Ask Lemmy

You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you'll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that's a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won't really need healthcare other than your yearly checkup and some vaccines.

The biggest thing with healthcare in the US is that it's very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that's part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.

You basically have "premiums" that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don't outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can't afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.

Depending on the "style" of the plans, they cover things differently. They all (I think) cover "preventative care" completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have "co-pays", which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don't pay anything until you hit a limit (the deductible). Finally, there's an "out of pocket" limit. That's most you'll have to pay in a year, after which point the insurance covers everything.

All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.

The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don't have insurance, you typically don't pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.

I work at a large, private university health system.

Annual up front cost for insurance is $4967 for medical insurance and $609 for dental. Those cover me, my wife, and two of my three children. The insurance is a plan funded by my employer, but managed by Independence Blue Cross, AKA "Personal Choice".

There are three "tiers" of coverage.

First tier is for facilities that are part of my employer. Generally, for procedures performed at my employer's facility there is no additional charge. For a primary care provider who is part of my health system, there would be a $20 copay per visit. Specialist would also be $20, and an ER visit would be $200.

There is an "in network" tier, made up of external providers that accept personal choice. Primary care copay is $35, specialist is $50, ER $200.

The third tier is "out of network". If we see someone out of network, we would have to pay them directly, then try to get partial reimbursement from insurance.

There's also a prescription plan, but we get a discount by using the hospital's outpatient pharmacy.

Everyone always talks about the cost to give birth. All three of my kids were born at the hospital where I work, and none of the births cost us any additional money.

I pay 9.79$/month for medical only, pre-tax, myself only on the plan, working for a mental healthcare nonprofit. My medical copays have been free lately for routine office visits. I have to get labs done 4 times a year for the meds I take and those have all been free so far. Because they’re classed as “preventative” to make sure nothing goes wrong with the meds, it’s free 🤷🏽‍♂️. Non preventative things have a 2000$ deductible, so I have to pay that much before medical care for the calendar year becomes free to me. That means that if I get sick in December, I have to pay 2000$to cover for December and again in January to cover for the next year.

Dental coverage is free. I pay 40$/visit as a copay for cleanings and all else (if I’m not in perfect health) I pay 30% of that bill. Recently I had periodontitis and my bill after treatment was 600$.

mine is decently inexpensive through Obamacare, and I'm in a low enough income bracket. but it still isn't ideal, I needed a sleep study. with or without my insurance it was going to cost $1,000 so I just never had it

idk, maybe im just fucking insane, but like, i can't run the numbers for insurance to make sense.

Unless the courts are LITERALLY broken, or the entire society will collapse without the presence of insurance, i don't think it makes much sense.

Healthcare maybe, if it worked, it doesn't though. Life insurance is fucking stupid unless you work in an dangerous job and have a family, it might be useful then, but only when you die. Car insurance is only legally required because people driving cars can't accept their own responsibility of owning a fucking car. (you could argue it's for the public good, but lets be honest, it's not) home/building insurance might make sense if you live in a suburban home and your contract doesn't change, or like actually covers what it should.

There are more insurances but i feel like you'd be a fucking dumbass to even consider those. Insurance for your business? My brother in christ this is why we invented LLCs.

When I used to live in the states my family would pay something like $2500/month for health insurance that covered all of us. Don’t know what the deductible was but apparently this was a very good plan. This was back around 2000.

Your friend should let all the Americans going into bankruptcy each year due to medical debt that they imagined it all along.