Tag: Insurance

Affording Health Insurance in the US. Over 60 But Too Young for Medicare.

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.

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

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.

See also:
Fighting the Insurance Company – Example of

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

Cost of Health Care in the US – Some People’s Experiences

Trump Took Credit for Making Insulin “So Cheap It’s Like Water.” Tell That to People Paying For It. from politics

BOOFIN_FART_TRIANGLE
With good insurance my insulin, pump, and glucometer supplies cost over 650 per month.

REO_Jerkwagon
Pretty much. I didn’t mind my insurance at my old job. Never went to the doctor either. When I *did* end up having to have stomach surgery, I quickly learned to hate my insurance company. Tried to tell me hernia repair was fucking elective.

foxnkatz
Yeah that’s ridiculous. A similar thing happened when my wife had appendicitis. They said it was going to burst and as such would have to remove it. Insurance tried to tell her it was elective so they wouldn’t be covering the $77,000 hospital stay. Very crazy.

Deadsolidperfect
I’m a teacher and my insurance SUCKS! I had to pay 10k out of pocket 2 yrs in a row for random medical issues. We have a lot of teachers that are much better off on their spouse’s plan. I’d love to see what a good plan looks like

scrapmoneybenny
It costs $6 for a 3 month supply of insulin, here in Australia. That’s what’s cheaper than water is Trump, not $300 a week 

BOOFIN_FART_TRIANGLE
There are people from the United States in Southern California that open up pharmacies in Tijuana Mexico specifically for the diabetic market in San Diego. In Mexico, they can sell all types of insulins for pennies on the dollar. Less than what a copay is in the United States with excellent insurance. People drive down there and buy insulin, from a pharmacy owned by someone that lives in the US, for cheaper than what they can get it in the US for. It’s stupid.
… Decent plans disappeared long before the aca. They were well on their way out in The late 90s and early 00s (prolly even before that). I owned a business around 2004, and the overhead for employees to get healthcare was so astronomical, that it’s literally the only reason why we kept everyone as private contractors.

Quesoleader
I had the gall bladder removed about four years ago. Still paying off the 20k portion of my bill. It was more (45k) before I fought them over “choosing” out of network doctors when the hospital emergency room I went to was in network.

What People are Paying for Health Insurance

In California, one person told me that the cheapest insurance they could find — for one person, with very little coverage and a high deductible — goes for $330 a month.

I talked to a dog walker in Seattle who pays $675 — without dental coverage.

Another person reported that their bargain basement plan in Minnesota costs $250 a month.

In Dallas, $378 a month for a catastrophic plan with a $10,000 deductible.

And that’s if there’s just one of you: A freelance writer told me she’d had breast cancer, and her husband, a freelance photographer and photo editor, is an insulin- dependent Type 2 diabetic. They live in suburban New York, and currently pay $1,484 a month for coverage.

Anne Helen Petersen, BuzzFeed
How The Gig Economy Screwed Over Millennials

Fighting the Insurance Company – Example of

After My Son Suffered a Traumatic Brain Injury, I Was Told Insurance Would Cover His Medical Bills. I Was Dead Wrong.

When RJ was discharged from the ICU after three weeks, he was transferred to a rehab facility. After he got there, they called me on the phone and said, “Your insurance company called and said RJ’s rehab benefits are up on Friday.”

I said, “No, no, no, no. That’s covered. I was told by my insurance company that this facility is covered for at least 60 days and possibly more. We have more time.”

But all I had was a voice on the phone. Without written proof, without the summary plan description, I couldn’t prove it. So when the rehab facility got another call from my insurance telling them these benefits had lapsed and I couldn’t prove otherwise, I went to the facility and I asked, “Where am I supposed to take him? He’s in a coma.” I remember a social worker telling me I could look into foster care.
…
Months passed, and I still couldn’t get the summary plan description. I kept calling my insurance company, and they’d be telling me my benefits, and I’d say, “You’re giving me information that you’re looking at. Give me, like, a screen grab of your computer screen.” But they wouldn’t do it. They kept telling me it was being “revised.”

I did some research, and I found out that under a law called ERISA—the Employee Retirement Income Security Act of 1974—I was entitled to the details of my insurance policy.

So I called an ERISA lawyer and told him the situation, and he said, “I can help you, but you’re going to have to give me a retainer of $30,000.”

Stephanie Peirolo
First told at a show by the Moth, the live storytelling group, at the Neptune Theatre in Seattle
Readers digest: https://www.rd.com/true-stories/survival/when-insurance-stops-paying/

Stephanie Peirolo is executive director of the board of the Health Care Rights Initiative, a nonprofit providing advocacy and navigation services for patients and caregivers. This story was excerpted from All These Wonders.