

Health Insurance in 3 Minutes - mwasser
https://www.healthsherpa.com/press/mar-21-2014-health-insurance-in-3-minutes

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dangrossman
I'm still clueless as to why the lowest cost plans are twice the premium I'm
paying today, on top of having higher deductibles. You'd figure that (a) it's
so much cheaper because of some policy change and should have been cancelled,
or (b) it's so much cheaper that they should have cancelled it to force me to
pay twice as much.

* 29, non-smoker, Pennsylvania

* PPO through Aetna

* $3000 annual deductible / max out-of-pocket

* 0% coinsurance, no annual coverage limit

* $90 per month premium, up from $85 when I first signed up, yet I got a rebate check back last year for part of it

Essentially the same plan from the same insurer, but with a $6350 deductible
instead of $3000, is now ~$200/month if I were to sign up today.

~~~
DavidAdams
(My startup helps companies navigate healthcare reform, so I'm a bit of an
expert on this)

The key to your question are the terms "guaranteed issue" and "age
bracketing." I'm going to guess that you're pretty young and at least at the
time that you enrolled in your health insurance, you'd never had any health
problems. They way that individual health insurance worked prior to 2014,
insurance companies would offer extremely low rates to individuals, and keep
their expenses down by refusing to insure anyone with even the most dubious
"pre-existing condition." So if you'd gone to the doctor complaining about a
pain in your side, that would be considered a disqualifying event, and they'd
turn you down. Or, much worse, you'd get the insurance, pay premiums for
years, then if you ever developed cancer, they'd later comb through your
health records, find where your doctor wrote down that you'd had a pain in
your side, cite it as an undisclosed medical issue, and refuse to cover your
cancer treatment.

Needless to say, that's a very effective way of keeping the cost of coverage
down: only insure healthy people who never go to the doctor. As you aged, the
insurance company would start jacking up your rates to cover their increased
exposure. If you ever developed an illness, you'd have no choice but to pay
what they asked, because you wouldn't be able to get insurance from another
company since you now had a pre-existing condition.

Healthcare reform's two boldest and most popular changes are guaranteed issue
(health plans must accept you, regardless of pre-existing conditions) and
outlawing "recission," or retroactively searching for disqualifying health
records to deny claims. So what that means is that insurance companies can't
cherry-pick the healthy people anymore, which means that the young, healthy
minority is going to see higher prices for individual health plans.

Second, the ACA reduced the number of allowable age brackets, meaning that
plans for the oldest people can only cost 3x what the youngest people pay. So
that hits younger people again, since they have to be roped in with an older
age contingent than before.

You may have heard Obamacare proponents worrying about getting enough young
people into the risk pool so we don't end up with "adverse selection." They're
not worried about that just because young people are feckless and think
they're invincible. It's also because they know that they're the ones that are
seeing the biggest rate hikes. Of course, while someone like you have to pay
$200/mo instead of $90, the flipside is that a family that used to be unable
to afford $1500 per month and can now be insured for $250, and that seems like
a decent tradeoff, especially since, in general, young people will eventually
get older and have families themselves, and they'll benefit from the changes.

The good news is that at least for the time being, you'll still have cheaper
insurance, until your insurance company starts with the shenanigans and starts
jacking up your rates or discontinues that line (and blames it on Obamacare
whether it's true or not).

And by the way, if anyone out there is involved in a business that's having a
hard time with health benefits costs, my startup is taking advantages of
lesser-known provisions of the new healthcare law to save companies a lot of
money. Let me know and I'll hook you up with the details. We're called
Benefitter.

~~~
kayhi
Is the result that many young people will not enroll and use private plans
instead? As people age it would then make sense to enroll, but will the system
be successful without the young (young including healthy)?

~~~
dangrossman
> not enroll and use private plans instead

Whether you sign up for coverage through an employer, or on healthcare.gov, or
ehealthinsurance.com, or an insurer's own website, it's the same companies
providing health insurance today as 10 years ago. "The system" includes
everyone with insurance no matter what channel they used to sign up for it.
The ACA or the healthcare.gov marketplace aren't a separate system that needs
its own enrollment numbers to work, AFAIK at least.

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bluthru
I can't wait until health insurance takes 0 minutes like most of the first
world.

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Datsundere
Wow All of those plans. Even after you pay monthly, you're still charged $30+
copay for every visit.

It's sad to see that healthcare is being played with by businesses.

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bluedevil2k
It's crazy that a Gold PPO plan would charge me $800/month with a $12,000 out
of pocket max. $22,000 a year for health care!

~~~
tomfakes
The $12000 out of pocket is only if you use it because you need medical help.
You don't actually spend the whole $22K unless you have a lot of medical
issues, and then you'll be happy that you _only_ pay $22K per year!

When I left my last employer, I had the same company plan under COBRA. It
started at ~$1000, and then went to ~$1300 at the next new year. It had lower
out of pocket expenses, but those came at the cost of more monthly payment.

My current Gold medical plan (2 years later) is $820, plus dental at $120 or
so. ~$950 for Gold plan, vs $1300 for my COBRA plan (in between, I had a
really crappy personal plan that covered almost nothing for ~$600)

People who have employer payed medical have no idea how expensive their plans
actually are

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thrill
_People who have employer payed medical have no idea how expensive their plans
actually are_

People in general have no idea how much their employers pay for any of the
mandates - this is by design. If people were forced to pay all (the exact
same) expenses from their own paychecks then the idea that they were getting a
good deal would fade away.

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rdl
This is really fast!

What I want is a way to actually evaluate the quality of the plans; coverage
network (esp while out of state), etc. Ideally vs. my actual medical expenses
for the previous year. This is much much harder, though.

(Also, wow, health insurance plans in the state/zip I tried dropped a lot over
the past month!)

~~~
mwasser
We do as well! Coverage networks (physicians) and actual costs are at the top
of our minds. Check out sorting by 'worst case' \-- while this isn't actual
medical costs, if you have one or more chronic conditions, this is likely the
cost you'll pay rather than just the premiums. Physician networks are harder,
but we are working on it!

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joshontheweb
My cheapest plan is $474 per month. That's not happening. Healthcare tourism
seems to be the way to go these days.

~~~
gsands
Might make sense for routine/planned services, but what would one do for
catastrophic events?

I ask because 474 doesn't sound so bad to be protected against 100k in medical
bills.

~~~
novalis78
a 100k bill that most likely is actually just 5k inflated. See Dr. Keith Smith
on this topic. Excellent:
[http://surgerycenterofoklahoma.tumblr.com/post/79972487684/b...](http://surgerycenterofoklahoma.tumblr.com/post/79972487684/broken-
nose-redux)

~~~
EricDeb
It's great that there's one surgery center in Oklahoma willing to compete on
price. Unfortunately that's simply not reflective of the rest of the nation.
I'm torn on this article because on one hand I don't like how embedded
insurance companies are in the current system (it makes it difficult for a
young, motivated person such as myself to find good doctors for my condition),
but I also don't like the writer's tone - if he's making a legitimate point,
why call it the 'Unaffordable care Act?'

~~~
novalis78
You really need to follow Dr. Keith Smith - he has been writing about this
topic for a long time. There is actually quite an interesting movement towards
price transparency gaining traction in recent months, checkout for instance
[http://www.pricepain.com/why](http://www.pricepain.com/why) with a detailed
reference list to articles/discussion on this topic from recent months

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iandanforth
While it's clear on your website, "sherpa" is unusual enough that I completely
missed it trying to read your URL. healths-her-pa, health-spa, health sher pa
... oh! Health Sherpa!

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novalis78
a great website that quickly and plainly tells me that healthcare is b r o k e
n. Those prices are i n s a n e. Time to go to a local doctor and pay him
directly.

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latchkey
This is a helpful site, but I feel like what is missing is the fine details
like 'Does this plan cover the XYZ medication that my wife requires on a
weekly basis?'. I ended up having to go with a more expensive plan in order to
get the coverage I needed for her.

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lastofus
I tried signing up for an Anthem PPO plan to see how this works. I was
redirected to a branded but non-functional page on
[https://www.ehealthinsurance.com](https://www.ehealthinsurance.com). The form
submit button did nothing at all...

~~~
mwasser
We can only sign people up that are in one of the 36 states on healthcare.gov
-- otherwise we rely on our partners to help get people signed up

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honksillet
Who is George Kalogeropoulos? "All insurance products are sold by George
Kalogeropoulos."

~~~
dangrossman
Co-founder of the website. It appears all the licenses to sell insurance are
in his name instead of the company's.

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abeinstein
This may be helpful for people like me who don't know anything about health
insurance: [https://www.healthsherpa.com/learn/how-insurance-
works](https://www.healthsherpa.com/learn/how-insurance-works)

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ilbe
How do you guys submit it to healthcare.gov afterwards?

~~~
mwasser
We're what is called a 'Web-Based Entity'. This means we have been given the
right to integrate with hc.gov on the backend.

~~~
ilbe
Cool, I like how you guys show the Low/High $ amount. Is high the same thing
as 'out-of-pocket maximum' on hc.gov?

~~~
mwasser
High is the premium for 12 months + annual max out of pocket. We included it
so people who know they'll have a lot of expenses can pick a plan based on
what they'll likely pay that year rather than just the premium.

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seanccox
"Sherpa"...

In a day in age when "red skin", "gypsy", and "chinaman" are not the preferred
nomenclatures, you should consider incorporating under a name that doesn't
have an ethnic component. Maybe "porter"?

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jpeg_hero
That's right , 3 min is too many

