[bioChE]

Good Friday afternoon, everyone. Due to the recent discussions around healthcare, I was curious to know what your personal costs are vs. the benefits you get from your insurance or government healthcare. If you care to share your numbers, I think it would be really interesting.

During the 2016/2017 years I've changed plans so my numbers will look different this year. However, here's my best estimate at a retrospective of 2016 costs and benefits, as well as some 2017 projections. My numbers below are specifically related to mental health; I didn't really feel like tallying up other services as the overwhelming amount of my spending is due to MH. I've been using a high-deductible plan for a few years including 2016, but due to the cost of Latuda I changed to a PPO in 2017.

2016 Insurance premiums:
Payroll Deduction: $3,432
Employer: $14,400
Total: $17,832

Deductibles: $5,600

Doctor: $267 (co-pays) $1,068 (insurance)

Medications: $4,703 (co-pay) $11,800 (insurance)

The total of my care cost $17,838 for doctor visits and medications. I paid $14,002 out of pocket, and my employer kicked in another $14,400 for a total of $28,402.

Overall, that's a lot of scratch. I found this analysis interesting because my assumption has always been that I've been paying in less to the system than the benefits I've been receiving. This has definitely been the case in years where I've needed to be hospitalized to the tune of about $20k/visit, but last year that wasn't needed.

Next year it should hopefully look something like this [assuming no hospitalization, and a stable med cocktail]:

2017 Insurance premiums:
Payroll Deduction: $5,304
Employer: $16,800
Total: $22,104

Deductibles: $1,000

Doctor: $240 (co-pays) $1,095 (insurance) [assuming doctor rates stay the same, which they won't but I don't know what they'll be so I'm using 2016 rates]

Medications: $1,032 (co-pay) $14,933 (insurance)

That makes a total out of pocket $7,576, with my employer kicking in $16,800 for a total spend of $24,376. That's interesting from a couple of angles, but I'm itching to post this and am not going to slice and dice it right now. I think I made the right choice by taking the higher-price plan for 2017, simply because my total out of pocket will be roughly $7k less year-over-year. It makes sense that since I use a lot of services it makes more sense to pay into the higher-cost plan.

All I can say is holy crap my meds are expensive.

Anyone else feel like giving a run-down of your costs and benefits? This got to be a much longer post than I intended it to be and I'm not looking for the long analysis from anyone else - but I really do think it would be interesting to hear from anyone else regarding out of pocket costs vs. benefits realized.

Thanks for making it through this really long post!

The only time I've had to pay for anything medical-wise was an ambulance bill for $45. Aside from that, all meds, hospitalizations, ECT were covered 100%. I am on disability and living in Canada, thank goodness.

Whenever I've worked, I imagine money is taken out of each paycheck towards taxes that pay towards universal health care, but I don't know how much. At the moment I am unemployed.

[Moose72]

I'm on Medicaid. I sometimes have a small copay on scripts, but otherwise everything is covered.

[JustJace2u]

My deductible is $3000 but my monthly premium went from about $200/month to $300/month. My out of pocket costs for my t and pdoc will be astronomical because they are now considered out of network since my company switched insurance carriers. My meds aren't so bad as long as I use the generic brands. My issue will be what they do about those with pre-existing conditions. I know they claim they won't touch that, but I don't have any faith in the GOP.

[bioChE]

Originally Posted by JustJace2u

My deductible is $3000 but my monthly premium went from about $200/month to $300/month. My out of pocket costs for my t and pdoc will be astronomical because they are now considered out of network since my company switched insurance carriers. My meds aren't so bad as long as I use the generic brands. My issue will be what they do about those with pre-existing conditions. I know they claim they won't touch that, but I don't have any faith in the GOP.

Wow, a 50% hike in your premium? That's a lot to cover. Sounds similar to the increases seen on the exchanges.

[bioChE]

Originally Posted by scaredandconfused

The only time I've had to pay for anything medical-wise was an ambulance bill for $45. Aside from that, all meds, hospitalizations, ECT were covered 100%. I am on disability and living in Canada, thank goodness.

Whenever I've worked, I imagine money is taken out of each paycheck towards taxes that pay towards universal health care, but I don't know how much. At the moment I am unemployed.

Do you have any way to know what the actual costs are that your healthcare providers charge the government? I assume Canada has private doctors and hospitals, and the rates are negotiated with the government?

$20 copay for drs
$20 copay for specialists (used to be $25)

I have a PPO plan

As far as meds go:
$15/30/55 for tier3/tier2/tier1 meds

Used to be $15/30/45, but I've never had a tier 1 med before, so it doesn't matter to me. I take all generics.

[fishin fool]

Our health care system has become an total ripoff and a joke at this point.
It is just another big scam by the rich and powerful making billions and that
is all it's about. Your health is the last thing they care about.
There is no reason in the world that we don't have universal health care other
than that. Our politicians have the best health care possible on our dime and
they don't pay one cent into it. So they have universal health care and we pay
for everything. Very very sad.
Sorry for my rant but this is a big sore point with me.
Also I did not mean to mess up this thread sorry about that.

[gina_re]

I'm not going to even pretend like I want to do the math on yearly costs. Every paycheck $84 comes out for health/vision/dental insurance. I don't do name brand drugs because they tend to be pricey and I don't want that in my budget. So my generics are $20 for a three month prescription (3 meds), one I can only get a month at a time for $10, and the last is $40 for a three month prescription because I will only pick them up at a particular pharmacy. Premiums and deductibles, couldn't tell ya. The fact that I can do a lot of communication with my pdoc via their electronic messaging system has cut down drastically on actual appointments so I'm not paying nearly as much in copays like I used to.

[Unrigged64072835]

Other than the $110 payment for Medicare I'm not paying anything. Meds go to the base hospital pharmacy. Visits are covered by Medicare and my military health insurance. One of the benefits of serving my country for 22 years.

[JustJace2u]

Originally Posted by Fharraige

Other than the $110 payment for Medicare I'm not paying anything. Meds go to the base hospital pharmacy. Visits are covered by Medicare and my military health insurance. One of the benefits of serving my country for 22 years.

My dad was in the Army for just under 25 years when he finally 'retired'.

[bioChE]

Originally Posted by Fharraige

Other than the $110 payment for Medicare I'm not paying anything. Meds go to the base hospital pharmacy. Visits are covered by Medicare and my military health insurance. One of the benefits of serving my country for 22 years.

Thanks for your service. Glad you get coverage.

[MobiusPsyche]

I get insurance through my employer and have only a $1,500 deductible. More importantly, after I meet that deductible all of my prescriptions and outpatient care is fully covered. I'm very fortunate.

ETA I think I pay about $130 a month for my insurance through employer. Whatever it is, I get much more out of insurance than I pay into it.

[boogiesmash]

I have state insurance and my paycheck deduction for medical is 107 a check. 15 co pay for any doc. 3, 10 for prescriptions or 5, 15 if I do 3 month mail in

[raspberrytorte]

I have insurance through my state now so my prescriptions are a dollar, but everything else is covered.

However, when I was working the insurance I had was horrible! It was better than nothing obviously, but there's a reason why I'm so medically in debt right now.

[bizi]

We pay $200 a month premium. blue cross from state groups benefit
$4K deductible.
$80 a month meds
$120 for pdoc out of pocket not on insurance every 3 months.
I will be paying $300 or $400 not sure for a bone density scan...insurance won't pay for that.

We could have chosen A higher premium plan $450 a month and had co-payments for doctors visits and therapy visits with a $1,500 deductible but chose to go with the cheaper plan because we are healthy.

But I want to go back into therapy and it will cost me big bucks out of pocket for that.
bizi

[neverending]

With the VA system I don't pay anything but I have had to change therapists n the clinic rules they operate by refuse to provide the therapy I need so it looks like I m going to have to use my other insurance so copays will run a little under $200 per month.

[GeekieChic]

My insurance doesn't cover psychiatric treatment or medication, but therapy is fairly cheap in India. I pay ₹1,500 per session (I go once a month) and my monthly meds expenditure comes to around ₹4,000.

[bioChE]

So far it sounds like I get shafted on costs. Wow.

Thanks everyone for sharing, it's great to get a perspective you don't see every day on the news.

[MtnTime2896]

Arm and a leg. I'm out of those and vital organs so my soul's next on the platter.

[bioChE]

Originally Posted by fishin fool

Our health care system has become an total ripoff and a joke at this point.
It is just another big scam by the rich and powerful making billions and that
is all it's about. Your health is the last thing they care about.
There is no reason in the world that we don't have universal health care other
than that. Our politicians have the best health care possible on our dime and
they don't pay one cent into it. So they have universal health care and we pay
for everything. Very very sad.
Sorry for my rant but this is a big sore point with me.
Also I did not mean to mess up this thread sorry about that.

No worries about messing up the thread, universal healthcare is a worthwhile discussion. From my perspective, I feel fortunate to be making a salary that allows me to pay into the system. Something in me feels that is "fair." I know a lot of people are struggling financially (I am too, I have some large debts from medical and other things which I'm paying off over time), and at the same time I've been blessed by the opportunity to provide for myself and my family.

Aside from healthcare, my next largest payment is taxes, some of which goes to Medicare, Medicaid, and VA. Again, I feel it is fair to be making those payments to help others. Part of having bipolar is not knowing how long I'll be able to work. So many of us are out of work or underemployed, and there might come a day when I'm in the same boat. In 2015 I had three hospitalizations and was on short-term disability for a while. It was scary to have uncertainty surrounding my income and having someone else make those decisions was kind of emasculating.

[bioChE]

Originally Posted by Só leigheas

Arm and a leg. I'm out of those and vital organs so my soul's next on the platter.

The soul I can live without. It's when they start wanting to take brain tissue that I'll start getting concerned.

[gayleggg]

I pay 86. through Obamacare and the deductible is 250. Meds are $10, $50, and $100 depending on the drug.

But in a month I go on medicare which will cost me $240 with supplement. Deductible is $186 and drugs vary. One I take will cost $376. I'm in the process of changing that one.

I can't really afford the extra money to cover me but I don't have a choice.

Our premiums have actually gone down for two years in a row. Deductible is only $1500/individual and $3000/family. Co-pays are $30 (and we don't have to meet our deductible before our insurance kicks in). We've actually gotten money back from our employer the last two years (several hundred dollars) because of the rule that insurance companies cannot make more than a certain level of profit (something like that - I'm sure I'm not explaining it correctly). Medication co-pays are low (5/30/60). Insurance company has been excellent in covering our healthcare needs.

[Trippin2.0]

Zero
0.00

Government pays for everything, Therapy, DBT, Pdoc and meds.

If I tried going private I would not be able to afford it, therapy alone would be 2k per month, DBT 800 a session, and pdoc 600 a session. Meds would cost at least a grand a month.