Ask Slashdot: IT Contractors, How's Your Health Insurance? 468
An anonymous reader writes "In the tech industry, as the economy continues its downturn, IT folks in my circles who were either laid off or let go are turning to contract work to pay their bills. Layoffs and a decline in tech jobs has affected older IT workers the most. Many of us find it more lucrative and enjoyable in the long run and leave the world of cubicles forever. However, there is much to be said for working for a large company or corporation, and health insurance is one of the benefits we value most. But what happens to those who find themselves in this position at mid-career or later in life? Hopefully they have accumulated enough savings or have enough money in an HSA to survive a major medical emergency. Unfortunately, many do not and some find themselves in dire straits with their lives depending on others for help. I have been working IT contracts mostly now for the past 11 years and I've done very well. I belong to a group insurance plan and the coverage is decent, but as I get older, premiums and copays go up and coverage goes down. If you work contracts exclusively, what do you think is the best plan for insurance? Any preferences?"
High Deductible Health Plan (Score:3, Interesting)
In my experience, High Deductible Health Plans from *major* carriers are quite good. I'm not talking about those discount $50/mo. plans you can get through trade organizations. I'm talking about "High Deductible" plans from Aetna, Blue Cross, etc... You might have to cover the first $2k - $3k per year out of pocket, but after that you're often covered at the 90% to 95% level with no upper limit for major medical events like cancer, etc...
If you're self-employed, you ought to easily have $2k - $3k per year available to pay pre-deductible health expenses. It's really not that much money.
My observation is that most people seem conditioned to have this totally irrational expectation that ALL of their health expenses should be covered, with maybe a nominal $20 "co-pay" at every office visit. That's silly! Why not just pay for ordinary expenses out of pocket, and save your insurance premiums for the truly disastrous stuff (i.e. broken bones, appendicitis, car accidents, etc...)?
I'm just continually blown away by two income professional households with $120k+ income who just absolutely can not bring themselves to shell out a few thousand dollars per year out of pocket to pay the doctor. What's the big deal? 5% of your income is too much out of pocket expense? They'll happily blow $1500/year on mobile phone service, but $2k - $3k / year on pre-deductible health expenses are too much? But I digress......
High Deductible Health Plan from major carrier. The only way to go.
Re:After 20+ years of contracting... (Score:5, Interesting)
Actually, expect LESS increases due to "Obama Care"
The reason is more people will be paying in to plans because they have to by law.
I've paid for my own health care since I was 18. I require it due to having moderate to severe Psoriasis. I pay $1300 a month right now for Blue Cross Blue Shield in NY. Yes... Its fucking insane.
The same plan was $250 a month 15 years ago.
Every year they want to increase it about $150.
The theory with Obama Care is more people will now have to pay for a plan so more people paying in, should slow the increase in rates. However we will see if that happens in practice.
Initially the democrats fought for control over price increases but republicans and the insurance lobbyists obviously won that battle.
This country is out of control insane. If you are sick, you better be rich, or just die. That is how our country looks at people. We are burdens on society, and they would rather us all die than provide some kind of help. That is a fact.
America is a disgusting fucking country that I am ashamed to say I belong to. We simply do not care about doing the right thing.
Obama Care is a step in the right direction but its been corrupted by the insurance industry. The public option was eliminated. Single Payer universal Not for Profit insurance wasnt even considered. Big Money runs this place... and Big money sees us all as a burden and thinks the sick should simply die.
If you want health insurance in America. Either you have to pay very high monthly rates, or simply move to another country.
Re:Spouse (Score:5, Interesting)
Funny you mention that because I did marry someone with health benefits, and I didn't really like her that much at the time. But to avoid paying $12,000 a year for health insurance...eh...I'm puckering up.
Re:Best Preference (Score:2, Interesting)
Of all of the UK expats I know living the in US, I have never once heard any of them belly-ache about the US healthcare system.
Re:Best Preference (Score:4, Interesting)
Most Europeans I have met, particularly those who were only staying for a year or so, never STOPPED complaining if they had any cause to visit a hospital while here. Months later they'd still be complaining about the costs to anyone who would listen. Of course, as a recent college grad, most of those were students here on visas...and I can't imagine how you'd get health insurance in such a situation...no work, no family, not gonna be here long term...
Vote for People Who Support Single Payer (Score:5, Interesting)
Seriously.
When health insurance and health care are sold as a for-profit products, it is inevitable that some people will go without insurance and/or care. Why? Because they can't pay enough to make it profitable to sell to them. The market is fine and all, but it can't survive without profit.
Your best bet now is to look very hard for some form of group insurance. The older you are, the greater the probability you will succumb to somthing that requires surgery and/or long-term treatment/rehabilitation. i.e., things that generate 6-figure bills. (Think about things happening that cost $500,000 to deal with. Think about pills that cost $100 a pop.) Better to have good coverage for that eventuality and poor coverage of things like routine doctor visits than vice-versa.
Re:Mine's outstanding, but... (Score:2, Interesting)
If he is in MA, he can buy healthcare from the state exchange for a lot less than $1300/month.
Re:Best Preference (Score:5, Interesting)
Re:The only choice is to vote DEM / obama (Score:2, Interesting)
....
I'll just leave this here.
http://www.opensecrets.org/industries/indus.php?ind=F09 [opensecrets.org]
Re:Best Preference (Score:5, Interesting)
Please subtract Canada and the UK.
Please stop watching fox news.
The latest story I heard is that the UK is cutting doctor salaries (in order to balance the government budget) and it's leading to many doctors quitting
Probably, the conservatives are gutting the local trusts or whatever they're called too. But that doesn't mean there's going to be a massive shortage of doctors in the UK. When you make cuts and those doctors can pack up an move to switzerland or the US inevitably some will. And then you expand immigration or raise salaries and attract a bunch more. This isn't anything new. The UK can still attract doctors from eastern europe for example.
But as a canadian, there is no way in hell I would trade what we have here for the US system. For the french system or the british system, sure, they have different cost/benefit tradeoffs, but all of us provide on average better care, for less money than the US, and if you're in the US and you care about healthcare the answer is to leave.
After reading the various horror stories of patients unable to find a doctor, or being left to die in waiting rooms, or denied basic preventative measures like PAP smears
The reason you hear about is because we take these things very very seriously. Governments and government agencies are held accountable when they fuck up like this. It does happen, sometimes intentionally so too, as I say with the example of the conservatives in the UK, or with the 'voucher' programme proposed by Paul Ryan for Medicare, when you elect politicians they have a platform they run on for healthcare, sometimes that's good, sometimes bad, and most of the time somewhere inbetween.
And YES I know you've had nothing but great service in your CA or UK care.
No, you really don't understand. Between canada and the UK there are 95 million people, within canada each province runs it's own healthcare service under federal law, in the UK the NHS covers england and wales and northern ireland but not scotland I believe. Inevitably there will be things that go wrong, and an underfunded department will perform as well as any under funded agency will, some doctors are corrupt, some nurses are incompetent, some places can't attract enough qualified people especially in rural canada there aren't going to magically people who want to move 2 hours from the nearest walmart to provide healthcare etc.
http://www.who.int/healthinfo/paper30.pdf is pretty much the definitive guide to healthcare outcomes and assessment methodology, I suggest you read that. Seriously. It's not particularly complicated. If you're scared of reading page 18 has the table summary that's important.
That combines coverage, quality and spending into a single index. The French and Italians have the best systems overall (along with san marino) even though they have very different spending profiles.
Now in the long run 'Obamacare' which is basically a copy of the swiss system should be reasonably be expected to have similiar costs to canada (around 11.5% of GDP today), and produce better outcomes (as the swiss system does). So in 2016 or 2017 you might have an argument. But english canada only judges our healthcare system compared to the US, so we pay less, and have better outcomes, and as long that's true no one is going to rock the boat, even though there are better options available. And I'll point out that the swiss system is worse than the UK on both cost and coverage, so theirs isn't really the system you want to copy.
You hear horror stories from our healthcare systems because we actually care about these things as problems that need to be solved. In the US healthcare system you have one party base that advocates "let them die" and 'vouchers' as a policy platform, so we're not even having the same debate. In the US the question is whether or not you should even try to cover people, in canada in the UK it is a question of how best to do that, and who is responsible when something goes wrong.
Re:there are only two correct answers... (Score:5, Interesting)
If your contracting..first...incorporate yourself, I went for the subchapter "S" version, look it up, lots of benefits to this, including saving yourself significant payroll taxes (SS, medicare, etc)...
After this..get a high deductible insurance policy...my deductible was about $1200....this is for major medical, the emergency route, heart attack, hit by a bus..etc.
With a high deductible account..set up a HSA...and load it with money pre-tax...it is not a use it or lose it...at the end, you can roll it over for retirement if you wish..but load this up pre-tax for routine care.
Do this immediately when starting contracting. I am currently W2...and really miss doing my healthcare this way....although I still have funds in the HSA I can access...I just can't add more to it due to Obama admins even more restrictive terms on HSA's with the affordable care act (I still can't understand why they added more restrictions on it rather than opening it up to make it easier to get and use one)...
But this worked well for me...insurance premiums were quite reasonable and easy to get..and I'm older than the usual Slashdotter, and I do have pre-existing conditions (sky high triglycerides)...and no problem getting covered. First insurace covered was a little fly by night, but got them, kept them for about 8mos...and then switched to BCBS....
I had to go that route because I screwed up and let my last W2 insurance drop...it is much easier to get new insurance when you have coverage rather than letting it lapse too long. Get that Cobra if you have to to fill the gap.
Of course there are special circumstances...but I think this is an excellent system....you maintain it..you shop around for your own Dr. and make your decisions with your Dr.
I also found, that often, when I told the caregiver I was paying myself, I got up to about 15% discount right of the top....I had an MRI where they did this.
Re:Best Preference (Score:4, Interesting)
So what's your opinion on forcing everyone to pay for a military to protect your free society?
For things that have to service an entire populace, 'Free Society' sucks. Everyone's out to look after #1 and everyone else suffers as a result.
Re:Best Preference (Score:2, Interesting)
The problem with your argument, and the point you seem to be missing, is that the health care system is ALREADY fucked up. It is becoming increasingly fucked up as time goes on. And there is little incentive for the health care system to fix itself, because it is already insanely profitable.
Every speculative argument (except, of course, the non-sequiturs about dogfood and the post office) you make against government-run health care (and you have made many of them) ALREADY APPLIES to the system we have TODAY. And we have MANY real-life, working examples of government-run health care elsewhere in the world where they DO NOT have the problems that our system has. You're hilariously willing to strike Canada off that list of examples because of a couple anecdotes you read about, but even then you STILL have nothing to say about the dozens of other systems that are -- objectively -- measurably better than ours.
For someone as notoriously cheap as you are, you sure are penny-wise pound-foolish in this case.
--Jeremy
Re:Best Preference (Score:5, Interesting)
I think emulating the Swiss would be fantastic. There are incredibly capitalistic. Almost all the insurance companies are private, but they can't make a profit on health insurance. To level the playing field the gov't sets the price list and claims policy.
What I find most interesting is while the companies actually ended up fine in the end. They can't make money on core health insurance, but they can sell other insurance products to the customers at a profit. In the end studies show the insurance companies ended up making more money because they had a semi-captive customer base to market and bundle other products too.
We pay way too much for services here in the US. MRI in the US is $1500-2500. MRI in Japan is under $200. A Cardiac Surgeon in the US makes a seven figure salary. That level of salary would be a scandal in other parts of the world.
Re:Best Preference (Score:2, Interesting)
People who make below $25k are covered by Medicaid already. Of course, this program is under attack by the Tea Party, but it works reasonably well.
People who make over $100k per year can generally afford the cost of $1,200 per month to insure a family (or have employer covered insurance). The median cost of insurance for a family of 4 in the US is about $20,500 per year. This is the median across the board, meaning half are higher (and half are lower).
This leaves the rest out to dry. Self-employed people making under $100k, students over 25, and about 40% of the middle class. These are the people who can't get insurance.
These are the EXACT people who most deserve to be covered based on their potential future income, and the benefits to society by keeping them healthy. They're also the least expensive group to ensure. It's completely insane to leave only this group out of coverage, but include the rest (elderly, poor, corporate employees) when leaving out mid-life entrepreneurs and self-employed people, etc. WTF?
I've lived in both the US and Canada and spent 4 months waiting for an important surgery TWICE while living in the US because my insurance company was stalling to avoid paying benefits and as a result, I have a permanent problem with my knee. I had to retain a lawyer and pay for the procedure out of pocket to get it done (and then threaten to sue unless they reimburse me).
This procedure would have been covered by Canadian provincial health care system and handled in less time (no less than 4 weeks based on the severity right now).
When someone has an enormous amount of money, they generally are not willing to wait for services, so they pay out of pocket. Folks like celebrities will fly to the Mayo Clinic for cancer treatment and pay out of pocket, no matter where in the world they live - even wealthy Chinese and Africans fly to the Mayo Clinic or UCLA Medical, etc for this type of procedure. There's a number of such centres or advanced medicine in other places (like Europe and Japan) as well.
On the other hand, the most prominent heart-surgery facility in the world is in Belgium, and several Americans have traveled there for that surgery, if they have the $100k to pay out of pocket. That doesn't make the Belgian system better, it's just a quirk.
On the other hand, many Americans in the south travel to Mexico for procedures to avoid the extraordinarily high cost of services in the USA. This doesn't mean the Mexican system is better, it's simply targeted differently.