Health insurance: Ever been presented with a choice where there's no good choice?

[MontanaMama]

Last edited Wed Dec 15, 2021, 11:43 AM - Edit history (1)

It happens this time every year...I have to choose a health insurance plan for my little family of three for the next calendar year. We're self employed and so options are few and they are outrageously expensive. The Affordable Care Act did a lot of good. For example, insurance companies can't charge more for pre-existing conditions and they can't deny coverage if you have a pre-existing condition. That said, insurance companies base premiums on your age. My husband is 60, I'm 57 and my son is 16. We're healthy, thankfully, and still we pay through the nose for our insurance. I can't take the chance of being uninsured and having something catastrophic happening where we might lose our house or business. That said, I'm sitting here fuming over my "choices".

Here's the lowdown:

Pacific Source:

Gold plan with a $3000 per person deductible is $2170 per month
Silver plan with a $4500 per person deductible is $1955 per month
Bronze plan with a $7000 per person deductible is $1674 per month

BCBSH of MT:

Gold plan with $2900 per person deductible is $2474 per month
Silver plan with a $4400 per person deductible is $2204 per month
Bronze plan with a $6500 per person deductible is $1797 per month


Mtn Health Coop
Gold plan with a $1000 per person deductible is $2125 per month...with that low deductible this plan has a $6500 max out of pocket and is HSA ineligible
Silver plan with a $4400 per person deductible is $1912 per month
Bronze plan with a $7000 per person deductible is $1668 per month

All these plans cost more than my mortgage and yet I have to choose one. This is all that is available on the individual market in Montana. I get why people work at jobs they don't like just to retain the health insurance benefits. I am furious because we don't cost any more to insure that a member of Congress. Why can't we buy into their plan?

Rant off.

[luvs2sing]

1. I hear you.

I’m 64 and basically healthy, but I have a couple health conditions that have to be closely monitored. I was on Hubster’s COBRA, but that ends at the end of the month, so I need to be on the ACA for ten months till I can start Medicare.

Policy choices suck. Premiums okay. Whoever said you can keep your doctor is lying because the coverage options in my area only cover specialists. So I have no primary care doc for ten months. Luckily, my specialists are covered..supposedly. I’ll believe it when I see it.

[MontanaMama]

2. Keeping your doctor is important.

Fortunately, the vast majority of doctors and hospitals are in network with the three insurance companies offering plans in MT.

COBRA plans are really expensive. I hope you can get a good plan for the 10 months prior to starting Medicare.

[ProfessorGAC]

3. A Suggestion

I retired 3 years before Medicare. So, I had to do 18 months COBRA, 18 months personal plan.
What I found for both, was that it would be cheaper to get separate, identical policies for my wife & I, then a single plan to cover both of us.
It was not trivial. $100+ per month. I don't get that at all, but it was true with 3 different companies, and the COBRA plan.
Maybe you could get a plan that covers you & your son, and a separate plan for your husband. It's not a gigantic savings, but it's something.
Assuming, of course, things are like they were 38 & 20 months ago.
Also, are you not eligible for any ACA subsidies?
The costs you're quoting look much like those I saw and we're well above the income limit for any assistance from ACA.

[MontanaMama]

8. Nope. We're not eligible for subsidies.

And, we provide health insurance for a couple of our employees who don’t have coverage through their spouse. We have a little group plan for our small business. The premiums above are just for my family, however. We’re not well above the income limits from the ACA but we’re above enough that we are not eligible. I am grateful for that.

[ProfessorGAC]

13. Check On That Other Option

As weird as it is, it's not uncommon.
Even my insurance guy was aware of it & often recommends two separate policies.
I'm not sure how having to cover your son would influence that, though.

[MontanaMama]

15. Okay.

So check on an individual plan for my husband and a separate policy for me and the kiddo? I’m not sure our group plan would allow it but I will check.

[onecaliberal]

4. Yes I have a job that will not allow me to go into the market to buy my own insurance.

The same insurance that nearly bankrupted us after my husband stroked 5 years ago. We were hit with a 200,000 bill. That was out of network costs. They have moved in the summer to narrow that network even more because they actually think this bullshit insurance is the best. A fucking HMO is better.

[MontanaMama]

9. That's horrible. I get it and I'm sorry.

I’ve had to refinance my house twice over the years for huge medical bills not covered by our crappy insurance plans that we had before the ACA. Once for giving birth at the age of 41 which apparently costs more (@#%!) and then when we found a tumor in my son’s brain that needed immediate surgery and a rebuild of his left inner ear…we had to do that same surgery twice in one year.

[onecaliberal]

20. Oh my. I'm so sorry.

[róisín_dubh]

26. Same. I work for a state university and must use the state insurance plan.

Which, quite frankly, is garbage. I had to cancel a surgery because since I "elected" to have it (biopsy to check on non-cancerous tissue that may cause future problems), they wouldn't cover it and I couldn't afford the $5000 or so it will cost. The biopsy that I initially had, deemed necessary, netted me a bill of $2000. Then I had to go to the ER for a CT scan, that bill is around $4000. I'm not sure what insurance will cover.
Mind you, I'm a fully employed faculty member. And I can't afford these fucking bills.
I'll have the surgery in England once my visa is renewed. Because it's free. I full on understand why people just die of preventable and curable things. Because the alternative is massive debt.

[onecaliberal]

44. I'm sick of living in a country that thinks you should have a handful of people with 90% of the

Wealth in the country while children starve and people work themselves to death and die of completely preventable causes.. The shit hole country is America. The richest nation on the face of the earth. The land that doesn’t give a rats ass about the least among them.
The people who live comfortable and don’t have to worry about living with chronic diseases that they can pay for medicine to treat. Paying 3,000 for a 10.00 dollar vile of insulin. And NO ONE has the balls to stand up to the handful of people who could do something about it because their pockets are also being lined with cash.

[Demsrule86]

42. I think anyone should be able to switch to the ACA and qualify for a subsidy...many work place

insurance plans these days are shitty.

[karynnj]

5. Wow, those are really high rates

As to the people in Congress, they have to use the ACA exchange. The difference in their cost is that the House or Senate can provide a subsidy that pays part of the cost - just as businesses do for their employees. Before the change with ACA, they selected one of the federal government plans just like people working for a federal agency. (The change for Congress people and their staff was because of a Republican amendment that was intended as a poison bill to kill ACA - meaning that it has long been a lie when Republicans said that Congress itself had a better plan.

At least when it first passed, there was a cap on the ratio of the premium for older people to younger people. The argument was that the very concept of insurance is to share the risk and leveling the difference by age could be seen as fair because young people now will be the old people later. The counter to that was that it was already hard to get the "young invincibles" to buy insurance when many argued that it was cheaper for them to just pay for medical bills. (works until an accident or unexpected major illness happens.)

I assume that you checked to see if you qualify for a subsidy based on income.

[MontanaMama]

10. Yeah. We don't qualify for subsidies.

For that I am grateful, don’t get me wrong. It’s just getting ridiculous to pay these premiums for insurance where we never meet the deductible and they don’t pay for anything but an annual physical and a mammogram. Our annual health insurance costs more than tuition at our state universities.

[W_HAMILTON]

6. Mine costs $100/mo and I have a $500 deductible.

I also have a lot of medical costs normally, so I get a plan where my out-of-pocket maximum is ~$500, have one big medical bill at the start of the year (usually when I first renew my prescriptions), and then I'm basically paying nothing other than premiums the rest of the year for my health insurance.

Not sure why yours is so out of whack, but I couldn't be more pleased with my healthcare insurance that I've gotten through Obamacare the past few years.

[MontanaMama]

11. What state are you in?

ACA rates vary per state depending on what companies offer plans for those states.

[W_HAMILTON]

25. South Carolina.

[MontanaMama]

27. That makes sense.

More population, more demand, more choices.

[W_HAMILTON]

29. Yes, relatively small states like Montana, Alaska, etc....

...are inherently harder to insure due to the smaller insurance pool

[RobinA]

33. Wow

Here in PA, I don't know anyone who is working who can afford Obamacare if they need it. It's fine I guess if you qualify for a subsidy, but if you don't you're kinda screwed. You were actually better off before.

[W_HAMILTON]

34. I highly doubt that.

Before Obamacare, I wouldn't have even had the option of purchasing insurance as a single person because I would have been rejected outright due to my preexisting medical conditions. I would have had to find employment that offered health insurance and then work just to maintain my health insurance, since going without would basically be a death sentence. The only other option would have been a state high risk insurance pool, which I believe are still offered now; however, if you can't afford an Obamacare plan, good luck on trying to afford one of those...

As a side note, due to the American Rescue Plan, Obamacare healthcare insurance premiums in 2021 and 2022 are limited to no more than 8.5% of household income, for even high earners. Thank you, Biden and Democrats! I believe this has been extended through 2025 in the House-passed Build Back Better Act.

[Demsrule86]

43. No you were not because many could not get insurance due to pre-existing...and companies often

refused to provide the benefits that people were paying for...the ACA is wonderful. Montana, Florida, etc... do their best to make it miserable...when folks get sick of it and elect Democrats, it will improve.

[Ron Green]

7. One Risk Pool Is A Health Care System. Multiple Risk Pools Is An Investment Scheme.

We have enough investment schemes in this country; we need a health care system.

I can’t believe the people of this country haven’t risen up against this profit-driven, patchwork, market-based, cherry-picking, lemon-dropping, legislator-buying, hard-hearted, bullshit arrangement that American politicians call “health care.”

[MontanaMama]

12. No kidding.

I can tell you that I’m busy working my behind off to pay these outrageous premiums. I’ve written everybody I can think of that might be able to offer something different or change the laws. I guess I keep paying for another 8 years until I can get on Medicare.

[leftstreet]

22. +1

[DFW]

14. Wow, that sounds like what I was presented with here in Germany

I was quoted €2500 a month, or about $35,000 a year, for German insurance. My employer is in the USA, so I keep my work insurance. Unfortunately, my employer has BCBS, which covers NOTHING. Every medical expense I have is paid out of pocket. Since I haven't had anything that has accumulated to $35,000 a year, or anywhere near that, I'm ahead of the game, but if that should change, and I can still be transported to the USA for treatment, BCBS would still probably continue to deny everything, and say tough luck, old man, you're on your own. Like Groucho Marx sang, "whatever it is, I'm against it."

[MontanaMama]

16. Really?

I’m so glad you chimed in here DFW. Is the German insurance you’re referring to just for people who aren’t German citizens? I assume citizens have access to a national health care system?

BCBS of Montana is a shit show and their premiums reflect the fact that they don’t want to sell plans on the individual market.

[DFW]

17. German insurance is NOT universal

It is a patchwork system, and there are hundreds of thousands (not millions like in the USA) of Germans with no health insurance at all. I know that some people like to insist there is some universal national health care system here in Germany, but it is a myth. A lie, really, when it comes from people who know better. My wife, who is German, was a social worker for decades here. She worked with streams of Germans who had no health insurance, and tried to get them what she could squeeze out of the bureaucracy,

Here, you have to actively go about getting health insurance if you don't have a full-time job, or are over retirement age. It is NOT automatic. Even then, you have to register for it, like with Medicare. If you are a German or have a German employer and a work permit for Germany, THEN it is easy to get covered, although mostly as a "Kassenpatient," or Second Class coverage, which maybe 90% of Germans have. This means that when you call for a doctor's appointment, you may have to wait several months to get one. Usually not, if it's an emergency, though. If you are in a top income bracket, and want to, you can opt for "private" medical insurance. That means you pay up front and get reimbursed--IF they feel like it. As a resident foreigner with a foreign employer, this is all I had as an option here. Luckily, the "foreigners office," which keeps track of non-citizens here (and they REALLY keep track of us--don't think those sci-fi stories are too far-fetched), accepted my BCBS as health insurance, which is required for a residence permit. Can you imagine if every town in the USA had an "Ausländeramt," an office that did nothing but keep track of foreign citizens? Here, they do. I found it sort of funny. Here they wanted to see every aspect of my life in triplicate, everything but a DNA sample (maybe they took one in secret, I wouldn't know), but the accepted BCBS as proof of health insurance, whereas in Texas, they laugh at me, knowing full well that BCBS denies just about every claim I submit.

[MontanaMama]

18. That's fascinating and

not at all what I would have thought existed in Germany. Thank you taking the time to post all of that…I appreciate the info.

When I had BCBSH of MT back in the day, I was filing state insurance commission complaints against them on a regular basis when they denied services that should be covered. Those complaints were successful for the most part. These days BCBSH only offers self funded plans and this are not regulated by the state insurance commission. Bastards.

[DFW]

19. In 2019 and 2020

I noticed a huge uptick in posts here on DU by supporters of certain presidential candidates praising some fictitious universal health care system here in Germany. They got very huffy when I pointed out that they were telling fairy tales, but they were posting from the USA somewhere, and I am here on the ground, married to a social worker and live my private life in German. They could keep on telling me all day long that the sky was green, but they were getting their info from blogs that wanted them to spout a certain political line. Things just aren't always what you want them to be. In France or the UK, there is something far closer to a national health coverage. My friends in Sweden say they have one, but, as they say there, "man måste vara nästan död för att komma i sjukhuset," or " you gotta be almost dead before you can get into the hospital."

By the way, in case Swedish looks like gibberish, it is really far closer to English than it might seem. The Swedish phrase I posted gets a lot more familiar if you translate it this way: "a man must be (vara) almost (nästan) dead for to come into the sick house (hospital)."

BCBS are definitely bastards. I call them "Great Benefit" after John Grisham's corrupt health insurance company in "The Rain Maker."

[MontanaMama]

21. Oh my gosh!

Completely off topic…but you brought up the Swedish language…just tonight my 16 year old son told me he signed up for an online class to learn Swedish. He said “it’s pretty close to English, mama.” This is how the universe works.

[DFW]

23. Like the song goes

“There’s nothing you can know that isn’t known”

[Elessar Zappa]

30. I think Canada also has a pretty good national health system too.

Or am I wrong? I knew Germany’s system isn’t ideal but I’ve always liked the UK NHS (even though it certainly has its problems).

[DFW]

32. Oddly enough, my ignorance about Canada is vast

A friend of mine was the Canadian Ambassador to the USA, and then to France. He retired from the foreign service when his uncle stepped down as P.M. But since he WAS a foreign service officer, all we ever talked about was world politics, never Canadian internal matters.

[JCMach1]

24. Mine went from about 120 with subsidy to 540 per month this year

So, I had to change to a plan that doesn't include my PCP.

With my myriad of health problems, this really isn't good.

[highplainsdem]

31. Sorry to hear this. I don't know what kind of work you do, self-employed, but does your

profession have any unions or organizations that offer insurance? It can be well worth the fees for joining to access those plans.

[MontanaMama]

38. Those are excellent suggestions.

No professional organizations or associations that offer group plans. I wish there were! Thank you for the post.

[W_HAMILTON]

35. Question for you:

For 2021 and 2022, the American Rescue Plan capped Obamacare health insurance premiums to no more than 8.5% of household income, even for high income families.

The fact that you are claiming monthly premiums sometimes reaching thousands of dollars makes me wonder: are you a very high income household? Did the numbers you posted in your original post not include subsidies for which you are eligible? Because there seems to be something missing here...

[TexasBushwhacker]

36. Part of the problem is you're in Montana

Insurance companies are not required to offer plans in every state, so there's less competition to drive prices down. That being said, my boss is 64 and his wife is 58. They pay $2200 for just the 2 of them with BCBS.

[MontanaMama]

39. You're correct. That's a big part of the problem.

BCBS doesn't want any of the individual market in MT and prices their plans accordingly.

[DenaliDemocrat]

37. Congresses Plan is just as expensive

It’s just employer subsidized. I pay $800/month. My employer pays $1000 for me. I pay an additional $200 for dental. Everyone is paying these costs, some employers just pick up more of the tab. Obviously being self-employed you pay the whole thing. Medicare part B and the a supplemental are expensive as hell too

[MontanaMama]

40. Ugh. That's horrible.

I thought Medicare was cheaper than that! Damn...

[DenaliDemocrat]

41. Oh Medicare is

It’s the part B and supplemental where they suck your blood like leeches