Wednesday, June 19, 2024

Obsessing About Insurance

Sometimes insurance blinds us to the obvious.

I tried to make an appointment with the eye doctor to have my eyes checked as it's been a couple of years since I had my last prescription done. I called the doctor's number and receptionist answered and immediately asked me what my insurance was. Although we have Ambetter (Obamacare) I don't think we have eyeglass or eye doctor coverage. She immediately told me that they don't take Ambetter and even suggested I go to a different doctor for my prescription.


I kept trying to make the appointment and she kept going around and around about insurance. Finally, I asked her how much it costs to have the eye exam and she said "$95". I said, "I think we can swing that."

People get so obsessed with the covering trivial expenses with insurance and forget the big picture. This receptionist was actually turning patients away from the practice.  Crazy!

Ambetter offers plans in three basic levels, gold, silver and bronze. We opted for the low-cost "zinc" plan which provides very little other than some basic services and 50% of medical costs once you reach your $9,000 deductible. After you reach the max out-of-pocket they cover 100% of expenses and I believe the max out-of-pocket is $16,000. In other words, we are interested in catastrophic coverage not nickel and dime bullshit. I'd rather pay a smaller annual premium than cover scraped knees and infected toenails.

And we're not talking about a small difference in premiums, either. The difference between our plan and the gold plan is about a thousand dollars more per month – and not covered by any Obamacare subsidy, either. So I could get rid of my $9000 deductible if I paid only $12,000 more per year.  Thanks, but no thanks!

Of course come I'm in the minority with this opinion.  Others want cradle-to-grave coverage and they're willing to pay exorbitant sums to get it.

Just to be sure, I logged onto the Ambetter site and checked my coverage and indeed ophthalmology and optometry are not covered under the plan other than for pediatric optical care and emergency care (such as getting your eye poked out). But for routine eye doctor appointments, it's not covered - nor are eyeglasses.

I mean, sure, it would be nice to get a lot of free stuff - but it doesn't work that way with insurance in America. You have to pay a monthly premium and you get what you pay for. If we had signed up for the gold or diamond or platinum plans or whatever, I'm sure they would cover this stuff.  But the premiums would be $500 to $1000 to thousand dollars more per month. I can buy a lot of glasses online and have many eye doctor appointments for that much money. 

What I thought was interesting was the receptionist at the doctor's office looked at everything through the prison of insurance. She wanted to know immediately what insurance we had and whether they accepted it. She warned me direly that they would not accept my policy and therefore I should shop elsewhere!  I wonder if the doctor knows that she is turning away customers?

But her attitude is very common among people who are obsessed with trivial expenses - and not seeing the big picture.  Before we had Obamacare - before Obamacare existed - we had a high deductible Blue Cross plan that cost very little per month but had a ten thousand dollar deductible. A friend of mine were shocked at this, asking me where I would get the ten thousand dollars if I ever got sick. I asked about the policy he had for him and his wife and they had a very low deductible, but were paying $10,000 more per year than I was, in premiums. "To answer your question," I said, "I would get the $10,000 from the same place you're getting the $10,000 you pay every year for your health insurance premiums!  And if I'm not sick that year, I'll bank that money for next year."

He still look flummoxed.  His wife made him buy an expensive plan because, "what if something happened?"  They were spending their way into the poor house based on what-ifs rather than what-is.  Obsessed with the thought of routine medical costs, they insured themselves to the hilt.  The only way to win that  game is to hope you have a chronic, expensive, illness,  Even then, though, I could afford ten grand a year - easily.

And I can afford to pay $95 for an optician, without insurance!

So far, I have gone over 30 years paying for my own insurance and not having a major medical issue.  My friend who spends $10,000 more per year has spent $300,000 in the same time period.  Imagine that invested over 30 years at even 5%.

More than enough to offset the cost of deductibles later on...