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Senior Contributor

Health insurance

My husband just went through a job change, and we find ourselves without employer-paid health insurance, at least for now. I was shocked when I learned that COBRA would cost around $1,300/month for our family. I knew it would be expensive, but wow. 

 

I did some looking online for alternatives, but since DH and I both have a few pounds to lose, it's just as expensive. We did find alternate insurance for the children, which is very reasonable is the same coverage they have now, so we're just going to have to pay around $7-800 for the two of us through COBRA.

 

If nothing else, this is a good incentive to lose weight! We are both very healthy other than the number on the scale, but I realize that won't stay that way forever. It's time to get down to brass tacks. The health risks haven't prompted me to lose weight, but maybe saving $3-400/month will.

 

Who's your insurance provider, and have you experienced anything similar with getting insurance on your own?

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23 Replies
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Senior Contributor

Re: Health insurance

Ed is insured through his retirement plan but stil has to contribute to the monthly premiums.  When we first married, spouses were covered but no more.  I can purchase it though his retirement but it would be about $800 month just for me! 

 

I elected to go self-insured.  I have a $5000 deductible but my premiums are only $3600 per year.  My organization reimburses me for $3000 toward the premiums. 

 

My coverage does not include prescription coverage but the only med I take is about $60 per month and I have a HSA for pre tax expenses.  So, I am still ahead with the higher deductible and paying my own prescription versus the expensve alternative which has a high co-pay and a $1500 deductible. 

 

 

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Honored Advisor

Re: Health insurance

Absolutely understand.  The insurers fo by height and weight tables.  If you are too heavy by those standards, you will fall into rated policy coverage, or even guaranteed issue.  God help you if you have to go there....

 

I was in the guaranteed issue category for a few years, before I got my act together a bit better.  Losing weight got me back on standard issue, which let Mike and me onto the same policy. 

 

Don't know your whole deal, but we chose to risk $10,000 per year on a BC/BS HSA plan, HSA 10000.  Our deductible was $6000 a year anyway, and the premium was 2.5 -3 times more each month. 

We put the same amount into health each year, but the premiums for Mike and me are around $375 a month,  at age 57, and I am diabetic...not too bad.  I drop $7,150 into our Health Savings Account, pre-tax dollars, which we can tap to use for eyeglasses, meds, doctors, etc. 

 

That may sound daunting, but it is roughly the difference we would be paying for the $6K deductible policy.  The money in the HSA is still OUR money.  The money we would have paid in higher premiums was simply down the insurance company rathole. 

 

I have written about this before, but the really good reason to be convered by a huge company like BC/BS is the negotiated discounts.  Most times, even of we have services to pay for, they are greatly reduced in cost.  The provider who is in the PPO agrees to accept what that company allows them to charge. 

 

Often, I see writedowns of 30-80%...50% is very typical.  If a doctor has charged $200, my responsibility may be only a hundred or so. 

 

No system is perfect, but this one works well for us.  I strongly urge you to drop thsoe few pounds apiece, and that will be a start..  Be ready to pay when cedrtain "big" birthdays roll around, though.  I think the five-year bumps are usually bigger than in years when our ages do not end in 5 or 0.  Annual cost increases will make the premims higher, too, even if you didn't spend a cent the previous year. 

 

I will suggest tha you check with NFIB, and see if they offer group helath policies in your state,  They do not in NC, but sometimes, membership in such a group does afford some safety in numbers.   Farm Bureau may or may not still offer group policies anymore...here in NC, they went to all individual coverage a few years ago.  BC/BS in  most states has good online applications and policy information. 

 

This is no fun, and it does cost a lot, but it has to be done. 

 

At least COBRA is capped with the moves the government made a couple of years ago, right? Or has that help expired?

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Honored Advisor

Re: Health insurance

What's best for each family and/or individual depends a lot on how you use healthcare as a rule, and whether or not you have any pre-exitsting conditions.  We can afford a ten thousand dollar family deductible about as easily as a six thousand dollar one...fortunately, we have never gotten close to either one.   

 

The $7,150 we can put in the HSA every year is ours, not theirs.  We go to the doctor for annual physicals and screenings, then otherwise, only for real emergencies or illnesses.  The physicals and some screenings are paid policy benefits..."free" to us.  If I still had a posse of kids following me everywhere, I might opt differently. 

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Advisor

Re: Health insurance

We pay ... well, we just made some changes ad I forget the new numbers .... $600-$700 per month for high deductible, what I call "catastrophy insurance" through Reserve National

 

I am diabetic, controled by diet with no meds.  We discovered this when my then part-time employer changed insurance providers.  After everything was all said and done, papers signed, checks written, the agent off-handedly said "You do realize Mike won't be eligible because he is not full-time?"

 

No, nobody had caught that and the agent(s) involved had not mentioned it.

 

Want to guess which agent(s) I did not contact about insurance?

 

No problem, I went to my Country Companies agent where all my other insurance was and applied for health insurance.  Nurse came out, weighed and measured and poked and prodded, drew blood and left.  Couple weeks later my agent calls.  Seems I had been denied.  Why? Took 2 months to get an answer.  My blood sugar was too high. I was not pleased.  If it wasn't because I really like my agent all my busines would have walked away.  Not because they denied me, but because they had indicatons of a serious health issue and it took 2 months of trying diligently to get an answer.

 

As soon as you put the "D" word on an insurance app you are denied.  I stumbled across Reserve National.  I talked with them and they said after looking at the details it wasn't a problem.  It has been 10 years.  The coverage isn't great, but it is OK.  If you look at the policy they have never failed to do exactly what they promised.

 

As has been mentioned, one of the biggest advatages has been negotiated pricing.  As an example my wife had a recent office visit totalling $190.  The repriced charge is $161.50. It can be a hassle because we have had doctor's offices try to bill us for the difference.  They back off very quickly when you say "Let me call my insurance company and ask about that".

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Senior Contributor

Re: Health insurance

My negotiated price for a routine doctor visit is not much more than the co-pay was when I had a lower deductible....seems that if the doc is getting paid on the spot he is more willing to take less and be done with it....

 

Other than no prescription coverage, I have been happy with the higher deductible and lower premiums....I put the difference in the HSA "just in case" and am still money ahead.

 

Under the new ObamaCare, Mike, is it possible you could re-apply and not be denied?  I dont know much about it but I thought the new law did away with pre existing conditions?

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Senior Contributor

Re: Health insurance

We are having insurance issues right now.  We carry BCBS and have for years.  The policy we had was 1000 deductible per individual with all deductible being satisfied if 2 individuals met their deductible or something like that because we never met the deductible.  We had I believe 10% copay on prescriptions.  Very good insurance but very expensive.  It was around $1900 a month for my husband and I and the last child.

 

Then in 09 when the dairy market crashed my husband changed to a BCBS HSA.  Premiums were cut by more than 50% per month and we were told coverage would be exactly the same once the 2500 per individual was met.  Sounds good.

But because he did it as a budget saving device he has not put any money into the HSA.

 

Now I am having some issues and we are finding out they were not truthful with us and nothing I need is being covered, will not be covered even after the deductible is met.  Plus I'm finding my husband really reticent to pay for things he knew used to be covered.  For instance they want to do a stress test.  I had one in 06 and it was completely covered and now he is waffling on whether to let them do another one now.

 

Basic things that you would think any health insurance policy would cover.  I tore my rotor cuff (the pain in my shoulder) but the policy would not cover physical therapy.  Although partly our bad because he thinks he remembers asking specifically about physical therapy and the agent said he didn't know and would get back to us and we went ahead and signed the papers without his answer. although I don't remember that part of the conversation.  Basically I would say HSA might be good for a younger couple, if done correctly, but for a couple our age to switch was not a good decision.

 

They discovered I have some sleeping issues and want me to use oxygen at night.  The policy will not cover durable medical equipment.

 

I absolutely hate the insurance industry.  I think they are one of the biggest problems in this country.  They need regulation so badly.  Why should they be able to even sell policies that do not cover basic needs.  It is not hard at all to think of many many things that could happen that would require some measure of physical therapy and yet they sold us a policy that will not cover it

 

 

Another problem I have with the insurance industry goes back a few years ago when we had our house fire.  Yes we had insurance but it was not replacement insurance.  We got nothing near what it cost to replace the old kitchen appliances we lost in the fire.  I had my mothers solid wood dining room set that was 50 some years Old and you would spend many thousands of dollars to buy the same quality set today.  I got nothing for it in the fire settlement.  I simply do not understand why they are allowed to sell policies that will not cover replacement, especially when the difference in premium is minimal.  So everybody check the policy on your house especially if you have older things.

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Honored Advisor

Re: Health insurance

We have had one chiropractor try to bill us for the difference, even though we always pay their allowed charges with our HSA debit card at each office visit. This was not our regular guy...it was one where I tried a tad bit of accupunture.

Almost two years after my handful of visits, I got a bill with collections warnings on it, so called their office. When the billing person was sort of snippy about zeroing out the account- I give everyone one chance to correct their mistakes before fixing it for myself- I called BC/ BS and reported the abuse. The rep there said she would handle it, and she did.
A provider can lose ALL participation with a health insurer for such conduct. They have a contractual relationship to accept allowed charges, not one cent more. Charging a patient in excess of allowed fees is essentially breach of contract.
We all need to understand that health insurance is a series of contracts...between us as insured parties, the insurance company,
and providers. This is one reason why on principle, I find a mandate for forcing people to engage in commerce for health insurance sort of legally ( constitutionally) problematic...which is part of the crux of the VA case, I think.

As for diabetes...it used to be the death knell on gaining additional life insurance, too. If you lose weight, control your levels, especially with diet and exercise, and shop around, you can re- enter the ranks of the standard- issue insurable once more.

And, as friendly warning to anyone whom has had such a warning in the form of insurance rejection: If you haven't been diagnosed as diabetic yet, you are basically playing a waiting game until you do cross the line...it can be a very fine one. Your options shrink as your waistline expands.
Diabetes is a cruel and debilitating disease. Turn it around while you can...as Mike Huckabee's apt book title says: Stop digging your grave with your knife and fork.
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Honored Advisor

Re: Health insurance

I am no fan of insurance companies...but, I pinned an agent against a wall, figuratively speaking, and told him NEVER to offer me actual cash value coverage...either it was replacement cost or nothing.
He stated that not many people know the difference, much less to insist on replacement value in ther policies. You pay a bit more, but they get away with robbery when you have a loss and everything is not brand-new, and they depreciate down to chump change.
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Senior Contributor

Re: Health insurance

Are you with Farm Bureau??  we have been for years.  We were up to 990 per month for H/W/girl 22 and boy 17.  No dental and no vision with that.  I cannot believe the jumps it can make when our paychecks don't make that kind of jumps!  I am very fortunate (or at least I think I am) that I got on full-time and now have my health insurance paid for with work and have dental.  Got family vision with it.  So we should be down to about 530 for the rest of the family.  What I didn't like is that the prescriptions are $10 for 30 days and even $10 each month if you want 90 days so that is $30.  I used to pay $5 for a 90 day prescription.  But I got my doctor visit down to $15.  so I guess it is give and take.  God help me if I would lose this insurance because I really worry it would go way up over what we were paying if I went back on what everyone else is on.  My DH told me NOT to do the HMO plan because he had heard alot of unhappy people with that. 

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