Health insurance

[urge]

To put things into perspective for all you ACA lovers.

1.2013 pre ACA we paid as a family of four $750/month for full blown PPO with $6000 max in network deductible.

2014 it went up to $1100/month with $7200 deductible PPO

2015 it went up to $1400/month with $7200 deductible

2016 it went up to $1600/month with $7200

2017 up to $1750 with $7200 PPO (or I could pay $1050 with a whopping $12700 deductible)
(Or I could pay $1450 with a more restricted (EPO, like a cross between hmo and PPO)

Of course I got maternity coverage!! From all this with the ACA. Yet my previous self employed insurance was only $400 in 2010 (plus the $200 a month maternity rider for family )

U see the ACA jacks up prices for healthy people making over 400 percent of poverty.

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

Add to the increased cost the 0.9% Medicare tax on all income over 250k. Plus the 3.8% tax on investment income.

For 2017 you are paying over 2k a month thanks to the ACA. Almost triple what you used to pay.

And then the Fed wonders why the CPI inflation is lower than expected. People are left with no money after all the new taxes!

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[Precedexed Out]

would it suffice to agree with you that the Obama administration blew it, that the results are a disaster, and we are all literally paying a huge price?

That was the original point of starting the thread, trying to figure out a way of paying $30-50k on health premiums next year.

My comment in support of the law in general is based on my belief that the law, in its essence, was not intended to enrich insurance executives but to get everyone covered at reasonable cost. This task may have been and continue to be impossible. How can government correct a problem when half the country is rabidly apposed to government intervention in that problem. “Keep government out of health care, and keep your hands off my Medicare!!!” The viable solution for the Obama administration was to cover the gap through private insurance, subsidizing those who need it. The crux, and where the law was wise in concept but inept in execution, was getting young and healthy people into the insurance pool. Why have such a ridiculously low penanlty for failure to comply? Clearly this incentivized the young and healthy to avoid buying insurance, leading to the vicious cycle of increasing costs, leading to a sicker older insurance pool, leading to higher costs. Trump sees that he can easily finish the bill off by further destabilizing the exchanges.

Yes, the law was a tremendous disaster. Not surprisingly since many democrats admitted they didn't read it. Pelosi famously stated we must pass the bill to see what is in it. That is why government can't do anything right and shouldn't be given the chance to run a single payer health care system. Young and health people are not incentivized to buy something that clearly will not benefit them. The exchanges need to go, the insurance they provide is mostly useless unless you have $16,000 laying around to meet your deductible on top of your $500 premium. So stupid, and yet democrats won't acknowledge this. It isn't the responsibility of the young to pay for the healthcare of the old. Maybe a little personal responsibility? How about this. Save when you are young because healthcare costs will be more when you get older.

 

[Precedexed Out]

So @Precedexed Out , what’s your better solution? The rates of raise of the healthcare costs slowed after the ACA compared to pre-2008ish.

Repeal the ACA? And the insurance companies will drop their prices because they are altruistic? Nope. I predict even more healthy patients would drop out, and the pool then is relatively sicker so premiums need to rise to compensate. That’s my one sentence summary of the effect of repeal.

I hear you that you don’t like it. But what’s the next step? What do got propose to make it better and cheaper and maintain coverage? Cause pissing and moaning doesn’t add to the discussion or solve anything. I don’t know what to do. Except possibly a single payer, which makes the biggest pool. And we have near 50% on a governmental payer (TriCare, Medicare, Medicare, etc). Or “death panels” - though we arguably have those already by insurance pre-authorizations, but it’s just not done by the government cause that’s even scarier to people.

I don't care about rates supposedly slowing. The annual premium increases is unsustainable. Part of the problem may be there aren't enough insurance companies. Perhaps break up the monopoly is a good start, there are to few insurance companies.

I agree with the idea that the young currently don't get health insurance and should. I think those who are responsible and maintain health insurance without allowing their to be gaps in coverage should have a much lower premium because they are actually utilizing the idea of insurance. You can't buy home owner's insurance after your house is on fire. HSA are a good start. The biggest incentive for people to stay covered is knowing if they allow a gap in coverage, there will be a penalty based on how long that gap persists.

At the most fundamental level, I believe consumers should be at the center of acquiring health insurance and understanding how it works and when it is appropriate to use it. The real reform that needs to occur with healthcare is cost transparency and bringing costs down in a meaningful way.

A single payer system is not going to fix the real problem, which is cost. It will just mask it and allow the government which is largely unaccountable to screw it up more.

 

[Precedexed Out]

I think this country framing healthcare as health "insurance" is a completely wrong narrative to begin with. Millions of people go their entire driving lives with never having to file an accident claim. Regular car maintenance is not paid for, but it's also typically affordable. On the other hand, literally everyone (barring a few nutjobs in bathtubs) required thousands of dollars worth of medical care as a newborn or a parturient. Almost every kid requires a decent amount of medical care as an infant and toddler. If we are to follow USPSTF guidelines, every woman needs reproductive health checks once they hit their late teens or twenties. Every person needs preventative health checks (mammo, colo, PSA etc) once they hit their 40s-60s. A service required this frequently is not something one should need "insurance" for

I agree with some of this.

Most people, including me, use the word "insurance" too loosely as it refers to healthcare. We really should call it health plans because there is very little about it that represents the spirit of insurance. The bottom line in regards to preventative services and other services is that someone has to pay for them. Requiring them to be "covered" just means the cost is included in the monthly premium instead of the copay. Requiring things to be covered doesn't magically make them not cost anything. It is really just misleading.

 

[Precedexed Out]

He couldn't address the "real issues" because the republicans did everything they could to prevent it. The initial plan was to start the transition towards a single payer system which is the only viable solution, but the republicans wouldn't allow it because it hurts the fat cats of the insurance and pharmaceutical mafias.
The result was a complicated and sub-optimal solution but it still allowed millions of people who never had health insurance to be insured.
Now they have decided to cripple that solution and hold the American healthcare system hostage for a stupid political gain and an idiotic campaign slogan.

Classic democratic talking point that failed in November. Obamacare is owned by democrats, they passed this awful law that is failing. Republicans had nothing to do with it. You're an idiot if you believe this law "hurts the fat cats of the insurance and pharmaceutical mafias." Do you read anything outside of fake news? Insurance and pharmaceutical companies are making bank!!! Incredibly ignorant response, it really sounded like many of Hillary's failed campaign speeches.

 

[Precedexed Out]

To put things into perspective for all you ACA lovers.

1.2013 pre ACA we paid as a family of four $750/month for full blown PPO with $6000 max in network deductible.

2014 it went up to $1100/month with $7200 deductible PPO

2015 it went up to $1400/month with $7200 deductible

2016 it went up to $1600/month with $7200

2017 up to $1750 with $7200 PPO (or I could pay $1050 with a whopping $12700 deductible)
(Or I could pay $1450 with a more restricted (EPO, like a cross between hmo and PPO)

Of course I got maternity coverage!! From all this with the ACA. Yet my previous self employed insurance was only $400 in 2010 (plus the $200 a month maternity rider for family )

U see the ACA jacks up prices for healthy people making over 400 percent of poverty.

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

Take this down, you can't seriously be talking real numbers that affect average Americans. The democrats will have none of this. More people have insurance even if it doesn't help them. LOLZ. Maybe some name calling is in order.

These are the realities of Obamacare, can't deny it. I have witnessed similar numbers over the years as I helped others sign up for this disaster. Those stubborn numbers, yeah, they don't lie. Obamacare sucks!! All these increases are going straight into health insurance company profits.

 

[Precedexed Out]

Yes because that's obviously what I said.

Why don't you go actually look and tell me how much all of the preventive medicine stuff we do costs before you accuse me of something ridiculous.

No point to argue with @Planktonmd

That user doesn't care about facts if they interfere with the single payer healthcare is best for all narrative.

 

[Precedexed Out]

I am not accusing you of anything! Just confirming that you think that the majority of people in this country are smart enough to pay out of pocket for preventive medicine even if it costs pennies. You are obviously an optimist.

So we must pay for stupidity? Sorry, but if you won't spend a few dollars on your health, too bad. People don't seem to have problems paying for expensive phones with unlimited data plans, beer, cigarettes, cars...etc. The priorities in this country are backwards.

 

[chessknt]

Yes, the law was a tremendous disaster. Not surprisingly since many democrats admitted they didn't read it. Pelosi famously stated we must pass the bill to see what is in it. That is why government can't do anything right and shouldn't be given the chance to run a single payer health care system. Young and health people are not incentivized to buy something that clearly will not benefit them. The exchanges need to go, the insurance they provide is mostly useless unless you have $16,000 laying around to meet your deductible on top of your $500 premium. So stupid, and yet democrats won't acknowledge this. It isn't the responsibility of the young to pay for the healthcare of the old. Maybe a little personal responsibility? How about this. Save when you are young because healthcare costs will be more when you get older.

So much wrong with this.

First you continue to ignore that the insurance is preventing complete financial ruin which us what it is supposed to do with a bronze level deductible. Stop using that as your example.

Second since the inception of Medicare we have decided that it is the responsibility for the young to pay for the old--the aca didn't invent that.

Third the costs of illness in old age would drain the retirement of even the most frugal savers. No amount of personal responsibility can insure against an episode of critical illness or a traumatic hip fracture. Even if you save 2.5m for 30 years of retirement that can be wiped out in a few weeks in a hospital or have a large bite taken out with a simple fall and rehab afterwards.

I know you don't understand this because of your relatively basic interaction with the healthcare system thus far but as you gain more experience you will begin to have a glimpse of the bigger picture. As far as I can tell you have about as much expertise on this as the people who wrote the aca.

 

[chessknt]

So we must pay for stupidity? Sorry, but if you won't spend a few dollars on your health, too bad. People don't seem to have problems paying for expensive phones with unlimited data plans, beer, cigarettes, cars...etc. The priorities in this country are backwards.

And what happens when they get sick--we let them die? Do ee deny them emergency care? Who pays for this care if not them?

It isn't realistic to think that can or should happen or we would have dead people all over the place in this country. I used to think that way as a libertarian at heart but after being in the trenches I understand that it isn't a realistic or humane viewpoint to have.

In my opinion having committees of physicians of appropriate specialties involved in high utilization or futile cases would be a good start but the political palatability of 'death panels' makes this a fantasy until our system collapses.

 

[Precedexed Out]

So much wrong with this.

First you continue to ignore that the insurance is preventing complete financial ruin which us what it is supposed to do with a bronze level deductible. Stop using that as your example.

Second since the inception of Medicare we have decided that it is the responsibility for the young to pay for the old--the aca didn't invent that.

Third the costs of illness in old age would drain the retirement of even the most frugal savers. No amount of personal responsibility can insure against an episode of critical illness or a traumatic hip fracture. Even if you save 2.5m for 30 years of retirement that can be wiped out in a few weeks in a hospital or have a large bite taken out with a simple fall and rehab afterwards.

I know you don't understand this because of your relatively basic interaction with the healthcare system thus far but as you gain more experience you will begin to have a glimpse of the bigger picture. As far as I can tell you have about as much expertise on this as the people who wrote the aca.

1. It isn't preventing complete financial ruin. Most people on these plans would experience financial ruin just to meet the deductible.

2. We haven't decided anything. Self-responsibility and accountability, dirty words for democrats. Work hard when young to take care of self when older.

3. It wouldn't have too if costs weren't so out of control.

Last sly comment: I have extensive interactions with the healthcare system. More so than you likely do. I have multiple family members with chronic medical conditions. I know how healthcare insurance works very well and probably better than most.

 

[Precedexed Out]

And what happens when they get sick--we let them die? Do ee deny them emergency care? Who pays for this care if not them?

It isn't realistic to think that can or should happen or we would have dead people all over the place in this country. I used to think that way as a libertarian at heart but after being in the trenches I understand that it isn't a realistic or humane viewpoint to have.

In my opinion having committees of physicians of appropriate specialties involved in high utilization or futile cases would be a good start but the political palatability of 'death panels' makes this a fantasy until our system collapses.

There isn't an easy answer for the point above. At the same time, it isn't fair to the rest of the country to use a bad system like Obamacare because of an irresponsible minority in this country. We won't have "dead people all over."

 

[Precedexed Out]

I think we can all agree there are a number of Paradigm shifts that need to happen in patient attitudes. From where I sit, we need to divorce everyone from the idea that insurance should pay for an expensive things. One of the biggest drivers of cost is the fact that no one knows what anything actually costs and insurance pays for it anyway.

That lipid panel and Lipitor prescription that someone mentioned previously, cost $7 per test and around $5 per month if you pay cash. If insurance pays for them, they are more like $50, and $30 per month respectively.

Like I have stated previously, the real problem is costs. Everything in healthcare costs too damn much.

 

[chessknt]

1. It isn't preventing complete financial ruin. Most people on these plans would experience financial ruin just to meet the deductible.

2. We haven't decided anything. Self-responsibility and accountability, dirty words for democrats. Work hard when young to take care of self when older.

3. It wouldn't have too if costs weren't so out of control.

1. Having 40% of your annual income in Costs is a significant hardship but it isn't ruinous. You can space payments out and eventually catch up. Getting a bill so high that the payments exceed your annual income is literally impossible to ever pay. For someone so experienced with poverty you sure dont seem to have a great grasp of how these people live.

2. Jibberish. Young people pay Medicare taxes that fund healthcare for the old now just as the seniors did when they were younger. Go back in time and try to stop it but don't blame obama.

3. Do you know how much a bottle of precedex costs? Do you know how many an icu can go through in a week? How about rn and ccm physician pay? Respiratory therapy? Tubefeed costs? Central line kit? Abx? Rehab costs? You think that is going to be something in the realm of affordable if grandma gets pneumonia and has to pay out of pocket in the unicorn system where the weak have all died off and everything is at cost? Or are all the drugs free and labor at minimum wage in this system?
What about people born with cystic fibrosis, should we let them die too because they don't have 4 million saved up for a lung transplant at 27 years old?

 

[Precedexed Out]

1. Having 40% of your annual income in Costs is a significant hardship but it isn't ruinous. You can space payments out and eventually catch up. Getting a bill so high that the payments exceed your annual income is literally impossible to ever pay. For someone so experienced with poverty you sure dont seem to have a great grasp of how these people live.

2. Jibberish. Young people pay Medicare taxes that fund healthcare for the old now just as the seniors did when they were younger. Go back in time and try to stop it but don't blame obama.

3. Do you know how much a bottle of precedex costs? Do you know how many an icu can go through in a week? How about rn and ccm physician pay? Respiratory therapy? Tubefeed costs? Central line kit? Abx? Rehab costs? You think that is going to be something in the realm of affordable if grandma gets pneumonia and has to pay out of pocket in the unicorn system where the weak have all died off and everything is at cost? Or are all the drugs free and labor at minimum wage in this system?
What about people born with cystic fibrosis, should we let them die too because they don't have 4 million saved up for a lung transplant at 27 years old?

1. 40% of income being spend on costs isn't ruinious? That is about as illogical as it gets.

2. Wasn't blaming Obama for medicare, but stating my belief that people should save money when younger to help pay for the rising cost of health insurance when they get older.

3. Add up the cost of the bill and then all the variables you mentioned. Still way higher than it should be. A 27 year old with health insurance doesn't need $4 million.

 

[chessknt]

Who subsidizes people with c.f. though?

Reread your post--you equate Medicare and the aca...

 

[VA Hopeful Dr]

I hardly agree with Precedexed Out but do you really believe that healthcare ever was or is a free market? Sure you can "shop" for a PCP you like but that's not on a cost basis. You certainly don't get any emergency care on a cost basis. There's no competition outside state lines much less country lines for the vast majority of people. You can even argue that the ability to provide competition within a state has largely passed to the wayside with Obamacare (i.e. there are 1-2 large hospitals that run healthcare in most places now). Healthcare is not a "free market". Pharmaceutical and device companies patent everything, helping further innovation at huge consumer costs.

There is no easy or right answer for healthcare in this country. The prior model favored young and healthy people. Obamacare only truly helps the destitute and sick at the expense of the rest of the population. People love to tout all these international healthcare models that don't really apply that well to our population. The access in the French system is nice and accounts for less money than we spend but at least theoretically hampers innovation. Beyond that, compare the two population's BMI. WE WAY underestimate how obesity skyrockets healthcare costs. I personally think we need some degree of personal accountability built into whatever system is settled upon.

Admittedly, there are lots of things that a more free market health care system won't ever fix. A CABG, for example, will never be cheap.

But there are lots of areas that a more free-market would be perfect for. Imaging prices are the easiest to work with. For example: the local hospitals here have essentially the same MRIs as everyone else. Nothing out of the ordinary special. There cash price for a noncontrast joint MRI runs about $2500. There are 3 local free standing imaging centers. Same basic MRIs. Their prices for the same scan range from $350-$550. You see something similar for x-rays. Ankle, 3 view, runs about $180 at the local hospitals. Free standing? $50. Its amazing how cheap things can be when the provider of the tests has to compete with others.

Second easiest is drug prices (generic only of course, patent law is a different story). Using goodrx.com, I see that the cash price for lipitor 40mg is $138/month. Yet using this free coupon on the internet, its now $14/month. Had the same thing happen with ketoconazole for my dog. 30 pills was going to be $90. Used goodrx and now its $19. I have no idea how goodrx works and why a free coupon drops the price this much. But it sure makes the drug stores seem shady. I suspect its just an agreement to offer a lower price to get the price-conscious shoppers, but I don't know for sure. If that's all it is, why isn't CVS charging say $20 to everyone? Because they can get away with more.

 

[parcus]

I am pretty sure it is some sort of a scam... Here in Brazil we get an epiduo cream tube for about 20 USD, in the US it cost an absurd 200 USD (don't remember exactly how much out of the top of my head, I saw this during my dermatology elective). Then surprise! with the discount it is about 30 USD. It is all a trick to make people think they are getting an amazing deal.

 

[acidbase1]

To put things into perspective for all you ACA lovers.

1.2013 pre ACA we paid as a family of four $750/month for full blown PPO with $6000 max in network deductible.

2014 it went up to $1100/month with $7200 deductible PPO

2015 it went up to $1400/month with $7200 deductible

2016 it went up to $1600/month with $7200

2017 up to $1750 with $7200 PPO (or I could pay $1050 with a whopping $12700 deductible)
(Or I could pay $1450 with a more restricted (EPO, like a cross between hmo and PPO)

Of course I got maternity coverage!! From all this with the ACA. Yet my previous self employed insurance was only $400 in 2010 (plus the $200 a month maternity rider for family )

U see the ACA jacks up prices for healthy people making over 400 percent of poverty.

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

It's the liberal way. Screw the producers

 

[urge]

Admittedly, there are lots of things that a more free market health care system won't ever fix. A CABG, for example, will never be cheap.

But there are lots of areas that a more free-market would be perfect for. Imaging prices are the easiest to work with. For example: the local hospitals here have essentially the same MRIs as everyone else. Nothing out of the ordinary special. There cash price for a noncontrast joint MRI runs about $2500. There are 3 local free standing imaging centers. Same basic MRIs. Their prices for the same scan range from $350-$550. You see something similar for x-rays. Ankle, 3 view, runs about $180 at the local hospitals. Free standing? $50. Its amazing how cheap things can be when the provider of the tests has to compete with others.

Second easiest is drug prices (generic only of course, patent law is a different story). Using goodrx.com, I see that the cash price for lipitor 40mg is $138/month. Yet using this free coupon on the internet, its now $14/month. Had the same thing happen with ketoconazole for my dog. 30 pills was going to be $90. Used goodrx and now its $19. I have no idea how goodrx works and why a free coupon drops the price this much. But it sure makes the drug stores seem shady. I suspect its just an agreement to offer a lower price to get the price-conscious shoppers, but I don't know for sure. If that's all it is, why isn't CVS charging say $20 to everyone? Because they can get away with more.

That Goodrx thing is amazing. Thanks for the tip.

 

[d9sccr]

Admittedly, there are lots of things that a more free market health care system won't ever fix. A CABG, for example, will never be cheap.

But there are lots of areas that a more free-market would be perfect for. Imaging prices are the easiest to work with. For example: the local hospitals here have essentially the same MRIs as everyone else. Nothing out of the ordinary special. There cash price for a noncontrast joint MRI runs about $2500. There are 3 local free standing imaging centers. Same basic MRIs. Their prices for the same scan range from $350-$550. You see something similar for x-rays. Ankle, 3 view, runs about $180 at the local hospitals. Free standing? $50. Its amazing how cheap things can be when the provider of the tests has to compete with others.

Second easiest is drug prices (generic only of course, patent law is a different story). Using goodrx.com, I see that the cash price for lipitor 40mg is $138/month. Yet using this free coupon on the internet, its now $14/month. Had the same thing happen with ketoconazole for my dog. 30 pills was going to be $90. Used goodrx and now its $19. I have no idea how goodrx works and why a free coupon drops the price this much. But it sure makes the drug stores seem shady. I suspect its just an agreement to offer a lower price to get the price-conscious shoppers, but I don't know for sure. If that's all it is, why isn't CVS charging say $20 to everyone? Because they can get away with more.

I understand your sentiment but I also disagree to a point. A CABG won't ever be cheap but can be cheaper. We used to rotate with a CT surgeon who could do a mini AVR in 45 minutes or a CABG in about an hour. His patients left the hospital POD 3/4. The total cost for that visit has to be less than the 4 hour CABG or 6 hour AVR with 3-4 day ICU stay before even being downgraded to floor status. Emergent care is one thing but nearly everything else COULD be shopped.

If there are any interns or really anyone that actively prescribes meds following, I can't say enough about GoodRx. Def used it all intern year to help patients find affordable medications

 

[Planktonmd]

Classic democratic talking point that failed in November. Obamacare is owned by democrats, they passed this awful law that is failing. Republicans had nothing to do with it. You're an idiot if you believe this law "hurts the fat cats of the insurance and pharmaceutical mafias." Do you read anything outside of fake news? Insurance and pharmaceutical companies are making bank!!! Incredibly ignorant response, it really sounded like many of Hillary's failed campaign speeches.

It looks like you got banned but I still have to say I agree with you, the insurance/pharma are making bank because the ACA was neutered and not allowed to have any regulatory power to please the republicans and their sponsors. As for the rest of your Fox news rhetoric there is nothing I can say to that.

 

[deleted500612]

We are definitely not houses or cars but insurance is insurance no matter how you dice it.

That’s not specific to Australia. Every socialized healthcare system has 2 tiers. Since the public one always sucks (because of rationing), the people who can afford it get their care, unrationed, privately.

This isn't really true. Canada for example is fully single tier. Private insurance or private fees above the government reimbursement rate that offer a patient expedited or higher levels of care is illegal. Private hospitals are illegal. You can get private insurance plans that cover supplementary services like dental, drug plans, physiotherapy, rehab, etc., but the actual core medical/surgical coverage is true single tier where everyone has the same coverage and no amount of money you are willing to pay will let you buy better coverage or see a specialist sooner. The fortune 500 CEO waits in the same line at the same hospital for the same service as the homeless guy (not really though, because in reality he just gets on his jet and flies to the US and pays for private treatment there instead of waiting for treatment in Canada)

 

[deleted500612]

I'll take our healthcare over Canada anytime. Move there if it is so wonderful. Just another liberal trying to degrade our country as it is the only way to make it equal to all other countries. America is the best country, end of story.

I don't remember even remotely implying that the Canadian system is better or desirable, I was simply explaining how it actually works...

 

[caligas]

Crappy system if it makes everything except substandard care illegal

Welcome back, you crazy Trumper. Why’d you get banned?

 

[urge]

This isn't really true. Canada for example is fully single tier. Private insurance or private fees above the government reimbursement rate that offer a patient expedited or higher levels of care is illegal. Private hospitals are illegal. You can get private insurance plans that cover supplementary services like dental, drug plans, physiotherapy, rehab, etc., but the actual core medical/surgical coverage is true single tier where everyone has the same coverage and no amount of money you are willing to pay will let you buy better coverage or see a specialist sooner. The fortune 500 CEO waits in the same line at the same hospital for the same service as the homeless guy (not really though, because in reality he just gets on his jet and flies to the US and pays for private treatment there instead of waiting for treatment in Canada)

The private tier for them is the USA.

 

[chocomorsel]

Not so much an optimist as a realist. If things are inexpensive, patients will pay for them. This is coming from a guy who ran a successful cash only Family Medicine office for 2 years. I know what I'm talking about with regards to this.

Why did you stop running this successful clinic? I hadn't followed you in a while but thought you were still cash only

 

[VA Hopeful Dr]

Why did you stop running this successful clinic? I hadn't followed you in a while but thought you were still cash only

The practice was going great, but an opportunity came to move back to my hometown (translation: my wife finally agreed to move). We now live in a 100 year old house in the same neighborhood as my mother, both of her brothers, and one of my father's sister's. As a guy with twin toddlers I couldn't pass this up.

 

[aneftp]

Consider this for those who want to go the self employment route. While doing ur own billing (no middle man to take off the top) can be lucrative. Any downtown in payer mix or case load. Consider health insurance and medical practice.

A yearly occurrence (no tail ) policy runs around $17-25k a year.

A claims made policy at 5 years maturation runs similar 17-20k a year (factor in paying the tail (potentially upwards to 40k) if u need coverage when u switch to another employer that doesn’t use ur policy

Now add raising health insurance cost. Roughly 20k a year in just premiums alone excludes out of pocket expenses which can bring that figure to 30k potentially for the year.

Malpractice premiums plus health premiums (20k plus 20k). U are out close to 40k a year in expenses alone. That is a lot of money to be self employed. U better be generating more than 400k plus to make it worth ur while self employed.

Most self employed friends of mine either make 2x as much as that 400k figure. Or those who make 200-300k (internist/fp/ and even outpatient Anesthesiologists have working spouses who they use for health insurance through their spouses employer insurance.

 

[deleted162650]

Consider this for those who want to go the self employment route. While doing ur own billing (no middle man to take off the top) can be lucrative. Any downtown in payer mix or case load. Consider health insurance and medical practice.

A yearly occurrence (no tail ) policy runs around $17-25k a year.

A claims made policy at 5 years maturation runs similar 17-20k a year (factor in paying the tail (potentially upwards to 40k) if u need coverage when u switch to another employer that doesn’t use ur policy

Now add raising health insurance cost. Roughly 20k a year in just premiums alone excludes out of pocket expenses which can bring that figure to 30k potentially for the year.

Malpractice premiums plus health premiums (20k plus 20k). U are out close to 40k a year in expenses alone. That is a lot of money to be self employed. U better be generating more than 400k plus to make it worth ur while self employed.

Most self employed friends of mine either make 2x as much as that 400k figure. Or those who make 200-300k (internist/fp/ and even outpatient Anesthesiologists have working spouses who they use for health insurance through their spouses employer insurance.

Malpractice costs are highly variable by state. In CA for instance, your policy will only be 8k/year at maturity (only about $1200 your first year out). Keep in mind in a true PP model that all these expense are still there. The only difference between W-2 PP and 1099 self-employed is what line these items go on in the spreadsheet.

 

[Vergie]

Did we really need to ban precidexed out? I guess conservative views are not allowed on here now?

Or hopefully it was for something else

 

[WisNeuro]

Did we really need to ban precidexed out? I guess conservative views are not allowed on here now?

Or hopefully it was for something else

It was for various TOS violations, not viewpoints. The offending posts were deleted. It was more than warranted. I'm surprised it went as far as it did.

 

[ZzzPlz]

Yeah I'm pretty sure that was the Donald. Kinda miss him though

 

[Arch Guillotti]

Did we really need to ban precidexed out?

Yes. Decision is made with site-wide staff input, not just me.

 

[pgg]

I guess conservative views are not allowed on here now?

Viewpoints short of outright hate speech are not censored, however unpopular. You’ll notice that there are still 361 messages from him that are still up.

When a banned user re-registers, we typically delete every new post, regardless of content, as soon as possible, in order to discourage re-re-re-re-registering shenanigans.

There are plenty of conservative and libertarian minded people here. You should feel free to argue those viewpoints with polite, reasoned, fact based arguments.

 

[chocomorsel]

Consider this for those who want to go the self employment route. While doing ur own billing (no middle man to take off the top) can be lucrative. Any downtown in payer mix or case load. Consider health insurance and medical practice.

A yearly occurrence (no tail ) policy runs around $17-25k a year.

A claims made policy at 5 years maturation runs similar 17-20k a year (factor in paying the tail (potentially upwards to 40k) if u need coverage when u switch to another employer that doesn’t use ur policy

Now add raising health insurance cost. Roughly 20k a year in just premiums alone excludes out of pocket expenses which can bring that figure to 30k potentially for the year.

Malpractice premiums plus health premiums (20k plus 20k). U are out close to 40k a year in expenses alone. That is a lot of money to be self employed. U better be generating more than 400k plus to make it worth ur while self employed.

Most self employed friends of mine either make 2x as much as that 400k figure. Or those who make 200-300k (internist/fp/ and even outpatient Anesthesiologists have working spouses who they use for health insurance through their spouses employer insurance.

Meh, I am self employed. Barely make 400, probably more in the 250 to 350k 1099 and pay my own insurance. My yearly malpractice premiums are 10 to 12k, per year since I don't work too much and my insurance for me and spouse is 700 a month. But we are young and healthy. It's not the Cadillac plan but it gets the job done.
So what's that, about 20k a year?. Glad I have no kids.

 

[nimbus]

Meh, I am self employed. Barely make 400, probably more in the 250 to 350k 1099 and pay my own insurance. My yearly malpractice premiums are 10 to 12k, per year since I don't work too much and my insurance for me and spouse is 700 a month. But we are young and healthy. It's not the Cadillac plan but it gets the job done.
So what's that, about 20k a year?. Glad I have no kids.

It depends on your risk pool. My group has high utilization with partners getting cancer and needing AVR/CABG so our rates are very high. Cheapest high deductible PPO is $1000/mo.

 

[caligas]

It depends on your risk pool. My group has high utilization with partners getting cancer and needing AVR/CABG so our rates are very high. Cheapest high deductible PPO is $1000/mo.

Yep, and some insurance companies will not offer an individual plan if you are eligible through a group plan, so if your partners are old and sick, you’re screwed.

The exchanges are a possible bailout but it will be an HMO plan and may not be HSA compliant.

Can anybody comment on having an HMO plan?
I worry about someone in my family needing some sort of expensive care and it being refused.

 

[deleted162650]

Yep, and some insurance companies will not offer an individual plan if you are eligible through a group plan, so if your partners are old and sick, you’re screwed.

The exchanges are a possible bailout but it will be an HMO plan and may not be HSA compliant.

Can anybody comment on having an HMO plan?
I worry about someone in my family needing some sort of expensive care and it being refused.

Keep in mind that if you are eligible for a group plan and instead opt to purchase your own plan through the exchange, your premiums are not tax deductible. May negate the lower cost - at least it did for me.

I can't speak to HMOs as a whole, but I know people with Kaiser, and they have been very happy. My dad is self employed, and switched to a Kaiser plan probably 4 years ago (not yet Medicare eligible). The first year with Kaiser his wife had 2 THAs and my Dad was dx'd with CLL - his meds have been very cheap.

 

[caligas]

Keep in mind that if you are eligible for a group plan and instead opt to purchase your own plan through the exchange, your premiums are not tax deductible. May negate the lower cost - at least it did for me.

I can't speak to HMOs as a whole, but I know people with Kaiser, and they have been very happy. My dad is self employed, and switched to a Kaiser plan probably 4 years ago (not yet Medicare eligible). The first year with Kaiser his wife had 2 THAs and my Dad was dx'd with CLL - his meds have been very cheap.

I’m not certain but I think what you are saying about losing tax deduction applies only if the group plan is “subsidized.”

I’ll see if I can find a reference...

 

[chocomorsel]

Yep, and some insurance companies will not offer an individual plan if you are eligible through a group plan, so if your partners are old and sick, you’re screwed.

The exchanges are a possible bailout but it will be an HMO plan and may not be HSA compliant.

Can anybody comment on having an HMO plan?
I worry about someone in my family needing some sort of expensive care and it being refused.

What do you mean a group plan? As in with your partners? Even though we are all self employed and are only in partnership to assist with assignments, call and office billing? Sounds weird. My last practice was with a bunch of older men all 20+ years older than me. Wasn't a problem getting my own insurance.

I have an HMO. So does my mom with lots of health issues. Some of her meds initially get denied but then get prior authorization. Haven't had problems with her care. Referrals are done as needed without problems.

 

[caligas]

What do you mean a group plan? As in with your partners? Even though we are all self employed and are only in partnership to assist with assignments, call and office billing? Sounds weird. My last practice was with a bunch of older men all 20+ years older than me. Wasn't a problem getting my own insurance.

I have an HMO. So does my mom with lots of health issues. Some of her meds initially get denied but then get prior authorization. Haven't had problems with her care. Referrals are done as needed without problems.

S Corp, private practice group. We have an optional plan that we can buy through the group. Don’t think it’s uncommon.

 

[caligas]

Deducting Health Insurance Premiums If You're Self-Employed - TurboTax Tax Tips & Videos

Trying to find something on irs website...

 

[caligas]

From the IRS:

“Other coverage.

You can’t take the deduction for any month you were eligible to participate in any employer (including your spouse's) subsidized health plan at any time during that month, even if you didn’t actually participate. In addition, if you were eligible for any month or part of a month to participate in any subsidized health plan maintained by the employer of either your dependent or your child who was under age 27 at the end of 2016, don’t use amounts paid for coverage for that month to figure the deduction.”

Publication 535 (2016), Business Expenses | Internal Revenue Service

 

[deleted162650]

I’m not certain but I think what you are saying about losing tax deduction applies only if the group plan is “subsidized.”

I’ll see if I can find a reference...

From the IRS:

“Other coverage.

You can’t take the deduction for any month you were eligible to participate in any employer (including your spouse's) subsidized health plan at any time during that month, even if you didn’t actually participate. In addition, if you were eligible for any month or part of a month to participate in any subsidized health plan maintained by the employer of either your dependent or your child who was under age 27 at the end of 2016, don’t use amounts paid for coverage for that month to figure the deduction.”

Publication 535 (2016), Business Expenses | Internal Revenue Service

What exactly do they mean by subsidized? Ours must be "subsidized" because my CPA told me my individual plan would no longer be deductible.

 

[caligas]

What exactly do they mean by subsidized? Ours must be "subsidized" because my CPA told me my individual plan would no longer be deductible.

Exactly, it’s not defined. So I’d say define it however it benefits you most as long as you can defend it in an audit.

I’d ask your accountant again and please let me know if I’m missing something, I can only stand to read the IRS website for so long.

 

[caligas]

What exactly do they mean by subsidized? Ours must be "subsidized" because my CPA told me my individual plan would no longer be deductible.

Ok, I think I found the hitch. See the part about having to be reimbursed by the partnership below.

• For partners, a policy can be either in the name of the partnership or in the name of the partner. You can either pay the premiums yourself or the partnership can pay them and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in your gross income. However, if the policy is in your name and you pay the premiums yourself, the partnership must reimburse you and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in your gross income. Otherwise, the insurance plan won’t be considered to be established under your business.
  
  
• For more-than-2% shareholders, a policy can be either in the name of the S corporation or in the name of the shareholder. You can either pay the premiums yourself or the S corporation can pay them and report the premium amounts on Form W-2 as wages to be included in your gross income. However, if the policy is in your name and you pay the premiums yourself, the S corporation must reimburse you and report the premium amounts on Form W-2 in box 1 as wages to be included in your gross income. Otherwise, the insurance plan won’t be considered to be established under your business.
  

 

[aneftp]

Ok, I think I found the hitch. See the part about having to be reimbursed by the partnership below.

• For partners, a policy can be either in the name of the partnership or in the name of the partner. You can either pay the premiums yourself or the partnership can pay them and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in your gross income. However, if the policy is in your name and you pay the premiums yourself, the partnership must reimburse you and report the premium amounts on Schedule K-1 (Form 1065) as guaranteed payments to be included in your gross income. Otherwise, the insurance plan won’t be considered to be established under your business.
  
  
• For more-than-2% shareholders, a policy can be either in the name of the S corporation or in the name of the shareholder. You can either pay the premiums yourself or the S corporation can pay them and report the premium amounts on Form W-2 as wages to be included in your gross income. However, if the policy is in your name and you pay the premiums yourself, the S corporation must reimburse you and report the premium amounts on Form W-2 in box 1 as wages to be included in your gross income. Otherwise, the insurance plan won’t be considered to be established under your business.

Yes. It’s a little tricky. I’ve been self employed 10 out of my 13 years in practice so basically know every tax code. I’m w2 now again.

Suckie thing about being LLC (elect S corp status for irs purpose in Florida) is while it’s deducted on the business side (1120S). Those same premiums get re added back to the W2 wages paid. So it’s not a true 33% write off. More like 10% write off in real life.

Yes. Premiums for full ppo in Florida even for relatively younger Early 40s and mid 30s spouse and 2 kids can run $1700 with a $7200 deductible in 2017.

U can drop down to hmo style plan for around $1000/month with narrow network but out of pocket expenses still high. I can’t remember for sure. It wasn’t cheap. Still around $9000 of pocket for hmo.

That’s why I wanted to compare apples to apples saying my premiums were pretty cheap pre ACA for similar PPO wide network of $700/month with $6000 in 2013. And now the equivalent is $1700/month with $7200 (hsa compatible).

$1700/month x 12 months equals $20k a year in premiums alone. PLUS THE $7200 our of pocket

Florida “blue options” is a more broader network than Florida “blue silver “

For 2018 they tried to keep premiums similiar yet deductible for the family is now a whopping $14000!! It’s simply crazy to be paying $1700/month and ain’t nothing paid out till u pay $7000 for one person. And if second person gets health issues. That’s another $7000. So u are potentially out $34k before anything gets paid.