I Don't Want To Go To Work

Capitalism is too 90s.

Stop being old and obsolete

Out of network really hurts, do you not have HDCP / HSA type options? Insurance provided healthcare is a scam, for them to be profitable they need to provide $50 of healthcare for every $100 they take in once you add on all the administrative and processing crap. We found that it was a far better option to structure them as an "emergency only" provider with high deductible that was funded through pre-tax dollars with a limit while using their price setting contracts with healthcare providers.

Trying to do a whole "I pay you $2,000 per year and expect $10,000 in healthcare" isn't going to work. Understand that the healthcare providers inflate everything on their bills by 2~5x, then discount it by 50~80% during the network price negotiations. That is the real benefit of health insurance, the pre-negotiated set prices. Secondary benefit is catastrophic coverage, which is triggered once you hit that high deductible.

The HDCP + HSA system was the best thing to come out of the ACA, too bad it's just so poorly understood.

It's neither, it's all the hands in the way between the consumer and the provider. Each level is driven to take their cut of the money, especially with government money. There is so much fraud and corruption baked into the system that is obscures the true cost of services making informed decisions hard to make.

There are ways to handle this, but it requires educating people and those people then making smart choices. Getting people to make smart responsible decisions about food is hard enough without going into the complicated realm of finances.

High Deducible HSAs were around for at least a decade before ACA. (nothing good came out of the ACA).

I WISH.

The HDHP + HSA tax system was significantly expanded by the ACA.

https://www.irs.gov/publications/p969

Health Savings Accounts (HSA) requires being on a HDCP and enable someone to put a large amount of medical expenses into pre-tax dollars.

• You can claim a tax deduction for contributions you, or someone other than your employer, make to your HSA even if you don’t itemize your deductions on Schedule A (Form 1040).

• Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income.

• The contributions remain in your account until you use them.

• The interest or other earnings on the assets in the account are tax free.

• Distributions may be tax free if you pay qualified medical expenses. See Qualified medical expenses, later.
  

• An HSA is “portable.” It stays with you if you change employers or leave the work force.

With either a PPO or HMO plan the subscription fees (aka premiums), copays, deductions, and non-covered / out-of-networker bills are paid for with post-tax money. With a HSA you can move everything but the subscription fee to pre-tax money while also substantially lowering the subscription fee. Use of the funds in the HSA do not require approval from the health insurance company, you are free to use them for any qualified medical expense.

https://www.irs.gov/publications/p969#en_US_2024_publink1000204083

Qualified medical expense is an immensely broad category. When my wife went back to Korea to visit her family, she also got LASIK eye surgery and some other cosmetic procedures (requires doctors approval) and paid for it with the HSA VISA card connected to my HSA. It works just like a credit card and can even reimburse yourself if you had to pay for someone out of pocket. I recommend people keep receipts when doing this incase the IRS ever does an audit.

Functionally it's a 401K with credit / debit cards connected to it. You contribute tax-free money along with your employer also providing tax-free money into it. You can then spend that money to meet your deductible. Once that happens the insurance provider is responsible for everything else (coinsurance can sometime exist for the lower deductibles), and because it's a HDCP there is very little room for them to play approval games with you. You can see whomever you want, no need for referrals or approvals, doctors visits become super easy once they see you have a HSA, they treat it like cash payment.

The downside is that it takes a year or two to get setup and going, but once going medical insurance ceases to be something you get worried about. You end up prepaying your entire deductible a year or two in advance, and it's money that belongs to you and goes with you if you change jobs, do not have a job or retire. All from pre-tax money, which is easily a 25~35% discount on medical costs.