MA Health Insurance (Boston, Harvard: broker, how much, buying)

[AngelEyez02403]

I'm a current senior in college in Boston and will be remaining here after graduation in May. I'm currently still covered under my parent's health insurance plan while I'm a full time student, but my coverage will expire the day I graduate.

Since I recently claimed residency in MA, I will need to purchase health insurance once I graduate. I've looked into every plan on the commonwealth connector, (I'm not eligible for Masshealth or Commonwealth Care because I would have to wait 6 months to apply after being off my parent's plan) and wanted to know others' experiences with various health insurance plans in MA. From what I've seen, Harvard Pilgrim appears to be the best for what I need.

Any advice or feedback would be appreciated. Thanks!

[Jimrob1]

I had Harvard Pilgrim for a number of years when I lived in Mass. I liked it for the most parts. Any problems I did have were mostly related to finding Doctors in my region that were accepting patients. Sometimes it seemed there were just not enough Doctors. I didn't live in Boston so maybe it was easier in the city area itself. I lived in Southeastern Mass about 45 minutes outside Boston. That was really it for problems I found, but I guess that is a problem with all plans now. A plan that I always heard recommended was Tufts Health Plan, If its still available in Mass, check that one out.

[goyguy]

The problem with regional networks is just that, they're regional. What happens if you get sick or injured while you're out of town? (Fate tends to be unkind to travelers, lol.) My reco is to investigate policies offered through a national company such as Blue Cross/Blue Shield, Aetna, or United Health Care. Go with a "PPO" (preferred provider option) or "POS" (point of service) plan, not an "HMO" (health maintenance organization.) You won't have to select a primary-care doctor from a list and then be stuck with seeing only that doctor except in emergencies.

Also find out whether potential plans carry an "escape clause" or "early termination option." If you find work or enter another academic situation where a comparable or better policy is available to you for less money, why be stuck carrying two policies or having to forego picking up the new one? You ought to also find out whether you'd be hit with one big bill for a premium, or whether the company allows for installment payments.

Don't be automatically sold on a policy which has a comparatively cheap "sticker price" but carries a high "deductible." When you run up $1,966 in medical bills on a $2,000-deductible plan, guess who pays? That's right, 'tain't the insurance carrier. You'd save money if the medical provider(s) have negotiated discounts on their charges, but that full two grand still has to be accounted for before your benefits kick in. Pay as much extra as you need to for your plan deductible to not exceed $500.

One more important tip, this time around: When you've signed on for health insurance, the company is required by Massachusetts law to mail you an "HC-1099" form. This form has to be kept for reference when you file state taxes. It carries the start and stop dates for your policy during the current calendar year, the Federal Tax ID number of the insurer, etc. Save it in a safe place when it arrives.

There are comprehensive Web sites for all the big-name insurance companies, and each also has customer-service call centers for handling any questions which may arise. Joining a health insurance plan is a major purchase just like a flat-screen TV or a car is, so take your time "shopping around" and choose carefully.

I've made a living in the health insurance industry, both public (MA Medicaid) and private sectors, since 1996. Feel free to send any questions my way.

[AngelEyez02403]

Thank you for the comments so far.

I currently have a PPO plan, and when I'm forced to switch plans, I really would like to stick with a PPO. Correct me if I'm wrong, but won't some HMO's allow females to have a gyn as their PCP? I currently have a gyn at NEM and do not want to switch. If for some reason I had to go with an HMO plan which didn't allow a gyn to act as a PCP, could I ask my PCP to refer me to my current gyn? I get all of my medical care at NEM, and it appears that all of my current doc's are covered under all of the plans.

On the commonwealth connector site, it appears that almost all of the plans listed are HMO's. When I visited the insurance companies individual websites (blue cross, harvard pilgrim, etc), they did have PPO plans as well. Would the PPO plans still meet the MA requirements even though they are not listed on the commonwealth connector site?

Thanks for the deductible tip. (I love how all the young adult plans have about a $250 deductible, but the only charges applied to the deductible are lab tests and medical equipment---and how nothing goes toward the out of pocket maximum).

Does dental insurance need to be purchased separately?

[smarty]

Insurance is a bet... I bet you will not get very sick...

If young and healthy... get the cheapest thing with highest deductible. For regular dr visit, it is less than $100... so why pay big $$$$ premium?

dental insurance is separate unless the dental work is due to a special accident. Most dental insurance do not cover much... but then... premium is cheap.

[AngelEyez02403]

Regular dr visit less than $100??? My last one was about $600...

[WannaGoHome]

I'm not too familiar with health insurance in MA. my husband and i signed up for a PPO plan. There are Point of Service of HMO plus plans that allow you to pay a slightly higher co-pay ($30 versus $10 for example) to self-refer. That way you can get out of the authorization trap if it's urgent. As for a GYN as a PCP, i'm not sure about that. I do know that when we had an HMO, I was able to get into a gyn no problem. I didn't even need an authorization. As long as the doctor accepts your insurance. I would ask your current gyn if they accept the insurance you are looking at. you can't be the only one with this issue. I'm sure they might be able to help. Good luck.

Cheers!

[maggiekate]

I also had harvard pilgrim and it was a good plan for me. The doctor I did have did
take it so I was fine with it. Do you have a doctor you see? You should find one
while you are covered under your parents health insurance, then see what insurance
they take. I also had blue cross, but found I did better with Pilgrim. Also where will
you be working many companys do provide health insurance as a benefit.

[goyguy]

The insurance plan I work for is comparable to a PPO, and it meets the state specs just fine.

Ditto on the response re dental insurance. Very few health plans include any kind of dental care outside of impact-injury treatment. You may be better off not buying a dental plan, since some have a low maximum benefit meaning that you wouldn't save all that much. Aetna has a "Vital Savings" dental program wherein you buy a membership card for a low fee and get up to half off your bill for routine care at participating providers for a year. Something like that tends to pay for itself starting from when you show up for your first appointment.

I'd inquire with insurance companies you're looking into re the PCP question. Many policies don't require you to report to them who your primary provider is now, and among those that do it doesn't much matter whether the doc is an OB/gyn specialist or internist or family practitioner. The policy I carry allows total leeway.

[emilybh]

[quote=goyguy;4938631]...............Don't be automatically sold on a policy which has a comparatively cheap "sticker price" but carries a high "deductible." When you run up $1,966 in medical bills on a $2,000-deductible plan, guess who pays? That's right, 'tain't the insurance carrier. You'd save money if the medical provider(s) have negotiated discounts on their charges, but that full two grand still has to be accounted for before your benefits kick in. Pay as much extra as you need to for your plan deductible to not exceed $500..............

With all due respect, this is AWFUL advice if the seemingly cheap sticker price ends up being the better quality plan with actual STOP-LOSS protection------WHICH IS SUPPOSED TO BE WHAT INSURANCE IS ALL ABOUT. There is NO SUCH THING as stop-loss protection with co-pay plans. Show me the most expensive supposed "BEST" " RICHEST" plan with a $10 office visit and I will show you an individual or an employer who is paying WELL OVER the $2000 deductible IN THE FORM OF HIGHER PREMIUMS EACH AND EVERY YEAR ON TOP OF all the UNLIMITED CO-PAYS you'll pay which can add THOUSANDS of $$$$ MORE in exposure.

Ten prescription drugs filled monthly each with a $50 co-pay adds up to $6000 per year just for one person's Rx co-pays!!!!! DO THE MATH. I'd take the plan referred to by the poster as "cheap" if all it has is a $2000 deductible and after that is met will pay for all of my Rx drugs 100% ANY DAY over the expensive low deductible co-pay plan with ZERO real protection against anything subject to unlimited co-pays and well over $2000 per year in higher premiums year in and year out.

Co-pay plans are only BEST for the Insurance Companies .

An easy way to evaluate any health insurance policy is to figure what your out of pocket costs would be if you had a terrible year versus a good year. Make two columns with column one being "good year" and column two being "bad year" for each plan (copay and high deductible).

In a good year all you pay are the insurance premiums and perhaps an office visit for a physical. In the good year the plan with the high deductible wins because you save thousands of dollars in premiums.

The analysis for the BAD year comes out the same. You still enjpy the savings of thousands of dollars because you were smart enough to choose the plan with the high deductible that covers you 100% for EVERYTHING after you meet the deductible! So in the bad year where with the so-called "best" co-pay plan, you'd need to shell out thosands of dollars in co-pays IN ADDITION to the thousands of dollars you pay year in and year out just to have a plan where the insurance company pays for most of a visit (but without realizing it you are paying THOUSANDS of dollars EXTRA year in and year out, just so you don't have to pay any more than $20 for an officie vist. BOTTOM LINE: The CO-PAY PLAN LOSES BIG TIME IN A BAD YEAR. When you are sick and need STOP-LOSS protection most, w/ co-pay plans, you just keep paying and paying and paying those co-pays. You have no protection against co-pays exceeding a leve you are comfortable with.

As a seasoned independent health insurance agent and broker who has worked in Massachusetts, the mandate is onerous and will cause you to pay MORE than you would if you lived in a "normal" state like New Hampshire or states south of NJ and MD and West of NY where state legislatures that are completely clueless about the health insurance industry, get involved and end up mucking it up for everyone in their state. That is what has happened in every state in the Northeast except New Hampshire and Connecticut altho that state is getting worse. Therefore need every strategy there is to make sure you have quality protection for a worst case scenario.

Also avoid the quasi SCAM plans out there that are actually limited benefit plans masquerading as full comprehensive major medical plans-- WHICH THEY ARE NOT. If the plan has a schedule of benefits listing dollar maximums for each service they provide ie $1500 per day maximum for hospitalization. $3500 maximum for cardiac surgery.etc....and on TOP of this has a high deductible, AVOID IT LIKE THE PLAGUE. A quality plan with not limit doctors visits, or put dollar amounts on surgeries, diagnostics nor therapies after you meet the deductible.

This is just COMMON SENSE if you think about it. Too bad none of the so called "experts" with syndicated columns offering financial advice to business owners thought of this in the past 20 years. It seemed EVERYONE was pushing the co-pay plans (except for the few of us who had a conscience and could explain to our clients how they were being ripped off with co-pay plans). Sadlu too many insurance agents became order takers for co-pay plans rather than the consultants they should have been--pointing out WHY the high deductible plan with 100% coinsurance is a FAR better value than any co-pay plan on the face of the earth! It always has been and always will be unless the insurance industry starts to put a cap on how much in co-pays you are responsible for before they start paying 100% for the ER, UR, prescriptions, office visits, etc.