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Veteran Contributor

Health ins. what would you do?

Well this is a subject that has come up before.....so here is my question?

 

Our health ins. will be going up close to $1000 a month for our family of 5

 

went online to check for other ins., must of went to Wellmark blue cross/sheild of iowa and filled out app.

was accepted, got the acct. letter...bill...and cards in too...have not got a completed policy in yet but just called for it and she is going to send me one.  price will be $357.45 and goes up in april to $390 ish just because that's when they raise their rates.

 

Is this a no brainer to switch or what should I look out for??

 

Thx for any input

 

S.

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7 Replies
Senior Contributor

Re: Health ins. what would you do?

Know what your limits are as to deductables, office visit co pays, ER visits,  maximums on policy, any "riders" or pre existing conditions they won't cover, and if the doctors & hospitals you go to are in the program.  Also what specialty or larger hospitals are on it.  I would think being BC/BS you would not have a problem there.  Is there anyone you know who has it you could ask if they're happy with it?  I called our doctors office & talked to the gals in billing one time when I was thinking of changing to see if the company was reputable.  We have BC/BS of IL & ours is pricey but pays pretty well.

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Senior Contributor

Re: Health ins. what would you do?

I don't know what you currently have, maybe it is over priced? But that is too much difference in monthly premium. You get what you pay for... Having worked as an agent, I am leary of on-line quotes. On the other hand, a lot of agencies are getting out of the health insurance business due to the low commission and the high volume of time involved in the app and maintenance etc. A local agent will usually fight for you if needed.

Look for pre-condition clauses, hospitals and doctors on their list, co-pays etc. Never lie about health conditions, that can back fire. Look into the type of plan that Kay has, I have forgotten the name right now.  Go with a high deductible. I always tell people it isn't the regular small bills you need to worry about but those huge bills from surgery and accidents and cancer. $100,000 at a hospital does not go far today.

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Senior Contributor

Re: Health ins. what would you do?

Sundae, I think you better look into that  new plan closer.  It doesn't sound right.  Ours is going up to close to $1000 for family of 4.  DH smokes.  We are both near 50.  We had a guy come out from Farm Bureau from a differant office than what we had been going through and he can get us about $50 cheaper.  We are going to try to up our deductible.  We also looked at HSA plan's which are cheaper.  The first $3500 is out of pocket and the rest is paid for by BCBS.  They catch there is no maternity (we have a 22 year old iyoung lady in our household), no mental health (family history on both sides) and no chiropractor (we use one once or twice a month each for DD, DH and me) .  I am not sure I can live without coverage on those things.  THey got us coming and going.  I just am leary of changing companies.  With my history, I wouldn't make it past underwriting on any new policys.  We tried last year to up deductible and they threw a bunch of riders at us.  That was screwy. My friend checked into the same plans and her guy (our previous guy) said that no riders, just more money for the problems you have.  I don't know...who do ya trust.

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Senior Contributor

Re: Health ins. what would you do?

Health care is so important, yet I am like the rest of you, who do you trust. We have BCBS and it went up when I hit 55. In reality I guess it is pretty good, I pay about 8500.00 a year. I do have a 2500. deductible. I have also looked at different policies, but I am afraid to switch. Do any of you on here have any insurance with AARP?

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Advisor

Regular small bills...

..will be less if your healthcare provider is a participating provider in your plan...this is a PPO setup.  BC/BS is a very large and powerful company, and has leverage with most providers, but not all participate.  It is good to knwo if your regualr physicians are in the PPO you are contemplating. 

With those that do participate in a PPO, the company negotiates discounts.  For example, my pulmonologist a few weeks ago, for all of his visit and the battery of tests, which I elected to do in that office that day, saved me probalby $900 or so off a nearly $2000 bill.  I paid under $1100, which I use my Health Savings Account for the costs of treatments and meds. 

I pay whatever the Explanation of Benefits says is my share.  I present my insurance card, the provider files, and the BOB lets us both now what the final bill will be.  Participating providers have a contract with that insurer to accept that amount and not one cent more.  That is the negotiated discount for that service. 

Typical doctor's visit at our FP office is roughly $125, we pay $64 and change.  The difference is the negotiated discount.  My surgeons accepted $3200 for his $7000 services five or so years ago.  We paid the $3200. 

Mike and I pay about $373 a month at age 56.  I am a type II diabetic, but use no meds or insulin...use diet and exercise to keep it under control. That can make a big difference. 

The Tax Code allows us to contribute $7150 per year ( we are over 55, so get an extra $1000 contribution allowance annually) to our HSA.  I figure that is about the difference between premiums for our former $6000 per year deductible and our present  $10,000 deductible one. 

This money goes into an account with our names on it, instead of the coffers of BC/BS.  We risk an extra $4K per yar, to tax shelter an additioanl $7150, which still is OUR money.  It was a no-brainer for us, but we are healthy. 

We do not function on co-pays, and it does hurt to pay a billl instead of just mailing off a claim, but our previous coverage under Mike's job did not pay nearly everything, either.  It was excedllent insuracne for a family wiht severla small kid,s sicne it padi well baby care and such, but I'd imagine that policy would cost $1200-1500 a month now, because it had such a low deductible.  Our son's Anthem Keycare individual policy is higher due to his very low deductible and an accidnt rider to cover the first $350 of an injury, which makes sense in his trade.

You have to learn the ropes, and make decisions based upon your family's health picture.  Other than my well-managed diabetes, we are in very good health.  We are accepted as standard issue insureds.  Rated people are in a whole different world. 

I will say this, and I mean it from the bottom of my heart:  Health insurance is not a DIY project.  You really need to study up and get a good agent to explain it thoroughly to you. 

I have taken a position that allows us to take a mroe active role in a lot of our own healthcare decisions, and that is precisely what "consumer-driven health insurance" like our HSA 10000 is meant to be.  We manage our health mostly via lifestyle.  Food and water are your two most important "drugs."  We have no significant family histories for any serious disease processes or conditions.  We live low-risk lives, healthcare-wise.

In addition, we have executed legal documents (advance directives and living wills) to prevent a care provider from raping our family for money, just becasue our insurance will pay for some of it, if one of us is beyond salvaging in terms of quality of life. 

If you won't do that, then carry whatever you can get to cover your hind parts as much as you can, because they will keep dragging your body through several levels of Hell to resuscitate you without legal instructions not to do so.  In most places, the law requires this to occur. 

I treat health insurance as a mostly catastrophic coverage insurance for us...we can afford to pay the bills we generally generate in a year, and use the HSA to pay for them, eyeglasses, dentist's appointments (my $4000 bridge this January, for example), etc.,  and to control costs via discounts our insurer has beaten out of most who charge for healthcare.  Not all insurers have BC/BS's clout. 

A very complex subject, and not one to be taken lightly.  We can shop coverage on the BC/BS website, but only your agent can take your application.  I'd never drop any existing coverage, until I saw what the new offer of coverage is, and what it excludes.  Also, check to see if regular annual physical screenings such as exams and mammograms/PSA are covered.  We get this wellness care, plus periodic screenings such a colonscopy, covered at no additional cost to us, at prescribed intervals...the insurer covers this because it's cheaper to treat conditions caught early. 

Good luck.  I've spent months of time studying health insurance in the past decade or so. Choosing the right policy is crucial, and it is as specific to your family and its health as anything else your family will ever need...what is perfect for one is not nearly close to right for another. 

 

 

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Senior Contributor

Re: Health ins. what would you do?

Kay is correct never, never drop a policy until you have a new one in hand and you have read it. As I have said before, once a person has health problems you are usually stuck with the insurance you currently have in place. (You can't call and say you need long term care for your mom who is in a nursing home.) You gals already know that be some people don't.

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Advisor

As usual, i Google:

Using the phrase "evaluating health insurance policies" wioth Google as my easrh engine, I foudn a number of goo articles adn worksheets for htis purpose.  I'd suggest you do the same. 

Here is an exampole of a worksheet for comparing policies, which is how you make sure what coverage better/equal/worse:

http://healthinsuranceinfo.net/managing-medical-bills/worksheet.pdf

It occurs to me that Cooperative Extension may also have some guidance in the form of evaliuative worksheets. 

Blue Cross/Blue Shield on its website for you state (health policies can be VERY state-specific, especially on rates) will compare its different polices side by side, and if youc an plug in the same values from your present, pricey coverage, you should be able to see where the differences lie.  You do tend to get what you pay for and pay for what you get...but, you can be enrolled in a group that at present is topheavy with older, sicker subscribers, and are paying more for their care. 

Some group policies enter what's called a "death spiral," which is an interesting phenomenon where peopoel who are healthy enough to find coverage elsewhere leave a particular group, leaving it to pretty much people who are stuck b/c of pre-existing conditions.  Since premiums must cover claims and some administrative costs, they spike and drive ever-more members out of th egroup, until it it is too expensive for anyone to belong, really. 

Farm Bureau in NC went away froim group coverage to all individual policies a few years ago.  They will still administer policies for members, but you are pretty much going to stand on your own family's health status for premiums. 

I have administered my own policies for a few years, and it is a PITA.  Now, I can rely on FB to draft our premiums monthly, and they sned me a notice once a year for renewal, telling me what the new premium will be. 

It's gone up 10 to 20 dollars a month for about five years now...and we've jumped to the 50=plus age bracket and the 55-plus age bracket...policies tend to take bigger jumps on five-year age increments in my experience. 

Also, I have heard that some companies made big increments in premiums this year, to get ahead of some restraints under Obamacare.  I have not really reseracehd them since I think some of the legal challenges to national healthcare coverage may prevail, at least on some counts.  VA and NC both had been upheld on different causes at the Federal court level. 

Either way, we have to pay what it costs, don't we?  Healthcare costs are the main driver of personal bankruptcy in the US, from some stats I've read. I consider my HC coverage as a first line defense in our family and farm's risk management. 

Given that, it was important to me to educate myself as much as I could on the subject.  It is not rocket science...if I can understand it, so can you...just read soem of the articles and do some of the side-by-side comparisons, before you drop either policy you have in hand now. 

If I found comfort with the new, cheaper policy, I'd pay for it for a month on top of my existing coverage, to buy time to consider it carefully, for the peace of mind that would provide. 

 

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