POLL: UPMC or Highmark? (Pittsburgh, Duquesne: middle-class, health insurance, contractor)

[SteelCityRising]

So I'm putzing around this morning on the Federal Health Care Exchange prior to heading into work. I didn't enroll in health insurance last Fall (shame on me!), but this year I'm going to. I'm noticing UPMC and Highmark are EXTREMELY competitive in terms of pricing this time around whereas it seems like last year Highmark was by far more budget-friendly for the "Bronze" plans---I guess UPMC woke up and decided they needed to come down in pricing a bit to take market share away from Highmark here in Pittsburgh.

Anyhow, my employer doesn't offer benefits since technically I'm in a gray area where I'm employed by a company yet also simultaneously "self-employed" as an independent contractor. Basically I sell myself to them. I also make too much money (about $30,000 in taxable income after accounting for job-related deductions) to qualify for a Federal subsidy. Therefore I'm one of the lucky "rich" Americans who will be paying 100% of my monthly premium out-of-pocket (thanks, Obama). Given that both Highmark and UPMC are competitive in pricing for the plans I'm looking at right now (both around $150/month for what I'm seeking), which provider would YOU choose, and why?

For me it seems like UPMC is superior in terms of medical professionals and facilities, but they're "evil", according to City-Data. Highmark has West Penn Hospital in Bloomfield, which is probably where I'd prefer to go for treatment if and when I needed it because I could easily walk or take public transportation there. UPMC Presbyterian is probably the "best" hospital in the area, but after having worked there I don't know if I'd wanted to be treated at a hospital where the staff is always so stressed and angry because it's packed to the gills with patients 24/7. Obviously if I had Highmark I couldn't be treated by a UPMC doctor, and if I had UPMC I couldn't go to West Penn Hospital.

Essentially I'm just so lost and confused. I'd probably benefit from talking to a counselor one-on-one, but it seems like they're only available in distant low-income areas like Duquesne, which makes me think I should be able to handle this one on my own and be able to figure it out. I'm guessing most people have it easier since their employers kick in a portion towards their health care costs.

[PghYinzer]

Are those your only two options? I had to switch to Aetna from Highmark for next year and can go to either a Highmark or a UPMC facility.

[gg]

Originally Posted by SteelCityRising

Obviously if I had Highmark I couldn't be treated by a UPMC doctor, and if I had UPMC I couldn't go to West Penn Hospital.

I don't know the ins and outs of your situation, but some Highmark plans can go to UPMC.

[SteelCityRising]

Originally Posted by PghYinzer

Are those your only two options? I had to switch to Aetna from Highmark for next year and can go to either a Highmark or a UPMC facility.

I suppose since I don't qualify for a Federal subsidy because I'm "rich" I can just go onto individual insurer web sites, like Aetna's, and see what they have to offer. Aetna doesn't have any local plans listed on the exchange.


Assurant Health (never even heard of them) has a high-deductible "Bronze" plan for ~$100/month MORE than either of the high-deductible "Bronze" plans for either UPMC or Highmark, so I'm writing them off.

Coventry Health has high-deductible "Bronze" plans that are cheaper than those offered by Assurant but still higher than those offered by either Highmark or UPMC, so I'm also writing them off.

United Health Care, which I know has a major local office in Braddock Hills, has a high-deductible "Bronze" plan that is comparable (just slightly more than) either UPMC or Highmark's high-deductible "Bronze" plans, yet its deductible is also slightly less than either of those two providers.


^ If not UPMC or Highmark, then I may look into that plan from United Health Care OR go directly onto a web site for Aetna (or another recommended insurer) and see how their rates stack up compared to those listed on the Exchange. I'm looking to pay ~$150/month for a no-frills health plan since I'll generally just be selecting a PCP and going for an annual check-up, as I'm in great health. I can always upgrade to a more expensive plan in the next enrollment period if I foresaw myself needing more extensive medical care.

[SteelCityRising]

Originally Posted by gg

I don't know the ins and outs of your situation, but some Highmark plans can go to UPMC.

Good to know. In my opinion UPMC Presbyterian Hospital is probably the best trauma center in the region (potentially the state). If I'm in a bad car accident with head trauma and have Highmark I'd hate to be sent via ambulance to Allegheny General Hospital if the trauma surgeons are better at Presby.

It's such a shame that we live in such a developed nation and tell the lower-middle-class "go die in a corner" if they can't shell out $300/month+ for better health insurance options.

[SteelCityRising]

I'm also seeing the phrase "20% coinsurance after deductible" after ER visits from some plans.

Translation?

If I have to go to the ER and require expensive care I will have to pay a $6,000 deductible and then ALSO pay 20% of what's remaining beyond that while the insurer would pick up 80% of the remainder?

[rimc]

Originally Posted by SteelCityRising

I'm also seeing the phrase "20% coinsurance after deductible" after ER visits from some plans.

Translation?

If I have to go to the ER and require expensive care I will have to pay a $6,000 deductible and then ALSO pay 20% of what's remaining beyond that while the insurer would pick up 80% of the remainder?

Up to the out-of-pocket max.

[gg]

Your are a young man, why worry so much about it? Go as cheap as you can.

[SteelCityRising]

Originally Posted by gg

Your are a young man, why worry so much about it? Go as cheap as you can.

I'm also partially socialist, I guess, because I know the more extraneous money I pay into the system, the lower premiums will be for those who are older, need more frequent care, and who can't afford that more frequent care because they're on fixed incomes. I'll be old someday, too, with less discretionary income (although probably more than today's seniors because I'm actually prudently saving for retirement in my 20s, which they, apparently, did not). I'll probably want 20-somethings in 2050 to be paying more than they need to so I can pay less than I should be paying when I'm older, so maybe I SHOULD overpay now to help today's seniors so tomorrow's young people can bail me out, too, when I'm old, the way the current Federal Exchange is set up?

[I_Like_Spam]

As a young man without serious health concerns, I'd go with Highmark if anything. More accepted if something happens when you are traveling than UPMC.


BTW, many of today's senior citizens have a lot of savings. Growing up in the Great Depression, they knew how to pinch a nickel until the buffalo squealed.

I know my father never made any real money, mum never worked outside the house, they raised 4 children, bought a house, yet my mother still is sitting on a decent amount of cash.