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Health Insurance

This may be a bit off-topic but I really hope it doesn't get deleted....

For those of you who bought individual health insurance in the USA (especailly those of you who are self-employed), what were the most important benefits to be included with the plans?

Yoey
Friday, August 27, 2004

Catastrophic.

I am relatively healthy and when I paid for my own health insurance, I opted for low monthly premiums and higher deductibles/co-payments.  But make sure you are covered in the event of a bad illness or accident.

If you need prescriptions or have a lot of doctor visits per year, then you might want to opt for better coverage.

Lou Franco
Friday, August 27, 2004

Hijacking this a bit, but don't you have a public health service??

A European
Friday, August 27, 2004

If car insurance was like health insurance, we'd be paying $200 for an oil change.

You won't believe how expensive health care is until its free.

Yo
Friday, August 27, 2004

"You won't believe how expensive health care is until its free."

Is 'Yo' short for Yogi Berra? ;-)

Edward
Friday, August 27, 2004

"You won't believe how expensive health care is until its free. "

A bold, triumphant assertion contradicted only by the facts....
http://members.shaw.ca/tfrisen/which_is_the_better_health_care_.htm

JP
Friday, August 27, 2004

+++what were the most important benefits to be included with the plans?+++

This is highly subjective and very specific to each person.  If you are chronically ill, as I and my daughter are, you'll want either a PPO plan with a modest (less than $4,000 or so) deductible up front and 100% coverage (usually not including prescription copays) thereafter, or an HMO with low copays (if you can find such a thing anymore, with a premium that makes it cost effective).

If you are generally healthy and will only need expensive medical care in the event that you're hit by a train, then go with the above advice about higher copays and catastrophic coverage.

muppet
Friday, August 27, 2004

"If you are generally healthy and will only need expensive medical care in the event that you're hit by a train ...."

Indeed.  If you are generally healthy, I would ask about a high decutible plan.  Something like you foot the bill up to $X,000 per year, then the insurer kicks in.

Price the low dedicutive plans, then stick 4/5 of the savings you get into the bank (and, eventually, a mutual fund) to pay for the $X,000.

In the long run, unless you get hit by the bus, you'll make out, and you can keep the cash you don't use and use it in retirement, when you _will_ need $$ for health coverage.

JMHO.  I work for a managed-care (HMO) organization, so take it with a grain of salt, but the recommendation above is what I'd do if I ever went indepdent consultant.

www.xndev.com (Matt H.)
Friday, August 27, 2004

+++Price the low dedicutive plans, then stick 4/5 of the savings you get into the bank (and, eventually, a mutual fund) to pay for the $X,000+++

Good luck:

a) quantifying your savings.
b) having the discipline/opportunity to put them aside.

muppet
Friday, August 27, 2004

>> b) having the discipline/opportunity to put them aside.

Incidently, that's one of the reasons why all other industrialized nations imposed a nation-wide health system, ie. if left to themselves, most people overestimate their luck, and society is left to handle the consequences.

Fred
Friday, August 27, 2004

Fred-

It's not always so much overestimating your luck for some people as it is not really having those dollars in the first place.  With a fictional budget item, it's difficult to divert that phantom money into a savings balance.  :)

muppet
Friday, August 27, 2004

Right, but it's the same reason we force people to buckle up: From experience, governments know that most people won't, will crash themselves badly... and leave the whole of society to pay for the consequences, including those more cautious.

Besides the issue of insurance companies stuck with those most likely to get sick (the young, healthy, and single people don't need insurance), if people are not forced to enroll in health + retirement plans, many of them won't... and then force the government to foot the bill. The S&L debacle comes to mind :-)

I'm actually reading a bunch of books currently on the issue of social systems around the world, the different solutions countries came up with to control health spendings for instance, and the reason all countries end up offering a national coverage, is simply because a privatized system has a lot of hidden costs (more $ on advertising and management to find new customers, more $ to shell out to shareholders, making sure you don't end up stuck with "bad risks", etc.) Quite interesting issues, actually.

Fred
Friday, August 27, 2004

Generally I believe you will find that a high-deductible, "catastrophic" plan is actually obtainable, with a good carrier (e.g. Blue Cross, etc.) at a fairly affordable rate.  Talk to your local independent insurance agency.  You may not get the best rates if:

- You have had any illness/medical history in the past few years, other than common cold/flu type stuff.  For example, my wife had an episode of vertigo which was treated successfully with medication, but that ticked her rate up a bit.  Also anything you list will be a "pre-existing condition" which they won't cover for some period of time.  All this is disincentive to be honest about your history, and I don't know to what degree they can investigate that through other channels.

- You need maternity coverage.  Most of the basic individual plans exclude this, and getting it is very expensive.

- You have no current coverage or your prior coverage expired more than 30 days ago (actually I'm not sure what effect this has but I know I was asked about it when I applied).

AMS
Friday, August 27, 2004

"Besides the issue of insurance companies stuck with those most likely to get sick (the young, healthy, and single people don't need insurance), if people are not forced to enroll in health + retirement plans, many of them won't... and then force the government to foot the bill."

=

antiselection

I am Jack's LOMA training
Friday, August 27, 2004

"If you are chronically ill, as I..."

muppet, once they cure your hypochondria, you should be able to switch to catastrophic, saving us all a few bucks.  Thanks.

Dr. Bombay
Friday, August 27, 2004

My dad buys individual health insurance.  Several years ago he was on more of a traditional PPO, relatively low-deductible plan.  Then the insurer decided to raise the rates to the point where it wasn't a viable option.  So my parents decided to go with a high-deductible plan and save the difference between what their premiums would have been under the PPO and the catastrophic policy.  They're generally healthy and only go to the doctor when it's absolutely necessary and within a few years they had enough saved to cover the deductible if something catastrophic occurred.

I actually think some form of this is the way to go for employers because the individual is incentivized not to go to the doctor unnecessarily, which is one factor driving up costs.  I think Whole Foods(?) recently moved to a company-funded Medical Savings Account plus a catastrophic insurance policy.

Me?  My company only has the low-deductible options and they're generous enough to pay for a good chunk of it.

And having formerly worked for an HMO, it would extremely difficult to pry the PPO plan away from me.

Jeremy
Friday, August 27, 2004

I buy insurance for the BIG item. There are lots of companies here and in Brazil (where I saw more of this) that sell "insurance" that helps for the little stuff and pays nothing that expensive.

Just the other day I had to get a berium swallow. They were telling me it was expensive. How much I asked. Oh maybe US$500.00 or so they said. Oh well. My premiums are less than US$100.00 a month buy my deductible is US$5K a year but I'm already saving money. Well, it turned out I got the thing for US$156.00 as they said "this guy has no insurance and is paying cash".  My father shows me the bills he gets. Some of his doctors bill X and then medicaid pays 20% of that and they accept it. He has one doctor who just bills what he knows medicaid will pay. The whole thing is like a 3rd world Bazaar.

Anyhow, what worries me is if my insurane company will do the right thing when I have that operation or whatever that costs the big bucks. I use Golden Rule and I had to join this organization called fact to get my rate which is under US$100 a month.

It would be nice to find a site where people can rate their experience with health insurance companies. I haven't seen any GOOD site that does that. It would be nice to know if a lot of people are complaing about service.

me
Friday, August 27, 2004

Me,

If I understand what you're saying, you're lucky.  In my experience, when you pay cash w/out insurance you pay more.  The insurance cos. negotiate down the charges so even if you have a high deductible you are better off since you pay the lower negotiated cost not the "cash" cost.

Example you need a chest X-Ray.  Let's say that would normally be $200.  I have no idea if that's right but this is just an example.  Your insurance co has a negotiated reimbursement for a chest-xray of $120.  Even if you have not met your deductible and have to pay the cost out-of-pocket, you still only pay the $120.

This works to the insurance company's benefit in two ways: it takes longer for you to reach your deductible limit, and it costs them less once you do.

AMS
Friday, August 27, 2004

not 100% to the point, but worth looking at:
as a self-employed, you might be able to find a better deal going for group insurance rather than individual.
it can be done (at least in my state). you want to check the whole picture, not sure what it worth:
you begin with a company/corporation/partnership with a single employee: yuorself. if this is not how you work today, it may still be worth doing it.
continue by having this company join a small-business group which provides group medical insurance.
in ma its:  http://www.mbamembership.com/

naive bystander
Friday, August 27, 2004

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