Reply
 
Thread Tools Display Modes
  #1  
Old 10-13-2019, 11:47 AM
mixdenny is offline
Guest
 
Join Date: Apr 2016
Location: Cleveland suburbs
Posts: 2,213

Health care cost - self plus one


In the past most medical insurance was divided into self or family. This meant that if you were just insuring a couple you paid the same as someone with numerous children. A few years ago they added the "self plus one" option. For some reason insurers charge more for "self plus one" then they do for two single accounts. Do they have any justification for this?

Dennis
  #2  
Old 10-13-2019, 12:03 PM
Thudlow Boink's Avatar
Thudlow Boink is offline
Charter Member
 
Join Date: May 2000
Location: Lincoln, IL
Posts: 28,385
I know very little about health insurance. In particular, I don't know who the "insurers" are that you're talking about, or whether what you say applies to all insurers or just the particular ones you've had experience with.

Are you talking about insurance offered through your employer? And if so, are you talking about what you pay, or about what you and your employer pay?

The insurance plans my own employer offers cost me very little to cover just myself, but they would cost me much, much more if I were including anyone else. My employer wants to and/or is obligated to help me have health care, but they don't want to or can't afford to spend a lot of money on health care for other people who don't work for them. If I had a spouse who worked elsewhere, they would prefer that she get health insurance through her own employer.
  #3  
Old 10-13-2019, 12:47 PM
mixdenny is offline
Guest
 
Join Date: Apr 2016
Location: Cleveland suburbs
Posts: 2,213
The insurer I have is Medical Mutual. The insurance plans are offered through my former employer (I'm a retired Federal employee). We have many plans to choose from, both national and regional, HMO or pay for services. The open season to select a plan is coming up. The fee I am talking about is my monthly premium. Here is the 2020 premium structure for the level of insurance I have - a high end HMO:

self - $516

self + one - $1168

self + family - $1282

As you can see it is less expensive for two self plans then a self + one. I haven't received the complete listing of all plans yet but the others I looked at last year had similar fee structures.

Dennis
  #4  
Old 10-13-2019, 01:07 PM
Manda JO is online now
Charter Member
 
Join Date: Jul 1999
Posts: 11,753
I've seen that myself, even when the employer's contribution is adjusted for. In my school district, if a couple who both work for the district get married, their premiums go up. The only advantage is that you may now share a max-put-of-pocket or deductible. Assuming that's a high number (ours are), that would only kick in to offset the increased premiums if both people had significantly higher than average health costs in the same plan year. In my district you don't have to switch to the married-but-both-employed plan, so most don't.
  #5  
Old 10-13-2019, 02:01 PM
Manda JO is online now
Charter Member
 
Join Date: Jul 1999
Posts: 11,753
I looked it up.

A district employee pays $61.00/month for our cheapest plan. If they marry another district employee and the two opt for the "pooled" plan, they EACH pay $216.00/month for the same coverage. Assuming you do everything in-network, for that extra $3630 out of your household budget, you each still have a $2750 individual deductible, but you also have a shared $5500 deductible. I am not sure if one person's post-deductible costs count toward the shared deductible, but I would home it does; if not, it only helps for like the last $500 of the second person's deductible. Your individual max-out-of-pocket is $6750 individual/$13,000 family, for covered expenses. So basically if one partner has a lot of medical expenses, you can save money by pooling, but that's a big risk unless you know something is coming.

For reference, if you add a spouse who DOESN'T work for the district, you pay $760/month for the same coverage for both of you.
  #6  
Old 10-13-2019, 08:16 PM
doreen is offline
Charter Member
 
Join Date: Dec 1999
Location: Woodhaven,Queens, NY
Posts: 6,838
Quote:
Originally Posted by mixdenny View Post
In the past most medical insurance was divided into self or family. This meant that if you were just insuring a couple you paid the same as someone with numerous children. A few years ago they added the "self plus one" option. For some reason insurers charge more for "self plus one" then they do for two single accounts. Do they have any justification for this? Dennis
It's probably not the insurers , it more likely the employers. It is not uncommon for the employer to pay a different percentage of the premium for the employee vs the dependent. For example, my employer pays 90% of the employee's premium and 75% for the dependent coverage.

So lets say the premium the insurance company charges for me is $1000 and for "single plus one" the insurance company charges $2000 ( $1000 for each of us) . My employer pays $900 toward my premium and $750 toward my dependent's. That leave me paying a total of $350 ( $100 for mine, $250 for dependent), which is more than twice what two single employees would pay.


You can't just look at what you pay- you have to look also at what the employer pays to tell if the insurance company or the employer- but my guess is that it's the employer.

Last edited by doreen; 10-13-2019 at 08:19 PM.
  #7  
Old 10-13-2019, 10:30 PM
Tired and Cranky is offline
Guest
 
Join Date: Dec 2014
Posts: 1,750
Self is less than half of self+1 because the employer is paying a bigger part of the self-only premium than they pay on self+1.

I seem to recall reading (but no cite handy) that self+1 was more expensive than family because of the demographics of the people choosing those plans. Family plans were generally chosen by people with dependent children whereas self+1 was typically chosen by empty nesters who no longer had dependent children. On the whole, self+1 were thus being chosen by older couples. Older couples have more medical problems and were charged higher premiums accordingly. This is not rational pricing because older couples could still choose the family plans and get the benefit of the cheaper pricing. I suspect this only works because not everyone reviews the cost of the medical plans closely every year. It's also possible that many people who are picking self+1 don't know that they can choose the cheaper family plan and get the same coverage for less.
  #8  
Old 10-14-2019, 12:01 AM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,690
Quote:
Originally Posted by Tired and Cranky View Post
Self is less than half of self+1 because the employer is paying a bigger part of the self-only premium than they pay on self+1.
Not on federal plans. Uncle Sam pays between 72 and 75 percent of the premiums on all plans (self, self+1, self+family).

Quote:
Originally Posted by Tired and Cranky View Post
I seem to recall reading (but no cite handy) that self+1 was more expensive than family because of the demographics of the people choosing those plans.
I've never seen a setup where self+1 was more expensive than family, and at least on the federal plans, this is not correct. Family plans are consistently more expensive than self+1.

However, I suspect the reason why self+1 is more expensive than twice self-only is indeed due to demographics. If spouse is working, it is at least reasonably likely that spouse qualifies for their own health insurance, quite possibly at better (more highly-subsidized) rates. So, self+1 is more likely to be chosen in situations where plus-one isn't working, and the reasons for not working (such as disability or pregnancy) may be related to higher medical costs.
  #9  
Old 10-14-2019, 07:37 AM
Manda JO is online now
Charter Member
 
Join Date: Jul 1999
Posts: 11,753
Quote:
Originally Posted by doreen View Post
It's probably not the insurers , it more likely the employers. It is not uncommon for the employer to pay a different percentage of the premium for the employee vs the dependent. For example, my employer pays 90% of the employee's premium and 75% for the dependent coverage.
I just showed that my employer charges married people who are both employed by the district over three times as much as when they were both single and employed by the district. The per-employee contribution stays the same.
  #10  
Old 10-14-2019, 08:19 AM
doreen is offline
Charter Member
 
Join Date: Dec 1999
Location: Woodhaven,Queens, NY
Posts: 6,838
Quote:
Originally Posted by Manda JO View Post
I just showed that my employer charges married people who are both employed by the district over three times as much as when they were both single and employed by the district. The per-employee contribution stays the same.
I'm not sure where that conflicts with what I said, which is that it's probably the employer causing "self+1" to cost more to the employee than 2x what "self" costs.

You also said that each employee will pay $216 monthly for the pooled coverage , for a total of $432 while an employee married to someone who doesn't work for the district will pay $760 for the "same coverage" for both of them. I'm not sure if "the same coverage" is family or self-plus one, or if those married to non district employees can get the pooled coverage or not. But it makes no sense to even offer the married district employees "self+1" coverage for $462 when they are allowed to each keep their own single coverage for $122/month - why would anyone take it? On the other hand, family coverage for $432 is less than the $760 those married to non-district employees pay.


On a side note, I'm not sure the demographics make a difference. People are talking about older empty-nesters, and those whose spouses are not employed being more likely to use single +1 and also being more likely to have medical problems - but there are lots of reasons to use single plus one and they don't all involve less healthy people. There are couples who both work who choose it because single plus one on one person's plan costs less than covering each person on their own employer's plan, because one person has better coverage, and people who choose it because they are single parents who only need to cover one child.

Last edited by doreen; 10-14-2019 at 08:23 AM.
  #11  
Old 10-14-2019, 09:50 AM
Thudlow Boink's Avatar
Thudlow Boink is offline
Charter Member
 
Join Date: May 2000
Location: Lincoln, IL
Posts: 28,385
Quote:
Originally Posted by doreen View Post
On a side note, I'm not sure the demographics make a difference.
I'm not sure they do either, but it at least sounds plausible to me that they might.
  #12  
Old 10-14-2019, 09:01 PM
Mdcastle is offline
Guest
 
Join Date: Oct 2004
Posts: 2,196
I don't work in underwriting , but based on the type of claims I see from various plans, I agree it's likely a demographic thing. If you choose a single plan you could be about any age, but likely younger. I've seen younger individuals go years without accumulating claims. Family you might be young to a not very old. It's true you have a lot of kids to cover, but your teenage daughter's annual checkup, immunization shots, and blood work aren't that expensive compared to an empty nester couple on an employee plus one coming down with cancer and heart problems, either of which can very easily top $100,000

Last edited by Mdcastle; 10-14-2019 at 09:03 PM.
  #13  
Old 10-14-2019, 10:20 PM
Tired and Cranky is offline
Guest
 
Join Date: Dec 2014
Posts: 1,750
Quote:
Originally Posted by slash2k View Post
Not on federal plans. Uncle Sam pays between 72 and 75 percent of the premiums on all plans (self, self+1, self+family).

I've never seen a setup where self+1 was more expensive than family, and at least on the federal plans, this is not correct. Family plans are consistently more expensive than self+1.

However, I suspect the reason why self+1 is more expensive than twice self-only is indeed due to demographics. If spouse is working, it is at least reasonably likely that spouse qualifies for their own health insurance, quite possibly at better (more highly-subsidized) rates. So, self+1 is more likely to be chosen in situations where plus-one isn't working, and the reasons for not working (such as disability or pregnancy) may be related to higher medical costs.
Here is the article I must have read, from the Washington Post. It talks specifically about government plans and explains exactly the phenomenon I described. Perhaps the problem has worked itself out over time as people started choosing family plans rather than Self+1 plans, thereby altering the risk pool of family plans and pushing the price to at least parity.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 06:18 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2020, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright 2019 STM Reader, LLC.

 
Copyright © 2017