this could get ugly. it could also get too honest. and maybe too personal. and too detailed.
this is the week. i’ve been dreading it for months. it is the final week to select health insurance for 2020. sometime this week i will wait online for probably hours to take my turn, to take my turn to sign up for a plan on healthcare.gov. i have been awake all night on and off for weeks.
we are artists. both of us. neither of our jobs and none of the other work that we do provide health insurance or benefits. we live in the state of wisconsin and have four options of healthcare companies on healthcare.gov. an insurance agent pointed out that we could opt for short term health insurance (up to 360 days) instead of a regular policy, but those do not cover any pre-existing conditions, do not provide for physicals and most preventative care and are basically catastrophic plans. hmmm. as a grown-up who has been working my entire grown-up life, i would really like to have grown-up insurance.
so. four companies. bronze, silver and gold plans in each. none of these companies provide nationwide coverage and a couple do not even allow for emergency room coverage out of network. two of those companies do not cover our doctors, professionals with whom we have established relationship through years; last year (2018) our coverage did not allow us to go to our own doctors, so we didn’t. we paid for coverage and never visited the doctor’s office at all.
so let’s get more mealy here. there are plenty of arguments about healthcare out there and plenty of naysayers and supporters -each- of the affordable care act. are you even familiar with it? if you would prefer not to know, i would stop reading here. but if you really want to know more, please read on… but keep in mind, i love math and research.
we are 60 and 58 and healthy. these four companies on healthcare.gov presented bronze, silver and gold plans that will cost between $1600 and $2800 per month out of pocket, which is a total of $19,200-$33,600 per year. the $1600 options have deductibles between $14,000-16,000. in many cases, this is what you must satisfy before the company even begins to pay a portion. that would mean you have paid in the neighborhood of $33,200 a year for you and your spouse to be treated on a bronze plan, without figuring in the actual cost of the treatment.
let’s explore an example for example’s sake.
let’s say you make a combined salary of $70,000. let’s assume a meager (and understated) tax bracket of only 20%. $70,000-14,000 = $56,000. now let’s assume you own a house or pay rent and your mortgage plus escrowed real estate taxes are about $1200 combined (also underestimated in most cases). $56,000-14,400 = $41,600. add to that your utilities bills; let’s just estimate that at a lowish $250 per month, which is $3000 year. $41,600-3000 = $38,600. now subtract out for cellphones, home phones, cable, wifi again lowballing at $250 per month, $3000 per year. $38,600-3000 = $35,600. at this point you have not included any of your outstanding student loans or parent plus loans, nor have you subtracted out for home insurance, car insurance, life insurance, dental insurance, any kind of retirement savings or a car payment. nor have you even considered food, clothing or gas for driving to and from work, even if you don’t drive anywhere else. any outstanding rotating credit card debt or medical related costs that you are paying on installment are not subtracted. but you are sitting at $35,600 usuable income.
so. if you take the bronze plan you must assume that you have approximately $16,000 in the bank for the deductible and you must subtract $19,200 (27% of your gross income) from your $35,600 leaving you with $16,400 to cover all the aforementioned items we hadn’t subtracted and maybe perhaps saving a little to cover the percentages of medical expenses you need to cover post-deductible. OR you can take a silver plan, which is in the neighborhood of $2200 per month or $26,400 year (38% of your gross income) leaving you with $9200 to cover loans, home insurance, car insurance, life insurance, dental insurance, car payment, food, clothing, gas, etc. you clearly can’t even consider a gold plan at $2800 per month (the most grown-up plan) because that would cost $33,600 a year, leaving you with a mere $2000 to spend on the rest of life (as listed above). again, that’s assuming a meager 20% income tax rate and not considering state or local income taxes as well.
i’m sure you are beginning to see my point.
and then there are the subsidies. yes. if you earn below 4 times the poverty rate in your state, you are eligible for subsidies for this healthcare insurance. naturally, the more you earn, the less subsidy you are able to receive. that makes sense. it feathers out as the numbers go up. and then? there is a dollar level – one dollar this way or that – that a granted subsidy would drop from hundreds, even more than a thousand or fifteen hundred to – ZERO – . for instance, if you are granted a subsidy because of your level of income and sometime in the year (as you have worked hard to earn more to live a little better) you go over the healthcare cliff by ONE DOLLAR, ONE dollar, you will owe back the entirety of the insurance plan. in the above case, that would be anywhere between the difference of what you paid in and the plan total of $19,200 or up to $33,600.
we are the poster children of this so-called sweet spot in the healthcare crisis of our country. a bit older, working hard, multiple jobs, no job-provided healthcare. not making enough to scoff at spending say $29,000-$33,000 (silver or gold plans) or even $19,200 (bronze) for one year of health insurance, nonetheless be able to actually budget that, but making a bit more than the cliff. no ropes. no guardrails. just a cliff.
the professional insurance agent on the phone said she had “a lot of people your age in that circumstance.” she suggested considering short term health insurance, the kind i mentioned above that precludes pre-existing conditions etc etc. etc. that doesn’t sound like grown-up health care to me. and the deeply disappointed, frustrated cynic in me asks this question – when will breathing be considered a pre-existing condition?
something needs to be done. is the health of the people of this country important or not? it’s a basic question. with an obvious answer. where do we place value?