

Ask HN: How do US HNers get their health insurance? - tommichaelis

Hi guys,<p>I&#x27;m from the UK and am engaged to a US citizen. A month and a half ago she lost her job, and health insurance, and since then I&#x27;ve been helping her through some sort of Kafka-esque nightmare regarding that. She&#x27;s decided for now to use COBRA, under which she can continue with her old employer&#x27;s coverage. It took about 3 weeks for the paperwork for that to come through, which we returned immediately, and we&#x27;re now being told that once the payment comes through, it&#x27;ll take a week and a half for the coverage to restart. So all in all, it looks like my fiancee is going to have spent over a month without health coverage. While once the coverage restarts, it&#x27;ll be backdated to the 1st September (so she can claim for any out of pocket expenses she incurred), it seems crazy that for the last month any sort of serious health issue could have financially ruined her.<p>The plan is to move to the US post marriage. This whole ordeal has put me off the idea of getting health insurance through an employer - I certainly don&#x27;t want to spend time uninsured on the offchance I lose my job for whatever reason - not least because sods law states that that&#x27;s the point that I&#x27;ll get hit by a bus or some such. How many American HNers pay for their health insurance themselves? If you&#x27;re working for someone who generally offers health insurance, but you choose not to take it, is there ever any scope for persuading them to contribute some money to your personal costs?
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Someone1234
As someone who moved from the UK to US under almost identical conditions, let
me say this: If you have a job that offers health insurance 99% of the time
you will be better off taking that health insurance rather than buying it
directly from the exchanges.

Why? At least two reasons:

1\. Employers are in a stronger negotiating position as insurance companies
really fight for the business (it is for multiple people, so even if each one
is less profitable the entire account will be more profitable with less
overhead, so they WANT it).

2\. The people buying directly from exchanges are higher risk/greater cost.
They're normally poorer, self employed (which includes a lot of people in
physically demanding professions as well, who get injured often), and some are
early retirees (pre-medicare age, but still "older").

Plus the biggest reason is that almost all employers pay a % of your health
insurance premium. If you go with the exchange you're paying 100% (of a higher
base) rather than 70% of a lower one. So unless your employer has simply
terrible health insurance, it is almost never a better idea from a financial
perspective to go private.

If you're really paranoid about it, just take the employer health insurance,
assuming they pay 30% and you pay 70% of the premium, take an equivalent
amount out of your pay and save it (e.g. save 30% of the premium a month).
Since that is what you would have been paying privately anyway (100%), now
you're just using the employer's cut to save for a rainy day.

Personally if it was up to me employer provided health insurance should be
banned in the US and everyone (aside from the US Military) should be required
to go out and get private coverage (e.g. car insurance). That way the prices
come down, competition goes up, and certain demographics (unemployed, self-
employed, early retirees, etc) aren't unfairly "punished."

But I don't see that happening any time soon (or ever) because employer
provided health insurance is too heavily ingrained in US culture. Nobody even
discussed destroying that link during the ObamaCare debates. So whatever...

For now, until things change, employer is the way to go.

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Looksee
Your options depend on where you live.

I signed up for Covered California, which is subsidized insurance. My husband
(non-US citizen, but perm resident) is part of my plan. This depends on what
state you live in. Some states rejected the federal healthcare funds.

As for employer contributions, it depends on the employer -- I offer my
employees insurance. If they choose NOT to take it, I don't give them a pay
bump -- the cost per employee is negligible, and insurance is not offered in
lieu of higher pay here. The purpose of me buying insurance for employees is
mostly to ensure they're healthy while working for us, and getting care so as
not to sicken others while on the job.

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joshkaufman
We use a HSA-qualified high-deductible policy from Humana One
([https://www.humana.com/individual-and-
family/](https://www.humana.com/individual-and-family/)) with 100% coverage
after deductible, and we deduct premiums as a business expense. We make the
maximum HSA contribution every year, which makes all of our family healthcare
spending tax-deductible. Coverage can be obtained quickly and prices are
generally reasonable, particularly if you don't have kids.

For routine care, we subscribe to MDVIP
([http://www.mdvip.com](http://www.mdvip.com)), which has been fantastic. The
subscription pays for a very comprehensive annual physical (of the type
Fortune 500 execs get every year), and helps the physician maintain their
practice with a smaller number of clients, so you can schedule visits same-day
if you need to.

Because we cover healthcare expenses out of the HSA, it pays to shop around
for things like prescription drugs. Tools like GoodRx
([http://goodrx.com](http://goodrx.com), details on how it works at
[http://kk.org/cooltools/archives/22342](http://kk.org/cooltools/archives/22342))
help save a lot of money.

Hope this helps.

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Spoom
Full time employed, health insurance through my employer.

Group coverage (i.e. employer-based coverage) is the best insurance you can
get in the US because of a number of already-given reasons, as well as the
fact that they can't reject you for a preexisting condition. All private plans
will exclude preexisting conditions, so if you're already one some medication
or treatment, you will have to wait at least a year before your insurer will
cover it.

I was a freelancer on a private plan previously. Private plans were kind of
bullshit (and _very_ expensive), but I don't know if the ACA has changed that.

I would like to see Canada-style single-payer health care in the US, but I
think it will be a couple of decades before we do.

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dangrossman
I went to [http://healthcare.gov](http://healthcare.gov), filled out some
online forms and picked a plan. It's like Amazon.com for healthcare -- sort by
brand/price/features, add to cart, check out. The only difference is that
whatever insurer you sign up with sends out their own bill afterwards rather
than paying the website.

I've been buying my own insurance since reaching adulthood. Before the federal
exchange, I typically found personal plans through
[http://eHealthInsurance.com](http://eHealthInsurance.com), though they have
less selection now than before the exchange. I think some insurers in states
with an exchange pulled out of the private comparison sites like this.

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gk1
I'm self-employed and use a catastrophic healthcare plan, found through the
healthcare market ([http://healthcare.gov](http://healthcare.gov)). There were
some hiccups in the beginning when I had to call repeatedly to ensure all the
paperwork went through, but that's expected (unfortunately).

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jtfairbank
Mom & School. Thanks Obama! No really, thank you. I presume you're older than
27 though?

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loumf
Get it from your employer. It's better and cheaper than what you can get in
the market.

You are allowed to supplement -- this may or may not make sense, but your
final coverage will be a lot cheaper if you start with employer insurance.

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nicholas73
I've had one employer offer to pay you the difference, but I don't believe
this is common outside of large corps known to be good places to work.

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orionblastar
I ended up on disability in 2003, been on Medicare ever since.

Got a part D plan.

Private insurance covers more, but the monthly cost of Medicare is cheaper.
Your private insurance costs more per month, than Medicare, but covers more
things.

Medicare for example has a doughnut hole for prescriptions and if you reach
it, you aren't covered until you spend $3500 of your own money to get out of
the hole on prescriptions. It used to just be for name brands but ACA added in
new holes for generics. My medicine that is generic is $370/month until I am
out of that doughnut hole.

[http://www.goodrx.com/](http://www.goodrx.com/)

That website gave me a discount code that got my medicine down to $112/month
instead. I'd recommend it for anyone having price issues with their
medication.

