Health insurance advice?

[Nickshu]

Hey guys, I'm currently paying over $1200/month for a Silver level plan with Humana for my family of 4. I'm a small business owner (17 employees) and I don't offer health coverage to my employees, just buy it direct myself.

My insurance was cancelled b/c of Obamacare. So to get the same level of coverage I was previously getting for $650/month my new plan went up to $1200/month. Lately I am seeing no value in paying $1200 a month. My wife calculated that last year we got about $55 in benefits from this $14,400 investment ($1200x12 months).

I am thinking about the concierge medicine route. I can buy a basic policy from Kaiser for about $500/month, which I would keep basically only for catastrophic coverage...major trauma, major diagnosis, etc. Then just pay out of pocket for the concierge retainer fee and regular Dr visits, preventive care, etc and go to the Dr that I chose.

Just seems like I am getting no benefit in paying so much for a Silver level plan, I'm still paying everything out of pocket (Actually I pay thru an HSA), and may be better off just to save the $$???

Thoughts? Please don't PARF this topic out, I'm just looking for advice and experience, not a political dialogue on our health system....trying to work within this ***** sandwich we're all stuck in now.

[VincentVega]

I did a similar calculation and went with a bronze plan. I think of it more as catastrophic coverage so I would rather save the $$ as I only use medical services in emergencies. I'll rethink this as I age but for now I'm relatively healthy.

[MRM]

My firm works with a lot of small businesses. This is a common problem. We refer them to an HR consulting company called Inspirity HR Outsourcing & PEO Services from Insperity for Small to Medium Sized Businesses. One of their specialties is providing health insurance plans to small businesses at group rates. You might be able to get coverage for yourself, and/or your company for a significant after tax reduction from what you're paying now for yourself.

Basically what they do is buy large blocks of health insurance as the employer themselves and they let you buy into the group. They have high underwriting standards so they won't sell to just anyone, which keeps the pool relatively low risk. The benefit to you is that you're able to join a larger risk pool of lower risk members, which allows lower premiums. They offer a suite of services but they don't try to sell you on their product. Their approach is to price things for you and let you make the decision. They are smart enough to know that if the price point is right they make the sale and if it's not, they won't, so they don't push.

I'd give them a try if I were you. I'd be happy to forward my contact's name if you're interested.

Otherwise, what you want to do is find a couple of health insurance brokers and let them prepare a bid for you and/or your business. They would shop the market and would be able to tailor a plan for you. I don't know any brokers in your area but I could probably get some referrals if you're interested. Just drop me a PM.

[onewhippedpuppy]

We dealt with the same issue last year when I was self employed and ended up on one of the lower cost bronze plans. Family of five, non-smoker, wife and I are 35, no health risks. If you do the math the higher level plans aren't justified for the benefits you receive. It is still rape, pure and simple. We paid close to $700/mo for a piss poor excuse for health insurance, but there were no other options. Progress, right?

[Crowbob]

"Thoughts? Please don't PARF this topic out, I'm just looking for advice and experience, not a political dialogue on our health system....trying to work within this ***** sandwich we're all stuck in now."

Just a thought. Go to Healthcare.gov. There you will find everything you need to know in one location with easy to follow instructions. Your current .003819444 ROI is pretty good. No rape, no ***** sandwich no piss poor excuse for health insurance, no options and no PARF.

[911SauCy]

obamacare...duh

[MRM]

Originally Posted by Crowbob

"Thoughts? Please don't PARF this topic out, I'm just looking for advice and experience, not a political dialogue on our health system....trying to work within this ***** sandwich we're all stuck in now."

Just a thought. Go to Healthcare.gov. There you will find everything you need to know in one location with easy to follow instructions. Your current .003819444 ROI is pretty good. No rape, no ***** sandwich no piss poor excuse for health insurance, no options and no PARF.

He already has a Silver plan, so Healthcare.gov isn't going to help him. He's paying the rate for a family of four. He pays full freight because he doesn't qualify for any subsidies and he isn't part of a group. And since he's paying for it out of pocket the only tax advantage he can generate is if he uses a healthcare savings account. The only way to reduce his cost is to find a way to join a group that offers a larger risk pool. The best would be to find a way to provide coverage through his company to maximize any possible tax savings.

This is complicated stuff. I don't do it on my own either. That's what brokers and consultants are for. They don't cost anything, so I encourage everyone to at least explore what they have to offer.

[t-tom]

It's pretty simple don't get sick. I'm a small business owner as well. Think One guy (me) working 70 hours a week. I don't qualify for O'care because I can technically get insurance via my wife's work. We would have to pay the school every month because it would cost us 200.00 more a month than she make's just to add me to her insurance. So she would be working for free plus it would cost us. Great idea. I'll just pay the fine.

[Crowbob]

There you go Nick. If Healthcare.gov can't help just don't get sick and pay the fine. The $2500 bucks your family will save in premiums is just around the corner so hang in there just a little while longer. And you can keep your plan if you like it and your doctor if you like him.

[ckelly78z]

From someone who has experienced virtually every form of bad luck from health problems, be careful with being underinsured. At 35 years old and healthy is one thing, being 50 years old and with the history I have had, I use alot of coverage for followup, and prescriptions for heart failure, cancer, and blood clots. I couldn't even come close to guessing the $$ amount of insured procedures I have had over the years, heck, the out of pocket is bad enough.

Just keep in mind that the $14,000 every year could be gobbled up in one day in ICU after an accident, or other unfortunate occurance.

[tadd]

I had this same issue for a year when I left my last job at a large company and went to work for a small company.

I was 'spoiled' at the big company because their buying pool of 90k employees was so large. It took a bit of mental chewing to come to grips that it is called health insurance for a reason and not a health plan. I came to realize that just like your car, whats it worth to you not to have to pay monthly for a possible big payout later?

I have a 2007 subie. Not worth covering the vehicle itself and I've been accident clean for 20 years (not my fault, been rear ended once in the p-car in that time). So I didn't carry on the car itself, but was darn sure to carry for hurting someone else (even if its the law). I just am not interested in having the remaining 1/2 of my life wiped by being sued into oblivion. Long story short, heavy traffic, long day, and oops. Fender bender. My fault by default. Guy I tapped said he was just thankful he didn't smack the guy in front of him (missed him by inches). I JUST clipped his bumper as he was going right on brakes and I was going left. Since we were on the brakes his bumper wiped out the headlamp/fender/inner support as I was nose down and he bumper up. So he got a scraped bumper (chrome on a ford truck) and I got a mess that got quoted at $5.5k just cause I hit him 'Just right'.

Moral of the story... expensive happens. Do you want to pay some now or pay a lot later. INSURANCE....your betting it does happen, the provider is betting it doesn't.

You hurt yourself, you cant write off your body like you can a car. Cancer happens. Falls happen. IMHO no insurance is not smart. Especially if you have kids.

Sorry for the long rant ....

[Nickshu]

Thanks guys, I wasn't considering dropping health insurance all together, just dropping down to the cheapest plan that is only for catastrophic needs, then paying the annual retainer for a Concierge doctor for me and my family. Seems like the ROI would be better as currently I'm paying my $14,000 per year in health premiums and then ON TOP OF THAT paying for all my preventive and regular care, minor stuff, etc that I am getting that's under the deductible, which is around $7000/family.

For example my wife slipped on some ice and twisted her ankle. We spent our max HSA contribution on this last year and the health insurance paid about $55 of it. Seems financially pointless if I could pay less than half as much for catastrophic care, then buy my own preventive/regular/minor care and still come out ahead??

We've looked at offering health insurance through the business. It's exponentially more expensive than buying it yourself and unless we stomach a large part of the cost for our employees it's cheaper for them just to go on Healthcare.gov and buy their own coverage. We gave our employees a choice...either have health insurance thru the business or have a profit-sharing bonus program (in addition to the safe harbor 401K we do). They chose the bonus program.

[Rick Lee]

Nick, check out Zenefits. I interviewed there a while back. They're a startup HR admin. company. Their service is free because they get paid a broker's commission by the insurance companies. I don't know much more than that, since I didn't take the job. But they seem to be growing by leaps and bounds every day.

[Tobra]

I can not in good conscience purchase a plan from Covered California. I am in the same boat with the doubling premiums. I am really small though, so I can get it for me and the few employees and it works out okay because the tax benefit and the expense are sort of a wash. I get it through a group deal that they do for doctors. They group similar employers together, have them pay a nominal membership fee to be part of the group, which is waived if you meet certain easily met criteria. My insurance guy turned me on to it.

In your case, I would buy a minimalist plan and hit the HSA hard with the premiums dollars you are not spending. I sort of have a bit of an advantage if I decide to go that way, because I can just buy medical supplies wholesale. My brother had some stomach virus a few years ago. He popped over to Mom's house, and I swung buy with IV start kits, tubing and a few liters of fluids. Mom, anesthesiologist, ran a few bags of fluid and he was right as rain.

[wdfifteen]

Originally Posted by tadd

I came to realize that just like your car, whats it worth to you not to have to pay monthly for a possible big payout later?

The difference is with a car your loss is limited to the value of the car. With health, the amount it could cost you is virtually unlimited.

Someone pointed out that a short hospital stay can cost you the $14k you are spending on insurance every year.

I'm on medicare now, but for the past few years I had a high deductible plan to limit my exposure and maxed out my HSA. Some years the $3600 I could put in the HSA wasn't enough.

[Tobra]

Now pretty much every year the money you put in the HSA will not be enough to cover your deductible.

If it were just me, I would be a fool if I bought health insurance.

[Rick Lee]

Originally Posted by Tobra

Now pretty much every year the money you put in the HSA will not be enough to cover your deductible.

If it were just me, I would be a fool if I bought health insurance.

Is that really so bad? I think my HDHP deductible is $2400 and I put $1800/yr in my HSA. I use the HSA for scrips, dentist, etc. But $2400 minus whatever is left in my HSA at the time isn't going to bankrupt me. Now, paying 10% of open heart surgery probably would.

[Noah930]

Originally Posted by Nickshu

I am thinking about the concierge medicine route. I can buy a basic policy from Kaiser for about $500/month, which I would keep basically only for catastrophic coverage...major trauma, major diagnosis, etc. Then just pay out of pocket for the concierge retainer fee and regular Dr visits, preventive care, etc and go to the Dr that I chose.

Are these not two separate issues? You're on a silver plan, and you want to pay less. So why not purchase a bronze-tier plan? Are the benefits so much worse that you won't be able to find a doctor to treat you? With a bronze plan, you can still see a doctor and get insurance-plan rates for services (even if your deductible/co-pay/etc are higher). Do you have to pay the retainer for a concierge PCP? Unless the doctor you want is in a concierge practice, why pay the $$$$ for that specialty access?

[Cajundaddy]

Welcome to my world. Small biz owner, healthy, 59yrs. We had a high deductible plan we liked that was $300/mo just in case. It was cancelled in 2014 and ACA introduced similar coverage (bronze) at $900/mo. That's a house payment. I gave it up and now self insure for any routine visits plus we signed up for a healthcare cooperative (not insurance) just in case at $280/mo.

Stay healthy and wait for the dust to settle. First time in my adult life I have chosen not to carry health insurance. In 3 years I will be eligible for some sort of Medicare coverage. Yay!

[porsche4life]

You guys taking the self insurance route, consider this...

In August of last year my mother, an otherwise exceptionally healthy 50 yr old found a 1cm lump in her breast. That pea sized lump lead to 8 rounds of chemo, surgery, and 30 radiation treatments. She still hasn't seen all the bills, but at last count she was well past the 250k mark that her insurance co had paid out. After every chemo round she was getting a Neulasta injection. That one injection was $10k.

So you guys that are self insured, do you have $500k laying around that you could throw to something like this? Not likely.

My parents are small business owners too, and while $700+/month is high for insurance, this would have ruined them financially without it.