Ever since publishing, How To Get Health Care Subsidies Under The Affordable Care Act, I’ve been feeling a little left out. In order to help others get health care subsidies, my family has been paying our full health care costs.
It is an honor to help others, so I don’t mind. However, after not visiting a doctor for five years and paying about $100,000 in health care insurance premiums, I decided to see if I could get my money’s worth.
For three months, I tried to get more health care coverage per month than what I was paying. But I fell short. This failure to get my money’s worth is one of the reasons why I’ve decided to downgrade my plan to Gold from Platinum.
Getting Enough Health Care To Warrant The Cost
In 2018, my family paid $1,760 for a non-subsidized platinum healthcare plan. This adds up to $21,120 a year after tax.
Given there were three of us, my health care expense share was $587 a month. For five years, I hadn’t seen a doctor. So I decided to do the following:
- Get a full physical
- Get a chest x-ray
- Go to see my primary care physician for a cold
- Go to the orthopedic surgeon to get advice on my shoulder, elbow, and knees
- Get an MRI for my knees and right shoulder
Surely, I was going to get my money’s worth with these five things!
Month #1: Getting A Physical
Before 2018, the last time I got a full physical was in 2013 when I was 36 years old. They say after you turn 40 you should get a physical every year. And after you turn 50 you should get a physical every year and a colonoscopy.
The estimated cost of the physical was $300, not enough to cover my $587 monthly share of health care premium costs. What I later realized was that getting an annual physical is free – no co-pay or co-insurance. A physical is considered preventative maintenance that is offered for free with most plans.
Therefore, for five years I had given up this free benefit worth $2,100. But that’s OK. I’m happy to not get physical because physicals are no fun.
Month #2: Went To The Doctor For A Cold
After I got a physical, I got a cold the next month. Instead of just resting and drinking plenty of fluids like I normally do when I have a cold, I decided to pay my doctor a visit. The doctor’s visit cost $100 plus a $20 co-pay.
I was having trouble breathing after speaking more than a couple sentences. When I was a kid I had asthma and it felt like I was relapsing a little. Instead of just waiting out my cough, I asked him for a script to do a chest x-ray.
The chest x-ray cost $400 and there was 20% co-insurance so I had to pay $80. Thankfully, nothing sinister showed up in the chest x-ray and my breathing eventually got better.
The total value of my second month of trying to get my money’s worth was about $500, still $87 below the cost of my monthly premium.
Month #3: Visited An Orthopedic Surgeon
In the third month, I decided to go to an orthopedic surgeon to check out my right shoulder and left knee.
In 2003, I went to an orthopedic surgeon to see why my knee buckled occasionally when I walked up stairs. We did an MRI and it showed I had a small meniscus tear. But the ortho didn’t recommend surgery if I wasn’t in chronic pain. So I decided to skip surgery and see if my knee would get better. It did.
For my health care experiment, I decided I wanted to get a checkup on my knee. Further, my right shoulder started clicking and was sometimes uncomfortable to hit a high topspin forehand or serve. Throwing a softball didn’t feel good either.
The orthopedic surgeon visit cost about $150 for 15 minutes of his time plus a $20 co-pay. In the end, he wanted to give me two cortisone shots. One for my knee, one for my shoulder. I decided why not! If that’s what the doctor ordered, I might as well listen.
Each shot would cost my insurance company about $250. At last! I was finally going to get my money’s worth for the month!
But when he came back with the two big needles and I saw the amount of cloudy fluid in each syringe I chickened out. Come on now. I wasn’t in that much pain. Further, I did some Googling while he went to prepare the shots and found some iffy feedback.
The Cost Of An MRI Is Absurd
Given I passed on the cortisone shots, I asked my doctor if I could get an MRI on my right shoulder and left knee. I wanted to see if there were any issues first before deciding on treatment. He said no problem.
However, the ortho said he would write a script for the knee first and then another one for the shoulder in three months. He said based on experience, insurance companies often deny more than one MRI at a time.
I discovered from the MRI billing department that each MRI cost $3,500. Score! I was finally going to feel great about my health insurance premiums.
I was about to go to the MRI center when my wife knocked some sense into me. She said, “You know we have a co-insurance of 20% right? Better check our insurance provider to see what your out-of-pocket cost would be.“
I did what I was told and I found out I would have to pay $700 out of pocket (20% of $3,500). Damn, foiled again! I cancelled my appointment and decided to wait until I was in significant pain.
I could have received about $4,000 worth of medical care in month three. In the end, I only received $150 worth of care from my one orthopedic surgeon visit. The 20% co-insurance really does save insurance companies money.
If my share of the MRI cost $200 or less, I probably would have gotten one. 10 years is a long enough time to wait.
The Affordable Care Act Is Expensive
Unfortunately, the Affordable Care Act has done nothing to keep my family’s health care costs affordable.
The same Platinum plan that cost us $1,760 in 2018, would now cost us about $2,160. That’s a 23% increase, which is supposedly relatively good.
But given we have another child, the Platinum plan now costs $2,532 a month for a family of four! We decided $2,532 a month was too much and downgraded to a Gold plan instead for $2,212 a month.
To save money, we will maximize our “free” annual preventative care visits. I’m assuming we can save money by going for an annual checkup when one of us has some health issue so we can get two consultations for the price of nothing. The better the relationship you have with your doctor, the easier it is to slip some health-related questions during the physical examination.
If we are lucky enough not to have a health issue that requires seeing a doctor, then we’ll each get an annual physical anyway.
To save money, we will also pre-order 3-months worth of prescriptions by mail during the last month of our existing plan.
Given the ACA is so expensive for us, I do wonder whether we have any downside if the ACA was abolished. But again, we must think about the greater good.
The Solution To Affordable Health Care
There is one solution to lowering your health care premiums worth considering. Invest in your health insurance provider’s stock. After all, if you can’t beat them, join them.
I decided to invest in UnitedHealth Group (UNH) five years ago as a hedge against rising health care insurance costs. So far, the investment has worked out. Unfortunately, I didn’t invest nearly enough. Take a look at the chart below.
UnitedHealth Group will generate over $240 billion in revenue a year. Further, UNH’s CEO, David Wichmann makes about $20 million a year, which includes stock compensation.
The health care system is meticulously set up to extract as much money from you to make health insurance companies rich. Therefore, you might as well invest in these atrocious beasts.
It’s Best Not To Get Your Money’s Worth
Although I’ve paid far more for health care insurance than I have received in health care benefits, that’s a good thing. None of us should want to get sick just so we can get our money’s worth.
Instead, for those of you who are paying high premiums, it’s best to just accept that it is our responsibility as patriotic Americans to subsidize the poor and less healthy. Chant in your head, USA, USA, USA every time you get you massive health care bill. If you can make money from your health insurance company’s stock, even better.
Yes, it is kind of irksome there are multi-millionaire early retirees who are receiving health care subsidies. We know subsidies are not meant for them, yet they still take advantage. However, feel good knowing that at least your income is high enough to provide for a more comfortable lifestyle.
Unfortunately, everybody’s health care premiums will likely continue to go up by at least 6% a year. Even if you are an employee with tremendous health care subsidies, this cost to the employer comes out of your paycheck.
All of us need to do our best to eat better, exercise more, and work on our mental health. Too much stress does a body bad. We also know 7+ months into a pandemic that COVID-19 is much harsher on those who are obese.
When You Need Health Care, Go
If you are experiencing significant health issues, forget about the cost of co-insurance and your co-pay. See a health care provider ASAP. Call 911. Go to the ER. Take that ambulance ride, no matter the cost. Your bill will be expensive, but at least most of the cost should be covered by health insurance.
Chances are high that you won’t need to repeatedly go back and see a doctor for your health issue. Make those one-off visits count. If you do need to see your doctor for many years, then at least feel good knowing that you’re finally getting your money’s worth.
Last Piece Of Insurance Advice
Don’t forget that every time you get treated for a health issue it will be recorded on your medical records. If you are looking to get a new life insurance policy or renew a life insurance policy, you may get hit with higher rates.
Because I wanted to check out this new sleep center years ago, I go riddled with sleep treatments that ended up jacking up my life insurance renewal rate. Therefore, make sure to get life insurance before seeing a doctor. You’ll likely save a lot on your life insurance premiums if you do.
Readers, have you ever got your money’s worth for the health insurance premiums you’ve paid? If so, maybe you can share what your bill cost. Do you think there is any solution to keeping health insurance premiums from rising?