Gambling on health insurance

[puglogic]

Talking with a friend who had opted for high-deductible, low-premium health insurance, and is now regretting it because she's battling cancer and her savings are being decimated.

For those of you fortunate enough to have health insurance, did you choose the cheapest policy, or the cadillac policy? What sort of coverage? (70/30, 80/20 etc) What were the reasons behind your choice? And if you went "cheap" (as much as any of them are....) do you have the deductible banked in case you needed it?

[Spartana]

I went to a high deductible plan after my cadilac cobra plan I continued after quitting work expired. The max out of pocket was only $4000 annual besides low co-pays and which I could cover easily. And the premiums were much, much lower than my cobra was. I also had use of the VA hospital since I am a disabled military veteran. So always had that to fall back on.

[ApatheticNoMore]

I have an expensive plan ($300 month) with a deductable (3k in network, 6k out of network - but of course this excludes basic preventive care which is covered) and it's employer provided -> seems the worst of all worlds to me, what kind of horrible plan do I have? :\

But I went with the PPO over the much cheaper HMO because I had fears of say ending up hospitalized and having medical people come into see me in that condition that were not in the HMO network (whereas the PPO even caps out of network at the high cap mentioned). Plus the HMO network said they didn't cover out of state, so I had fears of getting sick on vacation or something even though I'm usually in state. I have no idea whether this is worth it at all.

I could cover the deductable (and it would thrill me - well no not really). I'm insuring against medical *bankruptcy* is how I see it which is why I like having hard caps on expenditures ... or at least I hope I am :\

Most medical bankruptcies are people who HAVE insurance - that's what I hear and that always troubles me - makes me scared having to make insurance choices.

[catherine]

After we evaluated out options (higher price, but lower deductible vs. lower price/higher deductible) we realized that at the end of the day, we'd most likely net out about the same. So we went with lower monthly cost. Yeah, that high deductible is no fun, but if the monthly premium were higher, we'd have no choice anyway.

I skipped 5 years of going to the doctor, so it worked out better for me, because I didn't have to pay the high deductible. This year I loaded up on tests and after the results all came back fine, I told my doctor I was good for another 5 years.. not sure he agrees with me, but as long as I'm healthy, I'll knock on wood that I don't have to max out the deductible.

[Florence]

Our system of insurance is just flat out insane. IMHO. :(

[redfox]

Pug, your friend & I have the same insurance woes, except I am in treatment, not a battle at this point. Just cashed out my meagre retirement to pay bills... so, I am looking at nearly any job that has full coverage. I have an option on the drawing board for January, half my usual wage, but full med benes. I hope it firms up! It would be a fun, not super responsible job fundraising for a theatre I like & working for a former colleague & friend.

My out-of-pocket, stop-loss, & premiums add up to 20K per year. No, I did not have that in savings! I gambled, and I lost financially. I sure wish I had had the foresight to change my policy BEFORE seeing my MD when I noticed symptoms. Ah well. My hindsight: get as much as you can possibly afford, because a major diagnosis is freaking expensive.

And, yeah. What Florence said!

[try2bfrugal]

Our COBRA and HIPAA policies are / will be over 2K a month. At least the COBRA policy included things like dental, vision, hearing and mental health. The HIPAA doesn't even have all of that. And that doesn't even include co-pays and deductibles. They are what we can get for guaranteed coverage at our ages.

The out of pocket max on the HIPAA will be $7.5K but I don't know if that include the deductibles.

With exchange insurance from the affordable care act, in January we will be paying much less.

[try2bfrugal]

Pug, your friend & I have the same insurance woes, except I am in treatment, not a battle at this point. Just cashed out my meagre retirement to pay bills... so, I am looking at nearly any job that has full coverage. I have an option on the drawing board for January, half my usual wage, but full med benes. I hope it firms up! It would be a fun, not super responsible job fundraising for a theatre I like & working for a former colleague & friend.

My out-of-pocket, stop-loss, & premiums add up to 20K per year. No, I did not have that in savings! I gambled, and I lost financially. I sure wish I had had the foresight to change my policy BEFORE seeing my MD when I noticed symptoms. Ah well. My hindsight: get as much as you can possibly afford, because a major diagnosis is freaking expensive.

And, yeah. What Florence said!

Redfox, if you have coverage at work can you switch your insurance plan open enrollment time or get more affordable coverage through the health exchange insurance in January, 2014? The health insurance exchange plans will have caps based on income for out of pocket max contributions as well as premiums.

[redfox]

Redfox, if you have coverage at work can you switch your insurance plan open enrollment time or get more affordable coverage through the health exchange insurance in January, 2014? The health insurance exchange plans will have caps based on income for out of pocket max contributions as well as premiums.

THAT is a question I am trying to answer!

[try2bfrugal]

THAT is a question I am trying to answer!

Another option to explore if either you or your husband are not working full time now is to start a business. All states have guaranteed issue coverage for businesses with either one or two employees, depending on the state. I do not know what kind of policies you would have available in your state or if that would be better coverage. Usually your business can be something simple like reselling items on eBay or pet sitting. In California it has to be your primary occupation and you have to work a certain number of hours a week at it. You could ask at ehealthinsurance.com or a local insurance agent that sells small business policies.

It might be something worth exploring for insurance with pre-existing conditions. We would have gone this route if not for the Affordable Care Act. But we would have had to restructure our businesses to qualify, so for now we are just paying the COBRA / HIPAA premiums until January when we should be able to get health insurance on the exchanges.

[Zoebird]

We were high deductible before moving here (universal health care). Just before we had our son, we went to the company to move to their other plan, and they wouldn't let us switch. Once you choose, they said, you can't switch. This was NOT what they said when we initially chose. We knew it was a few years before we would ahve a kid, and we wanted to put that money by. I asked specifically if we could change later, and they said yes at the time. But, of course, their "policy" for that had changed in that couple of years. This meant we needed to save up more money in case there was something that the baby would need.

Luckily, he didn't need anything. And, we went out of network besides, paying out over $1k to a doctor for our family's medical care over the course of the year. And, we properly filed all the forms to get that money back (which was only a percentage of what we put in), but of course they had to "approve" of it -- and well, you can guess, we haven't seen that money.

I think it's an absolute racket -- the way that health care is run in the US. And, I think it drives up medical costs, to be honest.

Anyway, nwo that we are in a universal coverage, i feel much more secure in terms of social safety net, and I also just added health insurance to our insurance policies (we updated car, home/rental, the business, disability, liability, and added medical). This is basically a co-pay, no-deductible plan. It's meant to cover any costs that the national health care system wouldn't cover. It's an additional $27 per month on our insurance payment. We still pay under $200/mo for all of our insurance coverage.

And while there is always something to complain about, we've never had any trouble with ACC.

[redfox]

Another option to explore if either you or your husband are not working full time now is to start a business. All states have guaranteed issue coverage for businesses with either one or two employees, depending on the state. I do not know what kind of policies you would have available in your state or if that would be better coverage. Usually your business can be something simple like reselling items on eBay or pet sitting. In California it has to be your primary occupation and you have to work a certain number of hours a week at it. You could ask at ehealthinsurance.com or a local insurance agent that sells small business policies.

It might be something worth exploring for insurance with pre-existing conditions. We would have gone this route if not for the Affordable Care Act. But we would have had to restructure our businesses to qualify, so for now we are just paying the COBRA / HIPAA premiums until January when we should be able to get health insurance on the exchanges.

Thanks, Frugal! I did not know this, and will look into it. Both of us have a business; I am a consultant, and dutifully file my state & local tax returns. My husband has a photography side gig, and likewise files his. One of the sticking points for me is that I love my HMO. I don't know many folks who can say that. I have been with them under various payments structures for over 20 years, and have great relationships with my care providers. I don't want to leave this system. I really appreciate the tips here. Still wishing for a single payer system...

[ApatheticNoMore]

I guess the 3k in network and 6k out of network i mentioned is not actually a deductible but an out of pocket maximum. The deductible may be more like 1k and they do pay for ordinary doctor's visits (except for the copay). Anyway it seems my insurance plan is one of the worsts the company could have picked, $300 a month for me, employer contributing about as much or more, and I could be out the 3 and 6k if I actually needed major medical care. Horrible plan. I just hope I'm avoiding bankruptcy.