Health care costs in NY State

[NameRedacted]

[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 .

 

[Live And Learn]

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 ?

 

[NameRedacted]

.

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.

 

[Live And Learn]

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.

 

[MichaelB]

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.

 

[Sojourner]

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.

 

[Live And Learn]

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 !!

 

[NameRedacted]

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.

 

[Just_Steve]

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.

 

[bmcgonig]

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.

 

[pb4uski]

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.

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.

 

[NameRedacted]

.

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:

.
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.

 

[Mr._Graybeard]

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.

 

[bw5972]

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?

 

[Dash man]

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

 

[copyright1997reloaded]

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).

 

[pb4uski]

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.

 

[MichaelB]

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.

 

[copyright1997reloaded]

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).

 

[Live And Learn]

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

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"

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.

 

[daylatedollarshort]

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.

That is good to know. Thanks for posting. New York would be a lot less hassle to move to than Portugal for our gap years if we need affordable coverage from whenever the ACA ends and Medicare begins.

One of the front runners for the next California governor's race is making universal coverage a key part of his platform, so I'm hoping even if we don't really get universal coverage we at least end up with some affordable health insurance options for us pre-Medicare seniors here.

 

[pb4uski]

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).

Well, first and foremost, I don't read Michael's post as advocating anything... just explaining the status quo, so your first paragraph is WAY off base.

While it is true that Vermont abandoned single-payer based on cost concerns... its individual market is similar to one big group (no age-rating, no medical underwriting, etc.) and seems to function well at a reasonable cost compared to many other parts of the country (a HDHI plans cost about $440/month/person).

I totally agree with you on the last part... our current problem with heth insurance is an unintended consequence of that government intervention that resulted in the individual market being marginalized... if we could roll that back and have every person own their own health insurance (like they do with other insurance) then the individual health insurance market would be bigger, more diverse and hopefully more efficient.

 

[copyright1997reloaded]

Well, first and foremost, I don't read Michael's post as advocating anything... just explaining the status quo, so your first paragraph is WAY off base.

Michael wrote:

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.

That is making a value judgement. I gave one example (of many that can be given) where the same kinds of market segmentation is done.

While it is true that Vermont abandoned single-payer based on cost concerns... its individual market is similar to one big group (no age-rating, no medical underwriting, etc.) and seems to function well at a reasonable cost compared to many other parts of the country (a HDHI plans cost about $440/month/person)..

My economic issue with this (and with the ACA and even the proposed replacement) is that a major issue with the ACA is the issue of adverse selection. Those who are young and healthy (and pay way more than their share using a single community rated no preexisting conditions) have no reasons to join the party (buy health care) unless forced, or it is given to them (by employer or on a parents plan). Those who are older (and paying less than what they would be paying using age as a discriminator) or unhealthy will join the plan. The results are (as we are seeing and will continue to see) an ever increasing amount of high cost patients in the plan. The result of this is that plan prices increases, just reinforcing the viscous cycle. This is not politics, it is simple actuarial truth. A leveraging factor is the issue with American's health in general (overweight and sedentary and eating a bunch of foods that are bad for you).
[/QUOTE]

I totally agree with you on the last part... our current problem with heth insurance is an unintended consequence of that government intervention that resulted in the individual market being marginalized... if we could roll that back and have every person own their own health insurance (like they do with other insurance) then the individual health insurance market would be bigger, more diverse and hopefully more efficient.

I think the answer (as much as anything can be an answer) lies somewhere on this road. There must be some sort of weaning from employee sponsored health care to a system where all are treated fairly from a tax perspective in order to have a robust and large risk pool. Where I differ from many of those on this board (hey, I am an old geezer too and what I am saying would cost me money) is that insurance pools must be at least somewhat reflective of the risk factors of those in the pool in order to avoid adverse selection issues.

 

[pb4uski]

.... My economic issue with this (and with the ACA and even the proposed replacement) is that a major issue with the ACA is the issue of adverse selection. Those who are young and healthy (and pay way more than their share using a single community rated no preexisting conditions) have no reasons to join the party (buy health care) unless forced, or it is given to them (by employer or on a parents plan). Those who are older (and paying less than what they would be paying using age as a discriminator) or unhealthy will join the plan. The results are (as we are seeing and will continue to see) an ever increasing amount of high cost patients in the plan. The result of this is that plan prices increases, just reinforcing the viscous cycle. This is not politics, it is simple actuarial truth. .....

I agree that if you compare annual premiums to annual costs that community rating is unfair to the young and advantageous to the old. However, over a lifetime it would all even out ... someone would "overpay" when they are young and would "underpay" when they are older.... just like what happens with permanent life insurance... your "overpay" compared to term life insurance rates when you are young and "underpay" when you are older... or another way of thinking of it is that when you are young that you are prepaying to get favorable rates when you are older.

The reason to "join the party" is to have insurance coverage if you are one of the relatively few young people to have a significant health event or accident and to gain access to more affordable health insurance coverage when you are older.

.... I think the answer (as much as anything can be an answer) lies somewhere on this road. There must be some sort of weaning from employee sponsored health care to a system where all are treated fairly from a tax perspective in order to have a robust and large risk pool. Where I differ from many of those on this board (hey, I am an old geezer too and what I am saying would cost me money) is that insurance pools must be at least somewhat reflective of the risk factors of those in the pool in order to avoid adverse selection issues.

The problem with what you propose is where to draw the line... the ACA draws it in one place (3:1 IIRC) and AHCA would draw it in a different place (5:1 IIRC) vs VT/NY/group at 1:1.

A part of the adverse selection issue is people buying insurance only when they become sick. While I would prefer to mandate coverage it is clear that as a society we are not keen on doing that so the next step would be to deny coverage for existing conditions for a period of time unless someone has had continuous coverage (which AHCA includes as I understand it)... IOW, there is a penalty that could cost you a lot or bankrupt you if you don't continuously carry health insurance coverage... those who are short-sighted or have little to lose will likely decide not to sign up anyway but that is their choice and they will need to live with the consequences.

As a society we have lots of experience with large group coverage and it seems to work ok so I would like to see an approach that creates a huge group with the same approach as group coverage with a couple tweaks as appropriate in the circumstances... and adjust as needed for issues that arise.

 

[MichaelB]

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.

That is making a value judgement. I gave one example (of many that can be given) where the same kinds of market segmentation is done.

No value judgment in my post, it was a simple observation about insurance. Let me state it differently. The insurer can assess one broad market risk, and price accordingly, for the entire group. The insurer can also divide the market into smaller risk segments. Doing so has one primary purpose, which is to limit the risk group, assess, underwrite and price to each individual risk group. By definition, this will benefit some and exclude others. The group health insurance marketplace, which is considered effective and successful here in the US, does not operate on these principles. This is because there is no benefit or advantage to the group.

The total risk does not change, no matter how you segment or aggregate risk, it just spreads it around differently. The total cost of health care for universe also does not change. What market segmentation does do is add cost to the insurer, and also incentive to insurers and policyholders alike to exploit the segmentation scheme for personal benefit or profit.

If the goal is to enroll young policyholders, age rating might be one way to do that. If, however, the goal is to maximize enrollment across the entire population (age, genders, zip codes, health status, etc) there is no segmentation scheme that will make it easier to achieve that goal.

Health insurance cannot cost less than the helath care it intermediates. One way to reduce the cost of health insurance is to reduce unproductive overhead and then focus on containing and eliminating cost of health care itself in the US. But that's a different discussion.