Are you and your kids healthy?

I also have kids and, like most people on HN, have “good” health insurance that comes with a tech job.

But get one family member that needs to see a cardiologist or neurologist every few months and you’re hitting your $6,500 deductible every April.

I have a diabetic child. There was a point in time where I had the high deductible plan with a max out of pocket of 10,500. When I ran the numbers for other plans, what I was allowed to save pretax, etc. the high deductible plan actually made economic sense. With bloodwork and prescriptions, I would hit that by September.

If your out of pocket maximum for family coverage was $500 after ACA was passed, you were probably receiving at least $20k if not $30k+ per year in benefits via employer subsidized health insurance. Just the health insurance benefits alone were worth half or more the median annual income in the US.

https://fred.stlouisfed.org/series/MEPAINUSA646N

I have a friend that lives near Boston...

He had to visit a hospital recently, while he never disclosed to me what his medical condition was, at the end he mentioned that his hospital bill was almost $1500... "Only to find out I'm also allergic to penicillin" and that "if I would have taken an ambulance it would have doubled the bill"

>I have had many jobs with great health care

That is a kind of "loaded". Joe Average with a crap job, or no job, is not so lucky.

I saw a group of people on the street today begging for money for a two year old with brain cancer in South Texas. I wonder why their insurance didn't cover it? I also wonder what you would do in order to meet your children's medical needs if such an event were to occur to them?

Seems sus. I don't think donations from the street will pay for bills as efficiently as getting a job-- not that finding a job is an easy feat.

Additionally, many hospitals have financial assistance programs (for example) : https://www.texaschildrens.org/patients-and-visitors/insuran...

The Ronald McDonald house also helps families with a lot of other expenses: https://rmhc.org/

As a habit I don't trust anyone asking me for money, but they looked reasonably legit. I wonder how long it would take to save up enough money to pay for pediatric brain surgery on $15/hour - I would imagine longer than the presumed prognosis of the infant. I also thought that if we had universal care within the United States, I would not have to guess whether it was a scam or not - I would just know that the child would receive some hopefully reasonable amount of medical care.

It's not for the per-hour, it's for the group-based health insurance, even for part-time employees. If that's what a parent needs to do, then that's the most efficient path.

Even a sliver of insurance allows delays in payments while allowing the hospital to perform service up front. It's lousy to claim bankruptcy over medical bills, but if it gets your child the help they need, this is IMO a viable path.

Yes, I have some inkling, though it's interesting that the goal of this seems to have nothing to do with actually paying the medical providers who would presumably be helping the child. I will say that I have friends in all walks of life who do all kinds of jobs, and many of them can't even get coverage for themselves, let alone for families, so it might be more challenging than you think. That said, this is one reason among dozens why I will never have children.

Family living in Texas also had child with cancer, Cooks Children Hospital covered whatever they couldn't pay. I'm sorry to be cynical but I suspect a scam.

Not to mention Medicaid which covers children and pregnant women even in the States that didn’t expand coverage.

I would assume that was a scam. It is common for people to use children to garner more donations.

Refer them to St Jude’s Childrens hospital. Childhood cancer is their thing

And they don’t charge a penny. Even the cafeteria is free for patients.

> Two kids now and out of pocket expenses never exceeded $500 for either of them.

Do I understand right that this means you might have to pay up to $500 for medical problems?

That seems huge to me, it's higher than what one pays "out of their pocket" here for a childbirth for example and I don't think you can expect a regular person to spend this unexpectedly, that's about a third of the average wage (in Belgium).

> Do I understand right that this means you might have to pay up to $500 for medical problems?

I expect to pay at least $200 anytime I receive healthcare, even just for a 5 minute consultation with the doctor. Childbirth is minimum $4k to $6k, assuming vaginal and hospital stay is 2 nights. If C section and 3 nights, then add $2k to $3k. If using epidural, add $3k more. For both of our kids, we reached annual out of pocket maximum of $5k to $7k in the calendar year, for regular, non complicated vaginal births.

Deductible: What you pay before insurance company starts paying. Usually at least $2k, but varies anywhere from $0 to $10k. Could even be as high as the out of pocket maximum.

Out of pocket maximum: The maximum you pay in any calendar year for healthcare. After that, all responsibility falls on insurance company. Legal maximum for 2023 is $9,100 for individuals and $18,200 for families. Usually this is $5k per individual and $10k per family, give or take a few thousand.

The higher the deductible and out of pocket maximum, the lower the insurance premium (like any other insurance).

Insurance premiums are $400 to $1,200 per month per person from age 0 to 64, give it take a few hundred. That means for a family of 4, health insurance will be ~ $400 per month for each kid, and $500 to $900 per month for each parent. So roughly $24k to $36k per year in insurance premiums, plus out of pocket maximum is ~$10k, which means $30k to $45k per year will pay for a family’s (of 4) healthcare in a calendar year.

If receiving health insurance via employer, the employer will usually pay 70% of the insurance premiums. Sometimes more. If not receiving health insurance from employer, and you are lower income, then you can get tax credits (government subsidy). This lower income is usually $100k per year and below, the lower the income, the higher the tax credit.

Age 65+, the federal government starts paying for your hospital emergency healthcare, but you may or may not need to pay for medicines and outpatient (non hospital) healthcare depending on your income/wealth.

I'm curious why this is so shocking to you (as a Belgian) when the country literally right next door has health insurance, premiums, and deductibles.

https://www.zorgwijzer.nl/zorgvergelijker/english

The lowest deductible on that page is ~$400.

That said, I'm shocked that the average wage in Belgium is only $1500. That sounds very low, do you not have any workers protections for wages?

> the country literally right next door

Well I never lived in the Netherlands and I am not planning on doing so, so their healthcare system isn't really something I have ever had any reason to study. This system strikes me as very different from ours and the costs I see on this page are far higher than those in Belgium, France or Germany. This deductible system also does not exist in these countries.

Average wage in Belgium after tax is 19 000€ from what I can see, so about 1600€ per month, however various sources give different numbers and another number I can find gives 2250€ as median wage. The difference might be that 1600€ per month takes into account the whole population including people who aren't working while the median is calculated on the people who do have a salary, I'm not sure though.

It's not especially low either way when one doesn't have to pay "$30k to $45k per year [...] for a family’s (of 4) healthcare in a calendar year" (according to sibling comment). School and education in general is mostly free as well, which also helps I guess. A family of four in reasonably good health should expect to spend a few hundred euros per year on healthcare here.

I'm not sure if I've ever paid less than $500 for the deductible, let alone have that be a total for a year. The plans tended to be that I had to pay 10-20% after the deductible, and max out of pocket was in the thousands. This wasn't even counting premiums. On top of it all, some things just had set prices: You always had to pay some for the ER, for example. And prices have only went up since I've left the US 9 or 10 years ago. And I was pretty lucky: Family members had started jobs where the family plan for health insurance literally exceeded their pay. Heck, I had a job like that, but I didn't have a family to worry about. A lot of folks' health care sucks unless they have money or get very lucky indeed.

It doesn't sound like you know the plight of others very well.

An alternative way to look at this is that you are very much loaded. You just don't realize because a significant part of your compensation goes implicitly towards health insurance.