Health Insurance for self-employed (deductible, low cost, shop)

[texaslamar]

We are self-employed and are planning our move to SD this summer. Any suggestions on CA health insurance plans? Thank you.

[norcalscold]

We're in the same boat, wife and I both self-employed and we carry Kaiser health insurance. For us, the cost/coverage couldn't be beat (we have the $25 copay plan). Kaiser used to have a bit of an image problem in years past, but we have few complaints in the many years we've been with them. You have to be your own advocate and sometimes argue a bit to get what you need, but they haven't failed us yet. Maybe this is true of other HMOs?

[thepinksquid]

My husband and I have a plan with Blue Shield of CA. We pay $128/month for both of us, we have a $35 co-pay for one doctor's visit per year, and everything else is subject to the $5,000 deductible we carry. Maternity is covered as well. We are, also, in our mid 20's and healthy.

[kkii9]

I recommend Blue Cross or Aetna plans in California. They are from my research the most cost effective and coverage options. I personally have the Blue Cross Smartsense 1500 PPO plan, which I like, it has a low deductible, not restricted to doctors, half as much then equivalent plans elsewhere, and $30 co-pay office visits. Cost about $120/mo for me. I used to have Kaiser, I hated it. Took 2 weeks just to get a regular appointment, urgent care for same day doctors took forever, and I thought the doctors were mediocre at best. Same issue with HMOs. I prefer having a PPO plan so I can choose any doctor and specialist. I shopped for plans on uehealthinsurance.com it has a pretty good feature to compare plans when you're doing your shopping.

[avcoastal]

Hi

I too recommend going with Blue Cross - more so that Aetna because of the wide choice of providers in their PPO plans. You can google them (Blue Cross CA) and get a quote on the various plans and options that best suit your needs. I am another former Kaiser patient and would not recommend them at this time.

[RD5050]

BE VERY CAREFUL of low cost Anthem Blue Cross PPO plans, and carefully read and understand how they work, and when they will pay.

Some of their low monthly cost PPO plans require that you must be hospitalized with a serious issue FIRST before they will pay anything in that calendar year.

And while hospitalized, you will need to accumulate hospital charges that meet both the deductible and the entire out-of-pocket maximum first before Anthem Blue Cross will pay anything towards any regular doctor office visits, x-rays, lab work etc, during that calendar year.

And the only way they allow you to meet this deductible and out-of-pocket maximum, is through a covered hospital stay.

Regular doctor visits, and non-hospital procedures (x-rays, etc) do not get applied toward the deductible or out-of-pocket maximum.

Example. You have a car accident and are taken in an ambulance to the emergency room.

The ambulance charges $1500 and the ER charges $7000.

Anthem uses $1000 of the ambulance bill as your deductible, and pays $500 towards the ambulance bill. You pay the remaining $1000 out of pocket.

Anthem gets the ER (hospital) to reduce it's $7000 bill to $5000, and Anthem pays $3000 towards the $5000. You pay the remaining $2000 out of pocket.

Your yearly deductible is $1000, and your yearly out-of-pocket maximum is $5000.

So you've now accumulated only $3000 ($1000 + $2000) in covered charges towards your $6000 (deductible +oop max).

So Anthem will not yet pay for any regular doctor visits until you have another large covered hospital visit in that same calendar year which will potentially bring your $3000 up to the required $6000 in for that year.

So, you could potentially require at least TWO major accidents (or hospital stays) during each calendar year, before Anthem Blue Cross will pay ANYTHING towards your regular doctor visits (and other non hospital care) during that calendar year.

And follow up care (doctor visits, MRI, xrays, lab work, etc) after a serious accident is when doctor bills can really accumulate. And none of these non-hospital bills will be paid by Anthem unless you already reached your covered hospital care $6000 ded+oop max for that year.

The odds of your requiring TWO hospital stays in a single calendar year are pretty low, unless you have major health issues, or are accident prone.

So as I said, make certain you fully understand how the low monthly cost Anthem Blue Cross PPO plans work.

You may find yourself paying $10,000 or more out-of-pocket to regular doctors, specialists, MRI's etc. for follow-up care, and you will still not have met your $6,000 in covered hospitalized charges required by Anthem during that calendar year, for them to contribute anything to your follow-up care bills.

And on January 1st each year, the deductible and OOP Max totals are reset back to ZERO ... so you have to start over again for the new year.