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Posted by u/leros 3 years ago
Ask HN: How much does private health insurance cost you?
One of the big barriers in my mind of quiting my day job and going independent is that I'll be responsible for my own insurance, which is a cost I can't ignore.

To those of you that are independent, how much is your health insurance actually costing you?

prirun · 3 years ago
I have ACA coverage now, and had it in 2020 when I made a trip to Mayo Clinic. Mayo was out of network, insurance wouldn't pay anything, so I investigated getting private insurance, figuring I could force a "life event" if necessary to switch insurance coverage outside the open enrollment period. I ran into lots of roadblocks:

Part of ACA is that insurance companies can no longer refuse coverage or charge more for pre-existing conditions. IMO the insurance companies agreed to this because everyone was going to be forced into either buying insurance or paying a penalty to be self-insured (not carry insurance). The penalty was later removed by Congress, but the insurance companies were stuck with the no pre-existing conditions rules.

https://www.hhs.gov/answers/health-insurance-reform/can-i-ge...

When I tried to get private insurance from major carriers, I ran into:

- circular phone trees that couldn't be escaped

- forwarding to "agents for my area" that never answered the phone

- forwarding to agents that did answer the phone but said there would be coverage limits for 6 months since I had a pre-existing condition. This is illegal. One agent did give me a quote for $2400/mo with a $10K deductible.

- I did find prices on the Internet that said private PPO coverage would cost about $800/mo with a $10K deductible, but no insurance company would actually write it.

IMO, only writing new individual coverage (not via company employment) during open enrollment is a way for the insurance companies to keep their limit on pre-existing conditions.

I ended up paying cash ($12K) for a 1-week visit to Mayo. In hindsight, paying cash was a better deal than if I had private PPO coverage: PPO would have cost $9600 in premiums (or more!) plus I would have paid the first $10K, so nearly $20K.

Insurance in the US is a mess!

I do have to add though, ACA has been a lifesaver for me.

patja · 3 years ago
Our high deductible insurance with Kaiser is about 12k/yr for a family of 3: two parents in their 50s and a teen. Then I max out an HSA (untaxed health savings account to actually pay for things) with about 7k, which generally gets drawn down to zero at some point over any 3 yr period. So I call it about 20k/yr all up.
freedom2099 · 3 years ago
OMG… that is a lot!
candiddevmike · 3 years ago
It doesn't matter how much it costs anyone because your circumstances and needs will be wildly different than others, and you may qualify for subsidies.

I would figure out how much your current health insurance is (both the employee and employer contribution). This is the amount you would pay if you quit your job and went on COBRA. You can be on COBRA for 18 months and it's typically cheaper than finding an equivalent plan on the marketplace. That gives you time to grow your business and figure out a long term health insurance solution.

matt_attack · 3 years ago
I've found the opposite, though it likely depends on how "good" your insurance was. My COBRA was around $800/mo for a single person but that was essentially for a zero deductible plan.

I could get reasonable short term plans for about a quarter of that. As a healthy individual that was definitely the right choice for me, but if you have high utilization already it might not be for you.

beej71 · 3 years ago
But also definitely comparison shop independent plans vs COBRA. COBRA can also be really expensive.
lowercased · 3 years ago
> COBRA can also be really expensive.

But... it's not "expensive"... It's just the price. And many people never see or think about it because "employer" pays some/most/all of it. Until... you don't have an employer. Then it seems "expensive". But... the price has always been there, we just don't see it sometimes.

Employer-involved insurance is one of the biggest things slowing social progress, imo.

e1g · 3 years ago
NYC, $2,500/mo, two adults + one child. We're expecting our second child, and it'll increase to ~$3,200/mo.

We're in our mid-30s, healthy (run marathons), non-smokers, with no prescriptions. Not having insurance means carrying the risk of going bankrupt after one unlucky event.

sonthonax · 3 years ago
How does it feel to subsidise those who make poor health choices?
ceejayoz · 3 years ago
Everyone on the planet, basically without exception (pedants: I'm not counting people in vegetative states, babies, etc.), makes poor health choices. You'd be like The Good Place's Doug Forcett, otherwise.
swagasaurus-rex · 3 years ago
how does it feel to subsidize greedy health insurance companies?
swayvil · 3 years ago
You are pointing at a mosquito while Dracula sucks gallons from your neck. The aristocrats take the feast while we squabble over crumbs.
giaour · 3 years ago
You mean like those fools who choose to be born with the genetic marker for type I diabetes? How dare they!
voisin · 3 years ago
As someone from outside the US, I have two questions:

1) are these amounts tax deductible?

2) given the size of these amounts, OP’s statement that these are a big barrier to going independent would seem totally reasonable. Doesn’t this have a chilling effect on new business formation? If so, how is the US still so well known for startups? It seems significantly riskier than in other countries with better safety nets.

lowercased · 3 years ago
For someone self-employed, the numbers are tax-deductible. If you're employed, but still have insurance and expenses that aren't covered, those expenses need to be more than ... 7% of your adjusted income to be deductible (but only the amount over 7%). The 7% might not still be the correct number, but it's something like that.

So... you have a job, but there's no employer-provided health insurance. You make $60k/year. Your adjusted income (after some deductions) might be, say, $45k. You decide to buy your own health insurance, and it costs you $500/month. That's $6k/year. 7% of $45k is $3150. So... $6000-$3150 = $2850 which would be the amount that you could avoid paying taxes on.

Confusing much?

> If so, how is the US still so well known for startups?

Because there's metric-ass-loads* of money here looking for places to be invested, and we idolize the unicorn homeruns so much so that we have entire industries catering to their ecosystem.

* Note, this is one of the few times we use the metric system in the US. 2 liters of coke/pepsi, and metric-ass-loads of <fill-in-the-blank>.

Macha · 3 years ago
Interestingly enough, the inverse of your comment is true here. "Gallons upon gallons" as a superlative, and drinks in pubs are the two uses of imperial liquid measures here
alphabettsy · 3 years ago
1. It depends. If you itemize deductions and those combined are more than the standard deduction you can otherwise it doesn’t really make sense to. This does a decent job of explaining: https://www.investopedia.com/are-health-insurance-premiums-t...

2. I believe it does and I can’t answer the other question with any confidence. Insurance was a big reason my mother kept her job which covered us as a family when my dad started his own business even though she was basically working two jobs because she was also helping with the new business after work.

drcongo · 3 years ago
As another person from outside the US, I have one question:

1) Given the size of these amounts, why aren't you all marching on Washington with pitchforks? Your healthcare system is INSANE.

ceejayoz · 3 years ago
A lot of people are on employer-paid insurance which largely hides the costs. You'll often get an "oh, I only pay $20 in premiums monthly" sort of response from them.

$10k in premiums going away with taxes going up $5k is heavily portrayed as a "tax hike" when universal healthcare is discussed.

tjansen · 3 years ago
Is it? In Germany, a double income household can also pay about 2100 EUR per month for public health insurance (if both partners earn at least 85k). Many people have additional insurances for dental and possibly other things that are not covered.
devonkim · 3 years ago
Via healthcare.gov and COBRA from living in a state that dragged its feet maliciously and a prior employer in a really poor state with an awful risk pool for a family of two adults that cost me $1500 / month for mediocre coverage in 2015. It was so high it blew through my runway far faster than I had budgeted and along with other unforeseen factors led to me stopping with my independent contracting work basically ever. It was high enough I paid out of pocket for everything and had a catastrophic plan only for still $500 / month.
throwaway98797 · 3 years ago
$455/month

keep in mind that PPOs for independents aren’t the same as PPOs for companies even though the appear to be.

let’s say you have blue cross blue shield PPO with your current employer it’s not the same even on the platinum level blue cross blue shield PPO.

fewer doctors in network. lots of mini surprises await you if you actually use it.

that’s such bs.

in a way i was personally better of prior to ACA since i could get insurance for $150/month. yes it’s nice that i can’t be disqualified due to pre existing conditions but it isn’t the meca it’s claimed to be.

ceejayoz · 3 years ago
$2,400 a month, in NY, for a family of four. Going up 10% next year, too. Platinum plan on the exchange; costlier up-front, but comes with a $4k/year cap in copays we hit fairly early on, so it makes sense given our particular set of expenses. Cleared $40k in total medical expenses last year.

Moving back to Australia looks better every year.