Health Insurance is the Devil

I feel like I’m in a casino, except that there’s nothing to win and so much to lose; I’m just gambling on how much I want to lose. Such fun.

I get to spend a few years in the lovely state of IL. My current insurance, while free, only covers emergencies if I’m out of town, which I will be. That’s just fine and dandy if I get run over by a tracter or if some irate farmer pitchforks me, but if I get a strep infection, they’ll only start paying after I end up in the hospital because it killed my kidneys or something. I decided that I’m going to get an individual health plan. Easy, right?

It turns out that I won’t be shelling out much cash for one of these. I’m in my mid-20s and rather healthy. Us yonguns get a good deal (translation: we won’t hardly ever need to actually make use of the plan, therefore we are most likely just flushing our premiums.) Now I just need to pick a plan…

I am paralyzed by choice. How the heck do people choose an insurance plan and walk away feeling like they made the best choice possible? There are so many variables. Even just keeping things simple, there’s the deductible, max payment after deductible, drug benefits (yes, no, and how much if yes), office visit prices, etc. I am baffled. The only thing I’m sure about is that I don’t need maternity coverage! Are there any general guidelines for these things? Do any of you have Sage Advice? Any thoughts, bits of wisdom, or recountings of past experiences would be much appreciated.

(I have trouble believing that this hasn’t been asked before, but searching for “insurance” didn’t lead me to anything.)

I am an insurance agent, and though I work in auto insurance, I can tell you that when choosing insurance you either need to be prepared to pay out the nose for a policy that will rise in cost every term if you make use of it or pick an affordable plan and know that it is only for extreme emergencies that you simply cannot afford. That is how you should look at it in the automobile industry anyway. Health insurance may be a bit different though, and I do not claim to be an expert on that. Generally speaking though insurance is meant to keep you from being financially destroyed by a major incident, like having your 2 year old lexus stolen and chopped up for parts. Anything that costs less than your deductable is something you probably shouldn’t report to your insurance company (again, in auto insurance-check with a health insurance agent for information in that field).

Are you sure about that? As in, do you have something in writing from the insurance company that says so? I used to work for an HMO (and I’m assuming you’re in an HMO based on the out-of-area issue) and we frequently paid for emergency room visits even if the underlying reason for the visit didn’t qualify as an emergency. One I vividly remember some eight years or more after the fact, some princess was in Hawaii for spring break and her sandal rubbed a blister on her dainty foot. She went to the ER and we paid for the visit. I’m getting pissed off just thinking about it now.

So yeah, anyway, before making any final decisions (and I assume you haven’t dropped your existing coverage yet), talk to the insurance company and clarify the emergency coverage, urgent care coverage, whether you can get referrals from your primary, etc. Not-so-great coverage for free may turn out to be better than buying an individual policy, especially if you’re in good general health.

Yep. It ain’t the typical insurance; it’s a school-based thing. They’ll pay to airlift me out of Africa, but no strep swab. When that tractor runs me over, they won’t pay for the PT. Any referrals are to have some med student or resident poke and prod me down the street at the med school hospital. This does me no good in IL. It’s free, and I’m keeping it, but I need something more, which surely folks on this board have purchased before.

I am a health insurance agent in CA, so I’ll offer you some general advice.

In your mid 20’s, if you’re in good health I would go with a plan with a mid-high deductible as this will bring your monthly premium down. You say you’re only going to be there for a couple years and are currently on a school plan so it sounds like you’ll be going into the workforce in a couple years at which time you will likely have an employer sponsered plan. Basically you want something to help out in emergencies for a couple years.

If you’re not taking any prescriptions at this time I would look for something that covered generic drugs as cheap as possible but wouldn’t be so concerned about brand name coverage.

One of my normal group of questions to prospective clients (of which you are NOT one, hence this being general advice :wink: ) is, what medical care have you used in the last 5 years? Do you go to the doctor once a year for a check up or more often? Have you been in the hospital, do you take any prescriptions? If the answers are very little, just once, no and no…go for low premium/high out of pocket coverage at least for now. If not, then you can look at other options.

I hope this is somewhat helpful, if not feel free to post more and I’ll get back to you.

If you’d like to drop me an email, I’d be glad to help you out, I’ve done it before. You’re not Md based so I won’t get anything out of it, but I can put you in touch with someone in your area. For someone your age, your premiums shouldn’t be that high, even with fairly comprehensive coverage.

Well to show how little I know about this, I didn’t even know there was such thing as a health insurance agent. What do you all do? What’s the advantage of going through one instead of just applying directly to the health insurance company?

Thanks for the replies. Sorry about my slow turnaround time; work is long this week.

Yes, as Antinor01 put it, I “basically…want something to help out in emergencies for a couple years.” I’m not anticipating any problems, but I don’t want to invite any.

In what situations would someone want a really high deductible/low out of pocket, the opposite of what you described? I guess I’m sort of generally interested in how all this works. It’s something I (luckily?) never really had to deal with, mostly due to lack of choice

Growth in the health care industry has been in the double digits for years now, so this is definitely something to educate yourself on.

Just so you know where I’m coming from, I work for an HMO as well.

Antinor01 actually suggested a low premium plan, not low deductible.

A deductible is how much you have to spend annually before the insurance kicks in and starts paying for part of your health care. In general if you have a higher deductible (more risk for you) you get a lower monthly premium. People who are generally healthy and young can afford to take the risk and benefit from lower premiums.

Low dedutible plans are better for someone with a chronic illness like diabetes or asthma that requires maintenance medication and frequent dr visits. Since at that point there isn’t a risk of you needing health care so much as a certainty, you pay much higher premiums. “Out of pocket” is a misleading term since it only technically applies to money you pay in addition to premiums, but it’s all (premiums, deductibles, and copays) coming out of your pocket.

One of the sneakist things that health plans are doing right now to shift the cost to the patient is to charge a percentage copay rather than a flat fee. For example: my personal health plan charges $15 for a dr’s visit and $25 for an ER visit. My SO’s plan charges %10-%20. That can add up very quickly.

You probably don’t need prescription drug coverage unless you’re on a maintenance medication already. If you do have to take an acute medication like an antibiotic it’ll probably be either generic and cheap. or else it will be brand name and therefore not on your insurance’s formulary anyway :wink:

If at all possible, get dental insurance. There are few things worse than needing dental care and not being able to afford it.

BlueCross/BlueShield (whom I don’t work for) offers dental coverage with no deductible for $23/month here in Oregon as long as you are on any of their medical plans.

You also may be able to deduct all or part of your premiums and other expenses from your income, so save your reciepts.

If you decide to go with a high-deductible plan, check out an HSA. It’s another way to save for medical expenses tax-free.

Good luck, and feel free to email me if I can answer any specific questions.

In most if not all states in the US you must be licensed by the state to sell insurance. Some agents work on their own and sell for a number of companies. Others have exclusive contracts with one company and only sell for them but are still basically on their own. And others like myself, work as an employee of a health care company. All of these groups of people hold one of the two same licenses, usually a life/health license which allows you to sell life and health insurance or a Property/Casualty license which allows you to sell pretty much anything except life insurance.

Speaking from my own experience, both as a consumer and insurance professional, I prefer to deal directly with companies whenever possible. As always, YMMV.

What you’re trying to describe there is low or no deductible/higher premium. Those type of plans are best for people with chronic conditions, older folks and I often recommend them for people with school age children, expecially if they are involved in a lot of extra-curriculars.