Anyone else over 60 that has been priced out of the Marketplace? Anyone else considering just not having insurance?
Looks like I may be $680 over to qualify for my previous subsidy. I paid $550 per month for a crap policy but now am staring down the possibility of no subsidy, $1400 per month for crappy insurance. I can self pay routine stuff, but I don’t qualify for catastrophic coverage. I will be 65 in March of 2027. Anyone else in this boat?HidingoutfromtheCIA
Get a bronze plan and open a HSA. Drop a few grand in it and lower your MAGI below the 400% federal poverty limit and regain your subsidies.jhkayejr
A bronze plan for me is $1,700 a month. The idea that I’d then also be able to put money in a HSA is insane.LadyMaggieMae
Unfortunately that exact plan leaves me $680 over. With the smidge of SS COLA, my modest pension fund and again modest interest rates the $4400 HSA will not get us there[deleted]
This. You can actually put $5400 in your HSA since you’re over 55. It sounds like you don’t have earned income, so IRA/401k contributions wouldn’t be an option for you. Also, if you take the standard deduction, starting in 2026, you can do an above line deduction for charitable contributions ($1000 if filing single; $2000 for married filing jointly). That’ll reduce your MAGI. Edit to add: the charitable contributions have to be cash. Thanks for the clarification below, PeacefulCW.Responsible-Bid5015
For you the HSA contribution limit is $5400 in 2026. You can also look into using the BOXX ETF for some of your cash savings to get extra margin. Note there is some risk to BOXX since the IRS has not really decided if it is a valid scheme. BOXX pays capital gains on withdrawal but no interest/dividends. So if you withdraw the full amount next year, there is no benefit.
Tag: Health Care
Health Insurance Rates Going Up – Way Up
For weeks, policy experts and some political leaders have warned of a tsunami of high costs and worse access coming for the health care of ordinary America because of sweeping policy moves made in Washington.
Coloradans who get their insurance on the individual market — which is about 282,000 people — got a first glimpse of it on Wednesday after the state’s insurance division dropped preliminary annual insurance rates for next year: Average premiums will rise 28 percent for 2026; on the Western Slope, they could climb as high as 38 percent on average, and higher than that for many.
Colorado health insurance rates expected to skyrocket after budget bill slashes health spending
Notes on Medicaid and Rural Health
Or they’re just very humble and they don’t want to take something they can’t pay for at one night clinic. This story has always really stuck with me. A woman in her forties came in to the night clinic. She’d never been seen in our clinic before because of a complaint that people in the choir wouldn’t stand near her. Hmm. And she had started having an odor that made her unpleasant to be near and she’d avoided healthcare because she couldn’t afford it.
And she was a housekeeper. She had no access to any health insurance and didn’t wanna bankrupt her family. And so on exam that night, she had a breast cancer that was so advanced that had grown through her skin and that’s where the smell was coming from. Wow. And she, she ended up dying a few months later. We could have, if she’d gotten mammograms, you know, like we could have caught this very, very early and treated her and she would’ve gone on to be there for her family. But her fear of bankruptcy for seeking healthcare, or maybe it was, you know, she just didn’t wanna take services from someone else. It’s hard to know what keeps people from walking in the door.
One Rural Doctor on the Cuts to Medicaid
The Daily Podcast transcript
Health Care Reform Attempt – $7.50 Shot vs $75 Shot
Gruber: Yeah, that’s a great question. And I think that, ultimately, it’s providers. First of all, if I was the health-care czar, I wouldn’t just pay what Europe pays. I would do a study of what’s the value of a hip replacement, and I’d pay according to that study. Answer one. Answer two is, who’s going to scream? It’s going to be providers, in particular the specialists and the hospitals. And let me tell you a story that illustrates that, Derek. If you get a shot, a drug injected at the doctor—not one you buy at the pharmacy, but an injectable drug, like for cancer, at the doctor—the way the government reimburses you under Medicare, that’s our universal coverage for the elderly, is the doctor gets paid 7.5 percent of the cost of the drug.
So if I give you a shot, Derek, that costs $100, I get $7.50. If I give you a shot that costs $1,000, same effort, same risk of carpal tunnel, I get $75. That’s stupid. That makes no sense. So 20 senators wrote a letter to President Obama saying, “Look, the system’s broken, we should fix it.” So President Obama and his advisers came up with a new system where doctors would largely be paid a flat amount per shot. Budget neutral. We paid the same amount of money to doctors in total, but you get a flat amount per shot. Shortly thereafter, 80 senators, including most of the original 20, wrote a letter to him saying, “How dare you propose this radical revitalization American health care? You must stop this at once. It’s socialism.”
What happened? Well, the oncologists, the cancer doctors, are the ones that give the $1,000 shots, and they got upset and they lobbied. That is the challenge, Derek.
Why American Health Care Is a “Broken System”
plain-english-with-derek-thompson
AI Transcription, Problems With
SAN FRANCISCO (AP) — Tech behemoth OpenAI has touted its artificial intelligence-powered transcription tool Whisper as having near “human level robustness and accuracy.”
But Whisper has a major flaw: It is prone to making up chunks of text or even entire sentences, according to interviews with more than a dozen software engineers, developers and academic researchers. Those experts said some of the invented text — known in the industry as hallucinations — can include racial commentary, violent rhetoric and even imagined medical treatments.
Experts said that such fabrications are problematic because Whisper is being used in a slew of industries worldwide to translate and transcribe interviews, generate text in popular consumer technologies and create subtitles for videos.
More concerning, they said, is a rush by medical centers to utilize Whisper-based tools to transcribe patients’ consultations with doctors, despite OpenAI’ s warnings that the tool should not be used in “high-risk domains.”
Researchers say an AI-powered transcription tool used in hospitals invents things no one ever said
Losing Your Job and Your Insurance
Fired after telling HR I needed surgery. They cancelled my family’s insurance immediately.
ETA to answer some questions: I submitted an inquiry with EEOC. I have to wait for my interview in February to sue them. I can’t afford a lawyer, and none I contacted will do a contingency plan. I can’t afford COBRA, I don’t have a job. I am filing unemployment today. They fired me 4 days before the end of the month.It’s absolutely fucking insane that a job can just ruin your life on a weekday for something that had never been brought up prior. So now not only am I getting MORE sick from my surgery having to be cancelled, my oldest child has a cavity that she was supposed to be getting fixed next week and I will have to pay $400 out of pocket to do so when I have no income. Medicaid is backed up with applications, so all I can do is hope I’ll somehow get reimbursed.
I HATE IT HERE.
https://www.reddit.com/r/antiwork/comments/1fw07rf/fired_after_telling_hr_i_needed_surgery_they/
Valiant-Jellyfish
I was fired the day I had to get a biopsy for cancer. 3 weeks before Christmas. They canceled my insurance that day. No biopsy. Do I have cancer? Who knows.
Ok-Accountant5973
My brother was Fired the same day he told his manager that he had been diagnosed with lung cancer 2 weeks before Christmas. He had 2 small children and one on the way when they did that to him. They also gave him a week to move because the apartment he living at was at the same apartment complex that he worked at.
kearneycation
As a Canadian, having your health insurance tied to employment just seems so wild to me. This sucks, I just feel bad for y’all.
I was hospitalized a couple years ago for two weeks: had a chest tube inserted, had to have regular MRIs, xrays, blood work, etc. Had pain meds when I needed them. A follow-up a month later then again two months later.
I didn’t have to think about money once the entire time. When I was discharged I was just discharged, no talk of insurance or a bill or anything. It was stressful enough, the last thing I needed was financial stress on top of it.
Messing Up Your Insurance Paperwork – Hazards of
It Shouldn’t Be This Easy to Lose Your Health Insurance
By Danielle Ofri
Dr. Ofri is a primary care doctor in New York City.
“I’m sorry, Dr. Ofri,” the representative said, rechecking her records, “but you didn’t enroll this year.”
Could that be? Could I have somehow forgotten? Or missed the notification? “But don’t worry,” she said. “We’ve put you on the basic plan.”
“OK,” I said, starting to relax and thinking out loud. “I guess my kids will get to meet some new doctors.”
But the representative did not match my tone. “I’m sorry, but the basic plan is just for the employee,” she said, “not your family.”
That’s when a coil of disbelief clamped my heart to a standstill. My spouse and children would be left without health insurance? The panicked questions quickly percolated: What about their ongoing medical treatments? What about their medications? What if someone got hit by a car, or got cancer? There’s hardly a more devastating feeling for a parent than to realize that you haven’t adequately provided for your family.
from the comments:
Diane
Richmond
In 2015, I was sued for the first time in my life–for failing to pay for routine blood tests. I was sued for $600, then assigned $300 in court fees. I called the insurance company: aren’t these test covered by my very high (yet these days “normal”) monthly premium ? Yes, but I had failed to tell them my new group number, assigned by them. I was bemused. If you assigned it, don’t you have it? Yes, they said, but you had to confirm it. I spent hours on the phone to get someone with authority to reverse the $600 charges. They did, only after I explained I would sit on the phone (I was hung up on multiple times) until I cost them more than $600. I was given a “confirmation” code. It was a lie–the person who gave it was not “authorized” to cancel my charges. I got a lawyer–he said pay, for the law is on their side, and it is only $600. I did, but was deeply horrified to be in a system that is rigged to allow legal robbery for obscenely flimsy reasons. All said, this doctor is not alone, and all of this must stop. We must have sane, not-for-profit medicine. I am aware too this happens to the poor all the time. No wonder the inchoate rage.Mark
PA
As a psychologist I can attest to this phenomenon from the other side. I’ve had patient’s claims rejected for the flimsiest reasons. Each time, I was told that they acknowledged their mistake and would happily resubmit the claim, only to have it rejected for the next flimsy reason: diagnosis code 300.4 vs 300.40, no license number on the invoice (right there in the letterhead), no NPI number (not required), etc. I’ve spent hours on the phone advocating for my patients to get reimbursed, usually to no avail. And each time, the insurance corporation gets to hang onto the patient’s money a little longer and earn interest for another month.LovelyAfterMidnight
USA
I’m a physician too.
I lost my health insurance when I was 36 weeks pregnant over 36 cents.
At the time, I was working as a contractor. I foolishly bought my insurance through the ACA exchange to support it as a new government program. $3,500 deductible had been met. One day, I went online to pay my premium and my account was gone.
When I called, they said my payment from the previous month was short 36 cents (I switched the cents on the check.)
“If you had bought your insurance directly through the insurance company, we would have just let you pay the 36 cents and re-instated your policy.”
“But because you used the ACA, it only gives 30 days for payment, and if you don’t pay within the 30 days, the policy is terminated.”
No amount of begging, crying or calling changed this situation.
Kaiser Permanente Strike
75,000 Kaiser Permanente workers walk off the job. It’s the largest health care worker strike in US history
CNN
On Wednesday, more than 75,000 unionized employees of Kaiser Permanente, one of the nation’s largest not-for-profit health providers, walked off the job, marking the largest health care worker strike in US history.The striking employees, who work across California, Colorado, Washington, Virginia, Oregon and Washington, DC, are represented by a coalition of unions that comprise 40% of Kaiser Permanente’s total staff. The vast majority of the striking workers are in West Coast states. The strike began at 6 am local time, and will run through Saturday morning.
Losing Your Job Because You’re Sick Then Losing Your Insurance Because You’re Unemployed
There are plenty of cases in this book where you find just frustration with the way our health care system works or does not work. You know, one interesting story you tell is of a woman who comes into the emergency room. This is not during the COVID days. She comes into the emergency room, and she wants chemotherapy treatments, and she knows she has cancer. And in fact, she has detailed instructions from the oncologist who has been treating her. Why was she coming to the emergency room?
NAHVI: Well, she came to the emergency room because her oncologist had stopped treating her. So what her story was – she was a young lady. She was diagnosed with cancer. And then she started getting treatment for her cancer with an oncologist at a private – not-for-profit but private institution. And then what happened was that because of her chemotherapy and her cancer treatments, she took too many sick days from her job. So she ended up losing her job. Then she lost her health insurance because of losing her job.
So her chemo – her oncologist wasn’t able to see her anymore because she didn’t have insurance anymore. So he or she referred this patient to our hospital, which was a public hospital where I was working at the time. She didn’t understand that she had to go see an oncologist. So she just came to the emergency room. And I thought there was a misunderstanding.
I saw her, and I said, you know, I’m an ER doctor. I – if I could treat you, I absolutely would. I just don’t have these tools. I don’t have that capability. And then we ended up kind of going from there. But that’s how she ended up in the emergency room with me.
DAVIES: But it’s interesting – I mean, it would take her, I think she said, weeks or months to get an appointment with an oncologist. And she knew that if you come to the ER, they have to treat you, right? I mean, so she figured, hey, you can’t send me away.
NAHVI: That was what she told us, yes. She said that she was familiar, that there was some law out there, that if you are uninsured under any circumstances, you come to an emergency room, we have to treat you. And she’s right. Except the caveat to that, which kind of is what made me so uncomfortable at that time, was that she had a great understanding of the situation, except that what we have to do in the ER is stabilize you, not necessarily treat you. So you have to be evaluated by law. And whatever we can do to stabilize you, we have to do.
In the eyes of this legislation, she was stable. So she had cancer, and she was dying, but she was dying slowly. She wasn’t dying quickly. So she was technically stable. And it became this kind of horrible thing that I had to explain to her that, yes, you’re protected by this law and yes, you have cancer and yes, you’re dying, but I can’t help you.
An ER doc reflects on life, death and uncertainty in the early days of COVID-19
Fresh Air
Insulin – Unaffordable to Many in US
A study in the Annals of Internal Medicine found that in 2021, nearly 1 in 5 adults in the U.S. with diabetes either skipped, delayed or used less insulin than was needed to save money. That comes out to roughly 1.3 million adults, or 16.5% of those who need insulin.
…
“In the ICU, I have cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving drug,” said the study’s lead author, Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance in Massachusetts.“Universal access to insulin, without cost barriers, is urgently needed,” he said.
Starting Jan. 1, the Inflation Reduction Act, signed into law by President Joe Biden in August, will cap the monthly cost of insulin at $35 for seniors on Medicare. The bill, however, will leave out millions of Americans with private health insurance as well as those who are uninsured.
Nearly 1 in 5 U.S. adults with diabetes ration insulin to save money, study finds
Young adults and the uninsured — those who will be left out of the Inflation Reduction Act’s monthly insulin cap — were the most likely to ration their medication.
Berkeley Lovelace Jr.
NBCNEWS
Tears Will Cost You Extra – Health Care Bill
County General on Saturday Night
I put down her chart. He was right. A bullet through the abdomen wasn’t the worst case. It was nothing. Something that would wait till morning. There were people who were worse, people who had been run over by cars or stabbed in gang fights, people with multiple gunshot wounds, people who wouldn’t survive if they didn’t get immediate attention. And this was the judgment residents had to develop in a MASH unit like this.
As we walked away, he said, “You’ll get used to it. You’ll learn to do it.”
I thought, No, I won’t.
I was wrong. I very quickly saw more than I ever imagined, and came to realize that doctors are basically biological repairmen, especially in inner-city hospitals on violence-riddled Saturday nights. On my first night at County General, I treated a guy with a penis the size of a football. It turned out he’d been shot in the ass, and the bullet had exited through his penis. After a few Saturdays, though, I learned that two things could be predicted with 100 percent accuracy: If you asked anyone with a knife wound what happened, they’d say, “I don’t know.” And if a person had something stuck up their butt—which in my experience included lightbulbs, broomsticks, and grapefruits—they’d explain, “It was an accident. I sat on it.”
Pinsky, Drew. Cracked: Life on the Edge in a Rehab Clinic
50 Years of the War on Drugs
Hinton has lived his whole life under the drug war. He said Brownsville needed help coping with cocaine, heroin and drug-related crime that took root here in the 1970s and 1980s.
His own family was scarred by addiction.
“I’ve known my mom to be a drug user my whole entire life,” Hinton said. “She chose to run the streets and left me with my great-grandmother.”
Four years ago, his mom overdosed and died after taking prescription painkillers, part of the opioid epidemic that has killed hundreds of thousands of Americans.
Hinton said her death sealed his belief that tough drug war policies and aggressive police tactics would never make his family or his community safer.
Brian Mann
Morning Edition
Go Fund Me as Health Care Finance
‘Why Is It So Expensive?’
We Asked People From Around the
World What They Think of U.S. Health Care.
Video by Chai Dingari, Adam Westbrook and Brendan Miller
From the comments:
Nan
One day I had a serious hemorrhage and was taken to a nearby public trauma hospital via an ambulance. As the doctor was frantically trying to stop the bleeding in the emergency room, I kept rambling incoherently (under powerful anesthetic) to confirm that the hospital was “in network” – the healthcare workers reassured me “you are fine.”Zezee
When my friend fell and couldn’t get up she insisted that no one call an ambulance. She called her brother and waited – in excruciating pain – but she was more afraid of the cost of the ambulance.Jim
I worked for a major medical company (Think of big health insurer they are all the same) when Obama care came around. Did we worry? Nope, because their profit was built in. healthcare companies just wanted to “reject” preexisting conditions . We knew, all the health plans would go up…listening to our “elected officials”, us lemmings in the office KNEW IT WAS A LIE… everyone knew the cost of insurance would GO UP.We had unpaid claims that sat in our database FOR YEARS, never paying them because in a decade…that 50k is cheaper to process and it would just stay in a “round robin” appeals process that goes on forever. (literally we had claims that SAT unpaid for a decade or more because paying a 50k or 1 million dollar claims/debt from 10 years ago is cheaper, we talked about it openly)… All our executives made huge paychecks, huge paydays….. Its ridiculous. Meanwhile the rules are made by companies to pay as little as possible…I loved working for an insurance company, I had the Cadillac of Cadillac of insurance…. Literally it was the only redeeming quality .
Goldman Sachs and Chris Rock on Health Care Profitability
Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering “gene therapy” treatment: cures could be bad for business in the long run.
“Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.”
“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients Tuesday. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”
Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’
Tae Kim
PUBLISHED WED, APR 11 2018
Nothing’s been cured in my lifetime. Nothing. The last thing they cured was polio and that was during the first season of “I Love Lucy.”
At least they’re still working on AIDS. They won’t cure it, but they will figure out a way for you to live with it. They won’t fix it, they’ll just patch it up. Their hope is that one day someone will say, “How come you weren’t at work yesterday?”
“My AIDS is acting up. You know when the weather gets like this, my AIDS just pop up. But I got me some Robitussin and I’m fine now.”They don’t want to cure anything because the money is in the medicine. It’s like anything else. You think Cadillac can’t make a car that lasts a lifetime? Sure they can. But there’s no money in that.
“We need people to come back. We’ll make a car that lasts seven years. After that, shit’s gonna fall off.”
Diseases are just piling up. People still get cancer, sickle cell, tuberculosis, Jerry’s kids still limping around.
Cure some shit. Get rid of it.
Rock This!
Chris Rock
April 19, 2000