I need surgery. The list price is $40,000. The cash-up-front price through a hospital was $9500. The price for the same surgery through an ambulatory surgical clinic is $4700. I am offered insurance through my workplace. My monthly premiums would be $200, I would have an annual deductible of about $5000 before 20% coinsurance, and then an out of pocket maximum of $9500. My price through workplace insurance would be $11,900 (monthly premiums + out of pocket max). I can get a platinum plan on the Healthcare.gov that would cost me $750/mo in premiums–I don’t qualify for any subsidies because I can get shitty insurance through my workplace–that has an annual deductible of $750, and an out of pocket maximum of $1500. So the same surgery would be $10,500 for a full-price plan on the marketplace.
Short of a catastrophic accident or illness, insurance just isn’t affordable, and doesn’t make sense. Unless Biden can fix the system so that you can get subsidies on the marketplace even if you are eligible for insurance through your employer, it’s just not going to work. I would definitely pay $250-300/mo for a platinum plan, but I can’t afford $750/mo, and I can’t afford to pay both the premiums and the deductible for what I can get through my workplace.
“Affordable” Care Act.
Ha.
I need surgery. The list price is $40,000. The cash-up-front price through a hospital was $9500. The price for the same surgery through an ambulatory surgical clinic is $4700. I am offered insurance through my workplace. My monthly premiums would be $200, I would have an annual deductible of about $5000 before 20% coinsurance, and then an out of pocket maximum of $9500. My price through workplace insurance would be $11,900 (monthly premiums + out of pocket max). I can get a platinum plan on the Healthcare.gov that would cost me $750/mo in premiums–I don’t qualify for any subsidies because I can get shitty insurance through my workplace–that has an annual deductible of $750, and an out of pocket maximum of $1500. So the same surgery would be $10,500 for a full-price plan on the marketplace.
Short of a catastrophic accident or illness, insurance just isn’t affordable, and doesn’t make sense. Unless Biden can fix the system so that you can get subsidies on the marketplace even if you are eligible for insurance through your employer, it’s just not going to work. I would definitely pay $250-300/mo for a platinum plan, but I can’t afford $750/mo, and I can’t afford to pay both the premiums and the deductible for what I can get through my workplace.