Siderea (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
siderea) wrote2025-12-14 11:11 pm
siderea) wrote2025-12-14 11:11 pm
Entry tags:
flexagon (flexagon) wrote2025-12-14 07:54 pm
flexagon) wrote2025-12-14 07:54 pmThe week, words, reading
This week was a little less heavily scheduled. I've fallen out of the habit of recording daily snippets, and I wonder if that's part of why I had meaner voices in my head this week. The voices are adaptive and can keep up with whatever I do or don't do. Lately they are super harping on the idea that I can't work a corporate job anymore -- which, if that's even true, is true because I don't want to anymore, and obviously wanting to is a pretty solid precondition for doing it. As someone kindly said to me, Michael Phelps can't do another Olympics either, and so what? But I'm no Phelps, I'm just another crispy critter from the burnout zone that is tech. Sometimes that's scary, and sometimes I think recovery/pivots are going just fine.
Satisfying continuations on last week's stuff: I used the serger to make a cover for the serger, out of scrap denim, which felt right and proper. One thread still has a tension issue I haven't solved. And we bought a new dining table, a very beautiful refurbished teak table that will take weeks to get to us but which will probably be Our Table for the rest of our table-owning lives. I fed the new squirrel tenants every morning.
I had two catch-ups with old friends, outside of my usuals: one helping to unpack a new kitchen, and the other one playing in the friend's home gym. The friend has an aerial point with some straps, and spoke temptingly enough of straps as cross-training for handstands that I tried to sign up for straps 101 at circus school next session. Failed, but I just confirmed I can do the one cool exercise she taught me on my monkey bars in my home gym. Shrug.
Words I looked up: AIXI, philippic, sapid, abreactive, Blahaj, colliery.
Things I learned about: population axiology (not that I've finished the whole paper), gooners and gooning (those wankers are just the kind of bizarre subculture I love to read about), environmental causes of Parkinson's disease. Money quote from that last one: “The Human Genome Project was a $3 billion investment, and what did we find out? Five percent of all disease is purely genetic. Less than 40 percent of diseases even have a genetic component.” Oooof.
And just because it is the season, we now have a tree in our living room. Not decorated yet, but it smells nice.
Satisfying continuations on last week's stuff: I used the serger to make a cover for the serger, out of scrap denim, which felt right and proper. One thread still has a tension issue I haven't solved. And we bought a new dining table, a very beautiful refurbished teak table that will take weeks to get to us but which will probably be Our Table for the rest of our table-owning lives. I fed the new squirrel tenants every morning.
I had two catch-ups with old friends, outside of my usuals: one helping to unpack a new kitchen, and the other one playing in the friend's home gym. The friend has an aerial point with some straps, and spoke temptingly enough of straps as cross-training for handstands that I tried to sign up for straps 101 at circus school next session. Failed, but I just confirmed I can do the one cool exercise she taught me on my monkey bars in my home gym. Shrug.
Words I looked up: AIXI, philippic, sapid, abreactive, Blahaj, colliery.
Things I learned about: population axiology (not that I've finished the whole paper), gooners and gooning (those wankers are just the kind of bizarre subculture I love to read about), environmental causes of Parkinson's disease. Money quote from that last one: “The Human Genome Project was a $3 billion investment, and what did we find out? Five percent of all disease is purely genetic. Less than 40 percent of diseases even have a genetic component.” Oooof.
And just because it is the season, we now have a tree in our living room. Not decorated yet, but it smells nice.
Siderea (siderea) wrote2025-12-14 08:45 am
siderea) wrote2025-12-14 08:45 amEntry tags:
Understanding Health Insurance: The Three-Stage Model [healthcare, US, Patreon]
Canonical link: https://siderea.dreamwidth.org/1891517.html
When you have health insurance, you have a contract (health plan) with the insurance company that says that for the duration (the plan year) of the contract, you will pay them the agreed upon monthly fee every month (the premium), in exchange for them paying for your health care... some.
How much is "some"? Well, that depends.
To understand what it depends on, you have to understand the three-stage model that health plans are organized around.
This three-stage model is never described as such. It is implicit in the standard terms (jargon) of the health insurance industry, and it is never made explicit. There is no industry term (jargon) for the model itself. There are no terms (jargon) for the three stages. But health insurance becomes vastly easier to understand if you think about it in terms of the three-stage model that is hiding in just about every health plan's terms (agreements).
( Read more: 12,170 (sic!) riveting words about health insurance in the US] )
This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
This is part of Understanding Health Insurance
- Introduction
- A Health Plan is a Contract
- The Three-Stage Model ⇐ You are here
The Three-Stage Model
When you have health insurance, you have a contract (health plan) with the insurance company that says that for the duration (the plan year) of the contract, you will pay them the agreed upon monthly fee every month (the premium), in exchange for them paying for your health care... some.
How much is "some"? Well, that depends.
To understand what it depends on, you have to understand the three-stage model that health plans are organized around.
This three-stage model is never described as such. It is implicit in the standard terms (jargon) of the health insurance industry, and it is never made explicit. There is no industry term (jargon) for the model itself. There are no terms (jargon) for the three stages. But health insurance becomes vastly easier to understand if you think about it in terms of the three-stage model that is hiding in just about every health plan's terms (agreements).
( Read more: 12,170 (sic!) riveting words about health insurance in the US] )
This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
Siderea (siderea) wrote2025-12-12 06:49 am
siderea) wrote2025-12-12 06:49 amUpdate [me, health, Patreon]
So, I, uh, got my RSI/ergonomics debugged!* I then promptly lost two days to bad sleep due to another new mechanical failure of the balky meat mecha and also a medical appointment in re two previous malfunctions. But I seem back in business now. The new keyboard is great.
Patrons, I've got three Siderea Posts out so far this month and it's only the 12th. I have two more Posts I am hoping to get out in the next three days. Also about health insurance. We'll see if it actually happens, but it's not impossible. I have written a lot of words. (I really like my new keyboard.)
Anyways, if you weren't planning on sponsoring five posts (or – who knows? – even more) this month, adjust your pledge limits accordingly.
* It was my bra strap. It was doing something funky to how my shoulder blade moved or something. It is both surprising to me that so little pressure made so much ergonomic difference, and not surprising because previously an even lighter pressure on my kneecap from wearing long underwear made my knee malfunction spectacularly. Apparently this is how my body mechanics just are.
Patrons, I've got three Siderea Posts out so far this month and it's only the 12th. I have two more Posts I am hoping to get out in the next three days. Also about health insurance. We'll see if it actually happens, but it's not impossible. I have written a lot of words. (I really like my new keyboard.)
Anyways, if you weren't planning on sponsoring five posts (or – who knows? – even more) this month, adjust your pledge limits accordingly.
* It was my bra strap. It was doing something funky to how my shoulder blade moved or something. It is both surprising to me that so little pressure made so much ergonomic difference, and not surprising because previously an even lighter pressure on my kneecap from wearing long underwear made my knee malfunction spectacularly. Apparently this is how my body mechanics just are.
Siderea (siderea) wrote2025-12-12 06:17 am
siderea) wrote2025-12-12 06:17 amEntry tags:
Choosing Health Insurance: HSAs: FYI re bronze, catastrophic plans [healthcare, US, Patreon]
Canonical link: https://siderea.dreamwidth.org/1890494.html
0.
Hey Americans (and other people stuck in the American healthcare system)! Shopping for a health plan on your state marketplace? Boy, do I have some information for you that you should have and probably don't. There's been an important legal change affecting your choices that has gotten almost no press.
Effective with plan year 2026 all bronze level and catastrophic plans are statutorily now HDHPs and thus HSA compatible. You may get and self-fund an HSA if you have any bronze or catastrophic plan, as well as any plan of any level designated a HDHP.
2025 Dec 9: IRS.gov: "Treasury, IRS provide guidance on new tax benefits for health savings account participants under the One, Big, Beautiful Bill"
If you are shopping plans right now (or thought you were done), you should probably be aware of this. Especially if you are planning on getting a bronze plan, a catastrophic plan, or any plan with the acronym "HSA" in the name or otherwise designated "HSA compatible".
The Trump administration doing this is tacit admission that all bronze plans have become such bad deals that they're the economic equivalent of what used to be considered a HDHP back when that concept was invented, and so should come with legal permission to protect yourself from them with an HSA.
Effective immediately, you should consider a bronze plan half an insurance plan.
( Read more [3,340 words] )
This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
0.
Hey Americans (and other people stuck in the American healthcare system)! Shopping for a health plan on your state marketplace? Boy, do I have some information for you that you should have and probably don't. There's been an important legal change affecting your choices that has gotten almost no press.
Effective with plan year 2026 all bronze level and catastrophic plans are statutorily now HDHPs and thus HSA compatible. You may get and self-fund an HSA if you have any bronze or catastrophic plan, as well as any plan of any level designated a HDHP.
2025 Dec 9: IRS.gov: "Treasury, IRS provide guidance on new tax benefits for health savings account participants under the One, Big, Beautiful Bill"
Bronze and Catastrophic Plans Treated as HDHPs: As of Jan. 1, 2026, bronze and catastrophic plans available through an Exchange are considered HSA-compatible, regardless of whether the plans satisfy the general definition of an HDHP. This expands the ability of people enrolled in these plans to contribute to HSAs, which they generally have not been able to do in the past. Notice 2026-05 clarifies that bronze and catastrophic plans do not have to be purchased through an Exchange to qualify for the new relief.
If you are shopping plans right now (or thought you were done), you should probably be aware of this. Especially if you are planning on getting a bronze plan, a catastrophic plan, or any plan with the acronym "HSA" in the name or otherwise designated "HSA compatible".
The Trump administration doing this is tacit admission that all bronze plans have become such bad deals that they're the economic equivalent of what used to be considered a HDHP back when that concept was invented, and so should come with legal permission to protect yourself from them with an HSA.
Effective immediately, you should consider a bronze plan half an insurance plan.
( Read more [3,340 words] )
This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
Jenn (hafnia) wrote2025-12-08 10:21 pm
hafnia) wrote2025-12-08 10:21 pm(no subject)
Christ.
Things move quickly, I suppose. It's sort of ironic — I ended that entry with a note about plans changing, and this morning, they did.
Max texted me that the funeral is this weekend. Friday, specifically.
"So I guess I'm not going", because there were no flights.
I pointed out that thanks to the atmospheric river, temps are actually much warmer than they have been — "so if we want to drive..."
I texted a friend of ours that cat-sits for us, usually, asking if she was free. She said yes, as long as I was fine with them getting fed two hours early on Thursday.
"Yeah, of course."
So.
Text exchange with Maximo back and forth, re: whether or not he wanted me to go; I hate "well, it's up to you", because when it's shit like this, it's not up to me. If I'm going out with you as support, I want to know that you want that support, goddam.
Anyway he admitted at long last that yes, he would like it, so we're leaving Thursday.
Today was something of a mixed bag, shall we say.
Woke up with the alarm at 7:20, talked to Maximus about the whole funeral business, then fell back asleep because I hadn't actually fallen asleep last night until almost 3am. (Sigh.)
Almost immediately went into a nightmare about my ex, one where he found out where I'm living now and after I got home from running an errand in town (that I'd walked to; town is small enough that this is plausible), followed me home, stole my keys to keep me from getting into the house, and ended up literally chasing me through the neighborhood.
Woke up mid-panic attack, fully hyperventilating, fight-or-flight response in full gear, nearly kicked one of the cats trying to get free of the bedclothes. Cool.
Laid there for a very long time just trying to get my heart rate back down to normal. I haven't talked to him in eight and a half years. I have seen him at a few points, but it's been the sort of thing where I've had the ability to just leave, so I have, without talking to him.
(I know that if for some horrible reason I did end up in the same place as him at the same time with no way to escape, he would try to talk to me — I don't know that he'd be able to help it. I saw him do it to others. I also know that I would probably just end up giving him the cut direct, but, well, you know.)
Eventually did get up and get ready to do therapy, etc, but God, that cast a shadow over the whole fucking day.
Happier news, suppose: I made bread today. Very simple stuff. In essence:
500 g bread flour (~4ish cups but woe betide you if you're using volumetric measurements for flour)
1.5 c water
2 tsp coarse salt (kosher, or I use coarse sea salt for mine)
2 tsp instant yeast
Throw into a bowl, knead until it passes the windowpane test (about eight minutes at speed 2 in my KitchenAid). Allow to rise in a warm place (on top of the coffee maker, here) until doubled in size. Tip out onto a baking sheet, shape into a loaf, allow to rise until puffy and, well, large, another 45 minutes, then slash the top and bake at 425F until browned, about 25 minutes in my oven.
I opt for crispy crust by preheating a cast-iron pan with the oven and filling it with boiling water just before I shove the bread in, but you do you.
Anyway it's dead fucking simple and it makes a loaf of bread that the Maximus goes nuts for.
Literally — I put it out on a board, just as a, "we can have some of this with olives and cheese and some wine while we're waiting for dinner to finish baking" (I made pot pie), and he flipped and ate a third of the loaf by his lonesome. Good lord.
I did a tarot reading for myself as sort of a, "great, what next?" post-therapy.
It was...enlightening?
Midway through doing it, I had the funny little revelation that the deck I bought for myself a couple of years ago that I cannot do a proper reading with is something that a friend of mine would probably have better luck with, because it's moon-themed, and I am just...look, I know what I am, and I am not Moon Energy. So.
The upshot of the reading is that yes shit sucks right now, why am I asking my tarot deck for confirmation that it sucks? It does, you're welcome, the end. Acknowledging that it sucks and doing what needs to be done will at least maybe help with the feeling of absolute misery, so, uh.
...thanks, goblin deck, for that...?
I did laugh while doing the pulls, but — yeah.
I did tarot in part because I joked with my therapist that perhaps I should just pay an Etsy witch to uncurse me. "Do you know the name of the one that uncursed the Seattle Mariners? Do you think she does more than just baseball?"
He laughed.
The — reading was basically, like, "look if you want to reach out to weird metaphysical shit for help, then yes, find that Etsy witch and pay her", which was deeply funny to me, but yeah.
Some part of me is like, "this is ridiculous, you are a PhD scientist" — and another part of me is like, "but, you know..."
So I suppose we shall see? :P
If anyone has a preferred Etsy witch (or method of curse removal), LET ME KNOW.
Oh! Right, of course, yes.
The other weird thing is that one of my fics on AO3 has suddenly gained almost 125 hits over the last two days. No kudos, no new comments, just a fuckload more hits. Like, why?? Do I get to know?
...do I want to know?
(It's explicit, tagged clearly with what it is, and fairly unremarkable, so I can't imagine it's been linked anywhere, but — huh.)
Things move quickly, I suppose. It's sort of ironic — I ended that entry with a note about plans changing, and this morning, they did.
Max texted me that the funeral is this weekend. Friday, specifically.
"So I guess I'm not going", because there were no flights.
I pointed out that thanks to the atmospheric river, temps are actually much warmer than they have been — "so if we want to drive..."
I texted a friend of ours that cat-sits for us, usually, asking if she was free. She said yes, as long as I was fine with them getting fed two hours early on Thursday.
"Yeah, of course."
So.
Text exchange with Maximo back and forth, re: whether or not he wanted me to go; I hate "well, it's up to you", because when it's shit like this, it's not up to me. If I'm going out with you as support, I want to know that you want that support, goddam.
Anyway he admitted at long last that yes, he would like it, so we're leaving Thursday.
Today was something of a mixed bag, shall we say.
Woke up with the alarm at 7:20, talked to Maximus about the whole funeral business, then fell back asleep because I hadn't actually fallen asleep last night until almost 3am. (Sigh.)
Almost immediately went into a nightmare about my ex, one where he found out where I'm living now and after I got home from running an errand in town (that I'd walked to; town is small enough that this is plausible), followed me home, stole my keys to keep me from getting into the house, and ended up literally chasing me through the neighborhood.
Woke up mid-panic attack, fully hyperventilating, fight-or-flight response in full gear, nearly kicked one of the cats trying to get free of the bedclothes. Cool.
Laid there for a very long time just trying to get my heart rate back down to normal. I haven't talked to him in eight and a half years. I have seen him at a few points, but it's been the sort of thing where I've had the ability to just leave, so I have, without talking to him.
(I know that if for some horrible reason I did end up in the same place as him at the same time with no way to escape, he would try to talk to me — I don't know that he'd be able to help it. I saw him do it to others. I also know that I would probably just end up giving him the cut direct, but, well, you know.)
Eventually did get up and get ready to do therapy, etc, but God, that cast a shadow over the whole fucking day.
Happier news, suppose: I made bread today. Very simple stuff. In essence:
500 g bread flour (~4ish cups but woe betide you if you're using volumetric measurements for flour)
1.5 c water
2 tsp coarse salt (kosher, or I use coarse sea salt for mine)
2 tsp instant yeast
Throw into a bowl, knead until it passes the windowpane test (about eight minutes at speed 2 in my KitchenAid). Allow to rise in a warm place (on top of the coffee maker, here) until doubled in size. Tip out onto a baking sheet, shape into a loaf, allow to rise until puffy and, well, large, another 45 minutes, then slash the top and bake at 425F until browned, about 25 minutes in my oven.
I opt for crispy crust by preheating a cast-iron pan with the oven and filling it with boiling water just before I shove the bread in, but you do you.
Anyway it's dead fucking simple and it makes a loaf of bread that the Maximus goes nuts for.
Literally — I put it out on a board, just as a, "we can have some of this with olives and cheese and some wine while we're waiting for dinner to finish baking" (I made pot pie), and he flipped and ate a third of the loaf by his lonesome. Good lord.
I did a tarot reading for myself as sort of a, "great, what next?" post-therapy.
It was...enlightening?
Midway through doing it, I had the funny little revelation that the deck I bought for myself a couple of years ago that I cannot do a proper reading with is something that a friend of mine would probably have better luck with, because it's moon-themed, and I am just...look, I know what I am, and I am not Moon Energy. So.
The upshot of the reading is that yes shit sucks right now, why am I asking my tarot deck for confirmation that it sucks? It does, you're welcome, the end. Acknowledging that it sucks and doing what needs to be done will at least maybe help with the feeling of absolute misery, so, uh.
...thanks, goblin deck, for that...?
I did laugh while doing the pulls, but — yeah.
I did tarot in part because I joked with my therapist that perhaps I should just pay an Etsy witch to uncurse me. "Do you know the name of the one that uncursed the Seattle Mariners? Do you think she does more than just baseball?"
He laughed.
The — reading was basically, like, "look if you want to reach out to weird metaphysical shit for help, then yes, find that Etsy witch and pay her", which was deeply funny to me, but yeah.
Some part of me is like, "this is ridiculous, you are a PhD scientist" — and another part of me is like, "but, you know..."
So I suppose we shall see? :P
If anyone has a preferred Etsy witch (or method of curse removal), LET ME KNOW.
Oh! Right, of course, yes.
The other weird thing is that one of my fics on AO3 has suddenly gained almost 125 hits over the last two days. No kudos, no new comments, just a fuckload more hits. Like, why?? Do I get to know?
...do I want to know?
(It's explicit, tagged clearly with what it is, and fairly unremarkable, so I can't imagine it's been linked anywhere, but — huh.)
Siderea (siderea) wrote2025-12-08 07:42 am
siderea) wrote2025-12-08 07:42 amEntry tags:
Understanding Health Insurance: A Health Plan is a Contract [US, healthcare, Patreon]
Canonical link: https://siderea.dreamwidth.org/1890011.html
What we call health insurance is a contract. When you get health insurance, you (or somebody on your behalf) are agreeing to a contract with a health insurance company – a contract where they agree to do certain things for you in exchange for money. So a health insurance plan is a contract between the insurance company and the customer (you).
For simplicity, I will use the term health plan to mean the actual contract – the specific health insurance product – you get from a health insurance company. (It sounds less weird than saying "an insurance" and is shorter to type than "a health insurance plan".)
One of the things this clarifies is that one health insurance company can have a bunch of different contracts (health plans) to sell. This is the same as how you may have more than one internet company that could sell you an internet connection to your home, and each of those internet companies might have several different package deals they offer with different prices and terms. In exactly that way, there are multiple different health insurance companies, and they each can sell multiple different health plans with different prices and terms.
( Read more... [7,130 words] )
This post brought to you by the 220 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
This is part of Understanding Health Insurance
- Introduction
- A Health Plan is a Contract ⇐ You are here
- The Three-Stage Model
Health Insurance is a Contract
What we call health insurance is a contract. When you get health insurance, you (or somebody on your behalf) are agreeing to a contract with a health insurance company – a contract where they agree to do certain things for you in exchange for money. So a health insurance plan is a contract between the insurance company and the customer (you).
For simplicity, I will use the term health plan to mean the actual contract – the specific health insurance product – you get from a health insurance company. (It sounds less weird than saying "an insurance" and is shorter to type than "a health insurance plan".)
One of the things this clarifies is that one health insurance company can have a bunch of different contracts (health plans) to sell. This is the same as how you may have more than one internet company that could sell you an internet connection to your home, and each of those internet companies might have several different package deals they offer with different prices and terms. In exactly that way, there are multiple different health insurance companies, and they each can sell multiple different health plans with different prices and terms.
( Read more... [7,130 words] )
This post brought to you by the 220 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.
Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
Siderea (siderea) wrote2025-12-08 07:41 am
siderea) wrote2025-12-08 07:41 amEntry tags:
Understanding Health Insurance: Introduction [healthcare, US, Patreon]
Canonical link: https://siderea.dreamwidth.org/1889543.html
Preface: I had hoped to get this out in a more timely manner, but was hindered by technical difficulties with my arms, which have now been resolved. This is a serial about health insurance in the US from the consumer's point of view, of potential use for people still dealing with open enrollment, which we are coming up on the end of imminently. For everyone else dealing with the US health insurance system, such as it is, perhaps it will be useful to you in the future.
Understanding Health Insurance:
Health insurance in the US is hard to understand. It just is. If you find it confusing and bewildering, as well as infuriating, it's not just you.
I think that one of the reasons it's hard to understand has to do with how definitions work.
Part of the reason why health insurance is so confusing is all the insurance industry jargon that is used. Unfortunately, there's no way around that jargon. We all are stuck having to learn what all these strange terms mean. So helpful people try to explain that jargon. They try to help by giving definitions.
But definitions are like leaves: you need a trunk and some branches to hang them on, or they just swirl around in bewildering clouds and eventually settle in indecipherable piles.
There are several big ideas that provide the trunk and branches of understanding health insurance. If you have those ideas, the jargon becomes a lot easier to understand, and then insurance itself becomes a lot easier to understand.
So in this series, I am going to explain some of those big ideas, and then use them to explain how health insurance is organized.
This unorthodox introduction to health insurance is for beginners to health insurance in the US, and anyone who still feels like a beginner after bouncing off the bureaucratic nightmare that is our so-called health care system in the US. It's for anyone who is new to being an health insurance shopper in the US, or feels their understanding is uncertain. Maybe you just got your first job and are being asked to pick a health plan from several offered. Maybe you have always had insurance from an employer and are shopping on your state marketplace for the first time. Maybe you have always gotten insurance through your parents and spouse, and had no say in it, but do now. This introduction assumes you are coming in cold, a complete beginner knowing nothing about health insurance or what any of the health insurance industry jargon even is.
Please note! This series is mostly about commercial insurance products: the kinds that you buy with money. Included in that are the kind of health insurance people buy for themselves on the state ACA marketplaces and also the kind of health insurance people get from their employers as a "bene". It may (I am honestly not sure) also include Medicare Advantage plans.
The things this series explains do not necessarily also describe Medicaid or bare Medicare, or Tricare or any other government run insurance program, though if you are on such an insurance plan this may still be helpful to you. Typically government-run plans have fewer moving parts with fewer choices, so fewer jargon terms even matter to them. Similarly, this may be less useful for subsidized plans on the state ACA marketplaces. It depends on the state. Some states do things differently for differently subsidized plans.
But all these different kinds of government-provided health insurance still use some insurance industry jargon for commercial insurance, if only to tell you what they don't have or do. So this post may be useful to you because understanding how insurance typically works may still prove helpful in understanding what the government is up to. Understanding what the assumptions are of regular commercial insurance will hopefully clarify the terms even government plans use to describe themselves. Just realize that if you have a plan the government in some sense is running, things may be different – including maybe very different – for you.
On to the first important idea: Health Insurance is a Contract.
Preface: I had hoped to get this out in a more timely manner, but was hindered by technical difficulties with my arms, which have now been resolved. This is a serial about health insurance in the US from the consumer's point of view, of potential use for people still dealing with open enrollment, which we are coming up on the end of imminently. For everyone else dealing with the US health insurance system, such as it is, perhaps it will be useful to you in the future.
Understanding Health Insurance:
Introduction
Health insurance in the US is hard to understand. It just is. If you find it confusing and bewildering, as well as infuriating, it's not just you.
I think that one of the reasons it's hard to understand has to do with how definitions work.
Part of the reason why health insurance is so confusing is all the insurance industry jargon that is used. Unfortunately, there's no way around that jargon. We all are stuck having to learn what all these strange terms mean. So helpful people try to explain that jargon. They try to help by giving definitions.
But definitions are like leaves: you need a trunk and some branches to hang them on, or they just swirl around in bewildering clouds and eventually settle in indecipherable piles.
There are several big ideas that provide the trunk and branches of understanding health insurance. If you have those ideas, the jargon becomes a lot easier to understand, and then insurance itself becomes a lot easier to understand.
So in this series, I am going to explain some of those big ideas, and then use them to explain how health insurance is organized.
This unorthodox introduction to health insurance is for beginners to health insurance in the US, and anyone who still feels like a beginner after bouncing off the bureaucratic nightmare that is our so-called health care system in the US. It's for anyone who is new to being an health insurance shopper in the US, or feels their understanding is uncertain. Maybe you just got your first job and are being asked to pick a health plan from several offered. Maybe you have always had insurance from an employer and are shopping on your state marketplace for the first time. Maybe you have always gotten insurance through your parents and spouse, and had no say in it, but do now. This introduction assumes you are coming in cold, a complete beginner knowing nothing about health insurance or what any of the health insurance industry jargon even is.
Please note! This series is mostly about commercial insurance products: the kinds that you buy with money. Included in that are the kind of health insurance people buy for themselves on the state ACA marketplaces and also the kind of health insurance people get from their employers as a "bene". It may (I am honestly not sure) also include Medicare Advantage plans.
The things this series explains do not necessarily also describe Medicaid or bare Medicare, or Tricare or any other government run insurance program, though if you are on such an insurance plan this may still be helpful to you. Typically government-run plans have fewer moving parts with fewer choices, so fewer jargon terms even matter to them. Similarly, this may be less useful for subsidized plans on the state ACA marketplaces. It depends on the state. Some states do things differently for differently subsidized plans.
But all these different kinds of government-provided health insurance still use some insurance industry jargon for commercial insurance, if only to tell you what they don't have or do. So this post may be useful to you because understanding how insurance typically works may still prove helpful in understanding what the government is up to. Understanding what the assumptions are of regular commercial insurance will hopefully clarify the terms even government plans use to describe themselves. Just realize that if you have a plan the government in some sense is running, things may be different – including maybe very different – for you.
On to the first important idea: Health Insurance is a Contract.
Understanding Health Insurance
- Introduction
- Health Insurance is a Contract
- The Three-Stage Model
flexagon (flexagon) wrote2025-12-07 10:15 pm
flexagon) wrote2025-12-07 10:15 pmCrafting, HVAC, circus, books, planning (life is good)
- Sewing? I looked into using a serger at the local library, but then coraline had a spare serger to lend me (whoa) and we had a good time talking about clothing construction. I got as far as making sure the serger works, and figuring out how it cuts the fabric as it goes, before getting utterly derailed by the next few things. However, I have the machine and my other machine, and have ordered a few accessories to Get Going Soon. Let the mending and alteration begin.
- Death of a Table: during the above, with two sewing machines and a laptop and part of a friend on my dining room table, the table decided to disintegrate into its five component pieces. Amazingly, nothing and nobody else was hurt, but every single screw came out of the extension mechanism. It's time for a new table. The one we had was "mid-century" style, solid pine, and probably from about the 1920s -- we got it used, nearly 15 years ago, from a peer who got it from his grandmother. I just want another extensible oval, but the bug wants really nice wood, so we might eventually be headed for something like this. I've never paid a lot for a table before, but I guess it's up there with couches and mattresses in size and importance.
- New place: I had to lean pretty hard on the contractor to get someone to come over and fix a small issue with the HVAC. Wasted a couple of hours there, and more hours getting quotes on snow removal that none of the other unit owners wanted. But I also spent a couple of gratifying hours fixing a door so it doesn't scrape on the floor anymore, thanks to heisenbug coming over and helping. A door is really a two-person lift. Then there were tenants who wanted the place and then stopped wanting the place, but in between those two events I went through my last lease and identified all the little places to change wording for a new lease at this place. It's really so, so nice now. Someone is going to have a lovely time living there.
- Blue-Green place: the same unit that had a ton of trouble with AC this summer had their heat cut out on them, including for one very cold night that we felt guilty about (they had a space heater, yes, but they also have a baby). But eventually we got a really nice HVAC guy who walked me through the whole heating system, taught me a bunch of things I later took notes on in a Google doc, and found/fixed the problem with the boiler. Which stemmed partly from nobody realizing it needed water added to it manually every now and then, sigh. The boiler is also super old, so in the spring we'll drain a lot of our reserve fund and replace it. This all involved some running around on my part, over two days, but I do enjoy learning about the system.
- Social: cookie swap at my acro base's apartment (oh, yes, I baked cookies) and tree trimming over at Blue-Green Street. Things are getting kind of intense and stressful again for Helios and Perse, as one of them seems to attract job offers even when not looking and the other seems to attract surgeries even when definitely not looking.
- Circus: I guess doing 60lb TGUs is just normal now, but I did do that again, and also possibly did my best middle splits ever? I got down to two of the thinner yoga blocks, which means a height of just under six inches.
I haven't been playing any video games; real life has been compelling enough. I'm reading some books though (just started The Left Hand of Darkness on Audible), and poking at a knitting project, and curating gifts for Xmas. It's been fun.
I am also making the world's slowest progress on planning a trip to my birth state next spring. I hate it there, but I'll go. And Birdie will go, which is going to absolutely make my dad's whole year as well as introducing her to her genetic granddad. The bug will go, which always helps a ton, and it's starting to look like the squirrel, curious about my origin story, might go too.
flexagon (flexagon) wrote2025-12-06 10:12 am
flexagon) wrote2025-12-06 10:12 amEntry tags:
YOU get a home, and YOU get a home...!
Two pieces of good news, one expected and one not:
Creating environments and then watching them get used is absolutely and 100% my jam. Even when it involves talking to HVAC people more than I'd usually choose to, but that's for another post.
- I have tenants for the new condo! Nothing's signed yet but everyone wants to sign. I had two options, and I picked the pair of people who had a) lived together before and b) had owned a home before. Ex-homeowners make the best tenants. It's also the case that the ones I chose are the ones who're definitely going to use the back yard (for their small, middle-aged dog), and there's some petty pleasure in that, given how hard I pushed for a commonly-owned yard. Oh and one of them is a mechanical engineer who likes to learn how things work, but there was actually a mechanical engineer in each of my possible pairs of tenants so that wasn't a decider. (ETA: these folks flew home, measured their furniture and got a whole lot less excited. So oops, and maybe there'll be better news later.)
- I have tenants in my SQUIRREL NESTING BOX, omg, squeeeee! I saw one go into it yesterday morning, carrying leaves, and immediately got very excited and ran off to get wool and alpaca roving from apfelsingail. This morning, more activity between about 9AM and 10AM, with the one Very Responsible Grownup continuing to carry up batches of leaves. Then, incredibly, a juvenile reappeared, one that we'd seen a few days ago but not since, and it went into the box too, and we got pictures of all this. Then a third squirrel went in there at 10 and so they have remained. (Or actually -- the young'un just poked its nose out -- but mostly.) The warm fuzzies could not get any more literal! I've been hoping for this ever since installing the box in spring, and I guess it appeals more when the temperature drops, because there they are now. Curled up inside, with straw and leaves.
Creating environments and then watching them get used is absolutely and 100% my jam. Even when it involves talking to HVAC people more than I'd usually choose to, but that's for another post.
jakebe (jakebe) wrote2025-12-02 10:13 pm
jakebe) wrote2025-12-02 10:13 pmLover 48
Today was Husboo's 48th birthday! He spent the day playing Final Fantasy VII Rebirth, and for lunch we ordered in from a local place called Pasta Mobsters. In the afternoon, we took a trip over to Illusive Comics so Ratty could buy a couple of gift cards and Husboo could look into getting an Unsanctioned box. Then, off to Buffalo Wild Wings for a chill birthday dinner before an evening showing of Predator: Badlands.
The movie was pretty good! I really love what they're doing with the Predator mythos these days; using the simple premise to tell unusual, engaging sci-fi thrillers. This one featured the Predator as the main character, and the story was almost a bildungsroman about the runt of a clan learning how to become the hunter he wanted to be. I guess it's just accepted that the Alien and Predator universes are the same now, and it allows the former franchise to share in the renaissance energy of the latter. Dek, the Yautja/Predator, takes along an android in a partnership of convenience when he crash-lands on the planet where he means to take an impossible trophy -- the unkillable Kalisk. They both learn how to work with the local ecology instead of against it, and that proves to be how they triumph in the end.
It makes me kind of excited to dig into the local flora of California and start planting (maybe) native herbs or fruiting plants next year. The backyard is going to need quite a bit of work if I'm going to make a go of it, and it'll take some doing to wrangle some order into the garden. I really should make a project plan and schedule if I'm serious about it.
Anywho, that was the birthday. We'll extend the celebration out for a few days so we could reserve a table at a local steakhouse on Friday. Saturday, we have a D&D game and then a holiday party at a new friend's place. It should be a fun time!
We're well and truly in the holidays now, I suppose. I spent over a week at Boss Dog's place, where I slept through a Roll Party, made a pie and several batches of cookies, celebrated Thanksgiving, did our customary Black Friday trip, and came home. This year was a little different because we were down two of our regulars and met a lot of new people, but it was a wonderful time even still. The new folks aren't *completely* new; we had seen them a few times this year and follow each other on social media, that kind of thing. This was the first time we got to actually hang with them, though, and there's always some anxiety wrapped around that. Boss Dog has a number of friends who are highly successful in the world, know how to do a lot of varied, complex things, and see the world a lot differently than I do. I always worry I come across as some brain-dead yokel in company like that, but...I don't need to.
Both Husboo and I dissolved many of the barriers we had erected between us and our community through the trip, and that was just awesome to see/experience. Over the last several years, I've felt myself crossing over into a different stage of life. Even though I still feel like some messed-up little kid, the fact is that I'm 45 years old, a whole grown-ass man. As I shake off the torpor of the last decade or so, I find myself more and more motivated to step into the demands of adulthood. I'm already paying car insurance and rent, that sort of thing -- but I also want to shift my mindset from 'trauma survivor' to 'authentic, loving person'. Not that they're mutually-exclusive, of course. But for me, fear and anxiety make me curl up and brace for pain. It's hard to be open and vulnerable when you're always cringing from anything that gets near you. And that's just...where I've been for a while.
But at the same time, there's no denying that the pain and fear I've held for so long has changed me. It's not something I can expunge, but it IS something I can incorporate in a healthy way. I don't want to shut down anymore, but at the same time I have to recognize the situations that frazzle me, you know? I don't want to make any of it anyone else's problem, but I also need to make space for it and be OK with asking others to make space for it, too. Not everyone will be able to do that, for various reasons, and for the most part I think I can be OK with that. I get that my journey is my own, and that it might not look like anyone else's.
The trip...brought those differences into relief for me in a way that allowed me to see things a bit clearly. The Black Friday trip was a lot more physical than previous ones, and that was mostly the influence of the new folks. I don't think the host minded at all, and...neither did most people, I think. It allowed me to observe how folks behaved sexually with each other without feeling like a giant creep about it, and I think I finally realized just how...little sexual experience I've had in general.
I've been all but celibate for the past...20 years now? after a string of traumatizing experiences in my 20s. I think that my natural predilection is for less sex, especially on Fluoxetine, though -- so maybe it's not the trauma after all. I could be quite happy not ever being sexually intimate with another person ever again. That doesn't mean I don't like cuddling though, and touching and being touched. That's *quite* nice.
And if I could be reasonably confident that fondling didn't *have* to lead to orgasm, I might even be comfortable with that too. I *am* curious, and I would like to explore -- but I want to go at my own pace and direct my own experience. And that's not an unreasonable expectation in one's sexual life.
Tomorrow, I'll continue updating my job tracker and (hopefully) certifying for unemployment these last two weeks. Then I'll focus on writing for the rest of the day.
The movie was pretty good! I really love what they're doing with the Predator mythos these days; using the simple premise to tell unusual, engaging sci-fi thrillers. This one featured the Predator as the main character, and the story was almost a bildungsroman about the runt of a clan learning how to become the hunter he wanted to be. I guess it's just accepted that the Alien and Predator universes are the same now, and it allows the former franchise to share in the renaissance energy of the latter. Dek, the Yautja/Predator, takes along an android in a partnership of convenience when he crash-lands on the planet where he means to take an impossible trophy -- the unkillable Kalisk. They both learn how to work with the local ecology instead of against it, and that proves to be how they triumph in the end.
It makes me kind of excited to dig into the local flora of California and start planting (maybe) native herbs or fruiting plants next year. The backyard is going to need quite a bit of work if I'm going to make a go of it, and it'll take some doing to wrangle some order into the garden. I really should make a project plan and schedule if I'm serious about it.
Anywho, that was the birthday. We'll extend the celebration out for a few days so we could reserve a table at a local steakhouse on Friday. Saturday, we have a D&D game and then a holiday party at a new friend's place. It should be a fun time!
We're well and truly in the holidays now, I suppose. I spent over a week at Boss Dog's place, where I slept through a Roll Party, made a pie and several batches of cookies, celebrated Thanksgiving, did our customary Black Friday trip, and came home. This year was a little different because we were down two of our regulars and met a lot of new people, but it was a wonderful time even still. The new folks aren't *completely* new; we had seen them a few times this year and follow each other on social media, that kind of thing. This was the first time we got to actually hang with them, though, and there's always some anxiety wrapped around that. Boss Dog has a number of friends who are highly successful in the world, know how to do a lot of varied, complex things, and see the world a lot differently than I do. I always worry I come across as some brain-dead yokel in company like that, but...I don't need to.
Both Husboo and I dissolved many of the barriers we had erected between us and our community through the trip, and that was just awesome to see/experience. Over the last several years, I've felt myself crossing over into a different stage of life. Even though I still feel like some messed-up little kid, the fact is that I'm 45 years old, a whole grown-ass man. As I shake off the torpor of the last decade or so, I find myself more and more motivated to step into the demands of adulthood. I'm already paying car insurance and rent, that sort of thing -- but I also want to shift my mindset from 'trauma survivor' to 'authentic, loving person'. Not that they're mutually-exclusive, of course. But for me, fear and anxiety make me curl up and brace for pain. It's hard to be open and vulnerable when you're always cringing from anything that gets near you. And that's just...where I've been for a while.
But at the same time, there's no denying that the pain and fear I've held for so long has changed me. It's not something I can expunge, but it IS something I can incorporate in a healthy way. I don't want to shut down anymore, but at the same time I have to recognize the situations that frazzle me, you know? I don't want to make any of it anyone else's problem, but I also need to make space for it and be OK with asking others to make space for it, too. Not everyone will be able to do that, for various reasons, and for the most part I think I can be OK with that. I get that my journey is my own, and that it might not look like anyone else's.
The trip...brought those differences into relief for me in a way that allowed me to see things a bit clearly. The Black Friday trip was a lot more physical than previous ones, and that was mostly the influence of the new folks. I don't think the host minded at all, and...neither did most people, I think. It allowed me to observe how folks behaved sexually with each other without feeling like a giant creep about it, and I think I finally realized just how...little sexual experience I've had in general.
I've been all but celibate for the past...20 years now? after a string of traumatizing experiences in my 20s. I think that my natural predilection is for less sex, especially on Fluoxetine, though -- so maybe it's not the trauma after all. I could be quite happy not ever being sexually intimate with another person ever again. That doesn't mean I don't like cuddling though, and touching and being touched. That's *quite* nice.
And if I could be reasonably confident that fondling didn't *have* to lead to orgasm, I might even be comfortable with that too. I *am* curious, and I would like to explore -- but I want to go at my own pace and direct my own experience. And that's not an unreasonable expectation in one's sexual life.
Tomorrow, I'll continue updating my job tracker and (hopefully) certifying for unemployment these last two weeks. Then I'll focus on writing for the rest of the day.