Ask YC: Health Insurance? | Hacker News Reader

Ask YC: Health Insurance?

30 pointsthinkcomp24 comments

Hi,

I've been using a personal health insurance plan that is left over from the last startup I worked for in the summer of 2007, and recently learned that my rates would be going up by 23% as of January 1. I'd much rather be on a group plan, but there are a number to choose from, and my company is only one person right now. I expect that part of the reason for the overwhelming number of options is that different people have different health issues, and so there's no one-size-fits-all solution, but it is probably also true that some insurance carriers are simply easier to work with than others.

So, who do people use for insurance? (And is there anyone in or around Palo Alto who needs a LAMP developer job that offers health coverage? Because if there is, I'm hiring...)

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If you are healthy, the cheapest thing to do is an HSA + high-deductible health plan. I've been on an individual plan I found at http://www.ehealthinsurance.com for a few years. Remember to price shop your plan every couple of years as you can usually save 25% or so by switching to a different plan (even with the same company).

At least in the US, the way "health insurance" works nowadays, it's not really "insurance" in the true sense of the word. From Wikipedia:

"Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss."

Problem is, most people think health insurance should pay ALL of their medical bills. This is why health costs rise so much in the US. People think health care is "free" because insurance pays for it. So individuals consume health services without regard for the true costs and that punishes everyone. It's a classic tragedy of the commons.

An HSA plan + high-deductible health insurance gets back to how things should be; you have health insurance to protect you from a loss you can't absorb individually. But you still pay for routine & predictable care yourself, with your own money. It's cheaper for you, and better for everybody.

Plus, with an HSA, all of your "routine" expenses are TAX FREE!

Good advice, but remember HSA let you keep your money from last year FSA don't.

People think of 'health insurance' as a 'medical services subscription'. Why can't we just market it as such then? Alot less bullshit involved that way.

Because healthy young people wouldn't buy the subscription, and the risk pool would be flooded with high-risk people, and the system would fail. Wikipedia: "adverse selection".

There's also no such thing as a free lunch (which is why dental insurance sucks) --- if you know you're going to incur an expense, and your provider knows you're going to incur an expense, nobody is going to "insure" you out of it; you're going to pay one way or the other.

It should also be pointed out that your HSA can earn interest.

To someone making ten dollars an hour, a 2000 dollar medical expense is devastating.

The problem I have is that I have seen people with this same health insurance end up 50k or more in debt and worse because the provider fights you at every turn. At that point, is it health insurance?

Finally, going for preventative care saves more money than it costs for a provider. Having someone see a high cholesterol number and adjust diet and such is much cheaper than a heart attack a few years down the road. For the provider, it makes sense for them to cover basic health expenditures because it stops much bigger ones down the road.

Which is why you fund an HSA alongside your high-deductable plan.

Many providers do cover preventative care for this reason.

This is, IIRC, one of the problems in free-health-for-all places like Canada. You can get your bypass, but it may not happen until /after/ the heart attack it was supposed to prevent.

First of all, I would argue that $2000 is not irreversibly devastating. One could pay it back over a couple of years. Secondly, as another poster said, one should be contributing to an HSA, saving in anticipation of such an expense. Thus in all but the rarest of cases most of the money should be already available in such a situation.

I do agree that fighting insurance companies is a problem. Perhaps the government should require insurance companies to electronically code their policies so that you can get instant pre-approval for medical care on site, with steep fines to insurance companies for reneging on payment for pre-approved procedures.

As a society, we need to do everything we can to reduce the transaction costs of accessing health care. I'll bet that 15-20% or more of health costs are administrative, which is ridiculous.

Finally, many HSA plans realize that preventive care is important and provide "first dollar" coverage for preventive care, meaning the plan pays for it, not you (via your HSA account). See: http://www.ahip.org/content/pressrelease.aspx?docid=21554

First a disclaimer; I work tangentially in health insurance right now, so take this with a grain of salt.

That being said, health insurance can vary greatly from state to state. There are different carriers offering different plans. Sometimes the same carrier will offer different things based on the zip code you live in.

My recommendation to anyone looking for health insurance is to find a broker. It doesn't cost you anything extra, and they can look specifically at what your situation is and make recommendations based on that.

If you went to someone for your business insurance, then the chances are high that the same people can either talk to you about health insurance options or can point you the direction of someone who can.

Insurance offerings can be very complicated things; a broker who makes their money from dealing with insurance tends to have a pretty good awareness of what works and what doesn't.

Before people pipe in saying that broker will only offer you things that make them the most money; the difference between what a broker makes on the worst carrier (for them) and the best is maybe 2%. It's worth far more to them to keep you as a happy customer for as long as possible, because as long as you pay your insurance bill, that broker will continue to make commissions on it. (Even so, the carriers will give you the same rate directly as they would through a broker).

One thing that many people who have not had hospitalization may not realize it that hospitals really nail it to people without insurance. I had surgery a few years ago and the bill was $80,000. The insurance company disclaimed $60,000. I ended up paying only $2,000. Also make sure that all the doctors in a procedure participate in the insurance plan. Beware of anesthesiologists.

If you are a small company, check out HR outsourcing like Administaff. They can save money because they can pool all the employees of their clients. I have not used them, just an example.

http://tonik.com works for me. I pay $140/month for their best plan. Aside from the annoying over-friendly wannabe 20 something text on the website, it's been worth it for peace of mind.

If you're a woman or (obviously) if you have a family, this isn't going to work for you --- there's no maternity coverage. (I'm not trying to snipe at it).

I'd like to know more about this as well. I just graduated from college last week and made a point to get a year-long insurance plan that will cover me until august while I do my startup thing. It was from Pearce & Pearce, but that's because it is affiliated with Georgia Tech.

Term health insurance can be a bad bet: if you get sick on day 360, you're basically screwed, because your current insurer will drop you and your new insurance won't cover it. If you're young, the earlier suggestion of High-Deductable + HSA might be a better plan.

this was just me getting student insurance (dirt cheap) while I was still eligible. before it runs out i will get another plan and have an overlapping period where i have primary and secondary insurance, just like I had when I was covered as a dependent on my parents' plan while I also had this plan.

i'm on MA's state health insurance. i hear it would be pretty killer if i actually had a hospital visit...which to me defeats the whole purpose of health insurance. i don't care about the small beans for doctor visits. i just don't want to get saddled with a 10k hospital visit bill for broken bones or something.

i see health insurance as one of the biggest obstacles against going the startup route. i live cooperatively, so my monthly fees, when i had a 'real job' and was on BCBS, were more than rent + food.

sure, most startupers are young folk, but we also live pretty risky lifestyles. i bike and roller blade along city streets all the time.

It's also murder for recruiting people --- anyone with a family is going to require health insurance.

I work at a hospital in your neck of the woods.

Kaiser does a pretty good job with basic stuff, and their rates are pretty reasonable from what people tell me. A lot of other companies in the area use Blue Cross/Blue Shield. They can probably get you decent rates on an HMO plan for your business.

Another way to go about is is to find out what doctors groups in the area people really like. Then ask the offices in that group what insurance companies they are associated with. Insurance is one thing, but having to go to a crappy doctors group because that's who your HMO allows you to go and see really stinks.

Find an insurance agent. They are experts, and contrary to some beliefs, it's not cheaper to go directly to the insuring company. They will work to find out what's best for _you_.

We have United Healthcare, we worked with an agent through Paychex (our payroll provider) to get this set up. I talked to a couple of people in the medical field about the best plan for us (of the options provided by the agent) to help chose between our options.

If you join http://nase.org (National Association of Self-Employed) you can get a pretty good rate on health insurance through them.

Many useful threads, I'll need to read one day:

http://searchyc.com/health+insurance

I keep my fingers crossed.

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