Or the debt collectors haven't caught up yet. That happened to me around 2012 in the US. Went to the emergency room, had some tests done, got the hospital bill and paid a few hundred bucks. Then like 9 months later I get calls from a debt collector saying I owed $1,500 to a separate medical testing company that apparently provided the test I was given at the ER. I had never received that bill and it just took a while for them to send it to collection apparently.

Right, but you also benefit from the fact that it's an HDHP, right? Must you be on an HDHP (because the other plan is too expensive, or because another plan is not offered) or did you choose the HDHP even when presented with the options?

The big up-front deductible and an HSA is pretty much the point of the plan, and it's mostly advantageous to those that are young and/or don't have to go to the doctor that often, with a max downside of their deductible + catastrophic.

EDITL To be clear, I also believe significant reform is required, but there is also a lot of misunderstanding about how plans work which is not helping. The whole industry is extremely opaque.

The HDHP works out in years in which you need no medical treatment beyond the covered annual physical. Once you start needing anything, it ends up being a worse option. I discovered this a few years ago when I broke my ankle.

The big upfront deductible seems like exactly the wrong way to structure a healthcare plan, as it disincentives getting treatment until things get really bad.

True, but if you can offset that with an HSA to cover your entire deductible and sweep the rest into a qualifying retirement plan it makes a lot of sense _and_ you don't have to worry as much about the deductible. Note: I am on a typical PPO and optimizing for minimum catastrophic amounts, generally so this is not the way I usually go but many colleagues seem to like these plans

i work for a tech company in the fortune 500 top 25... i would assume the best insurance possible, still killing us (paid nearly $7000 out of pocket last year + the actual premium costs of several thousand more). i've got three small kids including one with a heart condition, so it's particularly bad right now.

> i would assume the best insurance possible

That's usually not a good assumption to make, not even among the FANG. There is extreme variability even with the same insurance company, depending on the negotiation between the company and the provider. And very few companies actually have any incentive to even provide the best 'possible' coverage.

Just looked it up and we're only in the top 50 (insert crying smiley).

For insurance, I have found it's difficult to beat the negotiating power of the multiple large Federal Government offerings - and you can shop before you decide to join:

https://www.opm.gov/healthcare-insurance/healthcare/plan-inf...

And I got downvoted here for saying that I would require a LOT higher salary to move from Sweden to the US. Your example is why.

A $5k bump in salary should probably make up the difference in the average year. That's not a "LOT higher salary" by my reckoning. Hell, the difference in tax rate alone would easily make up for that, even if the US salary is lower (which seems likely to be opposite of what would actually happen).