What is a FAIR Health Insurance Premium for a 5700 Deductible.?

a reply to: Kettu


Ironic that you bring up suicide, Kettu. A couple committed suicide in Manhattan last week due primarily to medical bills.

""The couple was found on the street after jumping out of the 9th floor window of an office building in the Manhattan neighborhood of Murray Hill at about 5:45 a.m. The 53-year-old man and 50-year-old woman have not been identified, but they both had suicide notes in their pockets.

According to a source who spoke to the New York Post, the woman’s note said “Our kids are upstairs, please take care of them.” The man’s note, pictured below, began with “WE HAD A WONDERFUL LIFE” and went on to say “Patricia and I had everything in life,” but “we both have medical issues, we just can’t afford the health care.” The note also mentioned a “financial spiral” that resulted in an inability to live with their “financial reality.”"

Source: www.complex.com...

I bet that their income was just above 400% of FPL. No subsidy assistance for their $1200 @ month ObamaCare premium, so they went without health insurance. A very common situation the past 3 years.

a reply to: pavil

The self-employed are completely screwed. Last year my AGI was about 53,000. I'm already paying 26% of that back to Uncle Sam for self-employment tax and federal income tax, plus a couple grand to the state for state tax. So out of that 53,000 I actually get to keep about 37,000. I'm a "single" person on paper (even though one of my kids and her man live with me and I support them, I can't claim them on my taxes because they're adults, and even though I also support their 2 kids I can't claim them either because they can be claimed by their parents). So by Uncle Sam's reckoning I should be able to pay 9.69% of my $53,000---not what I'm actually left with after Uncle Sam pulls his hand out of my pocket---for insurance. In which case, I'd have to subtract ANOTHER 5,000 or so for premiums. Which would leave me around 32,000.

And of course if I ever actually wanted to USE the damn insurance, I'd have to fork out ANOTHER 5-10k for the deductible, leaving me a measly $22-27k out of my original $53,000...which would barely cover rent, (cheap) food, car payment, utilities, phone, and internet* for the year. For reference: My son makes $22k working at WalMart.

If I really wanted insurance, I'd be better off throwing in the towel and going to work for someone else making half as much as I do now. How does this make any freakin' sense at all?


* (For all you who scream that "internet is not a necessity!"---yes, it is for me. My job depends on a reliable internet connection, and in my own home or office, not an internet café or free McDonalds wifi.)

a reply to: pavil

I would happily agree to that.

a reply to: the owlbear


Most people don't realize that from the medical provider's perspective, the goal of wellness checkups/physicals is to find something wrong. When something "abnormal" is suspected, a battery of extremely profitable tests can be ordered. If an illness, injury, or disease is found... PAYDIRT for the medical profession, if you have insurance, or are wealthy.

Car dealers and shops gladly perform those free "13 point inspections" for the same reason. Even Jiffy Lube is getting in on the act. I went to one for an oil-change last week, because I had a $10 off coupon. They recommended a tranny flush, new cabin air filter and engine cleaning...for $210! To the dismay of the manager, I declined. (Jiffy headquarters must put a lot of pressure on them to sell the extra stuff.)

a reply to: riiver

Before April of this year, most individuals and families in your situation were obtaining Short Term Medical plans that lasted 1 year at a time. The benefits are the same as Major Medical was before ObamaCare. The monthly premiums 40-60% less than ObamaCare plans.

Due to these STM plans being so popular, Obama's people felt that they were taking away badly needed $$$ from the ObamaCare pools. So his HHS Secretary added YET ANOTHER RULE to ObamaCare that prohibited insurance companies from selling these 12-month plans, effective April 1, 2017.

So what are the +400% FPL income earners doing now? Going to ObamaCare??? NOPE. They're flocking to the Health Sharing Ministries. ( See: en.wikipedia.org... ) For people who live moral lives, these are actually a pretty good deal, for now. Obama exempted them from ObamaCare rules and regulations.

originally posted by: hounddoghowlie
a reply to: carewemust

fair is not forcing someone to buy insurance or be penalized.
before obumacare no where in the Constitution does it say that the federal government can force a person to purchase any thing from a corporation or company.

what about car insurance?

a reply to: carewemust

If a families monthly medical premium is $283/mo, they are already paying out $3,396 per year, should that not cover their regular routing doctor visits with no extra charges ?

If each individual's deductible is $5,700 on top of that, they are likely never going to be covered by the insurance plan if they are generally healthy and only need to goto the doctor for routine visits and occasional illnesses that come up through out the year. If a generally healthy individual goes to the doctor in this situation, they have been paying their monthly premium of $283.00 and when they goto the doctor insurance doesn't cover them, they get slapped with a bill for $100 to $200 on top of their mo premium and on top of a copay paid at time of doctor visit each time they goto the doctor. This is not affordable for avg/below avg folks. They are only going to get coverage if they get really sick and suddenly have bills that max $2396 + $5700 ...what is the likelihood of that ? If one individual in the family gets really "sick", they have to pay out $8,096 before anything is covered.

Why is it that the monthly premium doesn't get used to help pay for bills ? The money goes into the insurance system but there is zero value in it for the patient. It's just going into the abyss as soon as its paid out, it appears that it has no value at all in any way for the patient. I think $283.00 is plenty to cover one regular simple doctor visit...why on top of that does their have to be new bills and because a "deductible" has not been met the patient still has to pay money out of pocket.


The deductible should go back down to $100 to $200 for only certain types of services or nothing at all...the monthly premium should cover them and the insurance needs to do what it was intended to do, cover individual/family. Otherwise its becomes a money pit where we place a high percentage of our income but never get anything back from it.



leolady

a reply to: kurthall
I agree know many self employed who are uninsured,most places will work with you if your paying cash,seems people rush to see a Dr too often now,eat healthy don't abuse drugs,liquor,or food and you should do fine,don't need to pay a Dr to hear that

a reply to: WUNK22

The facts are every western country has better healthcare and cheaper then the USA. We all pay in and everyone gets treated.
You need to get rid of the middle men and expand medicare for all.

why don't we ask ourselves what cost so damn much rather than trying to figure out if we are paying to much or not

a reply to: toysforadults

what about car insurance?

has been asked and answered already. page two
besides that, auto insurance falls under the states and there is no federal mandate for auto insurance.

And, of course, if we go single payer, that will be the *only* option for everyone, and what happens for the people who get screwed over royally by that option?

Then, you'll all be busy telling them at least they have something and it works well for you. And since you have yours, you could care less that others are getting screwed by the very system you forced on them.

It's a lot like public schooling is.

originally posted by: toysforadults
why don't we ask ourselves what cost so damn much rather than trying to figure out if we are paying to much or not

I've posted repeatedly about why it costs so much, and no one wants to hear it. They'd rather chase the chimera of "free" health care. With the idea that it costs so much because of X, Y, and Z, all of which could be removed and addressed, they are still left with the idea that they would have to pony up some cash to pay for general office visits.

a reply to: carewemust

I can figure that out without access to your chart.

A fair premium is IT DOES NOT MATTER BECAUSE TAXATION SHOULD COVER IT!

You can establish any corporatist argument against that which pleases you, but you will still be wrong to do so, no matter how good you think that argument is.

originally posted by: carewemust

originally posted by: seasonal
a reply to: WUNK22

Do you think it was a mistake that bush left negotiations out of the medicare prescription drug coverage? It is a cash cow that is lobbied for. In fact medical is the #1 lobbied measured by real dollars.

Seasonal, you raise an interesting point that I've never contemplated. How does it benefit the government to pay more for Senior's prescription drugs? You're hinting that the ability for drug-price negotiations for Medicare Part-D (Prescriptions) was omitted for a reason.

I believe in my little heart of hearts that Bush was (is) part of the problem.


If our medical system was our internet service we would have fired them and went with a different company. Can't do that with medical-ever wonder why?

a reply to: the owlbear

We are in a pickle.

What is against a citizen or family right now?

The repubs are
The dems are
Big Pharma is
The hospitals are
Every drug store or pharmacy are
The insurance companies are
The manufactures of testing equipment are
The testing facilities are
Any one or company that sells med equipment is

I can't see any way this is going to be solved with out an untouchable approach that was used against the MOB.

Well why don't they just take 9% out of everybody's paycheck and have the employers match the 9% ?

Medicare is at 1.45% + 1.45% and the take Social Security money away for "Part B".

Then let the insurance companies run the administrative bureaucracy for a flat rate per person.

originally posted by: seasonal

originally posted by: carewemust

originally posted by: seasonal
a reply to: WUNK22

Do you think it was a mistake that bush left negotiations out of the medicare prescription drug coverage? It is a cash cow that is lobbied for. In fact medical is the #1 lobbied measured by real dollars.

Seasonal, you raise an interesting point that I've never contemplated. How does it benefit the government to pay more for Senior's prescription drugs? You're hinting that the ability for drug-price negotiations for Medicare Part-D (Prescriptions) was omitted for a reason.

I believe in my little heart of hearts that Bush was (is) part of the problem.


If our medical system was our internet service we would have fired them and went with a different company. Can't do that with medical-ever wonder why?

Monopoly..like Ma Bell used to be. When I was growing up, a long distance phone call was astronomical. People would talk as fast as they could, and hang up. (Actually that was rather nice, if you're not a chit-chat type.)

a reply to: xuenchen

Would 18% be enough?

originally posted by: leolady
a reply to: carewemust

If a families monthly medical premium is $283/mo, they are already paying out $3,396 per year, should that not cover their regular routing doctor visits with no extra charges ?

If each individual's deductible is $5,700 on top of that, they are likely never going to be covered by the insurance plan if they are generally healthy and only need to goto the doctor for routine visits and occasional illnesses that come up through out the year. If a generally healthy individual goes to the doctor in this situation, they have been paying their monthly premium of $283.00 and when they goto the doctor insurance doesn't cover them, they get slapped with a bill for $100 to $200 on top of their mo premium and on top of a copay paid at time of doctor visit each time they goto the doctor. This is not affordable for avg/below avg folks. They are only going to get coverage if they get really sick and suddenly have bills that max $2396 + $5700 ...what is the likelihood of that ? If one individual in the family gets really "sick", they have to pay out $8,096 before anything is covered.

Why is it that the monthly premium doesn't get used to help pay for bills ? The money goes into the insurance system but there is zero value in it for the patient. It's just going into the abyss as soon as its paid out, it appears that it has no value at all in any way for the patient. I think $283.00 is plenty to cover one regular simple doctor visit...why on top of that does their have to be new bills and because a "deductible" has not been met the patient still has to pay money out of pocket.


The deductible should go back down to $100 to $200 for only certain types of services or nothing at all...the monthly premium should cover them and the insurance needs to do what it was intended to do, cover individual/family. Otherwise its becomes a money pit where we place a high percentage of our income but never get anything back from it.



leolady

As to whether or not regular doctor visits are covered, it depends on the plan. My current plan covers 3 or 4 doctor visits per year and 1 or 2 specialist visits for my wife (gyno visits). For this plan, I have the pleasure of paying close to $1,100 per month. Pre-ACA (as recently as 2014 I believe), the same policy was about $500 a month. Yes, I understand that health care costs have been rising for years, but each year, we price shopped and was easily able to find a policy with the coverages that we needed and wanted....affordable co-pays and deductibles, etc.

Even if rates had gone up 10% a year from 2014 to now, I'd be paying in the $665 to $675 per month range now. If rates had gone up 15% a year, I'd be paying in the $750 to $760 per month range. Both are more than I'd like to pay, but either would allow me to have more of my money each month...$300 to $400 more.