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Health Insurance Woes

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I was recently reading a debt update post over at Six Figures Under, where I saw that they were only paying $114/month for health insurance for a family of 5.

We pay $350/month for our family of 4. We surely must be overpaying then, right? This is one of the few areas that I haven’t examined yet for trying to reduce costs/fees since we started our debt reduction journey. Unfortunately, what I discovered makes me nervous for the coming year…..

I guess I haven’t thought about it (because I did know this fact), but our health insurance doesn’t fit the qualifications required now since the Affordable Care Act passed. Specifically, our current insurance does not include any prenatal coverage which is now a requirement of all health insurances (regardless of whether you are planning a pregnancy or not). When the Affordable Care Act passed, we received notice from our insurance that our policy would be expiring. But then a wonderful thing happened – due to some type of governmental stuff (protests? No idea, I’m not a hugely political person), our insurance was “grandfathered” in for another year. Basically, we got an extension until it is dissolved and goes away. That means we have our current insurance until December 31st of this year.

What do ACA-compliant insurance policies for a family of 4 look like in terms of price?

In a word…expensive!!!

The cheapest policies I found were in the $550ish range (through tax-payer subsidies), but they ran up to well over $1,000/month. I looked at several websites and some (through private insurance companies) were “set” prices. When I looked for insurance through the governmental/subsidy websites, they change based on what you earn (the more you earn, the more expensive the coverage). Since we’ve made a pretty decent income this year….it’s looking like the cost of health care is going to be pretty decent-sized too.

I definitely don’t want to start a political debate (I know this is an inherently political issue, so it’s hard to avoid), but I was really shocked by the numbers I saw. I guess it’s better that I priced the insurance now, in September, rather than get surprised with this fun fact on January 1, 2015. But at the same time, it doesn’t make me any less bummed to know that one of our non-negotiable monthly costs is going to skyrocket next year – possibly double, or more. *gulp*

This is all the more reason why we need to get rid of our debt – NOW! All those monthly payments are just consuming our monthly income! We’ve got to get out from under the weight of our debt!

Recommitment-city over here (not like I ever lost commitment, but this was one of those things that served as a big old wake up call!)

Out of curiosity (if you want to share) – How much does your family pay for health insurance? We currently pay out-of-pocket since my husband and I are both self-employed, but I think it might be worth looking into some sort of small business owner group insurance. I’ve heard of these but have never looked into them before. Perhaps my husband could get this for his small business and it would save us some money. Lots to look into!


39 Comments

  • Reply Financial Fan |

    My husband is covered 100% by his employer, but we have to pay for me. We pay about $275/month to cover me. (Our four children are grown.) It is, however, a fantastic plan that covers everything 100% with no co-pays whatsoever. My husband works in business planning at a large hospital in our city, so this could be one reason our coverage is so good.

    • Reply Ashley |

      Wow, that sounds incredible to not even have co-pays! I recently had my vision appointment, and I had to pay a $30 copay + an extra $50 because I had the “contact lens fitting” instead of just the standard glasses appointment. What is this extra cost and why isn’t it covered as standard, routine care???

      • Reply Tamara Ng |

        I think it’s because contacts aren’t generally considered medically necessary. Yes, you have to correct your vision, but that can be done with glasses. It seems pretty common in my experience for medical insurance plans to behave that way. They often only cover an exam at all every 2 years, when once a year is the recommended interval for contact lenses (and in my experience, doctors only write your contacts prescription for a year, though that might vary by state).

        We have a vision plan in addition to our regular insurance from a company called VSP, and it provides much better benefits.

        We pay $246/month for a family HMO plan, $21/month for a dental family plan, and $11/month for a vision plan that covers employee + 1 (it’s just my husband and I, but the other plans only have family or single options). This is through my husband’s employer.

  • Reply Juhli |

    We pay $444 a month for 2 adults as a Federal employee and have a lot of copays. I thinks health insurance that covers you well is expensive as health care is expensive in this country. Having had some serious illnesses I think it is worth every penny.

    • Reply Ashley |

      Health care IS expensive! It’s crazy! Hard lesson to learn, when my husband had his mystery illness and we had to pay 20% out-of-pocket, it was crazy to see how quickly our costs jumped up to our max out-of-pocket amount. I remember when I picked the max out-of-pocket cost (the lower it is, the more your monthly premium). Seemed so unimportant at the time (“oh, I’ll never need that much medical care in a year!”), but medical debt can be life-changing for many people! I’ve heard Dave Ramsey say its the #1 cause of bankruptcy, and its NOT from uninsured people, it’s from UNDERinsured people! (I cite Ramsey bc I’ve never verified this statistic). Craziness!

    • Reply Juhli |

      Oh, and that is medical only. No dental or vision coverage unless it is actually surgery (such as cataract removal).

  • Reply Chel |

    I agree, healthcare is such a huge/crazy expense that is very difficult to predict. We are in one of the most expensive states for healthcare on the exchange (Wyoming). If we moved 3 miles west to Utah, our costs would go down substantially. Our plan (through an employer) is also grandfathered in, which means we get NO preventative care, no immunizations, no baby well checks or anything. We pay for everything until we get to our deductible. Our deductible is so high that even with a surgery at a specialized pediatric hospital, we did not hit it.
    Funny thing is the employer is a hospital.

  • Reply Chris |

    My husband works for a very small company, about 10 employees. He has a high deductible plan, whereby we have to pay the first $5000 in expenses, excluding preventative care. We have a HSA that his employer puts some $$ into each year, as do we. We have the 2 of us, plus our son who is a college student. We pay $660/mo, no subsidies b/c we make too much. We pay everything out of pocket and are saving the HSA for a catastrophic expense. We have no vision, but do have dental @ $62/mo. I believe we are the kind of family who is subsidizing the lower income families. I hate to see what we will have to pay next year. I don’t want to get into a political debate either, because I think the idea of universal health care is a good one. I just feel like the only people who are really winning are the insurance companies, and I wish our govt had done things differently.

  • Reply Sheila |

    We pay $57.00/week through my husband’s employer. That includes health, dental, and vision. Co pays for the doc are $15.00 and $30.00 (specialists). Prescriptions co pays are $15.00 and $30.00 (brand name). $500.00 deductible for each family member. We get one pair of free glasses a year. I can’t complain about our insurance.

  • Reply Sue |

    In northern California we pay about $500 for a “family plan” through my husband’s employer which includes dental & vision. We have $30 co-pays and pay 20 for meds.

  • Reply christy |

    We pay About $300 a month for our family of 5 (through my husband’s employer). It is a high deductible health plan, with a $6000 deductible that has to be paid before the insurance will cover expenses. His employer contributes $1500 to an HSA yearly. Preventative care is covered at 100% with no deductible, so that is nice with the kids. But if they get sick, we pay out-of-pocket for those visits (makes you think twice about going to the doctor – I always call and ask to talk to the doctor before making the trip). The moral of this story is that we took the “cheapest” insurance option available, and we still end up paying A LOT every year toward that $6000 deductible. I had to take my 1 year old to the ER one time, and it cost us thousands for that one little incident.

  • Reply Juju |

    I am in an HSA plan, 100% covered by my employer, but my husband and two sons are $478 a month with medical and dental. I have quite a bit in my HSA bank that I can contribute towards my family’s co-pays so it works for us.

  • Reply Kristina |

    I’m 100% covered, but do have minimal copays. No spouses or dependents here! (or else I’d be in the $300s if not more)

  • Reply Sarah |

    My husband’s employer pays the premiums in full for our family – medical, dental, vision. Co-pays are $20, 100% hospital coverage, $1,000 annual deductible. We feel very blessed to have this coverage, especially with a chronically ill child. Twenty years ago, my husband left the career for which he went to college and took this job almost solely for the health insurance coverage which we desperately needed to get our son the proper care. It was a hard move for him, but it certainly was the right move for our family. I can’t imagine some of these premiums that people are having to pay now. There just has to be a better way.

    • Reply Ashley |

      So sorry to hear about your son and the difficult decision for your husband to take a job based largely on the health care package! While I cannot empathize (since we are fortunate to have healthy children), I certainly feel as though I can understand the motivation to take a “meh” job simply for the benefits offered! And it sounds like great benefits, so I hope your hubs has grown to like it!

  • Reply scarr |

    Health insurance is such a complex thing. Everyone has their own unique experiences with it – be it good, bad, neutral. Growing up, my parents had excellent health insurance: in fact my two open-heart surgeries were covered 100% – when one insurance ran out the other picked up the tab. As an adult, I had a few gap years where I was off my parents insurance but not working at a place that offered an employer-sponsored plan and I was unable to buy my own insurance since I had a disqualifying preexisting condition. During my gap years, I was unable to afford to see my heart specialist, receive my heart medication, or have any preventative care. If I were to have become sick during that time, I probably would have had to file for bankruptcy, I am thankful that is not the case and I now have employer-sponsored insurance.

    As this is such a complex issue, I don’t think anyone has the best solution for everyone. I wish it were simple and I wish we never got sick but that is just not the case. I also wish this weren’t such a political issue as healthcare really isn’t about politics it’s about people’s well-being.

    Also, here are a few sources that state medical bankruptcy is the most common (so it is not just a Dave Ramsey talking-point):

    cnbc: http://www.cnbc.com/id/100840148
    The New York Times: http://well.blogs.nytimes.com/2009/06/04/medical-bills-cause-most-bankruptcies/
    cnn: http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

  • Reply onefamily |

    I am covered 100% by my employer, but it would cost me almost $1200 a month to add my husband and daughter to the plan and another $100 a month for dental. No way I can afford that, so I have them on a private insurance plan. Pre-Obama care it was $271/mo – for my husband, daughter AND son. Now for just my husband and daughter I pay $471/mo – for less coverage and more out of pocket expense! Total rip-off. I pay dental and vision out of pocket – no insurance on that for them.

    • Reply Ashley |

      We’ve been paying dental totally out-of-pocket. It honestly seems cheaper this way (unless there’s major work to be done….and even then, there seems to be dental savings plans offered by many places that function similarly to insurance)

  • Reply Michelle |

    I’ve noticed that the states that decided to delay creating a health exchange separate from the Government’s Health exchange have really bad policies. There are about 35 states that dragged their feet on this, am wondering if you’re in one of those states?

    • Reply Ashley |

      Wouldn’t be surprised. I live in Arizona. We have notoriously poor policies…and poor school achievement…and on and on.

  • Reply Lisa P, |

    My husband and I are both self employed and pay $654/month for our family of 4 with a $2400 deductible. We pay copays of $30 or $40 for specialist after our deductible is met. Our insurance has continued to go up about $1000 every year since we got the plan 5 years ago. We don’t have dental or vision coverage.

  • Reply Stephanie @ Six Figures Under |

    I’m the one referenced at the top who is paying $114/month for insurance.

    Before the ACA change in January, we paid $453/month for a private plan (no insurance through work) with a high deductible (a $7,500 deductible I believe). We were happy with a high deductible plan because we are all healthy and don’t use very many medical services (For example, the only thing we’ve used insurance for this year is one well-child physical. We’ll have two others next month. That’s all.). The ACA took away private high deductible plans, so we had to switch to an ACA plan. Because we make only $39K a year and have a family of 5, we qualify for a sizable subsidy. As our income increases, the subsidy will decrease (and will be reconciled come tax time). We are not big fans of being on a taxpayer subsidy, but right now it’s the only viable option for us. We will be thrilled to have our income increase and have to pay more of our own premium!

  • Reply Sarah |

    We pay over $1000 a month for a family of four. It is also not a very good policy with a $1250 deductible per person.

    Our plan also isn’t ACA compliant and they extended it a year. We just found out they might have extended it another year. You should see if yours has been extended again.

    • Reply Ashley |

      Yikes – your plan sounds terrible! Why stick with it? Ours is definitely still the cheapest option so if it gets extended again we’ll certainly count our blessings and stick with it another year!

      • Reply Sarah |

        We stick with it because it offers basic dental and vision in addition to health. No crowns and not much for glasses but at least the cleanings and checkups. We started out at $361 per month in 2005 and it is now over $1000. We have a group plan between my husband and myself in our company which the ACA will no longer allow (husbands and wives can’t make up a two person group). Once we can’t do a group anymore, our rate will go up to $1600 per month and that is a bronze plan with the ACA. I guess that is why we stick with it for now!

  • Reply hannah |

    Uhhuh, obamacare sucks and so does he. I don’t mince words about how awful the new ” helpful” insurance is. You know, the one where he said it’d be MORE affordable? Ya right.
    We don’t do subsidies, because we don’t want to live off a government like this ( if you use subsidies, go for it, just our personal preference).
    So, insurance for spouse and I is $200/month, with $20 copays, and 30% coinsurance on everything. Our deductible per person is $6250, and family is $12,500. So we have to pay everything up to $6250 until the deductible is met for that person, and then its still 30% onward. Plus those $20 copays every single time we visit a doctor ( $50 for specialists) adds up really quick!
    Emergency room visits are $500 copay + 30% coinsurance.
    It’s just ridiculous and I’m so fed up with dealing with our government’s “improvements”. So sorry you are not getting the fun of dealing with this budget destroyer!!

  • Reply Christopher |

    You could look into getting a part-time job at the JCC, then you could possibly save on childcare, fitness, and healthcare. One friend got a part-time job at Starbucks for health coverage. You need to work at least 160 hours within two consecutive months to be eligible, which would mean you need to start soon. I have been debt free since 08/2012 and for three months, I had a part-time job with 100% of that income going towards debt. Keep up the good work!

    • Reply Ashley |

      Hmmm, every part time job I’ve ever had has only furnished health care benefits to full time employees, so I doubt the JCC gives health care, but there’s probably a break on the membership. Seriously, though, if Starbucks gives part-time employees health care, that would be the better deal for me. Though I still don’t think the savings would off-set the increased cost of childcare (I can’t work on MWF since that’s when I do my other work, and the girls aren’t in preschool on T/Th, so I’d be adding that expense). Unlikely to offset the childcare cost in the end. Sigh.

  • Reply Jerome |

    Living in a European country we pay about 360 dollar for a family of 7 including dental, vision, medication and coverage abroad. For the two adults, the first 450 dollar per year has to be paid by ourselves. And some limits apply, like new glasses only once every two years. All treatments by a general phycisian and in hospital are covered without limit.

  • Reply KK |

    I’m very grateful for my health insurance after reading these comments! To insure just myself I pay ~$80 a month. Last year I was grumbling because it went from $40 -> $80, shew do I feel silly now! We do have co-pays ($25 GP, $45 specialist). I think my deductible is $2,500, so nothing too extreme.
    To top it off, I have access to great dental and vision insurance, which cost me only $30 a month (two separate plans).

    • Reply Ashley |

      Yes, puts things in perspective doesn’t it!? It’s crazy the range of prices that people have commented on!

  • Reply Angella |

    We currently pay $224 per paycheck (biweekly) which includes medical, dental, and vision. Our deductible is $12,000 family, or $6,000 individual. Needless to say, our plan sucks, and we have mounding medical bills due to a car accident my husband was in last April, which resulted in a back injury. I miss our old insurance oh-so-much. 🙁 $45 copay, $65 specialist, $500 ER. At least prescriptions haven’t gone over…$10? When they’re actually covered. Not a happy subject for me obviously hehe.

    • Reply Angella |

      And let’s hope I never get pregnant again! Practically zero maternity coverage and this is an employer offered plan. Maternity is 40% covered for natural delivery, 20% covered for c-section, doctors appointments are 0% covered. Affordable healthcare my ass….just sayin’ ! 🙂

      • Reply Ashley |

        Ouch, that’s rough! My old insurance (when I was a grad student) was notoriously terrible but the ONE thing it did was provide full prenatal & maternity-related coverage (after deductible was paid). I’m so grateful since I ended up having TWINS and, being high-risk, had a million appointments and an eventual c-section delivery!

  • Reply Tania |

    Yeah… nothing around ACA is cheap, affordable or even reasonable compared to some ER plans. My employees would be paying $350/mo for 3+ (so family coverage, no increase by child amount), and we’re considered a small-midsize business! I am just paying for individual since I dont have a family. My costs are $117/mo. That’s just medical. Dental and vision are 100% employEE paid.

  • Reply emmi |

    We have coverage through employer but with 25$/50$ copays. Before we got married I was paying $700/month through a chamber of commerce just to cover me, and that was 6 years ago, I can’t imagine how much it is now. It’s no wonder the private insurance companies freaked out about letting anyone buy into medicare as part of ACA. Would have broken the back of the entire private medical insurance business.

So, what do you think ?