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ysg

What does it mean to not have health insurance in the US?

31 posts in this topic

NOTE: I don't care about what your opinions about healthcare in US or around the world is, I care about what my options are.  Your politics are meaningless to me.  I don't care enough the left/right position on this issue.  If you want to masturbate, start your own thread.

 

Hi.  I recently lost my health insurance.  I'm a healthy late-20s male.  My wife is a healthy mid-20s female.  What does it mean for both of us?  Emergency rooms are still obligated -- by US law -- to take people in.  Any other avenues that I can look into?

Edited by ysg
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It means almost nothing... unless you get sick or run over by a car. My family skated by for years without health insurance. We even had two babies while uninsured. We lucked out and came out ahead. We saved far more by not paying insurance premiums than we paid on checkups, vaccinations and even the delivery of two babies. If my wife had to have a c-section or there were other complications things would have been quite different.

 

Edit: Also, if you just lost your insurance and you want continued coverage, look into COBRA coverage.

Edited by tstrimple
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About half of all medical businesses (doctor, dentist, vision-related, tests) will take patients without health insurance, you just have to call ahead to find out if they do then pay up front.  The major difference is big-ticket stuff like surgeries, which may be refused if you can't pay, and if you develop or are diagnosed with a condition then when you do get insurance again it may count as an existing condition.  Also a pregnancy while uninsured is a mess.

 

You can, of course, buy minimal insurance if you can afford it - was something like 4-5k per year last I heard.

Edited by sunandshadow
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I have insurance and went bankrupt from medical bills. If you have any sort of retirement or investments, or possessions, you don't qualify for hospital charity or medicaid or any assistance, leaving you on the hook for huge bills.

 

My insurance has chipped away at the policy each year to the point I'm responsible for tons of co-pays that amount to thousands per year, as well as 20% of surgeries/procedures.

 

I'm 29 and was completely healthy until I got the worst pain in my face 1.5 years ago.

 

I had a craniectomy last week and it's been a nightmare financially, with health insurance: If I default on my mortgage and somehow cash in my Roth IRA I'd be on medicaid and pay nothing, so you may be better off depending on your assets. Liquidate anything you have of value and hide it if you develop a medical condition.

 

 

 

8660246919_e52b42521a.jpg

Edited by lmbarns
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Friend of mine (self-employed) has a high-deductible plan that costs about $200 a month. He'd only benefit from it if there were serious problems, but he has access to healthcare at a decent hospital if he needs it (that's the real reason he has the insurance). I've been uninsured for about 10 years and I've gotten by -- ignored a (probably) broken toe, taped up a couple of deep gashes, let my body fight off infections. I've saved a ton of money and so far I've healed ok. It's a gamble. Shop around though, there are a lot of ways to approach it. If you're healthy, you can do as my friend does, just try to have about 10k in the bank for emergencies.

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If you have any sort of retirement or investments, or possessions, you don't qualify for hospital charity or medicaid or any assistance, leaving you on the hook for huge bills.

 

This isn't true in my experience. For our first child we qualified for medicaid based on income alone. No investments are taken into account. Maybe you can't get medicaid since you already have insurance? 

 

It's also very true that not all insurance is created equal. Pay attention to maximum benefits, copay, coinsurance, etc.

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I work in insurance at a hospital. At its most basic, not having health insurance means that you are massively exposed to financial risk. It is true that emergency rooms are obligated to treat you, but only to the point of stabilization, meaning that once you're physically capable of surviving without immediate medical intervention the ER has no further legal responsibility to assist you in any way. Further, you are legally obligated to pay for any services you receive (both in the ER and as an inpatient if you are admitted). But you should avoid relying on the ER as much as is feasiible, as the ER is by far the most expensive way to access medical services.

You will lose access to any insurer's negotiated rates, meaning that you will be billed the full amount for any services you receive. All medical facilities have some form of uncompensated care funding whcih can defray some of the expense for you, but the procedures for accessing such funding varies from place to place and the degree of assistance is impossible to predict.

You will likely need to pay upfront for any non-emergency care you access. You should ask how much money you will be asked to pay when you schedule any appointment as you may be turned away if you don't pay when you present for an appointment.

You may be eligible to continue with your previous coverage through COBRA if your insurance ended because you left the employer who provided it. If that is the case, contact your former employer to start the COBRA process.

You can shop around for individual insuance policies from insurance companies, but they tend to be expensive and have a ton of variation in what sort of coverage you will get.

Many areas have sliding fee clinics where you can access routine care at variable prices based on your ability to pay. I strongly suggest trying such a clinic if you have any health concerns (other than in an emergency). If you need care urgently, many areas have urgent care clinics which tend to be far less expensive the ERs. In a true emergency, don't hesitate to go to an emergency room.

EDIT:

As for Medicaid, your options vary wildly depending on what state you live in. Adults without children rarely have access to Medicaid-- there are only a couple of states where it's available, and tends to be heavily restricted. And even then, eligibility criteria vary quite a bit in terms of what the state looks at. Count on income mattering a lot; assets tend to matter as well, though with lots of caveats.

What state are you in?
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Catastrophic coverage wouldn't have helped me as I had over 20 visits to specialists last year costing $40/copay each then $40/copay for prescriptions at the same time your income dries up, it just plain screws you.

 

For me they based medicaid and food stamps off income and previous years tax records. I also have a rental house that gives me income monthly but it's not cash in my pocket it goes to taxes, insurance and mortgage. I rent my house out and live with my gf, no kids, 29 years old. 

 

The prescription companies have programs to give you meds ONLY IF YOU DON"T HAVE INSURANCE. It's stupid they'll give you the meds at $250/mo cost to them but not just help you pay $40 and the rest through insurance.

Edited by lmbarns
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You can, of course, buy minimal insurance if you can afford it - was something like 4-5k per year last I heard.

Sorry to derail the thread, but there's always the option of emigrating tongue.png  $5k+ on insurance is insane!
When I had insurance, basic coverage for ambulance/paramedic costs was $40/year ($80 for a whole family), or more complete insurance was about $50/month for a couple. I cancelled it though because it's not a necessary expense and I wasn't getting my moneys worth.

Sure there's a lot more factors to consider than just the differences in healthcare costs, but it's an option, especially if you or your wife have an interest in living in other countries before you get to the age where you want to put down permanent roots.

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You should at least get a catastrophic plan. I'm currently self-employed and have a plan that costs around $130 per month. It has co-pays and a high deductible, but at least I'm protected should anything major happen. Just make sure you can handle paying the max annual out-of-pocket costs, should it come to that.

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When I had insurance, basic coverage for ambulance/paramedic costs was $40/year ($80 for a whole family), or more complete insurance was about $50/month for a couple. I cancelled it though because it's not a necessary expense and I wasn't getting my moneys worth.

That's a dream coming true. I guess I should write a few emails to the Australia immigration offices.
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There are usually clinics for people without insurance. Contact your local social services office for locations. They are usually staffed by nurse practitioners. They provide basic services like any general practitioner. I believe they are mostly located in rather poor areas, but it should be within driving distance.

Unfortunately, any specialized need you have, they can't help with. You'll be stuck heading directly to the specialist and paying out of pocket. Still, if you do get a referral, tell the doctor up front that you don't have insurance and are out of work. Sometimes(sometimes) they will reduce their fee.

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First, without any insurance coverage at all, you're exposed to healthcare providers charging you virtually anything they want.  Even with crappy insurance you will at least get the negotiated insurance rates, which are still typically not cheap.

 

Second, any sort of major medical issue will at best severely deplete any savings you have, at worst completely bankrupt you.

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You can, of course, buy minimal insurance if you can afford it - was something like 4-5k per year last I heard.

 

WOW! That is a lot, always assumed insurance was like $300 or something. eek!

 

Even in UK, that is enough for 1 or 2 private treatments and maybe even a little botox. :D any non-cosmetic treatment, surgery etc is free

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lol I had 1 bill for $10,203 from a brain MRI with and without contrast and an angiogram. The insurance paid $2k and told them to F off.

 

For my gf and I it's $800/mo premium (paid by employer) and I still went broke from co-pays.

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I'm 29 and my wife had an Eptopic Pregnancy.  When her tube bursted and was in immense pain, you don't get to "shop around" you go to the ER.  She was hours away from dying, they needed to do surgery (laproscropy) to stop the bleeding and remove the fetus.  I believe the bill was hundreds of thousands of dollars.  We paid $1,500.

 

That was probably the only case where Insurance really pays off.  Otherwise your usual checkups, and medications and copays tend to not really save you much.  I have a doctor that will charge us less if we give him cash vs going through insurance for minor checkups and things like that.

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Both of the "free" and "don't have to pay" responses made me laugh in a bad way.  Like the "Free phone with 2-year contract", or the cable companies that claim a less expensive rate on the bill but then charge a perpetual leasing fee on the mandatory equipment that, when totaled, brings it up to a higher number.

 

In the US, the average health insurance plan is going to cost about $6000/year. If you want better than average, you will need to pay more.  If you want minimal coverage, you can pay less.  Out of curiosity I looked up some health plans in my state, there are the low-risk high-premium plans that run about $3000/year, and there are the high-risk and the low-premium high-coverage plans that go up to about $15,000/year.

 

 

According to the Interwebz: In the US, a family of four with an employer-based PPO, the average employee will contribute $3,492 in premiums and $2,675 on copays, etc.
 
That's about $6167/year on health care in the US on the average case.

 

 

 

WOW! That is a lot, always assumed insurance was like $300 or something. eek! 

Even in UK, that is enough for 1 or 2 private treatments and maybe even a little botox. any non-cosmetic treatment, surgery etc is free

From the Interwebz: Citizens of the UK pay 11 percent of each pound they make in weekly income between £100 - £670 for the NHS, plus an addition 1 percent of income over £670 a week.
 
So for most well-paid professional programmers you are looking at about £90/week in taxes for the medical system, or about £4680 per year.  With currency exchange that is $7222/year in the UK.
 

I'm glad I'm living in Sweden where we don't have to pay for stuff like this.

 

According to Wikipedia, Sweden has the highest individual tax rates in the world, coming in at 57%.  

Again from the Interwebz: Sweden is a nation with extraordinary high tax rates. The average worker not only pays roughly 30 percent of her or his income in direct taxes, but additionally, close to 30 percent in indirect taxes. ... Per capita government expenditure on health at average exchange rate (US$) 3044 (2005) Out-of-pocket expenditure on average at average exchange rate (US$) 1125 (2005)

So there's a total of about $4169/year on health care in Sweden.

 

That rate is cheaper than both US and the UK. Good job on that part.

 

The point of this is that even for countries like the UK or Sweden or Australia or Canada, health care is not free, but is instead paid for via taxes.

 

 

 

 

 

Getting back to the OP:

 

You can play the numbers game and hope that you come in below average.  You are young and have no children so that immediately puts you below the average case.  So being below average, you should expect to spend something less than $6000 on personal healthcare expenses over the course of the year.  

 

There is a huge risk with playing that game: You may not be below average.  Flip a coin.  Heads, you saved a small amount of money and have good health; congratulations.  Tails, you suffer serious medical problems and also end up in the poorhouse, or bankrupt.   Or worse.

 

This is NOT a good game to play.

 

Insurance companies are managed and regulated on a per-state basis.  There are sites like HealthInsurance.org where you can look up the insurance options specific to your state. You might qualify for state-sponsored programs if you have no job or if you have low income.  Look in to those programs.  They will probably cost you some money, but it is cheaper than being on the catastrophic side of the coin flip.

 

You can also get private insurance.  Most likely your private insurance will cost more than an employer-sponsored system, so expect to pay around $7000 per year.  You might get lucky, and say "I had no medical issues this year", and feel like you overpaid.  Or you could be like lmbarns above, have your head  cut open in an emergency operation, and then spend time on your knees thanking God that you paid the relatively small amount of money for health insurance.

 

 

 

Personally, I do not see it as "should I get insurance?".  I see the question as "Which plan should I purchase?"  Invest the approximately $6000 in an insurance program that fits your own lifestyles and risk tolerance.

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Well first of all, US law is going to mandate health health insurance on January 1st, so this isn't exactly a long term question. That said, I pay my own private health insurance (not through an employer) and it's $97/month. No it's not the greatest coverage on earth, but the basic terms aren't bad and I'm largely covered in the case that something awful happens. AN ER visit will set me back a solid several hundred dollars, but never a hundred thousand.

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The point of this is that even for countries like the UK or Sweden or Australia or Canada, health care is not free, but is instead paid for via taxes.

 

I probably shouldn't have used the term free, what I meant was "NHS will cover it without you having to give them money directly, unlike cosmetic surgery etc". Assuming http://www.usgovernmentspending.com/ is accurate wouldn't that mean a large % of US taxes goes to health care too and if you compare the total spending 18% of UKs budget goes on health care, where as (according to that link) 19% in USA. Wouldn't this mean US pay for health care in both taxes AND insurance?

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Depending on your state and county, you may have options like public aid or other reduced cost health care through government organizations. In my state application for these kinds of programs are done at the state level, but services administered at the county level, with state funding going to the county. You can get minimal dental and medical coverage on a sliding scale based on your income, though I think two or three rounds of budget cuts ago it was made so that even those with no income required co-pays, so it's not free. For drug prescriptions, I worked in the pharmaceutical industry for a while and I know that some companies offer private patient assistance for people who are poor enough that they can't afford their prescriptions and well off enough that they can't get public aid. Edited by SiCrane
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The US health care system is massively inefficient, but "free" health care doesn't exist, contrary to the impression you'd get from some of the posters was I think frob's point.

 

The point of this is that even for countries like the UK or Sweden or Australia or Canada, health care is not free, but is instead paid for via taxes.

 

I probably shouldn't have used the term free, what I meant was "NHS will cover it without you having to give them money directly, unlike cosmetic surgery etc". Assuming http://www.usgovernmentspending.com/ is accurate wouldn't that mean a large % of US taxes goes to health care too and if you compare the total spending 18% of UKs budget goes on health care, where as (according to that link) 19% in USA. Wouldn't this mean US pay for health care in both taxes AND insurance?

Yeah, our system is ridiculously inefficient, hence health care reform popping up pretty often as a political issue, but I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.

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Yeah, our system is ridiculously inefficient, hence health care reform popping up pretty often as a political issue, but I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.

 

Meh. The US has very high prices for just about every possible medical procedure compared with other countries. While other countries tend to [i]also[/i] have better insurance options than the US the procedures tend to be less expensive as well, which has a very dense and complicated relationship with the costs of the procedures themselves and the insurance that is available. I would much rather get an MRI in France, for instance, than in the US regardless of any insurance considerations, buy prescriptions in Canada, see a specialist in Japan, and so on. Hell, you can't even [i]get[/i] a price quote for most medical services in the US without having an insurance policy.

 

Again, insurance is about risk tolerance and your individual budget. Insurance companies employ legions of actuaries whose sole purpose is to remove all possible arbitrage opportunities from you, the individual consumer. This is especially true on the individual market. There are a couple of advantages a consumer can leverage against insurance companies, but I don't know of any that the OP could use given the situation he describes.

 

Other peoples' experiences (with insurance coverage and insurance prices, cost sharing, and anything else) tend not to be informative for any given individual unless you're very careful in accounting for a lot of factors. Don't be dazzled or awed by prices other people pay. As someone posted above, your options will likely expand on January first of next year, though unpredictably so. For now, if you are uninsured, here's my checklist:

 

1. Check for any sort of government assistance. You will not get a better coverage:value ratio on the individual market, even in a stingy state, if you qualify for assistance. Contacting your county human services office is the best way to figure this out.

 

2. If you can't get assistance, ask insurers in your area for quotes on individual policies and make sure you get the following numbers for each plan offered: monthly premium, deductible, co-insurance rate, and out-of-pocket maximum.

 

3. Think about how often you need routine medical services (a physical, eye exam, dental visit, etc.) in a given period of time and add the per-visit costs (co-pays and anything under the deductible figure at a minimum) for these visits to the total premium costs for that period.

 

4. If you can't afford the amount listed in 3 for a given plan, remove it from consideration. If there are any plans left to choose from, you'll have to estimate your level of comfort with risk. Less risk = more money spent per month regardless of any medical services you access.

 

5. Locate clinics in your area and, more importantly, non-ER urgent care centers. Use these as needed, and avoid hospitals and emergency rooms unless you are truly having a health emergency (if in doubt, go to an ER).

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I think the point was that it's misleading to say "Well in my home country, it's free (or super cheap)" because that's simply not true.

if similar amounts of tax go into healthcare, and then you pay that same amount again on insurance, then that makes other countries about twice as cheap, which is just super.
And, what about the fact that when you don't pay tax, you can still get a doctor to remove your spleen? That's the "free" part. Lose your job: none of this panic.
This past financial year, I've been working on my own project with a tiny bit of contracting to get by, which means I'm way under the tax threshold of $18k, so I pay zero tax on my income. When i go shopping i of corse still pay GST(VAT) and other minor public revenue streams, but I can still get a free general practitioner, or a blood test, or help in paying for a specialist like a shrink as long as a GP writes a referral, and if I need complex surgery I can go on a public waiting list, or if I'm injured I can go to the ER and be X-Rayed ands treated.
By paying through tax, which is within everyone's means (no income like me right now = no means so no tax, or later if I make millions I'll be earning way beyond my own needs so I'll pay higher tax), yes, some people do get free healthcare and everyone has a doctor when they need one.


Trying to attack free healthcare on that ground is like trying to argue that public roads and toll roads are the same, when they're obviously very different. You don't need a tax payment receipt to get on to a public road, despite it being created through taxes.

 

There's also big differences in where your money goes. Excessive taxation goes to a not-for-profit service provider with a motivation to do well by their customers. Excessive insurance payments go to some rich shareholder with a motivation to take as much money as they can from you.


Also, in a lot of these countries, foreign tourists get the free healthcare too, despite obviously having payed no tax.
Meanwhile, a friend of mine that went to the US got a bad flu and went to a doctor, who recommended a flu vaccine while he was there. He was billed over $1k for being uninsured! At a private doctor here (not part of the free system) you'd expect the shot at near cost price ($20-$100) and the consultation to be around $60. That's a super big difference.

Edited by Hodgman
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Well first of all, US law is going to mandate health health insurance on January 1st, so this isn't exactly a long term question.

A $95/%1 fine isn't particularly daunting.

Edited by BladeOfWraith
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