After all, the government is just protecting me from all the terrible things that will befall me in the future. Over twenty years ago a saint by the name of Hillary Clinton tried to save us all with her own "Health Security Act". Don't you love these Orwellian word games. Seems like "Social Security" by its own definition should have already "secured" us a long, long time ago. I guess sometimes things don't always go according to plan.
How have we all managed to survive the last twenty years? If this is so dire, where have they been hiding all the bodies? I have to admit that the cost of health care has risen at an unsustainable rate. My insurance premiums over that period of time have gone up much more than I care to believe when I run the numbers.
I thought to myself, maybe I am just not being very fair. I should give the government health care option a fare shake. I mean, when the IRS points a gun at my head and says, "You gotta buy this!" I out to at least take a look at what I'm getting in exchange for my life.
I took the liberty of condensing the report from my prior comments and reproducing it here with my current (soon to be "withdrawn") coverage through Aetna.
Insurance is extremely complicated. There are in-network and out-of-network, copays and deductibles, maximum out of pockets and a whole slew of other tricky language and complex processes utilized to "insure" you. I do not pretend to understand them all, but for the average person out there, let me explain what you are seeing.
Under the Covered CA plan you see copays and a $2,000 (70/30) deductible with a $6,400 max out of pocket. This means that as you use medical services throughout the year you will pay 70% of the costs until you reach $2,000. Then you will have the copay for those services until you spend $6,400. At that point you will have reached the maximum out of pocket for the year and everything will be covered at 100% going forward.
Under Aetna's plan you can see there are no copays. I just have to pay until I reach the $5,500 out of pocket max and then I too get 100% coverage going forward.
When you examine these two plans side-by-side like this, Aetna doesn't look very good.
But here is where personal choice comes it. I, and my family, are fairly blessed with good health. Our genes cannot take all the credit however. We all eat right, exercise almost every day, don't smoke or drink. Although, I do try to get that one glass of red wine in every day.
I went back and pulled all my medical expenses for the last 10 years. Here is what I found:
For our purposes here, we can throw out the first two lines as they represent items that are not covered by Aetna nor will they be covered under Covered CA. As a side note, genetics were NOT kind to our kid's mouths. Orthodontics is expensive for kids with tiny mouths and more teeth than your average shark.
The next thing to do was to make some assumptions. Lets assume that going forward I will utilize medical services in much the same way over the next 10 years as I have over the last 10 years. I know that is not likely since I am starting (just starting mind you) to get old. It will give us something to compare Aetna with Covered CA however.
This is the main reason for my extreme frustration. When you look at these numbers they are not even close. You can see that there was some small savings for labs and MD visits. These items are not subject to the deductible with Covered CA. This means that you pay a small, set fee each time you use these services. Now Aetna is looking a hell of a lot better. After ten years I am going to save enough money to almost afford that new Porsche.
There are going to be a lot of nay-sayers that argue, "Well that is fine since you are so healthy and don't use any services. What are you going to do if you get cancer or something like that?"
First, I will not get cancer. I am almost superhuman. But, lets suppose that I did have to go into the hospital for a significant injury or maybe an infection. What would that look like?
In this case, I have an almost $40,000 hospital bill. And it is here that Covered CA and Aetna finally (although not really) come to parity. The Covered CA person paid a lot less for their services. But they paid a fortune more for their premiums. And something magical happened in the Aetna case - I met my *maximum out of pocket of $5,500 for the year so I did not have to pay anything more. At this point, Aetna's yearly cost still came under Covered CA.
I still have an ace up my sleeve though. My Aetna plan is (or was) an HSA (Health Savings Account) qualified plan. This means that I can set aside pretax dollars and pay myself back with them if I use any - I'll repeat that ANY - medical expenses. In my example, I paid myself back for my maximum out of pocket expenses in the amount of $5,500.
Just like that, I spend considerably less than the Covered CA person.
Disclaimer: I realize that these scenarios are very simplistic. I recognize that I still spent the same amount. But an HSA is an investment vehicle with the intent to save for future medical expenses. If you don't have any expenses, the money just accrues.
