Health Insurance selection for a healthy dude

behaviorkeltonSeptember 16, 2008

Does anyone have any tips for selecting health insurance?

I'm thinking about going totally self-employed. The online quotes for insurance that equals my employers insurance is about $200/monthly... and I added 25% just assuming that this isn't the real cost.

I guess my main concern is this:

How much can my insurance company jack up the rates if I get a seriously expensive or chronic medical problem? Is there a limit?

Would belonging to a 'group' insured policy assist with that risk?

BTW, I'm in the U.S.



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There are always limits on insurance policies, not all of them obvious.

Many policies do not pay for emergency room care, including follow-up Xrays, or ambulance transport.

Check to see what the total policy limits are capped at. Sometimes certain diseases are capped, such as a $500K limit on cancer and all related issues. Most policies have a lifetime $1M cap.

Yes, you'd probably get a better break on a group policy, but again, you'd have to take what they offer, and you might prefer to have something more comprehensive. So you'll need to check carefully.

Most policies don't cover dental or vision. Check to see what the prescription co-pays are. One of my friends was shocked when she had to get some emergency medication but was "in between" her termination date and the COBRA care pick-up. She got reimbursed eventually, but it was a real shock when instead of paying $20 at the HMO pharmacy, the HMO charged her $800 for the full cost!

    Bookmark   September 16, 2008 at 12:45PM
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Thanks... I'll check on that.

The only insurance I've looked into has been "individual", but I think I've seen "group" policies that I could buy into.

I've always been covered by my various employers, but with private insurance: Are they able to just "drop" you if you get too (expensively) sick? Can they raise your rates to ridiculous levels?
That is, after initiating insurance in the pink of health.


    Bookmark   September 16, 2008 at 5:38PM
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It really depends on your state of residence. Most individual (as well as group policies) cannot be canceled except for non-payment of premium. Rates only increase by the pool's experience and age-bands, not by your own claims experience.

You can usually only get individual coverage if you're very healthy. Or you if you have had continuous coverage, you can skip medical questions and get an expensive HIPAA policy.

$200/month sounds inexpensive unless you're very young and this is a high deductible plan. Make sure this is for a major medical comprehensive policy.

I would call your local BC/BS or einsurance.

    Bookmark   September 16, 2008 at 6:56PM
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I'm with Lynnemarie - $200 sounds *very* inexpensive. I'm self-employed, and buy my health insurance through a professional organization. It's a good policy with BC/BS, but it's an HMO with a $1,000 deductible per year, and I'm paying almost $500 per month. I may well be older than you, of course, but that wouldn't account for all the difference. Are you only looking for catastrophic coverage?

I would call BC/BS and also call any professional organization or small business group you belong to see whether they arrange for group health insurance. Then really compare. What I did when I was looking most recently was to create a sample scenario of the services I generally use in a year, and then run the numbers to see what insurance would get me the best coverage at the lowest cost. Of course, I also wanted to know what would happen in the worst-case scenario, too.

Good luck. I'm an intelligent person, but I found looking for health insurance to be remarkably confusing.

    Bookmark   September 16, 2008 at 11:46PM
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The AARP website has alot of good general info about health insurance. I believe they also offer group policies that one can go with.

If you aren't over 50, I don't mean to be insulting your age. The info is good, though. Take a look at some of the "Most Popular" links on the right side of the page.

Here is a link that might be useful: AARP Health Insurance info

    Bookmark   September 17, 2008 at 7:43AM
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I'm surprised that for ~$200/month everything looks pretty much like the insurance I have now with my current job.

I'm 43 yrs old, and fit with no big issues in my medical past.

The insurance that I've seen general has a $5,000 per year limit or less (for big stuff)... and I can handle that.

It's good to learn that, once I'm in, that the insurance rates remain stable with the "group".

I'll check that AARP site.

    Bookmark   September 18, 2008 at 10:19PM
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After our DS 'aged out' of DH's company coverage we bought a Blue Cross Blue Shield policy for him. It was low cost because it was mainly for 'catastrophic' (really, really expensive medical problems).

Well, even Mr. Healthy can have appendicitis! And a screw-loose emergency surgeon can mess up! BCBS paid every dime for what turned out to include a month-long hospitalization while DS fought infection in a private hospital room. (D@mn that surgeon. I hate to even think about this.)

    Bookmark   September 20, 2008 at 10:53AM
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Beaware that AARP does not cover as much as they claim. Many seniors in this state are dropping them and going with Blue Cross.

    Bookmark   September 20, 2008 at 4:13PM
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Doesn't this make you wish our system were like the one in Canada or Norway or Denmark or most any other developed world country, where you don't have worry about medical care expenses. Don't forget in our system as much as 25-30% is overhead.

    Bookmark   September 20, 2008 at 8:22PM
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haus_proud -- YES! Strangely enough it could be the MD's who so strongly opposed 'socialized' medicine in early days who will cause a national health insurance.

I've been to three doctors this year who do not accept Medicare assignment. Medicare pays them a pittance, and pays it late. Meanwhile the MDs have to pony up outrageous premiums for their own insurance.

Entirely too much paperwork, paper-pushers, greedy insurance companies. We spend way too much for this and have a worse health rating than most nations. Lots of money for extreme measures and elective surgeries and nil for preventive medicine, well-baby, etc.

    Bookmark   September 21, 2008 at 11:56AM
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You could find three doctors who would talk to you?

We weren't training enough nurses or doctors in recent years (and many that were trained absconded to the U.S. or other places) ...

... and now they are closing hosp. beds because they don't have nurses (and many that they have are offered only part-time work - no benefits - but having a different nurse every few shifts doesn't make for high quality care) ...

... and thousands in this area can't find a doc who'll take them on as a patient.

That said - I wouldn't trade the Canadian system for the one that they have south of the border.

ole joyful

P.S. In Ontario, if my taxable income is under $20,000. my medical fee is zero ... if in the 40s, about $450.00, if 50s and 60s, $600.00, and from $70s to $200,000.00 - $750.00., then top at $900.00.

o j

    Bookmark   September 21, 2008 at 5:15PM
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O.J. -- A few years ago our MD 'fired' us as patients! Bizarre guy. We'd only started with him because he would take our medical coverage. Then it was a challenge to find another internal medicine MD. Finally found a multiple-doctor practice nearby and were assigned their newby, who has worked out OK. (Not the best MD I ever had...but then THAT one never even billed an insurance company going back to the 1980s; it was pay upfront and submit your own claims.) One of the best things about our current situation is the manager of the practice. The whole office is run beautifully.

I agree about the problem about too few RN's. I've had two hip replacements and the removal of a staghorn calculus.. All surgeries were done in hospitals that were 'Top Rated' and with 'Top Rated' MDs. HOWEVER, the nursing staff was so thin that I was advised by my doctor to hire my own practical nurse for the first 48 hours post-op on the kidney stone surgery! (Was I ever glad I did! Still, I signed myself out prematurely -- before they could kill me with incorrect meds.)

Meanwhile that group of hospitals is really raking it in. I've followed their fortunes, having been born at the original one.

    Bookmark   September 21, 2008 at 5:40PM
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