Health Insurance Stupid?
May 29, 2013 2:31 PM Subscribe
(Supposedly) I pay $546.30 a month for Health Insurance. What should that get me as an (almost) 32 y/o male? Should I feel like I'm paying an absurd amount?
I want to know what I should expect given that I'm paying that much. I'm single, it's just for me. It's a group policy through work. Here's what my insurance card says:
PCP/Specialist $25/$50
Inpatient 30%
Outpatient 30%
ER 30%
Rx $10/$30/$50 or 20%
(No dental, vision may as well not exist as it only pays for a $30 eye exam and I wear contacts so I obviously go over the $30....)
I want to know what I should expect given that I'm paying that much. I'm single, it's just for me. It's a group policy through work. Here's what my insurance card says:
PCP/Specialist $25/$50
Inpatient 30%
Outpatient 30%
ER 30%
Rx $10/$30/$50 or 20%
(No dental, vision may as well not exist as it only pays for a $30 eye exam and I wear contacts so I obviously go over the $30....)
What insurance company? What part of the US? Individual or group plan? What is your deductible? What is your max out of pocket?
posted by magnetsphere at 2:36 PM on May 29, 2013
posted by magnetsphere at 2:36 PM on May 29, 2013
What's the deductible? Do you have a maximum annual out of pocket?
posted by colin_l at 2:42 PM on May 29, 2013
posted by colin_l at 2:42 PM on May 29, 2013
Response by poster: Anthem Healthkeepers. Hampton Roads, VA. Group. Not sure about the last two. I called and had them send the paperwork and I'm looking at it now and I can't find 'deductible' or 'max out of pocket.' Part of why I'm so confused. I have heard those terms before but they aren't defined anywhere in the literature I was sent.
posted by one4themoment at 2:43 PM on May 29, 2013
posted by one4themoment at 2:43 PM on May 29, 2013
Are you a contractor? I was paying over 1k a month for family full benefits when I was a contractor.
posted by wongcorgi at 2:44 PM on May 29, 2013
posted by wongcorgi at 2:44 PM on May 29, 2013
I'm confused a bit by your "(Supposedly)" -- do you or do you not pay $546.30 a month?
posted by brainmouse at 2:44 PM on May 29, 2013 [1 favorite]
posted by brainmouse at 2:44 PM on May 29, 2013 [1 favorite]
Do you mean "supposedly" in that your employer is covering a large percentage of the premium but that's the benefit value?
posted by DarlingBri at 2:45 PM on May 29, 2013
posted by DarlingBri at 2:45 PM on May 29, 2013
Response by poster: Between myself and my employer, according to my pay stub... that is what is paid.
posted by one4themoment at 2:45 PM on May 29, 2013
posted by one4themoment at 2:45 PM on May 29, 2013
Response by poster: According to the stub I pay $250 and they pay $296 (give or take a penny...)
posted by one4themoment at 2:46 PM on May 29, 2013
posted by one4themoment at 2:46 PM on May 29, 2013
What are the percentages signifying? That that's how much you cover, or how much your insurance covers?
What's the coverage for a hospital stay? Are you in a network? Can you see specialists without a referral?
According to the stub I pay $250 and they pay $296 (give or take a penny...)
Yeah, a monthly cost (employee premium + employer contribution) of close to $600 doesn't strike me as wildly out of whack for an individual within a group plan in this day and age.
posted by scody at 2:49 PM on May 29, 2013
What's the coverage for a hospital stay? Are you in a network? Can you see specialists without a referral?
According to the stub I pay $250 and they pay $296 (give or take a penny...)
Yeah, a monthly cost (employee premium + employer contribution) of close to $600 doesn't strike me as wildly out of whack for an individual within a group plan in this day and age.
posted by scody at 2:49 PM on May 29, 2013
The policy my work has is a fanfuckingtastic BC/BS PPO. As a single person, I have a $0 deductible with a copay of $20 office visit, $40 specialist, $100 emergency room. Rx drugs are on a $15/$30/$60 plan. The ONLY cost I ever pay is the co-pay. This also includes a fairly robust dental plan.
This costs a shade under $400 a month. Adding a spouse or child or family to that plan makes the cost go up radically, to nearly $1600/month for a family.
Our insurance broker (I'm the HR person at work, so I'm elbows deep in this shiz) constantly tells me how shocked he is that our employee-only rate is so low.
posted by phunniemee at 2:51 PM on May 29, 2013 [1 favorite]
This costs a shade under $400 a month. Adding a spouse or child or family to that plan makes the cost go up radically, to nearly $1600/month for a family.
Our insurance broker (I'm the HR person at work, so I'm elbows deep in this shiz) constantly tells me how shocked he is that our employee-only rate is so low.
posted by phunniemee at 2:51 PM on May 29, 2013 [1 favorite]
Response by poster: I'm going to stop ask sitting I swear! I guess the meat of my question is what should I expect given that price.
posted by one4themoment at 2:54 PM on May 29, 2013
posted by one4themoment at 2:54 PM on May 29, 2013
Best answer: If you're on your company's group plan, then, "What should that get me as an (almost) 32 y/o male?" is the wrong question. The right question is, "What are my company's employees getting for [$550 x number of employees]?"
It may be that your HR department has gotten a bad deal and that you're all paying too much for group health insurance. But if you're a small group, and some of the employees are older, or some of the employees have a history of expensive health problems, or you work in a profession where people historically make more health claims, or any number of factors are present that make your group look like a higher actuarial risk to the insurance company employee who sets the group rate, then the rate may be totally proportional to the actual costs of insuring your group.
You could ask your HR department for more information on your insurance plan and how they negotiate for it if you don't feel like you're getting your money's worth for your $250 per month. They may or may not give you an answer you'll find satisfying. You can also try to negotiate a raise with your boss if you feel as though your total compensation, including the health insurance, is too low for what you're giving your company. You may or may not get one. But the rate you pay for group health insurance has very little to do with what you, personally, are using your insurance for.
posted by decathecting at 2:56 PM on May 29, 2013 [3 favorites]
It may be that your HR department has gotten a bad deal and that you're all paying too much for group health insurance. But if you're a small group, and some of the employees are older, or some of the employees have a history of expensive health problems, or you work in a profession where people historically make more health claims, or any number of factors are present that make your group look like a higher actuarial risk to the insurance company employee who sets the group rate, then the rate may be totally proportional to the actual costs of insuring your group.
You could ask your HR department for more information on your insurance plan and how they negotiate for it if you don't feel like you're getting your money's worth for your $250 per month. They may or may not give you an answer you'll find satisfying. You can also try to negotiate a raise with your boss if you feel as though your total compensation, including the health insurance, is too low for what you're giving your company. You may or may not get one. But the rate you pay for group health insurance has very little to do with what you, personally, are using your insurance for.
posted by decathecting at 2:56 PM on May 29, 2013 [3 favorites]
Best answer: You could ask your HR department for more information on your insurance plan and how they negotiate for it if you don't feel like you're getting your money's worth for your $250 per month. They may or may not give you an answer you'll find satisfying.
I work for a small company, and because I Believe Strongly in Demystifying Health Insurance, whenever someone asks about our plan, I sit down and give them the whole spiel until they're absolutely sick of hearing about it. It's worth asking HR. (Because yes, like decathecting says, they might be getting a crappy deal, and it may be worth looking into getting it revised.)
The problem is that for many, many (often stupid) reasons, there really isn't a 1:1 I pay this so should expect that ratio. What I get for $X may vary wildly from what my neighbor is able to get for $X.
posted by phunniemee at 3:00 PM on May 29, 2013 [4 favorites]
I work for a small company, and because I Believe Strongly in Demystifying Health Insurance, whenever someone asks about our plan, I sit down and give them the whole spiel until they're absolutely sick of hearing about it. It's worth asking HR. (Because yes, like decathecting says, they might be getting a crappy deal, and it may be worth looking into getting it revised.)
The problem is that for many, many (often stupid) reasons, there really isn't a 1:1 I pay this so should expect that ratio. What I get for $X may vary wildly from what my neighbor is able to get for $X.
posted by phunniemee at 3:00 PM on May 29, 2013 [4 favorites]
You should expect health insurance with $25 copay for primary physician and $50 for specialists. You will pay approximately 30% out of pocket for other services up to your deductible. Your information doesn't include the deductible or lifetime max, but it's probably something like $2-4000 deductible and 1.5MM lifetime.
I'm not sure what perks you're expecting. There's a booklet somewhere that describes what procedures your plan does and doesn't cover. Some don't cover pregnancy. Most don't cover cosmetic or bariatric surgery. It can go either way for reconstructive surgery after injury or cancer. There are probably certain requirements for the treatment of diabetes or other chronic diseases.
The price means nothing except that your company has the buying power to get a pretty typical 30% plan for about $600. My company gets one for about $700. A bigger company might get it for $550. The amount you pay out of your paycheck is determined by your employer and how much they are willing to subsidize.
If you are feeling like they ought to be sending you fresh fruit bouquets for what you're paying, welcome to insurance sticker shock. At least your generic prescriptions are only $10!
posted by Lyn Never at 3:01 PM on May 29, 2013 [1 favorite]
I'm not sure what perks you're expecting. There's a booklet somewhere that describes what procedures your plan does and doesn't cover. Some don't cover pregnancy. Most don't cover cosmetic or bariatric surgery. It can go either way for reconstructive surgery after injury or cancer. There are probably certain requirements for the treatment of diabetes or other chronic diseases.
The price means nothing except that your company has the buying power to get a pretty typical 30% plan for about $600. My company gets one for about $700. A bigger company might get it for $550. The amount you pay out of your paycheck is determined by your employer and how much they are willing to subsidize.
If you are feeling like they ought to be sending you fresh fruit bouquets for what you're paying, welcome to insurance sticker shock. At least your generic prescriptions are only $10!
posted by Lyn Never at 3:01 PM on May 29, 2013 [1 favorite]
Best answer: Googling Anthem Healthkeepers looks to me like it is an HMO. $550 a month for an HMO in VA doesn't shock me though it is slightly higher than I would have guessed (I probably would have said $450). HMOs don't have deductibles so that is why you aren't seeing it in your benefits somewhere.
Yes, they could do better but once on an HMO is can be hard to get people off of them since people get used to the whole no deductible thing ("What do you mean I have to pat $500 before insurance pays for anything???"). That could be why your HR department hasn't made a change, they could also be getting bad advice from their broker or a million other reasons.
It could also be that your group has a lot of medical issues, if you are a smaller group having any significant medical issues can majorly jack with your rates. Just having a lot of women of child bearing age can jack your rates up.
posted by magnetsphere at 3:02 PM on May 29, 2013
Yes, they could do better but once on an HMO is can be hard to get people off of them since people get used to the whole no deductible thing ("What do you mean I have to pat $500 before insurance pays for anything???"). That could be why your HR department hasn't made a change, they could also be getting bad advice from their broker or a million other reasons.
It could also be that your group has a lot of medical issues, if you are a smaller group having any significant medical issues can majorly jack with your rates. Just having a lot of women of child bearing age can jack your rates up.
posted by magnetsphere at 3:02 PM on May 29, 2013
Deductible and max out of pocket, and any lifetime maximums if they exist, are the key numbers. Everything else -- the copays in particular -- honestly, is window dressing, because the real concern is how much you'll end up paying total if you get really messed up (e.g. bad car accident, whatever). That's the number you are actually paying for because it represents the worst-case scenario for you.
Your plan does seem expensive on first blush; I know someone who just bought insurance independently (not on a group plan with work), about your age, good health, with something like a $1500 or $2000 annual deductible and $3k or $5k annual OOP max, with preventative care but no Rx coverage (until a separate Rx deductible of like $1k is hit), and is paying under $150/mo for it. I think that is with BCBS Virginia, but you can get quotes online.
I have long suspected that some small-group plans may actually be more expensive than purchasing insurance independently for young people, if the "group" in question is overall less healthy than the general insurance-buying public (i.e. the risk is higher in the group). In a very large company that would be hard to achieve, but I could easily see it happening in a small company that was top-heavy with older people who want a Cadillac plan at reasonable cost and are using their younger employees to effectively subsidize it. While I would never suggest that anyone go without insurance, there's no reason you need to play along with that game as a young employee either (since if the company really wanted to make it worth your while to stay on the plan, they'd contribute more; they're not, so screw them).
As a result, it's probably worth getting some quotes online and carefully comparing the coverage you can buy yourself with your group plan's benefits, particularly if your employer isn't subsidizing your insurance heavily. But be very careful to ensure that you are comparing apples to apples though; health insurance is sort of a TANSTAAFL situation (although there are some very expensive, shitty lunches on offer), so be suspicious of anything that seems too good/cheap to be true.
Just like with car or homeowners or any other type of insurance, the more you are willing to risk in terms of a higher annual deductible / higher annual OOP max, the lower the premium will be. So you need to balance the amount you can afford in regular payments against what you could afford to shell out if you got unexpectedly sick. I would never advise anyone to ever have an OOP maximum that is more than their regularly maintained liquid savings (probably exclusive of an emergency fund, since you should keep in mind that after a bad accident where you hit your medical insurance OOP max, you may also not be in a condition to work immediately). So your personal finances play a big part in what policy is good.
On preview: Knowing that they are kicking in basically 50% of a $500/mo plan makes your employer look somewhat less shitty than I was imagining they were (I thought initially that they were making you pick up 100% of the plan cost of $500/mo which was ridiculous). Still, you might be able to do better than $250/mo if you want to, by going to a higher-deductible policy. But again, you should think about what a higher deductible and OOP max would mean in a real worst-case scenario.
posted by Kadin2048 at 3:07 PM on May 29, 2013 [1 favorite]
Your plan does seem expensive on first blush; I know someone who just bought insurance independently (not on a group plan with work), about your age, good health, with something like a $1500 or $2000 annual deductible and $3k or $5k annual OOP max, with preventative care but no Rx coverage (until a separate Rx deductible of like $1k is hit), and is paying under $150/mo for it. I think that is with BCBS Virginia, but you can get quotes online.
I have long suspected that some small-group plans may actually be more expensive than purchasing insurance independently for young people, if the "group" in question is overall less healthy than the general insurance-buying public (i.e. the risk is higher in the group). In a very large company that would be hard to achieve, but I could easily see it happening in a small company that was top-heavy with older people who want a Cadillac plan at reasonable cost and are using their younger employees to effectively subsidize it. While I would never suggest that anyone go without insurance, there's no reason you need to play along with that game as a young employee either (since if the company really wanted to make it worth your while to stay on the plan, they'd contribute more; they're not, so screw them).
As a result, it's probably worth getting some quotes online and carefully comparing the coverage you can buy yourself with your group plan's benefits, particularly if your employer isn't subsidizing your insurance heavily. But be very careful to ensure that you are comparing apples to apples though; health insurance is sort of a TANSTAAFL situation (although there are some very expensive, shitty lunches on offer), so be suspicious of anything that seems too good/cheap to be true.
Just like with car or homeowners or any other type of insurance, the more you are willing to risk in terms of a higher annual deductible / higher annual OOP max, the lower the premium will be. So you need to balance the amount you can afford in regular payments against what you could afford to shell out if you got unexpectedly sick. I would never advise anyone to ever have an OOP maximum that is more than their regularly maintained liquid savings (probably exclusive of an emergency fund, since you should keep in mind that after a bad accident where you hit your medical insurance OOP max, you may also not be in a condition to work immediately). So your personal finances play a big part in what policy is good.
On preview: Knowing that they are kicking in basically 50% of a $500/mo plan makes your employer look somewhat less shitty than I was imagining they were (I thought initially that they were making you pick up 100% of the plan cost of $500/mo which was ridiculous). Still, you might be able to do better than $250/mo if you want to, by going to a higher-deductible policy. But again, you should think about what a higher deductible and OOP max would mean in a real worst-case scenario.
posted by Kadin2048 at 3:07 PM on May 29, 2013 [1 favorite]
"If you are feeling like they ought to be sending you fresh fruit bouquets for what you're paying, welcome to insurance sticker shock."
Um, no. Speak to HR and get the full description. Just because insurance in this country is pure, inhuman insanity, it doesn't mean you can't ask questions and get answers. $550 is *a lot* of money, and you have the right to get a clearer breakdown in my experience, unless you really don't want to rock the boat/have reason to think this will reflect horribly on you with HR and your company.
posted by thegreatfleecircus at 3:08 PM on May 29, 2013 [1 favorite]
Um, no. Speak to HR and get the full description. Just because insurance in this country is pure, inhuman insanity, it doesn't mean you can't ask questions and get answers. $550 is *a lot* of money, and you have the right to get a clearer breakdown in my experience, unless you really don't want to rock the boat/have reason to think this will reflect horribly on you with HR and your company.
posted by thegreatfleecircus at 3:08 PM on May 29, 2013 [1 favorite]
"If you are feeling like they ought to be sending you fresh fruit bouquets for what you're paying, welcome to insurance sticker shock."
It always makes sense to ask questions and make sure you're working with the best options available.
I am a Sick Person, and thankfully I was in a position of relative power over this thing. I made sure that the plans my company offers has things that benefit Sick People (like the plan I have, outlined above) and also plans that benefit Not Sick People (for instance, we also offer a low-cost HMO that we offer at zero cost to the employees).
Sometimes all it takes is for the right person in the right position to be properly motivated. ALWAYS ask to see if it's possible to do better. HR may have just been maintaining the status quo. It's possible your company is on a plan it's been on for years, just letting the premiums rise and rise, without ever sitting down to look at other options. Don't be afraid to ask!
posted by phunniemee at 3:13 PM on May 29, 2013
It always makes sense to ask questions and make sure you're working with the best options available.
I am a Sick Person, and thankfully I was in a position of relative power over this thing. I made sure that the plans my company offers has things that benefit Sick People (like the plan I have, outlined above) and also plans that benefit Not Sick People (for instance, we also offer a low-cost HMO that we offer at zero cost to the employees).
Sometimes all it takes is for the right person in the right position to be properly motivated. ALWAYS ask to see if it's possible to do better. HR may have just been maintaining the status quo. It's possible your company is on a plan it's been on for years, just letting the premiums rise and rise, without ever sitting down to look at other options. Don't be afraid to ask!
posted by phunniemee at 3:13 PM on May 29, 2013
Sounds expensive to me. For grins see what it would cost you on the open market.
posted by Ruthless Bunny at 3:30 PM on May 29, 2013 [1 favorite]
posted by Ruthless Bunny at 3:30 PM on May 29, 2013 [1 favorite]
I pay $622 per month to cover me, my wife and my 5 children. $25 copay at physician, $50 ER co pay and that includes dental and vision. This is for a PPO so in-network hospitalization is, largely, covered. I work for a multinational megacorp so the pool of insured is much larger, I assume.
posted by brownrd at 3:38 PM on May 29, 2013
posted by brownrd at 3:38 PM on May 29, 2013
On the other hand, I had an individual plan which was jacked up to about $900 a month for a 35 year old male about a year ago. Very low deductible. Switched to a high deductible plan and it went down to "only" $300 a month.
posted by Justinian at 5:40 PM on May 29, 2013
posted by Justinian at 5:40 PM on May 29, 2013
Also, at the company where I work the percent of health insurance an individual is responsible for goes up based on income- the more you make, the higher percentage of coverage you are responsible for.
posted by the twistinside at 5:54 PM on May 29, 2013
posted by the twistinside at 5:54 PM on May 29, 2013
If you want to find out if it's a good deal or not, call a health insurance broker. I have insurance through my fiance's work (I was unemployed, and my new job doesn't offer insurance yet) and I wanted to find out if I could get a better deal somewhere else. My mom gets her insurance through a broker so I called him up and told him what insurance I have and how much it costs. He confirmed that the price was right in the range it should be, and that it's a much better deal than trying to get insurance on my own.
posted by radioamy at 6:55 PM on May 29, 2013
posted by radioamy at 6:55 PM on May 29, 2013
For comparison, an absolute bare-bones policy for a healthy male your age with a $10k deductible and no covered expenses (aka 100% out of pocket) might be $80/month.
posted by RobotVoodooPower at 8:53 PM on May 29, 2013
posted by RobotVoodooPower at 8:53 PM on May 29, 2013
I live in the Netherlands. We have compulsory health insurance here. For someone who earns 50.000/year, it's pretty common to pay about 110 euro's/month themselves (this is around the standard price for health insurance, but people who earn less get money back from the government). Their employer will pay about 320 euro's/month (7.75% of income up to about 50.000), so that's a total of 430 euro/month, which is about 550 usd. This does not include dental, glasses/contacts, physical therapy, and a lot of mental health care (it does include emergy mental health care and psychiatrists, but regular therapy is complicated). There is a 350 euro deductible for everybody. No yearly physicals or things like that. So, even in a country where health care is a whole lot less expensive than in the US, we still pay prices like this. Of course children are free here and you can't really compare the policies, but still, perhaps still useful to know that this is what we pay too.
posted by blub at 12:57 AM on May 30, 2013
posted by blub at 12:57 AM on May 30, 2013
Response by poster: Go sit down with HR, talk to insurance broker (and learn more about health insurance in general). Got it.
It's good to know that what I'm paying seems to be reasonable. Also I found "annual copayment limit" which I'm guessing is the max out of pocket I was looking for earlier, and that is $3000 so that makes me feel better too. But yeah, I know, talk to HR... :)
posted by one4themoment at 6:30 AM on May 30, 2013
It's good to know that what I'm paying seems to be reasonable. Also I found "annual copayment limit" which I'm guessing is the max out of pocket I was looking for earlier, and that is $3000 so that makes me feel better too. But yeah, I know, talk to HR... :)
posted by one4themoment at 6:30 AM on May 30, 2013
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posted by Oktober at 2:33 PM on May 29, 2013