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  1. #21
    Registered User Panzer1's Avatar
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    Default Health insurance.

    I believe hospitals are permitted to pass along costs that can't be paid by a patient to other patients that can pay. this is what keeps hospitals from going bankrupt.

  2. #22

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    Quote Originally Posted by Coffee View Post
    Putting aside politics, it is not uncommon for thru hikers, especially younger ones, to get ACA policies that are sometimes almost fully subsidized. Since thru hikers aren't working half of the year, subsidies are likely especially for those who don't have high paying jobs the rest of the year.

    This is just a statement of fact. Whether it should be this way is beside the point
    Agree with this.
    Also- for a relatively healthy person- a catastrophic plan (high deductible) can be purchased through the healthcare.gov website if there is a change in coverage outside open enrollment. You can purchase through private insurance as well but you need to be slightly more careful. You do get some tax breaks too if your income is below 50-60k or so (household).

    I'd say you're best off with a catastrophic plan for something big and keeping the rest in hand for a clinic visit or two for minor stuff. Let's face it- you break something or have some thing serious happen you're going home for follow up care. Every plan covers emergency visits out of network- but 99.9% of the time you're heading home and can deal with follow-up within network.

  3. #23

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    Quote Originally Posted by Panzer1 View Post
    I believe hospitals are permitted to pass along costs that can't be paid by a patient to other patients that can pay. this is what keeps hospitals from going bankrupt.
    And part of the plan with mandatory health insurance too (kinda like mandatory auto owners insurance was.)

    Regardless of the politics- next time you're a out hiking (not you personally Panzer) might wanna think a bit on things...

    The largest populations are baby boomers and millenials. Seniors or the greatest generation (boomers parents) are a much larger group historically than ever before. And kids and folks my age fill things out- with only folks my age paying premiums really.

    Have a baby- somebody is getting a 12-40k bill. Plus pre-natal care.
    Have a heart attack or other fairly common medical crisis for folks aged 50-70 and likely you're getting a 100k bill at minimum. Plus follow up care.
    Grandparents can chew up 10k a day for ER care. Even simply dropping dead is a bit rare as they bring folks into the hospital to linger for an extra week at 100k.

    So you think on the 100 or so people you know or in your nuclear family... and how many babies were born or surgeries took place, or minor health services took place.

    Even if everyone in that pool paid $500 a month (which they don't), for all 12 months of the year... that's 600k.
    Two grandkids born, one adult with a grabber and heart surgery follow-up, an aunt with breast cancer, and finally great grandpa passing away and that pool of 100 folks likely pissed away or even overspent their premium pool just that year alone.

    That's pretty much the health insurance problem- nothing to do with politics- just simple math.

  4. #24
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    Quote Originally Posted by Just Bill View Post
    ...That's pretty much the health insurance problem- nothing to do with politics- just simple math.

    Part of the simple math is exorbitant costs. One side of the argument says, "Hey, a heart attack can cost you $100k!" The other side is, "It shouldn't cost $100k!"

  5. #25
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    Quote Originally Posted by jpolk84 View Post
    Part of the simple math is exorbitant costs. One side of the argument says, "Hey, a heart attack can cost you $100k!" The other side is, "It shouldn't cost $100k!"
    When I looked into it some years back, close to 40% of the country's healthcare costs come from overhead and administration, both because of how insurance companies and by medical facilities operate. It's a nutty system to put it politely...
    Colorless green ideas sleep furiously.

  6. #26
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    Quote Originally Posted by Sarcasm the elf View Post
    When I looked into it some years back, close to 40% of the country's healthcare costs come from overhead and administration, both because of how insurance companies and by medical facilities operate. It's a nutty system to put it politely...
    It is crazy. Then you have a system that has been built on passing costs to each other and not strictly a market-driven system. Bandaids for $2 each didn't come about by market forces or Walgreen's would be selling them for that. It happens because of the unnatural (if you will) relationship between insurance companies and the medical community.

  7. #27
    Registered User DavidNH's Avatar
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    go on cobra. You'll have same policy you had while working but you pay full cost of the premiums. That is good for up to 18 months.

  8. #28
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    Quote Originally Posted by jpolk84 View Post
    It happens because of the unnatural (if you will) relationship between insurance companies and the medical community.
    Exactly. It isn't a normal market where the end consumer of a service negotiates with the provider on price and quality. Similar markets where consumers and providers have a more normal relationship (dentistry, veterinarians) have more transparent pricing and more room to negotiate.

  9. #29

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    Quote Originally Posted by jpolk84 View Post
    Part of the simple math is exorbitant costs. One side of the argument says, "Hey, a heart attack can cost you $100k!" The other side is, "It shouldn't cost $100k!"
    agree...
    Until uninsured folks stop ending up in the "general overhead" category it's hard to fix that part of the cost. (That's a political part of a solution)
    It would help some of the administrative costs on all sides if you cut out the 4 rounds of "billing" and counter billing before a check finally gets cut for the amount everyone knew it would be in the first place- but that could be done right now and cut overhead for both sides- though medical billing is a big industry in it's own right so hard to (politically) cut all those jobs out.
    Can't say much for tort reform as I don't care much for that part of things in either direction- but that's a form of overhead too.
    Not sure about you, but if it comes time to get my engine repaired I'd rather be at the dealer (hospital) than jiffy lube (some clinic)- so hard to put a fair value on healthcare overall when it's your personal care.

    You also have the traditional insurance company model of profiting on investments in the market or other sectors having been turned on it's head in the last decade at the worst possible time given the highest risk pool. If the decades long investments of un-used premiums had not collapsed (or been squandered/stolen by execs) then the funds would be there to cover a good portion of this pool of people today. Instead we must all simply cough up more and more dough to mitigate our personal risks to make up for the folks who were supposed to do that for a living and failed (or succeeded if you ask my stock broker/investment banker buddies).

    So even if medical costs somehow all got cut in half... it still might not do it.
    A generation ago- college aged kids were mainly out working (or at least hitting the street with a useful bachelors degree and earning by 25), now they are on their parents plans with deep debt and no real prospects. Fewer companies in general offer health insurance as standard for full time workers (or play games with payroll/hours to dodge it), so for some time a large portion of the working population no premiums. And the number of folks living from 80-100 is unprecedented as well.

    Not sure there will ever be a solution as 2-3 generations used to pay mainly for 1 generation at a time. And to be blunt- you had a heart attack or cancer and you probably didn't make it long enough to rack up a 5-10 years of aftercare/surgeries or recover at all. Now you have 3-4 generations of folks drawing from the same pool of depleted funds and no good solution for that issue except to come back to all of us and tell us to keep dumping in more money.

    It's very ugly, specially for someone my age dealing with parents, grandparents, and children as the only member of the workforce and trying to care for everyone involved.
    If you have nothing to lose, that's one thing, but if you do... no option but to pay the premiums as intelligently as you can.

    Sorry for the drift... this has come up a few times and so does the politics.

    Few folks take a risk- usually mostly broke folks with nothing to lose. (Or college kids still covered)
    Few folks keep insurance through Cobra.
    Few folks pick up a catastrophic plan.
    Few folks get some sort of trip/travel insurance and cross their fingers.
    Some folks just factor in health care into their costs of a thru.

    Just what you're up for depending on your financial position or risk tolerance.

    If you do want to thank "Obummercare" for one thing you could not do before that benefits hikers tremendously- it's that you can drop and pick up a plan with no (real) penalty either during open enrollment or under certain conditions outside that time (like layoff or loss of coverage). It is much easier to buy a plan (without egregious exclusions or hidden gaps) than it ever was before. At least now- if you buy insurance- you may have to navigate some networks or deal with some hassles... but you won't pay a bunch of money in premiums only to find out that there are gaps or an encyclopedia's worth of excluded conditions.

    In addition there are no longer blackout or waiting periods for coverage to take effect (mostly). So your policy won't say- preclude you from having a child within 24 months of signing up- or preclude non-emergency surgery, etc. So in the recent past a hiker who wanted to withdraw from insurance coverage could face some very real restrictions once they re-entered the work force or tried to restart their insurance. I personally paid cash for a decent bit of my wife's OB/GYN care as I was between jobs and could not, for any amount of money, purchase a private insurance policy that would even cover having children- it just wasn't an option for an individuals or small employers prior to the ACA. Thankfully the ACA went into law in time to cover the delivery etc... but if it had been a few years ago I would likely have had to file bankruptcy- not because I couldn't pay for health insurance- but because I simply wasn't even allowed to buy it. Happened all the time- and bankruptcy or not- somebody paid the bill when folks came in for healthcare not covered by their insurance- you know things like pregnancy, cancer, or the reasons you have insurance in the first place.

    So like it or not- ACA has many good implications for a hiker (or anyone) leaving the workforce, switching policies (due to job change), small business owners or individuals.
    There are some downsides for honest midsize employers- but most of those get mucked up in the overall mess that healthcare is for the foreseeable future, not because of actual issues with the new laws.
    There is also intentional confusion and spin from insurers who feel it is unfair to actually provide insurance to those they collect premiums from.

  10. #30

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    Hey folks let's keep the discussion on the options for insurance available and not why the system is in place or the mechanics of paying for the system.

    Thanks.
    "Sleepy alligator in the noonday sun
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    Whiteblaze.net User Agreement.

  11. #31
    Registered User volleypc's Avatar
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    I am curious how student health insurance works. I read a while back about retirees taking classes just to save on health insurance because the student rates were cheaper. If you have a college nearby on the quarter system and you take classes for a quarter (Jan-Mar) can you keep the same insurance for the year? Or do you buy insurance for the length of the school term?

  12. #32

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    Quote Originally Posted by Alligator View Post
    Hey folks let's keep the discussion on the options for insurance available and not why the system is in place or the mechanics of paying for the system.

    Thanks.
    Bad Bill... sorry

  13. #33
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    Our son is in Law School, over 26 and not working where they offer insurance. We contacted the agent that handles our car insurance and found out they sell health insurance also. We found a few others that offer health insurance, the cost for $2000.00 deductible ranged from $175.00 to $184.00 per month, comparing apples to apples, they were all very close to the same cost for the same coverage. We were told those costs were similar to what we would find on the Health Insurance Exchange (Obama Care,) but we would not have to deal with the headaches of the exchange. Since I work for a hospital, I can tell you, there were initially some issues with the Exchange, not sure if there still is. For the record, ER's might not refuse you service, but the bill still has to paid at some time.

  14. #34
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    Bloo$y Hell I'm glad I'm not an American. $576us for unlimited cover with a $140 excess, in the states for 7 1/2 months, with travel insurance. I'm actually covered under reciprocal rights VA agreement, but noticed that the VA hospitals and care don't receive very good reviews. So I'm paying for my own medical insurance cost for my time there.

    What's it actually cost to go to a local doctor? I might need to make sure I have extra money available just in case, as except for hospital care I have to pay for it and claim it back when I return.
    "He was a wise man who invented beer." Plato

  15. #35
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    For individual coverage, I've had luck in the past with Golden Rule which is now owned by United Healthcare. They have a national network so that's a plus. It was very affordable for me in my mid-30s. I'd look for individual coverage as opposed to buying on the Marketplace. (HR lady speaking.)


    "Your comfort zone is a beautiful place, but nothing ever grows there.
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  16. #36

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    I am covered through Kaiser, which is an HMO. This is my first year with them & am still figuring much of it out. My understanding is they cover out of network emergencies, but therein lies the dilemma. I was with an excellent company three years ago & was in network when I broke my arm. An ambulance ride to the ER, surgery with a plate & screws, two nights in the hospital, follow up visits, drugs & 40 PT sessions cost over $100,000, but my share was only $600. Had I been covered by Kaiser then I would probably have received pain meds & been transported to a Kaiser hospital for surgery. Not as good, but doable. If I break a bone on the AT I'm a very painful plane ride & days away from a Kaiser hospital. (can you even fly with an unstable broken bone)? At the very best I'm out of network & paying $6,000 in higher deductibles & co-pays. I plan to hedge my bets by buying a travel accident policy for the six day section hike I'm planning in August. It may be a waste of money, hopefully I won't need it, but it will give me peace of mind if I find myself carried off the trail in a litter.

  17. #37

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    This may be useful info to anyone with health insurance. As I said earlier, I am with Kaiser, which is an HMO. I will definitely be out of network when I hike the AT. I contacted my agent before I bought a supplemental travel policy, fully expecting him to tell me to buy one. He's an insurance agent, after all. I am not sure what a compliant plan is, but I bought my policy through Obama Care. He said:

    Your plan covers emergencies no matter where you are in the US. For situations involving ambulance, ER, Urgent Care, Hospitalization, Emergency procedures you need to do nothing to make sure you are not subject to any expenses above and beyond your deductible. This is now true with every compliant plan in the United States. There is no limit on your benefits for emergencies and there is not a separate deductible. If you become hospitalized than the hospital and Kaiser will work together to determine if relocation is necessary. Otherwise they would perform any necessary procedures, stabilize and release you. Your follow up care would need to be provided at an in-network facility. In short, no need to buy any additional insurance as you are covered for emergencies with no question.

    I guess the moral is - call your agent before you purchase supplemental insurance.

  18. #38
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    I have another insurance question. We plan to conduct IVF abroad next year. I am already doing tests and have completed a full diagnosis with my husband. Will insurance cover this procedure?

  19. #39

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    Quote Originally Posted by Cynthia_T View Post
    I have another insurance question. We plan to conduct IVF abroad next year. I am already doing tests and have completed a full diagnosis with my husband. Will insurance cover this procedure?

    Best way to get answers about what your insurance covers is to call and ask them.

  20. #40
    Registered User Venchka's Avatar
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    Quote Originally Posted by trailmercury View Post
    Best way to get answers about what your insurance covers is to call and ask them.
    Ditto. Should have asked before starting.
    Wayne

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