From the UK. Not knowledgeable about US Health Insurance.

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Caliscotsman
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From the UK. Not knowledgeable about US Health Insurance.

Post by Caliscotsman »

Wife and I live in CA.
When she was a teacher her health insurance covered us both.
When she retired from teaching 3 years ago her union negotiated health insurance was @ $100 per month.
We just got as letter saying that this is going up to $480 per month.

In America is $480 a month for the top tier coverage a good deal?
We can afford it but ouch a little.
Last edited by Caliscotsman on Tue Jun 28, 2022 2:43 pm, edited 1 time in total.
exodusNH
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by exodusNH »

Caliscotsman wrote: Tue Jun 28, 2022 2:30 pm Wife and I live in CA.
When she was a teacher her health insurance covered us both.
When she retired from teaching 3 years ago her union negotiated health insurance was @ $100 per month. (Until Medicare kicks in)
We just got as letter saying that this is going up to $480 per month.

In America is $480 a month for the top tier coverage a good deal?
We can afford it but ouch a little.
Yes.

$6000/yr is a bargain for meh coverage, let alone top-tier.

You can get idea of what it would cost by pricing it out on the ACA market place or your state equivalent.
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Caliscotsman
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Caliscotsman »

I will do that but since I was here I just thought I'd mention it in passing.
obgraham
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by obgraham »

Especially if you are in the "pre-medicare" age range, you have a bargain there.
Our individual health plan rate when we were 60-65 was $1400 monthly. That was 14 years ago!
Cautionary Tale
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Cautionary Tale »

That is an amazing deal.
InMyDreams
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by InMyDreams »

Just make sure you're comparing apples to apples. Even a union negotiated deal may have holes in it.

* Is it ACA compliant (I suspect it has to be?)
* What is the annual deductible?

So, yes, $480/mo for two peeps with a reasonable deductible/ACA policy is a great deal.
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by LittleMaggieMae »

Caliscotsman wrote: Tue Jun 28, 2022 2:30 pm In America is $480 a month for the top tier coverage a good deal?
We can afford it but ouch a little.
Yes, I would say it is.

Have you reviewed the coverage for the plan? What's the out of pocket cost for a trip to Urgent Care (my employers HDHP plan is $250 a friend's private insurance is $800.00 ).

Does your plan cover your perscriptions? (My employers HDHP plan includes insulin so it's like $100 a month. a friend's private insurance - insulin is $1000 a month.)

I'm sure my friend is paying WAY more per month than I am AND paying more for the healthcare she receives.

It's very difficult to compare health insurance costs in America - because every insurer negotiates the cost of care/drugs/procedures/etc with the providers of said healthcare stuff.

5 different people can be purchasing the same medication from the same pharmacy - and the odds are pretty high that they each will pay a different price FOR THE SAME PERSCRIPTION. Same goes for doctor visits, procedures, tests, etc...

You need to figure out what health care you will use and how much those things will cost you under your plan. Then you can determine the value of the monthly charge.

HINT: you might also want to be aware of which hospitals/doctors (and maybe even pharmacies) are "in network" for your plan... even with top of the line plans - you will pay more for out of network doctors, specialists, hospitals, etc... it just won't feel as bad because "I have a top of the line medical plan".
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Caliscotsman
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Caliscotsman »

Thanks. All great feedback.
Alfonsia
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Alfonsia »

What is your immigration status? It seems you must have been here a long time but talk like a new entry? Will you qualify for ACA/Medicare etc?
suemarkp
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by suemarkp »

I guess I'm spoiled. My retiree medical is $40/month to cover both of us. This is the same coverage we had while I was employed by a megacorp. Once I hit Medicare age, this plan stops. They offer a medicare supplement for about $400/month. Not sure if that covers both of us or just one. Its cost will change yearly based on the cost of the plan.

My current medical that is $40/month only applies to employees hired 1991 or earlier. Employees hired after that either get no retiree medical, or retiree medical at cost which I think is also around $400/month.

My wife was a teacher and they offered a plan for around $400-$500/month that was similar to the coverage she had while employed. It was never as good as mine, so we didn't use hers once she had to start paying for it when employed.

No one is going to beat $40/month though, but your $400 seems typical for megacorps and state employees if you've been there a while. These benefits keep getting chipped away so your kids may not be getting any discount when they need to pay for their insurance.
Mark | Somewhere in WA State
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Caliscotsman
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Caliscotsman »

Alfonsia wrote: Wed Jun 29, 2022 3:53 pm What is your immigration status? It seems you must have been here a long time but talk like a new entry? Will you qualify for ACA/Medicare etc?


I'm a citizen, from 2005. We've always been covered by teacher wife, but as indicated when she retired it's jumping up significantly.

Coming from a country where healthcare is 'free' Nationwide, (paid from everyone's taxes), I now have to deal with the mess, sorry I mean inhomogeneities in America.
Alfonsia
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Alfonsia »

[Political comment removed by admin LadyGeek]
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Caliscotsman
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Post by Caliscotsman »

As indicated.

free' Nationwide, (paid from everyone's taxes).


Least you can't go bankrupt.
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by MGBMartin »

Caliscotsman wrote: Wed Jun 29, 2022 4:27 pm As indicated.

free' Nationwide, (paid from everyone's taxes).


Least you can't go bankrupt.
Or have to call around to check they take your insurance along with everybody and their aunt at the facility who might treat you takes your insurance all while clutching your chest in the middle of a heart attack.
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Valuethinker
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Valuethinker »

MGBMartin wrote: Wed Jun 29, 2022 4:42 pm
Caliscotsman wrote: Wed Jun 29, 2022 4:27 pm As indicated.

free' Nationwide, (paid from everyone's taxes).


Least you can't go bankrupt.
Or have to call around to check they take your insurance along with everybody and their aunt at the facility who might treat you takes your insurance all while clutching your chest in the middle of a heart attack.
Joan Didion "The Year of Magical Thinking" which was also a stage play with Vanessa Redgrave.

Didion is one of the greatest essayists of late 20th century America. From the 60s to the 90s, her pieces are models of a very spare & refined form of writing (there's a documentary about her life which is very interesting, too). She turns that observational sharpness on the year her own life falls apart. All about grieving, and the sometimes unreal aspect of it.

John Gregory Dunne, her writer husband. Heart attack.

They lived (I think) on the Upper West Side of NYC. All the calculations as to which hospital to get to -- Columbia Presbyterian or ? And which hospital took which insurance, which ambulance etc.

Really struck home.
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Valuethinker »

Caliscotsman wrote: Wed Jun 29, 2022 4:15 pm
Alfonsia wrote: Wed Jun 29, 2022 3:53 pm What is your immigration status? It seems you must have been here a long time but talk like a new entry? Will you qualify for ACA/Medicare etc?


I'm a citizen, from 2005. We've always been covered by teacher wife, but as indicated when she retired it's jumping up significantly.

Coming from a country where healthcare is 'free' Nationwide, [
They do things different, there, in 'Merica.

(technically the NHS is free at point of dispense. The healthcare system as a branch of government is true in the UK, Sweden and to some extent Canada, but not true of Switzerland/ France/ Germany as I understand it ie the former system is called "single provider" whereas the latter is "single payer" (but not really, because you are legally required to buy health insurance, but receive help from the state if you cannot afford it or it is not offered through your employer)).

I always argued that the gap between America (particularly the southern states) and Canada, culturally, was greater than the gap between (English) Canada and Britain. That's not universally true - you can certainly find counterexamples - and it's probably less true than it was 50 years ago).

You have been a bit sheltered from that aspect of American life. But we could identify problems with the NHS etc (near meltdown, at the moment).

This isn't the place to discuss in any greater detail than to note that differences exist.
dbr
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Post by dbr »

It's a very good deal or it is not even close to a top tier plan. I would look very closely at what the benefits are and be aware.

A huge inhomogeneity is not just or even mainly the cost but the benefits and at what facilities you are even covered.
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Jack FFR1846 »

My current insurance for the family through my work, where they pay 80% of the cost is $400 a month. And when I go on Medicare, just for me, that amount will more than triple. So $480 a month is a complete gift.
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firebirdparts
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by firebirdparts »

Caliscotsman wrote: Tue Jun 28, 2022 2:30 pm Wife and I live in CA.
When she was a teacher her health insurance covered us both.
When she retired from teaching 3 years ago her union negotiated health insurance was @ $100 per month.
We just got as letter saying that this is going up to $480 per month.

In America is $480 a month for the top tier coverage a good deal?
We can afford it but ouch a little.
It's low, but if it was indexed to your age, it may be more "fair" for somebody really young, but I take it you're not.

I'm a fundamentalist: Insurance is simply a way of spreading the cost of actual health work to all the people, right? In the USA, the medical industry absorbs 4 trillion dollars and there are about 330 million people, so lo-and-behold, it's $1000 a month per person. This is not insurance cost, it's doctors, nurses, drugs, hospitals, and medical equipment. A fraction of that is under the medicare umbrella, so it's hard to say what the rest of us actually cost. But $400 a month for one person is cheap for anything good. For two people it's a steal, really.

4 trillion is about 20% of the USA GDP. We pay about triple what the world's other leading countries pay per person. With bogleheadism you would never consider a health care ETF anyway, but I do think sometimes that they can't take a big sustained run, as it's already an oppressive amount of money as it is.

$100 a month was never the cost of your health care no matter who you are. Somebody else was paying 90% of it.
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dbr
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Post by dbr »

My retirement plan still gives me about $6000/year to use to pay for Medigap, but make no mistake someone does pay.

On the whole either $400/mo is still a subsidized cost or the plan is minimal.
Valuethinker
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Post by Valuethinker »

firebirdparts wrote: Thu Jun 30, 2022 10:28 am

4 trillion is about 20% of the USA GDP. We pay about triple what the world's other leading countries pay per person.
To be fair you really have to look at cost/ GDP (percentage).

The reason being that much of the cost of anything is labour. But especially healthcare. A hospital cleaner in America is (probably) paid more than in most countries. US GDP per capita is higher, therefore costs of labour (probably not capital or necessarily land) are higher. In the same way it's going to cost less to run a hospital in Arkansas than it is in Los Angeles.

(In manufacturing, the US also has very high productivity per head. So American factory workers are quite well paid by world standards, but also more productive than most other countries**. In healthcare, productivity is a much harder thing to accurately measure or to do away with the fundamental labour intensity of it).

On that basis, the US is still very much an outlier. But not 3x. Other wealthy countries (Germany, Switzerland etc) are quite high. I invite anyone interested to go look it up.

UK has anomalously low--arguably the UK underspends on healthcare relative to comparable European peers and certainly that is widely debated here. Japan is also low, which given the age skew of the population is interesting. Japan has historically done a better job on lifestyle issues - diet & keeping old people at home rather than hospitalised.

There's a couple of other things going on in healthcare:

- Pareto's Law or worse - most people spend very little on healthcare. Probably 80% spending is on 20% of the people. It might be even more skewed
- Age. Most of us have a "tipping point" where we start spending more on healthcare than we pay into the system. My guess is that's around age 55 -- but I don't really know. I have a relation who is in their 80s, on a cancer drug costing I don't remember how much a month (thousands). As I put it to them "you spent 60 years paying into the system, it's reasonable to take some back out"

https://theincidentaleconomist.com/about/

is a very good blog about US healthcare economics. Started by Austin Frakt I believe (yes, related in some way).

https://theincidentaleconomist.com/about/

https://theincidentaleconomist.com/word ... economics/ is a view of how economics plays out in healthcare economics.

** Germany is perhaps the outlier here. Germany has a higher fraction of its GDP accounted for by manufacturing exports (cars, but also capital goods) than other large economies (possibly even than Japan).
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by firebirdparts »

This is totally a philosophical statement, but it really helps me:
The cost of everything is only labor or at least people. That is the only real cost in that you can only pay people.
"Materials" are actually just labor. You can't pay the river and the sky and the wind. You can only pay people.
"Capital" is just labor. When you raise capital you have to pay it to people so you can get something to work with.
"Infrastructure" is just labor done last year.

Health care is very much not special in this regard, but I certainly would agree that it's resistant to extreme advances in efficiency. We could call it "labor intensive" but we'd have to mean, if you consider everything is 100% labor, that there is more labor in person right at the customer and less extreme efficiency resulting from labor 40 years ago and 1000 miles away. I am very sure that's true.

I feel like people have simply forgotten that it takes work to meet human needs. If people start carrying signs saying "health care is a right" then they're talking about slavery at that point. It's hard work by other people.

Work is fun and we need it to avoid starvation, and we ought to have a lot more respect for it, really.
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Post by suemarkp »

Yes. And it would be even more apparent if our currency was called the "hour" instead of the "dollar" so you'd see thins priced by labor involved. You'd then realize that you want some people (namely yourself) to make more hours of currency per hour than the average guy. Otherwise, it is difficult to pay others for things when everyone makes the same wage.
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Post by LilyFleur »

Caliscotsman wrote: Wed Jun 29, 2022 4:15 pm
Alfonsia wrote: Wed Jun 29, 2022 3:53 pm What is your immigration status? It seems you must have been here a long time but talk like a new entry? Will you qualify for ACA/Medicare etc?


I'm a citizen, from 2005. We've always been covered by teacher wife, but as indicated when she retired it's jumping up significantly.

Coming from a country where healthcare is 'free' Nationwide, (paid from everyone's taxes), I now have to deal with the mess, sorry I mean inhomogeneities in America.
Yes, in our great country we have healthcare for profit and a VERY complicated, expensive healthcare system for the consumer. Evidently it gets even more complicated when you go on Medicare and have to manage Medicare as well as an "advantage" or a "gap" plan. We like making it difficult for old folks.
Your healthcare bill is very reasonable. Enjoy it.
One of my best friends is a teacher with even lower monthly costs than yours. There are limitations on her plan, though, on which doctors she can see.
Statistical
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Post by Statistical »

InMyDreams wrote: Wed Jun 29, 2022 10:49 am Just make sure you're comparing apples to apples. Even a union negotiated deal may have holes in it.

* Is it ACA compliant (I suspect it has to be?)
* What is the annual deductible?

So, yes, $480/mo for two peeps with a reasonable deductible/ACA policy is a great deal.
$480/mo is a great deal for a HDHP unless you have ACA subsidies.
Deblog
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Post by Deblog »

I retired and my company paid for 32% of cost. I pay 1484 for 2 people. Cost is way more than they charge for current employees, I suppose they put older retirees in a separate bucket. But that is less than on the exchange, I have 800 deductible and a fairly low out of pocket max. Luckily my husband gets an HRA of $888 from his State retiree plan (no longer offer health insure in retirement and only covered retiree anyway) the HRA gets our amount down to 600 per month.
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Re: From the UK. Not knowledgeable about US Health Insurance.

Post by Valuethinker »

firebirdparts wrote: Fri Jul 01, 2022 8:01 am This is totally a philosophical statement, but it really helps me:
The cost of everything is only labor or at least people. That is the only real cost in that you can only pay people.
"Materials" are actually just labor. You can't pay the river and the sky and the wind. You can only pay people.
"Capital" is just labor. When you raise capital you have to pay it to people so you can get something to work with.
"Infrastructure" is just labor done last year.

Health care is very much not special in this regard, but I certainly would agree that it's resistant to extreme advances in efficiency. We could call it "labor intensive" but we'd have to mean, if you consider everything is 100% labor, that there is more labor in person right at the customer and less extreme efficiency resulting from labor 40 years ago and 1000 miles away. I am very sure that's true.

I feel like people have simply forgotten that it takes work to meet human needs. If people start carrying signs saying "health care is a right" then they're talking about slavery at that point. It's hard work by other people.

Work is fun and we need it to avoid starvation, and we ought to have a lot more respect for it, really.
Technology changes though. It took Henry Ford a lot more people to make a car than it does Toyota now (at least at final assembly). Far more is automated.

And that's how you get productivity growth: faster & better ways of doing things, with the same inputs. US housebuilding has far higher productivity than it did 100 years ago.

Medical care is tricky. New technology does not necessarily increase labour productivity.

Yet you'd far rather have leukemia now than in 1972. Technology has made healthcare far more effective. Or even just simple patient monitoring.

I am sure someone who was knowledgeable about medical practice could tell me many ways in which healthcare is more labour productive than it was in 1970 or 1920, say.

Nonetheless Baumol's Cost Model does seem to prevail in healthcare

https://en.wikipedia.org/wiki/William_Baumol

https://www.vox.com/new-money/2017/5/4/ ... -explained

It's a pity the Nobel Prize in Economics committee never got round to giving him a Nobel. He certainly deserved it.
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