Insurance questions

It has been many years since we have paid for health insurance, so I have been out of the loop on what my friends and family have to pay for their health care. I am not even sure what percentage an employer pays for their employees' insurance premiums. If you feel comfortable sharing how health care factors into your benefits package, that would be great.

I have wondered how much people spend on insurance as compared to what they would spend just paying the doctor fee for service. With a quick online application, I discovered that, without any help from an employer, we would pay at a minimum $21K/year for comprehensive coverage. This price does not include maternity and the breakdown leaves out the 20% of any hospitalizations after the $15,000 family deductible, unexpected ER visits, antibiotics for when we are sick. The $20K annual out of pocket expense limit includes the deductible, but not the premiums. Here's the breakdown:

$436 monthly premium X 12: $5232 (I'm assuming the premium covers all 6 of us and is not per person)
$7500 deductible X 2 People (for the family rate): $15,000
$30 office visit X 2 visits per person each year: $360 (This includes 1 physical and 1 sick appt)
$15 Rx Co-Pay X 7 meds we get each month X 12: $1260

This is where the employer benefits come in. How much do they pay of this cost? Is this really what people pay?

I also looked at buying only the insurance plan that covers hospital stays, surgery, etc. It allows you to have a Health Savings plan, and I thought it would be much less expensive than the regular route. Here's the breakdown:

$10,000 deductible
$430 premium X 12: $5160

Once you hit your $10,000 deductible for the family, you pay nothing out of pocket. It turns out to be less expensive, but only if you would actually spend that much money on health care costs and spend it early in the year. Since you are paying cash to the dr until you hit your deductible, would they give you a price break? Neil says no because they would still have to turn that claim in to your insurance company to verify that you are paying your way up to your deductible and that the dr could get sued by the insurance company for charging you a rate lower than they charge the insurance company. Could you still use the $4 generics price at Wal-Mart with this insurance?

Just a thought. I recently read an idea for controlling costs: avoiding building new hospitals where there is no need. Apparently in New York or Texas (the paper did not specify), a hospital administrator wanted a transplant service and wing at his hospital, but the local and state governments turned him down because there were three other transplant services in the vicinity. So the administrator appealed to a state congressman with whom he had political ties, and the new hospital service and wing were on their way. If the gov't pays for health care costs, or if the costs are run through the gov't, there won't be any new shiny hospital wings operating at less than capacity.