Health Insurance (sales, how much, buy)

[Invicta67]

Help navigating the health insurance market please.

The Health Insurance market appears to be a minefield for someone used to free healthcare system where private insurance is either a luxury or a job perk added to the state system.

Comparison sites seem to quote between about $226 and $2,646 per month but PPO, HSA, HMO?

Am I right in thinking:
Annual Deductable = the maximum I would pay if hospital treatment required?
Physician Office Visits = the amount (eg. $40) is the amount 1 pay for the stated number of visits?
Prescription Drugs: Seems to have 3 tiers and states "$7,500 deductible/member/tier 2 & 3" - does this mean i pay the stated amount for the tier ($15 etc.)? Surely the $7,500 deductible doesn't apply does it?
Inpatient Hospital 40% = we pay 40% of the bill?

I'll leave it there for now - appreciate that you've read this far

Be great if you could help out here and even recommend a plan or two for consideration.

Cheers

[robbybee]

First off, let's dispel one myth...

There is NO SUCH THING as FREE healthcare. Even if you don't pay, somebody does...

Secondly, there are many different types of plans available if you are self-employed or working part-time or where insurance is not available. The monthly premium will be based mostly on the level of your deductible and the type of coverage you choose.

Go for the PPO. Stay away from the HMO. Many doctors won't even see patients with HMO anymore.

Determine your needs. If you are young, single and in good health you are really looking for something that will cover you in the event of a catastrophic event. You don't need to pay for a plan which covers tests, scans, evaluations and the like. You will have to reach your deductible amount before the plan pays for anything but the insurance company (mine anyway) will reduce the amount of any treatments and services to a previously agreed-upon amount. It's basically a discount from list price - and it makes a HUGE difference.

If you are a female (you didn't say) you should consider a plan that allows for mammograms and other female-specific services. If you are a dude, you only have to be concerned with the "rubber glove" which is done during a physical exam.

I have a plan with MEGA and while it's not inexpensive, it provides me with a level of security - even though I have a high deductible. They also have a very good prescription plan where generic drugs are available via mail order for very reasonable prices. I looked at Blue Cross and a couple of others and chose this plan - and I am happy with it for now. I have had this plan since 2004.

My sales agent is named Diana Jones. She has been out of the business for a while but is planning on restarting soon and would be happy to talk with anyone who might be interested in what MEGA can provide. Her cell phone number is 760-420-8221. Tell her you were referred by Robby Beck.

I hope this helps!

[Invicta67]

Thanks for the info "robbybee", I'll check MEGA out and bear Diana in mind.
Have a good one.

[killer2021]

I used Health Insurance - Find Affordable Health Insurance Plans and Buy Medical Coverage Online in locating my health insurance. They have a little survey thing that helps you pick what plan is right for you.

Robby explained it pretty good. It all comes down to how much you are willing to pay out of pocket. Lower deductible means you pay more per month which might not be a bad deal if you are at high risk for going to the doctor (ie. older person).

My health insurance is only for catastrophic problems like a car accident etc. I only pay 65$/month but I am in perfect health and low risk for everything. I'm also in my 20's. As you get older the premiums will go up exponentially, obviously older people go to the doctor/emergency more often.

[CAVA1990]

Originally Posted by killer2021

My health insurance is only for catastrophic problems like a car accident etc. I only pay 65$/month but I am in perfect health and low risk for everything. I'm also in my 20's. As you get older the premiums will go up exponentially, obviously older people go to the doctor/emergency more often.

So what if you get cancer or MS? Many diseases can hit you at any age, regardless of how "healthy" you think you are. Would that $65 cover all your treatments or is this just accident insurance?

[nurserosie]

Originally Posted by CAVA1990

So what if you get cancer or MS? Many diseases can hit you at any age, regardless of how "healthy" you think you are. Would that $65 cover all your treatments or is this just accident insurance?

OMG...we used to call you the "young and healthy" ...who think they are invincible...wow..how untrue

have been a health care provider for over 35 years (retired nurse practitioner)..and my advice has always been..."GET insurance..get the best you can afford" and always choose PPO option..yes it costs more..but as others have said..many docs and even hospitals will no longer take HMO coverage cuz the reimbursement is so low...this will only get worse..

if one cannot afford coverage..yes our ERS have to provide emergency treatment...but not ongoing or follow up...that is scarey if you show up in an ER and they dx cancer or diabetes..and yes it happens at any age ..and in any state of "health"..

do your research...obviously consider your budget...employer based is always better..as then you don't have to deal with "pre existing" conditions...

good luck..ask any other ??

[Invicta67]

Thanks NurseRosie

I agree - insurance is a must - but it seems to be a totally different beast than we are used to.

Having used a price comparison website, my main confusion revolved around what I would have to pay and when:

Am I right in thinking:
Annual Deductable = the maximum I would pay if hospital treatment required?
Physician Office Visits = the amount (eg. $40) is the amount I pay for the stated number of visits?
Prescription Drugs: Seems to have 3 tiers and states "$7,500 deductible/member/tier 2 & 3" - does this mean i pay the stated amount for the tier ($15 etc.)? Surely the $7,500 deductible doesn't apply does it?
Inpatient Hospital 40% = we pay 40% of the bill?

Can you clarify please?

Thank you

[pacific2]

Am I right in thinking:
Annual Deductable = the maximum I would pay if hospital treatment required?
Physician Office Visits = the amount (eg. $40) is the amount I pay for the stated number of visits?
Prescription Drugs: Seems to have 3 tiers and states "$7,500 deductible/member/tier 2 & 3" - does this mean i pay the stated amount for the tier ($15 etc.)? Surely the $7,500 deductible doesn't apply does it?
Inpatient Hospital 40% = we pay 40% of the bill?

My guess about this it that you must first pay $7500 annually before any insurance payments apply. Thereafter, you pay a doctor’s office visit fee of $40/visit for the insured year.

Additionally, you then pay $15/prescription for the insured year.

Finally, you pay 40% of any inpatient hospital stay, again after the deductible has been satisfied. For example, if you have a $10,000 inpatient hospital bill, but have not yet met any of your deductible of $7500, you will be expected to first pay $7500, and then cover 40% of the remainder of the bill ($10,000-$7500=$2500, and then .4x $2500=$1000) for a total of $8500 out of your pocket.

New Year: Start all over again with another $7500 deductible……

Just my take on it. Hope I haven't confused you even more.

I have never used this site, but it might be helpful. It includes a 24/7 help number so that you could arrange to talk to a licensed insurance agent.
Health Insurance - Find Affordable Health Insurance Plans and Buy Medical Coverage Online

Alternately, you might just want to contact an insurance agent not affiliated with the above website, and let him explain the details of available plans.

[Invicta67]

Thanks Pacific 2.

The web site you recommended is the one that prompted my initial thread - so many options makes choosing the right policy a real minefield!!

In the UK we simply visit a Doctor or ER and only pay £7 (approx. $11) for a prescription. We pay National Insurance (similar to your Social Security I guess) part of which goes towards our National Health Service. Many jobs offer Private Healthcare as an option but this is only used in major cases and the deductible is normally very low (under $1,000) so the concept of such a policy just for basic needs is new to us.

Appreciate you help.

[a34dadsf]

Originally Posted by CAVA1990

So what if you get cancer or MS? Many diseases can hit you at any age, regardless of how "healthy" you think you are. Would that $65 cover all your treatments or is this just accident insurance?

Thats a good question