I currently have health insurance through my employer, but I think it is within the foreseeable future that I will need to get it on my own. Right now, the insurance my wife and I have sucks big time, in which we end up paying most of the costs out of pocket, in addition to our monthly premiums. I’m trying not to make the same mistake again now that I am looking for private insurance. I think this would normally be pretty straight forward, but my wife has some monthly medical expenses (doctor bill and prescription meds) that come up to about $300/month, and will continue for a while. I am assuming (without any reason and maybe incorrectly) that we can get these expenses covered through private insurance after meeting our deductible.
If I ask the insurance company specifically about these costs, will they be able to tell me if they will be covered by the deductible? Because if they are, it seems it would make sense to balance out how much of a deductible to get with how much the monthly payments are, and get the cheapest rate there. I don’t necessarily want to scam anyone, but I would like to get these costs covered at the least expense to us also.
This is my first time purchasing private medical insurance. I would appreciate any kind of input on anything related to it, such as questions I need to make sure I have answered which I might not have thought of, or things I should deliberately not mention unless asked.
Thanks for your input.
ETA: I have not talked to any insurance agents just yet, because I am unsure of exactly what I am looking for. I’d like to go at least armed with some knowledge so I don’t get completely ripped off. If anyone believes that it would be in my best interest to just go and talk to one, say so. I’m just trying to be as prepared as I can before I start the process.
I wish I had some useful advice - I just came in to say I’ll be watching this thread closely, as we are in the position of needing to buy The Other Shoe some private insurance as well, and are complete noobs about the whole thing. Thanks for starting this thread!
Ah, on re-reading, I messed a few things up. Her expenses would be about 300/month if we did not have any insurance. Also, I realize things aren’t covered by the deductible. What I meant to say is, would they be covered after we have met our deductible?
I know an accountant who helps, or attempts to help, people with these sorts of questions. She gets her information off the internet someplace, someway.
I purchased a private policy a couple years ago, and suspect you’re in for a frustrating and disappointing shopping trip.
If your experience is like mine, you’re going to find that purchasing private insurance is going to be close to impossible with $300/month in ongoing medical expenses (I didn’t have anywhere close to that, and don’t have any significant health issues, but I still got rejected for several policies, presumably due to a minor surgery I’d had a few years ago).
Or, best case, you’ll be able to get a policy that specifically excludes your wife’s condition, so you’ll have to cover the $300/month on top of what you’re paying.
Good luck, hope your experience finding a private policy is better than mine was. Best bet: move to Europe or Canada.
I was afraid of something like the exclusion you are speaking of. We have a letter saying that she has received coverage before, and my wife says that it means she can’t be refused coverage based on her condition. I’m guessing that means now they would still cover her, just with an exclusion like you mentioned?
That was my experience. My COBRA insurance was $529 per month; to get the same coverage from an individual policy was going to be over $1300 per month. A policy with a $9000 deductible and pre-existing conditions excluded was $728. They really don’t want to sell me insurance.
Not necessarily. Any sort of laws about pre-existing condition coverage tend to refer to group insurance, which is what you get when your employer provides insurance. Individual insurance is a whole different thing, and they don’t have to cover anything they don’t want to.
Depending on just what her condition is, it’s entirely likely they will simply turn you down, or exclude coverage altogether. At the very least, you will pay more because of this. As an example, when I bought an individual insurance policy for Mr. Athena and I, he was taking high blood pressure medication. They still took him, but jacked the rate up. Not hugely, but not the “preferred” rate. And they do cover his medication, right from the start.
Stay on group coverage if at all possible. Find a new group if you have to but keep on group coverage. Insurance is based on spreading risk among a group of people, meaning that the healthy help pay for coverage for the sick. If you get an individual policy you are basically limited to your group of 1 person or a small handful of individual policies that have been grouped together at the carrier and you will therefore have a much higher premium since you have fewer people amongst which to spread the risk. Individual plans cost an arm and a leg because people who are healthy won’t pay that kind of premium so the only people who seek them out are the people who can’t be without insurance so the chance of their paying out on your policy is 100%.
I know it feels like it sucks to have a monthly premium and a deductible but your plan may not be as bad as you think it is. Do you have an HSA where you have an extremely low monthly premium and a high deductible? This kind of plan is meant for those people who really never use their coverage and are looking to be covered in the event of catastrophic illness or injury. Do you have a cost sharing plan with a decent monthly premium and a smaller deductible? This kind of plan is meant for people who use their coverage semi-regularly but are willing to pay some of their costs out of pocket in exchange for a lower premium each month. You can also get a plan with no deductibles and high copays for a higher monthly premium or a plan with no deductibles and small copays for an extremely high amount per month. These plans are for people who have more regular medical needs and know that seeing a doctor 8 or 9 times a year would not be abnormal or, conversely, people who know that they can set aside a specific amount to pay their insurance bill but can’t or won’t save up money to cover the deductible should they need to use it. This isn’t even going into the difference between in network, in and out of network, HMO, EPO, PPO, etc.
As you can see there are lots of different plans available so there should be something that meets your needs. Figure out exactly what your insurance needs are based on your medical needs, the amount that you can pay in premium per month and the amount you can pay out of pocket when using services to have a better idea of what kind of plan is right for you. Talk to your HR person and ask about various plans that are available to you through your work. If there are a couple of different plans and you want some help understanding them you are welcome to PM me and I will be glad to explain them to you.
I too used eHealthInsurance for comparison shopping. I also did some shopping in other states because I am thinking about moving.
You will find that the issues vary greatly based on where you live. Two of the most important issues are called ‘Guaranteed Issue’ and "Community Rating’. The former means you cannot be turned down based on medical history and the latter means that you pay based on age, not medical condition.
In my state, Washington - I get both, with a ‘modified Guaranteed Issue’ which means I cannot be turned down if I have coverage (from work or Cobra). In some states, NY and NJ (I think) you cannot be rejected at all - but costs are very high, often because people are going without insurance because of the cost of individual coverage.
In most states, you must fill out a medical history form and go through ‘underwriting’ where they decide if they want to insure you. If you have Cobra, they cannot refuse coverage - but typically costs for a ‘Cobra continuation’ policy are higher.
To determine coverage, you really need to dig into the fine print of each policy - most can be viewed on eHealthInsurance but will make you head explode trying to compare them. In my research, drug coverage (along with vision and dental) are usually much worse than employer group plans - if available at all.
You also need to look at yearly out-of-pocket maximums (if that applies in your state) - I am looking at a $210/month high deductible plan - where I pay everything up to the deductible and then 50% of anything past that - up to the max yearly. Since I don’t use much more medical service than an annual checkup, that works for me. Even if catastrophe hits, my out of pocket + premiums is about the same as a lower deductible policy with higher premiums. However, if you use a lot, paying more for a monthly policy and less deductible might work out better. You just have to crunch the numbers.
Above all, don’t let your current policy or Cobra lapse - it can be very hard to get insurance after a gap in coverage.
I don’t know hoe it’ll directly affect you but there’s a few health insurance changes from the health care bill passed last spring that take effect on Sept 23, for new policies. Older policies are grandfathered in with other conditions. This includes no co-pays on “well visits”, immunizations, certain cancer screenings, etc.