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Health insurance, would you skip it?


Janeway
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Honestly it all confuses me... I took dd to the ER a couple months ago. We had not reached our deductible so I was expecting a huge bill. Well after I filled out and returned the accident report they said yes, it was adjusted and no, we don't owe that much. So that makes me think if we didn't have ins. we would have paid a lot more despite not having met the deductible.  

 

On various insurance plans, various types of health services are not subject to the deductible.  We have high medical bills but rarely meet our fairly low deductible.  Most of what we pay is co-pays.  

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Well, that's how my insurance is, but that's not what OP wrote.  She wrote the deductible had to be met before it would pay anything and she didn't say anything about a max OOP.  Maybe OP could clarify this point?

It is possible that the OP doesn't realize what is and isn't subject to the deductible.  We have a deductible we have not met but our insurance pays thousands and thousands of dollars in claims and that's just this year.  

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It depends on what you mean by 'skip it'. If you mean skip the employer's plan and find a cheaper plan (or a same cost plan that gives you better coverage) then yes. But if you mean to skip having health coverage, I'd vote no.   The costs are pretty typical to what our insurance costs/covers.  But last year when dh had a double bypass it sure came in handy. 

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I didn't read all of the replies, so I apologize if this is a repeat.  We have to meet our high deductible before our insurance will pay anything, but it does two things up front. One we have a maximum out of pocket for each calendar year.  That ended up being a big thing for us last year.  The second thing is that the insurance company has negotiated rates with the doctors and for prescriptions.  So we only pay $43 for a pediatrician visit instead of the normal $85 ish. Our children thankfully are healthy.  Last year my youngest had an emergency surgery.  He was in the hospital less than 24 hours, and the hospital charged us over $17K.  That was just the hospital.  We got a bill from a different dr every day for weeks.  We ended up paying a little over $5K for this surgery, but it would have been well over $25K without our insurance. 

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Last year I meet  deductible in February!!!  It happens. Lots of testing and procedures to try and remove a probable bit of safety glass from lower right lobe of right lung, probably inhaled in car crash over a year earlier.  Let's just say - all unsuccessful and it is still in me, just chillin' in my lung.  Anyway, had a few other medical things done that year since had met deductible anyway. 

 

 

Edited by JFSinIL
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A comparable plan here on our Marketplace will cost about $1700/month, with similar deductibles. I wouldn't skip it, it's a good deal. Getting it through your husband's work also means that the premium will come out pre-tax, rather than the post-tax premium you would pay if you purchased it somewhere else. 

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Well, that's how my insurance is, but that's not what OP wrote.  She wrote the deductible had to be met before it would pay anything and she didn't say anything about a max OOP.  Maybe OP could clarify this point?

Maybe someone here could look at what I have and clarify? The wording says the deductible must be met before the insurance pays anything. Let me see if I can attach a picture of what it says.

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Maybe someone here could look at what I have and clarify? The wording says the deductible must be met before the insurance pays anything. Let me see if I can attach a picture of what it says.

 

It says it doesn't apply to services with a co-pay, preventative care, or medications.  That means the deductible would need to be met on things like labs, therapy, radiology, hospitalization, surgery, etc if they don't have co-pays. If your regular dr visits have copays, then they should not be subject to the deductible. Neither would well visits or medications.

Edited by TeenagerMom
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It says it doesn't apply to services with a co-pay, preventative care, or medications.  That means the deductible would need to be met on things like labs, therapy, radiology, hospitalization, surgery, etc if they don't have co-pays. If your regular dr visits have copays, then they should not be subject to the deductible. Neither would well visits or medications.

 

and you have an out of pocket max of about 13K per family, less for an individual, which would be met very easily with one hospitalization. Get the insurance. 

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There is also a limit on out of pocket expenses, so if I understand correctly:

 

You pay a copay only on preventative care, prescriptions, and some other things that require a copay (not sure what);

 

Then there are treatments that you must pay for until a deductible is met (for the individual that would be $2,275);

 

After that, you pay the 30% until you reach the limit on what you can be required to pay out of pocket (in network, $6,900 for an individual). Then nothing.

 

Is that right?

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Here is the first page...

 

OK..it is just a portion of the first page as I had to crop it to make it small enough to upload.

 

I don't know how your insurance will work, but with mine, we have deductibles and co-pays. I was expecting to pay a lot more than it has actually cost. I pay OOP for labs and stuff until I hit my deductible, but for regular visits I just pay the co-pay even before I hit my deductible. I'm not sure if the co-pays are applied to the deductible but I think they are.

 

Some things, like maternity care apparently, I seem to be getting with no co-pay and no need to pay towards my deductible. I'm sure I'll get a hospital bill, but I keep asking the office people what I owe them at every appointment and they keep saying nothing yet. I'm about half way through this pregnancy and haven't paid for anything. I haven't even been billed by the labs yet! 

 

I would definitely take the insurance. It probably will be cheaper than you expect and in the event of an emergency it could save your lives or at least your lifestyle. 

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Get the insurance. We had an incident this year and my daughter met her out of pocket max. Our liability was limited to about $6000. It is similar insurance to what you are offered. This incident was around $100,000 but the insurance knocked it down so they paid around $50,000 and we have to pay our $6000.

A few years ago my daughter got a ear infection that resulted in a hospitalization. This ran about $35,000 but once again we only ended up paying a few thousand.

We pay around $1200 a month but so worth it. It also lowers our tax liability. I know that we will get medical care and we won't go bankrupt.

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Take the insurance, *especially* in this political climate.

  

Do not skip it. 

 

Also, keep in mind that the bill trying to be passed would make you pay extra later, down the road, to get insurance if you had a gap in coverage.

 

 

The above is why I'd get it if I were you. I don't know the details, but I keep hearing something or other about how you need to keep insurance without gaps, or there will be big problems later.

 

Also, I worked for a health insurance company for a number of years in the claims department and you would not believe how much things cost. You need insurance.

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Getting individual coverage for your DH through his employer is most likely going to be the cheapest option to insure him. You and the kids should price out your options including individual coverage and one of those healthshare ministries if you qualify. The healthshares are not as comprehensive as the typical insurance policy through an employer (a big reason why they're typically cheaper) but they're still far better than going totally uncovered.

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Get the insurance.

 

THEN, it is a about $6400 out of pocket deductible before it starts to pay.

 

That is not entirely correct. The per-person deductible for in network care, according to the image you posted, is $2,275, and the insurance will pay for that family member's cost once it has exceeded this amount.

And preventive care is free.

 

The out-of-pocket limit for network care is $6,900 for a person - you will never pay more than that. 

 

Edited by regentrude
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$900/mth * 12 mth = $10800 for premiums + $6400 deductible = $17200 out of pocket before you see a nickle of benefit, and even then you're paying 30% of whatever comes next?  Yes, I'd skip it.

 

The 6.4k deductible is for  the family. The individual in net work deductible is $2,275.

Also, you're only paying the 30% until the out-of-pocket maximum of $6,900 is reached for the person, and nothing after that.

It does not take a severe emergency to create medical cost that exceed this.

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Take it.

 

Yeah, it's sub-par coverage, but I've seen worse. (I have worse!)  Still, we wouldn't have gotten through dh's "maybe cancer" tests a few months back without it.  And he barely met his individual deductible.  Still saved us somewhere between 10 and 20k.  It's hard to get an accurate number b/c he did go out of network for some things.  And that was all to find out that it's "probably" not cancer. (He still needs a 1yr follow up.)

 

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I would not skip insurance but I would go to the marketplace and run the numbers and see if you (or the kids) qualify for any other insurance that is better/cheaper.

 

Depending on your state, income, and family size, there might be other options.

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I would not skip insurance but I would go to the marketplace and run the numbers and see if you (or the kids) qualify for any other insurance that is better/cheaper.

 

Depending on your state, income, and family size, there might be other options.

 

I agree with checking it out just in case, but it sounds like the offered policy may be within the "affordability" guidelines, which would disqualify them from the marketplace.

 

We qualify because dh's company policy is outrageously higher.

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Based on the bit of your contract that you posted, your insurance is not as bad as it sounded in the OP.    I think you should try to talk to someone either at your husband's employer, or at the insurance company, to have it explained to you in detail.  Your OOP maximum is not that high, compared to many I have seen.  There is no way I would forgo insurance altogether.  If you can find something cheaper, great, but make sure you fully understand what you are getting.  

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It is possible that the OP doesn't realize what is and isn't subject to the deductible.  We have a deductible we have not met but our insurance pays thousands and thousands of dollars in claims and that's just this year.  

 

Honestly, that is what I am thinking.

I *theory* my husband's insurance says we have a deductible, but in practice, we only pay more than a co-pay if we go out of network.  

 

The deductible is met only when we end up having surgeries, or when my son needed quite a bit of out of network therapy, etc......

 

Otherwise, we never meet it with co-pays.

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Honestly, that is what I am thinking.

I *theory* my husband's insurance says we have a deductible, but in practice, we only pay more than a co-pay if we go out of network.  

 

The deductible is met only when we end up having surgeries, or when my son needed quite a bit of out of network therapy, etc......

 

Otherwise, we never meet it with co-pays.

 

We used to have a plan like this.  I never knew what applied to the deductible and OOP max.  I don't think we ever hit it.

 

Then the company changed to a high-deductible plan.  There are no copays; we pay the bill till the deductible/OOP is met.  We do pay less than the doctor's initial bill due to negotiated rates, but we are still paying more than a copay.  But when we're done, we're done.  There is no confusion.  I think with some copay plans, the OOP max is misleading because of all the things that don't apply.

 

I think it's terrible that the plans can be so confusing.  

Edited by marbel
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$900/mth * 12 mth = $10800 for premiums + $6400 deductible = $17200 out of pocket before you see a nickle of benefit, and even then you're paying 30% of whatever comes next?  Yes, I'd skip it.

As a nurse I disagree since even though the deductible is large, they would still get a massive discount on the cost of various services as negotiated by the insurance company. Also, $500 for a ER visit is a bargain really compared to full costs of a ER visit which can be thousands of dollars. Also, I took care of plenty of healthy people including children who racked up millions of dollars of care:( SO I would never do without insurance if I could help it.

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Here is the first page...

 

OK..it is just a portion of the first page as I had to crop it to make it small enough to upload.

 

It does show an out of pocket max of just under 14k. Cancer or a bad car crash will cost you far more than that without insurance.

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Many others have stated what I feel (don't go without insurance - or health share)!

 

Personally, I'd have rather paid in for years and never needed it than have to use it.  Because we had it (health share), we still have a stable financial life.

 

Looking at it from another POV, insurance/health share is a way of having everyone chip into the pot to pay for health care because health care is expensive.  One never knows who will draw the short straw when they are young, but sooner or later, short of quick death, everyone needs something.  Our country could opt to do this via taxes (my preference), but we don't. We count on everyone chipping in TBH. Very few of us are wealthy enough to pay for it on our own when we need it, so it's helpful that the pot is there when our turn comes.

 

Those who can afford it (even if it requires skimping) and go without - then hope for charity or "plan" on bankruptcy later - well, I have words for them but they aren't nice enough for a family message board.

 

This doesn't mean one has to buy the most expensive option out there.  As others have said, shop around.  I, personally, love health share and it's saved us thousands over the years (literally - in cost and having no OOP for major events), but that doesn't work for everyone.  Having read after you posted the info page, it sounds like this insurance isn't that bad of a deal compared to what many have.  If health share isn't an option (or a desired option) for you, I'd go with it.

 

I would never go without - due to both the financial risk for me and due to my love for my fellow human who could have drawn the short straw.

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We used to have a plan like this.  I never knew what applied to the deductible and OOP max.  I don't think we ever hit it.

 

Then the company changed to a high-deductible plan.  There are no copays; we pay the bill till the deductible/OOP is met.  We do pay less than the doctor's initial bill due to negotiated rates, but we are still paying more than a copay.  But when we're done, we're done.  There is no confusion.  I think with some copay plans, the OOP max is misleading because of all the things that don't apply.

 

I think it's terrible that the plans can be so confusing.  

 

Yeah, it does stink.  We used to have a much better plan that was very clear.  I should never have agreed to move away, quit my job, etc.....we were younger and I didn't fully understand the ramifications of that choice.

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Yeah, it does stink.  We used to have a much better plan that was very clear.  I should never have agreed to move away, quit my job, etc.....we were younger and I didn't fully understand the ramifications of that choice.

 

You probably wouldn't have that plan anymore. All insurance plans have changed and gone in the direction laid out here. At my dh's last job, the human resources department told him that they have many fewer choices in the insurance plans they can buy post-ACA. They used to be able to tweak a deductible here, a co-pay there, but no more. There are specific plans offered by the insurance companies and no changes can be made.

 

OP, get the insurance. Do not have a gap in coverage. It's actually fairly good insurance. It's equivalent to a lot of the silver plans on the marketplace today.

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You probably wouldn't have that plan anymore. All insurance plans have changed and gone in the direction laid out here. At my dh's last job, the human resources department told him that they have many fewer choices in the insurance plans they can buy post-ACA. They used to be able to tweak a deductible here, a co-pay there, but no more. There are specific plans offered by the insurance companies and no changes can be made.

 

OP, get the insurance. Do not have a gap in coverage. It's actually fairly good insurance. It's equivalent to a lot of the silver plans on the marketplace today.

 

I don't know about that.  The plan we have is nothing like that. 

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They tweaked a lot of things about our plan at the beginning of the year (adding ded/copay for somethings that didn't have it before, raising the deductible and maximum oop, etc).

 

I would not go without insurance or have a gap in coverage - especially not with the plan that the house passed hanging around out there. Like other posters there's a whole bunch I would drop or change before forgoing health insurance.

Edited by mamaraby
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I don't know how your insurance will work, but with mine, we have deductibles and co-pays. I was expecting to pay a lot more than it has actually cost. I pay OOP for labs and stuff until I hit my deductible, but for regular visits I just pay the co-pay even before I hit my deductible. I'm not sure if the co-pays are applied to the deductible but I think they are.

 

Some things, like maternity care apparently, I seem to be getting with no co-pay and no need to pay towards my deductible. I'm sure I'll get a hospital bill, but I keep asking the office people what I owe them at every appointment and they keep saying nothing yet. I'm about half way through this pregnancy and haven't paid for anything. I haven't even been billed by the labs yet! 

 

I would definitely take the insurance. It probably will be cheaper than you expect and in the event of an emergency it could save your lives or at least your lifestyle. 

 

That's... weird.  We had one number owed for the entire maternity care plus expected hospital stay.  We were told what that amount would be and were expected to pay it in chunks before the baby was due.  That paid our deductible that year, plus 20$ coinsurance thereafter.

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With a family, I would never go without insurance, though I'd probably shop around and compare.

 

Health catastrophes can hit even the healthiest young people.

 

It's terrible how confusing it is though.  When I was shopping around a few years ago, I'd even get different answers/explanations from different agents within the same insurance company.   I don't think they even really understood what they covered and how.

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That's actually a decent plan. Better than most you could get on our exchange. BCBS right? I recognize the benefit page. 

 

You would pay a copay for Dr's appts and urgent care and therapy appts. Anything bigger than that would be subject to the deductible, and the out of pocket max per year is $6,900 for in network. I'm not sure where you live, but BCBS is a very easy network to credential with and work with, so every Dr and therapist that I've ever heard of is in-network with them. 

 

It's a good plan.

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I forgot to add that going without insurance risks going without care as well. Sure emergency rooms cannot turn you away for emergencies but they only treat emergencies until one is stable. They do not treat chronic conditions that are not emergencies. So if you need chemo or radiation or gallbladder surgery that is not an emergency you are out of luck unless you can cough up the cash-lots of it!

 

My mom was told if she could not pay her bill even with insurance then no chemo or radiation! Then there are prescription drugs which can cost a ton of money without insurance. My meds for asthma would cost about a couple thousand dollars a month without insurance. If you cannot pay, then no meds:(

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My no complications hysterectomy (due to a fibroid so big it was blocking the drain to my left kidney) was $80,000 4 years ago.  It was covered because we had already hit our $6,000 deductible.

 

We've been slammed by healthcare, but we're still buying insurance.  Our rates have more than tripled in the last 5 years-6 years.  We currently pay $1500 per month for the 4 of us (no major, chronic preexisting conditions and middle daughter is working full time with benefits) with a $13,000 deductible.  After that it will cover 50%. That was our least expensive option. I just saw the in network orthopedic surgeon about my knee.  That cost me $120 out of pocket.  I need an MRI. 

I'm not sure who to blame politically for this, but the last administration did not make it affordable care for us and I suspect this one isn't going to solve this problem either.

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I would not have a gap in insurance if I can help it.

 

We're a healthy family--DH and DS typically so, & I'm a Textbook Healthy Person. Last year DS needed minor surgery (no overnight stay) and I spent one night in an emergency room (first time in my life), making insurance absolutely worthwhile.

 

My regular doctor told me to go to the ER. I was there ~11 hours, had tests rule some things out but did *not* get an accurate diagnosis or successful treatment, and was not admitted. The insurance company paid $12,000 for that.

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Our income is too high for chip too.

 

There were several threads around last Christmas regarding health share companies. Would this be an option? If so, I'd read through some threads to get more details and check out some websites.

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Janeway, since you are concerned about it, why not call the insurance company directly and ask questions about the policy? This way you get clarification from the horse's mouth, and you could develop a couple of what if "story problems" to relate to them, and ask how the insurance would pay out in order to better understand how it will work for you.

 

Also find out if the company offers an HSA with a company lump sum contribution. DH's company does, and that helps us a lot with our out of pocket expenses. 

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That's a reasonable.plan. ours has stopped offering the individual deductible...that essentially means an extra 4k oop, or I skip some bloodwork and imaging that is the standard of care for my disease.

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This is the kind of plan we have. Our premiums are a bit lower, and our deductible and OOP are a bit higher.

 

I think that it can be hard for chronic illnesses that require a hospitalization almost every year (because $15,000 a year, year after year, adds up), but it's also pretty standard isurance policies for private industry these days.

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Also find out if the company offers an HSA with a company lump sum contribution. DH's company does, and that helps us a lot with our out of pocket expenses. 

 

This is what we have, and I love it.  It does take a willingness to better understand your insurance than other policies, but it's a great value, and the lump sums each year really can accumulate if you don't have many issues. 

 

Interestingly, my dh said that we are the only family in his company that uses the HSA option, according to his HR person.  Apparently many people feel it's too complicated.

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On various insurance plans, various types of health services are not subject to the deductible.  We have high medical bills but rarely meet our fairly low deductible.  Most of what we pay is co-pays.  

 

Ahh. Maybe that explains it. I literally just had two weird things happen today like that where I thought I would owe more. They said they will let me know if anything changes but didn't think I owed more than a co-pay when I took dd to the eye dr (they billed it as medical not vision).

 

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