Question for DUers who purchase their own Health Insurance

[ComerPerro]

Given that I have been laid off twice this year and had a contract cut short by one employer, its been hard for me to keep health insurance that I once had.

And, after calling the pharmacy and finding that the perscription I take every month that used to cost a $20 copay will now cost over $400 a month, I find the need for individal health coverage to be quite pressing.


So far I have been looking at plans through Blue Cross, Humana, and a few others.

Looks like a $500 deductible with office copay of $25 and perscription (name-brand) coverage with copay of $30, as well as hospital visits, is gonna cost around $160 a month for my area.

I am prepared to pay this if I have to (its cheaper than $450 a month for perscriptions, that's for sure).

But I would just like to survey some of you, see how you get coverage if you have it, who you go through, what kind of plan setup you have, and what kind of premium you pay.

Given the personal nature of this information, If you don't want to get specific that is fine, especially in a public forum like this. If you would like to send me a PM, that's fine too.

I am really just trying to find out where I might want to look, what companies other DUers are happy with, and what kind of services I should expect for my money.


Thanks for the responses.

[W_HAMILTON]

1. They probably won't cover pre-existing conditions

Meaning, they probably won't even pay for any of the prescriptions you already take. Depending on the type of conditions, they may just turn you away.

Individual healthcare is, in my cases, crap. If it's at all possible, I would look into getting a job that has group healthcare as soon as possible (well, duh I guess). Also, you can check around your town and see if there are any group plans you could get into.

[Kber]

3. They have to cover pre-existing conditions now.

New law passed under Clinton.

[W_HAMILTON]

9. It depends

It would depend on how long they've had continuous healthcare, and what types of break in coverage there are.

Also, if you are referring to what I think you are referring to, that only works for group plans I believe. It sounds like the original poster is just interested in buying an individual plan.

[OhioBlue]

12. I think you are right

that it only applies to certain types of group plans. In 2002, I switched insurance - started with a new organization and pre-existing conditions were not covered - they were defined as any treatment in the past 6 months. Since then , the organization that I'm with has switched insurance plans and all pre-existing conditions are indeed covered under their new plan.

For the OP to purchase his own insurance plan, his meds might not be covered until he has not been treated for the condition for a certain amount of time. It may take some creativity - ask the docs for samples, seek generics, etc. until a plan will cover the meds.

[sandnsea]

31. No they don't

I talked to an insurance company just a few weeks ago and he told me that my doctor's visit about my ear would cancel out treatment for it and my head pain; and that the only way to get my husband on was to just shut up about his hernia because he hasn't gone to the doctor for it in a long long time. If you have insurance, it's transportable. But if you don't, you're screwed, or you have to sign up with the state insurance program which is astronomical.

[SiouxJ]

38. They get around this by making the policy outrageously expensive

Yeah, they have to cover you but you'll pay way more than you would if you just paid all your medical expenses out of pocket. It's a joke really.

[Kber]

2. My husband is self employed

and I got laid off two years ago (about 6 weeks before I got pregnant - good timing no?)

Anyway, he hired me as an employee and we applied for health insurance as a two person company. Not sure if this is an option, but it was several hundred dollars a month cheaper for us.

[evlbstrd]

4. Not a bad premium.

You must not be covering dependents.
Besides the obvious need for insurance in general, keep in mind that, if you accept new employment and a company health plan, you'll probably have to show that you've been continually covered.

[ComerPerro]

19. yeah, im 24, not married, so no dependants. just me

[evlbstrd]

34. While I was unemployed,

I paid two months of COBRA premiums to continue my employers group plan. That cost over $700 each month. I found another plan on my own and still paid over $370 a month for much less coverage, higher prescriptions, all that. By the way, I carried my two kids on that.

[Yupster]

35. Seems like a great rate to me

We were paying almost $ 900 a month for catastrophic care only.

My wife went on the State High Risk Pool and that saved us a little more.

I ended up selling my business and going to work for a company that offered insurance.

Biggest problem I had with my own plan was that it went up so much every year even without us filing a claim. Twenty percent increases seemed normal.

[Rose Siding]

5. That looks like an amazingly good price to me

We have ins through my husband's word. For a family of 3, with $200 deduct, our monthly premium is nearly $800.

[ComerPerro]

20. just me though, even if i was married it would be 400

[Rose Siding]

29. You mean they more than double it for 2 people?

I wonder if that's for the possibility of maternity costs. Since only married people ever get pregnant. ;)

Seriously, that sounds like a great deal.

[ComerPerro]

30. i thought that odd as well

[leftofthedial]

6. Anthem BCBS

Premium has gone up 32% in the last year. My prescription copay on a monthly refill scrip also went up from $30 to $40.

[OKNancy]

7. $160.00 per month!!

That sounds really low. You must be young.
A plan like that for my husband and me ( both over 50 yrs old ) is about $800 or more per month.

[ComerPerro]

21. 24, single, no children

[Fridays Child]

8. Where I live, that would be an unimaginably low premium for an...

...adult male with a less than perfect medical history. Have you checked Pacificare? I think they just merged with another biggie. Also, see if Aetna and Cigna offer individual plans in your market.

Good luck. :hi:

[ComerPerro]

22. not sure if they are in Kansas, I will look

thanks!

[datadiva]

10. That looks like a really good plan to me

I am 61, pay 490.00 a month with a $500 deductible, even for tests. Do not cover prescriptions. I get a discount of about 20% on prescriptions. I also have a copay of $25.00.

[SmokingJacket]

11. Sounds good to me.

I don't know what coverage for one person goes for around here, since I buy insurance for a family of four, but that sounds reasonable to me. In this state, I don't think you can get anything LIKE that. My policy, the only one I could find, has a $10,000 deductible -- and you have to pay out of pocket for everything until you reach that point. No prescription coverage. It's through Mutual of Omaha and they apparently got rid of these individual plans everywhere except in NY, where it was against state law.

We pay about $4,500 a year for the policy, and whatever else we need to pay for actual health care. Not a great deal, but at least we won't lose our house if someone has an accident or gets sick.

[W_HAMILTON]

13. To follow it up

If you plan on buying an individual plan, most places are not required to honor pre-existing conditions. In fact, most healthcare providers will deny your application outright depending on what type of pre-existing conditions you have.

If you apply for healthcare and get turned down, that will severely put a damper on any future individual plans you are able to get.

So as I said before, my advice is to look to get into a group plan asap (through work, or sometimes organizations in your city).

If you are worried about being insured for any future problems, I would look into getting short-term healthcare insurance. You usually cannot be denied for it, it's relatively cheap, and will be enough to tide you over for about six months. Again, this doesn't cover any pre-existing conditions though. You would take this out if you are just worried about anything popping up in the near future that you would need healthcare insurance for.

Otherwise, I would just say to save your money to use on your prescriptions and medical care now, and just try to get a group insurance plan as soon as you can (even though it's easier said that done).

Unless I'm completely off-base -- which I don't think I am, I've done a lot of checking into this in the past -- there isn't much you can do (short of getting into a group plan) that will lessen your medical bills right now.

[ComerPerro]

23. That's a lot of what I am trying to find out.

What I've heard from the people I've talked to from a few companies is that since my last seizure was over six years ago and has been controlled by medication, then they would cover the perscription costs since its just preventative...

Hope its true.

Thanks for the advice though, that is one of my concerns.

[W_HAMILTON]

32. Keep checking around

Call the companies and seeing how they would handle a seizure. And I would check a few times, with different CSR's. I called BCBS one time and one of the ladies told me something, then after I signed up, I found out that she was wrong, and it was too late to cancel my plan. I'm not sure how they view seizures. I know certain things, like having had cancer, and high blood pressure, usually means automatic denials if you apply. I would think, at best, they would accept your application but not cover seizures (or any medication to treat or prevent them), and at worst they would deny you outright. So it sounds like even in a best-case scenario, buying an individual plan wouldn't help with your medication costs right now.

Also, you can ask your doctor and see what he would think insurance companies would do. He would probably have a good idea whether or not they would accept or deny your application.

Don't give them any personal info, and don't apply unless you are relatively sure that you will be accepted. As I said, if you are denied, that causes future problems if you try to buy an individual plan, ie, you can't get a short-term health insurance policy for the next five years if you are denied coverage.

Also, if you aren't already using them, see if the type of medication you take has a generic version. That would help some with the price, assuming you are using the name brand version now, and assuming they have a generic version.

And another off-the-wall suggestion; you could check with local colleges to see what their requirements are for healthcare. They would qualify as a group plan, and you may only need to take a couple of classes a year to qualify, it just depends. But it would be worth looking into as well.

[Jack1963]

14. health insurance

I have my solo insurance via UNICARE. They offered the lowest rates at one time, and the original coverage was pretty good. Rates have increased and the coverage has decreased some with my plan, but they are offering some newer plans now that might be better. I'd have to reapply to get one of those.

JR

[OhioBlue]

15. My advice

is to check into the pre-existing condition issue. Also - can you get COBRA and if so, will that be cheaper than purchasing your meds if the new plan doesn't allow it?

Just an anecdotal - my b/f is self-insured, young, healthy - has a plan for $130 a month with the Farm Bureau.

But, if the new plan you're checking will cover your meds, it sounds like a fantastic deal.

Another quick note - prices for health care for those insured are a fraction of what they are for those who are not insured. I was looking at my insurance statement of benefits earlier - a couple of HUGE mark downs:

Blood test: Billed at $121 - insurance mark down for in network: $18.50

Doc visit, tests: Billed at $540 - insurance mark down for in network: $195

[ComerPerro]

24. LOL, I used to have blood drawn monthly for a drug I was on

glad I don't need those anymore...

[BlackVelvet04]

16. I pay $500 a month with a

$5,000 deductible for my husband and myself. We have prescription coverage after a $250 separate deductible.

It sucks, but I've had back surgery and that upped the price.

[ComerPerro]

25. Yeah, that's what I am worried about

[BlackVelvet04]

27. We are probably older than you

and I had back surgery and my husband had 3 knee surgeries so they socked it to us. It sucks, but what ya gonna do?

Good luck!

[Sgent]

17. One other thing

If you have access to COBRA, continue that -- as it will almost always be the best coverage for the money (unless your in perfect health). And I know its not cheap.

Once you have exhausted COBRA, you have 3 options:

1) Obtain coverage on the "open" individual market. This will exclude pre-existing conditions.

2) Obtain a "Cobra Continuation Policy". This is the next best option -- but is only available in about 1/2 the states.

3) In the other 1/2 the states, you will have a state gaurenteed risk pool. This is your worst choice -- but it maybe your only one.

Make sure you sign up for option 2 and/or 3 about 60 days before the end of your COBRA policy to ensure that there will be no pre-existing exclusions.

[W_HAMILTON]

18. Yep

Someone else mentioned COBRA too, and it's probably the best option. Yes, it's usually pretty expensive, though. But considering the other options, it's worth looking into.

[ComerPerro]

26. thank you

[cyclezealot]

28. We moved to France.

Our visa allows us to buy into the French national system.. France loves us more than our home country did...
Monthly premimum for two are $166 - covers medicines, doctor visits, hospital visits, and dental. Co-pay is $3. Before we subscribed. My medicines cost us $142 a month in California . Pharmacy cost here is $32, before we had the national insurance.
you all are chumps. sorry.
And the UN rates the French system as one of the best delivery systems in the world. US right wingers will say, that's why the country is bankrupt. But, French system costs the country less of it's GDP than does the American system.

[silvertip]

33. Medical ins.

   Every one of the posts about medical ins. sound to me like
one hell of a lot of good reasons for demanding universal med.
ins. through our govt. and paid for by our tax money. My vote
goes for getting rid of all of the blood sucking ins. co's., I
know its a pipe dream but worth a shot.

[cyclezealot]

36. Hell, the cost savings you'd have by moving to France.

The cost savings from buying US insurance to buying French Insurance, if allowed to; would pay your monthly rent- and you could live overseas.

[cyclezealot]

37. Repugs. tell us Medical Insur. companies give us choice.

Insurance companies are one of the bigger scan artists in the US economy. Americans are insurance poor and they go back for more.
And remember the hurricane victims after Katrina. In fact Sen. Lott's beach front home was destroyed. THe insurance companies had the gaul to scam him. But, in his case they are threated with a fight. Bet, Lott's influence is less than whatever insurance company he wants to take on. Good, lesson for Lott; but doubt it will influence his votes towards national health insurance.