Hello,
I have a question about the healthcare insurance in US.
I have heard that it is tied to your employment and the company provides for it.
So here are a couple of questions:
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Is there no way for an individual to get their own personal insurance and not be dependent on the company?
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What about freelancers, business owners and retirees? Do they forfeit their insurances?
There is a way, and it is required, but it is much more expensive; therefore people usually pay for the least amount of coverage.
If you fall under a certain income threshold you can get free healthcare through medicare/aid.
Only some states offer free healthcare for people under certain income thresholds without other qualifications such as being disabled or pregnant. There has been progress with states finally accepting the Medicaid expansion, and there are often “low-income healthcare options” available, but A LOT of people are unfortunately still unable to get coverage because they’re too poor.
All states offer Medicaid below the income threshold. Those that have not accepted the expansion payments from the federal government have a much lower income cutoff than those that have accepted it.
From what I know that is not the case. I am by no means an expert (and honestly I’m hopeful you know something I don’t that can finally help me get treated) but I have tried to get it and have never been eligible in the state of Georgia. Again, I’m not an expert, but my doctor even recommended to me (half jokingly) that if I wanted coverage and could not afford Ambetter then I should just have a kid. These are even the requirements listed for Medicaid on the Georgia.gov website.
You may be eligible for Medicaid if your income is low and you match one of the following descriptions:
Even when I had no income at all because of health issues I was only able to be treated via hospital indigent care, not Medicaid.
Edit: In fact, even information regarding the Medicaid expansion seems to line up with my experience as well.
"Under the expansion guidelines, Medicaid eligibility is extended to adults under the age of 65 with incomes up to 138% of the federal poverty level/FPL (133% plus a 5% income disregard).
Pre-ACA, Medicaid was generally never available to non-disabled adults under age 65 unless they had minor children. And even then, the income caps to qualify as a parent/caretaker were very low."
What would be the difference in price? Just a ball park figure if you have it.
What about freelancers and people that don’t work traditional jobs?
Private health insurance is going to cost you ballpark $400/month, provide no coverage for any preexisting conditions, provide no coverage for your family members (just the enrolling individual), you will typically pay the first $10,000 or so each year before your insurer covers any of the costs, and if you end up needing to use it a lot they will cancel you the next year.
Affordable Care Act coverage will cost about the same but cover preexisting conditions, you can usually cap your own cost for regular checkups to $20, and they won’t cancel you the following year unless the insurance company leaves the marketplace entirely.
Private employer provided coverage varies wildly depending on the size of the employer (because they have more leverage in negotiating with insurance companies) and the employer’s own ideas.
Christ when you hear it laid out like that it sounds like a waking nightmare
It is a walking nightmare. Thats why it sounds like one. Source: American, luckily on state healthcare.
There’s a lot of misinformation in this post.
The Affordable Care Act basically eliminated all health plans that provide no coverage for preexisting conditions. All private plans are required to cover that now. ACA plans are private plans.
All health plans come with the option of covering just you, you and your spouse, or you and your whole family. It obviously costs more to cover your whole family, but it’s way less than every person getting their own plan.
Most plans have a deductible - meaning your insurance doesn’t “kick in” until you’ve paid a certain amount. But preventive care and an annual checkup is covered, and your insurance might get you good discounts on a lot of care. Also, you have a choice of paying less per month and having a higher deductible, or paying more per month with a lower deductible. This is exactly the same as auto insurance, home insurance, etc. - those all have a deductible too.
The ballpark $400/month is meaningless if you don’t know the person’s age, gender, and state at a minimum. A 25yo woman living in Idaho might pay $200/month, and a 60yo man living in New York might pay $1,800/month for the same coverage. It really does vary by that much.
The ACA does not require all private plans to cover preexisting conditions. It requires all marketplace exchange and ACA compliant plans to do so. But many insurers - including Blue Cross Blue Shied and UHC - withdrew from the healthcare.gov exchange years ago to sell non-ACA compliant plans instead. With the death of the individual mandate, they lost the insured numbers to make it work. The remaining plans there are from companies like Oscar and are frankly not competitive with what you can get separately - other than preexisting coverage.
Yes you can buy family plans, and of course it scales in price. Averages out to about $400 per person, but of course that also depends on the PPO list, copay v coinsurance, coverage for ancillary services like mental health and prescription medication, and etc.
Not all private health plans cover routine preventive care at a reduced rate. I was on a UHC plan where my annual checkup cost me several hundred dollars.
The ACA was awesome at first. It dramatically improved my personal health insurance. But within a couple of years, the exchange in my area was a ghost town. It is a shell now.
Got it, thanks for the clarification. I wasn’t aware that insurers were offering non-ACA-compliant plans. That’s frustrating. It sounds like those plans are basically there only to cover catastrophic emergencies and illnesses, e.g. a car accident or cancer.
I still stand behind the comment that it’s meaningless to throw out a monthly number. It varies so dramatically depending on your gender, age, and location, to the point where it’s meaningless to give a number without that context.
Non-ACA compliant plans are the norm now that the individual mandate is dead. I have one and it is definitely not for catastrophic only coverage. It is just mediocre compared to a major group plan. I deal with health insurance through work, and ACA compliant plans have become the rare exception rather than the rule.
You are right about the rates. $400 is a ballpark because it is what my office uses to determine monthly reimbursement for coverage purchased by individuals, since we are too small to bargain for a decent group plan. But we have no cancer survivors or other extreme high risk individuals.