Health Care

willsgramJuly 20, 2006

For 25 years I worked for one company and health care was completely paid for. Three years ago, at age 59, the company closed and I spent the next year looking for another job. I'm now working part-time (32 hrs) and pay for my own insurance through the company group plan...370.00 a month is deducted from my pay. I'm healthy, take no prescriptions and very rarely need to see a doctor (just my yearly ob/gyn checkup and mammogram). I'm considering going with a health care company with a high deductible, take the balance of what I normally pay and put into a savings account, sort of a health care emergency fund. What do I need to know, when looking at different plans? Exclusions, limits, etc.

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you only need health care for a few years until medicare starts at 65. Then you will need to shop around for another insurance which is a supplement to medicare.

The limits are very important these days. 1 to 2 million dollars will be gone easily in severe illness. I would say that you need several million if not unlimited, if you want to be really safe. Yes, they do cut you off if you run out of limit! Then you will have to go through the legal harangue.....

Examine prescription benefits carefully. Find out where chemotherapy falls in, for example.

Co-pays can be important if you find yourself going to see a doctor on daily to weekly basis while sick. Again, this is relative to your income. If you can easily afford it, this can be an easy way to save a few $ on the premium.

Good luck.

    Bookmark   July 20, 2006 at 1:06PM
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We found co-pay's on most of the high deductibles to be out of sight. We focused on what they would pay for outpatient surgery, cancer treatments, etc. Routine care was rarely covered for much at all and those tests are expensive. Do you currently have dental and vision with your company? How long would it take you to put aside the money for the deductible and co-pay? Do you have it right now or would you be in a world of hurt if you got in an accident or had a cancer diagnosis?

$370 a month sounds high, I know, but for independent individual coverage I think you will find it hard to beat and get anywhere near the coverage. At your age, the rates can be high, since many of us tend to fall apart after 45. If you do, please let us know the company.

You will need to investigate the options for the health care fund if you are wanting it in one of the pre-tax programs. I was reading in the paper that some are not managed well.


    Bookmark   July 20, 2006 at 8:29PM
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The plan I'm considering would allow me to save almost $200 per month. Yes, it's with a very high deductible, but with a generic script co-pay of $15 and a $500 yearly wellness allowance (for pap and mammogram), I think it makes sense for me to go with it. Also, between my savings and investments, I already have an emergency fund to fall back on, should the need arise, and I plan on putting the additional amount saved into a special account. I have a separate dental plan that I plan on keeping and am considering enrolling in an accident insurance plan, offered here at work.

    Bookmark   July 25, 2006 at 10:39AM
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I had health insurance w/BlueCross/BlueShield for one year when I used to think that everyone needed health insurance. I was paying $6K in premiums ($500 a month) and had a $5K deductible. DUH.

I'd usually make a visit to the 'doc in the box' once a year at most, and the obgyn yearly. This does not add up to $11K per year.

I quit that and then had to have an operation. OOPS.. NOT.. Once I announced to all of the creditors that I was paying with BenFranklins, the hospital knocked off $1800 of the $5K fee, the anesthesia guy knocked off $400 of a $499 fee, MY OWN GYN went from $450 to $250 ... Self insured can be a good thing.

On the other hand, while I was taking my mother (with absolute insurance) to other docs, I casually mentioned what my costs might be... To his HORROR..he said that it is unconsienceable that the hmo he was associated would charge me MORE than anyone else.

Ma's foot doc charged her lots more than they charged me, once I asked the billiing girls... they gave me the medicare rates.. ma got the mecicare rates PLUS the supplemental insurance rates. Go Figure.

Call around and ask if they are independent doctors or are on some sort of hmo or other plan.

    Bookmark   July 29, 2006 at 11:08PM
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My insurance is paid by my employer, but I added my husband and the cost for him alone is $368 per month. It costs my employer the same for me.....and this is a group plan. I can't purchase insurance for my husband. He had a heart attack about 3 years ago and nobody wants to insure him. If I ever leave my employer (or they leave me) I don't know what I will do for insurance for him. The plan we are on is a PPO and we spend a lot out of pocket, but KNOWING FIRST HAND how quickly we could be in debt many thousands of dollars with another heart attack, I will just have to pay the out of pocket expenses. I used to work for a local doctor. He charged one amount if they were paying cash, one amount if they had insurance and another amount if they had medicaid. It his case, the cash amount was the most expensive, then the insured, then medicaid.

    Bookmark   July 30, 2006 at 6:20PM
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Gina, people with insurance are charged more than those without insurance because the doctors have to "make up" the difference. Basically, the reduction in fees you received was subsidized by someone who had insurance. Yes, I don't agree with the system but if doctors didn't work that way, there would be fewer doctors. More and more doctors are getting out of medicine because they are making less and less each year because of insurance caps and high malpractice insurance rates.

I sincerely hope that you aren't diagnosed with a chronic disease or cancer while you are uninsured. I do understand your position. If you have a catastrophic medical issue and end up with hundreds of thousands of dollars of medical expenses, who will pay them?

    Bookmark   July 31, 2006 at 8:54AM
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Have you looked into Health Savings Accounts? More and More states allow them now and they offer a good opportunity to control health costs if you can manage the high deductable.

Here is some information from 1 web site that gives some basic information:

An HSA is an account you use to set aside funds on a pre-tax or tax-deductible basis to pay for routine healthcare - such as office visits, prescription drugs and lab tests. The money you put into your HSA will reduce your income taxes similar to the money you save in a 401(k) plan. An HSA can be established at a bank, insurance company or third party administrator. If your HSA is part of your employee benefits program, your employer may also make contributions. There are annual limits on the amount of money you can contribute to your HSA. Whatever you don't spend from your HSA rolls over year-to-year for future healthcare needs. And if you retire or leave the company for any reason, you can take the balance in your HSA with you. Funds deposited into the HSA can be conveniently accessed through the use of a debit card or check.

A high-deductible health plan.
To qualify for an HSA account you must also be enrolled in a high-deductible health plan that provides additional protection. The annual deductible is higher than you might find on a typical health plan; however, the money withdrawn from your HSA for qualified medical expenses will generally apply toward your deductible. So, depending on how much money you have in your HSA, you may not have any out-of-pocket expenses before the health plan starts paying benefits.

    Bookmark   August 2, 2006 at 3:16PM
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I have been doing the research on buying my own insurance also. It sounds like you are perfect for what you are contemplating. Being willing to be responsible for preventive and routine (dental, etc) costs will save you a lot of money in the long run. Get a health savings account linked to a high deductible plan. Look at the yearly out-of-pocket limit. Compare how much you have to pay after you meet the deductible. Be sure the plan has a high lifetime limit (3-5+ million). Make sure you won't be penalized for emergency care; triple check the list of exclusions. Think about your family and health problems they have--are those well covered? Is there a wide variety of primarycare, specialists and hospitals available? What do they pay for hospital stays (dollars per day vs percent of bill). What about care after the hospital--Physical therapy, for example. You are basically insuring for catastrophe, so make sure the catastrophe will be well covered. Might even ask your doctor's billing person which companies are difficult to work with, which ones are very persnickety about the paperwork...

Most importantly, be aggressive in protecting your health: keep or get your weight down, exercise, eat whole grains and those five servings of fruit/veggies and healthy oils, don't smoke. Believe it or not, the majority of patients in intensive care are there due to obesity, smoking or drugs/alcohol (and obesity/smoking far outnumber the rest)

good luck

    Bookmark   August 22, 2006 at 1:04PM
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Gina, people with insurance are charged more than those without insurance because the doctors have to "make up" the difference. Basically, the reduction in fees you received was subsidized by someone who had insurance.

If you look at the Explanation of Benefits that you get from your insurer, you frequently will see that what the healthcare provider charged and what they were allowed by the insurer are two different numbers, and that there often is a significant writeoff between the two numbers. Kind of an "ask for the moon but at least get the stars" thing.

As for cash discounts, the bottom line of any business is to make money. Part of making money is in not wasting it in overhead. My mom was a medical-office manager and I worked in that same office (Family Practice) for a couple of years. I saw the rigamarole that insurers (and the government) put providers through; filing all those forms and carrying those accounts receivable costs money. A doctor who also is a businessperson is smart enough to figure out that taking a slight discount to get paid today is better than paying an employee (or outsource firm) to fill out forms and send invoices and then waiting months for whatever the insurer will pay. The inmates really are running the asylum here. That's unfortunate.

    Bookmark   August 23, 2006 at 10:53AM
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jlhug.. sorry this is so late, haven't been here in a while. Not to start any arguments, but once I had that hospital experience, I started asking questions. The gal at my Dentist's office was most helpful.

She had a 2" thick looseleaf binder of what the insurance companies would pay, and patients were charged accordingly. Non-insureds were charged the highest rates... don't think anyone was subsidizing me there. I 'subscribed' to a phamplet on the counter, and now I pay about $150 a year for my 4 cleanings, X-rays, checkups, whatever.. used to be $75 per visit plus Xrays. Insurance isn't subsidizing me, docs are willing to accept lower payments to be on someone's referral list.

If I end up with chronic disease/ cancer/ whatever, then I will foot the bills. Thank God that I can and that I don't have any kids to "leave stuff to". I just question medical insurance for folks that are generally healthy and who's yearly medical bills add up to a month or two premium.

As an aside, State Farm Insurance is really pushing the "How State Farm helped me during the hurricanes in FL" in their ads. State Farm no longer writes homeowners in FL.. they're just trying to get you suckers in the upper states to think they're so good and kind. BS.


    Bookmark   August 30, 2006 at 12:02AM
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I've been paying for private health insurance with BC- BS for two years. My monthly cost is almost $1400 for the two of us. My husband has cancer and his monthly chemo costs in the vicinity of $30,000. A trip to the drug store can be over $100 in co-pays. Health insurance is not optional. I just don't think it's worth taking a chance of not being covered. The peace of mind is worth the cost.

    Bookmark   August 31, 2006 at 5:33PM
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Fran1523: did your husband have cancer when you applied for BC/BS? They increased my premimum by 25% when someone came to my house. I had to go to other house in FL heat for ID, did it in record time (walking) she then immediately took my BP and pulse, told BC/BS I had tachycardia.

Lord knows what the premiums would have been if I really had a known condition of Tachy.

Had a recent ekg that noted none of that, but BC/BS didn't care. Subsequent tests didn't impress them either. I have no love for BC/BS

    Bookmark   September 4, 2006 at 11:59PM
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Yes, he had cancer but we were already insured by a different company under Cobra. Here is Massachusetts, you can't be refused coverage because of a preexisting condition if you've had coverage right along.

    Bookmark   September 5, 2006 at 5:24PM
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