Seriously considering not having insurance and going cash. Any recommended plans for freelancers / solo self employed?
Also interesting ideas in this reddit thread https://www.reddit.com/r/HealthInsurance/comments/1hgg2q4/se..., probably skewed towards young/single people.
I paid for my own insurance for decades and the ACA absolutely made things better, and cheaper, for individuals seeking insurance. Not even counting the subsidies for lower incomes.
Don’t buy insurance outside of the marketplace. The ACA places limits on what insurers can deny, and those limits protect you from the rampant problems that existed before the ACA. I’m not sure if those protections apply to insurance purchased outside the marketplace.
So, if you're young with minimal healthcare needs, you can get multiple benefits:
1) High-deductible insurance that's (relatively) cheap but still protects you against financial ruin
2) After 10 years of maximum contributions, you'll have ~$10K in cash for emergencies and about $33K in retirement investment contributions.
Be careful about non-ACA-compliant plans. They're cheaper because they engage in sketchy behaviors that leave you without coverage when you need it.
*Well, except Medicaid, Medicare, etc.
I pay ~$400 but the government kicks in ~$350 too due to my low income. Its a Silver PPO plan and not bad, though, I haven't used it for anything serious yet. The Silver plans have extra subsidies so are usually better quality than bronze.
It also can be helpful to switch insurers if the plan is bad. My insurer up until last year was once decent but has gone downhill. They are also the dominant insurer in my area. The one I switched to this year is trying to gain market share in my area, so they seem to be a better deal, the plan is more generous and has less red tape.
IMHO, health insurance makes it hard to do cost control of healthcare. Patients can't do it, because they won't know how much stuff costs until 6 months after service, so they can't really make decisions on cost. Providers can't do it either, they have even less idea of what things cost for patients, and they have an interest in providing more billable care. Insurance companies could do it, but denying care for economic reasons is hard, so they just go with denying care for beuracratic reasons; also, ACA insurers have revenue limits based on ratios to covered care, so covering more things allows them to get more revenue. Even government paid healthcare has trouble because everyone gets grumpy when they can't get all the care available.
My understanding was most of the cost of healthcare was human services.
Their stocks have been doing great!
I know firsthand that a lot of insurers substantially increased internal efficiency as a result of no longer being able to pass excesses along to consumers in premiums.
Because the only true guiding moral truth in America is that capitalism is the only economic system that could possibly work and we should allow capitalists to pursue profit by any means.
I think both positions were untenable, but one interesting point that one guy made was that, while called "insurance", health insurance is structurally very different.
If you buy flood insurance, you have very low expectations you will actually need it. It's a way to pool tail risk and spread it out over a larger population.
Healthcare insurance, however, pays for all your medical costs, many of which you can reasonably expect to have to pay. So you're no longer socialising risk. You're not even socialising cost really, sonce plans have many carevouts, exceptions, copays, limits etc.
So a more efficient system would be one where you selfpay for regular procedures and have insurance for rare, life altering conditions.
[1] - https://www.thesohoforum.org/upcoming-events/2025/7/16/jacob...
But to be clear, you are socializing risk though. You're just doing it a different way, by genetics and age.
Your monthly payment (and what your employer kicks in) are for all those day to day costs. And of course there's the deductible. But people in their 40s to 50s often don't have young kids. Meanwhile, people in their 80s to 60s have more health risks.
So what happens elsewhere is that everyone throws money into the same pot for their entire lives, and your costs are averaged as per above. It's why a single insurer, the government, is perfect for this. And it works for rare conditions that might happen to some during their lives, and not all too.
And typically, for thousands of years, we've had more young than old. So while elderly people do have more issues late in life, they've paid into the system the whole time. And, now there are young people to pay just as they did.
The only downside is when you end up with an age skewed population, such as is happening with the entire planet. It's affecting all health care systems, private or public. The US has this problem too, as medicare is being hit by spiraling costs.
One thing I find really weird, is the need for-profit in the US system. Other systems have that too, sure, but not like the US. An example, the fire department isn't for profit. It'd be insane if so! Why would it be?! Yet, there is private sector work in the fire department, such as all the equipment bought from the private sector, chemical analysis done on debris post-suspicious-fire, and even training in some cases.
Most health care systems around the world are like that. The insurance is public, not for profit. The hospitals too. Many parts of the system as well.
But then some aspects are private.
https://www.huffpost.com/entry/firefighting-in-the-1800s_b_2...
This is sort of what a high deductible plan is, which were encouraged by the ACA. After premiums, my first ~$4,000 in medical expenses each year come out of my pocket. Then the next ~4,000 in medical expenses are shared between me and my insurance. Then the remainder is covered by my insurance. The difference is perhaps just what "rare, life altering conditions" means. For a lot of people the cost of medical care becomes untenable not at "oh god I need seven figures in surgeries" but instead "oh god that appendectomy is $50,000 before insurance" or even "oh god I don't have $10,000 to pay for that hospital visit."
Was this the outcome of Romneycare in MA?
Do other countries with single-payer health care have these types of sudden mass price increases by health insurers?
Congratulations you have what you wanted.
So, how have you fought off similar oppression in your utopic part of the world, wherever that may be?
Please, enlighten the rest of us.
Grow up already.
Voters consider it bad socialism.
oh my, empathy stat is high on this one
I don't feel sorry for them either, they were always parasites, but I am not sure what your point is or what it has to do with this conversation.
I fully expect the west coast states to implement single payer before the government ever catches on.
Or an ambulance ride in the US STARTS at $500. An ambulance ride in the EU is 260€/hour (obviously is free in case of emergency)
I think the problem is that the US is in this weird dynamic in which hospitals charge more because "the patient is not paying for it, the insurance is" but in the end insurance are going to raise premiums to pay for that
Currently, patients cannot price compare anything, not even for the exact same drug from two different pharmacies on the same street! To make it worse, most providers can't even make sense enough of the provider-insurer prices to shop on behalf of the patients.
To improve prices in healthcare, all care must have a price visible to all, paid by patients. Insurance should be required by law to publicly publish their reimbursement rates and immediately (48 hours) reimburse their insured patients for care at approved (in-network) providers.
This would end the current: impossible to self advocate, impossible for providers to advocate on behalf of patients, intractable insurer-provider price web.
Insurers and providers should never negotiate price. Providers should only be concerned with providing good care, how to classify/code it, and the amount they need to charge for that care to be financially viable. Insurers should only be concerned with how much they will pay out for each classification/code, and which providers they authorize as in-network.
Last, since there is a long tail of medical care that doesn't fit nicely into a code box, each plan should have a mandatory minimum coverage of something like 50% all unknown-care costs at in-network providers and pharmacies above $5,000 annually, with some annual cap.
As a society, if we want to further subsidize healthcare for those with lower economic means, and/or those who end up with catastrophic expenses, then that should be done on it's own, as two distinct standalone welfare programs.
mitchbob•5mo ago