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Health Insurance advice needed?

suesam

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What a stressful topic.
We get our health insurance through my dh's company.It is United HealthCare. We hate it. None of our lifelong Drs. or even our preferred hospital are in-network providers. Customer service is hideous and they always, always make mistakes which take us hours to get them to fix.
We used to get it through Blue Cross Blue Shield through my old job,I quit that job and that is why the change of company.
We both have jobs but also a small side business and we are the only two employees. We can get Blue Cross, Blue shield through our business, not group , but insurance. DH's company said they would pay as much to BCBS as they pay for us now through United Health Care. They would pay it directly to BCBS.
We are considering getting a Health Savings Account. I am wondering how that account would work for us since the business pays for our health expenses, out of pockets, co-insurance etc. I am sure I need to talk to our business accountant etc. about all of this. Are there any things I need to think of asking that I might not think of? Things I need to consider before changing plans? Of course I know that we need to figure out if they will cover some health issues we have been diagnosed in past year...which have not been many... but still expensive!

This totally stresses me out.

Sue
 

Fern Modena

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If you have new health issues, BCBS might not even take you now, even if you are a former client.

If you get an individual plan, as opposed to the group insurance plan you are under now, it could be quite a bit more expensive. I don't know how expensive, but I know people here who pay in excess of $650-700. a month for Anthem BCBS. Its probably cheaper in Iowa, but still something to think about.

Check what's covered, too, and up to what ceiling. Nobody expects to need a heart transplant or bypasses, have cancer, need a knee or hip replaced (with the attendant physical therapy afterwards), but it does happen. My husband's insurance has a $2 MILLION ceiling. His worst year he almost had $1 Million in claims. And the year before that he was what you'd call healthy. So don't shortchange yourself.

Fern
 

Luanne

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We have UnitedHealthcare and the only thing I really hate is the deductible.

Do you have a choice between a Health Savings Account and a Flexible Spending Account that you can designate for healthcare? We have the FSA. I like it because you can use the money before you actually accrue it in the account. With the Health Savings Account you have to have the money in it before you can "withdraw". The benefit to the HSA over the FSA, from what I can tell, is that you don't lose any monies you haven't used by the end of the year, and they "roll over" into a savings account. Supposed to be good if you are planning on retiring soon.

Our open enrollment is coming up soon as well. Guess I'll get ready to do a bunch of reading again.
 

suesam

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I have heard of other people actually liking UHC. My husband's company is based in Missourri and we live in Iowa. His co-workers who live in Missourri do not have near the problems we do...which is why his boss has said they will pay the same amount as they pay now for coverage we find ourselves.

Almost every time we have a claim they mess it up I kid you not. I can not imagine they do not do that to everyone, but possibly it is the regional people. My dh has to talk to them because I get livid every time this happens, which is literally every time we use our health insurance.

Sue
 

wackymother

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Have you checked to see how much the private BCBS will cost? If you're not in a group, it will probably be prohibitive. We were looking at a similar situation a few years ago and I'm remembering something like $1100 a month for family coverage in the group and over $3000 a month for private, IF they would take us. It was just a huge, huge difference.
 

suesam

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We have checked the rates and due to the fact we will go with Farm Bureau we will get a discount that will make it doable. The HSA plans are very reasonable due to the huge deductible. I do think we could handle that though. The plan I am looking at has a premium of $347.85 a month with a $3500 family deductible with a $7500 in network out of pocket max and $11,5000 out of network out of pocket max. This actually would make it that we would have no premium because DH's work would pay the entire premium and we would be saving the $380.00 per month premium we now pay and putting that into the HSA account

Do you think this all makes sense? Or am I missing stuff? This kind of stuff makes me absolutely crazy.
Then of course the money you put into the account is tax deductible and you earn interest tax free interest.

Thanks for any input by the experts out there.

Sue
 

wackymother

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Is there any kind of lifetime cap or annual cap on benefits paid?
 

Jimbo

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High deductible health plans (the kind you describe) are intended for the subscriber to be their own advocate. The deductibles are high to cut down on the administrative expense of the insurance and put the burden of tracking in your court.

Make sure you put enough into the HSA. You don't want to be caught short especially since it goes in tax free. As you state, you can keep the money and roll it into next year. You can also earn interest on this money - tax free. There is a third tax advantage but I can't remember it right now.

Best of luck in your decision.
 

Timeshare Von

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Having lived, worked and struggled with the medical insurance issues after leaving Iowa and my former IA based medical insurance this past summer, I might be able to help with a suggestion. Ask your employer to contact Merit Resources of West Des Moines. They are a "PEO" (Professional Employer Organization) that brings in small businesses and then provides benefits as part of a large (over 4,000 employee) group. My little 7 person staff was covered through Merit Resources with BlueCross and Delta Dental at a very affordable price (nearly half of what we're paying now in Wisconsin).

As an credentialed HR professional, I can attest to the quality of service and professionalism provided by Merit Resources and recommend them highly.
 

suesam

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There is a 5,000,000 lifetime maximum benefit.
Do you think that is enough?
I know a person who is about my age, early 40s, who has breast cancer. The University of Iowa said there is nothing they can do and her insurance will not pay for her to go to a different specialist. She would like to try a Dr. that a friend of mine went to who basically saved her life after Uof I told her there was nothing they could do for her non-hodgkins lymphoma and gave her 6 mos to live. It has now been 7 years and she is now organizing a benefit for the friend with breast cancer so she can see the another Dr. I just think it is so awful that she can not go to another Dr. for a second opinion. She does not have enough money to pay for it on her own.Anyway, all of this scares me and is making me think we need much better health insurance but it is such a big, big deal and I do not want to screw it up!!
Sue
 

shar

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We have had a health savings account for years. It has saved us money on health insurance plus we have earned interest on the money that is sitting in the health savings plan which rolls over every year. One year my husband had to have a hernea operation and it was still less expensive for us to pay out of pocket than pay the "standard" health insurance premiums. For someone paying their own insurance, I would highly recommend it. Our plan does not have a ceiling on costs paid out as benefits once the yearly deduction is met.

I went to a talk at a convention last week and an accountant was recommending a Health Savings Account for professionals in private practice. (She previously had worked for Blue Cross)

Shar
 

Liz Wolf-Spada

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In California, I am pretty sure, even HMOs have to allow second opinions. Maybe she should pay to go see this doctor once (the friend with breast cancer) and get the recommendations and go from there. I keep reading about people going to other countries for cheaper surgery and other medical care. Maybe that would be worth looking into for her.
Liz
 

Blues

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High deductible health plans (the kind you describe) are intended for the subscriber to be their own advocate. The deductibles are high to cut down on the administrative expense of the insurance and put the burden of tracking in your court.
Yes, but you always want to submit it to the insurance company first, even though you know you haven't met the high deductible. I always did when I had an HSA for 6 years. First, the provider wants to know that you have adequate insurance, even if you're just going in for a checkup, in case something major comes up. Second and most important, they charge you a different rate if you're insured vs uninsured. Sometimes 2/3 less! Finally, the rules of any policy are so complicated, you just can't be sure what's covered. I had a $5000 (per person!) deductible, which I never met. Still, once or twice the insurance paid for a minor service. I never knew why -- I just accepted it and went on.

Make sure you put enough into the HSA. You don't want to be caught short especially since it goes in tax free. As you state, you can keep the money and roll it into next year. You can also earn interest on this money - tax free. There is a third tax advantage but I can't remember it right now.
Always fund it to the max. It essentially acts like another IRA account. At a certain age (I think it's 65 rather than 59.5 for an IRA), you can spend it on anything without penalty. IIRC, you'll have to pay tax if it's a non-medical expense (since you put it in tax-free), but no penalties after that age. Or you can always spend it on medical needs tax free, even after you've stopped participating in the plan.
 

abbekit

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We have checked the rates and due to the fact we will go with Farm Bureau we will get a discount that will make it doable. The HSA plans are very reasonable due to the huge deductible. I do think we could handle that though. The plan I am looking at has a premium of $347.85 a month with a $3500 family deductible with a $7500 in network out of pocket max and $11,5000 out of network out of pocket max. This actually would make it that we would have no premium because DH's work would pay the entire premium and we would be saving the $380.00 per month premium we now pay and putting that into the HSA account

Do you think this all makes sense? Or am I missing stuff? This kind of stuff makes me absolutely crazy.
Then of course the money you put into the account is tax deductible and you earn interest tax free interest.

Thanks for any input by the experts out there.

Sue
One thing you need to think about is how much your premiums will increase each year. We are self employed and therefore self insured on an individual plan with BCBS of Texas. Our premium for two people (husband and wife) is $826 per month and we have an $8000 deductible so basically we pay in full for everything since luckily we haven't had a year yet that we've spent over $8000 for health care. But we have had years where we've spent over $4000 which is directly out of our pocket (to cover basic things like annual doctor visits, colonoscopies, skin cancer removal).

We do get the lower BCBS negotiated rates. And we get the BCBS drug co-pay benefit ($30 or $20 per prescription).

BUT for this plan our premiums have GREATLY INCREASED over the past seven years from $256 per month to the rate we have now at $826. Our premiums are raised once or twice every year! And we have almost no health issues or problems so they aren't raising the rates because we use the system much.

The insurance companies (at least in our state) can raise their rates whenever they want and our only choice is to pay it or start over every six months trying to find a new company to insure us. Last time we tried that we were turned down for my husband's "pre-existing condition" of skin cancer (basel cell, not even something serious!).
 

Blues

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Last time we tried that we were turned down for my husband's "pre-existing condition" of skin cancer (basel cell, not even something serious!).
Don't take this wrong, but are you serious? I'm not at all surprised. They turn you down for MUCH less than that.

I have allergies. Have had for most of my life. I take two meds for them; an antihistamine and a nasal spray. Taking two prescription meds is sufficient to get me turned down for almost any individual plan out there. When I was self-employed, I was only able to get (high deductible HSA-type) insurance through my professional society.

And I feel your pain about the rates. During the 6 years I was with my plan, the rates consistently went up 30% per year, every year. For the math-challenged, that's almost a factor of 5 in 6 years.

I'm now back at my former employer, where I get great health insurance. It's one of the reasons I went back to being employed. At the risk of getting political, we have a health-care crisis in this country and we need to do something about it.

-Bob
 

abbekit

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Don't take this wrong, but are you serious? I'm not at all surprised. They turn you down for MUCH less than that......



I'm now back at my former employer, where I get great health insurance. It's one of the reasons I went back to being employed. At the risk of getting political, we have a health-care crisis in this country and we need to do something about it.

-Bob

Yes, the system is broken. I can't imagine how bad it is for really sick people who have to self-insure.

We started off with a $5000 deductible. Whenever they raise our monthly rates they give us the option to "lower" our rate by raising our deductible. We did that once, raised our deductible to $8000 and lowered the monthly rate a little.

The next year they raised our monthly rates even higher than before and we were stuck with the higher deductible forever.

Not to be political either but people need to think about these issues.
 
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