Insurance Question?

[Irulan]

What you refer to as "gold plated" is really pretty minimal compared to what everyone had 30-40 years ago. It's pretty minimal compared to what a lot of people had 10 years ago.

And it may be the only thing that's available to someone who's coming over from COBRA or another policy. To be eligible for open enrollment, you have to have been uninsured for a certain period of time. Not everyone wants to take that risk.

well, I don't know about that. I looked at some self insure plans that had a premium for one person between $800-1200 a month, that had a $100 deductible, $1000 out of pocket maximum, $10 copay, full prescription coverage. In my book, that's pretty gold plated IMO, and if you can afford that, great.

I've never had a plan ( even prior to self employment) that didn't have some sort extensive PPO list to go off of, so I don't consider that a deal breaker. My primary care guy is contracted with every plan in the region. I've also never had a plan that didn't have a maximum of out of pocket expenses. Even my son's gold plated plan has a $1200 maximum out of pocket.

We have been self insuring (self employed) for years now that having to deal with COBRA is way in the dark dark past.

It's important to have something, even if it's just a catastrophic plan. I have an acquaintance who chose to not insure and then had to mortgage her house after a road bike crash. That would be great if you were taking that money you might have spent on a premium and put it aside, but even if you did do that, it's not going to cover the huge expenses that can occur in a serious situation.

well whatever. Shop around, talk to qualified broker, don't go with fly by night stuff advertised on the web/tv and educate yourself.

[OakLeaf]

My premium is $1750 per month for one person, $500 deductible, 20% in-network co-pay, out-of-network copays that I've seen up to 70%, yes prescription coverage, no out-of-pocket maximum, no vision, no dental, $2 million lifetime limit that I'm afraid to even ask how close I am to reaching. Minimal physical therapy, no occupational therapy (i.e., no non-surgical treatment for hand injuries, since that's all done by OTs), minimal mental health coverage (no parity even with the new law, because it's an individual policy).

My husband's is about the same.

Up until two years ago I had only minimal pre-existing conditions (which even then precluded me from getting any other insurance), and he has none.

We're lucky to be able to afford it, it's true. Considering the state of medical care in this country, I've seriously considered ditching it. But then I'll see something happen, like the son of a friend of mine got Legionnaire's disease and was in the hospital for two weeks ... another son of a friend had a non-displaced cervical fracture ... things that modern health care really can do something about, that would cost me tens of thousands of dollars after insurance. And I realize that even though I can afford insurance, I probably can't afford to go without it.

[Irulan]

Hmm. I wonder how much of the different is regional.

Three adults(49, 50, 21), $400 a month, 6000K into an HSA, $1700 individual deductible, $5K out of pocket per individual max, no prescription coverage, no vision, 10% copay after you reach deductible; 2 million max.

So folks, between me and Oakleaf you can see there is a whole wide range of choices.

[Irulan]

To go back to OP's question, if you are in an accident, and it's someone else's fault, yes, their insurance should pay. Ideally your insurance wil deal with their insurance and you don't have to do much. This is if you are dealing with a good insurance company.

There are a couple of scenarios, depending on how YOUR insurance operates.
1. Your insurance pays the bills and deals with going after the other guy, you pay nothing.
2. You pay the bills, submit them to your insurance for reimbursement who then goes after the other guy.
3. You try and get their insurance to pay directly. Remember it's the other guys insurances job to give you as little as possible.
4. You pay out of pocket and try to get the other guys' insurance to reimburse you.

[WindingRoad]

I have been looking long and hard at United Healthcare's major medical plan. It sucks but I really can't afford to get decent major medical AND have options for routine care. I can afford dental but that is about it, I am on a grad student budget and there isn't much fudge room. I have insurance now through Assurant and it's pretty lame for what I'm getting. It has a 3,500 deductible and is still only going to cover the big things. The plan with UH I'm looking at has a lower deductible and I have the option to add dental for $20 extra per month. I realize this isn't the ideal situation but I have to make some sacrifices. Aghaa I just don't know what to do!

[Crankin]

Wow, I believe there is a regional, or even a state-by-state difference. Before our mandated universal health insurance law, my son had good coverage for about 250.00 a month when he first graduated. I have no idea how he found this. After a year, the law passed, and he was able to get excellent Blue Cross coverage for $200.00 a month. It has a reasonable deductible, dental coverage, pays for check-ups, etc. Since he works for a company with 7 employees, he does not get health care. This is his last week there, after five years. His new employer offers 2 levels of plans (premium and basic) which seems reasonable for a single person, but is really a lot for couples (he's getting married next year).
I know some people don't think our law is good, and some think it's the work of the devil, i.e. socialism, but without it, my son would have had a real issue getting insurance, since he obviously does not fall into the "free care" category, but he doesn't make a huge amount of money. He has used it a few times and never had any problems and he has a decent pcp affiliated with Brigham and Women's.

[tulip]

I found my insurance coverage through ehealthinsurance dot com.

I have individual coverage from BCBS for $228 per month, $500 deductible. There is a copay for visits, but routine care/mammos/etc. are covered. It used to be $185/month but that went up when I turned 42. When I first got the coverage, they said I had a pre-existing back problem that they would not cover for the first year, so I upped my Pilates to prevent back problems. So far, I haven't had any back problems since. Interestingly, they never mentioned my 20-year standing eye issues, and they cover that without question. I don't take any meds, but I have gone to the ER for slamming my fingers in a car door and a serious ear infection. Covered, and the meds were covered, too (at least partially, if I remember correctly).

I could never afford Oakleaf's premiums. That's twice my mortgage payment!

Good luck.

[sj73008]

I have two ULIPs which bought for my children in 2003. I paid the premium religiously for three years. But to my shock my investment has not grown even after6 years. After reading some reviews on MouthShut..

Smith.
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[jessmarimba]

Oh, it's definitely regional. My company provides health insurance for us (luckily!) and it's actually very good - for most of the company. The three of us out in Colorado don't get the coverage that the rest of the company has, though, and many aspects aren't covered until you hit the max out-of-pocket (like PT. And having a kid). Also our vision insurance covers...nothing. I think we get 15% off of Lasik, or something.

That being said, at least we HAVE a max out-of-pocket. Plus we have additional coverage through someone else for 75% of the deductible, and I will not be bankrupted by my recent bike wreck.

I might even have enough left over from the original bike-savings-account to buy a bike again when I can ride