Health insurance, would you skip it?

[Homebody2]

Please don't skip insurance. Maybe don't do this plan, but do something. You honestly never know. 8 years later, our insurance has paid over a million dollars for our child's ongoing treatment. Medical emergencies can bankrupt you in an instant. That on top of a medical diagnosis can be just a level of stress and anxiety that can be unbearable.

[LarlaB]

Yeah, I would skip it and get a medical sharing plan instead.    Although $900 a month isn't that horrible.  

DH & I have been married for 21 years and self-insured the entire time- paying over $140K in premiums for essentially high deductible plans.  The clincher was 3 years ago when I needed knee surgery- MRI, various consults, surgery and PT still didn't hit my $7500 deductible.  So we paid $8400 that year in premiums (as we did for previous 15 years) for essentially nothing but a 'discounted courtesy rate'.    I'm just done with corporate insurance crap.

We switched to Medi-Share and self-negotiate medical bills.  Cash pay is a whole other billing rate in 90% of offices/hospitals!!!!  It really is.  I'm confident that we come out WAY ahead with Medi-share.   Medi-share is non-profit so that means our money is actually being used to pay medical bills, not pad the profit line and perpetuate a totally jacked up system.  If I'm going to pay out another $144,000 to have 'just in case coverage' over the next 20 years, I chose to put it towards something that seems to actually make sense- for me. 

For what its worth, I know of at least 7 families who have Medi-Share and have had major medical situations that were 100% covered (past their deductible). Including the scary thing like:   Cancer and treatments, multiple back surgeries, 2 broken legs required months of surgery and rehab, emergent care, maternity with complications etc.   Sure medical sharing isn't for everyone, but is certainly a viable option for some of us. 

[Guest]

Medical sharing keeps coming up--it is not a good solution for lots of people. They don't cover people with pre-existing conditions and, if they do, they don't cover the condition at all. They also only cover certain types of Christians. Just know what you are getting into if you choose that option.

[LarlaB]

Medical sharing keeps coming up--it is not a good solution for lots of people. They don't cover people with pre-existing conditions and, if they do, they don't cover the condition at all. They also only cover certain types of Christians. Just know what you are getting into if you choose that option.

ETA: That's not an accurate statement RE not treating pre existing conditions...3 years prior with certain limitations/parameters

 

They also don't deal with mental health coverage - at all. And have stipulations for coverage.

 

I didn't mean to imply it's a blanket solution for everyone, but felt it's only fair to present as a potentially viable option for some.

Edited June 1, 2017 by LarlaB

[Liz CA]

ETA: That's not an accurate statement RE not treating pre existing conditions...3 years prior with certain limitations/parameters

 

They also don't deal with mental health coverage - at all. And have stipulations for coverage.

 

I didn't mean to imply it's a blanket solution for everyone, but felt it's only fair to present as a potentially viable option for some.

 

Agree with LarlaB. Not everyone's cuppa but can be a very good alternative for some of us. Janeway and family will have to make that decision.

 

Just FYI: The place I am with treats people as having no pre-existing condition if the last event was five years in the past. There are several threads about this topic.

[Liz CA]

Medical sharing keeps coming up--it is not a good solution for lots of people. They don't cover people with pre-existing conditions and, if they do, they don't cover the condition at all. They also only cover certain types of Christians. Just know what you are getting into if you choose that option.

 

This was not part of my questionnaire. There are also sharing companies that are secular.

[QueenCat]

  Sure medical sharing isn't for everyone, but is certainly a viable option for some of us. 

 

I could be wrong but I'm pretty sure the OP has mentioned Aspergers for one of her kiddos. That would be an issue with many of the med share groups.

[idnib]

DH & I have been married for 21 years and self-insured the entire time- paying over $140K in premiums for essentially high deductible plans.  

 

FYI that's not self-insurance. Self-insurance is usually when an organization pools the resources of its own employees together or an individual knows they can cover expenses without insurance. In other words, assuming all the risk instead of spending money to spread some of the risk to a third-party insurer.

[LarlaB]

FYI that's not self-insurance. Self-insurance is usually when an organization pools the resources of its own employees together or an individual knows they can cover expenses without insurance. In other words, assuming all the risk instead of spending money to spread some of the risk to a third-party insurer.

You are correct. I used the wrong term. Thanks for pointing out my mistake.

[justasque]

Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure. 

 

Ok, so $1200/month.  

 

Your $1200/month comes out of pre-tax dollars, so figure it's more like $850/month if you had to take out of your dh's post-tax paycheck.  

 

For that, I am assuming that you get all well visits without a copay or other cost, yes?  So all of your kids can have regular check-ups and vaccinations, your dh and you can get regular checkup and standard screening tests (cholesterol, blood sugar, thyroid), things like annual skin checks, and don't forget your pap smear, mammogram, and when the time comes colonoscopies for both of you.  This may be something that you haven't been doing in the past, but don't underestimate the value of it.

 

You also presumably have an out-of-pocket limit.  Talk to the insurance company about exactly how that works.  Dh and I mentally plan to spend our out-of-pocket each year, and budget accordingly.  Should we not hit it, it means we had a particularly healthy year - yay!!! - but if we do, we are prepared.  If you have the option of an HSA, then much of your out of pocket costs can also be pre-tax dollars, again substantially reducing the cost.

 

Do you get dental and vision coverage? That's two cleanings a year for each of you.  Find out how much of each cleaning will be covered - that adds up quickly.  And new glasses every two or three years for those who need them adds up too.

 

And your oldest (and eventually the rest) will have the possibility of coverage through age 26, which could be a blessing if doesn't have employment which comes with coverage.

 

Lots of posters have shared how their healthy family was only one drunk driver, one premie baby, one seriously sick kid, one bout with cancer away from massive healthcare bills.  

 

Getting the insurance could play out two ways - either you end up really needing it, and you're grateful it's there for you.  Or you don't end up needing it - which means you're one of the lucky ones.  You win either way.

 

And given the current proposals being floated about premiums going up if there is an interruption of coverage, not to mention pre-existing condition issues, there are substantial benefits to getting health insurance for your family.

 

I never want to be in a position, if I can help it, where I cannot get the care my children, my dh, or I need to be healthy because I can't afford it.  Look at all your options, obviously, but think very seriously about the potential consequences of going without.

 

 

 

Edited June 1, 2017 by justasque

[ktgrok]

And given that you have posted about things like gymnastics and swimming and martial arts classes, I'd drop those before I'd drop insurance. 

[LucyStoner]

Health share is the functional equivalent of not having insurance when you have any behaviorial or developmental health concerns. IIRC, Janeway has more than one child on the spectrum or where she has discussed some concerns in that direction about.

 

That you are apparently opting out of most related health care for them now doesn't mean that you will always want to do so. I have two sons with ASD and for example, one of them is racking up bills now trying to get ready for the transition to high school. Also, you have mentioned other challenges that would be excluded from health shares.

 

From an ideological perspective, I refuse to give money to a health plan that flat out excludes mental health. I find that morally wrong.

Edited June 1, 2017 by LucyStoner

[heartlikealion]

I gotta admit those co-pays sound awful. I really hope you can find another solution. I don't know if everyone noticed the copay fees.

[AmandaVT]

I gotta admit those co-pays sound awful. I really hope you can find another solution. I don't know if everyone noticed the copay fees.

 

My Dr. charges $225 for a 20-minute visit. $40 doesn't sound bad, comparatively speaking. 70/30 isn't bad for insurance. It's not great - I've seen 80/20, but I've also seen 50/50 until people meet the out of pocket. All in all, it's not a premiere plan, but it's not crap either. We are currently paying more per month for less and we have to pay it post-tax, which really sucks. 

[heartlikealion]

My Dr. charges $225 for a 20-minute visit. $40 doesn't sound bad, comparatively speaking. 70/30 isn't bad for insurance. It's not great - I've seen 80/20, but I've also seen 50/50 until people meet the out of pocket. All in all, it's not a premiere plan, but it's not crap either. We are currently paying more per month for less and we have to pay it post-tax, which really sucks. 

 

$70 co-pay for specialist sounded high to me.

[wonderchica]

I pay the same copay. It does suck, but sometimes I get credits for the specialist I see regularly. I don't know why but I take it. Receptionist told me what some other ppl are paying and I felt much better.

[scholastica]

I gotta admit those co-pays sound awful. I really hope you can find another solution. I don't know if everyone noticed the copay fees.

There are plenty of plans in which copay is a percentage 20%, 30%, etc. of billed charges. That can land you with a pretty high copay.

 

So, those aren't so bad in comparison.

[creekland]

From an ideological perspective, I refuse to give money to a health plan that flat out excludes mental health. I find that morally wrong.

 

FWIW, there are two co-workers at school who have had serious mental health needs for their kids - very serious.  Each have taken out 5 figure loans and/or raided their retirement funds.  Apparently some insurances don't cover much either...  Just saying.  (Insurance covered part of hospital costs, but not much in treatment costs. It was quite the eye-opener for all of us.)

 

Otherwise, I fully agree that folks need to take many things into consideration when choosing between health share and insurance (or varieties of insurance).  What works well for one (like us with health share) wouldn't work very well at all for another.  I firmly believe everyone should have something to pay into the one pot or another so society benefits.  Well, I'm also for single payer so NO ONE has to worry about basic costs in addition to whatever medical issue they have to deal with, but that's another thread.

[LucyStoner]

FWIW, there are two co-workers at school who have had serious mental health needs for their kids - very serious. Each have taken out 5 figure loans and/or raided their retirement funds. Apparently some insurances don't cover much either... Just saying. (Insurance covered part of hospital costs, but not much in treatment costs. It was quite the eye-opener for all of us.)

 

Otherwise, I fully agree that folks need to take many things into consideration when choosing between health share and insurance (or varieties of insurance). What works well for one (like us with health share) wouldn't work very well at all for another. I firmly believe everyone should have something to pay into the one pot or another so society benefits. Well, I'm also for single payer so NO ONE has to worry about basic costs in addition to whatever medical issue they have to deal with, but that's another thread.

I live in serious developmental and behavioral/mental health land here so I know all too well the limitations.

 

That said, comprehensive medical insurance is better than not for my sons.

[vonfirmath]

I gotta admit those co-pays sound awful. I really hope you can find another solution. I don't know if everyone noticed the copay fees.

 

My own co-pay is $50. So $40 sounds cheap.

 

ER of $500 sounds about right too. Ours is a bit more complicated, but is in that range. Urgent care is $200.

 

[Mergath]

From an ideological perspective, I refuse to give money to a health plan that flat out excludes mental health. I find that morally wrong.

 

:iagree:  I've never understood the point of that. Is it a financial thing or a moral thing? Are people struggling with mental illness just not trying hard enough or something? Not praying enough?

 

I would never pay for coverage without mental health being included. Just my dh's bipolar medication is over $600 a month. After insurance, we pay more like $30. We'd be screwed if we were going through one of those health share plans.

[Alessandra]

Health share is the functional equivalent of not having insurance when you have any behaviorial or developmental health concerns. IIRC, Janeway has more than one child on the spectrum or where she has discussed some concerns in that direction about.

That you are apparently opting out of most related health care for them now doesn't mean that you will always want to do so. I have two sons with ASD and for example, one of them is racking up bills now trying to get ready for the transition to high school. Also, you have mentioned other challenges that would be excluded from health shares.

From an ideological perspective, I refuse to give money to a health plan that flat out excludes mental health. I find that morally wrong.

  

:iagree:  I've never understood the point of that. Is it a financial thing or a moral thing? Are people struggling with mental illness just not trying hard enough or something? Not praying enough?

 

I would never pay for coverage without mental health being included. Just my dh's bipolar medication is over $600 a month. After insurance, we pay more like $30. We'd be screwed if we were going through one of those health share plans.

I wanted to add another perspective. My plans (the best individual,plan in my state) includes mental health coverage.

 

For in network child psychiatrists, there are five listings for hundreds of thousands (guessing) subscribers. The five listings actually represent *two* doctors with multiple addresses. No individual plan in my state includes out of network coverage.

 

So what sounds like acceptable coverage on paper is actually skimpy coverage in practice. :-(

[Mergath]

  

I wanted to add another perspective. My plans (the best individual,plan in my state) includes mental health coverage.

 

For in network child psychiatrists, there are five listings for hundreds of thousands (guessing) subscribers. The five listings actually represent *two* doctors with multiple addresses. No individual plan in my state includes out of network coverage.

 

So what sounds like acceptable coverage on paper is actually skimpy coverage in practice. :-(

 

Exactly. Pretty much everything that can be wrong with mental health care in this country is wrong. There aren't enough providers, there isn't enough coverage, and there's a huge stigma when it comes to even seeking care. People talk about how hard it is to get those who are mentally ill to stay on their meds, but in some cases it's almost impossible to even GET the meds! My dh's psych will only prescribe a month at a time and requires his approval for every refill, which is fine except that sometimes it takes forever for him to okay the refill because he's so, so busy. And good luck actually finding someone who can do CBT. And getting it covered by insurance.

 

:rant:

 

[scholastica]

Health share is the functional equivalent of not having insurance when you have any behaviorial or developmental health concerns. IIRC, Janeway has more than one child on the spectrum or where she has discussed some concerns in that direction about.

 

That you are apparently opting out of most related health care for them now doesn't mean that you will always want to do so. I have two sons with ASD and for example, one of them is racking up bills now trying to get ready for the transition to high school. Also, you have mentioned other challenges that would be excluded from health shares.

 

From an ideological perspective, I refuse to give money to a health plan that flat out excludes mental health. I find that morally wrong.

Well, under ACA, plans are required to cover it. I'm wondering how long that rule will stay in place.

[FaithManor]

$70 co-pay for specialist sounded high to me.

We pay $100.00 for a specialist, $40.00 for a GP, PA, or NP.

[EMS83]

Yep, but we've been skipping insurance for going on 4 years now.  

[LucyStoner]

  

I wanted to add another perspective. My plans (the best individual,plan in my state) includes mental health coverage.

 

For in network child psychiatrists, there are five listings for hundreds of thousands (guessing) subscribers. The five listings actually represent *two* doctors with multiple addresses. No individual plan in my state includes out of network coverage.

 

So what sounds like acceptable coverage on paper is actually skimpy coverage in practice. :-(

 

My state enacted mental health parity laws before the ACA.  

 

We do not have a dearth of mental health care providers for all ages and specialties who take at least one of the leading insurance plans here. We are fortunate in this regards.  

 

Unfortunately, people living in rural areas have far less access than is ideal.  As a family, we can't move more than driving distance from the urban core here.  

 

I would like to see universal coverage with steep incentives for providers to set up their practices in underserved rural areas.  Pipe dreams, but I think we should do better than we are now.  Health shares that exclude mental health care are part of the problem and not the solution.  

Edited June 2, 2017 by LucyStoner

[Alessandra]

My state enacted mental health parity laws before the ACA.

 

We do not have a dearth of mental health care providers for all ages and specialties who take at least one of the leading insurance plans here. We are fortunate in this regards.

 

Unfortunately, people living in rural areas have far less access than is ideal. As a family, we can't move more than driving distance from the urban core here.

 

I would like to see universal coverage with steep incentives for providers to set up their practices in underserved rural areas. Pipe dreams, but I think we should do better than we are now. Health shares that exclude mental health care are part of the problem and not the solution.

I am in a suburban area with loads of doctors and hospitals. The trouble is that the plans available to individuals face so much pressure to keep rates low that they control benefits ever more tightly. For, example, the major carrier divided its own network of doctors and hospitals into two tiers. As with drugs, tier 2 has higher rates. So it looks as though the plan is good, until you realize that every single specialist you see is in tier 2.

 

Our state has long had good rules about mental health and other types of coverage, but regulations don't specify how many doctors have to be available to subscribers. It's a becoming a bit like Medicaid -- coverage, but no doctors.

[JanetC]

In the OPs original post her insurance for that $300K situation you listed would still cost $17,200 + $90K (the 30% co pay part). That's already financial disaster for most people I know.

BTDT. Health plans generally have a maximum out of pocket after which they pay 100%.

[solascriptura]

This is a case about the lesser of two evils. I would get the insurance.

[LadyR]

 

Generally the insurance companies negotiate a rate for their customers, which is lower than a cash payment.

 

We no longer have health insurance (we belong to a health sharing ministry) and have found that our doctor visits and tests are either the same as when we had insurance or they are greatly reduced.  My son recently visited a specialist.  They told us that the charge would have been $500 for the visit if we had insurance, but because we were cash payers we were charged just $80.  For blood work, the bill came to $1200 but was discounted to just over $200 because we were cash payers.

[Hikin' Mama]

No, I would not. I had a pretty minor thing last summer, a broken leg requiring surgery. My total bills were 26K for the ER and same day surgery. I ended up paying a little more than 7500, which is my deductible, because the ins. company negotiated the original amounts down to that. When I called the hospital to inquire about why my original ER bill was so high ($5500), they told me not to worry, my ins. co. would negotiate and knock it down. When I asked them if people without insurance would have to pay the whole amount, they said yes. I told them that was crazy! (The ER bill in my opinion was ridiculous. It seemed like alot of double charging to me. I went through it charge by charge with them.) There's only a discount if you pay right away, but it's very small compared to what the discount after insurance negotiation is. The surgery center told me they offered no discount for cash pay and if you didn't have insurance, you would have to pay the full amount.

 

I've known people with MUCH larger medical issues who were very happy to have the insurance once the unexpected happened. Key word being unexpected.