Hi all. I am interested in acquiring medical insurance for my family. Until now I have been “self insured” paying out of pocket for visits.
I have a number of quotes, the most affordable being $531 per month. It offers a 2500/5000 deductible and then 80% coverage with a 2000/4000 maximum out of pocket expense, followed by 100% coverage with a 2.5 mil max. So, over the course of one year, before I can get any coverage for needs above the standard office visit (and based on family max usage) I would pay $6,372.00 in premiums per year and $5,000.00 in deductibles before I received the 80% coverage. Then another $4,000.00 before 100% coverage kicks in.
Therefore, it will cost me $11,372.00 before any coverage kicks in for non-office visits. then an additional 4k for a total of $15,372.00 before complete coverage occurs.
Barring any major catastrophes, I would be better off to save the $11,372 per year and keep paying for regular visits.
BTW, the plan I am outlining includes a 25% copay by me for office visits.
Any advice or insight would be appreciated… or suggestions for a better way, short of quit working and go on welfare to get 100% free coverage with no co-pays.
<!—-> <!—-><!—->
I refuse to accept that there are limitations to what we can accomplish. Pete Draganic
Take life as a test and shoot for a better score each day. Matt Garcia
Replies
Salting away the premium amount each month, quarter, or year is a great plan as long as:
1 - you actually do it
2 - you don't get hit by something catastrophic before you build up enough to cover it.
3 - you're willing to pay "full price" for your medical care.
SWMBO and I signed up with MEGA five years ago after we both got laid off and started our own business. Shortly afterward, she developed a chronic pain condition that has resulted in ~$60k - $70k in medical bills over the last four+ years. The MEGA policy isn't the greatest plan, but our out-of-pocket costs are in the $30k range.
I learned the hard way how poor the MEGA ins really is.
Welcome to the Taunton University of Knowledge FHB Campus at Breaktime. where ... Excellence is its own reward!
Yeah, we tried to find something else a couple of years ago, but SWMBO's "pre-existing conditions" pretty well shot that plan.
You could also consider going with plans that offer 100% after deductible. We just changed our from a $1500 deductible to $3000 with 100% after deductible. You will have spent the same amount of money in premium + deductible but the 20% out of pocket can get real big real fast.
I personally view health insurance as a $13000/year expense, but I know that we are well covered if anything happens and all we need to worry about is the deductible. My little girl was in the hospital for two weeks about year ago-the bills were in in the $50K range after negotiated rates. My out of pocket was the $1500 deductible.
I would check into 100% plans.
Bruce
That price and plan is similar to mine now. Just over 13K for the insurance and the deduc is 2500 each, plus some small copay on medicine Rx so we budget 20K per year for medical for the two of us.And since we have to use it, it is a bargain.
Welcome to the Taunton University of Knowledge FHB Campus at Breaktime. where ... Excellence is its own reward!
All it takes is one bad event and many years of premiums will need to be paid for instantlyif one is not insured.
Bruce
One benefit of having the insurance is that you get charged the network's negotiated cost for a particular service.
The doc office may bill $300 for X, but the network negotiated charge for that X is only $200. Insurance pays their portion ($160) based on the negotiated cost and you pay the difference of $40. Before your deductibles are met I think you would still only pay the $200.
That is one one benefit but mostly you need it for the big events, so that you don't loose your house.
In the meantime the premiums are painful.
Get insurance. I have 3 close friends all fighting different cancers, not one had a clue before diagnosed. The cost of saving your life makes that yearly cost of insurance seem like pocket change.
I think the plan we have sounds about like what you are looking at....
i can choke down 15-20k if i have to... they will let you pay on time ect if it comes to that...but the deal is they will treat you if you have insurance... so if something happens that requires 200k worth of care... then they know they will get paid... and they really won't sweat you for your 15k part of it... many times they forgive it... at the least they will set up a payment plan...
the 10k a year sucks... but that what republicans do... we suck it up and pay for it... and skip buy'n the new $600mo car we'd like knowing there are more important things to take care of... if i wanted a free ride I'd be a democrat :) just thought i'd make this topic more interesting
P:)
who's the plan thru.
last time I bought for us ... looked everywhere and found the best group rates were thru a local chamber of commerce ... thru Chamber Choice.
they had the best rates of all builder group, etc.
then I found out didn't matter which group I joined, they all got the same price.
so I called and found out which group had the cheapest buy in.
became an associates member of a local chamber of commerce.
they offered full and associates membership ... I was on in for the health plan so I took the cheaper of the two options.
That was about 5 yrs ago ... paid somewhere around $600 - $650/month for a fantastic plan. Actually better than the one we have now ... but it's thru Cath's work so the monthly cost is much cheaper.
Jeff
Buck Construction
Artistry In Carpentry
Pittsburgh Pa
I forgot to add ...
best plan is to get the wife outta the house and off to work at a real job with benefits!
Jeff
Buck Construction
Artistry In Carpentry
Pittsburgh Pa
You might look into a health savings account [HSA] plan. High deductible but good coverage there after and for me at least it is the nearest thing to being affordable I've found. You can write off tax wise what you put into the savings account each year as long as it isn't spent for non medical uses. Far as I know BlueCrossBlueShield is the only provider and of course it varies from state to state. Whether or not it would benefit your situation I couldn't guess.
Golden Rule offers it also.I have had them for 16 years now.The savings part is great,can invest 100% of deductible amount in the savings plan pre-tax dollars. Use debit card for medical (prescriptions,visits etc.)
Guaranteed interest at 4%,dollars available for use at age 55 without penalty(but taxed).
100% coverage after deductible,no copay. It seems to be the best plan out there for the self employed.
Hi PeteDraganic,
Hi all. I am interested in acquiring medical insurance for my family. Until now I have been "self insured" paying out of pocket for visits.
Well, self insured really means you have the $ to pay for anything that could ever possibly come across your plate....got a client that is self insured......he "clears" about 8 million a year after taxes.....middle age, healthy with good genetics and fairly risk free lifestyle....doesn't hang off ladders and run across roofs etc.
On the other side.....my dad quit the health insurance game nine years ago....house is paid for....simple home and the only one so they can't make him sell it if he can't pay the whole hospital bill.....makes pretty good $ but spends it all on toys and stuff. He figures if he had a major hospital stay....he'll set up a pay plan which he found out an uncle has done....dang good fer nothin' drunk......drinks 2/5ths of Vodka a day, smokes 5 packs of cigarettes.....has had four heart surgery's and pays $15 a month to keep the hospital off his back and it actaully shows as "good" making payments on time on his credit....geeeez.....Dad said he could live with that if that ever happened to him.....and can you believe he's never voted democrat.......hmmmm.....maybe he'd never make the payments then.....get somebody to bail him out.......geeeezz
Ok, I'm gettin' ticked......
Now, the younger you are, the healthier you are, the better family history/genes you have are and the safer your lifestyle is.....the better candidate you are for a HSA insurance plan.....if you make less than a couple a million a year.
Outside of that, take the highest deductable, with the most out of pocket expense you can. The plan will get you the prefered rates, unless you want to negotiate that being self employed while your little one has a power tool in the abdomen.....of course you can always go back and discuss charges with the hospital admin after the fact etc.
Not intentionally being negative here......but insurance is just that....is a Vegas #### shoot.....either pay the Chicago mafia off a little each month or roll the dice and dream for the best......Dad will be on medicare next year....maybe he stay healthy until then.....if so I get all his toys the next few years....if not they'll be sold to pay part of his hospital stay and he'll get to keep his house.
Pedro the Mule - Still kickin' heart healthy
I had to do similar analysis about a year ago and concluded that the lower deductible plans made more sense. The savings in premium didn't seem to make up for the higher deductible. Of course if one is really healthy and lucky, that statement doesn't apply, but it seems like most years some minor thing occurs that would soak up the bigger deductible.
Pete,
The one big problem with being self insured, & we were for several years, is that if anything major goes wrong, you WILL be black listed for future insurance for life. For us all was going well, we were a normal healthy family then at age 43 my health took a hit and I got into trouble & that was with being insured. We were price shopping at the time do to rising rates & sold a bill of goods, but the rates were good.
In Feb of 05 I had a heart attack that left us owing right around $68,000.00.
Ten months later our oldest Daughter had a cardiac arrest, she spent 42 days inpatient, 22 days in the ICU, during that time my other Daughter & I each received defibrillator/pacemakers @ $100,000.00 a pop, our Son ended up with a implanted heart monitor for $56,000.00 and then a heart ablation. These are just a few of the things weve done medical wise since 05. Since then all four our of kids & I are black list for medical & life insurance
I don't know what to tell you what the right answer is, seems like either way you lose.
Here is a link on one of the stories done on our family
http://www3.jsonline.com/story/index.aspx?id=412690
Good luck
Paul
No one should regard themselve as "God's gift to man." But rather a mere man whos gifts are from God.
Edited 5/1/2009 1:40 am ET by CardiacPaul
Edited 5/1/2009 1:43 am ET by CardiacPaul
Quite a story , and an amazing comeback for your daughter. Beyond that all I can say is that I will be saying some prayers for your entire family.
They can't get your Goat if you don't tell them where it is hidden.
Thanks,
As for my daughter she has not faired all that well. The story written in the paper was all & all a very nice job but of course they can't go on & on with every detail. Even the reporter said he had so much more to write but of course his editors would just end up cutting it up, as it was it was a very generous article
Our daughter suffered quite a brain injury from oxygen deprivation, within the first few days of the event we were told there was really no hope for her & they gave her about 8-10 days to live. that there had been such wide spread damage to her brain that it would not be able to support her organs & functions. One by one she would have organs shut downs & pass away. My wife & I started making arrangements & continued to stand by her, holding her, loving her & just saying good by.
Late on the eight night we received a call from one of the doctors informing us Ame had pulled her vent tube & was breathing on her own. After a long talk with the doctor we agreed and put a DNR order on her and let her go if any thing else happened. Within 10-12 minutes the phone rang again of course our hearts sunk, all I could think was, "That was fast"
This time the doctor told me everything was okay but we had a different patient on our hands & we should come back to the hospital, she informed me that Ame was sitting up and trying to get out of bed.
When we arrived back in Ame's room there she was, sitting up & smiling at us.We had a few hours to spend with her & we talked & brought her up to speed as to what had happened. In those magic first hours with her it seemed she was pretty good for wear considering what she had been though.
The next day when we returned Ame's abilities were greatly reduced. Over the next weeks and months she would have to learn just about every thing over, use of her arms & hands, movement & use of her legs, feed her self, walk, ect.ect. finally Ame's ability to talk slowly started to come back.
Thats when we realized the extent to her injury, many things that came out made no sense. Sentences would have improper words inserted.
Too fast forward to today, three years later & age 26, Ame has to live with us & must be watched for her safety. She if very child like and dission making is pretty much gone, sense of time is erased.
There is so much more to this unfolding story and we could sit here all night and then some. Most times when people hear some of the other details they sit in disbelief some details are gut wrenching and some would light you up with anger.
The toll on the family is beyond belief. mentally, financially, legally.
I know the OP was about health insrance & this case is beyond that.
Thanks for the ear & offers of prayers
Paul
No one should regard themselve as "God's gift to man." But rather a mere man whos gifts are from God.
Paul, that is a terrible story... i am so sorry. However, still having her with you is a blessing... at least I would think so.With my father's recent situation and death I realize so much more about all of this type of stuff than i thought I ever would.
<!----><!----><!---->
I refuse to accept that there are limitations to what we can accomplish. Pete Draganic
Take life as a test and shoot for a better score each day. Matt Garcia
Pete,
Your right, we are very thankful to have her with us, it could be alot worse & we defiantly know others are faced with more trying times but of course we have our weak times & bad days. We try to laugh at the things that we can not control.
When faced with a situation like this witch has been life changing we realize all the dumb stuff we use to fret about in the past & have to laugh at ourselves.
Like you, we lost my Father also, although its been just over a year now, same time Ralph Wickland lost his Dad , its pretty hard to take.
We were fortunate to be with him as a family & hold his hands & help him in those last hours, not a great memory but a honor non the less.
As far a our Daughter Ame, we'll keep plugging along. Now were trying to find living arrangements for her & keep being met with challenges on that one.
Thanks for your concern
Paul No one should regard themselve as "God's gift to man." But rather a mere man whos gifts are from God.
"Barring any major catastrophes, I would be better off"
The reason for insurance is the major catastrophes!
unless you believe the general assumptions in society or from the socialists.
Have you looked into HSAs? That way you can bank some money pretax into an account similar to an IRA that remains yours. High deductible and lower monthly rates.
Welcome to the
Taunton University of Knowledge FHB Campus at Breaktime.
where ...
Excellence is its own reward!
Pete,
Don't know what to tell you about the health insurance. I've regularly employed for most of my life so I've usually had employee sponsored health insurance.
With my recent job loss I am without insurance. There are catastrophic plans available here through Blue Cross and Blue Shield.
If you take any prescriptions I have done a lot of shopping as of late and Costco is usually the cheapest way to go with generic. If you use brand names you go to Canada and get a 90 day supply for about what you pay for a 30 day supply here.
Buck is right, have your wife work a good job with insurance.
Lefty-Gonna swear odd all drugs soon....
P.S. Is the a Croatian American group or whatever you is that offers insurance. I know that the Republican National Committee probably doesn't :o)
Yea but...... when he gets elected Governor of OHIO then he will have full coverage... paid for by the TAX PAYERS. ;-)
They can't get your Goat if you don't tell them where it is hidden.
State Police protection too. Betcha Drago (like Blago) will get everywhere super fast.Betcha he fires all the building inspectors too....Might want to get the ballot boxes ready to stuff for however the Midgets....err...'Publicans run in '12.....Lefty-Pete in '12
my sister in law was just telling the wife she started checking the "cash" price on all her prescriptions that are covered under their insurance plan.
Guess she got something new, came up real high ... and her pharmacist told her she could buy it cheaper not going thru the prescription plan.
She started checking each one and looked at same med/alternative brands ...
and found they could get about half cheaper but not buying thru the plan.
Jeff Buck Construction
Artistry In Carpentry
Pittsburgh Pa
I feel for ya.
I go on Medicare this July 1, and it is looking as if there will be some real cost savings for me.
The amazing thing for me is seeing how many options there are for me in insurance companies and coverage types. I am talking about the different providers and policy types in Medicare Supplement, Medicare Advantage, and Part D Prescription Coverage.
For the last month and a half, I have been deluged with mailings and phone calls.
If you are reading this and think that Medicare is free, it isn't. Currently it runs you $96.40 monthly, which the fed lightly lifts from your monthly SS payment. And since Medicare is basically 80/20 coverage, most folks want additional private coverage to cover all or most of the 20, plus something for prescription drugs.
Contrast that with looking for private insurance, when you are not yet 65. What a nightmare! Very very few insurers, and policy costs that are astronomical.
But it varies state by state, county by county. I must be in a very hard place for private health insurance, that being poverty-stricken far-north upstate New York.
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"A stripe is just as real as a dadgummed flower."
Gene Davis 1920-1985
I am self/family employed and we have been very happy with the Anthem BC/BS plans. My wife and I pay ~$250 per month and that covers our baby as well.We are young(30 & 25) and fairly healthy, no dental or eye coverage but pretty decent insurance for the price.I would shy away from any life insurance company I hear advertising on talk radio...
If you go for it, expect the premiums to up substantially every year whether you make a claim or not.
Pete,
Have you tried the Chamber of Commerce or the home Builders/Remodelers assoc. in your area?
Been there....done that.
It won't be cheap but the better the coverage, the better off you'll be.
Noone plans for catastrophic medical issues...........but they happen. I've talked about my daughter here before. Had I not had insurance when she was born? I would have lost everything.............as opposed to the just most of everything I lost.
And worse, once it happens? You can't get insurance.
Self insured is NOT the way to go.
After my daughter came home and my wife stayed home with her we couldn't get insurance because the policy that covered my wife had lapsed.