Healthcare In America
Healthcare insurance in America has changed since Obamacare and some would say not for the better. Of course, there are more Americans insured than ever before but there are still way too many people uninsured simply because they cannot afford the monthly premiums.
Those premiums keep going up each year along with the deductibles and maximums out-of-pocket. Prior to Obamacare a male under 30 could get a $1,000 deductible, $3,000 maximum out-of-pocket for about $85 per month. Today, that plan doesn’t exist any longer and the deductibles and maximums out-of-pocket have risen to upwards of $7,000 for the deductible and higher for the maximum out of pocket. Americans need to understand that when you buy health insurance it is for catastrophic health events like heat attack or cancer and pay the doctor visits and the generic drugs using the contracted rate the insurance has with either the doctor or pharmacy.

To further clarify, all doctors and facilities who are contracted with a specific insurance carrier have agreed on how much the insurance will pay for any service. As an example, let’s say the doctor normally charges cash patients $150.00 for an office visit. The insurance company probably pays that doctor about $90 for the office visit. That is called the contracted rate and that’s what you would pay for the office visit on these high deductible plans. The money you pay goes towards the deductible and maximum out-of-pocket. That holds true for hospital stays, lab or Xray work, or any medical services covered by the plan. Honestly, you will never reach the maximum out-of-pocket unless you are hospitalized.
95% of the population will never reach the maximum out-of-pocket so these high deductible plans are now the way to buy health insurance. The higher the deductible and maximum out-of-pocket, the lower the monthly premiums. Most Americans do not understand the significance of these health insurance changes and opt for the lowest deductible and maximum out-of-pocket they can get but end up paying a much higher monthly premium.
Checkout HSA (Health Savings Account)
Have a suggestion that most people are not aware of and can lead to lower overcall costs of healthcare. I’m referring to the HSA type account. HSA stands for Health Savings Account. Under federal law these plans work is to have a high deductible plan with no copays for any services. (You end up paying the contracted rate as discussed earlier). The difference is under these HSA plans you can open a savings account using pre-tax dollars (meaning you take the contribution out prior to taxes.) These pre-tax dollars
reduce your gross income, thus reducing your taxes, so you end up paying less in federal income taxes.
While this seems to be a great way to reduce your overall health insurance premiums the facts remain that most Americans who opt for this type of plan never actually put any pre-tax dollars away to reduce their federal income taxes.
Regardless of whether you put money away in an HSA savings account, your monthly insurance premiums are reduced. As mentioned earlier, most Americans never hit the maximum and most never reach the deductible. They are still saving money due to the higher limits and lower premiums.
In today’s insurance market, this is the best way to obtain coverage which protects your investments because the maximum out-of-pocket can be viewed as a stop loss on medical bills. Reach the maximum, and the insurance company pays all bills for the remainder of the year. You really need to understand that concept so you choose a plan with a maximum out-of-pocket you can afford, in the event of a catastrophic health event.
This is the real world in 2025, and most Americans need to grasp that concept.
Recently received a phone call from a person who had group coverage and as the spouse of the employee, had to pay all medical premiums himself. He wanted to investigate individual coverage to replace his group coverage. After much discussion he realized that individual coverage is not all it appears. Individual coverage precludes you from going out of state even if you have an EPO (PPO in group coverage), unless it is urgent or an emergency. There is no national network.
This sums up the 2025 individual insurance landscape and as one can see, it has its limitations.
January 15th is the last day you can buy individual health insurance unless you have a life changing event, like marriage, birth of a child, moving to a new state, loss of a job that offered insurance, etc.
We are here to help.

The Barend Agency Inc.
Len Barend, Broker
Cell:702-250-2200
Email: len@insurance4unevada.com