Where can I find health insurance that won't break the budget?

[traces7]

My family is currently covered through my health plan at work. It's me (45), DH (41) and DD (11). We received word that premiums are increasing (no big surprise). They're going up $100 a month. I'll be paying $650 a month for health insurance that's not even that great! That's almost half my paycheck and almost as high as our mortgage payment!

Is there anywhere I can find a better plan? And on short notice? (this all goes into effect April 1).

The new plan will be $1500 deductible per person, maximum out of pocket $6,000 per family.

On top of that we still pay $125 a month for one of DH's prescriptions. Which is about 50% of the cost I think.

We rarely go to the dr. I think DH and I went once last year each, he for his yearly bloodwork and me for my OB/GYN stuff. DD didn't go at all, she's due for a checkup though.

Can anyone recommend a plan for us? Should we go for the higher deductible and maybe get a lower monthly payment, or stick with the $650 a month at my work? I'm really confused!

I know $650 a month doesn't sound like much to some people, but to us, it's a lot! We barely have enough for extras the way it is. Where could I even go to ask for advice and help with this situation?

Thanks for any advice.

 

[WDWisTheBest]

My family is currently covered through my health plan at work. It's me (45), DH (41) and DD (11). We received word that premiums are increasing (no big surprise). They're going up $100 a month. I'll be paying $650 a month for health insurance that's not even that great! That's almost half my paycheck and almost as high as our mortgage payment!

Is there anywhere I can find a better plan? And on short notice? (this all goes into effect April 1).

The new plan will be $1500 deductible per person, maximum out of pocket $6,000 per family.

On top of that we still pay $125 a month for one of DH's prescriptions. Which is about 50% of the cost I think.

We rarely go to the dr. I think DH and I went once last year each, he for his yearly bloodwork and me for my OB/GYN stuff. DD didn't go at all, she's due for a checkup though.

Can anyone recommend a plan for us? Should we go for the higher deductible and maybe get a lower monthly payment, or stick with the $650 a month at my work? I'm really confused!

I know $650 a month doesn't sound like much to some people, but to us, it's a lot! We barely have enough for extras the way it is. Where could I even go to ask for advice and help with this situation?

Thanks for any advice.

First, please contact two or three health insurance agents in your hometown, explain the situation and compare their suggestions. Don't ever get a plan though an internet website.

Unfortunately, you and over 50 million other families are going to find out what the impact of the healthcare legislation that was passed by Congress last year is on your family budget. Healthcare costs are going to skyrocket in the next few years, unless that legislation is modified. You will be paying for the 30 million people who have been brought into the system.

Again, get your advice through local insurance agents who have been in business for many years in your community.

 

[woodkins]

Honestly that isn't that high for family coverage. I pay about that amount just for the HMO coverage for my husband and myself (we have our dd on a different plan & pay that separately). You can check and see if that state you live in offers a plan that you can buy into as a family. The plan we buy into is through the state of NY & our is for small businesses (we are sb owners) but they also offer a Family Health Plus plan that people can purchase. The idea is that the rates are lower as you are essentially buying into a group plan rather than individually. Having said that the $690 that my husband and I are paying for the 2 of us is the reduced rate

 

[kittychatalot]

But since your husband is already on meds- whatever that condition is will be excluded. Pre- existing conditions are excluded under private healthcare. That means any treatments or flareups or meds would be paid for out of pocket. I have to me on a group medical plan because I am type 2 diabetic and anything related to diabetes would be excluded on a private plan. I basically only work for the healthcare. Paying $400 a month for just me with a $2500 deductible, and a $10,000 maximum out of pocket.

 

[JDUCKY]

Check out ehealthinsurance.com

I had a plan through Cigna for me and my DD for a while and it was very reasonable (less than half the price I could get a worse plan for through my work)

 

[Lewisc]

You didn't indicated what state you live in. It makes a difference. The rates you mentioned look OK in the NY area. I'll disagree with the PP. The problem isn't healthcare reform. The problem is healthcare is expensive. Check with your state. (probably deparment of insurance website) Some states sponsor insurance programs for people who make too much money for medicaid but can't really afford regular health insurance.

You might be able to get a better deal on your script. Sometimes there is a different, less expensive, drug that may work for you. Sometimes your script will be for an extended release (XR) drug. You take it once a day. A non-release version of the drug may be available as a generic for a fraction of the cost you're paying. I'd start with asking my pharmacist or call the customer service number if you're getting your drugs mail order. Ask to speak to a pharmacist. Ask them if there is a less expensive drug. If so you'll need to talk to your doctor about trying it.

Some drug mfg have a program to assist people who need help paying for a drug.

Don't rely on information you see on sites like DIS. Pre-existing conditions are almost always covered if you have a gap of less then 62 days between policies.

 

[traces7]

You indicated what state you live in. It may make a difference. I'll disagree with the PP. The problem isn't healthcare reform. The problem is healthcare is expensive. Check with your state. Some states sponsor insurance programs for people who make too much money for medicaid but can't really afford regular health insurance.

You might be able to get a better deal on your script. Sometimes there is a different, less expensive, drug that may work for you. Sometimes your script will be for an extended release (XR) drug. You take it once a day. A non-release version of the drug may be available as a generic for a fraction of the cost you're paying. I'd start with asking my pharmacist or call the customer service number if you're getting your drugs mail order. Ask to speak to a pharmacist. Ask them if there is a less expensive drug. If so you'll need to talk to your doctor about trying it.

Some drug mfg have a program to assist people who need help paying for a drug.

Don't rely on information you see on sites like DIS. Pre-existing conditions are almost always covered if you have a gap of less then 62 days between policies.

We live in Wisconsin. I checked their website and it looks like DD would qualify for state insurance, but not DH and I.
There is no other drug for DH, we tried that already, it's a name brand, no generic available and no other similar drugs. (but thanks for the advice) They do have a discount card through the company that makes the drug, it's $20 off with that. We use that already too.
Good to know about the pre-existing condition policy.

 

[traces7]

Check out ehealthinsurance.com

I had a plan through Cigna for me and my DD for a while and it was very reasonable (less than half the price I could get a worse plan for through my work)

I've done some research on this site. Can anyone recommend some other good companies to go through?

 

[traces7]

First, please contact two or three health insurance agents in your hometown, explain the situation and compare their suggestions. Don't ever get a plan though an internet website.


Again, get your advice through local insurance agents who have been in business for many years in your community.

I was going to try and do that next week when I'm on furlough!

 

[bdcp]

If you graduated from college a lot of alumni associations offer insurance plans particularly for catastrophic care. When my DS (27) graduated college, he had 5 months before he was starting his "career" job. He was working at the local Hallmark store during those 5 months, which offers no benefits. He got insurance through his university's alumni association and it was more like $300-400 for 3 months coverage. Once he started with the company he works for now, he got their insurance which is more comprehensive. There were different "packages" so he did his in a three month and then two one month increments. His had a high deductible (I think around $1500), but the point really was to cover him in case of illness or accident that would have cost tens of thousands of dollars out of pocket without insurance. Always check through any association/organization you belong to. A lot have plans that are lot cheaper because it's a "group" plan.

 

[Lewisc]

Did you try to get an exception to your medical insurance formulary? Did you price getting a 90 supply? Is the drug available at a higher dosage? Some drugs cost almost the same per pill for 25 or 50mg. Ask your doctor to prescribe the higher dosage and cut the pill in half.

Check all your drugs. You may be able to switch some to the $4 generics available at places like Target and Walmart. COSTCO (most states) allow non-members access to the pharmacy. Check the price.

Frequently insurance through your employer is the best deal. See how much you'll save if you take your kid off the plan and get her state coverage.

I may have given you misleading information. Many states let insurance companies underwrite an application. It's possible your husband's condition might be grounds of individual insurance companies denying coverage. The ban on pre-existing conditions doesn't require the company insure an applicant, only that if they insure the applicant they can't impose a ban on pre-existing conditions.

I don't know what the situation is in WI but you probably won't have enough time to apply for an individual policy by April 1.

 

[Debbie7452]

Have you priced what a policy would cost with your DD on the state plan and you on the company plan. This is what I helped an employee do when he couldn't handle any more rate increases. It was a lot more affordable for spouse coverage than "family" coverage.

 

[Marionnette]

From where I sit, the price you're paying for a family plan is not all that bad. We are self employed and pay more than that for coverage that isn't as good as what you describe.

If you decide to go for cheaper insurance on your own, then make sure that you know what you're in for. I recently needed an MRI - $250 co-pay. Physical therapy went from $40/visit in 2010 to $60/visit in 2011. I've been going every week, twice a week since the beginning of Dec. I'm still not done. My daughter's prescription went from a $20 copay to over $70/month.

You might be able to get a policy like I have and pay less than what your employer's policy is costing but you might wish you had better coverage if you start having to pay for all the higher out of pocket costs.

 

[GrnMtnMan]

Pre- existing conditions are excluded under private healthcare.

Not 100% true.

Depends on the state. Some states do not allow medical underwriting which means pre-existing conditions cannot be factored into a policy.

 

[mydisneyobsession]

Did you try to get an exception to your medical insurance formulary?

Can you please tell me more about this? We have several prescriptions that have no generic alternative or possible substitutes and have high co-pays. I'd love to know how to go about doing this successfully.

Thanks so much!

 

[Lewisc]

Can you please tell me more about this? We have several prescriptions that have no generic alternative or possible substitutes and have high co-pays. I'd love to know how to go about doing this successfully.

Thanks so much!

It depends on the carrier and your state. Sometimes the high co-pay is a method of making the insured pay "their fair share" of an expensive drug. In other words an appeal might not do much. Other times it's a way to encourage people to try less expensive courses of treatment first. Showing that there is no other option that works for you, will sometimes get you a lower copay.

Start with the phone number on your card. Do you have a separate number for pharmacy? Otherwise call the regular customer service number and ask for pharmacy. Ask for the procedure you in need follow in order to make an appeal and get a forumulay exception. You have nothing to lose.

 

[Frannie115]

The $650 a month sounds about right for that policy. I work full time and pay $720 a month for a family of 4 through my employer. I don't think it's possible to get a similar plan cheaper anywhere else for us. I checked online and plans that were a little cheaper had EXTREMELY high deductibles and out of pocket expenses.

I always say I work for health insurance not the pay

 

[bearzabout]

Are you currently covered by Blue Cross Blue Shield by chance? My husband and I went from paying $450 each per month for our company's group plan to less than $130/month for an individual policy through Blue Cross 3 years ago. It costs closer to $165/month now, but this is still an amazing rate since my hubby is no spring chicken (he is 58). Both policies have high deductibles but mine even covers $500 in preventative care per year for free. I get free annual gyn exams, pap smears and mammograms every year.

Prescription drug coverage is not included which works for us because we take homeopathics and stay healthy. We pay $50/year out of pocket for a complete blood panel test through a locally sponsored program called Project Healthy Living so we know exactly what our numbers are.

Look into individual plans or other options with your current provider. Ask your group plan administrator if you can go back on the group plan if someone gets really sick.

Make sure to compare the "annual stop loss" for your current and any new plans that you consider. That amount is the maximum you would have to cover out of pocket annually before the plan provides 100% coverage.

 

[traces7]

Did you try to get an exception to your medical insurance formulary? Did you price getting a 90 supply? Is the drug available at a higher dosage? Some drugs cost almost the same per pill for 25 or 50mg. Ask your doctor to prescribe the higher dosage and cut the pill in half.

Check all your drugs. You may be able to switch some to the $4 generics available at places like Target and Walmart. COSTCO (most states) allow non-members access to the pharmacy. Check the price.

Frequently insurance through your employer is the best deal. See how much you'll save if you take your kid off the plan and get her state coverage.

I may have given you misleading information. Many states let insurance companies underwrite an application. It's possible your husband's condition might be grounds of individual insurance companies denying coverage. The ban on pre-existing conditions doesn't require the company insure an applicant, only that if they insure the applicant they can't impose a ban on pre-existing conditions.

I don't know what the situation is in WI but you probably won't have enough time to apply for an individual policy by April 1.

Have you priced what a policy would cost with your DD on the state plan and you on the company plan. This is what I helped an employee do when he couldn't handle any more rate increases. It was a lot more affordable for spouse coverage than "family" coverage.

The one drug my husband has that is so expensive is not a pill, so not possible to split in half or available at a higher dosage, etc. He has 2 prescriptions, one for low testosterone (which is a gel and expensive), the other for an irregular heartbeat (it's cheap and available generic).

It's about $40 a month to cover my DD. So it's not much cheaper just for DH and I. I also found out that to cover her through the state is like $98 a month. Anyway I heard they stopped taking applications for that (BadgerCare here in Wis). Thanks anyway for all the advice!

 

[traces7]

The $650 a month sounds about right for that policy. I work full time and pay $720 a month for a family of 4 through my employer. I don't think it's possible to get a similar plan cheaper anywhere else for us. I checked online and plans that were a little cheaper had EXTREMELY high deductibles and out of pocket expenses.

I always say I work for health insurance not the pay

That's what I've been finding. Our work plan has $1500 deductible. With that same deductible everything I've found is even higher! We're probably going to stick with the plan at work and try and make do. Maybe pick up part time jobs, we'll see!