Ask HN: How do US HNers get their health insurance?

As someone who moved from the UK to US under almost identical conditions, let me say this: If you have a job that offers health insurance 99% of the time you will be better off taking that health insurance rather than buying it directly from the exchanges.

Why? At least two reasons:

1. Employers are in a stronger negotiating position as insurance companies really fight for the business (it is for multiple people, so even if each one is less profitable the entire account will be more profitable with less overhead, so they WANT it).

2. The people buying directly from exchanges are higher risk/greater cost. They're normally poorer, self employed (which includes a lot of people in physically demanding professions as well, who get injured often), and some are early retirees (pre-medicare age, but still "older").

Plus the biggest reason is that almost all employers pay a % of your health insurance premium. If you go with the exchange you're paying 100% (of a higher base) rather than 70% of a lower one. So unless your employer has simply terrible health insurance, it is almost never a better idea from a financial perspective to go private.

If you're really paranoid about it, just take the employer health insurance, assuming they pay 30% and you pay 70% of the premium, take an equivalent amount out of your pay and save it (e.g. save 30% of the premium a month). Since that is what you would have been paying privately anyway (100%), now you're just using the employer's cut to save for a rainy day.

Personally if it was up to me employer provided health insurance should be banned in the US and everyone (aside from the US Military) should be required to go out and get private coverage (e.g. car insurance). That way the prices come down, competition goes up, and certain demographics (unemployed, self-employed, early retirees, etc) aren't unfairly "punished."

But I don't see that happening any time soon (or ever) because employer provided health insurance is too heavily ingrained in US culture. Nobody even discussed destroying that link during the ObamaCare debates. So whatever...

For now, until things change, employer is the way to go.

Your options depend on where you live.

I signed up for Covered California, which is subsidized insurance. My husband (non-US citizen, but perm resident) is part of my plan. This depends on what state you live in. Some states rejected the federal healthcare funds.

As for employer contributions, it depends on the employer -- I offer my employees insurance. If they choose NOT to take it, I don't give them a pay bump -- the cost per employee is negligible, and insurance is not offered in lieu of higher pay here. The purpose of me buying insurance for employees is mostly to ensure they're healthy while working for us, and getting care so as not to sicken others while on the job.

We use a HSA-qualified high-deductible policy from Humana One (https://www.humana.com/individual-and-family/) with 100% coverage after deductible, and we deduct premiums as a business expense. We make the maximum HSA contribution every year, which makes all of our family healthcare spending tax-deductible. Coverage can be obtained quickly and prices are generally reasonable, particularly if you don't have kids.

For routine care, we subscribe to MDVIP (http://www.mdvip.com), which has been fantastic. The subscription pays for a very comprehensive annual physical (of the type Fortune 500 execs get every year), and helps the physician maintain their practice with a smaller number of clients, so you can schedule visits same-day if you need to.

Because we cover healthcare expenses out of the HSA, it pays to shop around for things like prescription drugs. Tools like GoodRx (http://goodrx.com, details on how it works at http://kk.org/cooltools/archives/22342) help save a lot of money.

Hope this helps.

Full time employed, health insurance through my employer.

Group coverage (i.e. employer-based coverage) is the best insurance you can get in the US because of a number of already-given reasons, as well as the fact that they can't reject you for a preexisting condition. All private plans will exclude preexisting conditions, so if you're already one some medication or treatment, you will have to wait at least a year before your insurer will cover it.

I was a freelancer on a private plan previously. Private plans were kind of bullshit (and very expensive), but I don't know if the ACA has changed that.

I would like to see Canada-style single-payer health care in the US, but I think it will be a couple of decades before we do.

I went to http://healthcare.gov, filled out some online forms and picked a plan. It's like Amazon.com for healthcare -- sort by brand/price/features, add to cart, check out. The only difference is that whatever insurer you sign up with sends out their own bill afterwards rather than paying the website.

I've been buying my own insurance since reaching adulthood. Before the federal exchange, I typically found personal plans through http://eHealthInsurance.com, though they have less selection now than before the exchange. I think some insurers in states with an exchange pulled out of the private comparison sites like this.

I'm self-employed and use a catastrophic healthcare plan, found through the healthcare market (http://healthcare.gov). There were some hiccups in the beginning when I had to call repeatedly to ensure all the paperwork went through, but that's expected (unfortunately).

Mom & School. Thanks Obama! No really, thank you. I presume you're older than 27 though?

Get it from your employer. It's better and cheaper than what you can get in the market.

You are allowed to supplement -- this may or may not make sense, but your final coverage will be a lot cheaper if you start with employer insurance.

I've had one employer offer to pay you the difference, but I don't believe this is common outside of large corps known to be good places to work.

I ended up on disability in 2003, been on Medicare ever since.

Got a part D plan.

Private insurance covers more, but the monthly cost of Medicare is cheaper. Your private insurance costs more per month, than Medicare, but covers more things.

Medicare for example has a doughnut hole for prescriptions and if you reach it, you aren't covered until you spend $3500 of your own money to get out of the hole on prescriptions. It used to just be for name brands but ACA added in new holes for generics. My medicine that is generic is $370/month until I am out of that doughnut hole.

http://www.goodrx.com/

That website gave me a discount code that got my medicine down to $112/month instead. I'd recommend it for anyone having price issues with their medication.