Tell Me About Private Health Insurance

[BiggieFries]

Since I got a new job about 3 months ago, we've been on my wife's health plan with the county since she is/was a teacher. Since she won't be going back to work after her maternity leave is over, we will have to switch to private health insurance come December first. We'll most likely be using the private stuff until my contract is up and I get hired full time here. This could be anywhere from 3 months to 9 months depending on how the budgets go within my group.

 

I'm pretty clueless about the specifics of health plans other than the options I've been offered at my previous employers. They would just offer a couple of choices and you just pick one and go on with your life.

 

I've been doing some research, but there are so many options out there that I can't make heads or tails of it. So this is why I turn to the all-knowing Huddle! If I can't find an answer here, it doesn't exist!

 

From our current insurance, we pay a $20 copay at every Dr visit. I think we have either a $5K deductible or $10K, not sure which. We also have a copay for all meds and we also have some deal with MedCo, but I don't think we use it.

 

The insurance covers me (30 yo), my wife (32 yo) and our 4 and 1/2 month old son and it's through United Healthcare.

 

Also, there's a pre-existing condition that might throw a monkey in the wrench. My wife has an under active thyroid. It doesn't cause her any real medical issues other than having to take 2 medicines for it. Is something minor like this an issue for private insurance carriers?

 

The most important part though is that this insurance be accepted by my son's pediatrician. I don't want to have to switch doctors because we love this one.

 

Thanks for your help! Let me know if you need any more info.

Edited October 15, 2007 by BiggieFries

[TheShiznit]

Since I got a new job about 3 months ago, we've been on my wife's health plan with the county since she is/was a teacher. Since she won't be going back to work after her maternity leave is over, we will have to switch to private health insurance come December first. We'll most likely be using the private stuff until my contract is up and I get hired full time here. This could be anywhere from 3 months to 9 months depending on how the budgets go within my group.

 

I'm pretty clueless about the specifics of health plans other than the options I've been offered at my previous employers. They would just offer a couple of choices and you just pick one and go on with your life.

 

I've been doing some research, but there are so many options out there that I can't make heads or tails of it. So this is why I turn to the all-knowing Huddle! If I can't find an answer here, it doesn't exist!

 

From our current insurance, we pay a $20 copay at every Dr visit. I think we have either a $5K deductible or $10K, not sure which. We also have a copay for all meds and we also have some deal with MedCo, but I don't think we use it.

 

The insurance covers me (30 yo), my wife (32 yo) and our 4 and 1/2 month old son and it's through United Healthcare.

 

Also, there's a pre-existing condition that might throw a monkey in the wrench. My wife has an under active thyroid. It doesn't cause her any real medical issues other than having to take 2 medicines for it. Is something minor like this an issue for private insurance carriers?

 

The most important part though is that this insurance be accepted by my son's pediatrician. I don't want to have to switch doctors because we love this one.

 

Thanks for your help! Let me know if you need any more info.

 

If you are looking for a short 3 to 9 months of coverage...which COULD extend longer...who knows... then I would look hard at an HSA high deductible plan. For example, you already have a 5000 deductible lets say, but that isn't for the whole family....that is times three. Each of you have a 5000 deductible currently. With a high deductible HSA plan, you have a 5000 FAMILY deductible. So, in that 3-9 months you would never spend more than 5k on health care and the premiums are sometimes 60% less than your standard full service co-pay type ppo plans. As far as your wife's pre-existing conditions. Is she taking Synthroid and some sort of diuretic...like HCTZ? If so, this is a rather benign condition. Worse things happen when you have an overactive thyroid...Graves Disease...mental issues. I don't foresee a huge problem for you here. Good Luck, PM me with any questions.

[BiggieFries]

If you are looking for a short 3 to 9 months of coverage...which COULD extend longer...who knows... then I would look hard at an HSA high deductible plan. For example, you already have a 5000 deductible lets say, but that isn't for the whole family....that is times three. Each of you have a 5000 deductible currently. With a high deductible HSA plan, you have a 5000 FAMILY deductible. So, in that 3-9 months you would never spend more than 5k on health care and the premiums are sometimes 60% less than your standard full service co-pay type ppo plans. As far as your wife's pre-existing conditions. Is she taking Synthroid and some sort of diuretic...like HCTZ? If so, this is a rather benign condition. Worse things happen when you have an overactive thyroid...Graves Disease...mental issues. I don't foresee a huge problem for you here. Good Luck, PM me with any questions.

 

How does an HSA plan work? How much can/do I need to put into it? This works like an IRA, correct? What are the specifics of this type of insurance?

 

My wife takes Synthroid & Cytomel to regulate her thyroid hormones. No diuretics that I'm aware of (unless this is what cytomel does).

 

Thanks for the input.

[TheShiznit]

How does an HSA plan work? How much can/do I need to put into it? This works like an IRA, correct? What are the specifics of this type of insurance?

 

My wife takes Synthroid & Cytomel to regulate her thyroid hormones. No diuretics that I'm aware of (unless this is what cytomel does).

 

Thanks for the input.

 

An HSA plan works similiar to any health insurance plan. First, most are PPO plans, so you use the same network as if you had the plans you are used to. But here is the kicker. When you go to the doctor now, you spend 20 bucks while the insurance company pays the difference of the negotiated rate. However, with a high deductible plan, you pay the entire negotiated rate. Now this may seem drastic, but if you spreadsheet the costs, I can almost guarantee you will spend less out of pocket, when you factor in premiums, with a high deductible plan.

 

Now, the HSA portion is strictly voluntary. I have clients who only put 100 dollars in the account just to have it open. They add up all their health expenses for the year and make a deposit of that amount into their HSA and then immediately withdrawl the funds...that way they get to wash the money for tax purposes while avoiding the pesky 7.5% rule when it comes to medical expenses. Anyway, I hope this helps. Just find a good agent who is willing to explain this to you inperson. Someone who will show you the differences in b/w. Good Luck.

[westvirginia]

I'm no expert on this subject, but it seems to me that if we're really only talking 9 months at the outside, COBRA might be the way to go. You pay for 100% of the coverage you currently have and there's no interruption. It's pretty easy, though it can be a little pricey comparatively. But why set up a year's worth of coverage, deductibles, etc when you can just continue what you have now?

 

But like I said, I'm noooooo expert. I just usually look at the options my employer puts before me and pick the one that will cost me least with my usage.

[TheShiznit]

I'm no expert on this subject, but it seems to me that if we're really only talking 9 months at the outside, COBRA might be the way to go. You pay for 100% of the coverage you currently have and there's no interruption. It's pretty easy, though it can be a little pricey comparatively. But why set up a year's worth of coverage, deductibles, etc when you can just continue what you have now?

 

But like I said, I'm noooooo expert. I just usually look at the options my employer puts before me and pick the one that will cost me least with my usage.

 

Cobra would be an option for sure, but, it seems that his family is very healthy so it would benefit them to have the MUCH lower cost. If it was a long term dry spell....say 15-18 months and there were health issues that were substantial...then yes...cobra is a great option. I would have this insurance underwritten about 40 days before you time to quit is. That way you get to know the answer and compare it to the employers options.

[Dragon]

Wife is expecting? Little one on the way?

 

COBRA!

[TheShiznit]

Wife is expecting? Little one on the way?

 

COBRA!

 

I think he mentioned that she will not be returning to work after her maternity leave....until then she will have work insurance. Again, if he does the cost/benefit analysis and finds cobra is cheaper...then I agree...but I have done too many comparisons and I am 90% certain that a high deductible HSA plan will be less expensive for whatever the time limitations.

[Dragon]

I think he mentioned that she will not be returning to work after her maternity leave....until then she will have work insurance. Again, if he does the cost/benefit analysis and finds cobra is cheaper...then I agree...but I have done too many comparisons and I am 90% certain that a high deductible HSA plan will be less expensive for whatever the time limitations.

 

Maybe, but what is the best INSURANCE in case you have a medical issue. You don't want to be caught pinching pennies in a situation that involves the little one's health. Trust me, I'm an expert on newborn's.

[BiggieFries]

Maybe, but what is the best INSURANCE in case you have a medical issue. You don't want to be caught pinching pennies in a situation that involves the little one's health. Trust me, I'm an expert on newborn's.

 

If I can save some cash on insurance that would be nice, but if it comes at the cost of not having enough insurance for my family, then I'd rather spend a little more for the next few months. Are there any insurance companies that are better than others? Any one have any particular recommendations?

 

Thanks again for the help guys!

[Atlanta Cracker]

If I can save some cash on insurance that would be nice, but if it comes at the cost of not having enough insurance for my family, then I'd rather spend a little more for the next few months. Are there any insurance companies that are better than others? Any one have any particular recommendations?

 

Thanks again for the help guys!

 

If you're looking for the easiest option then it would be COBRA - you pay and stay with United Healthcare. If you're looking for the most cost effective then that depends on how much you think you'll use it. If you're all healthy and there are no issues then some type of FSA arrangement would be best. If something comes up then Cobra would probably be cheaper though you would know your maximum exposure under a plan like Shiz described.

[Big Country]

I've got Blue Cross for the family. Not paid for by the employer. It's one of their PPO plans, so it is a bit pricey, but we've had great coverage for two pregnancies, go to the doctor's we like, have had great coverage for my kids, etc. It is the second highest regular monthly expense I have behind my mortgage, but the peace of mind knowing that we have real solid coverage should the need arise is well worth it.

[TheShiznit]

Maybe, but what is the best INSURANCE in case you have a medical issue. You don't want to be caught pinching pennies in a situation that involves the little one's health. Trust me, I'm an expert on newborn's.

 

Agreed. His current insurance is thought to have a 5000 deductible..that is per person...and then there is the co-insurance limit that has to be met. Now, a high deductible plan has a family deductible of say up to 2250 or 5000. You cannot spend more than that if you have 100% co-insurance option. I am not saying he will ultimately choose the High Deductible plan. But my experience has shown me, In the state of Illinois anyway, that my clients have a lower out of pocket cost per year with an high deductible plan versus Cobra....and this is even war gaming for a catastrophic circumstances. Run an analysis on yourself...even with a newborn. I bet it will be less expensive to have a high deductible HSA out of pocket than Cobra....remember, you have to add the premium into the cost equation.

[TheShiznit]

I've got Blue Cross for the family. Not paid for by the employer. It's one of their PPO plans, so it is a bit pricey, but we've had great coverage for two pregnancies, go to the doctor's we like, have had great coverage for my kids, etc. It is the second highest regular monthly expense I have behind my mortgage, but the peace of mind knowing that we have real solid coverage should the need arise is well worth it.

 

hey BC, just for grins, compare your Blue Cross plan with their Blue Edge HSA plan that has a 5000 family deductible. Add up your medical costs from last year and health premiums with co-pays. Now, when you add the cost under the HSA compatible plan...you pay the negotiated rate. My guess is that the pregnancy would have cost you actually less under the HSA type plan than the traditional plan. The most you would have spent was 5k, then everything for the rest of the family for the balance of the year would be at 100% coverage...including prescriptions. Again, I am not saying it will be...but I am 90% certain it WILL be. If you are up to it, do the comparison and report back in this thread.

[Atlanta Cracker]

hey BC, just for grins, compare your Blue Cross plan with their Blue Edge HSA plan that has a 5000 family deductible. Add up your medical costs from last year and health premiums with co-pays. Now, when you add the cost under the HSA compatible plan...you pay the negotiated rate. My guess is that the pregnancy would have cost you actually less under the HSA type plan than the traditional plan. The most you would have spent was 5k, then everything for the rest of the family for the balance of the year would be at 100% coverage...including prescriptions. Again, I am not saying it will be...but I am 90% certain it WILL be. If you are up to it, do the comparison and report back in this thread.

 

What's a typical monthly premium for one of those?

[TheShiznit]

What's a typical monthly premium for one of those?

 

 

Obviously the price is dependent on age and gender...and then ratings for health issues. Let me give a boiler plate. I just insured a family of 5, 2 parents and 3 kids under 5, all in good health. Parents were 30 and 32...NO HEALTH ISSUES at all....in the State of Illinois near Chicago, with the Blue Cross Blue Shield Blue Edge HSA with a 5000 dollar family deductible. The cost was I think 293 per month. Now, their total out of pocket limit for the year will be 5K. Add the premiums in and in the worst case scenario they will spend 8, 524.00 dollars. That is the worst case scenario. For the Select Blue plan with a 1000 dollar deductible X 3 and 80% coinsurance with a 20 copay at doctors and Rx copays, the premium was 562.00ish per month. That is a guaranteed 6, 744 out of pocket on premium alone. Now, that means if worst case scenario happens, they still have to come up with a couple of grand plus copays....you get the picture I have painted here don't ya?

 

BTW, I wish all people would buy the select blue plan....I make double the commissions cause it is usually double the premium...but the best interest of the client is served by taking advantage of high deductible HSA plans....oth on the cost end...and on the tax deductible side....no 7.5% floor before you can write off a medical claim.

[BiggieFries]

Obviously the price is dependent on age and gender...and then ratings for health issues. Let me give a boiler plate. I just insured a family of 5, 2 parents and 3 kids under 5, all in good health. Parents were 30 and 32...NO HEALTH ISSUES at all....in the State of Illinois near Chicago, with the Blue Cross Blue Shield Blue Edge HSA with a 5000 dollar family deductible. The cost was I think 293 per month. Now, their total out of pocket limit for the year will be 5K. Add the premiums in and in the worst case scenario they will spend 8, 524.00 dollars. That is the worst case scenario. For the Select Blue plan with a 1000 dollar deductible X 3 and 80% coinsurance with a 20 copay at doctors and Rx copays, the premium was 562.00ish per month. That is a guaranteed 6, 744 out of pocket on premium alone. Now, that means if worst case scenario happens, they still have to come up with a couple of grand plus copays....you get the picture I have painted here don't ya?

 

BTW, I wish all people would buy the select blue plan....I make double the commissions cause it is usually double the premium...but the best interest of the client is served by taking advantage of high deductible HSA plans....oth on the cost end...and on the tax deductible side....no 7.5% floor before you can write off a medical claim.

 

 

Thanks a lot for the info, all! I need to get started on this fairly soon as I don't want any possibility of a lapse in coverage. Hey Shiz, do you know of any insurance agents in South Florida that you would recommend?

 

Thanks, again!

[TheShiznit]

 

Thanks a lot for the info, all! I need to get started on this fairly soon as I don't want any possibility of a lapse in coverage. Hey Shiz, do you know of any insurance agents in South Florida that you would recommend?

 

Thanks, again!

 

No, well wait a minute...I just might. Let me check....PM me tomorrow to remind me while I am at work. I once knew an old Prudential agent who moved to MetLife and moved to Florida...his wife is a lawyer. He might either know someone or be able to do it himself....if you two were geographically close enough.

[BiggieFries]

No, well wait a minute...I just might. Let me check....PM me tomorrow to remind me while I am at work. I once knew an old Prudential agent who moved to MetLife and moved to Florida...his wife is a lawyer. He might either know someone or be able to do it himself....if you two were geographically close enough.

 

Will do! Thanks!