Co-Pays, Deductibles, Out of Pocket Expenses, and Me

[Tom Rinaldo]

As a self employed person who had private insurance and dropped it a few years back, let me simply share this with you. As I kept getting older and my premiums kept increasing, I couldn't afford what it cost me to keep my health care insurance. Before I took the final step of dropping that insurance, I progressively watered down my own coverage; opting for ever higher deductibles, dropping prescription drug benefits etc. all in an effort to contain the rising costs that I just couldn't afford.

It reached the point where I realized that the odds favored me being better off using all of that money that I was giving my insurance company each month to pay for my out of pocket medical expenses as they came up, instead of not being able to pay for them at all after spending huge sums on my insurance. In short I could no longer afford to pay for ANY medical care because of the amount of money it was costing me to retain medical insurance. There was nothing left in my pockets to pay for out of pocket expenses. My health insurance had drained me of my ability to seek and obtain medical care.

In the business world the choice I made might be called opting to be self insured. Instead of paying out huge sums of money to a profit making institution each month so that they could in theory pay my medical bill later when I got them, I "saved" that money myself for that later "rainy day". Except of course I didn't get to save anything - I actually needed that money to live on. But Instead of spending $600 on insurance every month, now at least I was able to squeeze out enough cash to see a Doctor from time to time, get an occasional test taken, and eat healthier foods etc.

If disaster strikes I'm screwed, but I was pretty much screwed anyway since I couldn't come up with the thousands of dollars needed each year to keep a policy that leaves me having to spend thousands of dollars I don't have on top of that in the event of any serious problems. At least now I can afford to cover routine medical expenses while I pray I remain basically healthy until I qualify for Medicare. In my case that might happen soon enough for me to avoid being hit with heavy federal tax penalties for my inability to afford buying health insurance. So it could be worse.

[lapfog_1]

1. And this hasn't changed with the passing of the Senate bill.

There is nothing to guarantee that, in 2014 when the exchanges are set up, there will be affordable plans.

And, worse, Mr. Rinaldo will now be forced into buying one of the plans or pay the fine.

And, if he is like me, he won't qualify for subsidies.

[Tom Rinaldo]

2. I forgot to add that by giving up insurance payments I have been able to save my home

For now anyway. I think I remember reading somewhere that homelessness contributes to poor health.

[hayu_lol]

3. Thanks Tom...

that spells the situation out for a lot of us...and the Repugs 'out there' will be suffering equally with us if this bill does not get aborted. Today we have choice...after the first of the year, that option will probably be gone forever.

[Tom Rinaldo]

11. Your welcome

I decided this issue was important enough to share personal information concerning it. That's not my normal discussion board style but in this case it seems appropriate.

[Lydia Leftcoast]

4. I'm almost where you are

Business is down this year, and when that insurance company pulls the monthly premium for their worthless coverage out of my bank account every month (that's the only way they'll do it--I guess people in dire straits have been "forgetting" to mail in their premiums), it feels as if they're ripping off a piece of skin.

I'm trying to figure out exactly WHEN the mandate kicks in. I have the side-by-side comparisons from the Kaiser Family Foundation, so I'll have to study those in the near future.

If it's not for a couple of years, I may be able to escape to some other country until I'm eligible for Medicare. (If I went to teach English somewhere in Asia--Japan, Korea, Taiwan, Thailand, etc.--I'd be eligible for THEIR national health systems.)

[Tom Rinaldo]

5. So far I figure I'm "ahead" about $20,000 in money not given to private insurers

That money has mostly gone toward mortgage payments instead, which is the only reason that my house has not been foreclosed on so far. I would much rather have health insurance than not. I am not looking for a free ride, I have never seen the inside of a luxury cruise liner or a tanker with a bare bones cabin either for that matter. The money I am "saving" is all going toward economic survival. I'm glad that this way I can at least afford to go to a doctor, maybe I can avoid dying from the Swine Flu anyway.

The so-called affordable plans being planned will be the ones with the highest out of pocket expenses. After paying Peter I would have nothing left for Paul.

[Lydia Leftcoast]

6. That's almost what I've spent in premiums in the past six years

Disgusting, isn't it?

And I've gained about $500 worth of benefit for it: the total price reductions on eye exams and checkups.

At least my car insurance pays up promptly when I have a problem.

When I was in an accident ten years ago while riding in my mother and stepfather's car, I never saw a bill for the ER treatment. Their insurance company paid it without question, as my car insurance company did 18 years ago, when I was in an accident in Oregon.

[girl gone mad]

8. I'm seriously considering..

going elsewhere, too. If I'm going to have to spend $9K for a product I don't want, I might as well spend the money on a good immigration lawyer. But I'll have to see if that will even be an option for escaping this mandate. I would be eligible for dual citizenship Germany, and I can get a work visa to China. I'd love to go to Korea for a couple of years. Sigh.

[Lydia Leftcoast]

9. Germany would have the highest living standard of the three

I looked into European citizenship, and it turns out that I'm one generation too far down the line for both Norway and Germany.

[Tom Rinaldo]

12. Aha! Change we can believe in defined: Germany! n/t

[amandabeech]

13. I visited the Kaiser Foundation site, too.

I'm 54 so my policy will be very expensive no matter what. However, if I earn no more than $43,000 a year, the bill restricts my premiums to 9.8% of income. That's still a huge chunk, especially since I have only the standard deduction and my marginal rate is close to 40% including state and local taxes.

If I were to earn over $43,000, my premiums would not be restricted in any way, and those premiums would skyrocket to almost 18% of my gross income. I would have to earn over $50,000 just to clear as much after paying my insurance at $43,000. It's almost as though I would be working for free for part of the year because I would see no benefit from my labor between $43,000 and $51,000.

My situation simply could not be unusual. The subsidies and restrictions should be phased out gradually. Otherwise, people will find a way to stop earning or find a way to cheat if they can't make that higher break-even part. My money is on cheating.

[jtrockville]

7. The senate bill doesn't recognize that INSURANCE is what's broken.

We need to eliminate this concept altogether.

[Tom Rinaldo]

10. Needless to say I am galled by the argument...

that critics of the fruit of this HCR effort to date are well insured elitists out of touch with the needs of those who suffer from financial duress who require medical care.

[LWolf]

14. I have insurance.

My employer pays some of the premium, I pay the rest.

I don't use it for that exact reason: there's nothing left in the budget for copays and deductibles.

[Tom Rinaldo]

17. If you had to pay all of it, it would be a bigger problem....

Simple math :) (and a more fun way to Kick)

[LWolf]

19. Yes.

If I had to pay all of the premium, I wouldn't have insurance.

[Tom Rinaldo]

15. Then of course there are the dental bills that won't be covered

They are out of pocket too. Sometimes after paying my mortgage I try to save some money toward those with part of the funds I didn't fork over for expensive low end private medical insurance that I couldn't afford to use anyway after paying that bill. Kiss that off if I'm mandated to buy private health insurance.

[thotzRthingz]

16. k&r (n/t)

[RB TexLa]

18. A HSA would have been a good choice for you