely nothing to do with each other. Imagine if the employer in Canada dictated where I can live, or what goods I can buy... that's how it feels for me when the employer dictates(or in fact…

>They should have absolutely nothing to do with each other. Says the healthy young guy. :-) Many people receive extended benefits at a significant cost advantage through group insurance. Also most employers pay a significant portion (if not all) of the premium of these benefits! You and I may see a health questionnaire as a simple form where you answer "no" to everything and sign it, but many, many people not much ol…

> It's like being offered a cell phone or a car allowance.

Which reduces your overall salary - you might not be aware of it, and it might not be said in those terms, but it's absolutely true. All "side benefits" or "perks" of employment are just a way for the employer to give you something other than money. Too bad if the last thing you want is a cell phone.

> Why in god's name you would turn down what in many cases is free money is beyond me, but that is your prerogative.

Because it's not free money! My salary is being docked for that expense, as the "benefits overhead" (my company told me to my face it's about 26%). I'm perfectly happy with the public coverage, and want the rest of my salary in my hand, thank you.

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