Self-Insured in America
As a freelancer, I do not have health insurance provided by an employer. My part-time work also removes me from health insurance plans provided to bulky time employees. Thus, it fell to me some time ago to insure myself.
This is my story.
I am insured by Aetna, under a PPO policy. My monthly rate is $45.00. I have a $5000.00 yearly deductable, I have a $50.00 co-pay, and I get negligible coverage for medicine. However, I am also in good health, and I am at least covered, which is more than I can say for a lot of people in my situation (both financially and with regards to employment). $45.00 a month is not that much, really; totals to $540.00 a year. Pretty cheap.
For a reason.
In September, a particularly nasty bug of the swine variety struck me. One execute of this was severe vertigo, to the point where I couldn’t really depart much. A concerned friend of mine took me to the hospital, where I spent ~8 hours, most of it in the lobby, to be told to take fluids and get some rest. Oh, and they prescribed valium, since the anti-vert (a medicine used to treat vertigo) they gave me didn’t work. This was after a CAT scan and an EKG.
All because I was severely dizzy.
Now, I’m not critiquing the health care I received. They did what they thought was best, and made sure I wasn’t sicker than we plan. But all of this was billed to my insurance, and then it was billed to me.
I owed the hospital over 700 dollars. And that’s not even a anxiety story by medical standards.
The reason I philosophize you this, is that while I shell out $540.00 a year for insurance, I am covered for very little. Now, I didn’t have to pay $55.00 to the doctor that read my EKG, because I’m insured. And the $50.00 co-pay I spent for my follow up visit to a physician was cheaper than what I would have had to pay out of pocket had I been uninsured. So, I saved some money there.
Furthermore, because I am insured, the hospital is only allowed to bill me so noteworthy. Care providers sign contracts with companies like Aetna, and Aetna stipulates how much a policy holder can be billed. In my case, around 100 dollars was knocked off the total; not because Aetna paid a dime, but because their contract with the hospital stipulated that I could only be charged as much as I was. So, more savings, accurate?
Wrong. The total I saved is somewhere in the neighborhood of $100.00; $200.00 if you include the cost reduction I received due to my insurance. But I pay over $500.00 a year; so really, I’m mild out over 300 dollars on this whole thing. I haven’t seen a major financial benefit for having insurance (as far as I can tell), but I’m lead to believe that without insurance, I’d be ruined.
To reinforce what I’m talking about, let me put it like this: I exercise $45.00 a month so that I only need $5000.00 a year on hand for medical bills. The $700.00 I was billed went directly to the hospital, and no allotment of it was paid for or reimbursed by my insurance. We often talk about the “insured” or the “uninsured,” but what about the “underinsured? ” People in my situation financially simply do not have $5,000.00 on hand for distinguished of anything, much less the possibility they will get very sick at some point.
The thing to remember, and it’s often lost, is that when you sign up for a policy, it is assumed that you have up to your deductable in cash, and on hand, for any medical emergencies every year. Our current system has a lot of people who can barely afford the insurance they have, getting grand care but still losing a LOT of money whenever they get sick or need to go to the hospital. And that’s a jam.
Making matters worse, say I wanted a cheaper deductable, somewhere around $750.00. According to Aetna’s website, my monthly premium would jump from $45.00 to $112.00. That’s over two times what I’m currently paying; and while the deductable is much less, paying over 100 a month in insurance (over $1200.00 a year) is simply too much for someone making only 15-20k, before taxes and business expenses. And this still assumes that I have a cash savings of $750.00 on hand for medical bills.
There’s always this sense of “it could have been worse!” that people have, even when they are shelling out thousand or tens of thousands of dollars for medical care. But is that true? Remember, even when you are insured, you can get bankrupted VERY quickly. And bankruptcy is bankruptcy, no matter what your deductable is.
For me, in my personal experience, I have been more confused or frustrated by my insurance than protected by it. And to be impartial, the only reason I understand ANY of this half as well as I do is because my parents work in health care. Without someone to translate for you, the place is even more confusing. We have a problem, and despite the hard work being done in the House, Senate and the Executive Branch, I don’t see it getting fixed any time soon.
-CJ
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