Affordable medical insurance

[mastermind238]

Originally Posted by Yssup Rider

You're doing the right thing, mm. Catastrophic with an HSA. That's what I recommended at the top of this thread.

I'm stuck in a situation from which I can't escape from for another couple of years and, as a self-employed businessman, with a family load of pre-existings, it's virtually impossible to switch plans. In fact, we've been told as much.

Yeah, I guessed there were some pre-existing conditions that jacked up your premium, but I didn't want to speculate. My condolences. They've got you by the short hairs.

[Yssup Rider]

Originally Posted by mastermind238

Yeah, I guessed there were some pre-existing conditions that jacked up your premium, but I didn't want to speculate. My condolences. They've got you by the short hairs.

I have no short hairs left! I work for the fucking insurance companies!

[tige1979]

I hope I can find something a little cheaper but I doubt it. thanks for the help everyone

[WyldemanATX]

OK I give up move to Canada. Do not let the door hit ya were the good Lord split ya...

[Yssup Rider]

OK I give up move to Canada. Do not let the door hit ya were the good Lord split ya...

No need to be rude about it. -- sigh --

For a lot of people, moving out of the US has been a solution. I know people who have retired to Mexico as well as Canada. However, things would REALLY have to be fucked up to make me leave Texas again!

[Natalie Reign]

Originally Posted by mastermind238

So that's roughly $35,000/year you're laying out for premiums and the deductible (12 x $2500 + $5000). Really? My employer's BC/BS plan costs only about $18k/year/employee.

Individual or self-employed plans are traditionally more expensive than small or large-group employer plans because the insurers count on a few "healthy" people offsetting the cost of every one person who requires an excessive amount of medical care. With an individual plan, it's less likely that the insurer will recoup the cost of doctor's visits, prescriptions, etc. through the member's monthly premiums and deductible alone. Thus the prevalence of pre-existing conditions exclusions and the like on individual plans.

Originally Posted by mastermind238

Obviously I don't know your circumstances so I can't say why you'd be paying $30K/year in premiums.

For a self-employed person, it really doesn't take much to hit $30-$35K a year in medical expenses. While the number is hard to swallow, it's not difficult to see how a family could pay that much, especially if they require extensive coverage.

I'm a relatively healthy person with two chronic conditions (asthma and allergies) that are never covered by individual insurance due to the infamous preexisting conditions exclusion. Prescription medications for those two conditions alone run about $500/month. Throw in birth control, and the occasional antibiotic or steroid medication, and I spend an average of $600/month on prescriptions alone ($7200 annually). In the past year, I've had 3 ER visits - two for acute asthma attacks (not covered, again due to it being a preexisting condition), and one following an accident - totaling $19,000 in out-of-pocket expenses. Periodic doctor's visits, women's health visits, monthly testing, plus my monthly premiums of around $180, and I'm easily at $30K/year in medical and healthcare expenses. Unfortunately, I'm not an unusual case.

OP, I would try requesting a quote on ehealthinsurance.com If you need to add additional coverage for you or a family member, like optional prescription coverage, dental, vision, maternity coverage, etc., I believe Scott & White is the only local insurer currently offering all of those options, and it's an HMO with dedicated facilities.

[Datura]

Originally Posted by Yssup Rider

That, sir, is utter BS. For a broken bone? REALLY? I've got a ton of family in Canada. They tell it differently, amigo. They bitch and moan -- but not like we do.

Where on earth are you coming up with this?

I'm with Yssup on this matter. I've had several Canadian SOs and have lived in Montreal. This has not been my experience, EVER, esp in regards to emergency or acute care needs.

I'd give my eyeteeth to have access to medical care such as Canada has... I have many loved ones in both MTL and Vancouver who have no complaints whatsoever.

[tige1979]

Thank you Natalie.

[Guest040616]

Over the course of the past 15 years or so, I have worked closely with dozens of Canadian citizens on several different projects, both in the US and in Canada. I have yet to hear one of those Canadians who would trade their government sponsored single payer system for our insurance based clusterfuck! To a person, they believe all of the American misinformation about their health care system is comical!

[conservative44]

Tige, if 1979 is your birth year and you don't have any pre-existing conditions, try Unicare. I had a plan with them several years ago when I would have been your age and was barely paying over $100/month for a HIGH deductible plan. If you're married, just kill yourself because women our age are expensive to cover.

[Yssup Rider]

Originally Posted by bigtex

To a person, they believe all of the American misinformation about their health care system is comical!

That's kinda the way I hear it, Bigtex. Obviously we haven't spoken to too many displaced nurses...

[Guest040616]

Originally Posted by Yssup Rider

That's kinda the way I hear it, Bigtex. Obviously we haven't spoken to too many displaced nurses...

I am not so sure that it was "displaced nurses" who were speaking. More than likely, it was FAUX News!

[mastermind238]

Originally Posted by Natalie Reign

Individual or self-employed plans are traditionally more expensive than small or large-group employer plans because the insurers count on a few "healthy" people offsetting the cost of every one person who requires an excessive amount of medical care. With an individual plan, it's less likely that the insurer will recoup the cost of doctor's visits, prescriptions, etc. through the member's monthly premiums and deductible alone. Thus the prevalence of pre-existing conditions exclusions and the like on individual plans.

This is a myth. An individual plan will be priced based on the circumstances of the individual being covered. The "group" he/she belongs to is the mass of insureds who are NOT in a group defined by an employer. The insurance company is still spreading the risk, just over a different group. The insurance market is still competitive for individuals, but not nearly as competitive as it could be if we could get mindless mandates removed (do you really need to cover sex change operations?) and allow competition across state lines.

There are cost savings associated with insuring employees of companies - big or small - and these do tend to be reflected in the lower premiums. They are small and mostly administrative, having to do with such things as sending one bill to cover 100 employees vs sending 100 bills to 100 individuals. Allstate can still extract the same price concessions for your medications at Walgreens and your physicians at ARC whether you are on an individual plan or a company group plan. It's the insurance company that has the buying power with the drug companies and the physician groups, not the company you work for that's buying the insurance contract (unless, perhaps, you work for a behemoth like IBM).

In a group plan at a company, premiums must be uniform, so they are averaged over the population being covered. If you're young and healthy you're still likely to get hosed on the premium. You will pay the same premium that Betty, the aged receptionist with congestive heart failure, pays. The fact is that any individual is likely to find his/her premium higher or lower than the "average" premium being charged in a company group plan - depending entirely on individual circumstances.

For all of you agitating for a single-payer, government-run plan, all I can say is HELL NO. In such a system I end up paying for Betty's heart transplant, even though I had nothing to do with her life-long smoking habit that led to her heart failure. And I end up paying for Mike/Michelle's sex change operation, even though I had nothing to do with whatever the hell it is that causes people to do that. Sorry, but none of that is my responsibility. There's enough moral hazard out there already in the tax-based and unsustainable Medicare and Medicaid system we have.

And one final note on pre-existing conditions. Health insurance is insurance. We're not talking about pre-paid health care delivery. That was the basis of the "HMO revolution" that hasn't worked out so well. Why would anyone walk into an insurance company office, knowing in advance that his/her healthcare costs $1000/month, and expect that insurance company to charge less than that in premiums? Anyone who does that isn't looking for insurance. They're looking for charity. Or to use a more PC term, they're looking for "cost-shifting" - they're looking for someone else to pick up part of the cost. My heart goes out to anyone in such a situation, especially if it's through no fault of their own. But to force me to subsidize, through higher premiums on my policy, the cost of a condition you developed before you thought to buy an insurance policy yourself, is just unethical. The only role for govenment in this mess is in prohibiting the insurance company from dropping you after you develop a chronic condition that will be expensive to treat. Such attempts by the insurance company to avoid responsibility for payment as specified in their policy are also unethical.

The best anyone can do is shop around for a plan with only the coverage they need. There's one out there. You may experience sticker-shock, but that'll be mostly because you don't have an employer willing to subsidize your premiums. And just keep reminding yourself that you're buying a policy to spread the risk against future, unexpected, catastrophic loses. You're not buying pre-paid healthcare.

[tige1979]

Originally Posted by conservative44

Tige, if 1979 is your birth year and you don't have any pre-existing conditions, try Unicare. I had a plan with them several years ago when I would have been your age and was barely paying over $100/month for a HIGH deductible plan. If you're married, just kill yourself because women our age are expensive to cover.

Yea unfortunately it is more than myself, and like a dumbass my wife is older.. I guess it's time to trade in for a younger model.

[Yssup Rider]

Originally Posted by mastermind238

This is a myth. An individual plan will be priced based on the circumstances of the individual being covered. The "group" he/she belongs to is the mass of insureds who are NOT in a group defined by an employer. The insurance company is still spreading the risk, just over a different group. The insurance market is still competitive for individuals, but not nearly as competitive as it could be if we could get mindless mandates removed (do you really need to cover sex change operations?) and allow competition across state lines.

There are cost savings associated with insuring employees of companies - big or small - and these do tend to be reflected in the lower premiums. They are small and mostly administrative, having to do with such things as sending one bill to cover 100 employees vs sending 100 bills to 100 individuals. Allstate can still extract the same price concessions for your medications at Walgreens and your physicians at ARC whether you are on an individual plan or a company group plan. It's the insurance company that has the buying power with the drug companies and the physician groups, not the company you work for that's buying the insurance contract (unless, perhaps, you work for a behemoth like IBM).

In a group plan at a company, premiums must be uniform, so they are averaged over the population being covered. If you're young and healthy you're still likely to get hosed on the premium. You will pay the same premium that Betty, the aged receptionist with congestive heart failure, pays. The fact is that any individual is likely to find his/her premium higher or lower than the "average" premium being charged in a company group plan - depending entirely on individual circumstances.

For all of you agitating for a single-payer, government-run plan, all I can say is HELL NO. In such a system I end up paying for Betty's heart transplant, even though I had nothing to do with her life-long smoking habit that led to her heart failure. And I end up paying for Mike/Michelle's sex change operation, even though I had nothing to do with whatever the hell it is that causes people to do that. Sorry, but none of that is my responsibility. There's enough moral hazard out there already in the tax-based and unsustainable Medicare and Medicaid system we have.

And one final note on pre-existing conditions. Health insurance is insurance. We're not talking about pre-paid health care delivery. That was the basis of the "HMO revolution" that hasn't worked out so well. Why would anyone walk into an insurance company office, knowing in advance that his/her healthcare costs $1000/month, and expect that insurance company to charge less than that in premiums? Anyone who does that isn't looking for insurance. They're looking for charity. Or to use a more PC term, they're looking for "cost-shifting" - they're looking for someone else to pick up part of the cost. My heart goes out to anyone in such a situation, especially if it's through no fault of their own. But to force me to subsidize, through higher premiums on my policy, the cost of a condition you developed before you thought to buy an insurance policy yourself, is just unethical. The only role for govenment in this mess is in prohibiting the insurance company from dropping you after you develop a chronic condition that will be expensive to treat. Such attempts by the insurance company to avoid responsibility for payment as specified in their policy are also unethical.

The best anyone can do is shop around for a plan with only the coverage they need. There's one out there. You may experience sticker-shock, but that'll be mostly because you don't have an employer willing to subsidize your premiums. And just keep reminding yourself that you're buying a policy to spread the risk against future, unexpected, catastrophic loses. You're not buying pre-paid healthcare.

What you haven't mentioned, mm, is that virtually all large employers -- even mid-sized ones now -- are SELF INSURED. The insurance companies charge a hefty fee to administer their clients' health plans but are NOT in charge of them. What they will and won't cover/pay/charge is by and large determined by the employer.

Different large employers keep the costs under control in different ways... like wellness programs, patient-centered primary care programs, alternative delivery models, etc. And some of these people have discovered tremendous cost savings through increased patient/employer responsibility.

What am I trying to say? (Wish I knew)

The notion that the health care industry is run by insurance companies is also a myth. If you're covered by a company plan, it's your company that's in charge, not the insurance company.

If you're on your own, chances are you're fuckee fuckeed.