10 years ago I could see my doctor when I was sick. Like, the same day. Now if it can't be done at the Target or CVS, it's the emergency room. I didn't even get an annual checkup last year because my doctor had to cancel, and the earliest I can be seen again is this summer. I'm now at the age where this is probably starting to matter.
And I pay like... $30,000 a year minimum for this?
I sort of find telemedicine to a be a scam. I’m sure it has its use case, but most of the time it feels like they are trying to limit liability so they just tell you to go see a doctor in person.
do you still get insurance coverage if it isnt requested by a physician?
Edit: answered my own question. Per questhealth.com "Tests purchased on questhealth.com are only for individuals who intend to pay directly for testing and do not want to submit a claim for reimbursement under their health insurance. "
You can still submit your own claim to your health plan even if the provider doesn't do billing. They may or not pay depending on coverage policies. You can also probably use an HSA or HRA to pay for these services.
Anecdotally, I prefer telemedicine for my PCP other than yearly physicals. I can usually get an appointment in the same week, often same day if I am willing to go to another provider in a different nearby office.
I pulled insurance quotes for my wife and I recently. Both of us are young and with no known health issues. Our monthly premiums for the cheapest plan was around $800 per month, but that was with very limited coverage and a deductible of around $15,000 before they would cover any major expenses.
The premiums would be $9,600 a year but all in we could spend around $25,000. We had options for higher premiums and lower deductibles as well, but the total max out of pocket was almost identical.
Make sure you are fully aware of federal subsidies for your insurance premiums.
It's a bit complicated to explain the details, but basically you won't pay more than about 8.3% of your AGI for insurance, no matter what your income level is.
Alas, these subsidies may expire next year if Congress does not renew them (they don't actually vanish, they are just income-capped at 400% of the federal poverty level).
An annoying aspect of the subsidies is that they have an abrupt drop as you cross 400% FPL.
From 133% (if you are below 133% you are supposed to use extended Medicaid instead of a subsidized marketplace plan) to 400% the amount of the subsidy goes down bit is still substantial at 400%.
This can result in a situation where if your income is a little over 400% FPL you might come out ahead by taking a pay cat to get under.
There is no abrupt drop at this time. There is a smooth gradient in the percentage of AGI that "the 2nd most expensive silver plan in your state" can cost.
Next year, if Congress does not renew the expansion above 400% that was started during COVID, then there will the most abrupt drop possible at 400%: from something to absolutely zero.
My wife and I save at least $6000/year thanks to these subsidies, which put our health insurance into the same general realm as most other industrialized nations (typically 8-12% of AGI on health insurance of some kind).
This is ultimately the route we'll likely end up in. I was surprised to see we could make around $75k and the cheapest plans ($800/month) would be fully covered. That said, that opens a much bigger conversation related to tax subsidies and whether the ACA accomplished enough for the pros to outweigh the cons.
I appreciate the details you shared here by the way, very helpful for me and anyone else coming by seeing similar premiums and isn't aware of what subsidies do exist.
Absolutely. Even though the subsidies have been extremely beneficial for my wife and I, I seriously question whether or not the policy of handling excessive medical costs by paying private insurance companies money to make their insurance premiums affordable to everyone makes much (if any) sense.
If medical costs are indeed so high that our insurer needs $X from us each month to make health insurance viable, how does it help anything to make sure they get $X pretty much no matter what?
Do feel free to ask if you have any other questions about this. I do my own taxes, and have had to do a deep dive into the rules/forms for this stuff for several years now.
My employer pays $3,575.49 per month for my HDHP ($12,000 deductible). Family of 3. It's Aetna, through one of the large small-business payroll providers. Are we getting ripped off?
You're probably not getting ripped off (relatively speaking). When I quit my job to take some time off 3 years ago, and signed up for COBRA, the out of pocket expense for 2 adults came to around $2000 per month, also for an HDHP plan.
Kaiser's "platinum-level" (90% average coverage, no deductibles) plan for a young nonsmoking adult runs about $450/mo in my state marketplace, and most of that is further subsidized for someone who isn't making middle class wages. The medium-deductible, 70%-average-coinsurance "Silver-level" plan is about half that.
I don't even understand the concept of a $12,000 deductible when the ACA established maximum out of pocket at:
> "For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family."
The individual marketplace plans seem to exist in a totally different world from employer-provided plans. When I went from my old employer's COBRA to an MD Health Connection plan, my premium dropped nearly fourfold even with no subsidies.
I have no idea! High-deductible plans give you access to HSAs, which are the "don't pay taxes" cheat code (you put in pre-tax money, it gets invested in the market and grows tax-free, and you can spend it tax-free if it's on medical expenses; if you're over 65 you can use it for anything and pay regular income tax). But I'm paying 42,000 per year pre-tax for that privilege + insurance; maybe it's better to just get paid that as salary, take the income tax hit, buy coverage on the open market for far less, and then invest the leftover money.
You still pay the premiums. You just have access to an HSA account you can make separate pre-tax contributions to. Sometimes your employer puts some amount in as well on some regular interval.
I mean my wife and I pay $700/mo premium, we both hit our $2500 deductible this year already, my physical therapy is out of network and costs me $800/mo
That's $23k already before prescriptions and we are in our 30s with no major health issues.
> my physical therapy is out of network and costs me $800/mo
That part doubles what you are paying yearly and is EXTREMELY uncommon. For most Americans, an appointment that costs $800/mo is one you don't schedule because you quite literally cannot afford that and will go through bankruptcy attempting to.
And I pay like... $30,000 a year minimum for this?