Help.....Need to Buy Health Insurance! (Houston, Cove: find a job, buying, deductible)

[tmc300]

We are moving from overseas to Houston and we are unfamiliar with how health insurance works in the US. We don't work for any US companies, so we need to buy health insurance for our family. I searched in the internet and found some health insurance providers and quotations. But I don't know which ones are good & reliable.

1. Pls kindly suggest which health insurance providers are really good and reliable and best for family. We have two kids (a 6 yrs old and a baby).

2. From the internet quotation, it has Deductible (like $10,000 or $5000, or $1500). What does Deductible mean and how does it work? If I have $5000 deductible, does this mean that if my medical bill is $8000, I pay $5000 and my health insurance pays $3000? If so, it seems crazy to me that I have to pay $5000 after paying several hundred dollars each month for health insurance.

3. The quotation also has Coinsurance (like 20% or 30%). What is Coinsurance and how does it work?

4. The quotation also has Office Visit (like $30, $40, $35 before deductible, or Not Covered). What does Office Visit means? What does all these prices like $30, $40, $35 before deductible, or Not Covered mean and how does it work? And how does the Office Visit charges work with Deductible?

For example, if my child has a bad cold and I take her to see a doctor, does the health insurance cover the doctor's bill or do I pay 100% myself? Also does the health insurance pay for the medicine or I pay 100$ myself?

Or let's say I fell off my bike and broke my arm and had to go to emergency? I assume the medical bill will cost less than $5000. So, does this mean I have to pay 100% myself?

What if I got really sick and had to stay in the hospital for a few days. How does the health insurance work?

Thank you for your time to explain to me.

[HBsteve]

You pay the set amount for office visits. For surgery, hospitalization, anything serious, you pay the annual deductible (which may be per person not per family) before they pay anything. After that, you pay the coinsurance. There is usually an annual out of pocket maximum, once you hit that you don't have to pay the coinsurance. There is also usually a lifetime maximum of $1-2 million, the insurance company won't pay anything once you reach this.

Buying your own health insurance is a sad prospect in this country. The rates and deductibles are much higher than for an employer-sponsored plan. Also with an individual plan there have been cases where once someone becomes seriously ill, their insurance company investigates their application and finds a way to claim that they lied on their application and drops them. Here's a story where a California couple were dropped after a car accident because the insurance company claimed the wife's weight was not listed correctly on their application.

State orders review of patients dropped from insurance | Health insurance, rescission, Department of Managed Health Care, reinstatement - Life - OCRegister.com

I would not move to the US unless you expect to find a job that provides health insurance benefits.

[chris_ut]

Ehealthinsurance.com is a good place for quotes. I am self employed and it is much cheaper to carry a high deductible policy for emergencies and just pay cash for all my regular medical expenses. I pay 1k per year per person for one of those policies through BCBS and about 2500 a year for my actual medical expenses.full coverage medical insurance would cost me around 18k per year.

[tmc300]

When you have employer-sponsered health insurance plan, do you still have deductible, coinsurance, and office visit? Do you also have to pay the monthly premium?

I read more from the internet about health insurance. There are HMO and PPO. I read the explaination for HMO and PPO. But having no experience, I don't know which one is better for my family. Can you share your opinion about HMO and PPO, and which one you think is better for family?

[chris_ut]

Originally Posted by tmc300

When you have employer-sponsered health insurance plan, do you still have deductible, coinsurance, and office visit? Do you also have to pay the monthly premium?

I read more from the internet about health insurance. There are HMO and PPO. I read the explaination for HMO and PPO. But having no experience, I don't know which one is better for my family. Can you share your opinion about HMO and PPO, and which one you think is better for family?

Yes, when you have employer healthcare all the same rules apply, just your employer pays from 50-100% of your monthly premium, and sometimes pays your deductible and co-payment. Also employer healthcare (called group insurance) can have some additional benefits such as maternity coverage that you won't typically find in individual insurance. Most people find PPO to be better than HMO but HMO is cheaper I think.

[tmc300]

From researching the internet, I found some health insurance providers like Blue Cross Blue Shield, Cigna, UnitedHealthOne, Celtic, and so on. Do you know which ones are really good and reliable for family health insurance?

Is it better to have higher deductible (like $10,000) so that the monthly premium is lower? With lower deductible (like $2500 or $5000), the monthly premium is higher. Then there is coinsurance like 20%, 25% or 30%. And then there is Co-Pay like $30 or $40. Not to mention different plans have different cost for medicine. I can't figure out which combination of deductible, coinsurance, and co-pay will be most cost effecient. Really confusing. Which genius thought of this? My head wants to blow up just reading the different Plan Details. Do I need a software to figure out the best cost combination?

With so many providers and each offers so many different plans, I don't know which one is best for my family. Any suggestion as to how to go about selecting which provider and which plan to buy? Thank you.

[oceangaia]

Of course it is confusing. The answer to almost all of your questions is "it depends". There really is no standard. Selecting the best plan is a crap shoot because you don't know for sure what the future holds and what would have been best in hindsight.

Most employers pay some or all of the premium for the employee on group plans. Most will pass the premium for dependents on to you. Whatever they cover is part of the employee benefits package. Most of the time this is part of a corporate policy and not subject to negotiation (but salary is) and it is definitely something you should consider in weighing a job offer.

A deductible is the amount you pay before the insurer begins paying. It usually applies to major expenses and specific procedures, not office visits. The deductible generally runs on a calendar year, on a per person basis although there is often a combined family deductible. As you noted, lower premiums mean higher deductibles and vice versa. Some prefer low deductibles and higher premiums because they can budget accordingly and not worry about big unexpected expenses. They may pay more in the long run but the expense is more predictable. Others prefer higher deductibles and lower premiums because they would prefer to chance the unexpected expenses in order to possibly save money if they don't have many health problems that year. Essentially, they are covering their own health care and using insurance to cover catastrophic care like major surgery.

A co-pay is usually for office visits and prescription drugs. This is a flat amount you will pay each time with insurance picking up any balance. The co-pay on drugs often varies by whether the drug is a generic, name brand, or specialty drug.

[chris_ut]

If you want someone to walk you through it call ehealthinsurance or any other insurance broker.

[tmc300]

Do you know which insurance providers are better and which ones not to use? From the ehealthinsurance.com, I see names like Blue Cross Blue Shield, Cigna, UnitedHealthOne, and Celtic, but I have no idea about the reputation for each one.
If two providers offer the same deductible, coinsurance, and co-pay, but one has higher monthly premium than the other, are we comparing the same thing like apple to apple?

[chris_ut]

I know that most people like Blue Cross Blue Shield and Aetna, the others I have no experience with. Another thing to look at is annual prescription cap, some are unlimited but some plans you can only get a couple thousand in prescriptions before you max which could be an issue if you have an expensive medication.