Here is the Long Story, If You Want to Read It.

If you have great health insurance through your employer that you love and you don’t understand why everyone else seems to have a hard time–stop yourself right here. This is not for you. Also, if you have Medicare, most of this site will not apply to you (you’re lucky even if you don’t know it).

For everyone else, health insurance is hard. We all know that, but no one needs another website that gives you a boring description of what “deductible” and “co-pay” mean (we have a glossary too, but it should at least make you laugh/maybe cry). You don’t need another lecture on how you really need health insurance and it can be affordable*. What you need is the “real, real”. It’s like when you discovered you or your partner was pregnant and you went to your friend with kids to ask what to expect from the birth. Do you remember that one person who gave you the real deal?

That’s we want to do what we want to do with HI Explained, give you the ugly reality that no health insurance broker, nonprofit, or government agent will–plus a few tools to make things better.

Once upon a time health insurance was invented as a way to fill hospital beds and later as a way for employers to have healthful employees (who can work more) while reaping huge tax benefits. It was never intended that you would visit a doctor regularly and that some third-payer would cover the cost of that while charging you 10 times what the doctor costs (for that month’s premium alone) for the privilege. The story of how we got here is a long and interesting one, too long for this letter, but you can be assured that it is not to your benefit.

Since then everyone (politicians on both sides, nonprofit idealists, public institutions, big companies, drug companies, healthcare providers, government agencies, and popular media) has benefited from and continued to push the message that health insurance is a fair means of directing the collective good. And it could be. It works fairly well in other countries with regulated non-profit and government single payer systems, but once there are huge profits to be made for powerful individuals, the public good aspect crumbles.

A few lies you may believe (we can set you straight):

• You need health insurance to get healthcare
• You have to provide massive amounts of income data to get health insurance through a state health exchange or healthcare.gov (Obamacare)
• A broker can get you a better deal (if you are asking yourself what the alternatives are to a broker, then you need to read more)
• You can’t see a doctor unless they are in your network or you have out-of-network benefits
• Not having health insurance is always irresponsible
• It’s illegal not to have health insurance (the individual mandate was always only a small tax, not a criminal law, and is defunct for 2019 in any case, but some states will still charge you a penalty)
• Traditional health insurance or nothing are the only options (not anymore)
• If you have bad insurance (including Medicaid), you have to travel a long way and wait long hours to see a terrible doctor (not necessarily)

Those are just a few, I can go on all day.

You owe it to yourself to find out more, but I will warn you, self-directed healthcare is not for the faint of heart. If you have always imagined yourself a warrior for your family, this can be a good battle to fight.

One more thing, we are not an anti-Obamacare, right-wing propaganda site (they exist and they are awful). We think the ACA is great and has really helped a lot of people, if you qualify for good subsidies and affordable insurance with access to good doctors, awesome for you! Not all of us do though… 

HI Explained FAQs

Who is this site for?

Anyone who doesn’t have great health insurance they love and can afford, including people who have no insurance at all.  Also, it might make wonks laugh when they realize how obvious all this is, and yet how rarely it is said.

What exactly do you provide?

Hopefully life-changing realizations that leave you empowered to make your own decisions based on careful cost/risk/benefit analysis. We try to make it fun to read, but this is tough stuff. It’s never going to be fun to implement (except for a few weirdos like me). We also offer a research service to find you some of the specific resources and answers you need to make important healthcare financial decisions such as strategies for picking a plan, living with alternatives to health insurance, and living with terrible insurance. We can’t tell you what to do, but we can only open your mind to more options and more data points than you ever thought of before.

Are you afraid someone will sue you?

This site is about learning and taking control of your own healthcare expenditures. In essence, it’s about money (not medical advice). Our goal is to get you to ask the right questions, but not necessarily give you the answers that are right for you. Everyone has to decide for themselves what level of risk is good for them: there is no such thing is no risk. If you decide for yourself to take a bigger financial risk after reading our research, that’s on you. We guarantee nothing. Also, you should listen to a doctor if you need medical advice and run tax strategies by a certified accountant.

Are you saying it is okay not to have insurance?

“Okay” is a moral judgement. There are no moral judgements here. I’m saying that it may not be financially sound for a narrow group of people to have health insurance as it stands now–until they fix it. If your combined premiums, co-insurance, and deductibles are as much as 30k per year, what are the odds that you will be unable to negotiate your health expenses down to less than that as a self-pay/self-insured patient with alternative mechanisms in place? The system depends on these people buying in, so you won’t hear that anywhere else. And yes, there is a risk of bankruptcy, but that is the case with many things such as starting a new business, buying a home, or retiring early.

Who are You Anyway?

This is a tough one. HI Explained is the vision of a wonky consultant who has spend years on the front lines just behind the spotlight and a team of advisors and helpers she recruited (or is currently still recruiting more of depending on when you read this). I, the wonky consultant, have spent a spent an insane number of hours reading fine print, CMS documents, legal analysis, actual congressional bills, regulations (CFR 45!), and all kinds of other things that you don’t want to read. I’ve trained hundreds of healthcare customer service representatives, and I’m a bit of an expert when it comes to red tape.