'Taking it in the shorts' for health insurance 2018
Health insurance rip off lying
—New Radicals, “You Get What You Give”
It’s that time of the year—time to bend over and take it in the shorts for health insurance—and I’m feeling that line at the end of “You Get What You Give” more than ever.
The bills for treating my fractured arm are trickling in, and it’s dawned on me: I’m paying my health insurance company for almost nothing. Despite the fact my monthly premium is about $750, I seem to pay 75 percent of every healthcare cost I incur out of pocket. (I paid 90 percent of the cost of the X-rays of my arm.) Based on my healthcare usage and need—no prescriptions and an occasional appointment for illness or injury—I may as well not have insurance. I pay my optometrist, chiropractor, and dentist out of pocket, so why not my primary care physician, especially since I’m paying most of his fees out of pocket anyway.
Let’s just say I am not getting a policy through Medica in 2019.
Am I being harsh? I don’t know. Medica, the only company offering private health plans in Iowa in 2018, pays what I pay it to pay. I’m the one who picked the policy. However, I thought I’d be getting a lot more for $750 per month. It is, after all, a silver-level plan. I guess Wellmark set the bar too high. I thought I had it bad in 2016, when I paid a $35 copay for appointments and Wellmark covered everything else. With Medica, I pay a copay (which I’m never charged at appointments because the information is not on my card) and almost everything else—on top of my monthly premium.
What a racket.
(To be fair, Medica, which entered Iowa’s marketplace in the last couple years, probably does not have the network of providers Wellmark does in the Hawkeye State. The company is based in Minnesota and, according to its website, “provides health coverage to 1.5 million members. Its coverage is available to individuals, employers, third-party administrators and government programs in Minnesota and select counties in Wisconsin, North Dakota and South Dakota.” [Note that Iowa is not included in that list.] The fact that its network and provider relationships are less established is likely one reason why my Medica plan is not as effective as those I had with Wellmark. Yes, you can keep your doctor, as former-President Obama said, but you will pay more out of pocket if he’s not in your insurer’s network.)
Given my experience in 2018, I have chosen a bronze-level plan for 2019. It’s the first time I have ever picked a bronze-level plan; the silver level was as low as I wanted to go in the past, mostly because the deductibles and copays are much smaller. Bronze-level premiums are around $200 cheaper per month, so paying a $150 copay for the few appointments I expect (and hope for) should turn out to be a bargain.
Of course, a bronze-level plan means more out-of-pocket costs if, God forbid, something unthinkable happens and bills pile up. That’s the con of the insurance industry, health and otherwise, that gives everyone pause when buying a cheap policy. I probably won’t need a deductible that low, I think when comparing health plans. But then I think about all the bad things that could happen, how health professionals charge for every atom of oxygen breathed in my presence, and choose to be safe rather than sorry despite the odds. (The fact that everything—and I mean everything—has a cost in the healthcare industry is likely unknown by those with health insurance through their employer and don’t see itemized lists of charges. Oh. My. God. Not only was I charged for the X-rays of my arm, I was charged for their processing [which is digital, by the way], their examination by a tech, and an examination by my doctor.) This year, though, I’m taking the risk based on past experience.
To be transparent, I did not pay $750 for my premium every month this year. I applied for and received a subsidy offered through the Affordable Care Act, so my share of my monthly premium was about half; the federal government paid the rest. However, the subsidy vanished when I filed my taxes in April and reported slightly more income. The difference in my income from one year to another was probably $200, but it was enough to push me over the income limit. Also, a health insurance stipend was included in the work contract I signed this summer, so my employers are finally chipping in. (“So I got that going for me.”) They’re not paying directly, though; the stipend was included in a raise. It’s another reason I chose the cheaper bronze plan: the stipend will cover a big chunk of my premium.
An employer contribution is one of the things I’m weighing in my seemingly endless deliberation regarding my next career move. Going it alone is expensive, so it would be nice to have a job that provides health insurance; that would be the benefit of being a full-time employee (in an ideal situation; I am currently employed full-time ... though I have two different jobs and receive income from three different sources). I often think about starting my own business, but any appeal of being my own boss and doing my own thing is often tempered by the thought of continuing to pay my own health insurance. The cost of insurance is no doubt a barrier to entrepreneurship and innovation that no politician is talking about, at least from what I know.
The one good thing President Trump and congressional Republicans have done is abolish the individual health insurance mandate. Yes, I understand that healthy people are now able to go without, potentially unbalancing the insurance pool and driving premiums higher, but it no longer forces people who don’t want health insurance into an either/or situation: either have health insurance or pay a penalty. Depending on how things go in 2019, not having health insurance is something I may consider for 2020. It’s an option I’m happy to have, especially since my experiences with health insurance are proving that the New Radicals are probably right.
