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Comment by ef4 | Hacker News Reader

If you want a practical takeaway from this article, it's don't buy cheap health insurance. It just gives you a false sense of security, when in reality you're still uninsured against the biggest health expenses.

Any health insurance policy that includes uncapped coinsurance, lifetime benefit caps, or limits on per-day payout is going to leave you high and dry if you really need it.

A good policy that doesn't have these limitation is probably going to cost three times more, but it's going to be worth a thousand or ten thousand times more if you actually need it.

If you can only afford a crappy policy, consider whether you might be better off saving that money instead so you can at least cover your own minor medical expenses. The major ones are going to leave you screwed either way.

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I don't think "cheap" is the best way to explain it. I have a high deductible plan which is pretty cheap and tied to an HSA. My wife and I are on the hook for the first $5,000 per year, and the insurance will pick up 100% of the costs after that. I won't run into the problems you're talking about. I like it because I don't really think minor medical expenses should really be covered by insurance anyway. I liken it to having car insurance pay for routine car maintenance.

My wife and I are on the hook for the first $5,000 per year, and the insurance will pick up 100% of the costs after that.

Sounds like you have a near-identical plan to the one my wife and I have. Don't bank on the insurance company doing what they say they will, at least not without a fight. Just to throw out a random example, in the few weeks after our daughter was born we received a dozen or so letters from the insurance company all telling us the company didn't think some aspect of the childbirth care was "necessary", and that they didn't want to pay for it. Quite a shocker for us, as the birth was relatively routine, and every intervention was something the medical staff thought was necessary. In the end, after hours of phone calls, we got them to pay for most of it, but definitely not 100% of the after-deductible amount.

Well, in that case, shit.

I hope your experience doesn't turn into mine someday. What a shady practice.

I wish I could buy such a policy, but it's actually illegal in Massachusetts.

Insurers are not allowed to sell a plan that doesn't cover a long list of routine preventative care. And they're not allowed to offer deductibles greater than $2000 per person or $4000 per family.

The problem with paying for routine health maintenance out of pocket (or HSA) is that, in the absence of insurance negotiating the price down, a routine 15 minute doctor visit costs $85, and a routine blood test costs $400. Granted, hiding those prices behind a monthly insurance premium allows them to remain high -- there's a bit of a chicken and egg problem.

Actually I get the insurance pre-negotiated rates when I pay through my insurance. The money just comes out of my HSA.

You should look into finding a doctor who doesn't take insurance. There are a few here and there, normally family/primary care type docs. You pay them cash, and because they have zero overhead in their practice for insurance billing, they can charge you less AND spend more time with you.

Interesting. If one found oneself seeking an insurance-free doctor in the future, how would one go about locating such a doctor? What questions would one ask, keywords would one search, or directories would one consult?

One advantage to a high deductible policy (besides being covered in case of something big and bad happening) is that your normal care will be billed at the rate the insurance company negotiates for all its clients, even if you are paying out of pocket or via HSA because you haven't hit your deductible.

HSA gets you the negotiated rate, you just pay the negotiated rate yourself. It's really the best of both worlds.

If fails if you have an ongoing condition which costs (at negotiated rates enough that the difference in premiums between a PPO and an HSA is less than the deductible for the HSA. Personally, I don't think charging $100-200/mo in premium and expecting to pay out $500-1000/mo in existing care from day one, plus the possibility of higher costs for new conditions down the line, is a viable proposition for a private insurer. That should be paid by individuals themselves or by government (as a direct subsidy), but it's not insurance.

As a non-american I think the healthcare system is broken.

This is clearly a nexus between insurance companies and hospitals to drain people of their savings. They together have a good interest in keeping health insurance at very high levels.

The barrier to market is very high in both the sectors because of government regulations. If I was in that couple's place I would have used the $80k to fly to India and get treated in the top most hospitals such as Tata Cancer Hospital. for $80k I would have got VVIP treatment.

I'm quite surprised we expect insurance to cover routine medical expenses. We're still paying for them anyway and now there's a middle-man to hide the true cost and take a cut.

It's still expensive, but catastrophic insurance the minimum people should be getting--like you said.

I've never seen a health insurance plan that doesn't have per-claim and lifetime limits and maximums. Insurance companies need to know their maximum loss exposures.

> Insurance companies need to know their maximum loss exposures.

Yes, but a dollar cap is only one way to do that.

In my case, my policy has no dollar caps, but of course it only covers reasonable and necessary care. I'm sure the insurer knows the probability distribution of expensive ways to die, so they still know their overall maximum exposure.

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