If I am going to keep riding my bike I need health insurance!

[kajero]

Actually I need health insurance no matter what.

I need help with selecting a health insurance policy. COBRA is really expensive. Can anyone give me advice. I looked on eHealth. I talked to a customer service person and he really helped me out. He provided reasonable quotes, I just don't know what to select.

Should I select a high deductible and lower premium?

Cobra will be 443 a month! I would have a 1000 deductible with 10% co-insurance. There is no limit of Dr visits. Co Pays are $25. It does include prescription benefits. All other plans don't.
The other plans have a limit of 4 visits with co-pays between $30 -$40. After that you pay a discounted rate. Those plans are between $258 and $301, but they have a deductible of anywhere between 5000-7500. The co-insurance is 0 which means once I reach the deductible, I don't have any more costs. the plans do have prescription coverage

I can handle, with only some difficulty, a $7500 deductible. I just hate knowing the inheritance from my Dad will be spent on medical insurance. :-(
Obama care is supposed to start in October. Premiums will be based on your income. I wonder if they will look at your current income. If so, I will come out great . . . I don't have any income -- unless unemployment comes through.

[goldfinch]

Keep in mind that under the new health care law eligibility for subsidies depends on joint income, for both you and your spouse if you are married. There is some basic information about subsidies here: http://www.businessweek.com/articles/2013-06-03/how-to-calculate-eligibility-for-health-insurance-subsidies The effective date is the first of the year but the exchanges where you can shop will go into effect in October. Unlike many states who are dragging their feet, Minnesota is ahead of the game in setting things up.

Here is a good worksheet for comparing different health insurance plans: http://healthinsuranceinfo.net/managing-medical-bills/worksheet.pdf

You can also talk to a insurance agent who may be able to find any other options for you that you haven't been able to find through eHealth.

[OakLeaf]

It really depends on your personal needs and risks, and you don't want to be talking about those in a public forum. If you have no pre-existing conditions and no known risk factors, you could take a chance. But if you have any health care utilization now, or any risk factors, add up what it is costing pre-insurance, or what one of those risk factors is likely to cost if it develops. That's the only way you can have a reasonable basis for knowing what to spend. I'm guessing that since you have options at all outside of COBRA before your state exchange goes into effect, you must not have any pre-existings, though.

Also, you can be too poor to qualify for the subsidy. Has your state approved the Medicaid expansion?

[goldfinch]

Minnesota has approved the Medicaid expansion. Things are really screwed up for some people in states that are not approving the expansion. No mandate, but no insurance either.

[kajero]

The only pre-existing condition: I tend to crash my bike more often than I should. LOL

[kajero]

There is some basic information about subsidies here: http://www.businessweek.com/articles/2013-06-03/how-to-calculate-eligibility-for-health-insurance-subsidies The effective date is the first of the year but the exchanges where you can shop will go into effect in October. Unlike many states who are dragging their feet, Minnesota is ahead of the game in setting things up.


This link was really good. eHealth had a lot of info on what will happen in October. I can't find when they will look at your income. I had a really good income until July 9. Now I only have dividends from my stocks. I can withdraw from my ROTH if I need to. And I can get Social Security February. Hopefully I can hold off on that.

[goldfinch]

I am currently on Minnesota's risk pool due to pre existing conditions, which will be closing down at the end of the year. So I will be shopping on the exchange too. If you want to compare notes via email come October I would be glad to chat. My current plan is to work with an insurance agent when shopping. I am also thinking about shopping in other states as there is no particular reason I need to remain a Minnesota resident.

To be eligible for any subsidy you will need to buy on the exchange. The absolute cutoff for subsidies at a certain income level means that my spouse and I will not be getting any subsidy. Oddly, it makes sense for some people to divorce in order to get a subsidy. I know a person who has health insurance through work but no family coverage for her spouse. They are not eligible for a subsidy because her income is too high. If they divorce he could get a significant subsidy.

Health insurance reform needs tweaking, it did from the get go. But it isn't going to happen in the near future.

[goldfinch]

This link was really good. eHealth had a lot of info on what will happen in October. I can't find when they will look at your income. I had a really good income until July 9. Now I only have dividends from my stocks. I can withdraw from my ROTH if I need to. And I can get Social Security February. Hopefully I can hold off on that.

http://healthinsurance.about.com/od/reform/a/How-Does-The-Premium-Tax-Credit-Health-Insurance-Subsidy-Work.htm

. . . Most people won’t want to wait; they’ll choose the advance payment option. However, consider opting to get the subsidy along with your tax refund if:

Your income is very close to 400 percent of FPL.
Your income varies from year to year so you’re not sure how much you’ll make.
When the subsidy is paid in advance, the amount of the subsidy is based on an estimate of your income for the coming year. If the estimate is wrong, the subsidy amount will be incorrect.

If you earn less than estimated, the advanced subsidy will be lower than it should have been. You’ll get the rest as a tax refund.

If you earn more than estimated, the government will send too much subsidy money to your health insurance company. You’ll have to pay back part or all of the excess subsidy money when you file your taxes. Even worse, if your actual income ended up more than 400 percent of FPL, you’ll have to pay back every penny of the subsidy. This could be thousands of dollars.

If you get your subsidy when you file your income taxes rather than in advance, you’ll get the correct subsidy amount because you’ll know exactly how much you earned that year. You won’t have to pay any of it back.

Basically, you can get an estimated subsidy but may have to pay all or part back if you actual income for the year is larger than estimated. Your income for 2014 is what is going to be relevant for your 2014 insurance premiums.

[kajero]

I spent all morning on the phone with internet insurance brokers. The are extremely helpful. I could never have done what they helped me with on my own. They found two really great policies for me. I applied for both and was denied. Apparently, some of the medication I am on points to a pre-existing condition. The brokers had other policies that were only $100 less than COBRA. The coverage is not as good as my COBRA and I don't even know if would be approved for those.

So I guess I will have to remain on COBRA. Thank goodness I can just "barely" afford it.

I wonder what will happen to insurance premiums for me come January 2014.

[kajero]

After all the work I did researching policies it was discovered that I have a pre-existing condition and qualify for nothing, so I must enroll in COBRA. It will be interesting to see what happens in October. I have been told that I might wind up paying $200 more or 10% less.

I really shouldn't complain about the premium.. I was hospitalized for a week in 2011. In addition to that I had two bike accidents one requiring an ambulance and 4 day hospital stay, the other was outpatient surgery. Both accidents were a result of stupidity of my part. I have since learned how to be VERY CAREFUL AND OBSERVANT! (plus I got a new bike)

I have also seen a mental health doctor numerous times.
I've used the prescription co-pay at least five times a year.

In the last 5 years I bet I have had nearly 85k in claims.

So today I am happy about having the insurance even if it is expensive. :)

Note: One of my friends is paying $562 a month. She said it the premium went up the minute she hit 62. She told me that one of her prescriptions was around $400. Her plan paid $0.44. Not a typo. She also has a pre-existing condition so she also has limited insurance options. I wonder how Obama care will affect her and me.

[shootingstar]

I continue to be amazed (shocked) by the U.S. health care system in terms of cost to the resident if they don't an employer to cover part of it as a benefit.

[Skippyak]

I continue to be amazed (shocked) by the U.S. health care system in terms of cost to the resident if they don't an employer to cover part of it as a benefit.\

I continue to be shocked that people I know choose not to insure, I can assure you that countries with UHC take your money (in the UK, NI was 11.5% last time I looked). Insurance requires spreading the risk and not just allowing people who need the care to pay in. Health care in the US is set up as a consumer activity but it is totally ripe for a two tier system. Obamacare has it's hands tied behind it's back unless insurance is mandatory. I don't think the American people have the taste for that, even the poor. It is such a shame.

[shootingstar]

\

I continue to be shocked that people I know choose not to insure, I can assure you that countries with UHC take your money (in the UK, NI was 11.5% last time I looked). Insurance requires spreading the risk and not just allowing people who need the care to pay in. Health care in the US is set up as a consumer activity but it is totally ripe for a two tier system.

Of course, if you live anywhere in Canada: you have no choice but to register with the govn't for publicly funded health care insurance card. (The insurance card is tied to some key personal ID government card numbers.) Otherwise....you pretty well WON'T get medical treatment in Canada. Yes, a Canadian doctor will ask for then for your private insurer's info. It's that simple. As long as Obamacare still includes the private insurance companies as driving the fee schedule, it will not solve significant inequities in the U.S. health care system.

Nothing wrong with that in my opinion: mandatory registration for universal health care provided by govn't funds.. and if required, a monthly premium payment to the provincial govn't. (Actually under $65.00 for a single person every 3 months for some provinces.) In Canada you register for public health care with the provincial govn't where you live. If you choose to add on additional private insurance, you can if you wish. Why can't the U.S. make the health care insurance system that simple for the public.?

People are incredibly naïve to think they are invincible and may choose in the U.S. not to be insured. It astounded me to know that ie some university students in the U.S., choose not to be insured. Are they crazy? Sorry, life is full of unpleasant medical/health care surprises.

Last week, I asked my father if he had to pay for his cancer drug treatments (and I know he doesn't have to pay at all for his oncologist appointments..averaging every 2-3 months now. It is a long wait, several hrs. But he's retired. No point, getting into a fit over wait times if you know you'll see a very good specialist physician.) He said no. He's been taking these drugs for last 3 years plus all these appointments.

He's a senior and low income. He didn't have to go through a 3rd private party for being screened for pre-existing conditions, etc. before he got medical care.

People may argue how can one spend such money on an elder?: my response is this a patient who hardly ever got sick at all for about 5 decades in Canada, before his cancer. And thankfully a patient who is dying of cancer but has no additional heart, respiratory, etc. problems.

[Crankin]

I just don't get why people think that health insurance is optional. I don't mind the government being involved at all. I agree, as long as we see it as a business, and not a right, this will continue.
What bothers me the most is that some people I know (in other states, not here) will pay 200.00 a month for cable TV, but not for insurance. And quite a few of my son's friends, opted to risk the tax penalty for not having insurance, when they first got out of school, rather than hook up with one of the very good plans offered through our health care connector. We insisted our son buy it, as he had no benefits with his first job.

[OakLeaf]

Y'know, considering how high the premiums are, and how little is actually covered when you get down to it, I've really considered going bare. I haven't taken that step yet, but I don't unthinkingly choose *to* have insurance, either. Yeah, if I were in an awful accident and had to have major orthopedic surgery, that would be mostly covered. But very little of the rehab would be, and over time that would be the bulk of the expense anyway. I could probably pay for surgery and a week in the hospital with what I've paid in premiums in the last five years.

Did y'all catch the article in the NYT Magazine a couple of weeks ago - which was really about end of life/quality of life issues, about the severely impaired quadriplegic guy (who was injured in a bicycle accident, incidentally) and his wife? It was mostly about how the couple dealt with the emotional issues surrounding his quality of life and whether or not he wants to continue, and whether or not she can cope with it if he decides he doesn't want to. But it mentioned in passing that even though they have extremely generous insurance that covered pretty much all of the initial expenses and much of his rehab, they are now paying $250,000 a year out of their pockets for the ongoing care he needs.

Most people, needless to say, don't get that choice. I wouldn't even get that choice, and I'm the one who can afford insurance on the private market. But I wouldn't be able to pay for the care that that insurance doesn't cover. It really does make me wonder whether it's worth having insurance at all.

[thekarens]

There are other things to be considered than just accidents, though I do get where you are coming from. What happens if you get a life threatening illness or let's say you are in an accident and you somehow injure your kidneys and end up needing a transplant. For those types of reasons I couldn't imagine not having any insurance.

[OakLeaf]

Yeah, those are decisions I've made for myself based on my age and my tolerance for reduced quality of life. I certainly don't expect everyone to make the same decisions that I have. But if that's the kind of thing you want to have insurance for, better make sure you have insurance that covers it ... most don't. People recovering from cancer treatment and severe infections need rehab/PT/home care/psych services, too. That's why you're always reading in the paper about people having bake sales and spaghetti dinners and car washes and poker runs to help with this or that one's medical expenses. And if you can even find insurance that covers ongoing care, like a transplant survivor would need, add up the premiums and think about whether you could invest that money just as profitably as the insurance companies do. It takes more discipline to write that check to your own investment account instead of to an insurance company, but that might well be the main advantage.

Obviously a younger person will not only have a different balance of decisions, they'll have a much lower premium than I do (and I'm only 53, so I've got two HUGE premium hikes coming yet before I'm eligible for Medicare, if I live that long, and in addition to any premium hikes that get imposed across the age range). All I'm saying, is that it's not a no-brainer either way. Having insurance is NOT a guarantee that your expenses will be covered if something happens.

[jobob]

I just don't get why people think that health insurance is optional.

Nor do I.

[kajero]

I don't know why the United States cannot have a decent health care system. Well, yes I do. Too many politicians.
Oakleaf,
Apparently we think alike. My health directive is very explicit and reiterates much of what you said. I have discussed this with my children until they are sick of it.
However, I will keep my insurance mainly to try to protect my life style as long as possible. Believe me, I don't have a luxurious life style.

[luvmyguys]

More companies do cover those things than you think. And the year dh had cancer, YES, I can say the payout alone from insurance for his care more than covered the amount in premiums we've paid in since we graduated from college. I'm irked at the nature of insurance companies, but one cancer diagnosis will make one appreciate even modest insurance.

The deciding factor for us was less "what was covered and what wasn't" and more along the lines of deciding which insurance company was going to fight every claim tooth and nail. Dh's company offers a few selections, and two of those selections offer what seems like similar coverage at drastically different rates, but when we did just a little research, we came to the conclusion that we'd be dealing with a whole lot more insurance drama with the cheaper company.

[mtbfan]

I ride alot, three times a week. I live in Cali and I do mountain biking. That is why I have 3 types of insurance policies. One is my health insurance plan with BlueCross Blue Shield (http://bcbs.com), then I have an heli-lift policy from CalStar (http://www.calstar.org/) and a stand-alone policy for my bike from Velosurance Bicycle Insurance (http://velosurance.com) . Only with these 3 policies I feel safe, well, not safe but protected from anything that may happen to me or my bike. For BCBS I pay $400 a month , for CalStar I pay 40$/year and for Velosurance I pay $120/year. The most expensive here of course is the health insurance but this one you have to have no matter what, cyclist you are or not, you never know when you might need it. Just like a helmet, you dont need it until you need it.