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Health insurance alternatives--asking for a friend who is struggling


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A friend of mine is a teacher who recently changed jobs. I do not understand all the ins-and-outs of his situation, so I will just cut to the chase:

 

As a teacher, he does not make a terribly high salary, even though he is in a good district.

 

His medical insurance costs are 30% of his income right now. That only pays for the big stuff. The little stuff he still has to pay for himself. (I am assuming he is paying a percentage based on whatever the insurance plan is.)

 

With two children and a third on the way, money is really tight.

 

My friend would like to investigate alternative insurance options. Can you suggest some avenues for him to investigate? Share your experiences, positive or negative?

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You could find out if there is an independent insurance agent in your area. An independent agent is not attached to any particular insurance company, and stands to make real money only if the client is happy enough to continue the policy (and therefore continue to pay his premiums). These guys not only know the ins and outs of all the available area insurance companies, they know about obscure policy options and riders that could be helpful for your friend's situation-- things that can reduce premiums but still provide coverage for things that he is worried about. Agents also have a little more ability to find reasonably priced coverage for individuals, sometimes able to bundle them into small groups for discounts and such, or simply negotiate on their behalf, or just know where the best deals are.

 

It is definitely worth asking.

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If he is under 200-250% of the federal poverty limit for a family of 5 (many teachers are) then depending on how his state uses their federal SCHIP dollars, they may qualify for very low cost insurance for the children and perhaps maternity coverage. Doesn't do much for him and his wife but if he can't afford the cost via his work for his kids, it could help a lot. If he did that for the kids plus a catastrophic for him and his wife, they would all be covered for less. The program has various names that vary per state. Well worth investigating. Also they should see if they qualify for WIC and/or food stamps. Many people do but just don't realize it.

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Make sure he checks before getting rid of it. Dh had terribly expensive insurance for years, and we could never get our own individual policy because you have to check the box that says that you can't get insurance through work. So basically we were stuck with the awful, very high deductible and expensive insurance. When dh left that job, then we were able to get our own policy.

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the income guidelines for Medicaid are different than Foodstamps and WIC. We make too much for foodstamps but we are within the guidelines for Medicaid (for the kids ONLY). Id rather have my children covered than myself if i had the choice. I am on DHs insurance at work but still, if i couldnt be, id rather go without than my kids.

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If his wife is expecting a baby, they should keep their current insurance until after the delivery. It is considered a "pre-existing condition". :001_smile:

 

Not here in Washington. Varies by state.

 

While they are unlikely to qualify for medical care from their state for themselves, they are fairly likely to qualify for the kids. Since they can't afford what they have now, they should investigate it for sure. And she may very well qualify for "pregnancy medical."

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They should definitely look into state insurance for the kids. For themselves too, if the state has it. Even if their income limits seem too high, they should have the mom apply for it anyway, because sometimes there are special state insurances for pregnant women. The kids may have to be uninsured for several months to get CHIP, though, so that's something to consider.

 

It makes me angry to hear that someone's paying 30% of their income for health insurance! I'm appalled that things got so bad in the US.

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