My INSANE Health Insurance Plan

So I’m still collecting invoices from my October
2nd appendectomy. So far they total about 6,500 under dollars, but I’m still waiting for what’s
called the facility fee, which includes the operating room, the anesthesia, the volume,
the staples that they use. You know all of that stuff. So when I have it all, I’m going to come to
you with a full detailed accounting for my appendectomy. But I do now have the proposed changes to
my health insurance plan if I keep the same plan going into 2020 and I think this will
be really informative because it’s going to actually expose the disgustingly broken nature
of how our healthcare system and health insurance system is fundamentally organized at a base
level and should really sound the alarm as it’s obviously, it’s not just me who sounding
the alarm, but this will once again sound the alarm is another data point for why the
system needs to change. So I live in Massachusetts, Massachusetts
considered to be one of the better places to be thanks to Romney care, sort of precursor
to Obamacare when it comes to health insurance. A very close to total health coverage here
in Massachusetts. Mass health is a program that is very popular
for people who have it on the basis of their income. Since I have my own business, um, and I exceed
the income limits for a subsidized plan or a mass health plan, I just buy my plan through
something called the Massachusetts health connector. I, it’s unsubsidized, it’s just, it’s a market
for people who are self employed or whose job does not offer health insurance. So I just pay for the plan. Now I chose what’s called a silver plan. They go bronze, silver, gold. I think there were still platinum plans, although
I’m not sure. Of course the higher you go, the more you
pay monthly, but the less you pay when you need things done. Silver for me seemed sort of like the right
balance between the monthly premium and how much I have to spend when I actually get care
of different kind. So in 2019 my plan costs $421 per month. That’s what I pay out of pocket. So let’s dig into how my plan will change
between 2019 and 2020 I was just notified of this if I stick with the same plan. So for starters, my premium goes from four
21 to four 58 okay. An extra $37 a month. That’s about a 9% increase in what I pay for
the premium. But the plan also gets worse in terms of what
will be covered. So my annual deductible stays the same. It’s $2,000 for my appendectomy, for example. It like I’m going to owe my full $2,000 deductible. Of course, in addition to the $421 monthly
payments that I’m making, my plans out of pocket maximum is going up from $6,500 this
year to $8,150 in 2020 so the out of pocket maximum is the most you would have to pay
for all covered services in a plan year. So my deductible’s 2000 imagine that I have
three or four instances, uh, medical events where I pay the $2,000 deductible this year. Once I’ve paid 6,500 total, my insurance would
cover everything next year. That limit is being raised to 81 50 okay. My primary care poke copay is going from $30
to $50. Remember my premiums going up as well, and
in addition it will cover less. My primary care copay going from 30 to $50. My specialist copay going from 50 to $70. If I go to a dermatologist, for example, or
a podiatrist, as many of you know, I went to back in June, that’s still not resolved
by the way, my urgent care copay, you might remember earlier in the day of my appendicitis,
I went to urgent care. I had a $55 copay. That copay goes up to 70 next year for blood
work and imaging like x-rays. This year I had a $50 copay after my $2,000
deductible was met. Next year it’s going up to $75 per instance. After my deductible is met, emergency room,
uh, this year my deductible is 350 my copays, $300. Next year it goes up to three 50 of course
after the deductible is met. So I am going to be paying, if I want to keep
this plan an extra $37 a month, that will make my yearly premium $5,500 and then I still
have to hit a $2,000 deductible for lots of things and to have even higher copays in other
areas like primary care specialists, urgent care and in the emergency room. I want to go back, I think I might have misstated,
uh, the 81 50 annual limit is the deductible of 2000 plus additional copays and everything
else. It is not multiple deductibles. I, I may have been unclear about that and
I apologize. So this is considered good insurance in the
individual market and Massachusetts is considered a good place to be. This is insane. The system has to change and we’re going to
go into this in more detail when I spell out the appendectomy costs that I incurred last
month. But part of what makes this not work, part
of what makes this system the wrong one is that there is completely inelastic demand
for a great portion of healthcare services using appendectomy. As an example, if I don’t have appendicitis,
my demand for appendectomies is zero. It’s not like with many other consumer products. If appendectomies are 10,000 thousand dollars
I don’t want one. If the appendectomy is $5,000 I sort of want
one at $1,000 I really want one and at a dollar I would want multiple appendectomies. I might as well take advantage because that’s
such a good deal. No, that’s not how it works, but then once
you have appendicitis, your demand is also not affected by the price. If you have appendicitis, I can testify to
this. If the appendectomy costs a dollar or $1,000
or $100,000 you need it and you need it right away and your demand for it is not impacted
by the price. Compare this to, for example, a Tesla. If a Tesla costs $100,000 it might be totally
out of your price range. Your demand is effectively zero at $50,000
it’s a big stretch, but you’re certainly more interested in it than at $100,000 if the Tesla
is $15,000 now you’re very interested. If the Tesla is 100 bucks, you want to buy
a whole bunch of Teslas. Potentially. That’s not how healthcare, how healthcare
works and that is why the system we have is a moral, and I was trying to explain this
the other day on a live Twitch stream where we have a lot of international viewers and
they kept saying, wait David, you’re, you’re saying you pay four 21 a month and you still
owe two grand for your appendectomy? Yes, I pay four 21 a month for the privilege
of limiting what I owe for my appendectomy to $2,000 rather than the eight or nine or
$10,000 that it will probably end up costing in total. This is a big piece of the immorality of the
profit, the for profit healthcare system that we have. We will talk about it more upcoming and I
will get you those. A appendectomy figures once I have them.

100 thoughts on “My INSANE Health Insurance Plan

  1. I'm glad I've never needed my appendix and/or tonsil removed. I'm still about 95% complete since birth — I've lost a couple of teeth and I'm circumcised (loosely). So, honestly, I can't imagine what the pain is like during an appendicitis — and hopefully never will need to.

  2. We are both retired and are currently paying $410/mo for my husband and me through my previous employer (that goes up to $471/mo in 2020). We have a $4K family deductible and a $10K annual out of pocket maximum. I went to the hospital in February with chest pains and was kept overnight and had a stress test, blood tests, etc. My hospital bill after the negotiated insurance write-downs was $4257. I applied for financial assistance and they wrote off $3746 because our only income was SS & 401K payouts. What a system! Thank God the lady in billing informed me that since we were on limited income, we could apply for the financial assistance. We will both be eligible for Medicare in 2020.

  3. Lol yours is generous compared to the average plan. Many Americans can only afford a low premium and end up with OOP of over 10 thousand dollars a year and even more for a family….

  4. Omg where are people going to get this money to pay for health purposes.
    Health care should be the priority for this election.

  5. This is a fucked up health care system and we have elected officials actively working for the health care establishment and against the interest of health care consumers.

  6. Where is the conversation about how little current medicare actually reimburses physicians and hospitals now and how long it takes? How is m4a going to fix that?

  7. It absolutely baffles me as an Australian, how disgustingly broken the US healthcare system is.

    Upwards of $7500 for an appendectomy? Absolutely absurd. And the fact that there is a significant portion of your country's population that continues to try and justify that broken, immoral, for profit system over the universal healthcare system that works in virtually every other developed nation on the planet should be exceptionally worrying.

  8. Insane! In Netherlands you pay 140EUR per month and you get dental+physiotherapy+everything else. The low-income get 100EUR per month reimbursement by the govt.

  9. My appendectomy cost me $28,000 with insurance! I had a silver healthcare plan, the hospital took my insurance card at check-in, then several months later, the hospital said my insurance was out of network, I called my insurance and they said they paid the hospital almost $5,000 which they estimated was reasonable for the procedure. The hospital applied that against $33k total cost and sent me a bill for remaining $28k which is what they claim the cost of the procedure was, out of network. Hospital said they would only accept $950 a month, so I hung up and I've paid them $500 per month since the bill. It just went to collections this month, no win scenario.

  10. I live in Japan. My whole family is covered for $160 per month. No deductible or Co Pay, whatever that is. My wife gave birth here for $4000 and spent a week in the hospital. The great thing is, we got a 100% refund for the birth from the government.

  11. I had an appendix removed 9 years ago. Turns out it was cancerous. In my country it was free. Imagine if I was American? I would probably be dead now. Thank god im not.

  12. The cost of Super Beta Male Supplements is much less than the cost of that procedure, but I totally understand if you want to be shot up with more government mind control drugs.

  13. Canada takes an average of $6k a year from taxes for healthcare. Every healthcare service is free. Canada doesn’t make you pay taxes for the largest military in the world and their endless wars.

  14. Am I the only one wondering why it says "HEiL" on the mic stand??? I know it's probably just the brand name, I just find it really weird and inappropriate.

  15. If you don’t like your health insurance, then do something about it. Re-think your finances, search for different job opportunities, take chances and start your own business. But don’t look at me and say “you have to much, you OWE me some”. It’s nobodies responsibility to fix your problems but yours.

  16. "The health care system of Spain (Spanish National Health System) is considered one of the best in the world, in 7th position in the ranking elaborated by the World Health Organization. The health care is public, universal and free for any legal citizen of Spain. The total health spending is 9.4% of the GDP, slightly above the average of 9.3% of the OECD." —- Wikipedia.

    I have posted this bit of info several times to illustrate the healthcare system in place in most of Europe is free. Meaning NO COPAYS, and NO PREMIUMS. You will pay only for prescriptions which are also heavily subsidized.
    Healthcare in the US is a system based on PROFIT. If you cannot pay the price, you die young for fear of going into debt. At best, unless you're very rich, you will go bankrupt, lose your home or lose your mind, but not lose your life. The CEO of your insurance company gets fabulously wealthy off the public and decides whether you live or die. Ain't that something, eh.?

  17. Being 57 I pay $1151 each month plus all the deductibles and copays. I receive no subsidies through the ACA since my income is slightly above the max income allowed. Premium alone is almost 25% of gross.

  18. thanks for being so transparent about the costs of your medical care…it's going to open some eyes and hearts so that we can get a single payer medicare for all plan passed at last

  19. It's a healthcare racket and they profit off the sick. They buy politicians to write the rules, legislating for them and not for you.
    …. Remedy? Don't vote for anyone (red or blue) that takes money from the Healthcare mob. Period.
    …. But how will I know if the candidate is on the take? Look up their donors at – and bonus points if you drill down to see who's really running their PAC's, goggle the search term 'who owns what'.
    …… But my Rep talks a good game and is pretty convincing…. Really? Actions speak louder than words. Look up their voting record at
    …… But I'm getting swamped (pun intended) with mailers, adverts and vidverts against M4A….. Of course you are. They don't want you to have it and they want to convince you that you don't want it either. Let them waste their money.

    If you want healthcare, then vote IN folks that want you to have it too.

  20. Our healthcare system sucks. Im old and got good ins. Becsuse im poor enough to get that. I went 28 years witjout healthcare because i had gad. P. R. E. E. X. I. S. T. I. N. G. Conditions so i was screwed. Not tgst il okd and my youthful yesrs were destroyed do now i can die healty. F those who woukd object to bealthcare fir all tgst includes. Trump and his minions of evangelical fools. Dump trumo for a christian like pence.

  21. seriously pizzes me off that if you go in for healthcare in the usa, you can get your first bill from some piece of it literally 6 months later. and if you get a bill quickly and pay it right away, it often turns out that they overcharged because the insurance wasn't totally deducted, and getting your money back is next to impossible. but if you wait to pay all the stack of bills till the dust settles, some immediately sell them to a debt collector, trashing your credit and triggering that annoying non-stop phone harrassment.

  22. In Australia your yearly premium is 1% of the salary. You don’t pay upfront. They will deduct from tax return at the end of the year. So vertically you pay ZERO.

  23. An anecdote from New Zealand: I had surgery on my right humerus for a fracture. I believe it cost the taxpayer ~$14,000 which was covered by our national health agency (ACC), i.e. fortunately enough it was completely free for me with how NZ's healthcare system works. — Inpatient service, the operation itself and follow up.

  24. I broke my neck and lived in the hospital for 14 months I can't imagine the millions of dollars that hospital bill would have been in the United States thankfully I live in Canada and paid 0. If I was in the states even with a super duper gold plan I still would have owed thousands and thousands

  25. I have a older co-worker who’s paying through the nose for several kinds of insurance. She’s a nice lady, but very republican. I told her that health insurance was a mess and she agreed. I told her it should be easier and she agreed. I told her everyone deserves good coverage and once again she agreed, but when I said that it sounded like she wouldn’t mind Medicare for All she immediately shut it down. She said what we needed was more competition to drive down the prices. I just shook my head…

  26. People in civilised nations are so confused by how Americans allow themselves to be ripped off for healthcare. When they get sick, they go to the doctor, there's no question about it.
    Meanwhile Americans know that their system is the best because… USA! USA! USA! And have to think about how sprained is my wrist really? Before they go to the doctor

  27. I have been living in the states for 8 years and i still think this shit is completely stupid and a scam premium wtf is this a gym membership? Or golf membership?

  28. I pay $45 a month, I see my Dr once a month and pay $7.00, I have 4 RX each are $3.00 each. I had shoulder reconstruction surgery, I paid $150.00 That’s it.

  29. I live in NEw Zealand and we have always had a public healthcare system. If anyone gets sick they can go to hospital, see a Specialist, be referred for surgery, or prescribed meds, (many of which are subsidised) follow up visits. All for free. It’s so great to know my parents are cared for or my child or neighbour no matter what. We are not a rich country by any means either! We all simply pay with our tax system via income taxes and GST and no matter how rich or poor we are, we all know our health care is provided should we need. USA could easily have this. Vote wisely is all I can say.

  30. One of the major problems of the healthcare system in the United States right now is people who are underinsured. They have healthcare insurance, but it doesn't meet their needs. So, for example, they will be paying a monthly premium, but when they need care they can't afford the cost of co-pays, deductibles and out-of-pocket expenses. So they forgo the care that they need, and get sicker in the process. They're basically throwing their money away on monthly premiums, because often the care they need requires them to pay the additional costs that I listed above.

  31. From Israel,here I pay about 30$ a month and I'm covered for everything basically.
    Well,not dental,but thats like super cheap in comparison too.
    America is insane. But you know,people gotta pull themselves from their bootstraps,right?

  32. Here in Toronto, Ontario just take your healthcare card to a hospital/clinic, and one is taken care of and it doesn't cost a penny. Sad to see this, David. Keep up the good fight!

  33. G'day David. Good to see the numbers. Here is a comparison to Queensland Australia. Up until about 8 years ago, my wife and I were in a private health fund. Cost = about AU$350 a month. It covered EVERYTHING HOSPITAL AND MEDICAL. Plus it covered a lot of stuff like dental, physiotherapy and other stuff like that. But the cost of dental was so high, that even after paying my health insurance and them paying part of the bill, something like a crown on a tooth would still leave me with an out of pocket expense of $1000 payable immediately. So, since we are old and on a pension, and could not afford the luxury of private cover plus extras on top, we opted out of Private health care. Since then, my wife has had a couple of minor surgeries, I have had cancer removed from my jaw, there have been NUMEROUS bloods and scans, we visit our medical GP once a month, we receive our prescription drugs for $3.50 per script and then after reaching a safety net limit, they are free for the rest of the year. We can call a number and get an appointment for dental work (maybe a 3 or 4 week wait, sometimes more sometimes less) – actually heading there tomorrow for my wife to see them. So, out of pockets FOR the operations, the scans and bloods and the GP visits = ZERO. So, when I see what you guys are going through in the USA, my thoughts are — "why do people even entertain voting for the GOP and ANY person who won't advocate for free health care? The greed in the USA is astounding.

  34. I am German, living in U.S. so due to my status as a german resident I have access to private health insurance in germany insuring me in foreign countries. In short: I have german health insurance paying the bills in the U.S.
    I pay $ 195 premium a month. I have a $30 copay for specialists, that's all. So I get dental, can get to any doctor in the U.S. (ANY doctor in ANY state), and $30 is the most I would pay.

    Case and point a family member of mine: Had an emergency surgery and had a two day stay at the ICU. Bill comes from the hospital: $ 41.000 , just from the hospital. The estimate from the doctors and specialist would be about $ 80.000. I called the insurance in germany and they took care of it. I can't imagine what would happend if I had only american insurance or if the hospital and the doctors where out of network.

    I just went to the exchange and checked prices, like I do every year. I would pay $ 485 premium a month, had a deductible of $ 7.000. So in case of the incident of my family member the price Tag would be $ 12.820 (12 month premiums of $ 485 and the deductible of $ 7.000). Sorry but I don't have $ 13.000 lying around. The american health system is broken!

  35. Thanks for the breakdown–I had done a column on my blog about healthcare as 'hostage capitalism', where the customer has no control over pricing or cost. There's nothing in this that wasn't foreseeable when Obama and friends were patting themselves on the back for the ACA.

  36. David understands that he has no control over how much he pays for health insurance. He votes for politicians to make these decisions for him, so it's up to them to decide how much they want him to pay the insurance companies these politicians take money from to represent their business interests. David doesn't understand what to do about it. Do you?

  37. It’s disgusting and sad part is that it won’t change. I say to plan a million man march for healthcare. Power in numbers!!!

  38. Well, I dont know how much you make a year, but here in canada you need to make 60k$/year to pay for your premium only if you consider how much in % of your tax goes to healthcare… and there is no deductibles or any of that bamboozle.

  39. That'll teach you to make the mistake of getting sick in America!

    Our system is atrocious. For a lot of people these numbers amount to a death panel.

  40. I've had patients refuse care because they cant pay for it so they accept that they will die because they wont put their families in debt

  41. got my leg cut off in January. found out in September my Silver plan covered none of my 20,000 dollar prosthetic leg. that's it for me. I'm over.

  42. I find it disgusting that people have to pay money out like this for being sick. The richest country in the world can't look after its citizens, disgraceful. I grew up in the UK under the NHS and now I live in France that has a different system but still universal. You still pay of course, but only if you can and nothing like the costs David mentions. It's ludicrous the lies people are being told about universal health care. You cannot have a system that's both fair on the one hand and profit based on the other ; the systems are mutually exclusive. Healthcare should be based on medical need first not profit first.

  43. Notice how David only talks about the cost of the care and not the quality of it. Medicare is junk insurance that neither he nor Bernie would ever want to be saddled with.

  44. Today I over heard a Pharmacist telling a customer that instead of purchasing his prescription, which would cost $500.00, all he had to do was buy and over the counter medicine and vitamin D. That combination was the same as the $500.00 prescription. Insane

  45. We have a gold plan too, hospitals or doctors do not even have a credit card machine, maximum cover through tax is 4000 $ a year…

  46. This doesnt make sense. If the deductible is $2000, that should be all that is required to pay for the appendectomy plus monthly premiums. What the heck does the OOP Max mean? Wouldn't that mean you pay no more than the $8000 as deductibles for any and all procedures for the year?

  47. Straya here. Another benefit of healthcare for all is that citizens are more concerned in the well being of their local hospital and services. When the word gets out that a hospital is short of equipment, staff, blood, needs an upgrade or something is amiss local politicians and leaders quickly find themselves in front of cameras answering pointed questions. Community volunteers form to raise funds and corporations donate cash and services.

  48. Check into an MSA account based insurance …it also has a tax break component where you get a tax deduction for your contribution to your MSA account…when I had one it had an $1,800 deductible and then after I paid that the insurance paid 100% …the premium started at $188 / month but by the time I gave it up for employer insurance it went up to $536 / month..

  49. I remember hearing an article that an insurance company would cover a baby because he was fat…

    Insurance companies are a scam and that is why the United States needs a complete universal health care system.

  50. My employer recently had open enrollment for its health insurance. I waived it. It's a scam to me. Monthly payments yet if you do need service. money still comes out of pocket before insurance kicks in.

  51. Wait what, 420 dollars a month and you still have deductables? I never realised quite how expensive non socialised healthcare is lol. Feel sorry for you guys

  52. hey, just for comparison:
    i am a german carpenter, i get paid ~3000€ a month, minus ~450€ in income taxes, minus ~600€ of it for my several insurances (health, retirement, unimployment, care) including ~240€ for public health insurance. that leaves me with ~2000€ a month. (numbers changed a bit for my data safety)
    my ~240€ health ensurance would cover all of your treatments and woulnd change, no matter how often i get sick.
    by the way; the premiums for public health ensurance will drop a little bit in the next years because they hav gotten a huge surplus over the last years.

  53. I am from Germany. We pay slightly under 10% of our monthly income as a health insurance “premium”, and for that we get a $0 deductible, unlimited free covered doctor’s visits, hospitalizations, medications, lab work etc. There’s never a co-pay, except you gotta pay for over-the-counter (non-prescription) drugs yourself.

    When I moved to the US a few years ago, I knew the system would be veeeeeery different but I was still shocked to see that people here were all paying thousands in their premiums alone, and THEN have a deductible and co-pays on top of that. The system is insane. We need Medicare For All or something similar.

  54. My recommendation is to have it done in Cuba just take a trip out there it'll be a lot cheaper they have top-notch medical facilities and they will take care of you for free.

  55. Insurance based healthcare systems suck on every level. Thank fuck I live in the UK where if I get seriously ill or injured I know I will get (the best) treatment and don't have to worry if I'm covered or about going bankrupt from the bill if I'm not. I don't understand why Americans put up with the scam that is the insurance based healthcare system, you guys are getting screwed top to bottom when it comes to healthcare, why do you accept it?

  56. Had Thyroid cancer, A hip replacement and then a knee replacement. Total cost 0$. After talking to friends in the states it's my understanding that would have cost over $100,000 . Thats why I love being Canadian. The "wealth" care system in the states is f-cked

  57. Where are people getting these shitty health care plans? My primium is $195 every 3 months and no deductable. I pay 0 co pay for in network and$20 for out of network. Sounds like you guys need to get better plans.

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