<p>It is time to shop for new health insurance. DH and I are self-employed so we buy our own policy, but in the last year the deductible has gone up to $10k per year for our family! So between premiums and healthcare costs we pay a bundle. (Sometimes I think about working for Starbucks or Trader Joes just to get the insurance!)</p>
<p>I am planning to look at the big well-respected names (Blue Cross, Aetna, etc) and see what is offered. Right now we are in a PPO which is great in case we have to see a specialist. It covers everything but maternity and mental health (which bugs me, as providers keep saying mental health issues should be no different from other chronic conditions, but there you go).</p>
<p>I am very scared of switching and then finding out something in the small print that I didn’t anticipate, should someone get hurt or come down with a serious illness. There are pre-existing conditions in our family too, but I understand that plans cannot hold that against you now?</p>
<p>So, any words of advice on how to look for a plan? And also, my S will be a college freshman this fall, I assume he will still keep coverage under our plan? He can do that until he’s 26, plus the school has a very good on site medical care facility.</p>
<p>Whatever you do now will probably look a lot different in 2014 when the insurance exchanges go into effect. I don’t know if that will be Jan 1 2014 or later during the year.</p>
<p>We just went through the process of changing our plan. We buy our own health insurance and were very pleased with our Blue Cross Blue Shield North Carolina plan but the 14% premium increase for 2013 got me to look for a cheaper alternative. We looked at Aetna and started a very lengthy application process, and definitely shared your fear:
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<p>We ended up staying with BCBS(NC) but increasing our deductible and increasing our copay % (also increased our copays for doctor and specialist visit) but dropped our monthly premium by around $400. We were able to do this by going online and one mouse click to select the new plan, since we were already BCBS customers. It is easy to select a lower level plan. Harder to upgrade. I am not sure what 2014 will bring, but I wouldn’t mind if less expensive plans became available. </p>
<p>I think the first question for you is what state do you live in? Because it seems there are large differences in what is available between states. Oh, never mind… I see you are “surf city” (here we come) is that in California? :D</p>
<p>Yep, for this year, you will be medically underwritten if you switch. Depending on what the preexisting conditions are, you may get a quote which is WAY above the advertised price. For example, Blue Cross took a look at my DH’s diagnoses for high blood pressure and high cholesterol (both well-controlled with meds and diet) and decided he should pay 50% more than the unrated base premium. Unfortunately, there’s no way to know how a particular carrier will rate your preexisting conditions without applying. BTW, Blue Cross is NOT a well-respected name in my house. </p>
<p>I know what you mean about being scared of the fine print, because make no mistake, they will use it against you. I recommend talking to a broker to help you navigate this mine field. </p>
<p>January 1, 2014 cannot get here soon enough for me.</p>
<p>Is your plan a group plan or individual plans? If your plan is officially a group plan, you won’t have to worry about pre-existing conditions. That went away with HIPAA a long time ago. You can have as few as 2 employees to be considers a “group”. If you stay with the same carrier and just opt for a different plan they offer, probably not an issue either. In some states if you have individual plans and maintain coverage, pre-existing conditions don’t apply either.</p>
<p>We are on an individual plan. We used to be members of the local chamber and buy thru them, but they discontinued that practice.</p>
<p>I am wary of plans that have a coinsurance part - many of them have a 20% coinsurance. One big accident or operation and that is a lot of $$$.</p>
<p>Right now we have the luxury of going to any specialist without a referral, and I have used that for various things in the past few years. So the PPO option is attractive that way.</p>
<p>I do have a referral for a broker to ask too, but I figure real life experience is valuable too.
(BTW I am in PA).</p>
<p>Regarding co-insurance: Most plans have an “out of pocket maximum.” That means that when your share of the co-insurance (the 20% or whatever) reaches the OOP max, the plan will begin to pay at 100%. So your liability isn’t open-ended.</p>
<p>We also purchase individual insurance. In my state, we used to be able to buy group insurance as I (as a spouse) was considered an employee. Now they require documented proof and the cost of doing that was greater than the cost of buying the more expensive individual coverage. (Sigh.) </p>
<p>In my state, there are very few insurance companies that offer individual insurance policies, so it became a simple matter of comparing the very few plans and making a choice. We now use AmeriHealth, and so far, so good. We’d had one emergency room visit and follow up care/therapy and so far, they have paid in a timely fashion. </p>
<p>Our monthly cost is so high that I was tempted to look at some of the religiously based medical-sharing ministries (Samaritan Ministries and the like) but I’m not quite ready to jump ship just yet. However, if my husband’s income takes a dive, we’ll be forced to.</p>
<p>surfcity–I agree, a co-insurance typically has an out of pocket max and often after that everything is covered at 100% for the rest of that plan year. I too would NOT get a plan with no out of pocket max though. Are you both self-employed with the same “company”? If so, look into a group plan. Usually the premiums are a bit higher but the deductibles and out of pocket costs are lower. Yes, contact a broker, they will be very helpful and you are paying a brokerage fee if you use one or not so you might as well use one. They can also help you weigh costs. Since you mentioned pre-existing conditions, are you a high user of your plan? If so, often it’s actually less expensive to go with a policy that has a higher premium but lower out of pocket costs. If you never go to the dr, the opposite is often true. I would also look into getting a plan that is tax qualified so you can have a health savings account and get the extra tax breaks from that too.</p>
<p>I was not sure what our son’s plan were after school and had investigated
some options for PT employment that provided health insurance just in case.
Trader Joe’s, Costco, Starbucks, UPS, etc.
He ended up with a public school teaching job so he didn’t get far pursuing these.
But seems like it might actually make sense for some families.</p>
<p>musicmom–just be careful about those retail plans. Most retail establishments offer “health insurance” however, the plans are crap and not worth taking. Usually they have a set benefit, often of $75,000/year or less with a per incident deductible, often in the $200-500 range–meaning EVERY time you go to the dr you are paying $200-500. It’s fine if you never use them but the cost of them is often the same or more than getting a real plan. Full-time, regular employees (managers, etc.) typically have access to real plans but part-time workers usually have a plan like I described.</p>
<p>SteveMA- good tip on checking into the specifics of the plans offered by some of those retail chains.
We actually purchased a ‘real’ plan for DS when he was kicked off of my employer plan at age 22. He went onto grad school for 2 more years and had a cheap individual policy…it would have covered hospitalizations and such but not routine doc visits. It was basically catastrophic coverage. It was fine for a healthy young adult but would not work for most family situations.</p>
<p>Luckily, son now has ‘real’ coverage through his FT employer.</p>
<p>The state insurance exchanges under Obamacare will start enrolling this fall, and that might be your best option. I’ll be looking into that. My congregations are paying for insurance for my family this year, after we exhausted our savings paying $1700 a month for COBRA all last year. But we have a $15K deductable under the current plan (the churches couldn’t afford our old, better plan), which is scaring me to death.</p>
<p>“Regarding co-insurance: Most plans have an “out of pocket maximum.” That means that when your share of the co-insurance (the 20% or whatever) reaches the OOP max, the plan will begin to pay at 100%. So your liability isn’t open-ended.”</p>
<p>^^THis was helpful. I had lost track of that fact. So now I have a whole lot of number crunching to do - premiums vs deductible vs copays vs coinsurance and how much I estimate we’ll spend on healthcare this year.</p>
<p>One other way to get insurance is if one of you are willing to attend CC or some in-state U or college and get student insurance (after checking their policy). Some of the policies in our state are excellent with student insurance and worth the minimal tuition for CC or other courses taken.</p>
<p>I tried to buy insurance for our S when he aged out of our family plan & graduated college but we were rejected since he has WELL CONTROLLED asthma that has never caused him to miss any school or go to urgent care & for which he rarely even needs medication. We had the choice of getting insurance for him being an alumni of his U, getting COBRA from the plan he had with the U, or getting our BCBS plan to provide him an individual extension plan. We explored all of the options & bought the extension plan for the months of Aug-Dec. Fortunately, on January 1, the Affordable Care Act kicked in and he was again covered under H’s insurance by our family plan, so we could discontinue coverage.</p>
<p>His coverage under the BCBS plan was about $300-400/month, had a deductible & co-pay, so he never used it but we didn’t want to risk it or having any gaps in coverage. </p>
<p>It is so hard to estimate healthcare. We have reached the $2500 cap on out-of-pocket several times in the past. It was nice having insurance cover 100% thereafter, except for Rx. So glad we have good coverage and that our kids are covered until they turn 26, especially since don’t know about D’s job prospects.</p>
<p>If either you or your H are interested, some alumni associations do offer group health insurance, if you qualify.</p>
<p>WE did look at an insurance plan offered by a professional organization (I don’t recall the name of it, but it’s for engineers/computer scientists). Turned out to be the same price as the individual insurance plans we were looking at and the coverage was not significantly different. so it was not worth it for us to join just to get medical insurance.</p>
<p>Re preexisiting - under law existing for YEARS already, if you switch without a gap in coverage, by federal law, no preexisting condition can be applied by your policy. HIPAA is the law. The gap in coverage can not be more than a specified time for this exception to apply, and I have to say I no longer remember off hand if it is 60 days or some other time period.
I guess they could refuse to insure you. In my state this is not possible.
Plans are rapidly changing, due to the new laws, but if you get a policy now, it will probably have to stay for 1 full year before the ins co can change it.</p>
<p>An agent is a great idea. We got good advice when we started using one.</p>
<p>I agree that an insurance agent is a great idea. We used one for many years (and I highly recommend this person. If anyone needs an agent and would like a referral, I’d be happy to give his info out. No, I"m not paid for the endorsement - just loved working with an ethical person.) When we switched to individual medical insurance, we no longer had an agent to work with as they get no commission when selling individual policies. Don’t know if this is true for all states, but that is the case in my state.</p>
<p>I agree that a GOOD insurance agent is well worth whatever commission they earn, especially so you get the coverage you think you have. They can also help you if and when you need to make a claim. We have switched to using an agent recently and it has been very helpful. We don’t get medical insurance thru her (because H gets great family coverage thru his employer), but she handles all our other insurance needs and we are thrilled. We also got her thru a referral from very satisfied customers.</p>