Out-of-pocket costs could be higher than you plan

[MichaelB]

It's nice to see a post from a self described "progressive" group explaining the issue. I'd post a similar summary from a less so group but that would undoubtedly be declared "political." All I'll say is that the massive Medicaid expansion has many landmines waiting for states that have and have not signed on. "Free" doesn't exist.

There are many links to opinion and advocacy articles and websites that represent a broad cross-section of public opinion, covering healthcare and many other topics. Nothing wrong with that, as long as our posts are clear as to what is being linked, the advocacy remains elsewhere and the posts are relevant to the thread topic.

 

[pb4uski]

I do feel that high deductibles discourage people from getting medical care. In some cases, it may have been for something that was real but would have gotten better on its own ("every little sniffle"), but in other cases it may be something that gets worse without prompt treatment.

We have a $3000 deductible on our non-ACA policy. Early in the year before the deductible is met I do hate to have go appointments where I have to pay it all myself (discounted of course). But, I do it as necessary......

Please keep in mind that this post is NOT directed at you Kats, but at US.

Same here. There is the rub. Unless you have a top of the line plan that you pay for the nose through every month in premiums, it is going to cost you to go see the doc and get medical care.

What gets lost in the shuffle, is when we pick our bronze plan we made a conscious decision to trade off lower monthly premiums for the risk that we might have a health event and have to pay deductibles and co-pays. IMO that is a good bet for most healthy people, but sometimes it doesn't work out and it seems that the older you get the less it works out.

I think the problem in may cases is that people have developed an expectation that if you go to the doc you only pay a small co-pay ($25 or $50) and insurance takes care of the rest of the bill. It is analogous to expecting our car insurance to pay for tires and oil changes and timing belts.

What we need to get to is a mindset where we each acknowledge that we are financially responsible for our health and realize that if we need medical care it costs money and we have to pay, and insurance is to protect us from a "bad" year health wise or some sort of health event. While I know many here understand that intellectually, why is it still so hard to go to the doc when we have something bothering us know that we'll be facing a ~$200 bill?

I'm not sure if it is necessarily a problem with high deductible policies as the same psychology may relate to those with silver pr perhaps even gold plans.

I guess that I think that even for people who can't afford deductibles and co-pays that a HDHI plan is better than no health insurance at all. At worst, they have a big bill they have to negotiate down and pay off over a number of years rather than likely bankruptcy if they have no health insurance and a huge hospital bill.

 

[jowi]

I recently had some throat symptoms that went on since January. It took me about 2 months to finally make an appt with an ENT. Had a scope done - $500 (after negotiated rate). Told to take antacids for 6 weeks - didn't help. Ended up at gastro and did a endoscopy - so here I'm at almost 4 months before finally doing the endoscopy! Luckily for me, all they found was some h pylori (at least they found something so I can feel less guilty about spending thousands on the endoscopy).

I do wait longer to go for sure with our massively high deductible (almost 11K) - but truly it does NOT pay to get a better plan because I would pay the full amount of lowered deductible in higher premiums - so the cost is just transferred. And on a good year, I won't hardly go to the doctor at all. It also motivates me to take good care of myself so that I don't get an attack of hypochondria (eating crappy and carrying an extra 10 pounds give me strange pains here and there that I might focus on and decide need to be checked out - I feel awesome when I eat right and keep my weight at optimal)

I guess the key is to have some sort of 'pact' with yourself to not be a cheapskate if something needs checking out.

 

[modhatter]

Please keep in mind that this post is NOT directed at you Kats, but at US.

Same here. There is the rub. Unless you have a top of the line plan that you pay for the nose through every month in premiums, it is going to cost you to go see the doc and get medical care.

What gets lost in the shuffle, is when we pick our bronze plan we made a conscious decision to trade off lower monthly premiums for the risk that we might have a health event and have to pay deductibles and co-pays. IMO that is a good bet for most healthy people, but sometimes it doesn't work out and it seems that the older you get the less it works out.

I think the problem in may cases is that people have developed an expectation that if you go to the doc you only pay a small co-pay ($25 or $50) and insurance takes care of the rest of the bill. It is analogous to expecting our car insurance to pay for tires and oil changes and timing belts.

What we need to get to is a mindset where we each acknowledge that we are financially responsible for our health and realize that if we need medical care it costs money and we have to pay, and insurance is to protect us from a "bad" year health wise or some sort of health event. While I know many here understand that intellectually, why is it still so hard to go to the doc when we have something bothering us know that we'll be facing a ~$200 bill?

I'm not sure if it is necessarily a problem with high deductible policies as the same psychology may relate to those with silver pr perhaps even gold plans.

I guess that I think that even for people who can't afford deductibles and co-pays that a HDHI plan is better than no health insurance at all. At worst, they have a big bill they have to negotiate down and pay off over a number of years rather than likely bankruptcy if they have no health insurance and a huge hospital bill.

I agree with most everything you say up to a point. Like Katsmeow said, she had the $1,500 so it wasn't such a big deal.

I think the difference lies in your income level and what you have been accustomed to before. A very low wage earner is not accustomed to carrying insurance and uses the emergency room or a free clinic when available for care. So if this same individual did have insurance, it would be more likely they would not go to see the doctor because of the deductible, and if it turned out to be a blood clot, would probably have died.

Also, the large deductible deters low income people from signing up for insurance, and therefore defeats the intent to keep them out of the emergency room. The idea also is to treat people's disease before it becomes a serious problem.

It is easy for us to sit back and say: "It is better than not having any insurance." And that is of course 100% true. But if the idea is to get them insured and out of the hospitals, I think deductibles of more than $100/$200 will be a problem in achieving this goal unless the person is chronically ill.

Daylatedollarshort: Your chart shows that just over 10% of the 21% say they don't have internet or a computer at home because of financial reasons. That represents over 32,000,000 people. In my store at least 1/2 of my employees did not have a computer at home and required assistance from the receptionist at the front desk to go online and renew their license each year from work.

Couple that with the people who just don't follow the news nor have the innate desire to keep on top of what is going on in the world, and you get "The man in the Street" syndrome posted earlier on this thread.

Then throw on top of that the well orchestrated campaign to convince people the new healthcare reform is "bad" because it is attached to a political party they don't adhere to, and you have people just accepting without really looking into it.

 

[MRG]

This change was made quite awhile ago - long before anyone signed up. In fact, I had never even heard of it (as someone who is just under 400%, I'd have loved the idea of lower max OOP). I'm guessing that's why it wasn't 'newsworthy'. Had they just made this change last month, it would have been front page.

Thank you, I couldn't understand why this is news. Now I understand. I shopped with this knowledge.
MRG

 

[youbet]

I guess the key is to have some sort of 'pact' with yourself to not be a cheapskate if something needs checking out.

There ya go........

I suppose most everyone has issues with insurance regarding the trade off between premiums and deductible levels. I struggled with picking a deductible level for my home owners insurance in a similar way. I went with a high deductible figuring I could easily self-insure for the occasional broken window or shingle blown off the roof and I really enjoy the lower premiums. Then, when a low cost incident occurs, I cringe because I have to pick up the entire cost due to the higher deductible!

Just human nature I guess......

But with health care, it's time to turn off the excessive frugality. Either pay the higher premium for a low deductible policy or be prepared to pay the deductible and get the health care you need.

 

[Bestwifeever]

There ya go........

I suppose most everyone has issues with insurance regarding the trade off between premiums and deductible levels. I struggled with picking a deductible level for my home owners insurance in a similar way. I went with a high deductible figuring I could easily self-insure for the occasional broken window or shingle blown off the roof and I really enjoy the lower premiums. Then, when a low cost incident occurs, I cringe because I have to pick up the entire cost due to the higher deductible!

Just human nature I guess......

But with health care, it's time to turn off the excessive frugality. Either pay the higher premium for a low deductible policy or be prepared to pay the deductible and get the health care you need.

Bingo.

 

[pb4uski]

....But if the idea is to get them insured and out of the hospitals, I think deductibles of more than $100/$200 will be a problem in achieving this goal unless the person is chronically ill....

While I see your point, it arises from a internal (erroneous) view that if you have health insurance that it shouldn't cost you much of anything if you go to the doctor for some minor malady rather than a view that it is expensive to go to the doctor but it is usually less expensive than ignoring things or paying the premiums for a gold or silver plan.

If it wasn't for this darn freedom thing I would like to require everyone on a bronze plan to set aside the difference between the cost of bronze plan and a gold/silver plan in a savings account and use it as needed for health care and if at the end of the year you haven't used it then you "got lucky" and can then transfer it to your Roth IRA. Or something like that anyway.

Here he says as he sits here with a persistent cough for the last 5 weeks and hasn't called the doctor yet.

 

[pb4uski]

Bingo.

+2 Sometimes we are too cheap for our own good.

 

[2B]

I suppose most everyone has issues with insurance regarding the trade off between premiums and deductible levels. I struggled with picking a deductible level for my home owners insurance in a similar way. I went with a high deductible figuring I could easily self-insure for the occasional broken window or shingle blown off the roof and I really enjoy the lower premiums. Then, when a low cost incident occurs, I cringe because I have to pick up the entire cost due to the higher deductible!

High deductible homeowners insurance (2% deductible) effectively eliminates home owners insurance except for a major fire or something linked to my liability/umbrella policy. My deductible easily covers the cost of replacing my roof and the likely cost of repairs for any of the trees within range hitting the house. I've tried explaining this to DW but she doesn't grasp the concept.

Health insurance is pretty much the same for the bronze plans I looked at. $6,000 individual deductibles are normal. When I priced moving up, the premiums only made sense if I knew I would be maxing out the bronze plan. I have the assets to cover this. If either of us were sick enough to blow through $6,000, we'd probably be too sick to spend a couple of weeks in Italy. Costs covered!

Unfortunately, the subsidies do not make the deductibles, copays and premiums affordable to many of thse with limited assets. Qualifying for Medicaid is "low cost" in theory but good luck finding doctors in the Houston area willing to treat you especially at the current reimbursement rate. People would have more luck showing up at free clinics or the local emergency room.

 

[youbet]

Unfortunately, the subsidies do not make the deductibles, copays and premiums affordable to many of thse with limited assets. Qualifying for Medicaid is "low cost" in theory but good luck finding doctors in the Houston area willing to treat you especially at the current reimbursement rate. People would have more luck showing up at free clinics or the local emergency room.

My comments weren't meant to address the needs of those who can't afford either low deductible policies or paying high deductibles. Rather, I was trying to address the issue of "human nature" and its impact on decisions regarding going to the doc and paying the deductible after you voluntarily chose the high deductible policy thinking you'd save enough on premiums to come out ahead.

I'm not sure how best to handle paying for the low income and indigent if Medicaid isn't the answer. The same applies to housing, food, etc. It seems like most everyone wants our truly poor (as opposed to the income poor but asset rich) citizens to be taken care of. But fewer wish to dig into their pockets and and kick in generously for doing so.

 

[travelover]

.........But with health care, it's time to turn off the excessive frugality. Either pay the higher premium for a low deductible policy or be prepared to pay the deductible and get the health care you need.

I agree, but that needs to be coupled with transparent pricing. This nonsense of in network and out of network providers roulette is just a scam with the hospitals providing cover for the scammers.

 

[samclem]

Then throw on top of that the well orchestrated campaign to convince people the new healthcare reform is "bad" because it is attached to a political party they don't adhere to, and you have people just accepting without really looking into it.

There's been plenty of misinformation from both sides, and for similar reasons. And, since the truth isn't simple, won't fit on a bumper sticker, and can't be covered in a 30 second TV spot, we continue to have lots of people who won't take the time to educate themselves. We'll see who ends up paying for that.
If the present construct remains in place, people will soon get smarter about costs/pricing/etc. The more we can facilitate this (e.g. with transparent pricing and info on quality of service from various insurance companies/networks/providers, smart online tools for making decisions, etc) the faster we'll get the cost/quality results that a real market can provide. If we keep the process opaque, if we insulate people from the impact of their decisions, then we should expect the situation (cost/quality/outcomes) to get worse. We have a whole lot of people who are new to this idea of buying their own health insurance/choosing a network, etc, and the number of them is probably going to rise. There's plenty of inducement for people to choose wisely, but they need to see that and also have tools available to assist in the process.
All kinds of interests exist to impede this. Some benefit from market inefficiencies, some benefit from the whole thing appearing to be "too hard" and favor a different approach entirely.

 

[Katsmeow]

I agree, but that needs to be coupled with transparent pricing. This nonsense of in network and out of network providers roulette is just a scam with the hospitals providing cover for the scammers.

That is so true. I was irritated when I found out after my ER visit that while the hospital itself was in network the ER doctor that I had no control over whatsoever was not in network! Apparently there is a discount worked out with the carrier so I only have to pay $450 instead of the $500 billed and since most of it went to the deductible it didn't make a big difference if it was in or out of network (In network insurer pays 80%, out of network I pay 60% and in network would have had a bigger discount).

 

[2B]

I'm not sure how best to handle paying for the low income and indigent if Medicaid isn't the answer. The same applies to housing, food, etc. It seems like most everyone wants our truly poor (as opposed to the income poor but asset rich) citizens to be taken care of. But fewer wish to dig into their pockets and and kick in generously for doing so.

Paying for the low income and indigent was the major goal of the ACA which (personal opinion) it falls very short of. Medicaid is a train wreck in many locations. Many states have not expanded their Medicaid eligibility because of the budget impact of the guaranteed 10% cost in 2 years and a mistrust in the feds continuing the 90% funding. The ACA also cut reimbursements for services which further threatens healthcare providers from participating. Of course, there is also the fundamental rejection of the concept which can be labeled partisan if so desired.

Hospitals like the concept of expanded Medicaid because they get something when the indigent line up at their emergency rooms. It's another question whether the cost is cheaper expanding Medicaid to the individual states since now the cost is shared with the people that actually have insurance that use the hospital.

Many like the "guaranteed coverage" aspect of the ACA which was meaningless to me here in Texas. Texas (until Jan 2014) had a reasonably priced high deductible for "high risk" individuals that was open to everyone. You just had to maintain coverage. I was surprised that there were states that rationed people's ability to get into similar high risk pools. I can't see why a state wouldn't want the people willing to pay for insurance to get it.

Providing basic resources to those truly incapable of providing for themselves is pretty much a universal goal. How can be debated. Unfortunately, there is a level of "free" that people will accept that will keep them from making any attempt to become part of the productive economy. The best example I see is the British dole. It was started right after WWII and it has created generations of people whose primary goal is to remain on it. They don't have a great lifestyle but they are the ultimate early retirees because they never really worked in the first place.

 

[jowi]

I agree, but that needs to be coupled with transparent pricing. This nonsense of in network and out of network providers roulette is just a scam with the hospitals providing cover for the scammers.

I just got off the phone with my insurance company - so frustrating! I got an EOB for an ENT visit where my negotiated rate was only a couple dollars less than the full rate. Recently my son had an appt with a specialist where the negotiated rate was less than 1/2. How can I 'shop around' when I can't find out what things cost. The only way is to have specific codes for specific doctors and then they can look.

 

[pb4uski]

I hate the idea of more regulation, but perhaps there should be a requirement that the provider tell you what the charges (or at least a range of charges) will be - after your insurance - prior to them performing a procedure.

We already require it for other things... mortgages, financings, some financial products, etc.

 

[jowi]

Ugh! Just got off the phone with the insurance company again with a code this time and a doctor name and nope, I have to download a FORM, fill it out and fax it to them before I can find out any pricing info. That's total BS!

 

[AllDone]

While I agree with the PNHP that single-payer is a preferable approach, the OP's source is a "critical from the left" group. Here is a Kaiser Family Foundation explanation of the cost-sharing for premiums, deductibles AND co-pays for lower income Americans which I think is both more clear and a fairer assessment.

In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays - Kaiser Health News

Our max OOP went up $5K while our total yearly premiums dropped $5K. That seems a win to me. Guaranteed issuance for continuous coverage has some drawbacks. (Texas, with it's extremely high rate of uninsurance, is surely not an example of good policy). What happens when you move between states? What happens if you have temporary financial problems and can't afford coverage for a while, etc.? I had a patient who let her COBRA eligibility lapse after she woke up one morning and found her husband lying dead next to her. She became deeply depressed and let everything lapse. Then she was unable to get insurance because of her history of depression.

I had continuous coverage for my auto-insurance before being sent overseas by an employer (to work for the US Army!) and was told that I would have to get coverage from the assigned risk pool due to the "lapse in coverage" until I examined the tiny print on my German policy and discovered that I had unwittingly purchased insurance from an Allstate subsidiary. After that Allstate had a hard time making the claim that I had been uninsured. I have a hard time trusting the good intentions of the insurance industry.