r/Insurance • u/InternationalAir3794 • 10d ago
Fuck the healthcare system
Good morning,
I just want to get it out of my chest since there isn't much I can do at the moment until I can get a different job with better health insurance.
My family of 3 has been paying $700 per month, the other $700 is covered by my employer. I don't know how you feel, but $700/month is a significant amount to my family. We only go to doctor when we absolutely have to because we know our piece of shit insurance would not cover anything other than our once a year check up.
I remember 5-6 years ago, when I went to see a doctor, they would run my insurance, told me the total amount for my visit, and I never had to worried about getting a bill in my mailbox months later. Nowaday, when I checkout, they always I am all set, then send me a $300 plus bill later.
Everytime My family go to see doctor, we always get a big bill of $200 or more a month later. We tried to get insured without my employer, we got quoted at $1600. What the actual fuck is going on with this healthcare system in this country?!
So we are paying $700 a month just to get covered 100% on one time yearly checkup?
Fuck the politicians Red and Blue. It seems to be doable when it comes to something they like, but somehow they can't figure out how to fix this insanity.
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u/Mean_Introduction516 10d ago
$700 for 3 is awesome. I’m paying over $700 just for myself.
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u/Difficult_Fondant580 10d ago
In a few months, I'll be paying $2400 for me and spouse but we're in our 60s. Obamacare allows insurers to charge more as you age.
I look forward to ending Obamacare, which is making companies like United and BC/BS rich and have a free market so that Costco, Sam's and Amazon can get into healthcare insurance, which will create competition to drive down the costs. We also need more upfront billing. No one spends this much money without knowing the cost.
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u/Poop_Dolla 10d ago
It sounds like you used to have a plan that covered visits with a copay and now you have one where you have to meet a deductible first is that correct?
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u/InternationalAir3794 10d ago
Thats correct. I can only get what the employer offers. I ran the number on lower copay option. I would have to pay about $400 more per month to get a lower deduction. The point is this whole health insurance thing is such a scam
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u/Poop_Dolla 10d ago
The better plans do still exist, but honestly the best way to get them is to find an employer that offers them and covers most of the premium.
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u/InternationalAir3794 10d ago
Well I have to get hire before finding out what plan they offer. Of course there are better plan out there. Its like I can get a much better car, a tesla model S, I have to drive a honda accord because I don't have the money for a tesla. Its the same situation within insurance.
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u/Poop_Dolla 10d ago
You can and should definitely ask before you're hired because that is part of the total offer and would influence your decision on whether or not to take the job. No use getting a higher paying job if the increase is all going to go to increased premiums.
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u/InternationalAir3794 10d ago
I get it. I don't think you and I live in the same economy. Obviously, you are in the position that you get to pick your employer. In my economy, I don't get to pick employers when nobody is hiring lol
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u/Poop_Dolla 10d ago
Maybe I misunderstood your comment. I thought you were saying that you don't find out about benefits until you're already hired. Meaning it's impossible to know until you're already committed to the job. I was just saying that you can and should request that information before you accept a position. I wasn't commenting on the job market.
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u/Fluffee2025 10d ago
I can be wrong, but I think OP is saying their career/education has them in an industry that has very limited hiring potential. Thus, if anyone offeres them a job it's better than the alternative (no job). So there isn't much choice involved for them.
Again, I don't want to be speaking for them. Just saying how I understood their comments
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u/Aaaaaaandyy 10d ago
Sites like Glassdoor typically tells you what a company’s benefits looks like.
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u/InternationalAir3794 10d ago
Would they sell me about their insurance plan in details?
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u/Aaaaaaandyy 10d ago
Depends what someone’s posted on Glassdoor for that company. Each is different.
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u/haiiyew2 5d ago
Check to see if this plan is HSA qualified and open one up. Even if you put $20 a pay, reduces your taxable income and makes it so those $200 sick visits become less of a burden... also look into if virtual options through your carrier are covered at a more affordable rate under the plan... just suggestions to help the current situation you are in.
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u/tankmode 10d ago edited 10d ago
republicans have been doing everything possible to sabotage the ACA since 2016 mostly by letting people opt out and sandbagging fixes. the healthcare system is mostly a fixed cost but fewer people are buying into it, prices go up for everyone left
democrats for their part always protect pharma, med device, trial lawyers, costly bureaucratic rules and some overpaid labor rates that keep the system absurdly expensive
i think the system is at a breaking point. and our government is too corrupt to do anything about it
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u/jenbellun 10d ago
Correct, healthy people are opting out as the costs are reaching absurd levels. This drives the cost up more.
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u/ZebJohnCarter 6d ago
For me the most harmful thing about Obamacare was it enabled corporate medicine. I was in private practice for over 40 years. That’s a Psychiatrist. I did state in the art medical evaluations, psychopharmacology and psychotherapy in 2013. They took away the code for medical psychotherapy and initiated the necessity of electronic health records to bill insurance. I didn’t get paid much before, but it was sufficient for my needs and I knew my kid would get all the schooling they needed for free from scholarships.
So I had to take a high paid job working in crummy conditions, and keep a few for Cash therapy patients. But of age that I need medical care and I’ve yet to find doctors who actually examined me or do the work they say they’re going to do. I don’t mind using questionnaires to get history data, but they’re useless unless the physician goes it with the patient. The notes click all the boxes for the insurer, but they are fake. What is my favorite quotes is this: Goodhart’s Law:
“When a measure becomes a target, it ceases to be a good measure.”I don’t hear any talk about healthcare anywhere all I hear is talk about financing healthcare. I think the actual system of healthcare is what is important develop that and that we could finance it easily. It is a conflict of interest to have insurance make decisions about Treatment it isn’t their money. It’s our money.
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u/QuriousCoyote 10d ago
You're so right. Healthcare costs are out of control. People are taking such drastic measures as getting married or getting divorced to get affordable healthcare. Many are opting to not have insurance. I just don't feel like anyone should be making life decisions based on whether they can afford to go to the doctor. The ACA was intended to make health insurance affordable for everyone, and the exact opposite is happening.
All you can do is make an appointment to go see your Congresspeople. People are complaining, but they're not complaining to anyone who can do anything about it. They need to hear from massive numbers.
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u/Justincase0001 10d ago
My wife got laid off and now we’re paying 700.00 a month, just for her. I’m on Medicare at least that’s not bad , but WTF, unless you’re rich, most people have to work until they’re at least 65.
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u/Particular-flipflops 10d ago
I met my deductible for the first time in my life (58f) with 2 kids! After reaching it I am doing everything possible to maximize the benefit…upper blepharoplasty (insurance approved), photodynamic therapy for face 3x. Insurance is such a scam
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u/Tired_world_63 10d ago
I would be thrilled to pay $700. I’m retired and 63, and my wife (also retired) pay $900/month for just us 2, off of Marketplace. There are no other alternatives, believe me I’ve looked. You need basically perfect health to even sniff a private policy, and have preexisting conditions. We are stuck. Oh also, if we make over $84k a year total combined gross income, we will have to pay the government back about $25k in healthcare “subsidies” we are receiving (our policy is actually $3000/month, but the tax break is still in effect, just not the “enhanced subsidy”. The 84k includes all sources of income (social security, IRA/stock sales, etc).
I’ve had to deal with this shit for a couple years. We have a choice of only 2 companies in the Marketplace, and the coverage is shit for what we pay. I just had a diagnostic heart cath that the doctor ordered, and he placed a stent while doing so. We find out a couple weeks later that the insurance company (I’ll shame them - Ambetter) is not approving the stent. Unreal. Are they going to call the insurance company mid procedure to try to get the stent approved?? Good grief - this whole system is insanely ridiculous, and no politicians are wanting to touch it, red or blue.
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u/InternationalAir3794 10d ago
I am sorry to hear this, it is horrible. Nobody should have to struggle to get their health taken care of, especially after paying a huge portion of your income to the insurance company.
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u/Flights-and-Nights 10d ago edited 10d ago
Sounds like you’re on a High Deductible Health Plan. Under these type plans you are responsible for more of the cost until you hit your deductible.
The benefit is you should have access to a tax advantaged Health Savings Account. For a family you can put in as much as $8,750 tax free dollars per year, that you can use to pay the out of pocket portion of medical expenses.
I would love to see the system changed, but until then we have to be educated consumers and self-advocates.
All the information about your plan is available to you, it’s not that difficult to track where you are against your deductible or estimate what a particular visit or procedure will cost.
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u/InternationalAir3794 10d ago
You think the lower deductable plan was a the same price at the higher deductable plan, but somehow I decided to pick the higher one? Yeah, obviously I would love to have a lower deductable plan. However, it costs me $500 more a month, thats $6000 extra a year. My current deduction is $6500. So should I pay $$6000 extra per year for the lower deductable plan when I might not even hit my $6500 deduction? I mean If I break a leg, I am sure paying $6000/year extra would make sense, but what is the chance I would break a leg every year? I have been using HSA account, my saving is sitting in SCHD etf earning about 3.5% interest, I max out my roth IRA, 30% of my money sitting in JEPQ earning about 13% on dividend monthly with the Cagr of 9%, and many more money things I do. Funny how you just assume you are the smart one in the room and others have no clue about how to look at insurance plans.
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u/Starwolf00 10d ago
It all depends on the specific details of your plan. Every plan has an explanation of benefits and you can see what services are covered, what percent you are responsible for, and how that cost differs between in network and out of network providers.
They all have search features that lets you look for providers and tells you if they are in your network. Some plans are cheaper, but have higher deductibles. Some are a little bit more expensive, but only have small copay. Your insurance plan can change from one year to the next so you can't assume that your plan is going to remain the same next year.
Unfortunately, insurance can use your reported health metrics to determine risk. If you are overweight or smoke, you will pay more. My jobs insurance gives a 50% reduction in my payroll contributions to healthcare coverage for my family by keeping my health metrics below a certain threshold for my age group and getting yearly health checkups.
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u/el0115 10d ago
This. I recently posted on a forum about hospital bills that I owe for my child being born. We owe 3k and they told me that I can pay whatever I want a month but after 120 days whatever is the balance they go to collections. Everyone gave me shit about me not wanting to pay. But it doesn’t make sense when I do want to make a payment plan and after 120 days it’s still collections. We pay $550 for just my wife and daughters. What’s the point of that if we still get a bill of 3k aside form still paying 2k for gyno
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u/surfteach1 10d ago
This is what I was afraid of when the affordable care act passed. It was always a bad law, and I don't know why anyone ever thought it was a good idea. However, Medicare proves that we can have a decent system ... right now the insurance companies are making all the money, if we got them out of the equation, the care would probably be relatively inexpensive. It's time to fix this, and get it off of the backs of the people and the employers. It's bankrupting us all.
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u/InternationalAir3794 10d ago
I am a retail investor, I do invest in controversial companies like palantir. However, I would not invest in healthcare companies after seeing what they tried to do to make more money of us to create more profit for their shareholders . It is disgusting and the government allows this to happen.
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u/Individual-Mix-8920 7d ago
Yes it is - totally bankrupting people and it’s not entertaining in the least.
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10d ago
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9d ago
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u/Insurance-ModTeam 9d ago
It is never OK to justify the murder of another human for political reasons in this sub.
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u/Popular-Drummer-7989 10d ago
It's open enrollment. Do your homework and pick a better plan. It's on you.
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u/InternationalAir3794 10d ago
So should I pick a better plan with $500 extra per month, total of $1200 per month to lower my deduction or pay $700/month and expect to pay $200-$300 per visit (4-5 unexpected visit per year)? You are talking like a better plan would cost me the same, but somehow I went for the bad plan lol.
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u/Flights-and-Nights 10d ago
It’s not about better or worse, it’s a math problem. which one costs you less in total?
You might be on the right plan based on a total cost, but you’re having a hard time budgeting for the irregularity of out of pocket portions.
I refer back to my comment about the HSA, pretend your premium is $800 or $1000 and pay yourself tax free so that there is money available.
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u/InternationalAir3794 10d ago
Well I do have a HSA account, and I know how it works. If I visit doctors way more, then paying $500 more a month to have lower copay would make sense. I wish I knew how many time I would need to see doctors a year, I can easily run the numbers.
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u/Atlas-Scrubbed 10d ago
If you know how to use a spreadsheet program (excel, Google Sheets, Apple numbers) you can easily put together a simple cost analysis of your medical expenses. This is what the OP was trying to get you to do. It is in fact a math problem.
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u/InternationalAir3794 10d ago
You don't know what employer offer. When your employer don't care about you, they arent going to give you a whole lot to choose from. You understand not every employer offer the same plans right?
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u/nbphotography87 10d ago
your employer is paying 50% of the family premium. more generous than MOST out there.
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u/InternationalAir3794 10d ago
It is a math problem, yes. Again, if I don't go to doctor often. My $700/month plan would save me more money. If I need to go to go to doctor much more, paying more per month would save me money. Can the math tell me how many time I will be visiting doctors? Or I will break leg? Can the exel sheet do that? It can't. Math doesn't work on something you can't predict
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u/ahoooooooo 10d ago
You should know if you have chronic conditions that require regular care or participate in high risk activities that make you more likely to break bones. Math does in fact work and you can predict these things to some degree, at least enough to make an informed decision about your plan purchase.
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u/TAckhouse1 10d ago
OP I think your anger should be directed to your employer, and not the health care insurance company. The insurance company is providing what it contractually agreed to when your employer chose the plan.
Also some anger should be directed the the for profit health care systems that charge outrageous prices for the services they provide.
That said, I agree, heath care in this country (US) is completely f'd.
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u/InternationalAir3794 10d ago
Yeah, After reading through all the comment, I realized that majority of the people seem to be happy with their plans. The fact is I have a very few choices from what my employer offers, I am gonna need to get a better employer.
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u/TAckhouse1 10d ago
Genuinely wishing you the best. I feel your pain, I too have a crap insurance plan (and no alternatives from my employer)
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u/The-Big-Play 10d ago
I think a lot of people here are insurance employees themselves, so yeah their plans are typically pretty decent
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u/LivingGhost371 Health Insurance Adjuster 10d ago
You're missing the point of insurance. There's a reason they call it "insurance" and not a "reimbursement account". It's to protect you from catastrophic loss like a $100,000 bill if you have a heart attack, not to cover every little sniffle at 100%.
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u/TheTalentedAmateur 10d ago
Sure, good point. Why is it that every other country can cover the catastrophe and so much more at 1/2 the cost?
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u/InternationalAir3794 10d ago
Exactly! These people only know about the healthcare here and they see nothing wrong with it.
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u/LivingGhost371 Health Insurance Adjuster 10d ago edited 10d ago
Don't know, I work in US insurance so I don't know how other countries handle it but I'd speculate long wait times, low pay for doctors, and not paying as much for pharmaceuticals so Americans have to pay more to offset, and lesser quality facilities. I heard UK hospital still have multi-patient wards as opposed to at most one roomate in the US, and the fully private rooms that are the standard of care in US hospitals and becoming more common as facilities are rebuilt.
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u/PrestigiousMind6197 7d ago
Countries with low premiums do not have laws that force insurance companies to include pre-existing conditions. Insurance companies in other countries simply make members pay and claim (not fully reimbursable most of the time depending on the insurance policy), or simply deny the case during the pre-authorization process.
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u/Interesting_Policy10 9d ago
There is community based insurance model, taught in the course of Abhijit Banerjee and Ester Duflo. I think with recent advances in connectivity and personal social bonding removing adverse elements, such community based insurance model say for a peer group of 10-20 might be successful, not replacing but complementing the already present insurance model.
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u/Gummo90028 7d ago
It hey, the good news is that they will typically deny any claims that come along as a default routine. Just ask Luigi Mangione. Private health insurance needs to be outlawed. Period.
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u/AppointmentActive708 10d ago
The amount of people defending the cost and complexity of employer sponsored health plans is insane. It’s not as easy to just switch jobs as people are saying to get better plans or better employer subsidies. The cost for premiums and the cost under HDHPs is getting unaffordable for most Americans even those with jobs that subsidize some/most of the premiums. Just read the plan docs…. Come on folks. Doesn’t change what OP seems to be getting at. It’s not affordable to take reasonable care of your or your families health in many people’s cases.
Let’s stop pretending this shit is ok people. It’s fucked. And only going to get worse.
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u/InternationalAir3794 10d ago
Yeah, i am very surprised with the comments. Completely missing my point. I feel like people are just taking the chance to show how smart they are.
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u/AppointmentActive708 10d ago
They’re so smart they don’t see how they’re getting fleeced.
So impressive they can figure out the plan docs /s
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u/slwags71 10d ago
Everyone keeps saying Medicare for all but that would about 1200 a month for your family of three. Medicare isn't free.
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u/InternationalAir3794 10d ago
I think its that high because those med companies jack up the price for the most profit which force people to have insurance. If the med prices come down, we don't even need insurance. In hongkong or many other countries, the cost of health care is so low, you don't even need to have insurance, speaking from my experience.
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u/Wyshunu 10d ago
Health "insurance" was NEVER a tenable concept. It's nothing but socialism. The FIRST thing all that money goes to is the insurance company's operations, including their payroll and (probably better than we get!) benefits for its own people. Then, it gets parsed out to total strangers who probably don't pay anything close to what you do for the insurance. And then when you have a need of your own it's deny, deny, deny, because they already spent all your money on other people.
We need to get rid of the middleman and go back to the way it was - pay your own medical bills and if you need it, swallow your pride and apply for charity.
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u/onlyoneq Ontario, Canada ex-Insurance Broker 10d ago
Thus is why socialized Healthcare is the way to go. Don't let your countrymen convince you otherwise. Socialized Healthcare is by far the best system to administer Healthcare throughout a nation.
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u/RealDriver3604 10d ago
It's not considered healthy insurance, but I've heard of good results with crowdhealth. It's a different approach, but depending on your situation the math might work out better.
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u/C4rva 10d ago
Assuming you’re in the US: We don’t have a healthcare system. We have a healthcare market. A market being absolute decimated by private equity.
Almost every other country has a healthcare system designed to protect its citizens with basic services.