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As a lot of you may know (it's been mentioned a few times in here), I'm self employed and we currently have no health insurance. The last time I priced it was about a year ago, when we started our business. The plans I was looking at then were all over the map, as we weren't sure how fast the business would take off and how much money we'd have to spend on insurance.
With all the talk about health insurance these days, and with all the threads going here discussing the "health care crisis" we are or aren't experiencing and the alleged outrageous cost of plans for those whose employers aren't bearing the brunt, I decided to take another look at the options available and their cost.
What I found was that as long as you're not wanting every single nickle and dime covered, the plans are actually pretty affordable. You do, of course, have to look at the details and really understand what it is you're signing up for, but then, shouldn't you always do that when you're entering into a contract? I would think that would be particularly important when dealing with something as significant as your health. I say this because a big part of the argument for some form of government run health care is that the insurance companies try to weasel out of providing care, and often the care in question isn't covered by the plan. Most people don't read what they sign...
Here's the basics of the plan that best fits our situation. We may or may not purchase this plan in the next month or two - I need to do some more shopping around. The comparison tool I used this afternoon was eHealthInsurance.com. The quote is for two adult smokers and two teenage boys.
Office Visits: $35, 2 per year per person
Specialists: $35, 2 per year per person
Coinsurance: 20% after deductible
Annual Deductible: $5,000, $2,500 per person, two persons max
Rx: Generic: $15 copay, no brand name coverage
Annual out of pocket limit: $3,000 per person + deductible
Lifetime Maximum: $3,000,000 per person
Out of network coverage: Yes
Out of country coverage: Yes, emergency only
Primary Care Physician Required: No
Specialist Referral Required: No
OB/GYN: Basics are 20% coinsurance after deductible
Emergency Room: 20% coinsurance after deductible, $500 copay if not admitted
Lab/X-ray: 20% coinsurance after deductible if performed within 2 weeks of surgery
Outpatient Surgery, Hospitalization: 20% coinsurance after deductible
Maternity: Not covered
Cost: $306.94 / month
There are some things in the list I'd like to see tweaked, but it's really not that bad of a deal. It's certainly not indicative of a "crisis." Would it be a free ride if there was a major accident or illness? No. Would it bankrupt us? No. There's enough coverage there to ensure that we'd get the care we need, and we'd just have to tighten our belts for a while.
I do agree that some things could be done to reduce the cost of health care, but I am, and always have been, convinced that there is no "health care crisis" in this country. Despite all the propaganda being thrown about these days, I still haven't seen anything that even comes close to convincing me that the Federal government should get involved. It's not their job, plain and simple, and if they're going to be sticking their hands into an industry that represents as much as 1/6 of our economy, they're going to have to provide a heck of a lot of proof that it's absolutely necessary. If the states want to experiment with some sort of UHC or mandatory coverage ideas, such as Massachusetts has, more power to 'em. I'm all about states' rights, and they have the right to do stuff like that. The Feds don't. It's not their place, and they absolutely should not get involved.
My experience was very similar to yours. At 62.5 I was laid off and lost my health insurance. I got a $2500 deductible BC/BS policy for $248/month as an individual. I take blood pressure and cholesterol meds but otherwise am in good health (non smoker). Continued to carry this policy until 65 when I got a medicare supplement and part D. The cost for this is almost identical to what I paid pre 65 to BC/BS.
As a lot of you may know (it's been mentioned a few times in here), I'm self employed and we currently have no health insurance. The last time I priced it was about a year ago, when we started our business. The plans I was looking at then were all over the map, as we weren't sure how fast the business would take off and how much money we'd have to spend on insurance.
With all the talk about health insurance these days, and with all the threads going here discussing the "health care crisis" we are or aren't experiencing and the alleged outrageous cost of plans for those whose employers aren't bearing the brunt, I decided to take another look at the options available and their cost.
What I found was that as long as you're not wanting every single nickle and dime covered, the plans are actually pretty affordable. You do, of course, have to look at the details and really understand what it is you're signing up for, but then, shouldn't you always do that when you're entering into a contract? I would think that would be particularly important when dealing with something as significant as your health. I say this because a big part of the argument for some form of government run health care is that the insurance companies try to weasel out of providing care, and often the care in question isn't covered by the plan. Most people don't read what they sign...
Here's the basics of the plan that best fits our situation. We may or may not purchase this plan in the next month or two - I need to do some more shopping around. The comparison tool I used this afternoon was eHealthInsurance.com. The quote is for two adult smokers and two teenage boys.
Office Visits: $35, 2 per year per person
Specialists: $35, 2 per year per person
Coinsurance: 20% after deductible
Annual Deductible: $5,000, $2,500 per person, two persons max
Rx: Generic: $15 copay, no brand name coverage
Annual out of pocket limit: $3,000 per person + deductible
Lifetime Maximum: $3,000,000 per person
Out of network coverage: Yes
Out of country coverage: Yes, emergency only
Primary Care Physician Required: No
Specialist Referral Required: No
OB/GYN: Basics are 20% coinsurance after deductible
Emergency Room: 20% coinsurance after deductible, $500 copay if not admitted
Lab/X-ray: 20% coinsurance after deductible if performed within 2 weeks of surgery
Outpatient Surgery, Hospitalization: 20% coinsurance after deductible
Maternity: Not covered
Cost: $306.94 / month
There are some things in the list I'd like to see tweaked, but it's really not that bad of a deal. It's certainly not indicative of a "crisis." Would it be a free ride if there was a major accident or illness? No. Would it bankrupt us? No. There's enough coverage there to ensure that we'd get the care we need, and we'd just have to tighten our belts for a while.
I do agree that some things could be done to reduce the cost of health care, but I am, and always have been, convinced that there is no "health care crisis" in this country. Despite all the propaganda being thrown about these days, I still haven't seen anything that even comes close to convincing me that the Federal government should get involved. It's not their job, plain and simple, and if they're going to be sticking their hands into an industry that represents as much as 1/6 of our economy, they're going to have to provide a heck of a lot of proof that it's absolutely necessary. If the states want to experiment with some sort of UHC or mandatory coverage ideas, such as Massachusetts has, more power to 'em. I'm all about states' rights, and they have the right to do stuff like that. The Feds don't. It's not their place, and they absolutely should not get involved.
I doubt this is legit. I have never heard of health insurance for a family of 4 to be this low. If it is legit, please post after you buy it and have the opportunity to use it.
NO NO NO! BOLOGNA! That's not what your premium will be. You haven't applied yet. Before you get approved, The insurance company is going to send you to have a physical and they will have all of your medical records pulled. They will take everything in your history into consideration.
Ok.
Quote:
Originally Posted by ozzie679
Who is the carrier?
United Health One. Never heard of 'em. See one of my last posts for more on that tangent - I don't like repeating myself when the information's already been given.
Quote:
Originally Posted by ozzie679
If it's so affordable, why don't you already have aprivate family plan? IMHO you're way too nonchalant in this post.
Ok, I'm going to have to refer you back to post #1 in this thread, and this time, I recommend you read it a bit more carefully. You clearly saw something that set you off, and you zero'd in on it without reading the rest of the post.
$500 copay for ER if not admitted? After a $5000 deductible?
Only two covered doctor visits per year and then you still have to pay $35? Last time I paid for a regular visit, it cost $95.
Lab/X-ray: 20% coinsurance after deductible if performed within 2 weeks of surgery? Very few of my labs and x-rays were related to surgery. No coverage for non-surgical labs and x-rays.
No brand name drug coverage? Those are the ones you need some coverage for. If you are prescribed a drug that isn't off patent, you have to pay the full cost yourself. There are cases where the brand name drug is the best choice.
I can see why they don't require referrals for specialist -- they're only going to pay $70 total per person no matter where you go or who you see.
Dude, that policy sucks.
I'm going to post that on some of my other boards where non-USAns post. They can't believe how our insurance works and how much we pay.
$500 copay for ER if not admitted? After a $5000 deductible?
Only two covered doctor visits per year and then you still have to pay $35? Last time I paid for a regular visit, it cost $95.
Lab/X-ray: 20% coinsurance after deductible if performed within 2 weeks of surgery? Very few of my labs and x-rays were related to surgery. No coverage for non-surgical labs and x-rays.
No brand name drug coverage? Those are the ones you need some coverage for. If you are prescribed a drug that isn't off patent, you have to pay the full cost yourself. There are cases where the brand name drug is the best choice.
I can see why they don't require referrals for specialist -- they're only going to pay $70 total per person no matter where you go or who you see.
Dude, that policy sucks.
I'm going to post that on some of my other boards where non-USAns post. They can't believe how our insurance works and how much we pay.
Yeah but then there are plans like the one I currently have at work
15$ doc
25 spec (no referral needed)
100 surgery
50 ER waived if admitted
RX 10,20(preferred brand), 50 (non preferred brand)
No deductible
500$ a month (250 a paycheck)for a family of 3
I just had major surgery. The insurance has been billed over 40,000$ so far. My responsibility is 100$. I love my plan, and there are no pre-existing condition limitations with it either. It's through Optima.
Yes my company offers a cheaper plan, but I am willing to pay more for the better coverage. Especially given the fact I've had surgery twice in 18 months.
This plan isn't even a Volkswagen; it's a tricycle. There are a number of drugs for which there is no generic equivalent. Your doctor may be able to find something "comparable", but it might not be the drug of choice for your condition. Lab work isn't too expensive (usually), but X-rays such as MRIs, CAT scans, etc, can get up there.
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Nuclear stress test: $4,000. We are so ripped off...I can't imagine why people aren't as agitated about that as about having the government help out all of our citizens with health costs.
By the way, if your post isn't completely fabricated (which I suspect it is)
You know, Nancy, I was going to respond to your questions and other points, but this statement earned you a drop down to rung zero on the respect ladder. You don't deserve a response.
I gave the site I used. My location is listed in every post I write. I said how many people the quote was for, and that we both smoke. It would have taken you less than five minutes to confirm or disprove what I said, but no, you opted to call me a liar, instead. Good job.
I'm being 100% straight in this thread. I'm not spinning a single thing, I'm acknowledging the deficiencies in the plan I posted, and I'm giving out more personal information than I normally would, all for the sake of trying to have an honest conversation about what the real options are for the average family under the current system.
Thanks for the input, Nancy, but no thanks. You can take your opinion and .......
No that means you'll have to pay 5,000 out of pocket before they pay anything. But instead of making each family member pay they pool the money.
Example 1
You pay 2500 out of pocket and meet your deductible they they pick up your appointments
Your wife pays 1000 out of pocket still owes on her deductible
You daughter pays 1500 toward her deductible out of pocket
Your other child pays 0 toward his/her deductible
Example 2 (this happened to us)
You pay nothing toward your deductible
Your wife meets her deductible + several thousand additional deductible
Your children pay nothing toward their deductibles
You and your children still have to spend a combined 2500$ out of pocket before the insurance picks up your costs.
The day you meet your deductible they pay more for you, but not the rest of your family. Once the families combined money spent is 5000 they pick up everyone even if their individual deductible is not met. We had a plan like this, and I hated it. One trip to the ER, and I met my deductible. The rest of my family still had to pay out of pocket. The thousands of $$ I spent, above my deductible, on surgery did not apply toward our family deductible. Meaning we were spending a lot of money on health care. One upside is the rate that you pay for medical care when you have insurance is less than what you would pay without insurance. Insurance companies have contracted amounts as to what you can and can't be charged.
Thanks for the info! I figured it'd be something like that, but I hadn't looked into it all just yet, and I didn't want to state something as fact when I wasn't sure.
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I wager to bet, this is a scam
