The Cost of Living (No I don't mean that kind)

Credit to Anastasiia Gudantova 
 
Healthcare and the costs that come with it are probably the most jarring thing to those outside of the US. With the US multiple-payor system, there are many layers to the maze that of which is billing the patient. That is not to mention the many CMS guidelines that help set the base standard of billing in the US. Even as I do research for this blog, I find out there are different markets for insurance you can explore to figure out what you are eligible to buy from. 

Before getting into the markets, you have to consider the plans. For all intents and purposes, "in-network" means the provider specifically has a contract with a third-party insurance company:

1) EPOs
EPO (Exclusive Provider Organizations) is a plan where you have to go to anyone in-network to be covered.

2) HMOs
HMO (Health Maintenance Organization) is a plan that focuses on prevention and wellness with integrated care but it's limited. For example, if you had a Blue Cross Blue Shield plan in the state of Michigan, most providers will say they are covered. However, an HMO may limit you by only covering certain BCBS providers in a 30 mile range from your reported home address or the address of your workplace.

3) POS
POS (Point-of-Service) is a plan where you can go anywhere but you will play less if the provider is in-network. They are also the plan that needs a referral if you want to see a specialist.

4) PPO
PPO (Preferred Provider Organization) is a plan where you can go to whoever you want without a referral needed and but you will pay more if they are out-of-network. However, it is a flat rate, typically for either in or out-of-network.

However, not every option is available when you are looking to purchase insurance. There are several markets you can look into.

1) Individual Market
This is where you personally go and find insurance yourself. This can be a private plan, this can be more public, but there is no middle man between you and insurance. 

2) Individual Exchange
This is where you can personally go and find insurance yourself, but it is managed by a government entity.

3) Small-group market
This is insurance that is provided to small companies for their employees. Small companies include places like a local bakery.

4) Large-group market
This is insurance that is provided to larger companies so those like General Motors or Starbucks.

Based on this, you might say that it's very easy to match one-to-one, PPOs are more likely to be at General Motors but even then, different departments have different plans. In fact, in the plants of GM, you are more likely to have HMOs and only after working for a few years will HR provide you a HSA (Health Savings Account).

That was just the basics that we need to understand how pricing occurs in healthcare. Now let's look at some healthcare pricing based on age.


According to Forbes, Kaiser is a cheaper option if you were looking to pay less for coverage. It doesn't include the fact Kaiser is almost California specific. These are not prices that are available to us in Michigan. It's more likely we find prices with United or BCBS. 

Forbes also reports that insurance averages $530/month in the state of Michigan or $6,360/year. According to ZipRecruiter, the average salary in Michigan is $49,834/year, but the median lies more closely to $33,000. 20% of your salary going to a healthcare plan that you may use only once or twice. Weighing risks and benefits, it might be worth it to go with a cheaper plan each month so that $6,360 could go instead into a used car and gas.


With different tiers, you can pay less, but that means you will have to pay out of pocket more when it comes to it. The monthly is just a premium. It's just to have a ground to stand on to say you don't have to pay the full cost. However, $400/month is still a lot to take out when that could go to gas or groceries instead.

In this case, you could opt for something called catastrophic coverage, where you only have to pay $79/month. But almost always, you have to pay out-of-pocket. Catastrophic coverage only covers when you are in an emergency.

This is actually the first result if you search for catastrophic coverage.

I cannot find an easy quote of a cost of medical procedure in the state of Michigan. In fact, I was directed to access my Epic page for Michigan Medicine, Henry Ford, and Corewell. From my own experience, if I did not have insurance, a well visit would have cost me $454 for the one visit. From there, I was referred to a specialist that can manage my meds and the cost is $300/visit. My medication is then $20/month. If I were to total everything, that's $4,292. I barely make $1,000/week working $22/hr and that excludes rent and food. 

Let's say that I was on the cheapest plan possible. Even if I am paying $373/month for health insurance, I may need to pay a higher co-pay to see certain specialists. This doesn't count for the deductible that I have to pay before insurance fully covers me. 
I still am far more optimistic about healthcare now than before. To new health insurance companies, I now have a pre-existing condition that makes me a higher risk for health care. I may need more coverage and that may cost the insurance company far more than someone who has no prior conditions. 

I wish that the cost of living was more robust and that it was much easier to quantify just how costly health insurance is in the US, but hopefully, this blog post sums up exactly how it feels to get insurance. It's layers on layers of information that you may never read again or be able to debate and understand. 


https://www.healthcare.gov/choose-a-plan/plan-types/ 
https://files.gao.gov/multimedia/gao-25-107194/interactive/map/IND_2022_map_webpage.html#map
https://www.forbes.com/advisor/health-insurance/how-much-does-health-insurance-cost/
https://www.ziprecruiter.com/Salaries/--in-Michigan#:~:text=Michigan%20ranks%20number%2049%20out,week%20or%204%2C152.83%20a%20month.
https://www.compare-health-quotes.com/DP/health/79BlueCross?utm_term=health%20insurance&matchtype=b&network=g&device=c&adposition=&devicemodel=&ad=725222873691&subsource=180572540788&publisher=&utm_source=Google&utm_medium=Search&utm_campaign=HealthInternal&gad_source=1&gclid=CjwKCAjw47i_BhBTEiwAaJfPpoY2MlVSP4RgdvQIuZnQQmpIk2h1sgYEOAi-WdthB8naKdIc1P3nvhoCyTMQAvD_BwE
https://www.hhs.gov/answers/health-insurance-reform/can-i-get-coverage-if-i-have-a-pre-existing-condition/index.html

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