Health law risks turning away sick

Not all conventional health insurance plans are HMOs.

The alternative offered by my employer was a traditional PPO plan. With that plan, the premiums were much higher, the deductible was quite a bit lower, and of course there was no attached HSA. Also, for that plan there are copays for every doctor or hospital visit, and the copays have to be paid even after the maximum out of pocket has been reached. When I worked the numbers, the total cost actually came out somewhat higher – I think it was around $8000 per year.

This is for coverage of a family of three – myself, my wife, and my infant son. In Northern California. It’s a group plan, so the same plan with the same costs was offered to everyone at my company in the United States who had a salary over $100,000. Those making less had the same plan offered but with lower premiums.

You should check if you are paying the same for standard doctor visits as you would be if covered. HDCPs are great under the model of bimodal expense distribution - either small costs or gigantic costs. If your medical costs average some significant percentage of the deductible, they may not be as good.

BTW, I looked at what my COBRA would have been if I had been laid off, and though I didn’t look that hard, I came to the same conclusion as you - it wasn’t that good a deal.

My point is that your good deal only lasts as long as you remain healthy. If you develop ANY chronic problem that requires on-going medical care you may well find your current policy no help at all, and your premiums skyrocketing.

It’s not impossible that you found a truly good deal, but back when I was working in the industry I saw a LOT of people get totally screwed by the high deductible policies like you have.

So far I’ve found that doctors/dentists charge less for cash visits than what they charge insurance companies. This is because there is an extra cost associated with submitting/re-submitting bills to insurance companies. I’ve watched my family doctor’s office grow from a few staff to an office full of people dealing with paperwork.

My policy is with one of the major insurers (actually the same insurer as the previous company I worked for). I’m not worried about not getting paid. As for raising my rates in the event of a major medical expense, there is nothing I can do about it. At worst, it would be like being forced back into paying for COBRA.

It’s not a truly good deal, it’s just common sense to insure for catastrophic events rather than pay for routine medical reimbursement. I was paying thousands of dollars for the privilege of a copayment that wasn’t much less than what I pay now for services. 2 doctor visits a year with a $20 copayment doesn’t justify the difference of a $50 doctor bill. The savings is less than $100 a year and for that I paid thousands for the privilege.

When offering anecdata for consideration, more detail would be appreciated.

Ask your auto or house insurer to quote you zero deductible. The cost difference will be substantial.

HMO’s represent a zero deductible policy (well sort of, you still have co-pays with most policies). The whole idea that I’m getting a good deal is a misnomer. I’m simply trading zero deductible for a policy that has a deductible. By default it’s cheaper. For me, the time to cover the cost of the deductible was less than a year. It was a no-brainer. At worst I’m forced to pay it. At best I pay none of it.

Do I miss my old job’s insurance. Yes, we had an on-site medical facility complete with therapy. I paid $10 once for therapy and used it twice a week for a month during lunch. It was a sweet deal. But instead of getting a $9,000 policy as part of my pay I now have to pay it myself while unemployed. For most people, it is beneficial to drop COBRA for a personal policy. The only thing to remember is to keep COBRA long enough to establish a new policy. If you drop it first and then look for a policy most companies won’t deal with you. That also holds true for car and house insurance.