Health Insurance Help?

[Brown.Eyed.Girl]

As many of you know, I'm currently jobless and out of law school, and too old to be on my parents' insurance. I've been insurance-less for the last three months but with the weather getting colder, the roads getting worse, and me driving more, I want to be covered at least to some extent.

The thing is, I have no idea which plan to pick. I know I can cut down on costs by choosing a plan with a high deductible - would that be the way to go? The cheapest I'm finding is ~$65/month, for 6 mos., but with a $5K deductible which seems high to me.

If I bump it up to ~$85/month, I can lower my deductible to $2000-$2500.

And if I pay up-front for 6 mos., all I have to pay through Blue Cross $427 with a $2500 deductible, and 20% co-pay.

So what do I do?

For the record, I'm healthy, I don't drink nor smoke, and I rarely visit the doctor. But you never know what could happen, right? Despite being healthy, I landed in the ER 4 times during college (gymnastics accident, severe allergic reaction, nasty stomach bug, and a very...um...unfortunate incident on the occasion of my 21st). So really, who knows what could happen? But then again, if I do end up in the ER for some reason or another, my high deductible would probably be met right?

So what do I do?

Thank you guys!!

 

[yssie]

What's the max out of pocket on both plans?

Do you expect to be on an employee plan within 6mo, or would it be worth it to consider the (likely cheaper) yearly?



When I had this debate I went with the lower monthly but higher deductible - the only way I would have broken even otherwise paying the higher monthly was if I *had* landed in the hospital and maxed out my deductible, and I decided my premiums were definitely due but there was no certainty of an accident.

I think my max out of pocket was 5k - so even w/ deductible + 80%coverage, a catastrophe wouldn't have been an insurmountable headache financially.

ETA: I don't know if this is something you'll need to consider but my policy was very stingy re. bcps, and I spent a mini fortune on the blasted things that year - in hindsight, I should've gone w/ a pricier plan that included more than the generics the cheapest basics usually cover.. it's just a little thing, all things considered, but an annoyance!

 

[megumic]

In my book, when you're deciding things like this you need to figure out exactly how much you could afford to pay out of pocket *today* if you needed emergency care. If it's not $5k, then I would not choose that plan. For the young and healthy, health insurance is meant for the emergencies, not the every day. Thus, your plan needs to work for you when you need it most.

Personally, I'd go with the $85/month plan, which I also have to say, is extremely reasonable. (What insurance provider is it -- what a freaking deal -- when I was looking for health insurance a few years ago, the cheapest I could find was $600/month!)

Just as a gauge for how much a small emergency might cost, DH had what we thought was an eye infection for about a week. After two trips to the doctor and an eye swollen shut (5 days before our wedding!) the doc sent him to the ER. Although he was not even admitted, the total bill was over $4k!!!

 

[Brown.Eyed.Girl]

Thanks guys!

Yssie, the Rx thing is a good point.

Meg, the $5K deductible should be fine - if I needed to, I could pay out of pocket for my $4999 accident. I just wouldn't be very happy about it, y'know?

So I reconfigured my search.

If I include the Rx, the cheapest I see is $91.81/month, $5K deductible, 0% coinsurance once the deductible is met, for 6 mos. (Yssie, I can't seem to find similar plans for greater than 6 mos.), $2 million cap per person (Assurant Health).

BUT, the plan says no charge for Rx brand or generic, AFTER the deductible. So does that mean unless I meet that $5K I still have to pay for my Rx? If so, then I might as well go with the $37.90 plan with $2500 deductible, 20% copay after deductible, but no Rx covered, $750K cap/coverage period of 6 mos. (BestM Lite)? Or am I missing something there?

Then there's the Markel Insurance option, which could be:

1) 6 mos., 5K deductible, 80/20 copay of the first $10K, $78.28/month, no Rx; or
2) 6 mos., 5K deductible, 100/0 copay of the first $10K, $87.39/month, no Rx.

ETA: Another Assurant/Meyer and Associates option (which is the provider my school recommends for its alumni needing temporary insurance) is 6 mos., 5K deductible, 80/20 copay, $83.47/month, Rx for accidents, etc. (and applied towards the deductible, but no BCPs), lifetime max coverage is $2M.

 

[perry]

When I was long term unemployed in the 90's I purchased a major medical policy. I covered all routine things - but it would cover well if I needed hospitalization or something major.

The insurance thing is tough - and I don't see any solutions for years (if ever).

Too bad your vet did not call... if it worked out you could be married and covered. I'm not recommending that you get married just to get health insurance - but it might be one factor to consider.

I also know of at least one person who enlisted in the military to get health insurance for their family.


Best of luck with this,

Perry

 

[Tacori E-ring]

My best advice is to talk to a health insurance broker in your area. They know all the plans, details, etc. I will say I have had blue cross for 7ish years and only used my deductible the year I gave birth. So that being said, a high deductible is not a deal breaker for certain plans.

 

[laine]

ETA: I don't know if this is something you'll need to consider but my policy was very stingy re. bcps, and I spent a mini fortune on the blasted things that year - in hindsight, I should've gone w/ a pricier plan that included more than the generics the cheapest basics usually cover.. it's just a little thing, all things considered, but an annoyance!

When I was just graduated and had no insurance (my parents bought a major medical plan for me in case of accidents/major illness, but it was the $5000 deductible type, I covered all regular stuff), I went to planned parenthood for my annual exam and BCP. I might have lied and said I was a student to get the cheaper exam price and BCPs were cheap there (for everyone, not just students). So, I'd check into something like that.

Doctors visits can be surprisingly affordable with no insurance. Many offer a cash discount--always ask! My husband just saw a ENT (had a bit of earplug stuck in his ear) for only $65. It probably would have been $50 with insurance!

 

[fleur-de-lis]

B.E.G., just so you know Blue Cross will not calculate and compensate in the way you are describing. Yssie's Q about focusing on maximum out of pocket rather than deductible will be more relevant. Let's say, hypothetically, you break your ankle and require surgery to repair it and physical therapy afterwards. The total bill comes to $20,000. So:

-- Up until the deductible, you pay 100%. So, if you have a $2500 deductible, you are paying the first $2500.
-- After you've paid $2500 out of pocket, THEN you get the 20/80 coverage until you hit your annual out-of-pocket. So if your $2500 deductible plan has a $7500 annual maximum, of the 20K you pay the first 2500 (leaving 17,500), and that 17,500will be paid 80/20, so you'll be responsible for another $3500. Thus, your 20K accident under a 2500 deductible 80/20 plan will cost you 6000, AND you will still not hit your out-of-pocket maximum.
-- If your accident happens in December and treatment is split between two years, January 1st puts you back at 0 dollars paid, so you lose your 80/20 split if you'd already hit your deductible so you'd be back to being on the hook 100% for the first $2500 again in January.

For the smaller things-- visit to the gyne for an annual checkup, a post-cold cough that won't go away, a trip to the skin doc for acne-- all of those little $300 visits will be paid by you 100% and Blue Cross won't pay a dime (or their 80/20) until you've hit your deductible, and they don't give full coverage until you've had something like $27,500 in bills in a year. And in a cruelty that personally baffles me, you are contractually obliged to pay your doctor at the Blue Cross negotiated rate... which is higher than what you'd pay if you negotiate a cash payment directly with your doctor (as Laine points out).

I hesitate to type all this because it's so Debbie Downer. Blue Cross purposefully chooses how they describe their program to be more beneficial than it really is, and most people don't discover this until *after* the accident and they're trying to figure out how the bill can be so much if they have insurance for which they're been paying ample monthly premiums on for years. I hope this info will help you work out which option would work best for you.

 

[Tacori E-ring]

B.E.G., just so you know Blue Cross will not calculate and compensate in the way you are describing. Yssie's Q about focusing on maximum out of pocket rather than deductible will be more relevant. Let's say, hypothetically, you break your ankle and require surgery to repair it and physical therapy afterwards. The total bill comes to $20,000. So:

-- Up until the deductible, you pay 100%. So, if you have a $2500 deductible, you are paying the first $2500.
-- After you've paid $2500 out of pocket, THEN you get the 20/80 coverage until you hit your annual out-of-pocket. So if your $2500 deductible plan has a $7500 annual maximum, of the 20K you pay the first 2500 (leaving 17,500), and that 17,500will be paid 80/20, so you'll be responsible for another $3500. Thus, your 20K accident under a 2500 deductible 80/20 plan will cost you 6000, AND you will still not hit your out-of-pocket maximum.
-- If your accident happens in December and treatment is split between two years, January 1st puts you back at 0 dollars paid, so you lose your 80/20 split if you'd already hit your deductible so you'd be back to being on the hook 100% for the first $2500 again in January.

For the smaller things-- visit to the gyne for an annual checkup, a post-cold cough that won't go away, a trip to the skin doc for acne-- all of those little $300 visits will be paid by you 100% and Blue Cross won't pay a dime (or their 80/20) until you've hit your deductible, and they don't give full coverage until you've had something like $27,500 in bills in a year. And in a cruelty that personally baffles me, you are contractually obliged to pay your doctor at the Blue Cross negotiated rate... which is higher than what you'd pay if you negotiate a cash payment directly with your doctor (as Laine points out).

I hesitate to type all this because it's so Debbie Downer. Blue Cross purposefully chooses how they describe their program to be more beneficial than it really is, and most people don't discover this until *after* the accident and they're trying to figure out how the bill can be so much if they have insurance for which they're been paying ample monthly premiums on for years. I hope this info will help you work out which option would work best for you.

That is not how my BCBS plan works...interesting...

 

[fleur-de-lis]

B.E.G., just so you know Blue Cross will not calculate and compensate in the way you are describing. Yssie's Q about focusing on maximum out of pocket rather than deductible will be more relevant. Let's say, hypothetically, you break your ankle and require surgery to repair it and physical therapy afterwards. The total bill comes to $20,000. So:

-- Up until the deductible, you pay 100%. So, if you have a $2500 deductible, you are paying the first $2500.
-- After you've paid $2500 out of pocket, THEN you get the 20/80 coverage until you hit your annual out-of-pocket. So if your $2500 deductible plan has a $7500 annual maximum, of the 20K you pay the first 2500 (leaving 17,500), and that 17,500will be paid 80/20, so you'll be responsible for another $3500. Thus, your 20K accident under a 2500 deductible 80/20 plan will cost you 6000, AND you will still not hit your out-of-pocket maximum.
-- If your accident happens in December and treatment is split between two years, January 1st puts you back at 0 dollars paid, so you lose your 80/20 split if you'd already hit your deductible so you'd be back to being on the hook 100% for the first $2500 again in January.

For the smaller things-- visit to the gyne for an annual checkup, a post-cold cough that won't go away, a trip to the skin doc for acne-- all of those little $300 visits will be paid by you 100% and Blue Cross won't pay a dime (or their 80/20) until you've hit your deductible, and they don't give full coverage until you've had something like $27,500 in bills in a year. And in a cruelty that personally baffles me, you are contractually obliged to pay your doctor at the Blue Cross negotiated rate... which is higher than what you'd pay if you negotiate a cash payment directly with your doctor (as Laine points out).

I hesitate to type all this because it's so Debbie Downer. Blue Cross purposefully chooses how they describe their program to be more beneficial than it really is, and most people don't discover this until *after* the accident and they're trying to figure out how the bill can be so much if they have insurance for which they're been paying ample monthly premiums on for years. I hope this info will help you work out which option would work best for you.

That is not how my BCBS plan works...interesting...

Is your BCBS plan an individual plan, or a group plan through work?

FWIW, I totally agree that it's interesting how different the level of care is, and how the industry has done a very good job at making this obtuse and unequal enough that a significant enough % of the population doesn't ever see the dark underbelly of insurance calculations and call for change. It's human nature to not see the need for health care overhaul if one receives reasonably decent health insurance through work-- and the terms of those plans are reasonable from a patient perspective.

 

[Tacori E-ring]

fleur,

It is an individual plan. My daughter and I are on one policy and my DH has his own. We have all been very happy with their coverage. DH is one of the few people who cost the insurance company money but as long as he pays his policy, they can't drop him. Are you talking about a HSA? One year I did do that and I had to pay 100% until my deductible was met and they BSBC paid 100%

 

[yssie]

B.E.G., just so you know Blue Cross will not calculate and compensate in the way you are describing. Yssie's Q about focusing on maximum out of pocket rather than deductible will be more relevant. Let's say, hypothetically, you break your ankle and require surgery to repair it and physical therapy afterwards. The total bill comes to $20,000. So:

-- Up until the deductible, you pay 100%. So, if you have a $2500 deductible, you are paying the first $2500.
-- After you've paid $2500 out of pocket, THEN you get the 20/80 coverage until you hit your annual out-of-pocket. So if your $2500 deductible plan has a $7500 annual maximum, of the 20K you pay the first 2500 (leaving 17,500), and that 17,500will be paid 80/20, so you'll be responsible for another $3500. Thus, your 20K accident under a 2500 deductible 80/20 plan will cost you 6000, AND you will still not hit your out-of-pocket maximum.
-- If your accident happens in December and treatment is split between two years, January 1st puts you back at 0 dollars paid, so you lose your 80/20 split if you'd already hit your deductible so you'd be back to being on the hook 100% for the first $2500 again in January.

For the smaller things-- visit to the gyne for an annual checkup, a post-cold cough that won't go away, a trip to the skin doc for acne-- all of those little $300 visits will be paid by you 100% and Blue Cross won't pay a dime (or their 80/20) until you've hit your deductible, and they don't give full coverage until you've had something like $27,500 in bills in a year. And in a cruelty that personally baffles me, you are contractually obliged to pay your doctor at the Blue Cross negotiated rate... which is higher than what you'd pay if you negotiate a cash payment directly with your doctor (as Laine points out).

I hesitate to type all this because it's so Debbie Downer. Blue Cross purposefully chooses how they describe their program to be more beneficial than it really is, and most people don't discover this until *after* the accident and they're trying to figure out how the bill can be so much if they have insurance for which they're been paying ample monthly premiums on for years. I hope this info will help you work out which option would work best for you.

Yes, that's how my BCBS individual worked. All those $300 visits counted toward my deductible - I'm wondering if you could negotiate to charge an end of year treatment as one "episode", or something, and avoid multiple bills that might span the new year..?

 

[Tacori E-ring]

Every doctor appointment, I only pay the co-pay and BCBS pays the remainder. Even when my DH was getting injections (for arthritis) that were *thousands* of dollars every month he only paid $50 co-pay (to see a specialist).

 

[perry]

I used to sell health insurance (not my best choice of careers as the company used a negative sales pitch which did not fit me).

Here is how health insurance works:

Each company offers multiple types of plans and policies. One BCBS plan may work totally different than another - so all the descriptions above may be correct. Different dealers may have access to different plans. Lesson Learned is to pay attention to the details of what the plan will and will not do. Its far more important than what the plan cost. Also, shop around to see what the different plans are.

All insurance sales people will tell you that your insurance policy cannot be individually canceled except for fraud. What they probably won't tell you (but might if you dig deeper) is that the insurance company can cancel all policies in your "Group" (these are identical policies issued to multiple people.

For sure here is what they will absolutely not tell you.... Many insurance companies intentionally limit group size to a relatively small number of people (your group may be as small as 25 to 50). Then when payout exceeds premiums the insurance company cancels the "group." Now if you are healthy with low claims they may offer you another policy in another group (with every so slightly different coverage). If you have developed a health issue.... Tough luck finding insurance then... (and the key health insurance reforms to prevent this do not kick in until 2014 - if they ever kick in).

A few places have historically avoided those practices. NFIB (National Federation of Independent Business: www.nfib.com ) - is primarily set up for small business owners. I am sure there are others - but I don't know them off the top of my head. NFIB will sell individual health policies - and used to have an 3-4 different levels of policies.

My major medical insurance policy in the 90's was through State Farm. I believe I maintained it for about a decade. Never used it. But if I had been hospitalized or in a major accident I'd have been set up pretty good.

Any way you do this - I wish you the best.

 

[Brown.Eyed.Girl]

Thank you guys! I just wanted to pop in and say I'm reading all the responses, but a little short on time in responding to each and every one because of a crazy week of suddenly applying for PhD programs and studying for the GRE on Friday. I promise I will return and respond, but in the meantime, keep the responses coming because they are super helpful! Thank you!!!