Any advice about buying health insurance and medications?

In My Humble Opinion
1

We might be in a position in which we will have to buy our own health insurance–Rick (my husband) might take a contract job that doesn’t offer benefits and I will be starting my own private practice, so I will be self-employed.

Has anyone been through this before? Would you recommend your carrier? Any pitfalls (aside from pre-existing conditions clauses) that we should look for? Both of us have always had employer-provided insurance, so we are pretty clueless.

Also, I might have to pay for two medications I take regularly. Any suggestions on where to purchase them? I assume the best prices are to be found online, but I would appreciate any reccomendations.

Thanks!

2

Oh are you in for a rude awakening!

Buying insurance on your own is very expensive, and sometimes impossible depending on pre-exisiting conditions. I recently had to get insurance for my SO and myself, and the best price I could find (for the two of us) was about $580 per MONTH! And that was with Blue Cross and it wasn’t even that wonderful of a plan.

I supposed a lot depends on your ages, and as you noted, your pre-existing conditions, if any.

Regarding purchasing of prescriptions, they recently did a few surveys and found that Costco and Sam’s Club and even Walmart were the cheapest. You really have to shop around there was well. Make some phone calls and you will be shocked to hear the price differences.

I really do wish you the best of luck, but you are about to see on reason health care is a hot button topic, and I only wish someone else had been elected President who gave a damn about it…ok, I will step off my soapbox.

One last thought, see if you can find an insurance broker in your area. Sometimes they can latch you on to a group (is United Mobil Home Owners, or Organization Of iPod Users) and slip you into the group, allowing you to be insured more cheaply. It is worth a shot, and trust me, when you start getting those price quotes, you will agree!

And let us know what you find - you are not the only one on this board who would love to find a fairly priced insurance carrier!!!

3

My only advice is to get insurance - and keep it - before you get any “pre-existing conditions.” I’m self-employed, and have a couple of health problems, and cannot get any insurance at any price. I’ve enrolled in a study in order to get some of my meds free, and the rest I get from Canada (while I still can).

Good luck.

4

If you are leaving a group plan, you may be eligible to pick up the cost of that plan yourself for (typically) 18 months due to something called COBRA. Usually you have 60 days after leaving employment to elect your COBRA coverage, but remember that you’ll have to pay th premiums back to the day after your group insurance expired.

Whether you opt for COBRA or not, your insurer should send you a certificate of creditable coverage which states the time period for which you were insured. Don’t lose it, because it can help you avoid veing subjected to pre-existing condition clauses.

I’m in the health insurance business, but my company doesn’t sell policies to individuals so I’m not as much help there. By all means, as DMark suggests, if you can become part of an “association” you end up being able to get insurance less expensively because the association is treated similarly to an employer group for rating purposes.

5

Gah!

Mr. S was downsized in February 2001. Goodbye HMO, and I’m self-employed, so we were covered on his plan. Group plans in professional associations were outrageous (at least on our budget), something like $600+/month for just the two of us and minimal needs.

We ended up going with a plan for self-employed people through Golden Rule. It’s one of those high-deductible ($5,000) health plans (HDHP) with a medical savings account (MSA) that Bush was saying was so great during the debates. Shya right.

I mean, it’s OK if you’re like us: self and spouse only, no kids, minimal health expenses. The HDHP (now $304/month for us, more than doubled since we started on this plan in March 2001) is meant to cover you if anything major happens. You get cancer or need surgery, pay the $5K deductible and the rest is covered 100%. Anything up to the $5K comes out of your MSA, which is basically a checking account. You make deposits and pay your costs out of that. The balance is tax deductible, earns interest, and rolls over each year.

It ended up being OK for routine stuff, because we could plan for those expenses and make deposits accordingly. I have one scrip and my annual OB-GYN exam, and we both have annual vision exams and dental visits every 4 months (me) or 5 months (him). That’s it.

The downside is that whenever you get sick, you start thinking about whether you can afford to go to the doctor. I recently caved and decided to get checked out for a scary but what turned out to be minor problem. $700 and counting. There’s ~$450 in the account right now, and that was supposed to cover my recent OB-GYN exam and our next couple of dental appointments. Not fun dealing with something stress-related when part of the stress is how to pay for being treated.

Fortunately, it’s looking very good for Mr. S to finally get a job that has GREAT health insurance, so (knock wood) we’ll switch to that when he gets the job officially. The HDHP/MSA arrangement was OK for a stopgap, but I’d hate to be on it if I had chronic problems.

Prescriptions: I got a much better deal on my BCs at drugstore.com than at the local pharmacy; I shopped around a bit recently on some other drugs and they still seemed to have a pretty good deal. YMMV and all that.

6

Weirddave might be the guy you should talk to. He works for a company that sells health insurance to individuals - he can not sell to you, so this is not a solicitation in any way - but I’ve forwarded this link to him. He will be able to help you with any questions you’ve got.

7

Brynda - Cobra is extremely expensive and can have many pitfalls for pre-existing conditions. The basic purpose of Cobra is as follows:

That being said, here is a great guide for a Q&A, and guide for those seeking health insurance when self-employed. The page is extremely informative and offers links and quality advice for those seeking health insurance when self-employed.

8

Hiya. I see you are in Michigan. I have private insurance I couldn’t be happier with (Anthem Blue Cross of Virginia). Pay $144/month for service that is about the same as I received from my last employer (includes prescription, emergency, routine visits, even basic dental). Then again, I am young, non-smoker, and healthy. Just the kind of person they like to have on their rolls.

Anyhoo, as they don’t sell my program in Michigan, its not much help to you. My pal Phatlewt recently began private insurance. I believe he has Blue Cross/Blue Shield of Michigan. Perhaps he will find time later to chime in about his experiences.

I have a medication I routinely taken (Birth Control) and it didn’t exclude me from any coverage. I’m sure it depends a lot on your exact condition. & medication. You may have to pay extra for Prescription drug benefit… in most cases the benefit savings outweigh the extra cost. (example: straight-up BCP is $30/mo… I pay additional $5 premium per month for prescription coverage… using the mail order pharmacy I pay $16.48/90 days supply. Total savings approx. $60)

9

Regardless of the policy you purchase and the high deductible it may have, use your insurance card when purchasing prescription medication.

Until I recently went back to work, we purchased a policy for self employed through Blue Cross. Our deductible was $2500 per person, and I never bothered to use the insurance card because I doubted we’d ever meet the deductible. Only later, much too late in fact, did I realize that using the insurance card when paying for the prescription would have entitled us to the agreed upon discounted price between the pharmacy and Blue Cross. Instead, I was paying the full pop for non-insured folks. On one prescription alone this amounted to a lost savings of over $100 per month. I’m still kicking myself in the butt.

10

Huh? COBRA can be quite expensive, that’s true, but the second half of that statement is dead wrong, and in fact is exactly the opposite of the truth. COBRA has to take you regardless of any pre-existing condition, that was it’s purpose-to ensure that people didn’t lose their health coverage (or at least the availability of coverage-the price alone often makes it an unrealistic option) when they leave their jobs because of a pre-existing condition. Even after your COBRA is up, you are still guaranteed coverage availability through HIPAA-although here the prices can get truly astronomical and the coverages often fall to shit. It’s a problem Congress didn’t understand, they thought mandating access to health coverage was the same as giving it to people, which is not the case at all. Just ask the 10 million additional uninsured people in this country since 1996 when HIPAA was signed into law.

11

I was going to write the same thing that Weirddave just wrote (in response to Phlosphr’s post) yesterday but I didn’t have time. That’s the beauty of COBRA - they cannot exclude you for any pre-existing condition. There are certain circumstances under which you can lose your eligibility to continue coverage under COBRA - for example, if your employer cancels its group health plan - but you cannot be excluded for having a pre-existing condition.

One thing to note: COBRA is only expensive if your employer’s total premium was expensive, because you have to pay the whole thing instead of the employer subsidizing part or all of it. If your employer’s premium was at a good (low) rate, then your COBRA payment will be at a low rate. If your employer contributed little or nothing to your health costs, then you are going to pay pretty much or exactly what you paid while employed.

12

Yes, definitely look into COBRA and the price. More than likely it will be expensive, but at the same time the employer plan that your husband was on will probably be much more comprehensive in coverage than an individual plan you may be forced to take (if you and your dependents even qualify).

As stated above, COBRA does not exclude pre-existing conditions. You simply remain covered on the group plan for up to 18 months, only you pay the full price (and I believe the employer can actually add a 2% admin fee to collect premium from you, as the insurance carrier will keep billing the employer for the premium).

One option if COBRA is expensive is to take it for just one month, use your copays for office visits, exams, etc., while you have it. Then worry about your individual plan. THe MSA mentioned above are now HSA’s (Health Savings Account), and with a $5000 family deductible you would be able to contribute up to $5000 to the account, which is completely tax dedcutible AND it rolls over every year and acts just like an IRA (the money is always yours). Of course, HSA-qualified plans come without copays or an Rx plan, but the offset is the lower premium. The simple trick is if a “traditional” family plan is $800/mo and and HSA-qualified high deductibe plan is $400/mo, you simply budget for the entire $800/mo by paying $400 in premium and putting the other $400 into the HSA. Either you use the $$$ in the HSA for prescriptions, office visits, etc, or you don’t, and the money is yours.

The HSA forces consumers to purchase their health care much like they would vehicles, or even their groceries. I know someone who needed a small outpatient procedure done in Des Moines, IA, and he was quoted between $1300 and $1500 from three different offices. He went back to each one and said that he would pay cash, same day. First place said they would do it for $500. The second place said they would do it for $450. The third place went down to $400.

HSA’s are not for everyone though, and I’m just ranting now because I’m sick of our healthcare system. Sorry.

13

HSAs are nice, but the tax advantages are signifigantly better with a HRA, if you qualify. You could get a plan with dollar one coverage and still get a write off bigger than that from an HSA-which often more than offsets the difference in premium price.

14

Is there such a thing as an individual HRA? I’ve only been aware of them in the group market, where the incentive is for the employer to fund the accounts, thus the employee wouldn’t realize the tax deduction, the employer would…

15

An HRA is a Health Reimbursement Account, and they have nothing to do with employees, they can only be set up by sole proprietorships where both a husband and wife are active in the business, or with an individual who is incorporated, with certain limitations.

16

First of all, thanks to everyone who responded. We really appreciate it. I will check out the links and recommendations you provided.

I waited to respond until I could find out how much my COBRA would be. It looks like it will be about $400 a month and since it is a network-based plan and we are moving out of state, everything would be out-of-network for us. All in all, I don’t think it will end up being the best option for us.

sigh

Rick has an interview tomorrow, for a job that has benefits. Keep your fingers crossed for us, as that looks like a much better option. Both of us are in good health, but we do have pre-existing conditions, which makes all this even more difficult.

Brynda (too lazy to sign Rick out, plus he can use the help with his post count.) :slight_smile:

17

Hey Brynda, did you talk to Dave? If you want him to call, email your phone number to him or me. I believe his email is in his profile, and I know mine is.

18

I can’t believe I didn’t see this thread before.

I wouldn’t throw out that COBRA paperwork until you get quotes from local carriers. I work in health care administration outsourcing, so I see the prices. $400 a month to cover two people is amazingly cheap for any sort of coverage - I often see worksheets go out quoting $900 - $1500 a month for just one participant. That’s not price gouging, just 102% of the premium cost (basically what you’ll be paying anyway).

The out of network coverage problem may be a bigger hurdle, but you’re actually probably ok. For most of the clients that I’ve worked on, this is how it would work:

  1. You sign up for coverage in your current plan. (As previously stated, you have 60 days, and another 45 to submit the first payment.)

  2. You inform the administrator (your old HR department usually, unless they’re outsourced) that you’ve moved. Moving out of the coverage area of a health plan is a QSC (Qualified Status Change, as described by Section 152, which controls the typical “cafeteria style” health plan used in the USA).

  3. They’ll allow you to change to another health plan that is in effect in your new zip code. Now, depending on the size of your company, that could be a great thing or a terrible thing, since your company might not have any HMOs or anything in that area. If you’re lucky and/or moving to a highly populated are, you may get to choose between several options with various price tags. You might even end up paying less.

Call up the administrator now, tell them that you’re thinking of moving, and see what they say would be available to you.

If for some reason your company doesn’t work like this (for instance, it is too small to be regulated by section 152), I would check to see what exactly the out of network benefits cover - it won’t be everything, but if you’re in a good plan, it may be 80% or something. Also, sometimes your health plan may have reciprocal coverage with another plan in another state (usually used for “snowbirds” - people who live in the north during the summer and Florida in the winter - or divorcees covering dependent children who live with the other parent, but it could apply to you as well).

On preview, I forgot to add:

  • 18 months is the minimum available, but under certain circumstances it may be extended to 36 months, though it’s probably not circumstances you’d like, i.e. if you got divorced, or one of you became disabled. Also, these are minimums… the company can always choose to be more generous. (Admittedly, this is rare.)

  • COBRA requires the employer to offer you whatever an active employee would be offered (for the health plans controlled by COBRA - typically, Medical, Rx Drug, Mental Health, EAP, Dental, Vision, and (only until the end of the year) HCAs. No life insurance or anything like that). In other words, if you pick up Medical coverage now, at Annual Enrollment time you can choose to get covered in Dental, even if you’re not currently in it. (At the full 102% premium, of course.) Under some, very generous, interpretations of the law, you can pick up any of those coverages at AE even if you don’t take anything now. I wouldn’t count on that one though - it’s very rare. It’s all in how a particular employer’s lawyers read the regulations.

19

Risha, is what you have said likely to apply in my case? I work for a consortium of hospitals and our care is provided by the hospitals and affiliated providers. I dont’ think it is a cafeteria style plan and I know they don’t have any connections to where we are moving, which is out of state.

20

First of all, :smack:. It’s section 125 that governs status changes. Section 152 covers stuff like imputed income and tax qualified dependents. Sorry about that - don’t know what I was thinking.

To answer your question - it depends. It’s really impossible to say without knowing how they’re set up for tax purposes. If they’re large enough, the odds of them being covered by those laws are pretty good. I know of a few similar consortiums of hospitals that are customers of ours.

And they might offer a plan for employees who live far away, or a national plan. It’s not unknown for them to only offer such a thing to those who actually need it, so you might just not know about it.

But all of these are just examples of things I’ve seen in other companies, and many of them are not common. Best thing to do is just call up and ask.