Need help deciding if I should get rid of my family's insurance

[kbkids]

I feel your pain. I HATED United. DH's employer used them for awhile, and I was ecstatic when they switched to Blue Cross. Our premiums are low - actually there were none when DH's company used United, so I tried not to complain, but geez!!! They were awful!! I had to call monthly on claims they had messed up. Anyway, now that we have Blue Cross, we do have a premium to pay - it's still not much, but I'll gladly pay it to be able to stay away from United.

 

[NotUrsula]

UHC's website will give you a list of all of the in-network providers in a radius from your address. If there really are a tiny number, then go to your DH's HR dept. and complain -- the broker they use will pressure UHC to sign up more providers in your area. They don't know where you want those doctors to be unless you tell them, you know.

Stop using out-of-network providers now, unless it is a specialty dr. that you only see once a year for a checkup or something. Anyone you see regularly should be in-network for your insurance. That's unfortunately the way the system works these days, you just don't get a completely unlimited choice.

 

[rigs32]

Because you're not using in-network providers, it's not *exactly* fair for you to complain about the high out-of-pocket costs. The nature of health insurance today is that you're stuck with the providers in their network.

Why don't you want to switch peds? Does one of your kids have a special problem that only your doc really knows how to treat? Familiarity? Convenience? You need to weigh all those factors and consider switching docs.

Why are there so few providers in your area? Does your DH commute a long distance? How far a drive is it to the in-network providers?

 

[mickeyfan2]

well in order to open up a HSA, you first have to purchase a high deductible Health Insurance Policy (ie pays expenses after the Deductible is met - like $2000 a year or so.) Purchasing that policy will eat up a good portion of that $6000 you plan to put into the savings account. So if you go with an HSA, you will still have very bad insurance, you'll just be paying less money for it in premiums.

Beyond that I really can't tell you the answer. I don't know of many people that are choosing these plans voluntarily. They do seem to be used heavily by the self-employed and very small business owner's, because some insurance coverage is better than none.

We looked into them a year ago and then ran away. It was a bad idea for us.

OP don't go without insurance.

 

[CarolA]

If the Doctor's office does not have a clue about what you are going to owe then that's a bad sign.... it means they don't care.....

They can figure this out, they just didn't want too.

$6,000 will not cover ANYTHING and with two kids it would take just one major accident to go thru that $6,000 and EVERYTHING else you have saved.

 

[Jaklackus]

I would shop around..(ehealthinsurance is a good place to compare)....hubby decided to run his business full time and dropped his regular job...we found a catastrophic policy through Humana...they covered everyone but me(I'm going back to work for benefits...but while I am looking and waiting everyone else is covered at least)....it's $100 per month. With a $5200 per person deductible ...$10400 for the family and covers 100% after that up to 5 million per person...because we live in FL they have to cover the kid's well child visits without the deductible being met....the HSA allows us to deposit as we need it , it earns interest and rolls over from year to year(we don't have to use it all in one year) If one of us was chronically ill I would pay more..to be quite honest hubby's old policy wasn't that great...by time we were done with deductibles and co-insurance and co-pays we only pay a few thousand more in the worst case scenario this way and our maximum is higher on the catastrophic.

 

[4eyedbuzzard]

It also depends upon where you live. If you live in Massachusetts, it is illegal (as of today) to go without health insurance.

Having insurance is mandated under the new law, but it is not "illegal" not to have it - you just lose financial/tax incentives. The law is that by Dec 31 you must have proof of health ins in order to claim a $219 exemption on your MA State Income Tax Return.

From the Associated Press - "...Although today marks the beginning of the “individual mandate” — the legal obligation to obtain health insurance — the real deadline is Dec. 31. When Massachusetts residents file their state tax returns next spring, they must certify that they had acceptable coverage by the end of 2007 or lose a $219 personal exemption. The penalty grows steeper in subsequent years.

The state’s 175,000 employers have to pitch in, too. Businesses with 11 or more full-time employees that do not offer health insurance must pay an annual “fair share” assessment of $295 per employee. The government, for its part, is defining basic coverage and trying to make insurance more affordable. Under its new Commonwealth Care program, it is subsidizing coverage with no annual deductible on a sliding scale for people with incomes of up to 300 percent of the federal poverty level, or $61,950 for a family of four. About 130,000 low-income people are already enrolled either in Commonwealth Care or MassHealth, the state’s Medicaid program, state figures show. The poorest pay no premiums.

Those who do not qualify for subsidies and cannot get coverage through their jobs can buy low-cost but unsubsidized health plans through the Connector Authority under the Commonwealth Choice program. Costs are still too high for some. Already, state officials expect to exempt 60,000 residents from the new mandate because they cannot afford the insurance, but earn too much to qualify for subsidies. The state’s costs are a concern, as well. Some analysts wonder whether Massachusetts will be able to keep funding the $1.6 billion-a-year program if the economy slumps or costs jump over the next few years."

 

[Tink-aholic]

Having insurance is mandated under the new law, but it is not "illegal" not to have it - you just lose financial/tax incentives. The law is that by Dec 31 you must have proof of health ins in order to claim a $219 exemption on your MA State Income Tax Return.

"

Thanks for clarifying this. I live in NH and keep hearing about all of the incentives and deterrants to make sure MA residents acquire health insurance. I work in Mass in the medical field and I know that there are larger penalties for employers who do not offer insurance.

One of the reasons for this is that Massachusetts Medicaid is one of the easiest to qualify for and offers many more benefits than most other state aids. For example, they cover Viagra and Penlac (a solution to paint on toenails to get rid of fungus -- a sample-size bottle costs about $140). To me, impotency and nail fungus are two things that shouldn't be covered by my tax dollars.

I used to work with someone on Mass Medicaid. She was 24, lived in HUD housing (even though we both worked at the same doctor's office), had no kids, and had MassHealth. She managed to get a new Coach bag every season...

 

[Bsetter]

My advice would be to see the Movie "Sicko" and then contact your Senator and Representative - this should not be a choice that someone should have to make for their family - changes have to be made!!!!!

 

[DebMcDonald]

Yes bad insurance is better than no insurance and baring any serious health issues you could be fine, but as with any health issues you don't see them coming and you could go from financially fine, to being on the road to financial ruin. Normally with any insurance you meet a yearly out of pocket expense, maybe 2000 in your case and then you would be covered 100%. Health insurance is the same as homeowers, life, etc. You hope that you don't use it, but if you do, some coverage is better than none.

 

[WendyisDarling]

To answer the question simply, keep the insurance. It is better than nothing for all the reason already given.

I am glad to read that I am not the only one that HATES UHC. DH's employer has used them for 3 years now. Everything is going up so much (I know this is partly due to the employer's choices). We have the tiers for medications. They keep moving meds. to the highest level and say it is not the preferred. Co-pays are $45/month! A few they won't cover at all. And the co-insurance increases more and more. Many doctors are dropping them (but in fairness some of our doctor's are no longer taking any insurance!)

To everyone who uses in-network UHC--get this: I called last week about a claim and at the end of the conversation, the rep. said "the next time you are scheduling a dr. appt. you should go to our website and click on this and that and you will see our PREFERRED in-network doctors. These are doctors who we have found to be less costly with their care and make dx's quicker, etc. " I'm thinking what about quality and accuracy?! These characteristics weren't mentioned.

 

[mum4jenn]

I did not read all the replies so if someone has brought this to your attention already plaes forgive me.

You were talking about you going to work at the place your dh used to....Make sure you check with BOTH employers plans to see if the BIRTHDAY RULE applies. With this if both parents are working and if an insurance plan is offered, the parent who has the earliest birthday, has to be the one who carries the insurance for the children. For example: If Dad's BD is in February and Mom's BD is in April, Dad would have to have the insurance on the kids.

 

[dhardawa]

I work for a major health insurance company (not United) and there are a few things to consider.

1. Legally, United can't sell to you without meeting a minimum number of peds, ob/gyns, hospital, and general doctors within a certain radius. So, the doctors are out there, you just need to go online and find them.

2. Most insurance carriers will allow you to nominate a non-par doctor. They can then to go the doctor and say "XXX is a patient of yours but you are non-par and she would like you contracted with us." It gives the contractors leverage.

3. It is very likely that your doctor's office doesn't know what United will pay for out of network claims. This is YOUR insurance policy and they don't know the details of everyone's insurance policy. Typically, your insurance will pay a percentage and that will be of billed charges. So, say you had an 80/20 in network and a 60/40 out of network plan, if you went to an in network doctor and s/he charged $100 for an office visit, the insurance company would pay 80% of their NEGOTIATED rate which might be more like $50. So, you'd pay out of pocked $10 and the insurance company would pay $40. If the provider was non-par, they would pay $60 and you would pay $40 because there is no negotiated rate.

4. Do you have any idea what type of plan you have? You really need to read it and understand it to make the best decisions. My daughter has United (through her dad's work) and I have never had a problem at all, but I also understand her plan. Being in the business doesn't hurt either. If you want to send me a private message with the details, I'd be more than happy to put it into English for you.

 

[dhardawa]

I did not read all the replies so if someone has brought this to your attention already plaes forgive me.

You were talking about you going to work at the place your dh used to....Make sure you check with BOTH employers plans to see if the BIRTHDAY RULE applies. With this if both parents are working and if an insurance plan is offered, the parent who has the earliest birthday, has to be the one who carries the insurance for the children. For example: If Dad's BD is in February and Mom's BD is in April, Dad would have to have the insurance on the kids.

We must not do that here! I have never heard of that. I bet most people just go on a family plan with one employer though so it may not be too common. Interesting.

 

[Hedy]

We must not do that here! I have never heard of that. I bet most people just go on a family plan with one employer though so it may not be too common. Interesting.

The respondent is mistaken, the birthday rule has to do with coordination of benefits, not who can carry the kids. http://www.businessplansinc.com/newsletter_do_you_know_the_birthday_rule.htm

 

[ladysoleil]

However, if the flex plan company is Wage Works, run far far away and ignore the above advice. They are *this* close to being dumped by DH's HR department for FSAs, because they are messing up everyone's flex account (including ours...it's now July in a January-start use-year and we still can't use our card), and one of their reps is known to visciously rip into people who call for help (including my husband), and if you call another rep once you've recovered from Alex's scorn (he seems to feel that funding an FSA isn't "budgeting" your health care dollars, when it absolutely IS, and not having access to one's money really truly does cause problems when THAT is how one has budgeted), and if you tell the next rep who you talked to, THEY will apologize for his behaviour, he's THAT bad.

Flex plan = good.

Flex plan with Wage Works = awful

Seconded, WageWorks is horrid. I worked for a company that used them and the company dropped them after less than a year. It was just a mess. The last straw for me was when they sent me a check and it bounced! (They wouldn't reimburse me for any of the fees, either, so my piddly $15 reimbursement cost me $28 in fees. Never again.)

 

[mum4jenn]

The respondent is mistaken, the birthday rule has to do with coordination of benefits, not who can carry the kids. http://www.businessplansinc.com/newsletter_do_you_know_the_birthday_rule.htm

Note: These are generally accepted rules, not laws. Always read your policy to fully understand the procedures your plan has in place.

All I know is that my husband works at a tire manufacturing company. When I was pregnant with my dd (and I was working at Publix) his plan covered the pregnancy and once I gave birth I had to take out insurance on Me AND my child because my birthday came before his and because my employer paid part of the premium. This might just be a stupid rule on his employers part but we were told that if my employer paid even $1 towards my plan (as in the employees paid less than a person buying BC&BS straight out as a non employee would) that I HAD to carry the insurance.

OP this is still something to look into before making a decision. It might be different in different states as well because when I worked for Wendys as a manager they had the same rule but back then we did not have kids and my DH's employer at that time did not have insurance for the employees so the Birthday rule did not apply to us then.



I apologize if I have given out any info that does not apply to your state.

 

[jennilouwho]

I agree that if you use in network it will be a lot cheaper! We have a UHC HSA and we are happy with it. We pay $131 a month in premiums and $4000 a year for the whole family in deductibles. Hubby's company gives us $50 a month toward the deductible. After we hit $4000 we pay nothing. It was great when I had my baby last year. In fact our deductible was $2200 then. Hubby got a new job now and it's increased. All routine visits (regular check up, prenatal, well baby, immunizations, etc) are covered so we pay nothing for those. So if it's a normal year and we only have to go to the Dr. a couple of times for illness, we don't pay that much, usually about $100 a visit. We do go in network though. If it's a year when we are having a baby or heaven forbid something horrible struck one of us, $4000 is nothing compared to what the insurance company is paying. I also love that it's tax deductible.

 

[Colinsmom]

I did not read all the replies so if someone has brought this to your attention already plaes forgive me.

You were talking about you going to work at the place your dh used to....Make sure you check with BOTH employers plans to see if the BIRTHDAY RULE applies. With this if both parents are working and if an insurance plan is offered, the parent who has the earliest birthday, has to be the one who carries the insurance for the children. For example: If Dad's BD is in February and Mom's BD is in April, Dad would have to have the insurance on the kids.

I don't understand this comment either. The birthday rule definitely applies for coordination of benefits (if kids are covered under both mom's plan and dad's plan). But in our case, our kids are insured only through DH's plan because it is much cheaper to cover them there than through my employer. I am the only one on my employer's plan.

 

[mum4jenn]

I don't understand this comment either. The birthday rule definitely applies for coordination of benefits (if kids are covered under both mom's plan and dad's plan). But in our case, our kids are insured only through DH's plan because it is much cheaper to cover them there than through my employer. I am the only one on my employer's plan.

Well...OP just forget what I said then. Evidently the companies in SW GA that I have worked for and my dh now works for are the only ones that have ever enforced this the way we had to do it. Sorry for any problems I have caused. I was just speaking from the way we had to handle things in MY family. Gee I thought that maybe others in the USA have gone through this as well and I was only trying to help. I worked at my job for only a couple of years after dd was born and and I no longer have this problem.