Health Insurance Plans:

[Daseal]

Hey guys,

I'm going to be buying a personal insurance policy shortly, problem is -- I'm totally clueless what's important and what isn't. Im not looking for anything really fancy, just something that will cover medicine, doctors visits, broken bones/etc. I got some quotes and from what I understood, the insurance only kicked in once I spent X amount, typically 5000, 3500 or 2500 dollars. Does that even count towards Dr. visits?

I know I didn't give you much to work with, but any help would be appreciated!

[FRPLG]

Originally Posted by Daseal

Hey guys,

I'm going to be buying a personal insurance policy shortly, problem is -- I'm totally clueless what's important and what isn't. Im not looking for anything really fancy, just something that will cover medicine, doctors visits, broken bones/etc. I got some quotes and from what I understood, the insurance only kicked in once I spent X amount, typically 5000, 3500 or 2500 dollars. Does that even count towards Dr. visits?

I know I didn't give you much to work with, but any help would be appreciated!

For it to be affordable you'll have the deductible which means everything that is covered in the policy you'll have to pay for up to certain amount before they actually start paying for it. Everything. Now they may have some wellness clauses that will cover a wellness exam short of the deductible but maybe not.

[Schneed10]

Originally Posted by FRPLG

For it to be affordable you'll have the deductible which means everything that is covered in the policy you'll have to pay for up to certain amount before they actually start paying for it. Everything. Now they may have some wellness clauses that will cover a wellness exam short of the deductible but maybe not.

Yeah this is about right.

When you're employed and are covered through your employer, to get really good coverage with low deductibles/copays, the employer ends up spending like $7000 a year on you, with you kicking in something like $2000 in payroll deductions, combining for a cost of $9000 (rough numbers). And the only reason it's not more than that is because your employer would have negotiated lower rates, promising to bring lots of employees into the plan.

For an individual buying insurance like you're doing, you lose that negotiating power and would have to pay even more for that same great coverage, it would end up being much more than $9000.

Since hardly anybody can afford to pay $9000 for health insurance all by themselves, you have to look at high deductible plans like you're doing. The goal of these plans is just to avoid the potential financial disaster:

- You get in a car accident and need multiple orthopedic surgeries and countless hours of rehab.

- You come down with diabetes which eventually leads to kidney failure, resulting in countless hours of dialysis and ultimately a kidney transplant procedure.

- You get hit with cancer and have to pay out the nose for very expensive chemo treatments.

All you're doing is paying for the peace of mind to know that your financial life won't be ruined if something like this happens. The plan won't cost too much, but you'll have to front the cost of routine out-of-pocket care like physician office visits, medicines, psychiatric/psychological therapy, etcetera. It's not designed as something to take away the need for you to pay for routine care, it's just a safety net for the most dreaded of circumstances.

You'll want that. If you did get hit by a bus, the last thing you want to worry about is how you're going to pay off the debt from the hospital bills. Better to focus on healing and walking again.

[mredskins]

I would get something that covered like major issues, like heart attack or something big like that. I am assuming you are young and insurance providers will give you some kind of premuim for that.

When I was younger and bartended in Hilton Head for a year I had no health insurance through my employer so I did the above. I actually went to Urgent Care twice, once for a virus posioning (apperently you can not eat raw oysters by the dozen for a week straight) and the second time was for a sprain in my ankle. Each time my insurance didn't cover it but it was only like $125 a visit.

It is a risky way to go but if you know it is just temporary and you are in decent health you can pull it off for a short time.

Now with that said not to scare you but my buddy once got low potissuim (sp) and slipped into a coma with no health insurance. He told me as soon as they load him into the helicoptor he should have started filing for bankruptacy. His bills were like $200k, it was crazy.

[firstdown]

My current plan is $740.00 per month for very good coverage (family of 3) and we just pay like $20 co pays when we go to the doctor. I'm switching to a health savings plan which has a highe ded. like 2500 and has some tax advantages. The premium is much lower and the idea is you take the money your saving and put that into a savings plan to pay for the small stuff and this also goes toward meeting your ded. The good part is if you don't rack up alot of small bills then this savings acount keeps growing and then you have plenty of money to cover the higher ded in the savings account. Here is a link that explains them better just ignore the sales stuff.

[FRPLG]

Originally Posted by firstdown

My current plan is $740.00 per month for very good coverage (family of 3) and we just pay like $20 co pays when we go to the doctor. I'm switching to a health savings plan which has a highe ded. like 2500 and has some tax advantages. The premium is much lower and the idea is you take the money your saving and put that into a savings plan to pay for the small stuff and this also goes toward meeting your ded. The good part is if you don't rack up alot of small bills then this savings acount keeps growing and then you have plenty of money to cover the higher ded in the savings account. Here is a link that explains them better just ignore the sales stuff.

These are great ideas I think. My wife's company went to something somewhat similar. They went to a high deductible plan which cut their premiums in half. The deductible went to $2000 but the kicker is that her company then provides her a benefit card that pays for the first $1300. So if she doesn't go much to the doctor then we never pay a dime out of pocket outside of the much lower premiums and her company saves money by paying lower premiums on their side plus a little bit of the deductible. If she ends up with a long hospital stay then the $700+premiums we end up covering basically breaks even with the amount of the old premiums.


It doesn't have any savings to it but the concept is the same. When people go to the doctor less then everyone, including her company, saves money and the 1300 deductible coverage takes most of the "bad" motivation away from employees.

"Bad" = never going to the doctor, just to save money, and then getting really sick and costing more in the long run.

[Schneed10]

Originally Posted by FRPLG

These are great ideas I think. My wife's company went to something somewhat similar. They went to a high deductible plan which cut their premiums in half. The deductible went to $2000 but the kicker is that her company then provides her a benefit card that pays for the first $1300. So if she doesn't go much to the doctor then we never pay a dime out of pocket outside of the much lower premiums and her company saves money by paying lower premiums on their side plus a little bit of the deductible. If she ends up with a long hospital stay then the $700+premiums we end up covering basically breaks even with the amount of the old premiums.


It doesn't have any savings to it but the concept is the same. When people go to the doctor less then everyone, including her company, saves money and the 1300 deductible coverage takes most of the "bad" motivation away from employees.

"Bad" = never going to the doctor, just to save money, and then getting really sick and costing more in the long run.

These are good plans because they put a financial incentive in the hands of the patient. Some people run off to the doctor to get antibiotics for every sinus infection that comes along. They figure hey, my copay is only $15, it's worth it. Meanwhile the insurance company is reimbursing the physician $125 every time, and paying for antibiotics each time. But with these plans, the patient has to think about whether it's worth it. Maybe that sinus infection isn't worth the $125 to fix it, given that it will go away on its own eventually.

It makes intuitive sense. If you stay healthy, you pay less. If you don't, you pay more, but not so much that would financially cripple you.

Now, it's still important to get to the doctor when something's not right. If you know it's a sinus infection that's one thing, but acute pain in your abdomen shouldn't be ignored. So paying $125 out of pocket shouldn't stop you from erring on the side of caution.

In the end, that comes down to managing your money right. If you're saving money because you're paying lower premiums, then you have to keep that money around in case you need it. Some people love to spend whatever is available to them, which is of course retarded given that you'll need $125 around for a sick visit on occasion.

That's where those HSA debit cards come in really handy.

[MTK]

Originally Posted by firstdown

My current plan is $740.00 per month for very good coverage (family of 3) and we just pay like $20 co pays when we go to the doctor. I'm switching to a health savings plan which has a highe ded. like 2500 and has some tax advantages. The premium is much lower and the idea is you take the money your saving and put that into a savings plan to pay for the small stuff and this also goes toward meeting your ded. The good part is if you don't rack up alot of small bills then this savings acount keeps growing and then you have plenty of money to cover the higher ded in the savings account. Here is a link that explains them better just ignore the sales stuff.

Good link

[GhettoDogAllStars]

I was on a Blue Cross Blue Shield personal policy a couple years ago. It started at $89 per month, and steadily went up to $110 per month.

I'm on a high-deductible HSA plan with my employer now, and I'm totally satisfied. I put $55 a month into my HSA and my employer puts in $1125 at the beginning of each year. All the money goes in before taxes, and as long as it's used on medical services it isn't taxed ever. I have a debit card to access my HSA funds, and when I exceed the deductible ($2250) the insurance kicks in. Good for people who don't go to the doctor unless it's serious. Also good for pregnancies -- a delivery of octoplets would only cost you $2250!

[firstdown]

Originally Posted by GhettoDogAllStars

I was on a Blue Cross Blue Shield personal policy a couple years ago. It started at $89 per month, and steadily went up to $110 per month.

I'm on a high-deductible HSA plan with my employer now, and I'm totally satisfied. I put $55 a month into my HSA and my employer puts in $1125 at the beginning of each year. All the money goes in before taxes, and as long as it's used on medical services it isn't taxed ever. I have a debit card to access my HSA funds, and when I exceed the deductible ($2250) the insurance kicks in. Good for people who don't go to the doctor unless it's serious. Also good for pregnancies -- a delivery of octoplets would only cost you $2250!

Not sure if they have changed but 5 years ago when we first looked at a the Heath Savings Plan they did not cover prehnancies and that why we went with an HMO type policy. Now that we have had a child and our current premium has jumped we are now looking at one of those ploicies.

[GhettoDogAllStars]

Originally Posted by firstdown

Not sure if they have changed but 5 years ago when we first looked at a the Heath Savings Plan they did not cover prehnancies and that why we went with an HMO type policy. Now that we have had a child and our current premium has jumped we are now looking at one of those ploicies.

I haven't had any children, but recently a couple guys I work with have. They have said they only had to cover their deductible.

You bring up a good point though, which is to be sure the policy will cover what you need. However, if it doesn't, with an HSA you (should) always have money in savings to pay for medical services regardless.

I work with a progressive guy, who doesn't care much for modern medicine. He goes the holistic route, and has money in savings to cover those services -- ones not covered by most insurance. Here is gets kinda tricky though, because while his payments for holistic services won't be taxed (since it's a medical expense), I'm not sure if the policy will allow him to use those expenses towards his deductible (so that when he exceeds it, the insurance will kick in). I guess the bottom line is to be thorough and check out everything.

The best thing about HSAs is that you're saving your money pre-tax, and if you never make a claim, the money is yours to spend however you want (with a big tax hit for non-medical). In the case of traditional insurance, if you never make a claim, all the premiums you've paid have essentially been money lost.

[FRPLG]

Originally Posted by GhettoDogAllStars

I was on a Blue Cross Blue Shield personal policy a couple years ago. It started at $89 per month, and steadily went up to $110 per month.

I'm on a high-deductible HSA plan with my employer now, and I'm totally satisfied. I put $55 a month into my HSA and my employer puts in $1125 at the beginning of each year. All the money goes in before taxes, and as long as it's used on medical services it isn't taxed ever. I have a debit card to access my HSA funds, and when I exceed the deductible ($2250) the insurance kicks in. Good for people who don't go to the doctor unless it's serious. Also good for pregnancies -- a delivery of octoplets would only cost you $2250!

When my wife had our first kid it cost us $10.00. I always thought that didn't seem right. Especially when she had an emergency c-section and then stayed in the hospital for 5 days. On top of that my kid was in the NICU for 2 1/2 weeks and we never spent a dime on it. All in all the pregnancy probably cost north of 100K but we paid $10.00.

[GhettoDogAllStars]

Originally Posted by FRPLG

When my wife had our first kid it cost us $10.00. I always thought that didn't seem right. Especially when she had an emergency c-section and then stayed in the hospital for 5 days. On top of that my kid was in the NICU for 2 1/2 weeks and we never spent a dime on it. All in all the pregnancy probably cost north of 100K but we paid $10.00.

$10 is your hospital copay? Damn!

[FRPLG]

Originally Posted by GhettoDogAllStars

$10 is your hospital copay? Damn!

For pregnancies usually Dr's offices do universal billing. If you go to a Dr. affiliated with the hospital it is all covered.

[CRedskinsRule]

Originally Posted by FRPLG

When my wife had our first kid it cost us $10.00. I always thought that didn't seem right. Especially when she had an emergency c-section and then stayed in the hospital for 5 days. On top of that my kid was in the NICU for 2 1/2 weeks and we never spent a dime on it. All in all the pregnancy probably cost north of 100K but we paid $10.00.

My first son was born in Colorado, was in NICU, had to have a specialist brought in. Turned out, he was the only one in the area, but he wasn't on our plan. After literally years with the insurance commissioner involved, we got most of it covered, but still had about $5000 dollars worth of out of pocket.