Does anyone have it? I guess this is GQ, so I just want to know if you would recommend it. Is it as advertised, or do you get hassled when making claims?
I have it, the one for the self-employed. My two daughters are on it with me.
For the most part, I’ve found the Humana folks I’ve dealt with on the phone to be polite and friendly.
The insurance itself is good - IF you make sure that what you’ve got going on is covered. Two examples:
- my son was carjacked in March of 03 (he was on it at the time). His sister took him to Baptist Hospital. Humana paid the claim as an emergency, no questions asked, boom.
- I had to have an emergency appendectomy. I was sent to St. Dominic’s Hospital by my doctor, where they did the surgery post haste. Humana turned this down because St. Dominic is not in their network (I was too out of it to be able to check). Even though my doctor wrote a letter to Humana stating it was a ‘medical necessity’ or whatever, they wouldn’t pay it. However, they did talk the hospital into cutting the bill down (about half).
Another problem I have is with getting things resolved. I think one of the ways they are cutting costs is by cutting staff. Thus, when I send in the evidence that my daughter is still in college and therefore still eligible to be on my plan, it takes them about 3 months to acknowledge it. This past year they got the older one’s paperwork on the medical side, but not the dental - so they dropped that part. :rolleyes:
Other than that it’s been fine. The prescription part is good, most medicines I get are $5 each.
Not a Humana policy, but I have a high-deductible policy. Don’t worry about making claims. You won’t have to unless the need is quite obvious (i.e. your arm is in the cooler next to you). Nothing like forking over $100 a month, then STILL paying $600 even though you went to their “Preferred provider” for a simple allergy test. :mad:
since the OP is looking for opinions, IMHO is the place to go.
Samclem Moderator, General Questions
Insurance is complicated. I highly recommend sitting down with your agent and explaining your situation and having them give you several plans to choose from that would best suit your needs. When I help customers with their insurance* I tend to recommend that they pay a little more per month and have the peace of mind that comes with the better coverage if they can afford it. If they can’t afford it I make sure that they understand that the trade off for their low cost insurance is going to be higher costs when they need medical care. Make sure you really, truly understand the policy you are buying before you sign up for it because the time to deal with all the complicated language and exclusions and whatnot is now, while you are healthy and calm, not when your leg has been severed and you are trying to get someone to sew it back on.
*I am an insurance agent but I am not your insurance agent. Please contact your agent for any specific information you may need.
I have an HDHP. Administratively speaking, my carrier (UHC) is no sweat.
The critical thing to get into your head about HDHP is it is truly “insurance”, not the “magic somebody else pays 98% of my bills” thing many of us have enjoyed for the last 30-ish years.
Under HDHP, the insurance pays for BIG expenses. You pay for small expenses 100% out of pocket. How small is “small”? For my plan, $8000 / year between wife & I. So I must consider my worst-case annual health expenditure to be whatever the premium is, plus 8000 additional out of pocket dollars.
For me alone, my annual OOP is about $200. For my wife, more like $5K. So over the last couple years of HDHP I have gotten a grand total of $0 paid for by insurance. Just like my car insurance hasn’t paid for new tires, nor my homeowner’s policy paid for painting the trim.
If wife has another acute episode, or I develop something nasty or get seriously injured, then the insurance will pick up the $100K I really couldn’t handle (but only after I lay out my $8000). And that’s what I’m paying premums for. Not to cover my annual checkup or pills for a cold, or an annual eye exam.
The real value of the HDPD versus going completely bare is that I get the “discount” on services as if the insurance company was paying. With no insurance, I’d be paying full retail. Kinda like full fare on the airlines, full-up retail price on medical is a lot more expensive than you think it is. $400 for a quick visit with your GP for the sniffles, $800 for a blood test, etc.
Couple an HDHP with an HSA for tax avoidance and a disciplined approach to saving & you have a decent mixwhich can save you some money, or a lot if you’re healthy.
Bottom line:
I am a great candidate for HDHP becuase I am very healthy. The money I don’t spend on PPO/HMO premiums goes into the HSA and I end up a bunch ahead. I’ll still be ahead (a little) even if something bad happens next year.
My wife is a crappy candidate for an HDHP. She’s got enough maintenance meds & periodic checkups to eat up all her premium savings in higher OOP costs.
Together it’s just about a wash versus a traditional HMO/PPO.
HDHP is ideal if you’re planning to have a near-fatal car accident. Just make sure to get your pre-certs approved first.
I’m self-employed with no health insurance at all. And it’s stuff like this that makes me not question that position.
Not having a family, why the hell would I want to shell out money for… nothing? If I go for an emergency appendectomy at the wrong hospital they’re going to fight it, and I’ll end up paying anyway.
I’ll save my money until we get some sort of genuine insurance going in this country. If I can be assured that I’d actually get something for my money, I’ll sign up.
If possible in your area, you might want to see if you can find a job with minimal hours. I worked at a hotel and as long as I got 20 hours I got health insurance through them. They let me work 10 hours a day Sat and Sun (the two days most people want off). I made 50¢ more than minimum wage, but it was OK cause it was good insurance.
So you might want to see if Starbucks or some other store offers insurance. Even if it gets to be too much, once you are in with the group plan, you can quit and get Cobra. I found it only ran me $200/month when I left. And it was great insurance through Humana. And I got to keep the Humana Insurance through COBRA for 18 months.
I found Humana easy to work with, as long as you undertsand things. Like not everything is an emergency. Actually I’m surprised the hospital you went to didn’t send him elsewhere when they found out Humana wasn’t in their network (for the appendectomy)
If you want to avoid having to have everything approved before hand I recommend looking into a PPO. These tend to cover you anywhere and everywhere but provide less coverage than an HMO which would only cover you at certian doctors or hospitals.
Please, please don’t go without insurance if you can help it. You may not ever need it, but if you get diagnosed with cancer and you have $100,000 worth of doctor bills and treatment and exams you will really wish someone was there to cover part of that expense. A HDHP would be for that kind of thing, not for regular check-ups and the like, and could be the difference between being in debt for a while and losing everything to pay for your medical bills should an emergency situation come up.
Hubby and I are both self-employed, and have a policy that costs us about $350/month and has a $3850 deductible. After that, they pay 100% of everything.
Being recently diagnosed as a diabetic, I’m guessing that next year there’s at least a chance I’ll max out that deductible. I’ve been bumming about not having chosen a lower deductible, until I really thought about it. I’ve had lots of employer sponsored insurance plans that are 70/30 or 80/20 plans (that is, you pay 20 or 30% of costs up to a max that’s typically around $10-15K/year). It’s not like there’s no out of pocket on those plans, either. At least with mine, I know my out-of-pocket will not exceed $3850. High, but at the same time, we’d pay at least a couple hundred bucks more a month for a plan that paid for more. It’s all about finding the balance point.
Seems to me that only big businesses offer that kind of insurance anymore. I’ve worked for many small to mid size companies that had pretty high co-pays and the aforementioned 70/30 or 80/20 plans.
I was surprised, too. But probably by the time I was admitted, it was too late to send me down the street to Baptist.
I was frankly suprised that St. Dominic wasn’t in their plan. shrug
This is what I was wondering. Even if I’m well under my deductible, I can still present my insurance card to my physician or my pharmacist and get the rates that Humana would pay for the product/services, right? Not the rip-off $300 for a blood test rate…
LSLGuy makes some very good points, and I’d like to add to them. Let me use some real numbers for a client I just helped. She had some regular medical issues and elected to go with an HSA qualified HDHP (forget the HSA for the moment, although it only enhances the point I’m making). She has a $2600 annual deductible for prescriptions and medical combined, then the plan pays 80% and she pays 20% with her 20% capping at an additional $2K. For this she pays $150/month. Her total annual liability is thus $4600, and she is spending $1800/year in premiums, thus her total annual medical expenditure is $6400. Her choice was between this and a traditional PPO plan with a $500 annual deductible, 80/20 coverage with a $3500 out of pocket maximum for her (including deductible), co-pays for her Dr visits and medicines (in other words, a fairly typical PPO plan), priced at $390/month. See, here’s the fucked up nature of how people think health insurance: Everyone she knew was telling her to go with the PPO plan because it had a lower deductible, co-pays at the doc, scripts were covered right away, etc, etc… I told her to add up the total numbers and then make the smart choice. I’ve done the HDHP math above, doing the PPO math we get $3500 oop, $4700 in annual premiums- that’s $8200 right there-PLUS doctor co-pays and Rx co-pays (not included in OOP max), with the meds she’s on and the number of times she goes to the doctor, this will easily add up to several hundred dollars more. Once she looked at the numbers, the choice became obvious. She benefited because she purchased the insurance instead of trying to cover herself with a bloated entitlement plan that makes no sense. Having low deductibles, low co-pays at the doc, etc makes perfect sense if you’re not paying for it-as in an employer is offering you a benefit in lieu of salary, but when you’re the one footing the bill, insurance, actual insurance the same way one insures their car or their home or their other property…it almost always just makes more sense. We wouldn’t have a health coverage crisis in this country right now if people were willing to pay for the small stuff out of pocket-while insuring themselves against a major loss.
ETA: I forgot to come back to the HSA: In addition to the lower costs above, her HDHP will get her an additional almost $5K/year tax deduction as long as she pays for her out of pocket costs thru an HSA. At a 30% average tax rate, that’s an additional $1500/year savings for her, making her true annual medical cost under $5K/year.
/hijack I was one of the last babies born at St Dominics, it’s cool to see it so casually mentioned, since I’ll be 40 on Saturday! (I worked at Baptist through college, too, once I moved back from CA.)
Sorry for the hijack.
WeirdDave, you confirmed kinda what I’ve been thinking - for a lot of people, the HDHP makes sense. I added up the numbers, and the total out of pocket for both me and my hubby is about $8400/year - not bad, considering your client was at $6K for one person.
Also, I just wanted to say that WeirdDave is an incredible source for info about health insurance here on the Dope. He took the time to talk to me several years ago when I first was in the market for self-employed health insurance, and I’m still reaping the benefit of all the stuff he explained to me. And all of this knowing he could not sell me anything because I lived in another state. Thanks again, Dave!
(and, for what it’s worth, I once again tried to get a quote from your company, WeirdDave, about a year ago. For the life of me, I couldn’t get the local rep to call me back…)
Excellent info. (By all posters) But I have one more question:
When I was on an employer provided health-plan, the premiums (not sure of the right term, but the portion I had to pay) was taken out of my check and I didn’t have to pay tax on that.
But, if I understand correctly, since my job now doesn’t have an employer plan, I have to pay the premiums after tax?
That makes no sense. It seems as if the government is saying that if you have a shit job with no health bennies that we will tax you for buying private insurance, but if you have a good job that gives you group coverage, then you pay no tax on your premiums.
Am I mistaken?
Sounds like you had a Cafeteria Plan with the premiums taken out of that so that the amount was tax-free.
I’m not sure what deduction (if any) there is for someone whose job doesn’t pay benefits yet isn’t considered ‘self-employed’. It looks like you can deduct the amount paid for premiums, although bear in mind I’m not a tax professional:
From here.
Here’s the way it works for self-employed: when I do my taxes, there is a spot to put the expense of my insurance premiums (Line 29, Form 1040). I think that comes straight off of your income - it’s not taxed. Also, the amounts I put into the HSA aren’t taxed (there is another worksheet for that, Form 8889; the amount is entered on Line 25, Form 1040).