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PaperclipPerfector  3mo ago (text post)   27025 thread views

Culture War Roundup for the week of August 25, 2025

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Interestingly, google-gpt says about 20% of plans have co-insurance.

I think this is a mistake on GPT's part. The majority of plans have 20% co-insurance, meaning the patient pays 20% after the deductible is met. See https://www.healthcare.gov/choose-a-plan/plans-categories/ or even just try to look for an example of a plan without co-insurance.

I asked Gemini, "Is it possible to get a Health Insurance plan without co-insurance?" and the response was:

"Yes, it is possible to find a health insurance plan without co-insurance, but they are not as common."

I followed up with, "What percentage of Americans have a health care policy without co-insurance?" and got:

The available data does not provide a specific percentage of Americans who have a health insurance policy without co-insurance. However, we can infer some information from the general landscape of U.S. health insurance.

Most health insurance plans, particularly those obtained through employers or the Affordable Care Act (ACA) marketplace, include some form of co-insurance as a cost-sharing mechanism.

The types of plans most likely to have little to no co-insurance are:

Medicaid: This is a public program for low-income individuals and families. 1 While cost-sharing can vary by state, many services are covered with a very small copay or no out-of-pocket costs, effectively making it a no-coinsurance plan for most enrollees.

The Uninsured Population and Health Coverage - KFF Source icon www.kff.org

High-Tier ACA Marketplace Plans (Gold and Platinum): These plans have higher premiums but lower deductibles and out-of-pocket costs, and sometimes have a copay structure for a wider range of services, which can reduce or eliminate the need for co-insurance.

Some Medicare Plans: Traditional Medicare has a coinsurance for many services (e.g., 20% for Part B services). However, many beneficiaries enroll in Medicare Advantage or Medigap plans, which can reduce or eliminate this cost-sharing.

While we can't provide a precise number, it's safe to say that a vast majority of Americans with health insurance are enrolled in plans that include co-insurance. Plans without it are available but are less common and typically come with higher monthly premiums.

I think it does matter, because it's not solely insurance deciding how much the patient pays. How the hospital codes and the choices the doctor makes regarding patient care has a direct, visible consequence on how much the patient pays. It is interesting to see that doctors might not realize that.

I can tell you that in my personal practice I try and be cost aware when possible but that a number of practical concerns come first. For one my job is to get people better, not spare their wallet, the threat of litigation makes it extremely hard to deviate from that even when both the patient and myself want to.

In some situations it appropriate (or required, most often with homeless people) to be more careful about this but I can't always do so. A classic example is inhalers, insurance change what they cover all the time, if I don't know your specific insurance plan well....it's just going to be wrong some of the time, even if I do know the insurance. Hospitals have invested in tools like e-prescribing which help with this.....but all kinds of negative effects of those things have also been generated.

One of those is that I am highly limited in what I can do. The hospital owns most physicians right now because of increased costs like EMRs we do what they say. Some times that involves practicing on our license essentially. It also frequently means things like me signing away my right to bill the hospital just does it for me based off of what I charted.

When it comes to inpatient medicine ultimately I'm going to be like "I'm sorry you are going to get a fuck off huge bill and I have no control over it and depending on your insurance that may or may not be a problem." I am also incentivized to not think about it too much to avoid burn out.

For outpatient medicine usually it's a stripped down professional fee that I have no influence over and a medication bill that I can try and save you money on.

I don't really know what percent of patients have co-insurance, and as you demonstrated and like I said I don't think about co-insurance at all most of the time. This is because legally and practically it has nothing to do with me, that's what the regulatory and legal environment have decided.

Usually when this kind of thing comes up it's "put the doctors on it" but the hospital and insurance company are in charge!

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