Can we discuss health insurance?

[Unicorn.]

What company do you have health insurance with? And are you happy with them?

 

We can't afford to add me to dh's insurance, and are shopping for individual insurance for just me. Any suggestions or companies to avoid? I live in TX if that makes a difference.

 

Thanks!

[Desert Rat]

We have Pacificare right now and are happy with it. I don't know the private costs though. We've also had United in the past and were pleased with them. My mom works for United HC as a nurse case manager so I have the insider scoop. I think with any type of insurance, it's important to know what's covered and where as well as hoops that need jumping through-like referrals and which doctors are on the list.

I have used gap coverage, Aliant, I think was the name in between jobs. It doesn't cover perscriptions, dental, vision or well checks but it paid 50% of all major medical/emergencies. It also counts as insurance should you add to your dh's policy later and that way you will have continuous coverage for preexisting conditions. It's very cheap too. I think we paid $500 for a family of 4 for 3 months.

HTH

[Ravin]

DD and I are on my crappy insurance at work. It's blue cross/blue shield, and I pay about $33/mo. It's better than nothing, but the copays, etc. are still more than I can afford. Which is why we're also on medicaid, as secondary insurance.

 

DH has no insurance at all.

[i.love.lucy]

We used eHealthInsurance to find quotes for indiv coverage for me and the kids. We got Aetna. It's not perfect, but pretty good and all our doctors are on there. It'd be twice as much for dh to add us to his coverage, and not as good (he works for a small company). I had United when I had my son, preemie, and it was all covered nicely. I've had BC/BS too and that was good also.

 

For Aetna the kids and I cost $430/mo.

[joannqn]

I was fairly happy with my Regence BlueShield until they sent me a letter a week or so ago. They are increasing my rates to $376 a month to cover just me...or I can triple my deductible and pay just $9 more a month.

 

Been thinking about whether I want to try to find someone new before the end of the month or go without...putting that premium into savings instead.

 

We are pretty limited in choices here in WA due to some government bureaucracy crap.

[LizzyBee]

I don't know about Texas, but Blue Cross/ Blue Shield of MD and NC are fantastic. Best insurance I had in either state.

[Nestof3]

We have Anthem Blue Cross Virginia. We have the Health Smart plan for the five of us, all Level 1 (lowest) with a $5,000 deductible (we have it for the big things). We pay $400 a month (it went up $9.00 this year). This includes $91 a month for dental insurance which pays for itself with 5 cleanings times 2, sealants for the boys and x-rays.

 

They are extremely fast with processing claims and were very quick refunding me when we met our deductible last year after my cardiac ablation. Even a prescription that I paid $10 for was refunded in less than two weeks. We have been very happy with this company and the plan.

[Nestof3]

DD and I are on my crappy insurance at work. It's blue cross/blue shield, and I pay about $33/mo. It's better than nothing, but the copays, etc. are still more than I can afford. Which is why we're also on medicaid, as secondary insurance.

 

DH has no insurance at all.

 

I tend to look at it like this: Even with copays, are you paying less than you would without insurance? At $33 a month, it sounds like you're getting a bargain since I cannot imagine copays being that much compared to paying everything out of pocket.

[Ellie]

We used eHealthInsurance to find quotes for indiv coverage for me and the kids. We got Aetna. It's not perfect, but pretty good and all our doctors are on there. It'd be twice as much for dh to add us to his coverage, and not as good (he works for a small company). I had United when I had my son, preemie, and it was all covered nicely. I've had BC/BS too and that was good also.

 

For Aetna the kids and I cost $430/mo.

Some doctors and hospitals here (Austin area) don't like Aetna. I had to change doctors because mine quit accepting Aetna. :-/

[Dobela]

My dh is an insurance agent and our health insurance is kicking our tail cost wise. Nothing like not being part of a group. He has been calling all over trying to find something more affordable with decent coverage. Lots of companies are trying to put out new products but they aren't helping much. We have Blue Cross in our state, and while they are well accepted, our premiums are so high that we couldn't afford it any more. Hopefully we can find a new company soon that has good coverage, low deductibles, and be something we can afford.

 

If you haven't already, start calling all the insurance agents in town. Some write for several companies and may be able to get you several quotes with different companies.

[Mommyof4ks]

BC/BS is what we have, but it is through dh's employer and pays VERY WELL for cheap premiums.

 

BC/BS is accepted at most major hospitals in our area (central TX). We have yet to find a place that does not take it in a 20 mile radius. We have even gone as far south as Austin and as far north as Dallas with it and not had any issues.

 

I don't know what your health is like, but we have a high deductible plan through dh's employer and we only pay X amount out of pocket each year regardless of our actual healthcare costs. The premium is like $50 or so a month with no copays (we pay the adjusted rate given by the insurance until the deductible/max is met). We have a son with a medical condition so this is so much cheaper than copays and coinsurance but it also works if you don't go to the doc much. It covers you though if you ever have a major illness or surgery because you only pay the max out of pocket that year. You also have the option of opening a HSA, so you can put money in there and roll it over year after year if you do not use it to pay for any visits or whatever. Just a thought.

[creekland]

It's NOT insurance, but rather a private Christian health-share group that we've chosen to go with - Samaritan's Ministries.

 

It costs us $300/month for our whole family to belong and has a $300 deductible (if I remember correctly) and a $170/year membership fee. We have chosen to add amounts covered about $100,000 and motor vehicle coverage, so it could be less if you didn't opt for those. It's also less for a single than a family.

 

One MUST be a church-going Christian to join and it doesn't cover pre-existing issues, dental, prescriptions, abortions, drunk accidents or annual physicals, etc. However, considering we were having to pay $600/month with a higher deductible and co-pays, the $$ we save by belonging to this group more than pays for the other for us.

 

We have used it twice - once for a broken collar bone for my oldest and once when hubby passed out in our horse pasture with no recollection of what had happened and went to the emergency room to get checked out. We didn't have any problems with it at all - and rather like it to be honest. We'd be sticking with it now even if we could afford traditional insurance...

 

Here's a link if anyone wants to check it out further:

 

http://www.samaritanministries.org/index.php?I=25b2822c2f5a3230abfadd476e8b04c9

[Dirtroad]

Blue Cross & Blue Shield.... they are awesome, dependable, and a good value. Multiple plans that DH can pick (from his job). We chose one in the middle... bit higher deductible & we chose our doctors. I think he could select from 4 different combinations.

[TraceyS/FL]

Individual insurance brings on its own set of fun..... underwriting.

 

Are you in good health with ZERO pre-existing? In CA certain things make you uninsurable (I was/am), but in other states they are willing to write a rider for exempting that body part.

 

One thing about it, we all *think* that we don't need it, but we really can't predict that at all.

 

I think i'm uninsured again - i think the STBXH officially changed jobs, but that info isn't something apparently i need to know ( :glare: ). I'm going to have to go try to find one of the plans they are showing on TV for $100/mo. Those are thru Blue Cross around here.....

 

Do check with your current doctors to see who takes what - and they can tell you if someone is a nightmare in your area. BC/BS is the most accepted, no one likes to work with United here.

 

Good luck, it's so NOT a fun thing to be going thru....

[Unicorn.]

Dh has BC/BS through work, but it would be at least $350 a month out of our pocket to add me. I don't go to the doc very often. I just want to have something "in case" ya know? Thanks for the suggestions and info. I guess my first call should be to my doc's office to see what they accept!

[Kathy in MD]

DD and I are on my crappy insurance at work. It's blue cross/blue shield, and I pay about $33/mo. It's better than nothing, but the copays, etc. are still more than I can afford. Which is why we're also on medicaid, as secondary insurance.

 

DH has no insurance at all.

 

A heads up about insurance. The insurance company will modify their policies to fit the company's desires and what the state requires. Also the company will often self-insure and only hire the insurance company to admisister the plan. This way some state requirements can be side stepped. I discovered this when I sat in on these discussions when my company was renewing the health insurance policy.

 

BTW, my family also has Blue Cross Blue Shield and find that it's very good, (through my dh's former employer (retired). Another friend had BCBS through a different employer and she had more hassles dealing with the same diagnosis, treatment and doctor though BCBS would pay up. I should also add that both us paid far more per month for family coverage, which does affect the insurance benifits.

[Quiver0f10]

I tend to look at it like this: Even with copays, are you paying less than you would without insurance? At $33 a month, it sounds like you're getting a bargain since I cannot imagine copays being that much compared to paying everything out of pocket.

 

Well we have BC/BS and don't pay that much on monthly premiums but our co- pay and amount not covered is killing us financially. We have accumulated an insane amount of medical bills in the last two years and we are fairly healthy people.

[Kathy in MD]

Another thing about BC/BS, and I assume other major insurers. If you go with a doctor or medical provider who is part of the plan, BC/BS can really lower the initial cost of the service or medicine. Not always, but I've recieved bills where one shot had a retail value of $1200 and the price was knocked down to about $6-700. That alone reduced my co-pay by about $120. Sometimes paying more up front pays big dividends in the end.

[Renee in NC]

Well we have BC/BS and don't pay that much on monthly premiums but our co- pay and amount not covered is killing us financially. We have accumulated an insane amount of medical bills in the last two years and we are fairly healthy people.

 

Would the premiums you have paid cover the amount you have in unpaid bills?

[TraceyS/FL]

Dh has BC/BS through work, but it would be at least $350 a month out of our pocket to add me. I don't go to the doc very often. I just want to have something "in case" ya know? Thanks for the suggestions and info. I guess my first call should be to my doc's office to see what they accept!

 

Well, a quick check shows that i would be $39/mo for the doctor visit type of plan. That includes ZERO major medical. NONE. That is the "no questions asked" type of policy. The coverage is basically $50 per visit, then if you use a preferred provider, they do the reduction on the visit (so while Joe public pays $95 for a visit to urgent care, they will take $60 from blue cross, so you only then pay $10 for that visit).

 

GoBlue

Guaranteed Issue

Plan 91

Guaranteed Acceptance - no health questions or medical tests

Preventive and basic dental coverage included

Lab Services covered at 100% when using Quest Diagnostics

 

A "normal" individual plan for me is $285/mo.

Family physician copayment plan

Dental coverage included

$15 copay for generic prescription drugs

 

Plan Type: Predictable Cost

Deductible: $500 per Individual

Copay: Family Physician: $20 copayment; Specialist: $40 copayment

Coinsurance: 20%

Out-of-Pocket: $4,000 / $8,000

Prescriptions: Included

Maternity: Available

 

Note however that while it's cheaper than the cost of your DH's plan, you are now NOT stacking your out of pocket limits per family. That can really help in a yearly cap.

 

Frankly, i'm not sure you will find anything with decent coverage much less than the $350 if you want major medical (which is what insurance is really for - the big stuff..... a friends DD had an unexpected stroke at 30 a few years ago, is now disabled and has probably hit her first million for bills.)

[Quiver0f10]

Would the premiums you have paid cover the amount you have in unpaid bills?

 

No.

Edited July 8, 2009 by Quiver0f10

[Renee in NC]

No. However we had BC/BS in NH and after our premium and co-pay per visit( I think it was $25 per visit?) we paid zero. We have already paid thousands OOP this year and have just as many unpaid bills sitting there.

 

We would qualify for medicaid if our adult kids weren't living at home because I have to count their income towards "household" income. They are all college students and don't pay us, but that's the rules.

 

That stinks, Jean! Medical care is just really, really expensive.

[Nestof3]

Well we have BC/BS and don't pay that much on monthly premiums but our co- pay and amount not covered is killing us financially. We have accumulated an insane amount of medical bills in the last two years and we are fairly healthy people.

 

I guess I don't understand what you mean. Are you saying they don't cover very many of your claims? That they are outside of your policy? I don't understand what sorts of claims would not be covered by BCBS for fairly healthy people. My policy covers everything except the more off-the-wall things.

 

Are you saying that you still pay quite a bit every year because the deductible is so high?

 

Since you are fairly healthy, you may consider trying to reapply under their Health Smart plan (or is this a company insurance plan)?

 

Once we meet the deductible (which in our case is $5,000 and that was only met once because of a nearly $30,000 procedure), I don't pay anything at all out of pocket. The Health Smart plan doesn't actually have copays. You pay everything (at the reduced, discounted rate) until you reach the deductible.

[TraceyS/FL]

The old, "we can't afford to USE our insurance" thing.

 

That has been my life, i have a variety of things i NEED fixed, but can't afford to :(

[LizzyBee]

Another good thing about BC/BS, at least in NC - Everything related to a dr. visit is covered by one copay. No more out-of-network lab fees or that sort of thing. Also, in order for a hospital to be in network, all of their providers have to accept in network rates, too. So again, no more out-of-network bills from the lab, anesthesiologist, ER doctor, etc.