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Health Insurance Costs [circa 2016]

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The most devious tax increases in modern history? 

Rick Kahler MS CFP

By Rick Kahler MS CFP®


A few months ago I scoffed when my wife told me about a report from CNN that the average individual, unsubsidized health insurance premium was going up over 60%.

After receiving my 2016 premium notice from Wellmark Blue Cross and Blue Shield, I’m no longer scoffing. My monthly premium for family coverage went from $1,400 to $2,140, an increase of $740, or 53%. According to healthcare.gov, the average Wellmark increase in South Dakota is 43%.

I immediately started looking for ways to decrease my premiums. This has become an annual ritual ever since Obamacare was pushed through Congress in 2010. Back then, my family health insurance policy (now considered a Platinum plan) had a low deductible with a maximum out-of-pocket of $3,500 and cost $660 a month.

Despite the President’s promise that “If you like your plan you can keep your plan,” I can’t even purchase that same plan today. If I could, I estimate it would cost over $3,500 a month. In order to keep health insurance affordable, each year I’ve reduced my coverage, increased my deductibles, and paid a higher premium than the year before.




I set out to analyze my options for 2016. After spending six hours crunching numbers and pouring over online calculators, I admitted defeat. There is no simple way to analyze plans to determine whether, based on your personal health care expenditures, you are better served to go with a copay or a deductible plan, a Bronze or a Silver plan, or if a Health Savings Account is preferable to a plan with coinsurance. All the online calculators I found were limited in scope and woefully generic. My health insurance agent didn’t know of any better ones, either.

Adding to my angst, while Wellmark makes policyholders’ year-to-date healthcare expenses available on its website, it doesn’t provide any breakdown of costs. You must figure out for yourself how many drug or doctor co-pays you had, the average cost of a copay visit, the average total costs of those visits, and any other information you need for any type of analysis.

This task was daunting for me, a financial planner and numbers guy. How are average consumers supposed to navigate it? The need for this information is so obvious, one wonders what the insurance companies are hiding by not providing it.

Ultimately, I selected a Bronze plan with no copays and an out-of-pocket cap of $11,900 on in-network providers and $18,500 on out-of-network providers. Based on my family’s average health care costs for the last three years, my out-of-pocket spending for premiums, covered drugs, and approved in-network medical providers will be $2,612 per month, or $31,344, in 2016. It was $11,420 in 2010. That’s an increase of 273%, or 18.3% a year.

By comparison, during the same time period medical costs only increased 16.0%, or 2.7% a year. The increase in premiums is clearly not about increasing health costs.

The $1,660 extra per month I had available to spend on consumer goods and services in 2010 is now going to insurance companies to subsidize the health care of others. This is a clear-cut example of a massive transfer of wealth.

Based on my family’s needs, if I earned $97,000 a year I would qualify for a subsidy of $912 a month. But since I earn over $98,000, I pay the full premium.





Clearly, the only people who find the Affordable Care Act affordable are those who receive a subsidy or who have preexisting conditions. For them, Obamacare was a godsend. For the rest of us, it turned out to be one of the most devious tax increases in modern history. 


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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™



4 Responses

  1. Covered Workers’ Out-of-Pocket Costs Rose 77% in Ten Years

    Kaiser Family Foundation recently conducted an analysis on out-of-pocket cost trends for employees. Here are some key findings from the report:

    • Between 2004 and 2014, covered workers’ average out-of-pocket costs grew 77%.
    • Health plans’ average payment per enrollee rose by 58% between 2004 and 2014.
    • Overall, workers’ out-of-pocket costs rose from an average of $422 in 2004 to $747 in 2014.
    • Average payments by health plans rose from $2,748 to $4,354 between 2004 and 2014.
    • Health plans covered 85.3% of covered medical expenses in 2014, compared with 86.7% in 2004.
    • Workers’ payments toward deductibles rose 256% (from an average of $99 to $353).

    Source: Kaiser Family Foundation, April 12, 2016


  2. The $629 Band-Aid!

    The case of the $629 Band-Aid and what it reveals about American health care.




  3. 53% Have a Pre-Existing Health Condition in Their Household

    Kaiser Family Foundation recently released an analysis of medical underwriting for pre-existing conditions before the Affordable Care Act. Here are some key findings from the report:

    • 53% report that they or someone in their household has a pre-existing condition.
    • 52 million have an uninsurable condition under pre-ACA underwriting practices.
    • 22% in Colorado and Minnesota have conditions that would likely be declinable.
    • In 2015, about 8% of the non-elderly population had individual market insurance.
    • Prior to the ACA expansions, 18% of individual market applications were denied.
    • Prior to 2014, medical underwriting was permitted in 45 states and DC.

    Source: Kaiser Family Foundation, December 12, 2016


  4. Family Premiums For Employer-Sponsored Coverage Rose 3% This Year
    Kaiser Family Foundation
    and the Health Research & Educational Trust recently released their 2017 Employer Health Benefits Survey. Here are some key findings from the report:
    • 151 million Americans rely on employer-sponsored coverage.
    • Annual family premiums rose an average of 3% to $18,764 this year.
    • Since 2012, average family premiums have increased 19%.
    • Workers on average contribute $5,714 annually toward their family premiums.
    • Those at firms with fewer than 200 workers contribute $6,814/year on average.
    • 36% of workers at small firms pay most of the total premiums for family coverage.
    Jeorgia Mostanza 


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