The elephant in the room must be acknowledged: Healthcare costs are about to go through the roof Jan. 1, 2027.
I own my own business, myMDadvocate, and I have no employees. I get my health insurance from the ACA marketplace, and I actually count myself lucky because I can afford to pay the monthly insurance premiums. I’ve managed to do well with a plan that covers most of what I need … “most” being the operative word here.
I’ve never assumed that insurance will cover everything. There are copays, deductibles, out-of-pocket costs, out-of-network expenses, plan benefit exclusions, formulary restrictions … and that is just a partial list. I’ve learned to play their game and adhere to their rules. And, I’ve always paid my bills.
I’m a physician. For 25 years I was an owner and shareholder of a large, physician-owned, multispecialty practice. I know a few things about overhead and operating margins. I recall patients who never paid their bills, and were sent to collections. I also remember how deeply in the red we were after the pandemic hit, despite physicians working longer hours and with no days off.
I’m also a patient. Like most of us, I’m acutely aware of healthcare costs landing squarely on my shoulders. The cost of everything is going up these days, and not just in the healthcare arena … getting groceries and filling my gas tank on the same day is sobering enough. It hurts when we are already paying more for less: less access to experienced physicians, fewer covered services, increasingly restricted drug formularies, and so on.
Last week, I received a letter from my health insurance company. They are no longer offering coverage in my county and my current coverage will end Dec.31. King county has an estimated population of 2.4 million people. It is the largest county in Washington state, and the 13th-most populous county in the U.S. I also learned that several major medical centers in the region have not renewed their contracts with a few large insurers.
Of course, I immediately logged into the online health plan finder to start my research for a new insurance plan. I already know what most plans cover, so I could zero in on the ones that would be best for me to consider. I had recently learned that our state’s insurance commissioner had approved up to 22.2% increases in many marketplace plans for the coming year. What I wasn’t prepared for was that my monthly premium will essentially increase by 45%, since I have to change to an insurance plan that includes the county where I live. So, it looks like in 2027 I’ll be paying $1,600 per month just for the privilege of having health insurance that won’t even cover all of my medical expenses.
I don’t have the luxury of purchasing catastrophic health insurance coverage, since I’m more than twice the maximum age requirement of 30, and my current income won’t qualify for a hardship exemption. That being said, my coverage is actually similar to a catastrophic coverage plan with a deductible of $7,000 per person and an out-of-pocket limit of $10,150 per person before any benefits kick in. All that for an annual premium payment of approximately $20,000.
To borrow from the late, great Bette Davis, navigating health insurance plans is not for sissies! In the past year, I’ve incurred jaw-dropping medical expenses averaging $80,000 per month. Prior to that timeframe I was hospitalized for cancer surgery … that was not cheap, either. Sadly, I’m sure many families have a comparable story of their own to tell.
Most of us pay for car insurance, homeowners or renters insurance, life insurance, and computer insurance, and some even have pet insurance. Going without health insurance is not in the cards for me. Yet, many people are doing this, either intentionally or unintentionally. I’m certain the numbers will only increase in 2027.
If this American reality wasn’t so dystopian, it might seem comical. What other expensive product would you knowingly pay for, year after year, even if it was guaranteed to not perform the way it should? We pay, so that our medical needs are denied (prior authorization). We pay, so that we don’t get consistent access to necessary medications (pharmacy benefit management companies and drug formularies). We pay, so that we don’t have access to physicians who are valued, respected and aren’t suffering from moral injury (private equity-owned corporations and corporatized consolidated systems). We just keep paying.
While open enrollment for Medicare plans just got under way two days ago (spoiler alert: do NOT select a Medicare Advantage plan), marketplace plans will start their open enrollment on Nov. 1. And even though I consider paying for my health insurance plan a necessary requirement of living in this country, I don’t have to like it; and I don’t.
I do want to end this article with a glimmer of hope. I’ve paid for direct primary care for many years, and my personal physician is amazing. I couldn’t see getting my medical care any other way. I’m privileged to be able to afford this extra cost … but it’s not a practice style meant for all. If you want to learn more, I recently had the pleasure of hosting Rebekah Bernard, MD, on Voices With Vigor in “DPC, The Best Primary Care.” Watch the on-demand video replay now … it may just be the one healthcare-related item you can actually get for free.
Dr. Baumgaertel owns and operates myMDadvocate, a virtual consultation service for patients in Washington state.
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