What I'm told is, the working class are the ones who struggle with healthcare/insurance. If that's so, what are the well-to-do doing for health insurance?

Suppose I had an enlarged prostate and wanted a laser prostatectomy. And I don't want a long wait or for my insurance to labor over whether I've had too many prostate procedures this year to approve the surgery. How do I get that?

As 50 years old, I have had Kaiser my entire adult life and the majority of my childhood. I recently switched to Blue Cross of California PPO through PERS. I made the switch because I didn’t like the rigidity of Kaiser. I felt like they didn’t look at patients individually, instead had a flow chart of symptoms and treated everyone as if they were the same prototype. For example, my LDL is 145. I am extremely fit and in extremely good shape. I should not have a cholesterol that high. My doctor informed me that her flow chart told her that I am not likely to have a heart attack or stroke within the next 10 years and therefore I do not qualify for cholesterol medication. She didn’t order any additional testing , no suggestions, end of story.

I live in the Sacramento area and can seek care from UC Davis Medical Center, Sutter, and Mercy. It has been extremely challenging to find a primary care doctor. Davis only had a handful of doctors accepting new patients and as of 1/1, the soonest I could get in for a new patient appointment was May. If I need to see another doctor for an ongoing health condition, I can be seen in March. WHAT IN THE ACTUAL F!$k!?

My son is having some health anxiety and wants to get an STD check. After 30 minutes on hold with UC Davis, he was informed that he could go in for a screening in March. So my son is concerned that he may have an STD and he needs to wait almost 2 months to be seen? In what universe is this acceptable? I made a few calls and he has an appointment with Planned Parenthood today.

Have I made a huge mistake? I’m paying hundreds of dollars a month for health insurance that is not accessible. Does anybody have any suggestions, tips, tricks. I’m feeling very frustrated and overwhelmed.

I’ve written my elected officials in government. What else can we do? It’s depressing and it’s wrong. That people can’t get healthcare easily and affordably. People are dying early because they don’t get the care they need.

I take an expensive drug. Will probably take it for life. Am I wrong to worry that it could affect the group rate for a small employer and also be a drain on a medium large employer that’s self insured. Wondering what kind of employer is best for me where this would impact the bottom line the least…

my job charges around 300 a month for health insurance. as I’m looking at the prices of my diabetes supplies it will cost me almost exactly as much to pay for them without insurance then it would cost for me to pay for insurance for the year and co-pay my prescriptions. What is the point of the system? It’s beyond frustrating that I’m paying almost $8000 just for the basics for me to survive as a diabetic. Even market insurance is only slightly better, but since it costs more it again is around the same cost. is there a third option?

My girlfriend has Aetna insurance through her job with a $3500 deductible and $7000 OOP max. Her OBGYN gave us a paper today to sign stating that we will have to pay them $3803 for the delivery because of the $3500 deductible plus $303 for a 20% copay. It also said that this does NOT include the hospital stay fees, which I guess could be another couple thousand or maybe even another $3500 and eat up her entire $7000 OOP max.
She makes $65k a year so she won't qualify for most programs and we could pay it if we have to but I am wondering if anyone has any advice/ideas for us to help lower this massive amount? Some sort of supplemental insurance or a government program that anyone knows of? My insurance deductible is only $500 but we are not married so I don't think that my insurance can be used in any way. Even if we had a shotgun wedding could my insurance somehow be used to help?

edit: she is only 11 weeks pregnant

Thanks In Advance

My new employer offers $1200 toward the yearly deductible (via an HSA) and $800 per month toward the premium. Because of this, my health insurance will cost me more than it has in quite a while, so I began asking questions in order to estimate the costs I expect to incur over the next year.

One agent told me they would need the service codes for each item, and the cost for each code varies based on the plan I select. I asked for the costs for these codes for each of the 13 available plans.

Today they told me their policy is not to provide "pre-service estimates" to a non-customer. They told me to contact the providers and get their "total charge before processing" would be. In other words, use worst-case pricing to determine how much each plan might cost me.

Please don't comment with anything saying "it's impossible to tell what a procedure will cost because things come up in the OR blah blah" - the things I'm asking for estimates of are all routine and predictable.

Edit: thank you all: this is a great illustration of how broken US health insurance is! Health insurance is indeed exempt from any market logic whatsoever 😂 Summing up the most knowledgeable among commenters, the answer is: tough luck, you don't get to shop around because they don't have to let you. And, shame on you for expecting that 🤷‍♂️

Hi all,

I just got a job offer in NYC where the cost of living is crazy high, as you probably know. This is my first corporate job and I need advice/feedback on is this pricing structure for insurance is the norm.

I know you can’t believe everything you read on the internet but I’ve read that the general norm is for the employer to cover 80-85% of the monthly premium.

I would be earning less than 75k and only covering myself but the price still seems quite high? I’ve never paid more than $118 bi-weekly.

Thank you.

I own my own SMALL company. I had Humana and the health insurance policy was deleted and no longer offered. My insurance agent hooked me up with a plan from UHC. For six people it’s a little over $6,000. A month. With the event this morning I am reading terrible reviews of UHC that is completely freaking me out. Are they really that bad? Should I look elsewhere and if so where? What company is less on the evil side? I’m not looking for anyone to quote me pricing, I’m looking for those in the industry which companies they would want based on their dealings.

Thanks for any insight!

I wasn’t thrilled with Humana either, ER visit for a tick bite cost me $3,000. and I was never in a hospital bed or seen by an actual doctor.

Edit: Well I just noticed that Anthem BCBS is not going to cover anesthesia if the surgery goes into overtime basically in my state. Everything I’m reading since yesterday is just appalling.

My wife and I are healthy not on any medications in our Mid 40s and self employed. Looking into medical cost share programs that are nondenominational. Seems a good deal for catastrophic unexpected bigger bills. Anyone have any experience with these … good or bad?

I went on my United Healthcare account to look for PCPs in NYC. I had not previously chosen one, and I want to have my annual physical soon.

I see they already assigned to me an MD, Rachel. I thought - oh that’s weird, I don’t remember picking one yet - but okay. Let me book with her. She’s got decent reviews. 

I click on the number to call to book an appt and it takes me to “Amazon One Medical.” Amazon’s doing healthcare now I guess. $99/year WITH a Prime membership. 

I ask the woman on the phone “Hi so I went to book an annual with a PCP and this is the PCP that UHC auto-assigned for me. Do I need to sign up for this Amazon One Medical thing to see her?” 

She tells me yes, I’d need to become an Amazon OneMedical member to book an appointment with my PCP that UHC has assigned me.

So let me get this straight. We gotta now pay for:

1. UHC insurance

2. Amazon Prime membership 

3. Amazon OneMedical

Just for a freaking ANNUAL PHYSICAL. I obvi ended up just picking another PCP.

But makes me wonder - are Amazon and UHC in cahoots?! Cuz why the F would it auto-assign me someone that I don’t have direct access to?

Family of four in Illinois. Grateful to say that at the present moment, we are all healthy. No major claims, just typical checkups and a sick visit or two to the doc each year.

2024 BCBS G532PSN HMO

I just took my son to the ER at the advice of his school when they thought he broke his nose. It looked broken. Fortunately it wasn't. They put him in a bed, took his vitals, did an xray, told us he was fine and sent us on our way. I got a bill for $1k.

Why am I paying almost $16k a year for this? Is this just how it is, or does someone here know of a better solution?

Thanks!

Starting a new job in about 2 weeks, and these are the options for coverage. My old job had Aetna, and I paid about $100 a month for the highest coverage, lowest deductible plan. Granted my company only offered us two options, but my premium was less than $100 with a non-smoking credit and my deductible was only $800. Now I am switching to a new position in the field I want to work in, but the new insurance (United) seems to leave a lot to be desired. The different “tiers” come from a separate app called Vitality where you earn points for various random things like app health screenings, getting check ups, and doing “goals check ins”. From the looks of it, it will take several months to a year to earn the amount of points to get to silver tier even when maxing out points, and even if I get there it is not clear whether the upgrade is automatic or whether I have to wait for the following year. It all just feels very convoluted and as someone in a not very high paying field (publishing) the $200 premium for the most bare bones, high deductible coverage is scaring me. The deductibles for the different plans (starting from lowest premium to highest, reading from right to left on chart) are $3300, $1650, and $500 respectively. I have 3 regular prescriptions I can’t go without, and I see an audiologist/otologist a few times a year for check ups after hearing restoration surgeries I had this year and last year. Would love to hear other people’s experiences with this kind of structure and any advice on what plan seems best for someone making less than $50k yearly.

Hey! So i’m 21 year old female (IL), and have been covered by my parents health insurance. I make around 18-20k a year, my partner makes more than me, and is the primary income, but is still covered by their parents policy. I just bought a house, and my mom didn’t really approve of the location since it’s an hour and a half away from her. She’s always been quite overbearing. After this all went through, she asked for my social security number and said that she wants to take me off of her insurance policy. I know that I can stay off of it until i’m 26, but truthfully I do not know much about the criteria of being taken off. I would preferably like to stay under her policy, she has great insurance, and pays for my brothers, and mine is not much extra. but she’s made it clear that she doesn’t want that since i’m “on my own now” can she take me off without my permission? If so that’s okay, just confused with how it all works. My job only offers insurance to the manager and assistant manager, so I can’t go through them. I could get my own insurance, but I can’t find anything for under like $270 a month. Given that I just put so much money into the house, and wasn’t aware I was being removed, I don’t really want to spend that money when it could be free through my parents. I don’t mind getting my own insurance, i’m really just stressed about the fact that she told me this last night and said so have until the end of the month to find something else because I’ll be removed from hers then. Im very much a planner and don’t like when serious things especially, spring on me. I would not have minded as much if she’d let me know in advance. She says she’s been planning this since November. Any advice will help, whether it be cheaper options for insurance or the guidelines around my mother removing me or any advice in general. Thank you!

My workplace (~125 people) is a nonprofit mired in terrible benefits decisions. The only care is for saving money. At a meeting today, I asked if offering income-based healthcare to employees was an option, because we have hourly and salaried employees and salaries range from minimum wages to $200k+.

I was immediately told no and that it was class discrimination. The conversation was ended there. Is this true?

M 31, New York. Unemployed and shopping for health insurance. My dad wants me to sign up for a plan with Strategic Limited Partners, LP. I have no idea what that is but it 100% feels like a scam, and not in any way legitimate health insurance. Anyone have any insight? Is this is actually a reputable health insurance provider?

Hello everyone,

I currently don't receive health insurance through my employer, so I've been on my father's BCBS health insurance plan. The problem is I'm turning 26 years old in April, and my dad's insurance is already preparing to boot me off his plan.

The good news is I'm fortunate to have been accepted to medical school, which will be starting in July. My school includes health insurance for students in its tuition plan, and its benefits look great. When the school year starts, I definitely plan on enrolling in it.

That leaves a 3 month gap of health insurance. To add to the urgency of the problem, I'm a type 1 diabetic and very much need health insurance for insulin and doctor appointments.

I started some very preliminary google searches into Medicaid, but I'm feeling lost. Any help would be greatly appreciated. If it helps I'm located in the state of Texas.

Over the past 10-15 years, my health insurance as a self-employed individual has become insane, while the deductibles have increased to $10k-$15k+. How are other self-employed people getting health insurance?

My employer is changing from Cigna to Planstin Administration which is apparently something called a reference based pricing plan. What is this? Please explain this to me in the simplest terms possible.

My benefits manager said that before every single doctor's appointment and every single test (labs, x-ray, etc), I'll need to contact Planstin's Care Coordination Team. I have multiple chronic medical conditions. I see a lot of specialists, get a lot tests done, and take multiple prescriptions.

How screwed am I with this type of health insurance?

Long story short I got "private insurance" only to realize it's actually a Healthcare discount plan, not health insurance. Now I've gotten three bills from my doctor totaling $1600 dollars and absolutely no way to pay this. What can I possibly do? If I get actual insurance can they backdate coverage for these visits? My employer offers insurance but the entry is way too steep so i need to find some else thats legitimate

UPDATE: after many phone calls I managed to clarify that it IS in fact legitimate insurance and there is no deductible or copay. But they did set me up with incorrect coverage. When setting up the service I specified I needed coverage for ADHD related doctor visits and medications. But the coverage I have is only very basic coverage and does not cover the services that I specified I needed.

Additionally, for those who offered helpful insights I greatly appreciate the time you took out of your day to respond with advice or recommendations, you are a wonderful human.

And for those who chose to respond with no intent other than to be negative or to be condescending, I honestly wish you the best.

We both work for the same company and have insurance through our corporate policy since we are both in management. But if we were to get married is there any way , if I were to step down back to union and go on union insurance, would he be able to be on my plan? We could afford it when he was union but now our new insurance barely covers anything. Say like his insulin use to cost him 50$ a month in Union insurance before it’s now 400 for two month supply with corporate insurance! These aren’t the real numbers but that’s how drastic the change is. He is struggling and I really want to help. He has tried many of programs but he technically “makes too much” to qualify. But it’s literally like all his money for the money for his pump and reader…. Any advice or suggestions would be much appreciated honestly…

I recently sold my house and decided to start traveling with our RV. I'm having an issue though with refilling my hydrocodone meds when traveling. I'm told to fly back and forth to FL each month to get a new script. Financially that's not fees able for me. I'm out $450 for some damn pain Dr in NY To tell me that and now don't have money to fly if needed Any suggestions ?

We're in North Carolina. What are our options for the next three months? Our two daughters are on his health insurance. I have insurance through my employer, but my employer doesn't cover dependents. I read that we can use the money in his HSA to pay for COBRA, but I'm wondering if there is a better option.

Hi everyone. In the past I've always had my insurance through state programs, but am now starting a job that provides insurance as a benefit. (Yay!!) I used to have BCBS, and currently have Kaiser. I didn't like BCBS very much. I don't smoke, don't drink. I care most about mental health services, but I know those are kinda shoddy no matter who my provider is. Definitely planning on seeing quite a few doctors, since I've avoided it financially in the past. My gut tells me the Cigna OAP Exclusive is the way to go since the max out of pocket is low. I am a bit worried about Tier 3 and 4 drugs costing more, though that's just because being limited in the kind of medication I can get sounds like a problem--I rather get whatever I need.

Income: 165k
State: California
Age: 28M

I've attached photos, but here's a table too with the same info for anyone using a screen-reader :)

Thank you so much.

I have two health plans to choose from.

Plan A: $11856 per year premium. Deductible is $1600 with 20% coinsurance afterward. Out of pocket max is $6250. Plan Type: PS1

Plan B: $8050 per year premium. Deductible is $7500. Out of pocket max is $7500. Plan Type: EP1

My wife wants to have another baby, but the last one she had pre-eclampsia and we spent a total of 3 weeks in the hospital.I am fairly confident that she will hit the Out of pocket max.

Question 1: Why does Plan B look like the better bet even though it is cheaper than Plan A? Am I missing something?

Question 2: Is the "out of pocket max" truly a hard limit? Or is there some way for them to weasel more money from us after that?

Question 3: I Plan to put the premium difference ($3805) in a HSA to offset the birth costs. Would it be wiser to go with plan A with less HSA savings? Or plan B with more HSA savings?

Sorry for the long first post and thanks for reading! I've been wracking my brain for hours and I think that I just need another set of eyes on it.