Health insurance question/help

[duid12]

Hi folks.

A question for you, a problem for me. I don't get health insurance thru an employer any more so I have been paying it myself for about 5 years now...in that time it has gone from about $430 month (for a family policy) and now is upwards of $850 per month.

Policy is with Blue Cross/Blue Shield of Mass. It is schedule to go up another 16% next year (and probably thereafter...) which brings me to about $12000 per year or more than 1/3 of my gross income....its rapidly becoming unafforadable. (It is already)

I have 4 kids and maybe another on the way next year so just doing without health care is not an option. Questions are: does anyone know of any cheaper policies in Mass? Also, we are pretty healthy family and are considering just pocketing the $12K per year and saving it for a disaster and paying for expenses out of pocket...anyone else do this? Anyone know what routine care costs? How sick would you need to be to actually use up $12K in health care?

The way I see it, over the next 5 years I'll need to make and pay around $65-$70K in premiums, and chances are I'll almost certainly not need that much care. But you never know for sure until it is too late...

Suggestions? Comments? Is self-insuring to risky?

[tpub]

1. ACK! Don't go without, especially if you have kids!

What do you do for a living? You might be able to get in on a small business or group rate. Have you looked into those kinds of options?

[CPschem]

2. too risky...

i would strongly suggest not pocketing the 12 grand and using it as an emergency stash. there are far too many things that can cause your 4 kids to require not only a doctor's visit, but a hospital stay. simple procedures (like a tonsilectomy) can run in to the thousands of dollars. i'd keep looking for a cheaper policy...

[ewagner]

3. Shop around

There are some Major Medical or catastrophic policies that cover only the most devastating medical costs, but the premiums are a little cheaper.

Also shop for plans with higher deductibles or co-pays, those are generally a little more affordable. In a sense, a higher deduct or co-pay is "self insuring".

Do you have a cafeteria plan at work? (Like a Flexible savings plan or Medical Reimbussement Account?) Thos can help you a lot with the cost of insurance.

Get a good knowledgeable individual health ins specialist to help you.


I don't know about your state, but where we live there is a special "risk sharing pool" for high medical risk, lower income families. If your family qualifies, you may get into some sort of pool.

Good luck.

end note: Yes I do sell the stuff in my home state only.

[ewagner]

16. btw

Whatever you do, don't let your coverage lapse. That causes other problems...

again, good luck

[NewYorkerfromMass]

18. I'm looking for catastrophic (critical care) for my family

my Cobra's $800 per and it runs out in 6 months. Any suggestions?

[ewagner]

25. don't know the locals in your area

but generally speaking, talk to a "multi-line" or independent agency about their different plans. There are plans that cover just catastrophic illnesses and hospitalization but I don't know which ones are operating in your area.

I feel bad that I can't be more specific, but I don't want to misrepresent what is available or the relative costs.

[SharonAnn]

4. You don't have to be very sick to use up $12 K in healthcare

An emergency appendectomy would take more than that. A complicated fracture would take more than that. A concussion could take more than that. Lieukemia would take way, way more than that. I'm talking here about things that often happen to kids but there are the same kinds of sticker shock for adult injuries and illnesses too.

Remember, as an uninsured person you would pay the HIGHEST rates for any medical care, prescription drugs, hospital care, physical therapy, etc. It usually ranges from 40% to 130% of what the insurance companies pay for the same services.

As an example, we just received the bill for my husband's overnight stay and the placement of a stent in an artery. $54,000. Fortunately we have Medicare and the supplemental insurance to cover the bill.

I'm sorry we don't have better and more affordable health care coverage in this country and I'm sorry that people like you, who are trying to be responsible citizens, are being shafted. All I can do is everything I can to get the Repugnants out of office so that we can finally address the real issues in the United State.

[SeattleDem]

5. tough call, but self-insuring really scares me

the amount you are being asked to pay is an outrage, no question about that. But, the flip side is the catastrophic unknown. Having another child could easily be $10K next year, which would spend your whole "budget" at once.

And I hate to be a naysayer, but having worked in health care for a long time now, no one ever thinks it's going to be them, or their child, that needs the bone marrow transplant or ends up hospitalized for some unforeseeable reason. A few years ago, each nite in an intensive care unit cost around $1000.

I would look for the policy with the highest deductible that covers basically only expensive procedures. You might save money that way. You'd still pay most of your expenses out of pocket, but you'd be covered for a major illness.

Can you or your wife set up a home-based business, even part-time, to get self-employed status? If you can, you can deduct some of those premiums.

[HFishbine]

6. Might Help a little

A medical savings account?

My girlfriend established one of these last year. She's dropping it because it was administered horribly, but the concept may help you out.

Basically, you put in a set sum each month BEFORE TAXES. Because it is for medical expenses, it remains untaxed. You then can draw on that accout for anything medical: drugs, co-pays, deductibles, eye-glasses, dental etc.

If you know that your household has a certain amount of out-of-pocket medical expenses every year, this can keep you from paying taxes on the money you use to pay for those things. Estimate wisely though, because what you don't use, you don't get back. My girlfriend ended up spending hers down to zero, so it worked for her.

If you go this route, you might feel more comfortable about raising your deductible on your health insurance, thereby lowering your rate.

[Yupster]

22. Sounds like you're describing a

cafeteria plan -- not a medical savings account. That's a whole different animal.

[dflprincess]

24. We have the pretax medical thing at work

I think the cap on it is pretty low. It wouldn't help much.

[kainah]

7. self-insuring is risky

I understand the temptation and, if all you had is routine care, you'd probably be OK. The problem comes when one of the kids breaks a bone, or an appendix ruptures, or your (maybe) new child is born premature. One "major" medical episode will wipe out that $12,000 (which, of course, you won't have until a year is up) and take nearly everything else you have built up before you can bat an eye. The reason that universal health care is such an issue of social justice is because everyone is at risk, every day, for a major medical problem.

My best advice would be to look into high-deductible, catastrophic policies. If you could buy a $10,000 deductible policy for $100/mo (I have no idea what they cost), then you could begin to build up the deductible amount with the savings and, once you felt safely covered for the deductible, you could begin to pocket some savings.

You should also talk to a tax advisor, if you have one or know someone who's up on those things. The repugs and all their free-market everything have enacted some tax breaks in the last few years for "medical savings accounts" but I don't know who qualifies or how much it's worth.

And, whatever else you do, don't forget to write some letters to the editor and legislators complaining about the situation. We've got to get them to understand that, while they've shuffled their feet, the health care debate has moved WAY BEYOND Rx coverage for Medicare!!

Good luck.

[tpub]

8. duid12, my SO sells health insurance in your state

He works for MassMutual. He is based in NYC, but handles MA and some other states, as well. Let me know if you want his contact info.

[xray s]

9. You could look at raising your deductables

But I imagine they already are pretty high.

DO NOT try to self-insure. You can easily burn $12,000 in a day depending on the medical problem you will run into. Even healthy people have accidents. They will take every asset you own except your house to pay the bills. Then, when you are destitute, you will qualify for Medicaid (unless the Republicans gut it by then)

This is the horror of health care in the US. Your premiums should be thought of as a tax. You are paying 1/3 of your income for health insurance coverage, plus more for out of pocket health costs like deductables, co-pays and caps.

Kind'a makes you think about becoming a Canadian, or Englishman, or Swede, or Dane, or Italian, or German, or Afghani, or Iraqi (who will soon have national health insurance, courtesy of the US).

[Jacobin]

10. Call Blue Cross

and see if you can increase the deductible and find out how much they will reduce the premium.

You could self-insure for the first few thousand in expenses and save money on the premiums.

[ikojo]

11. Health insurance

Your post illustrates why we need UNIVERSAL (for ALL Americans not only those under 18) Health care. I mean truly universal available to all regardless of income. Yes, that means even the rich would get government funded health insurance.

I have some questions: Are you paying your premiums because you are self employed? Are you a consultant? Why are you not provided health insurance through an employer? Do you not have to work?

How low or high is the deductible and out of pocket on the policy you have with Blue Cross? If you go for a policy with a higher deductible and out of pocket then perhaps you can lower your premium.

If you are self employed perhaps you could ask the Chamber of Commerce about insurance for small groups. Is there a group or organization you can join who has catastrophic policies? Is there a professional organization that you belong to and if so do they have some sort of health insurance plan? Some small businesses have banded together to get better rates on their premiums.

What about checking with the people you insure your car with and seeing if they have some sort of rider you can attach to your auto insurance. Check with AAA. I think they are selling some sort of health insurance policies now. It sounds like you need some sort of catastrophic policy to use just in case you get really sick.

I had a friend who owned a comic book store at one time and he had his health insurance through a small insurer in Indiana. He and his wife rarely went to the doctor and wanted it just in case something happened. I think he found the policy on the Internet.

Most national insurance companies are licensed in all states. You just need to make sure that the doctors you currently use are in the network of which ever insurance company you decide to use.

That $12k you are currently spending in premiums could probably be put in some sort of investment account.

Just some suggestions. Good luck. I would not be able to afford $12k in insurance premiums. I would have to hope for the best and go without insurance. If I became sick I'd have to get what care I could and declare bankruptcy if necessary.

[BonjourUSA]

14. I'm very happy not to have to ask me these questions

[acerbic]

15. Another point:

Your post illustrates why we need UNIVERSAL (for ALL Americans not only those under 18) Health care. I mean truly universal available to all regardless of income. Yes, that means even the rich would get government funded health insurance.

This whole thread illustrates how much time and energy people have to waste dealing with this mess. With universal healthcare they could instead concentrate more on their own occupations and just living their lives and the net result would be a more efficient society and higher average standard of living.

[jagguy]

12. BC/BS is seldom the low cost provider

also if you are somewhat near the border to some other state (CN, RI), consider shopping there.

But ALWAYS, shop shop shop and you need to do it every year. Loyalty is meaningless.

[sybylla]

13. Been in your exact position.

Hubby and I went into business on our own 6 years ago. Had to pay for our own insurance. We couldn't afford full coverage at $500/mo for a family of four so we went to a large deductible of $3500/per $7000/family. The difference in the cost ($500/mo vs. $500/quarter) meant that we could have $4000 in medical expenses in a year and still come out ahead.

Sounds like you are paying ridiculous premiums but I imagine full coverage in Wisconsin probably cost about the same now too. The cost of our medical coverage has doubled in the 6 years since we began. Like it was when we started, you are being asked to pay $1000/month for full coverage while we are still only paying the same each quarter.

Don't drop your insurance. It's too scary with kids. Teh bills can add up so fast and you wouldn't want to risk denial of service from corporate medical facilities. My son had a dislocated shoulder in sports last year. In this case the school's insurance paid for it, but for just 2 hours service in an emergency room and 6 xrays they charged $2500. Imagine if he had needed emergency surgery or had to spend the night.

Trust me, you don't want to have to make medical decisions based upon whether you can afford it. Consider the increased deductible instead.

[grasswire]

17. would it be cheaper to insure separately?

I was getting info on BCBS for my niece and was surprised to learn that insuring family members separately was cheaper than a family rate. In some states, BCBS has low cost insurance for kids, too. The age of the oldest family member can make a difference in the premium; that's why it can be cheaper to insure separately.

[The Lone Liberal]

19. See if you can find one of the Consumer Driven Plans

It is a plan where the first specfied dollars of benefits are paid at 100%, then you have a high deductible, once through both of those you will have benefits paid usually at 50% co-insurance up to the stop/loss which is usually around $5,500,per individual and $11,000 per family. The premiums usually are less than what you are currently paying. It is a risky thing you are banking that your health expenses will not fall outside of the first dollars covered at 100%.

Hope this helps.

Here is one, I am not recommending just that this is a plan that I recently evaluated. http://www.definityhealth.com/marketing/home.html

[twilight]

20. Costco for drugs

I heard that Costco's pharmacy is much less than a regular pharmacy. Maybe you can find a plan that doesn't pay for drugs - a catostrophic one perhaps?

In any event, you can go and use the Costco pharmacy apparently without being a member I've heard.

What a nightmare for you! Good luck!

[twilight]

21. what about an HMO?

HMOs tend to be a lot cheaper than Blue Cross/Blue Shield. I'd think there would be stacks of them in your location - ???

:kick:

[Yupster]

23. We're in the same position

We pay 900 per month.

The best solution is someone in the family needs to get a part-time job with a local school district or somewhere else that offers group insurance.

However when I suggested this to my wife, she suggested that she believes in a family only having one person working outside the home, and the person she had in mind was not her.

[twilight]

26. you are quite right

Luckily, I had taken a crummy part-time job working for the State - had lousy pay but great benefits.

Then, I got very sick and was 'retired' from my job and I retained the medical benefits. With Medicare thrown in its about $9,000.00 a year for 2 persons, both on Medicare.

Luckily, my former employer pays for about 2/3 of the cost of the plan. If I hadn't taken that crummy job with the great benefits, I'd be in sorry shape right now.

:dem: