Comment by losvedir 2 days ago
Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).
> I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums).
Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.
So I'd say ... nah.
i'm 36, self-employed. silver plans in my state are ~800/month next year, with 8k deductible, no out of network coverage at all, with no in-network providers out of my state, so god forbid I get injured while traveling to visit my in-laws. the marketplace is a joke and health insurance in this country is pointless.
As usual, they find ways to limit that.
https://www.emergencyphysicians.org/press-releases/2017/10-1...
> In a controversial decision, health insurance giant Anthem Blue Cross Blue Shield is warning policy holders—in Georgia, Kentucky and Missouri—that they may have to pay for their trips to the ER. The company has developed a secret list of diagnoses that they will not pay for, such as "chest pain on breathing" and blood in the urine, even if the patient thought it was a medical emergency.
Too expensive? check
Deductibles too high? check
Stupid coverage limitations? check
Pointless? nope
> My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible
That's really nice - are there state/government subsidies involved?
I work for a top tier company and my premiums are not that much lower than yours.
When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).
Yes, those are numbers with
(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) ! (b) for 2026, NM temporary subsidies
A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.
Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).
That's crazy, I looked it up and the average cost for a hip replacement here in the private system in Australia is about $24k (US$16k).
You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.
> And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.
The point of insurance is to mitigate risk. If you think you have enough money to cover your risk, there's no reason to buy insurance.
The sleight of hand here is first complaining that you did not incur enough hazards to offset the risk premium and then citing this as a reason the risk premiums should not exist. Where is the story of the family being weighed down by bills? Or of not getting physical therapy after an injury and having permanent, income-reducing disabilities?
OP was talking about a family for $30k.
Imagine 2 people get injured in a year, you are now at $60k. Plus, $150 a visit for primary and $300+ for specialist.
My 5 year old has been to the hospital 3 times, stitches once. US healthcare will ruin you if you don't have insurance. A cancer treatment can bankrupt a millionaire.
Had the same reaction when I saw how the 40K was calculated (BTW I strongly believe in Medicare for all to control costs and to pay for civilization. To be paid out of progressive taxes on all income).
If Aaronontheweb had the misfortune of getting seriously sick, required surgery .. he would pay $7,150 for something that could easily cost $100K+++. Saying he's paying premiums just for having a baby really feels like weaselly logic .. so he thinks he or the rest of his family will absolutely never fall sick? What if a cancer diagnosis hits one of you out of the blue (I hope it doesn't, but that's what insurance is for).
The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it.
The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
I only keep this plan because we're planning on having children, so yes, it's included in the pricing decision.
Did you try reading the lengthy section of the article where I answered your question?
I skimmed your 2400-word article a second time just now, and I still don't understand why your math is allocating 100% of your family's health insurance premiums to childbirth. And now I additionally don't understand your abrasive tone in answering this fairly straightforward question.
Multiple commenters are raising this point, so perhaps you should consider that you aren't conveying this information well?
I think OP here is just keeping a completely dominated plan (and his health insurance company knows it). He has less than 50 employees, he is not required to offer health insurance to his employees and he should go on the ACA market.
Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (easy to do when you have a company).
He also says uninformed things like:
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those.
The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
> HMOs or EPOs that have some issues with them: coinsurance
What matters at the end of the day when you have a child is your maximum out of pocket (which you will 100% hit the year you have a child!). Whether you have copays or coinsurance after a deductible does not matter here. The ACA caps your maximum out of pocket at $18,400 no matter what (which, yes, is too high), so what you need to optimize for is premium + OOP for the providers that you care about.
Like, I get it, it's America, for healthcare like many other things (student loans, credit card debt, ...) it's easy to end up in a bad situation, but at some point you have to spend time understanding the game.
> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies
I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.
> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.
I explicitly address this point:
> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
and
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.
Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!
ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post.
You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf
Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.
> the $14300 is the family out of pocket max
You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.
Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.
I have to ask - why are you defending this?
> ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...)
that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?
> And "manipulating your income" is not really feasible with a pass-through entity.
I don't know if you have a CPA, but this is a sentence my CPA has never uttered.
> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.
The explanation of benefits simply doesn't cover child birth - this is extremely common for individual marketplace plans.
Welcome to healthcare plans in Texas.
This same price gets you a platinum plan with Sharp or Kaiser in San Diego and wouldn't have those gigantic deductibles.
He moved his business from California to Texas and is now complaining about pricing problems in markets caused specifically by the lack of regulatory environment in Texas.
Why do you need to get insurance for your child to be born anyway? Isn't the hospital already insured? Isn't that kind of janky?
In America, you basically need insurance to act as a larger stronger party in the negotiation of prices with the hospital on your behalf. Without the bargaining power of the insurance company the prices you'd pay can be significantly inflated. So paying for the insurance is the slightly lesser of two evils. Supposedly. From your question it seems perhaps you live somewhere with a saner system in place. I'm envious.
I’ve been told that too. But I’ve done self pay for the last year, and every time I go to the hospital they instantly give me a 30% discount.
That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay
Birth injuries are insured by the ob/gyn, which is part of the very high cost of delivering a baby in the US (because such injuries often lead to a lot of care).
Also not a big impact on the message, but $200/mo for a phone is a bit disingenuous.
Claiming $200/month for a phone makes one wonder which numbers are valid. I'm not saying everyone needs to make a $100 phone last 5 years and use a $15/month plan, but I'm not even sure how I would get to $200/month in phone bill, even including financing an iPhone 17 Pro Max.
$200 seems valid - it comes from the linked article [0] and it includes home internet (I pay $110 / month Comcast just for home internet in Bellevue. In Seattle I paid $130 / month). Maybe Aaron could have phrased it better. (I also recommend to read the linked article as it is a phenomenally well done financial analysis.)
With $85/month service (AT&T unlimited premium with only a single line) and financing a $2,000 phone (The smaller storage version of the Galaxy Z Fold 7 at MSRP) over 18 months, you’d hit almost exactly that; you could so the same with a cheaper service and/or phone with some add-ons (e.g., while Apple Care is billed directly by Apple and so wouldn't be on a phone bill, insurance for non-Apple phones is often billed by carriers on phone bills.)
$200 doesn't seem that crazy if they are buying several phone lines. I assume he pays at the least his wife as well, so that's two. If they have home internet bundled in as well, that would easily explain that figure. All to say, AT&T. He may also have a home phone line for a fax machine. It is perhaps a bit disingenuous to bundle it all together, but it also isn't the main point of the article.
What he said was:
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
That makes it sound like this is the minimum that you have to pay to get a smartphone and service to get by in modern life.
$200/mo is definitely high for that. An iPhone 17 Pro Max with maxed out storage (2 TB) is under $85/mo for 24 months.
A Visible+ Pro prepaid plan is $45/mo ($37.5/mo if you pay for 12 months at once) if you don't use one of their frequent promo codes to get a discount.
That includes unlimited premium data on Verizon's 5 G UWB, 5 G, and 4 G LTE networks, support for a cellular smartwatch, 4K UHD video, and unlimited mobile hotspot. By "premium" data they mean no deprioritization. Visible users get the same priority as user's of Verizon's own postpaid plans.
The hotspot is only 15 Mbps, so you probably wouldn't want to rely on it if you have frequent or long internet outages, but I've found for the occasional short outage it was fine for email, HN/Reddit/etc, and YouTube videos.
This will be massively more than enough to cover the smartphone hardware and service needs for everything probably 99% of the US population needs to get by, at $130/mo.
Note that includes getting a new top of the line iPhone every 2 years. With a more modest phone and keeping it for 5 years we are looking at more like $60/mo.
I pay that at least much for my family, hence why I used it
When you say
> I pay that at least much for my family, hence why I used it
and your article says
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
I know you've got a lot going on with a small business, and a new kid... but if money is important to you, maybe spend the time to switch to prepaid phone plans. There's lots of options [1], whatever network you need, you can do direct operator plans, MVNO owned by the operator, or like actual MVNO. If you're short on time and T-Mobile's network works for you, MintMobile has a promo going right now where $180 pays for 12 months of "unlimited" which is $15/month if you divide it out.
> I also pay $1250 per month to TriNet for the privilege of being able to buy their health insurance in the first place - sure, I get some other benefits too, but I’m the only US-based employee currently so this overhead is really 100% me.
Do you live in a state with a reasonable healthcare exchange? You might want to shop and see if an off the shelf plan from the exchange is better than paying TriNet to get access to their insurance; it may well be, but you should check. If you only have one US employee, and it's you, there's a lot of expense for not a lot of value IMHO. It's not really Apples to Apples though --- I think a lot of the TriNet plans have out of state coverage where a lot of exchange plans don't.
Consider changing your plan?
I pay $70/mo for 2 phone lines. Unlimited everything (well, OK, 5 GB data cap before slowing down).
It’s also what critical thinkers do when evaluating “what percentage full of shit do I think this author is?”
If a glaring innumeracy or terrible estimate is in the article, why did the author include that? What was their angle? Does that make me trust the rest of the article more or less?
I included screenshots of my actual health insurance premium terms, including the plan number, which is what is at issue in the article.
I think he's quoting that from the other article, not necessarily computing it himself. I think that article was about the cost of broadband + smartphones.
We pay ~$100/month for 1G broadband (I realize this could be lowered somewhat), and ~$100-120 for 5 phone lines for the family (AT&T prepaid). I'd like to see you make a household with multiple lines + broadband work for less than $100-125.
And that's not even that hard - I know some people spend $300+ JUST on their phone plans, in addition to broadband. And then if you factor in amortized cost of phone replacement? It's closer to $200 than to $50 for example, IMHO.
$200 seems to include home internet (which I think everyone needs these days to function). The $200 quote comes from the linked article [0] (speaking as a former financial analyst, this is an amazingly well done financial analysis). Maybe Aaron could have phrased this better.
> Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading.
I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?
I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.