buying health insurance on your own

[FinanceGeek]

Back in the days before ACA, there were stories of RE types standing up a small business as a means to access small group HI policies which didn't exclude pre-existing conditions. Some states even permitted a "group of 1".

Post-ACA, pre-existing conditions aren't the issue, now the boogieman is getting coverage outside of an extremely narrow provider network. Will this strategy endure as a means to access PPO policies?

 

[athena53]

If you have enough money, nothing is a problem (finance-wise).

<snip>

And if you have lots of money, you can always self-insure.

Something serious could run $500K- $1 million. Remember you're being charged the sticker price, not a negotiated price through the insurer.

I'd have to have an awful lot of money to be willing to put that much at risk rather than leave a legacy for my family. I'd prefer a gigantic deductible instead.

 

[Alex The Great]

In some areas of the country health insurance is reasonably affordable so what you say makes sense. But in other parts of the country, health insurance is $600 - $1,000/month or more per person.

It would be useful to know, in which parts of the country health insurance is "affordable" i.e. premiums are substantially less than the above numbers? I thought $600 is the minimum premium you can find (without ACA subsidies) for a person older than 50?

 

[cathy63]

It would be useful to know, in which parts of the country health insurance is "affordable" i.e. premiums are substantially less than the above numbers? I thought $600 is the minimum premium you can find (without ACA subsidies) for a person older than 50?

Well, if $600/mo is your affordability line, then I guess we qualify here. These are the unsubsidized monthly premiums for all the bronze plans available in San Diego county for a single person who is age 50:
$324.55
$349.57
$358.74
$352.52
$361.70
$408.45
$449.05
$458.45
$467.21
$482.40

There are also 6 silver, 5 gold and 2 platinum plans with premiums under $600/mo.

 

[Sarah S]

Plymouth County Massachusetts as well. Cheapest bronze age 50 250
Cheapest standard silver 340

 

[joeea]

It would be useful to know, in which parts of the country health insurance is "affordable" i.e. premiums are substantially less than the above numbers? I thought $600 is the minimum premium you can find (without ACA subsidies) for a person older than 50?

Unsubsidized, the premiums for my wife and I together would be a total of about $850/month in Mass.

If you consider that "affordable" depends on your alternatives, I suppose.

 

[REattempt]

52. Ohio. Single. $550 month, $2500 deductible.

 

[pb4uski]

It would be useful to know, in which parts of the country health insurance is "affordable" i.e. premiums are substantially less than the above numbers? I thought $600 is the minimum premium you can find (without ACA subsidies) for a person older than 50?

BCBS of Vermont offers a bronze plan for $438/mo... all ages since Vermont does not allow age rating. Pick a bunch of zip codes for areas that you are interested in and search using healthsherpa.com.

 

[Alex The Great]

Thanks to all, this is a great piece of info! I think I was looking at PPO plans and that's why I did see something around $600 in SF Bay Area. HMO plans such as Kaiser are indeed cheaper.

 

[MBSC]

Something serious could run $500K- $1 million. Remember you're being charged the sticker price, not a negotiated price through the insurer.

I'd have to have an awful lot of money to be willing to put that much at risk rather than leave a legacy for my family. I'd prefer a gigantic deductible instead.

While I strongly agree one should think twice before self-insuring, the uninsured also have access to negotiated rates. A few weeks ago, a relative had his gallbladder removed at an Ambulatory Surgery Center. Before surgery, he asked how much it would cost. The ASC told him his insurance would be billed $12k. He reminded them he does not have insurance (2 years until Medicare) and was charged $5k (58% discount off the MSRP). In the past, he has received similar discounts for hospital procedures by paying the cash rate.

Medical procedure pricing is like buying a car. The ill-informed pay the MSRP, the uninsured pay the invoice price, and the insured get the even lower fleet rate.

 

[Pilot2013]

What you pay can ALWAYS be negotiated. like any debt, they will consider a % of it better than nothing. I see strong arm tactics in that negotiation as no less "ethical" than gaming the subsidy system for low premium, all while having a couple $MM in a retirement fund.

 

[Aerides]

Sure, it call all be negotiated, but not if you are being wheeled into emergency on a gurney after the ambulance. By the time you're (hopefully) fixed up, those costs are spent, so it's harder to negotiate after the fact.

When I see things like standard blood tests getting submitted to insurance for $500, and them coming back with negotiated rates paid under $100, that's the sort of thing that means even a very high deductible plan is worth it.

 

[Alex The Great]

A few weeks ago, a relative had his gallbladder removed at an Ambulatory Surgery Center. Before surgery, he asked how much it would cost. The ASC told him his insurance would be billed $12k. He reminded them he does not have insurance (2 years until Medicare) and was charged $5k (58% discount off the MSRP).

The fact they charged him $5K, means that he has a reasonable income or he does not live in states where Medicaid expansion is implemented. My former colleague had an urgent surgery, when he was out of job and did not have either insurance or income, to cover expenses. It was free for him, although he did not qualify for Medicaid.

 

[Pilot2013]

Sure, it call all be negotiated, but not if you are being wheeled into emergency on a gurney after the ambulance.

That's true, you can't negotiate (before) in this case, but you can negotiate after, just like with any debt. Just like before ACA, and even now for someone still not paying for insurance, ER's and emergency care are going to be given regardless.

 

[eroscott]

I checked just now and found the same.

I remember 20 years ago when the longterm ehealthinsurance plans could be bought - I guess now that is not the case in many locations.

I thought ehealthinsurance was just a front end aggregateor for *some* insurance companies. (i.e. kickbacks) I checked them out for NC I think and they had none which gave me a clue because there are health insurance companies there.

I think these guys are more general. Others *please* correct me if I am wrong.

https://www.stridehealth.com/

 

[MBSC]

Couldn't I buy health insurance through esurance.com or somewhere else (not ACA coverage - but private regular insurance), and have the same coverage as I always did?

I thought ehealthinsurance was just a front end aggregateor for *some* insurance companies. (i.e. kickbacks) I checked them out for NC I think and they had none which gave me a clue because there are health insurance companies there.

I think these guys are more general. Others *please* correct me if I am wrong.

https://www.stridehealth.com/

The OP was interested in off-exchange plans. This link is to on-exchange plans for a health insurance broker (NPN 17068737) where NPN stands for National Producer Number and "producer" is just a fancy term for an agent/broker. Obtaining an NPN is part of the agent/broker licensing process.

For on-exchange plans, members generally link to https://www.healthsherpa.com/ or https://www.healthcare.gov/see-plans/

Off-exchange ACA compliant plans can be found at https://finder.healthcare.gov/

For Short-Term Medical (STM) plans, you are correct that ehealthinsurance or any other website will only list some of the available plans.

 

[eroscott]

The OP was interested in off-exchange plans. This link is to on-exchange plans for a health insurance broker (NPN 17068737) where NPN stands for National Producer Number and "producer" is just a fancy term for an agent/broker. Obtaining an NPN is part of the agent/broker licensing process.

For on-exchange plans, members generally link to https://www.healthsherpa.com/ or https://www.healthcare.gov/see-plans/

Off-exchange ACA compliant plans can be found at https://finder.healthcare.gov/

For Short-Term Medical (STM) plans, you are correct that ehealthinsurance or any other website will only list some of the available plans.

healthsherpa looks like a 3rd party company (aggregate) like ehealthinsurance.

https://en.wikipedia.org/wiki/HealthSherpa
https://www.crunchbase.com/organization/healthsherpa#/entity