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Health care costs in NY State
Old 05-26-2017, 10:15 AM   #1
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Health care costs in NY State

[Sorry this kind of turned into an ad for New York state.]

I've been looking through some of the other threads here and see people posting large numbers for their health care premiums, much, much higher than what I'm paying. I live in upstate New York and New York state has a reputation for the most expensive health care in the country. For example:

10 Best and Worst States for Health Insurance Costs | HuffPost

I'm wondering where the disconnect comes from? Here are the ranges of rates for different metal levels where I live. There are three providers offering around 10-20 plans per metal level. Couples plans are exactly double the individual plans.

Individual
-----------

Catastrophic: $158-$193
Bronze: $320-$370
Silver: $378-$513
Gold: $455-$616
Platinum $563-$715

Family
-------

Catastrophic: $450-$550
Bronze: $914-$1056
Silver: $1079-$1464
Gold: $1297-$1756
Platinum $1605-$2040

Since most of the people posting here are probably looking for a couples plan. That would cost $756/month for silver and only $1126/month for platinum.

I also looked at some of the costs for what I consider expensive counties around New York City and they don't seem that much higher.

Plus, New York state has something called the Essentials plan for low income people that costs $20 a month and has no deductible and seems to have copays equivalent to a Platinum plan. The income limits are fairly reasonable.

Household Size Most you can make
1 $23,760
2 $32,040
3 $40,320
4 $48,600

If you can keep your income low enough - this is a huge deal.

The one big advantage that New York State has over other states, is that insurance companies cannot discriminate based on age. So a 21 year old pays the exact same amount that a 64 year old pays. There are only two states that I know of where this is true. The other one is Vermont. Furthermore, if the AHCA, as it stands, ever becomes law, not only will older people benefit from this rule but they also get a higher federal tax credit.

I see quite a number of threads where people complain that they can't retire because of the high cost of healthcare and often see suggestions that they retire abroad but I'm wondering if they might consider New York state, which seems crazy considering it's reputation for high costs.

Where I live, property taxes are quite high but houses are really cheap. I live in a 3 1/2 bedroom house, 3 bathrooms on 1/3 acre and it's valued at around $170,000. Similar houses in other parts of the country sell for over $500,000. Anyone living in a HCOL area could probably relocate and get a nice lump sum.

The only major downside, other than property taxes is the winter weather which can be brutal.

And finally as everyone knows - New Yorkers are some of the kindest, most amenable and most considerate people in the world .
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Old 05-26-2017, 11:01 AM   #2
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This is exactly why my Plan B is to go back to NY. I used to have a small cabin in Sullivan County and I could definitely see spending the spring, summer, and autumn there and come down to Florida for December through March.

How much are your property taxes and which county are you in ?
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Old 05-26-2017, 11:23 AM   #3
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Originally Posted by Live And Learn View Post
.

How much are your property taxes and which county are you in ?
I'm in Monroe county. Property taxes are almost $8000/year. We do get the Star rebate and there is a much bigger rebate when you hit 65.
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Old 05-26-2017, 01:07 PM   #4
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I'm in Monroe county. Property taxes are almost $8000/year. We do get the Star rebate and there is a much bigger rebate when you hit 65.
WOW you weren't kidding when you said taxes are high ! I won't pull the trigger on Plan B unless Pre-existing conditions preclude me from getting reasonable insurance coverage here in Tampa Bay. NY may still pay off if that should happen. (I ask every to please refrain from making comments on the likelihood of pre-existing condition coverage possibilities. I don't want another thread closed down).

Dutchess county would be my pick since there is a commuter train into NYC so that I could take advantage of the museums. I think taxes are probably even higher there so I need to have a think on that.
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Old 05-26-2017, 01:18 PM   #5
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The article in the OP compares the lowest cost silver plan around the states. Differences in premium may be due to underlying cost, but also provider network depth and reach. A better comparison would be to compare the same policy with the same network, around the country. The BCBS Bluecard network, for example.

Our health insurance marketplace is segmented into far too many small pieces. This leads to the type of coverage and pricing anomalies that we continuously wrestle with.
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Old 05-26-2017, 01:41 PM   #6
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Our health insurance marketplace is segmented into far too many small pieces. This leads to the type of coverage and pricing anomalies that we continuously wrestle with.
Yes, reading the referenced Huff Post article I was struck at how seemingly nonsensical the differences in premiums are between various states. For example, Colorado has the 10th highest premiums, yet it is consistently ranked as one of the healthiest states in the union based on things like low obesity rates, higher frequency of exercise, lower smoking rates, etc. And then you have West Virginia at #26 in the rankings, far ahead of Colorado in terms of better/lower premiums. Yet it's one of the least healthy states in the U.S. It makes absolutely no sense to me.
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Old 05-26-2017, 02:41 PM   #7
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Good points MichaelB. I am already budgeting 40k / year for HC (including OOP costs) for 2 people, so hopefully that's enough for most places anyway .... I hope ! I pray !!
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Old 05-26-2017, 03:21 PM   #8
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Good points MichaelB. I am already budgeting 40k / year for HC (including OOP costs) for 2 people, so hopefully that's enough for most places anyway .... I hope ! I pray !!
Just out of interest, how much do the plans cost this year where you are?

40K/year seems way too high to me. I looked at several different metal plans in my area and they seem to be roughly the same, about $17,000-$18000/year for the premiums and OOP costs, assuming that you both hit the maximum OOP cost. So, to get to 40K the cost of health care would have to rise by about 128% and you'd both have to spend the maximum OOP costs every year.
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Old 05-26-2017, 03:59 PM   #9
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Dutchess county would be my pick since there is a commuter train into NYC so that I could take advantage of the museums. I think taxes are probably even higher there so I need to have a think on that.
My house in town of Lagrange, Dutchess County: $250k 1/3 of an acre 3 BR 2.5 bath 1,800 sf School tax $3000 Property tax $3000 Total tax 6k.
I'm 6 miles from one train station and 4 miles from another.
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Old 05-26-2017, 04:11 PM   #10
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Just out of interest, how much do the plans cost this year where you are?

40K/year seems way too high to me. I looked at several different metal plans in my area and they seem to be roughly the same, about $17,000-$18000/year for the premiums and OOP costs, assuming that you both hit the maximum OOP cost. So, to get to 40K the cost of health care would have to rise by about 128% and you'd both have to spend the maximum OOP costs every year.
In the Bay Area my premium per month for silver is $1022. With Max OOP that would be over 18k/yr. That's a single, not a couple. With the new rules that could easily be over 20k. Also that's age 61. Assume it will get more expensive as I age until Medicare.
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Old 05-27-2017, 05:41 AM   #11
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I think effective regulation of hospital budgets and age rating are the principal differences in premiums for people our age between VT and other parts of the country.

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This is exactly why my Plan B is to go back to NY. I used to have a small cabin in Sullivan County and I could definitely see spending the spring, summer, and autumn there and come down to Florida for December through March. ...
When we bought our Florida winter condo I considered becoming a Florida resident because a few of our other retired friends did... however, the increased cost of health insurance because Florida age-rates health insurance would be far more than the state income tax savings so until we are on Medicare in 3-4 years we will remain Vermont residents.

In terms of ACA changes, given that no medical underwriting and no age rating are state law, I don't expect much change no matter what happens in ACA.. in VT we essentially treat the entire individual market as one big group policy... I'm not sure why they couldn't do the same for the nation... especially if they prohibited employers from providing coverage and implemented a continuous coverage requirement like they do for group health insurance.
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Old 05-27-2017, 06:23 AM   #12
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.

In terms of ACA changes, given that no medical underwriting and no age rating are state law, I don't expect much change no matter what happens in ACA.. in VT we essentially treat the entire individual market as one big group policy... I'm not sure why they couldn't do the same for the nation...
This is why:

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.
especially if they prohibited employers from providing coverage.
Although having said that universal coverage did pass the lower chamber of the house last week in NY state. The CW is that it won't pass the senate though, which explains why it hasn't been reported much in the press I imagine.
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Old 05-27-2017, 08:32 AM   #13
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Here in Wisconsin, we're rated near the bottom 10 in health insurance cost, yet a recent study showed doctor's fees in the most populous east/southeast as 40% higher than the national average. Doctors' fees in Milwaukee area 41% higher than national average, study says

The story suggests that the prevalence of large medical groups in the area plays a role in the high fees. Independent doctors are rare around here.

My favorite quote from the story: "Nothing in health care pricing, as far as I can see, is pegged to cost," said Ross Bjella, chief executive of Alithias Inc., a Milwaukee company that analyzes health care costs for employers.
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Old 05-27-2017, 08:55 AM   #14
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WOW you weren't kidding when you said taxes are high ! I won't pull the trigger on Plan B unless Pre-existing conditions preclude me from getting reasonable insurance coverage here in Tampa Bay....
I have a friend in FL who always jumps on me saying:

"You live in Tampa Bay if you have a houseboat in the water, otherwise you live in Tampa. There is no city of Tampa Bay."

Is that true?
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Old 05-27-2017, 03:52 PM   #15
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I have a friend in FL who always jumps on me saying:



"You live in Tampa Bay if you have a houseboat in the water, otherwise you live in Tampa. There is no city of Tampa Bay."



Is that true?


Yes
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Old 05-27-2017, 07:44 PM   #16
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I
The one big advantage that New York State has over other states, is that insurance companies cannot discriminate based on age. So a 21 year old pays the exact same amount that a 64 year old pays.
But they *are* discriminating...against the 21 year old who should (given a typical 21 year old medical expenses as compared to a 50 year old) be paying about $150 per month.

You don't mind the discrimination as it is in your favor.

As an aside, I live in up state NY and don't mind the weather (I downhill and cross country ski in the winter, hike/run in the summer). The property taxes on my 2800 sq ft house are now over $9000 per year. That I do mind. (My taxes don't include water (well) or sewer (septic), garbage pick up (private) but do include the fact that almost 90% of the counties taxes are used for state mandated items (over 50% for just medicaid).
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Old 05-27-2017, 10:40 PM   #17
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But they *are* discriminating...against the 21 year old who should (given a typical 21 year old medical expenses as compared to a 50 year old) be paying about $150 per month. ....
I guess it depends on which end of the looking glass you are viewing, but group insurance is not age rated, so there is lots of precedence for health insurance that is not age rated.

If you continuously have health insurance throughout your entire adult life (as I have) it probably all evens out... I probably paid more than what would be fair based on my projected medical expenses when I was young... about the right amount during middle age, and less than what would be fair later in life... and it should all even out.

Permanent (whole) life insurance is designed the same way... you pay more than you should when you are young and less than you should when you are older... those early payments build up a kitty for later more expensive mortality coverage even though you pay the same fixed premium throughout.
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Old 05-28-2017, 03:58 AM   #18
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Large group policies charge the same premium for all members of the group and do not differentiate for gender, age, health, previous conditions, or anything else. They also require everyone in the group to hold the same policy coverage. It seems to work. There certainly is no complaint at all about the pricing.

Individual insurance sets prices based on factors such as age, but that is a business model that was developed to exclude groups, divide the marketplace into small segments, underwrite, price them individually, and deny coverage to many. The segmentation is artificial, it adds substantial cost overhead, and the only purpose is to artificially lower the price for one segment, at the expense of all others. Age is just one condition used to underwrite, there really is no limit to the factors that can be used to segment a human population.
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Old 05-28-2017, 08:37 PM   #19
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Large group policies charge the same premium for all members of the group and do not differentiate for gender, age, health, previous conditions, or anything else. They also require everyone in the group to hold the same policy coverage. It seems to work. There certainly is no complaint at all about the pricing.

Individual insurance sets prices based on factors such as age, but that is a business model that was developed to exclude groups, divide the marketplace into small segments, underwrite, price them individually, and deny coverage to many. The segmentation is artificial, it adds substantial cost overhead, and the only purpose is to artificially lower the price for one segment, at the expense of all others. Age is just one condition used to underwrite, there really is no limit to the factors that can be used to segment a human population.
There are plenty of insurance examples that utilize age as a factor. Would you argue for "community" rating for car insurance? Imagine such a system where you paid the same car insurance rates regardless of age, sex, accident history, driving record, or vehicle. Do you think the dynamics of such a system would lead to higher overall rates or lower?

Even Vermont has given up on its single payer "Medicare for all" solution, when they figured out it would require a 11.5% payroll assessment and up to 9.5% of individual income. (That is even suspect in terms of whether ti would have fully funded the program.)

There are many aspects of health insurance that drive me bonkers from a libertarian perspective (including the fact that the WW2 price controls ended up generating the employer-sponsored beast we see today).
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Old 05-28-2017, 09:46 PM   #20
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Just out of interest, how much do the plans cost this year where you are?

40K/year seems way too high to me. I looked at several different metal plans in my area and they seem to be roughly the same, about $17,000-$18000/year for the premiums and OOP costs, assuming that you both hit the maximum OOP cost. So, to get to 40K the cost of health care would have to rise by about 128% and you'd both have to spend the maximum OOP costs every year.
I always assume that both of us will hit our OOP max per year and that there is no subsidy. I have an expensive pre-existing condition so I know that at least one of us will hit the OOP max every year. Anything we don't spend in a given year for healthcare goes towards something fun (travel, etc) the following year. This year the calculation is approx $35k but since I am overly cautious in my budgeting I knock it up to 40k

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I have a friend in FL who always jumps on me saying:

"You live in Tampa Bay if you have a houseboat in the water, otherwise you live in Tampa. There is no city of Tampa Bay."

Is that true?
It is commonly called "the Tampa Bay area". It is true that there is no city named "Tampa Bay"

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My house in town of Lagrange, Dutchess County: $250k 1/3 of an acre 3 BR 2.5 bath 1,800 sf School tax $3000 Property tax $3000 Total tax 6k.
I'm 6 miles from one train station and 4 miles from another.
Sweet ! That is my plan B ! I appreciate the info.
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