Private health insurance for young, healthy family

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Private health insurance for young, healthy family

Postby usaa13 » Wed Jan 23, 2013 6:04 pm

I've done a lot of general research, but think it's time I shought some more particularized opinions.

Here is my situation:

- 30 years old, as is my wife, with a 2 year old daughter
- none of us have any major health issues or recurring health expenses other than regular check-ups
- leaving high-paying job for self-employment with speculative income and no health coverage
- no immediate plans to add to our family, but probably will in the next 1-2 years (will be living in Colorado, which seems to require maternity coverage for all policies)
- have savings sufficient to cover expenses exceeding any deductible (including 2 years of my/spouse's HSA contributions)
- have reasonable options for re-entering a more stable working arrangement and good family/friend support network in a multiple-disaster scenario

My goal is to protect my family's assets/long-term health while avoiding unnecessary premiums for a young, healthy family. My plan is to try to secure new coverage before my COBRA option period expires (60 days after end of Feb) and only exercise it if needed (looking at over $1k/mo. premium).

Here are my specific questions:

1) Should any plan that excludes prescription benefits be a non-starter, even though we have no present/anticipated need? Any other, similar things I should look for as baseline requirements for avoiding financial and health ruin?

2) In terms of a coverage mix -- i.e., what you get at a given premium price points -- the major trade-offs are deductible, co-insurance, and co-pays (or lack thereof) for visits/prescriptions. My inclination is to prefer a lower deductible and no co-insurance, while sacrificing coverage for visits and prescriptions (subject to question 1 -- i.e., perhaps I should ensure at least some coverage for major drug costs). So:

a) Am I right in thinking that I shouldn't effectively pre-pay for visits that I might not need, instead of preferring, say, a lower deductible?

b) Am I right in wanting to avoid co-insurance, or is an out-of-pocket limit adequate protection from a really, really big bill?

c) It seems I can either choose a combo of individual and family deductibles, or just a family deductible. Should I prefer a plan with both (on the premise that it is exponentially less likely for multiple family members to hit their individual deductible), or is that just priced in already such that I should be neutral?

d) Am I missing any major considerations in this weighing of coverage types?

3) In terms of assessing what premium price point I should choose, how do I go about setting a risk premium? Obviously, I don't want to be paying an extra $5k in annual premiums for a plan that will only save me an additional $10k if I have a huge expense, but if a 1:2 ratio isn't enough to warrant coverage, what is the right ratio?

I realize this is highly individualized, but again -- we are a young family with no known health issues and cash reserves to cover even a big bill. I don't want to insure against a $1k medical bill, do want to insure against a $100k medical bill, but don't know how to decide where to draw the line in-between.

4) If anyone has faced a similar situation and landed on a certain plan, I'd love to hear about the mix of coverage, etc, that you chose, reasoning behind it, and any observations with the benefit of hindsight.

5) Should I ensure I get an HSA-compatible plan? I'm almost certan to be in the 15% tax bracket, and don't want to handcuff myself financially (or spend extra in premiums) just to get a marginal tax benefit, but I'd hate to miss out on that if it's still a good option.

6) Somewhat off-topic, but with a speculative, un-established income, can/should I be looking to get private disabilty and/or life insurance? I am inclined to do so, both for my wife and I, but whereas I would have previously warranted >$1MM coverage, I'm not sure what I can/should seek in my new situation.

Many thanks, and apologies in advance for any missing info.
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Re: Private health insurance for young, healthy family

Postby linuxuser » Wed Jan 23, 2013 6:52 pm

Here in NJ, the Horizon Blue Cross Blue Shield website is very useful for comparing actual cost.
On the other hand, Aetna's website is useless for that.
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Re: Private health insurance for young, healthy family

Postby jeffyscott » Wed Jan 23, 2013 7:32 pm

Given that as of Jan. 1, 2014, pre-existing conditions will no longer be an issue, I wonder if the best option might be a temporary policy to cover you to Dec. 31, 2013. In the fall you can sign-up for a policy via the new exchange and if your income is below about $57K, your share of the premium should be limited to no more than 9.5% of your income.

http://www.colorado.gov/healthreform
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Re: Private health insurance for young, healthy family

Postby zebrafish » Wed Jan 23, 2013 8:46 pm

usaa13 wrote:
1) Should any plan that excludes prescription benefits be a non-starter, even though we have no present/anticipated need? Any other, similar things I should look for as baseline requirements for avoiding financial and health ruin?

...

I realize this is highly individualized, but again -- we are a young family with no known health issues and cash reserves to cover even a big bill. I don't want to insure against a $1k medical bill, do want to insure against a $100k medical bill, but don't know how to decide where to draw the line in-between.


Just commenting on prescription drug coverage. If your goal is to avoid catastrophic 100K bills, then you need prescription drug coverage of some sort. This is what your insurance is for. Any illness requiring chemotherapy or enzyme replacement or growth hormone, etc. will wipe you out. No one thinks they will get sick until they do.
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Re: Private health insurance for young, healthy family

Postby lindisfarne » Wed Jan 23, 2013 10:26 pm

If your COBRA is not that much over $1,000 per month, I'd say keep it. It's going to be more expensive than some high deductible option, but is it going to be that much more expensive? It will be the easier, less time-consuming option as well. At least you'll have decent coverage - with a 2 year old that's important. Your daughter might qualify for CHIP if you meet eligibility rules; some adults can qualify but you'd have to research that.
As mentioned above, you'd be eligible for an insurance exchange & possible subsidies as of Jan 1, 2014. (What a concept - affordable health insurance options that don't keep people tied to a job!) You might just want to do some research & make sure having a COBRA doesn't somehow affect your eligibility for the insurance exchange - I doubt it, but cover your bases.

I don't know how COBRA works - are you retroactively covered for March if you sign up in late in March if you need coverage? (can you skip paying for March but retroactively get coverage if you end up needing it some time in March?). Just watch your 60 days - if time starts counting Mar 1, there are more than 60 days between Mar 1 & May 1 so you'd have to buy April coverage.
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Re: Private health insurance for young, healthy family

Postby usaa13 » Thu Jan 24, 2013 2:05 pm

Thank you all for your thoughts.

Given that as of Jan. 1, 2014, pre-existing conditions will no longer be an issue, I wonder if the best option might be a temporary policy to cover you to Dec. 31, 2013. In the fall you can sign-up for a policy via the new exchange and if your income is below about $57K, your share of the premium should be limited to no more than 9.5% of your income.


Is there a substantial difference between a temporary policy and just seeking new, permanent coverage? I don't expect to have any pre-existing condition issues. I will certainly do more research on the exchange and new laws/regs, thanks.

Just commenting on prescription drug coverage. If your goal is to avoid catastrophic 100K bills, then you need prescription drug coverage of some sort. This is what your insurance is for. Any illness requiring chemotherapy or enzyme replacement or growth hormone, etc. will wipe you out. No one thinks they will get sick until they do.


Thanks. This is what I was thinking. Looks to be fairly costly, though I think I will try to find a plan that provides major downside protection rather than a pre-set expense schedule to balance out the risk/expense.

If your COBRA is not that much over $1,000 per month, I'd say keep it. It's going to be more expensive than some high deductible option, but is it going to be that much more expensive?


Well, quotes I'm seeing for seemingly reasonable plans are more in the $350-500/month range, and guaranteeing myself an additional $6k annual spend on medical doesn't seem like the best idea for me. But then I think to myself -- how can there be such a big gap, and what am I missing?

I don't know how COBRA works - are you retroactively covered for March if you sign up in late in March if you need coverage?


As I understand it, yes, that's right. You have 60 days to make your election, so you can essentially go uninsured and then retroactively choose the coverage before the deadline if you incurred an expense in the meantime that makes coverage worthwhile or if you haven't been able to secure an alternative plan. But good point, certainly, I will make sure to be very careful with the deadline!
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Re: Private health insurance for young, healthy family

Postby MN Finance » Thu Jan 24, 2013 2:21 pm

Timely post. I just open my computer and was going to post a similar question. I just left corporate america and am starting my own business. I looked at health care options, and I'm actually having trouble even justifying buying coverage at all. I too am in my 30's, married with kids. Everyone is currently healthy.

If we opt for a $500/mo policy with $3000 ind / $6000 family deductibles, I feel like I'm spending $12K a year to protect against a $20k or $30k bill. I fully understand something much more catastrophic can take place, but the cost vs. the protection seems so extreme. I pay $200 / year for $1M umbrella coverage, I pay $500 / year for $1M life insurance coverage, but I'm going to pay $12,000 / year for $1M medical coverage? I know it's not the same, but we're really insuring the risk of something huge ($1M) not $20k for a broken elbow since most people could cover that themselves (especially if I save $6k / yr in premiums)

My cobra is $1500/mo so, like you, a new policy seems to make the most sense.
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Re: Private health insurance for young, healthy family

Postby jeffyscott » Thu Jan 24, 2013 7:28 pm

usaa13 wrote:Is there a substantial difference between a temporary policy and just seeking new, permanent coverage?


Temporary is usually cheaper, but you would want to check on any coverage limits, etc., of course. Just a thought that at this unique time there may not be the usual risks of temporary coverage (e.g. you develop a condition and now have a pre-existing condition and can't get coverage after the temporary ends).

quotes I'm seeing for seemingly reasonable plans are more in the $350-500/month range, and guaranteeing myself an additional $6k annual spend on medical doesn't seem like the best idea for me. But then I think to myself -- how can there be such a big gap, and what am I missing?


You are young and healthy, so individual insurance is cheaper for you than the group coverage, which charges the same premium to all.
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Re: Private health insurance for young, healthy family

Postby dm200 » Thu Jan 24, 2013 8:20 pm

Just my 2 cents, but just because you are all healthy now is no assurance that such will be the case in the future. I would lean towards reasonable cost vs. lowest cost, with a considerable degree of protection from serious expenses.

I would start with COBRA to stay insured and see if that COBRA/employer coverage can be "converted" to an individual plan.

I would also look at HMOs in your area.
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Re: Private health insurance for young, healthy family

Postby linuxuser » Thu Jan 24, 2013 9:31 pm

dm200 wrote:Just my 2 cents, but just because you are all healthy now is no assurance that such will be the case in the future.

+1000

Isn't the phrase, past performance is not an indicator of FUTURE results?
Same applies to one's health.

dm200 wrote:I would also look at HMOs in your area.

Here in NJ, HMO coverage isn't cheaper. Look at something called EPO which only covers only in-network.
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Re: Private health insurance for young, healthy family

Postby englishgirl » Thu Jan 24, 2013 11:52 pm

I was also able to find HDHP for a lot less than the COBRA cost of the HDHP that I used to have through my employer. I'm not THAT young, but still healthy. And yes, the plan I went with has a higher deductible, and I'm sure fewer benefits than my old plan, but that was a trade off I was willing to take, and I'm saving $350 a month vs. the COBRA cost.

My deductible is $5000, and the plan I picked has a pharmacy deductible that is the same as the medical deductible. Whether that means $10k or $5k if I have an illness requiring both $5k medical expenses and $5k pharmacy expenses, I don't know. But I'm mostly trying to insure against the costs of major problems so I figure I'll cross that bridge if (hopefully never) I get to it. It works for me for now to have to pay out of pocket for pharmaceuticals - I don't take anything regularly, and would always go with generic cheapies if possible anyway (such as if I had to take antibiotics). I don't see the need to insure for that, but of course DO see the need to insure for very expensive issues.

By the way, I also have a speculative, unproven income and obtaining a disability insurance quote was very difficult. When I did get one, it did not provide much coverage but cost a lot. I do not have dependents, so I decided to skip it. It's a risk though and something I plan to revisit regularly. But this was one reason that I decided I would definitely have an HSA, and I would try to build up a cushion in there in case of disability. Of course, if you end up with a disabling condition, you'll probably burn through your HSA quickly, but it at least made me feel a bit better about coming up with the extra cash to sock away in the HSA - it is somewhat of a second tier emergency fund in my view. Term life insurance is pretty cheap, and you should get that.
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Re: Private health insurance for young, healthy family

Postby Wolkenspiel » Fri Jan 25, 2013 2:11 am

usaa13 wrote:- none of us have any major health issues or recurring health expenses other than regular check-ups

That is true for many people/families, until it suddenly isn't. One of my kids, entirely out of the blue, develop a health condition that has required $5k in prescription drugs per month over the last 3 years. Thankfully, he is getting much better now.
1) Should any plan that excludes prescription benefits be a non-starter, even though we have no present/anticipated need? Any other, similar things I should look for as baseline requirements for avoiding financial and health ruin?

I think a plan that leaves you open to practically unlimited out-of-pocket expenses misses the point of "insurance". One of the treatment options for my kid were $14k infusions every 6 weeks (he had an allergic reaction to that, hence the cost is only $2k/month for an alternative + $3k for other drugs).
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Re: Private health insurance for young, healthy family

Postby Dandy » Fri Jan 25, 2013 10:14 am

A serious health issue can cripple your assets and your business. It is one of the only things that can turn a good financial situation into being homeless, depressed and untreated. So, if you really need to scrimp you may want to go for a high deductible health coverage with RX coverage. You might want to have a 90%/10% coverage on hospital stays. You don't necessarily need a lot of coverage for doctor's visits since you can usually afford to cover those.

There are many that say it makes sense to have high deductible health insurance since most of us can afford to self insure several thousand a year. It is something like having a high deductible on auto insurance collision rather than insure for every scratch and pay a higher premium. Note: every analogy has problems - there is a lot of difference between fixing a car and keeping loved ones healthy and pain free over time.

A lot may change next year when insurance exchanges will be in force. Doesn't mean coverage will be cheaper but it should provide a wide variety of choices.
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Re: Private health insurance for young, healthy family

Postby usaa13 » Fri Jan 25, 2013 10:56 am

If I wasn't clear in my original post, I definitely do not subscribe to the view that my family's "past performance" means we can just avoid paying for insurance. Quite the contrary, in fact. I'm really just trying to figure out what the right extent of coverage is since our current health does at least give us reason to believe that we have a lower likelihood of incurring big-ticket expenses in the immediate future than, say, someone with the kind of medical history that points to likely development of other issues or recurring costs.

All of the helpful thoughts above have pretty much confirmed the direction I was headed anyway: I will make sure that any plan includes reasonable coverage for major downside scenarios in all areas (hospital, surgery, illness, drugs), but will probably look to save money on my annual premium while effectively applying that savings (conceptually) to a reserve in the event we exceed the deductible in a given year or years.
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Re: Private health insurance for young, healthy family

Postby usaa13 » Fri Jan 25, 2013 10:58 am

jeffyscott wrote:
usaa13 wrote:Is there a substantial difference between a temporary policy and just seeking new, permanent coverage?


Temporary is usually cheaper, but you would want to check on any coverage limits, etc., of course. Just a thought that at this unique time there may not be the usual risks of temporary coverage (e.g. you develop a condition and now have a pre-existing condition and can't get coverage after the temporary ends).

quotes I'm seeing for seemingly reasonable plans are more in the $350-500/month range, and guaranteeing myself an additional $6k annual spend on medical doesn't seem like the best idea for me. But then I think to myself -- how can there be such a big gap, and what am I missing?


You are young and healthy, so individual insurance is cheaper for you than the group coverage, which charges the same premium to all.


Thanks for these explanations, that makes sense. I guess I'm a little bit wary of relying too heavily upon those anticipated changes (though I will be mindful of them and consider them in planning), since the political/legal/financial winds could always shift in the meantime. Even if I could save a couple hundred bucks in the meantime, I think I'd rather set up a solid, permanent option that I can utilize if I'm not able for whatever reason to take advantage of the new laws.
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Re: Private health insurance for young, healthy family

Postby robebibb » Fri Jan 25, 2013 11:15 am

I would apply for individual coverage ASAP and not wait for COBRA to run out. As a healthy family you should not have problems finding coverage currently. If someone’s health takes a turn for the worse between now and when you obtain individual coverage it will become unaffordable/impossible to get coverage until ACA kicks in (2014 I believe). The individual plan also will likely be cheaper than COBRA (it may cover less) so it’s a win-win.
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Re: Private health insurance for young, healthy family

Postby usaa13 » Fri Jan 25, 2013 11:28 am

One other thought that I'd love to get any opinions on. Since we expect to have another child in the relatively near future (in a hospital), and perhaps another on down the line, I am somewhat inclined to spring for a lower deductible than I might otherwise since it seems pretty certain that will run over $5k and quite likely well north of that. (My wife had a c-section with our first child, though they say there's no reason she can't have a normal delivery, and my daughter spent 7 days in the NICU due to an infection though she's perfectly healthy now ... a repeat of that would probably run up to ~$30-40k.)
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Re: Private health insurance for young, healthy family

Postby usaa13 » Fri Jan 25, 2013 11:29 am

robebibb wrote:I would apply for individual coverage ASAP and not wait for COBRA to run out. As a healthy family you should not have problems finding coverage currently. If someone’s health takes a turn for the worse between now and when you obtain individual coverage it will become unaffordable/impossible to get coverage until ACA kicks in (2014 I believe). The individual plan also will likely be cheaper than COBRA (it may cover less) so it’s a win-win.


Thanks, yes, that is my current plan. I will apply now-ish, keep COBRA in my back pocket, and then look into new options entering 2014.
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Re: Private health insurance for young, healthy family

Postby Dianne » Fri Jan 25, 2013 11:41 am

usaa13 wrote:
If your COBRA is not that much over $1,000 per month, I'd say keep it. It's going to be more expensive than some high deductible option, but is it going to be that much more expensive?


Well, quotes I'm seeing for seemingly reasonable plans are more in the $350-500/month range, and guaranteeing myself an additional $6k annual spend on medical doesn't seem like the best idea for me. But then I think to myself -- how can there be such a big gap, and what am I missing?


People who buy COBRA plans usually have some health condition that prevents them from buying underwritten plans, since COBRA plans cannot exclude pre-existing conditions. So they are more expensive, because the insurance company assumes you have a condition that will generate claims.

People who buy insurance in the private market are usually pretty healthy, since the insurance companies can cherry-pick the healthy customers and refuse to insure anyone who is likely to make claims.

This could change on January 1, 2014, so I would take advantage of the market imbalance while it lasts.
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Re: Private health insurance for young, healthy family

Postby Dianne » Fri Jan 25, 2013 12:01 pm

MN Finance wrote:Timely post. I just open my computer and was going to post a similar question. I just left corporate america and am starting my own business. I looked at health care options, and I'm actually having trouble even justifying buying coverage at all. I too am in my 30's, married with kids. Everyone is currently healthy.

If we opt for a $500/mo policy with $3000 ind / $6000 family deductibles, I feel like I'm spending $12K a year to protect against a $20k or $30k bill. I fully understand something much more catastrophic can take place, but the cost vs. the protection seems so extreme. I pay $200 / year for $1M umbrella coverage, I pay $500 / year for $1M life insurance coverage, but I'm going to pay $12,000 / year for $1M medical coverage? I know it's not the same, but we're really insuring the risk of something huge ($1M) not $20k for a broken elbow since most people could cover that themselves (especially if I save $6k / yr in premiums)

My cobra is $1500/mo so, like you, a new policy seems to make the most sense.


If you purchase coverage, even high-deductible coverage, the insurance company may negotiate the prices you pay for routine care, so that even though you are paying out of pocket, you still get to pay the insured rates instead of the uninsured rates. Medications, blood tests, mammograms, and hospital charges are often much less expensive for insured people. (Quest Diagnostics charges uninsured people about 10 times as much for routine blood tests.)

When my son broke his leg, we paid about $2,000 total, at insured rates (even though the insurance company didn't pay a dime because our deductible was much higher than that). Based on the EOBs, I think I remember concluding that the uninsured cost would have come to 5 or 10 times that much. As long as you remain generally healthy (knock on wood...) it's not so much about the coverage as it is about being "in the system." The uninsured are second-class citizens in the health-care world.

Also, in my state, no matter what your deductible is, the insurance company is required to pay 100% of all legally-required childhood immunizations. Depending on the ages of your children, that can affect the cost-benefit analysis. There could be similar or comparable rules in your state.
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Re: Private health insurance for young, healthy family

Postby magellan » Fri Jan 25, 2013 12:11 pm

I'm certainly no expert on this, but here are couple of other random thoughts on this.

First, by law I think any new policy will cover well-care services such as routine physicals and cancer screenings without any copay or deductible. This is usually worth between $200 and $1k per year depending on your age.

Second, I'm not positive about the rules for grandfathered plans under the new healthcare law, but since your family doesn't have health issues, it might be valuable to get a permanent underwritten policy in place before 2014.

The rules on the transition are still a bit fuzzy, but insurance companies may be allowed to keep their old plans in place even after 2014 for existing policyholders. These plans are referred to as grandfathered plans in the new law. Hanging onto a policy in a grandfathered plan could mean lower costs compared to getting a new non-underwritten policy starting in 2014. It's likely that people in grandfathered plans that pay higher premiums because of a preexisting condition will opt for a new 2014 non-underwritten policy as soon as they can. This could mean that the people that stay in the old grandfathered plans may be healthier and have lower costs, which could keep premiums down in grandfathered plans compared to the non-underwritten plans.

Of course, it's anyone's guess how this will all work out. But since you need coverage now anyway, qualifying for a permanent underwritten policy could give you an option that might save you some money in the future.

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Re: Private health insurance for young, healthy family

Postby aude » Fri Jan 25, 2013 1:02 pm

To the OP -- I was in a very similar situation to you and signed up for an individual high-deductile Blue Cross plan as of 1/1/12. Family of five, always healthy. Until we weren't out of the blue. Both parents had moderately serious issues in November and December requiring short inpatient stays and some small surgeries. Possible ongoing monitoring.

Here's how the math worked out:

Monthly premiums: $475 x 12 months = $5,700 for 2012
Family deductible: $10,000 = We hit it but negotiated discounts with hospitals so ~ = $8,500 paid to hospitals and doctors

So our total healthcare spend was $14,200 pre-tax. Premiums were deductible above the line (self-employed). Out of pocket $8,500 does not exceed 7.5% of AGI, so no deduction for that.

Total healthcare spend post-tax was about $12,400. For that we got:

--Hopsital and doctor services and RXs with a sticker price of $55,000, which was then discounted down by at least $20,000 due to Blue Cross negotiated discounts, and then cut in half by our deductible, before we negotiated further discounts with the hospitals ("We have a lot of medical bills right now. Can we get a discount if we pay today by credit card?").
--"Free" (ACA/Obamacare) checkups for all five family members.

In hindsight, it would have been great to have started with a lower deductible (at least for 2012) but we hope to be healthy going forward. I'm really glad that we locked in the coverage before the medical conditions hit.

Overall very happy with $12,400 spend for these services.

--Aude
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Re: Private health insurance for young, healthy family

Postby Tom_T » Fri Jan 25, 2013 2:29 pm

MN Finance wrote:Timely post. I just open my computer and was going to post a similar question. I just left corporate america and am starting my own business. I looked at health care options, and I'm actually having trouble even justifying buying coverage at all. I too am in my 30's, married with kids. Everyone is currently healthy.

If we opt for a $500/mo policy with $3000 ind / $6000 family deductibles, I feel like I'm spending $12K a year to protect against a $20k or $30k bill. I fully understand something much more catastrophic can take place, but the cost vs. the protection seems so extreme.

My perfectly healthy, very athletic teenage son spent ten days in the ICU last year with viral meningitis. Totally out of the blue. The hospital bills added up to around $100K. With insurance, I probably paid $1000 or so.

The ICU can easily cost $10K/day if you throw in various tests and meds. My son recovered soon afterwards. Point being that you don't need a "catastrophic" medical event to wipe out your finances.
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Re: Private health insurance for young, healthy family

Postby lindisfarne » Fri Jan 25, 2013 5:12 pm

Dianne wrote:People who buy COBRA plans usually have some health condition that prevents them from buying underwritten plans, since COBRA plans cannot exclude pre-existing conditions. So they are more expensive, because the insurance company assumes you have a condition that will generate claims.


Is this correct? I thought under COBRA, you just what the employer was charged (which includes what you paid when you were employed, plus what the employer paid on your behalf. In other words, it's not more expensive. It's the same price - it's the price the employer negotiated to provide insurance to employees.
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Re: Private health insurance for young, healthy family

Postby dm200 » Fri Jan 25, 2013 5:17 pm

lindisfarne wrote:
Dianne wrote:People who buy COBRA plans usually have some health condition that prevents them from buying underwritten plans, since COBRA plans cannot exclude pre-existing conditions. So they are more expensive, because the insurance company assumes you have a condition that will generate claims.


Is this correct? I thought under COBRA, you just what the employer was charged (which includes what you paid when you were employed, plus what the employer paid on your behalf. In other words, it's not more expensive. It's the same price - it's the price the employer negotiated to provide insurance to employees.


Almost. The employer may add a very small processing fee (or something like that), but you are not charged a generally higher fee for COBRA than what the current employee participants pay.
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Re: Private health insurance for young, healthy family

Postby Dianne » Fri Jan 25, 2013 5:44 pm

dm200 wrote:
lindisfarne wrote:
Dianne wrote:People who buy COBRA plans usually have some health condition that prevents them from buying underwritten plans, since COBRA plans cannot exclude pre-existing conditions. So they are more expensive, because the insurance company assumes you have a condition that will generate claims.


Is this correct? I thought under COBRA, you just what the employer was charged (which includes what you paid when you were employed, plus what the employer paid on your behalf. In other words, it's not more expensive. It's the same price - it's the price the employer negotiated to provide insurance to employees.


Almost. The employer may add a very small processing fee (or something like that), but you are not charged a generally higher fee for COBRA than what the current employee participants pay.


dm200 and lindisfarne are correct. I should have said, "...since employer-provided plans (including COBRA coverage) cannot exclude pre-existing conditions."
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Re: Private health insurance for young, healthy family

Postby grabiner » Fri Jan 25, 2013 10:24 pm

Dianne wrote:If you purchase coverage, even high-deductible coverage, the insurance company may negotiate the prices you pay for routine care, so that even though you are paying out of pocket, you still get to pay the insured rates instead of the uninsured rates. Medications, blood tests, mammograms, and hospital charges are often much less expensive for insured people. (Quest Diagnostics charges uninsured people about 10 times as much for routine blood tests.)


You can see the effect by checking the Explanation of Benefits you receive on your current coverage. Typically, the form will say something like, "Provider billed: $300. Allowed amount: $120. Insurance covered: $100. Patient responsibility: $20". If you were uninsured, you would have paid the full $300; the insurer and you combined actually paid the doctor $120.

Therefore, a high-deductible health plan will often pay for itself, even before you consider the tax benefits of a Health Savings Account.
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Re: Private health insurance for young, healthy family

Postby usaa13 » Tue Jan 29, 2013 12:25 pm

Does anyone have any opinions on this plan - Humana Value 100?

1) Any thoughts on which deductible? It has deductible options ranging from $5k (~$400/mo) to $7.5k (~$285/mo) to $10k (~$250/mo). Obviously you pay quite a bit more for the gap between $5k-$7.5k than the one between $7.5k-$10k. Since we anticipate at least one hospital childbirth in the next ~3-4 years, which will likely run over $10k (great state by state average site: http://transform.childbirthconnection.org/wp-content/uploads/2012/05/Colorado.pdf), it seems like a no-brainer to at least bump up to the $7.5k deductible since we'll almost certainly recover that $2.5k difference and the gap in annual premiums is just $420 (plus, we're likely to . But to spend $1,380/year to further lower the deductible another $2.5k to $5k seems a closer call. On the one hand, we're very likely to earn back at least $2.5k for the aforementioned childbirth, which would cover ~2 years of the increase in premium while also giving us free medical care for anything else that my wife needs in the year of the childbirth and giving us further coverage in other years. On the other hand, if we have the plan for, say, 4 years and only have one kid, it could be an overpay for coverage we don't really need. Guess we could always drop back down if we need to, though, and it is far from certain that we won't have alternative coverage a couple years into the future anyway, so I suppose I'm leaning towards the $5k deductible.

Relatedly, am I right to think that individual/family deductibles make more sense for us than just a family deductible since we are more likely to have any major event occur to one person? It's hard to tell for sure on ehealthinsurance.com, but it seems like a lot of plans just have straight family deductibles. (E.g. the CO Health Savings 5000 lists a $10k family deductible ... although given the name of the plan, I wonder whether there is an individual deductible also?)

2) Are there any major gaps in coverage that I'm missing? Seems to offer reasonable protection across the board to my eyes:

Office Visit for Primary Doctor
0% after deductible
Office Visit for Specialist
0% after deductible
Coinsurance
0% after deductible
Annual Deductible
Family:$30,000($10,000 per person)
Annual Out-of-Pocket Limit
Family:$30,000($10,000 per person)
Includes deductible
Lifetime Maximum
Unlimited

Periodic Health Exam
No Charge (No Deductible)
Periodic OB-GYN Exam
No Charge (No Deductible)
Well Baby Care
No Charge (No Deductible)

Prescription Drug Coverage
Rx Deductible for Levels 2, 3, 4, then Level 1: $15 copay; Level 2: $40 copay; Level 3: $65 copay; Level 4: 35% coinsurance up to $5,000 maximum out of pocket. Levels based on specific drug
Separate Prescription Drugs Deductible
$1000 individual applies to Level 2,3,4.

Emergency Room
$125 Access Fee plus 0% Coinsurance after deductible (Access Fee waived if admitted)
Outpatient Lab/X-Ray
0% after deductible
Outpatient Surgery
0% after deductible
Hospitalization
0% after deductible

Pre & Postnatal Office Visit
0% Coinsurance after deductible
Labor & Delivery Hospital Stay
0% Coinsurance after deductible

Chiropractic Coverage
0% Coinsurance after deductible for 10 Visits per Calendar Year
Mental Health Coverage
50% Coinsurance after separate mental health deductible which is equal to the plan single/family deductible. No Waiting Period.
Substance Abuse Coverage
50% Coinsurance after separate mental health deductible which is equal to the plan single/family deductible. No Waiting Period.

Out-of-Network Authorization Required
Yes
Out-of-Network Deductible
Individual $20000/Family $60000
Out-of-Network Coinsurance
25% after deductible
Out-of-Network Out-of-Pocket Limit
Individual $5000/Family $10000
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