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:
You think you are pregnant. You are a child or teenager. You are age 65 or older. You are legally blind. You have a disability. You need nursing home care.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."
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What would be the difference in price? Just a ball park figure if you have it.
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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.
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An individual can sign up for a plan through their State’s health insurance exchange or the federal government’s HealthCare.gov website.
It is usually more expensive than getting it through an employer - but works to serve small business owners, freelancers, etc.
A few States (like Massachusetts) have semi-universal systems that cover all individuals that earn under 150% of poverty, independent students, newly unemployed, etc.
A lot of Americans are also covered under Medicare, Medicaid , Social Security and other programs.
Retirees aged 65 and older are eligible for Medicare - a semi-universal federal system that covers pretty much everything and accepted most places.
Also worth mentioning that your first couple points only became true with the Affordable Care Act passing in 2010. Prior to that it was practically impossible to get a private plan, insurance companies would deny coverage for any pre-existing conditions like diabetes or cancer, and the standard low-end plans at many employers were more expensive and covered less. The system is still a complete joke, but it’s better than it was before.
Indeed. Prior to 2010 - it was a roll of the dice. If insurance wasn’t provided through your work, you had to be lucky enough to live in a State with decent laws preventing some of these predatory insurance practices. Back then, the uninsured rate was close to 19%. Almost 1 in 5 Americans.
Today, that rate is 8.4%. Which hails the victory of the ACA because “91.6% of Americans have insurance” sounds nice. And compared to where we were 13 years ago, it is nice.
In reality, we have 28 million uninsured people, many of whom are children. There’s a long way to go.
While I’m personally satisfied with my level of coverage and standard of care, I don’t understand how we can comfortably accept a society that bankrupts our most vulnerable residents for being sick. I’m baffled how this wasn’t already solved or mostly resolved in my lifetime. Or at least seeing more states take on the Hawaii or Massachusetts health care models.
- Yes, however it’s usually a little more expensive to get the same coverage, as the employer pays a part of employee’s insurance costs.
- Forfeit? No, they’ll still need insurance (you get a fine if you’re without insurance for more than 3 out of 12 months (at least, I think that was the case)).
My state offers free insurance. I pay for my own insurance, so I’ve never used it, but most of the people I know use it and like it.
I’ve run my own business in the US for 16 years. Until recently I pay about $2000/mo for a family of 4. (Wife and I are in our early 40’s, kids are under 10). Recently my wife got new employment and it means we can insure the family with similar (slightly better coverage, (great coverage)) for less than half this amount.
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.
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.
- Yes, however it’s usually a little more expensive to get the same coverage, as the employer pays a part of employee’s insurance costs.
- Forfeit? No, they’ll still need insurance (you get a fine if you’re without insurance for more than 3 out of 12 months (at least, I think that was the case)).
a little more expensive
This is a gross understatement. Companies usually pay 50% or more of the insurance their employees get.
My partner and I pay $200 for the ~$1800/mo healthcare plan through their employer. There was a fully-covered option but the deductibles are so low on this plan it’s incredible.
So you get fined if you don’t take one of the slightly more expensive plans if you are a freelanced individual?
Yes, because you would be without insurance. A person can buy insurance on an exchange and it is similar in price as employer sponsored insurance - you just have to pay all of it. Typically an employer pays for at least some of the insurance if it is a benefit they offer.
It is worth noting that the fine is captured as part of a person’s taxes, so it can be a bit obvuscated. Although in typing this, I vaguely recall a SCOTUS ruling that said the fine wasn’t allowed.
It is actually more wild than all of this even! Each state has additional rules/requirements beyond Obamacare. So what is covered in Washington State may not be covered in Texas.
If you need help sorting through insurance, reach out to me - I’ve done a lot of it as a business owner with two special needs kids.
Yes, when tax time comes around, and our government makes us file our own taxes (that’s a whole other can of worms) there’s a fine if we don’t get health insurance.
The fine is less than if you are to pay out of pocket for insurance though, so a lot of people decide to eat the fine.
This is the first time I’ve heard about being fined for not having insurance.
Tv etc has led me to believe if you don’t have insurance you just hope and pray you don’t need to go to a&e. What about homeless people, for example? Is there something in place that issues fines to all the people who don’t have insurance at all? I’m so confused.
On point 2, the individual mandate was repealed in 2018. There’s no federal penalty for not having insurance.
Apparently it is still upheld at the state level in 5 states.
