The only way to motivate myself to solve problems that I hate is to write about them, so I’m writing about picking my insurance.
Note about the tables below: I assembled this from PDFs. It’s probably wrong – I didn’t understand most of the industry terminology until I got to the end. I very likely confused $ and % in various places. It’s certainly incomplete; in the interest of making my decision simply I left out a lot of service fee that I didn’t understand or will probably never incur.
The plan prices are from wageworks and may or may not be individualized, I don’t know.
|plan||price||in-net deductible||out-net deductible||in-net coinsurance||out-net coinsurance||in-net limit||out-net limit|
The limits and deductibles confuse me. Does in-net 4, out-net 6 mean my max limit is 6? Or 10?
- ad: after deductible
- dw: deductible waived
I think these mean that the coinsurance kicks in before or after you’ve spent to your deductible but am honestly not sure.
The hospital columns confused me. Does ‘up to 1500’ mean they pay after that or I pay? Or I get kicked out of the hospital regardless of my ability to pay? Or I pay retail rather than their negotiated price?
I think it may vary by plan.
|plan||in-net annual||out-net annual||in-net pcp||out-net pcp||in-net specialist||in-net urgent care||in-net hospital||out-net hospital|
|a2||100%?||30% ad||$30 copay||30% ad||$50 copay||$75 copay||$500 / day up to 1500||30% ad|
|a3||100%||$30 copay||$50 copay||$75 copay||$750 copay, 3x limit|
|b3||100%||$20 copay dw||$50 copy dw||$75 copay dw||20% ad|
|c3||100% dw||30% ad||$30 copay ad (?!?!)||30% ad||$45 copy ad||$75 copay ad||$750 copay ad||30% ad|
|f1||100% dw||30% ad||$25 copay dw||30% ad||$40 copay dw||$75 copay dw||10% ad||40% ad|
|g1||100% dw||30% ad||$30 copay dw||30% ad||$60 copay dw||$75 copay dw||20% ad||50% ad|
I left out emergency and ambulance reimbursement because it made little sense. My summary: ‘it depends’ and the documents don’t make clear what it depends on.
To my inexpert eye these plans by and large focus on subsidizing cheap routine care and have confusing exceptions for emergencies and catastrophes. This says, to me, that these aren’t insurance products. They’re more like the opposite.
Why do the last 2 rows have higher reimbursement for out of network hospitals than in-network? My only guess is that this is because they have different negotiated prices with each. Vermont tried to change its laws to require these negotiated prices to be published, and an insurer fought them to the supreme court and won.
Wageworks wins some kind of award for bad websites. To find out the prices of the plans, you have to check a box and wait 10 seconds for a dropdown to un gray out then open the dropdown + make a selection. Minimum time between clicking something and getting a response is 5 seconds, and their janky JS-based form system is the worst I’ve ever seen. Why do AJAX if you’re not going to provide a loading indicator?
This is an animated gif from screenshots, so the timing below is faster than it was in reality, but here’s what the slow AJAX looked like. Also note the prices on the right don’t fill in until you select a coverage type.
Wageworks doesn’t offer the PDF plan prospectuses for download, nor indicate in any way that they exist, so I had to do a bunch of email roundtrips. The PDFs refer to mysterious other ‘plan documents’ which I’m sure exist in the catacombs somewhere.
Wageworks thought my plan level ‘doesn’t exist anymore’ which is why they canceled it and sent me a late notice to renew instead of renewing automatically, but it’s pretty clear that it does still exist.
I’ve never ever hit my deductible. I picked the cheapest one.
FWIW wageworks, my COBRA operator, sent the notice by mail instead of email, it’s postmarked for a few days after the date on the letter, and I didn’t get it until after the deadline had expired. But the deadline turned out to be wrong.
Not sure what to conclude from any of this, but this isn’t a well-run system. Their master satan, who is lawful evil not chaotic evil, is unlikely to approve of what they have built.
My HSA is still the best investment I’ve ever made in the finance side of my health and has paid for many pairs of glasses. They’ve never turned down a reimbursement. If this selection offered an HSA I’d take it no questions asked.
This is made especially difficult by the fact that medical prices are different across different insurers and for all I know, different plans. It’s impossible to effectively comparison shop without price transparency. The fact that we’re in a situation where socialists + libertarians agree about the need for transparent markets in retail health makes me wonder who the other group is that doesn’t want it. If we’re easter island, health inflation is our moai.