I have never purchased my own health insurance; 38 years old, and this is the first time I am getting my own. In this post, I will torture you with how I got my own health insurance and share my 2-week long experience trying to finalize it.
Overall, the process isn’t as bad as dealing with the IRS but on par with dealing with the DMV. There isn’t much paperwork to sign up, which is nice.
Where to Shop for Health Insurance
I dislike PPOs, which I’ll get into in just a bit, and since their prices were higher than the HMOs I opted for Kaiser.
Private insurance groups can offer plans which aren’t advertised on healthcare.gov, though I will get into why this is sort of useless for the majority of us. They are often “catastrophic” plans that we won’t qualify for.
I didn’t bother contacting insurance brokers because I knew that I would never stop getting hounded by them once they got a hold of my information. Dealing with the exchange has already proven to be quite disruptive.
Healthcare.gov is the home for the healthcare exchange, the birthchild of the ACA. Any insurance groups that participate will be listed on here.
Overall, the website is very well designed, easy to navigate and you have the option of shopping without entering your personal information on there.
I highly recommend NOT entering your information on there until you know for sure that you want to sign up, because let me tell you, it’s a fucking barrage of phone calls and emails and text messages once you enter your information on that website.
There were only 2 companies in my state, for my zip code, that offered health insurance on the exchange, Kaiser Permanente and Providence.
You can’t get dental insurance through the exchange, or perhaps you can, and I was too dumb to figure it out.
The cheapest monthly premiums I found on the exchange were somewhere around $230/month – this was in 2017 when I wrote this. In 2023 it’s $400+.
The terminology is incredibly hard to figure out. There is a ton of jargon, and you would think it’s as easy as looking at a glossary, but it’s not that simple. It’s all legal jargon, designed quite intentionally to throw you off, forcing you to choose the higher-end plans.
ACA & Guaranteed Price Hikes
I’m adding this bit in 2023 – this is the first time I learned that back when the ACA went into effect insurance companies were capped at 20% towards profits.
If you’re a health insurance company what would you do to guarantee more profits? You’d want the cost of healthcare to go up and so you can justify charging more.
That’s exactly what has happened since the ACA.
Kaiser Permanente Insurance
I shopped on Kaiser’s website to see if other plans were available. I found one that was $220/month, it was labeled as ‘catastrophic’ insurance but frankly, it wasn’t much different from the other bronze plans out there.
I decided to sign up for this ‘catastrophic’ plan, went through the application process, and got it all done. 2 days later, I got a message saying there is a message; I clicked on the message link and got another message to open that said: “you have a message.” Enter the twilight zone.
Needless to say, a 6 yo child designed the KP website for signing up for insurance. I had to log in manually to figure out what was going on. Basically, they denied my application because I had to meet certain criteria for the catastrophic plan, which they didn’t mention on their website when I first applied.
Fine, I applied for the next level up, the cheapest Bronze plan is available for $228/month, also available on healthcare.gov.
I added a dental plan not so much because I wanted one but the laws surrounding open enrollment are so confusing and vague that I would rather have it than be stuck without one later in the year.
I’m a fanatic when it comes to healthcare delivery, KP being one of the better ones out there that I’ve known about and personally worked for.
But KP is also the worst place to be a patient who actually cares about their health. It’s a cash cow, it’s a farm, it’s a factory, and it’s a system with so much administrative burden that only a few patients can navigate it.
Too often, in the private insurance world, patients are getting scammed by greedy hospitals, ERs, and specialists. Where a patient needs reassurance, they are admitted for observation. Where they need outpatient observation, they are pushed into having surgery.
HMOs aren’t always that much better; their cost-cutting antics can put patients at risk in other ways. Thankfully, due to the patients’ voices now readily visible online, fewer such groups are willing to shortchange patients.
KP will get you the most efficient care but not the best care. They’ll get you access but you get timely access only after raising hell.
This is from a doctor who worked there for many years and was a medical director.
Any insurance plan you shop for will have a ton of insurance jargon. It’s not just words you don’t know the meaning of; it’s how they are strung together.
Sure, I know what the shit a copay is and what coinsurance is, but depending on whether it’s followed by before or after deductible it will make a huge difference.
Some fields aren’t even filled in. I was using the “compare” tool to look at 3 different plans side-by-side; some columns were empty – open to interpretation, perhaps?
Ponder this, the ACA cleaned up a lot of this terminology bullshit, can you imagine what it was like before? What a fucking mess. A mess that I’m a part of as a physician – that’s almost worse.
It’s quite obvious that this is intentional, not to sound like a conspiracy theorist, but the cheaper plans have so much wording that you forget it’s health insurance you’re buying. The more expensive plans have essentially 2 words, copay and deductible.
Health Exchange vs Direct Purchase
I view the exchange in the same light as hotels.com and Expedia. Once you purchase something through these 3rd party vendors, you are screwed when it comes to making changes – one entity will blame the other and you’ll be stuck in the middle with no recourse.
I decided to buy directly from KP.org because I know that I can go to a physical location and discuss any grievance or confusion I may have.
The exchange also wanted me to prove that I’m a citizen, so they sent me this packet which I had to fill out and send back copies of my passport. I’m not sure if Kaiser will ask me to do the same later, but I don’t care for handling more paperwork.
My Healthcare Strategy
I am grateful for the advances that medicine has made, but I’m also not very fond of the FDA or the animal testing needed to advance healthcare for the human race. The medical-legal scene is corrupt and backward, forcing some clinicians to practice out of fear.
Currently, I don’t take any medication, neither prescription nor OTC. I consider myself vegan though I don’t care too much about such labels, it’s all fluff, in my opinion.
How can you be vegan when you depend on medications, immunization and medical devices, all of which have been tested on animals? It’s silly. But as a so-called vegan who doesn’t want to cause harm to animals, I am not fond of taking medication.
What if I get in a terrible accident? What if I get a chronic illness that needs management? What if I have a disfiguring disease that can be treated? I have no idea what I would do in such circumstances; I’m feeling quite brave behind my keypad right now, thinking that I’m gonna choose my “higher” ground and forgo most medical interventions.
For everything in between, I’ve protected myself with a health cost-sharing plan.
Financially, I plan on using telemedicine and curbing specialists whenever I need healthcare. Now that I’m barely working, I’ll try to throw a few hours at Kaiser so that I can still be on the scene should I need a favor from someone.
I just had a conversation with my friend; she is a primary doctor and felt too shy to curbside a specialist in her medical group… that’s strange to me; I almost feel like we owe it to each other to go to one another for help without dealing with insurance and copays and all that jazz.
If I need an expensive procedure, specifically relating to dental work, I plan on shopping around, maybe going overseas where my money will have more buying power. I know some worry about the quality of care, but the same people probably think all HMOs are bad.
I got a lot of help from my financial adviser regarding the HSA option. The one company that was recommended was Health Savings Administrators.
This company is quite transparent regarding their Administrative and Custodial fees, the 2 major fees for having a HSA.
Administrative fee: $45/year
Custodial fee: 0.0625%/year of your HSA balance
To qualify for an HSA, you must have an HDHP – high deductible health plan, which really isn’t all that high. For a single person, like my lonely self, it’s only $1,300 with an out-of-pocket max of $6,550.
Though I barely see patients now, I still work for large medical groups that deal with insurance. I’m embarrassed to be a doctor in such systems, I mean that sincerely. It’s not just broken but intentionally misleading, bewildering and fear-inducing.
I also realize that the insurance my work provided for me was “worth” at least $700/month. Looking at what a comparable plan would cost, I now have a better understanding of what our employers are spending on our benefits.
Final word, health care isn’t health insurance. I can ALWAYS get healthcare, even if I am not insured. That’s another topic for another day, but it’s important not to group these 2 concepts together.