Why is health insurance so confusing and expensive! (long)

[traces7]

Our health insurance at work is up for renewal again and I'm confused as usual about what to do! It is going up again (of course!). I was paying $240 every 2 weeks for family coverage, now it will be $275 every 2 weeks. $550 a month/$825 a month when we have 3 pay periods in a month! YIKES! I don't know how much longer we can afford this. I haven't had a raise in 2 years and DH hasn't had one in 4 years, in fact he's had a pay cut!

I know that everyone will say that this is cheap for health insurance, but we can barely afford it anymore. We need new vehicles, but can't afford them because every penny is going for health insurance! We are trying to save for a new vehicle, but it's going slowly.

Can anyone recommend a good health insurance we could get on our own, is there one? I've been looking and nothing sounds any better. My DH is on 2 medications, one is very expensive ($400 a month, we only pay $40 for that now, but that will go up to $120 a month on this new plan).

Anyone have any advice? I don't know what to do, we'll probably just stick with the insurance at my job, but it's going to be tough! (financially) It's just all so confusing and I have only 10 days to sign up for the new plan!

It will have a low deductible $2250 for the family 80% copay, $20 copay for office visits and 100% coverage for preventive care. We really only go for checkups once a year. It's just the 3 of us, me, DH (we're in our early 40's) and DD who's 11.

HELP, anyone! Thanks for any advice!

 

[sam_gordon]

Can't help much but for us, if we have a 3rd payday in a month, insurance is NOT taken out.

 

[Taja]

Group health insurance generally will be less expensive than individual/family coverage. Not always, but usually.

See if you can get a recommendation for an independent insurance agent (not affiliated with one company) in your area and make an appointment. Have your group health plan available so he/she can compare apples and oranges.

FYI, my portion (50%) of the health insurance premium (for employee only) in my last position was $400+ per month (I think about $420). That means the actual premium was $800+! And it wasn't a wonderful policy. Decent, yes. Wonderful, no! *LOL*

Edited to add:

Every state has different requirements for health insurance policies and they are serviced by different companies licensed to do business in each state. Nothing is generic, unfortunately.

Also, rereading your post, it appears your DH has pre-existing conditions. That would be a factor that would significantly increase individual/family premiums outside a group.

 

[traces7]

Also, rereading your post, it appears your DH has pre-existing conditions. That would be a factor that would significantly increase individual/family premiums outside a group.

That was why we didn't get outside insurance last year. We thought we had found a good plan, but than they denied my DH coverage because of the medication he takes for a rapid heartbeat. But they can't do that now with some of the new healthcare reform, right? But, it would probably have a higher premium though I suppose like you said. I have next week off work and I'm going to call around and see what I can find out.

 

[snowiit]

That was why we didn't get outside insurance last year. We thought we had found a good plan, but than they denied my DH coverage because of the medication he takes for a rapid heartbeat. But they can't do that now with some of the new healthcare reform, right? But, it would probably have a higher premium though I suppose like you said. I have next week off work and I'm going to call around and see what I can find out.

as of right now... they can decline you based on your health history. I work for one of the biggest co. for health insurance and believe me, things are changing daily because of health care reform. Yes, they are working on policies where you can just apply and cannot be denied. BUt.. this as well will affect premium, and not in a good way. Consider... if this is the case, people could just apply for a policy (guaranteed acceptance) when they need it... when diagnosed with something... possibly get treatment... cancel the insurance.... and apply again the next time they are sick. The cost for something like that will affect everyone's cost.
Also.... with this healthcare reform, it can affect the policy you have and coverage. There is discussion on grandfathering policys so people can keep the coverage they have. It goes on and on. Sorry to say. no one really said it was going to be cheap. I can't understand.... Obama said healthcare reform... it should be called insurance reform. No one mentioned that the doctors don't seem to have to change a thing...

 

[KNEIPPK]

Our health insurance at work is up for renewal again and I'm confused as usual about what to do! It is going up again (of course!). I was paying $240 every 2 weeks for family coverage, now it will be $275 every 2 weeks. $550 a month/$825 a month when we have 3 pay periods in a month! YIKES! I don't know how much longer we can afford this. I haven't had a raise in 2 years and DH hasn't had one in 4 years, in fact he's had a pay cut!

I know that everyone will say that this is cheap for health insurance, but we can barely afford it anymore. We need new vehicles, but can't afford them because every penny is going for health insurance! We are trying to save for a new vehicle, but it's going slowly.

Can anyone recommend a good health insurance we could get on our own, is there one? I've been looking and nothing sounds any better. My DH is on 2 medications, one is very expensive ($400 a month, we only pay $40 for that now, but that will go up to $120 a month on this new plan).

Anyone have any advice? I don't know what to do, we'll probably just stick with the insurance at my job, but it's going to be tough! (financially) It's just all so confusing and I have only 10 days to sign up for the new plan!

It will have a low deductible $2250 for the family 80% copay, $20 copay for office visits and 100% coverage for preventive care. We really only go for checkups once a year. It's just the 3 of us, me, DH (we're in our early 40's) and DD who's 11.

HELP, anyone! Thanks for any advice!

ouch- 2250 deductable- i pay about the same as you and it is 600

 

[WishIwerethere]

Be careful of the preventive care. I switched to a more expensive policy through Anthem because it supposedly covered most preventive care. I went in for a physical, had my blood pressure taken as usual, and my blood pressure was high. As a result, Anthem treated it as a diagnostic appointment. I challenged it and was told basically that they would never pay for preventive care, such as a physical or mammogram, unless there was no diagnosis of any problem. In other words, if I were perfectly healthy, they would pay. If anything was coded on the chart because something was observed or detected (and doctors will code it every time they can because that affects their payment), Anthem will not pay. So basically I paid substantially more for a preventive care policy which has covered nothing over the last year (I have a high deductible).

 

[Colleen27]

By all means, call around and see what you can find on your own but odds are you'll be better off with what you have through work. My husband and I are both self-employed and pay for our own insurance, to the tune of about 5K/year for a family policy with a 5K deductible, and our premiums go up anywhere from 10-20% every year.

 

[leebee]

It's a racket, for sure. I think you are probably best to stay with what you have. We pay more than you in premiums, have a $5000 oop deductible, nice pharmacy plan BUT they don't cover any lab testing AT ALL. No blood work, no xrays, etc. It's a real pain but it's what's available. I was really hoping that Washington would realize that the biggest problem with health care is AFFORDABILITY of insurance, at least for most of us. I am glad to see there's been a tad of reform, but it really isn't helping me out. I think it's time for Congress to get booted out of their fancy-schmancy, free, good-for-family-for-life health insurance plans and join the rest of us. I bet there'd be real reform, FAST!!

(fyi, I know it's not that simplistic, honest I do!)

 

[traces7]

I was really hoping that Washington would realize that the biggest problem with health care is AFFORDABILITY of insurance, at least for most of us. I am glad to see there's been a tad of reform, but it really isn't helping me out. I think it's time for Congress to get booted out of their fancy-schmancy, free, good-for-family-for-life health insurance plans and join the rest of us. I bet there'd be real reform, FAST!!

(fyi, I know it's not that simplistic, honest I do!)

I know what you mean, healthcare reform probably won't help us either. We're getting to the point where we almost can't afford it anymore. But yet we make too much for any kind of help. I'm pretty worried about the future for us. Everything is going up and our salaries are going down or staying the same. It's really depressing!

 

[Tinkertude]

"If anything was coded on the chart because something was observed or detected (and doctors will code it every time they can because that affects their payment), "


For a Doctor to not code appropriately is concidered insurance fraud. The level of payment for a doctors visit is based on the time spent with the patient which has to be validated by specific guidelines.

 

[traces7]

ouch- 2250 deductable- i pay about the same as you and it is 600

It is for a family though. A lot of the plans I've seen have $5000 or $10,000 deductibles for families. So $2,250 isn't too bad really.

 

[j's m]

There is discussion on grandfathering policys so people can keep the coverage they have. It goes on and on. Sorry to say. no one really said it was going to be cheap. I can't understand.... Obama said healthcare reform... it should be called insurance reform. No one mentioned that the doctors don't seem to have to change a thing...

I'm really excited over this, I already have a real crappy plan, high deductible and we just got notice that our renewal is up 30%. We're a small business and can't really afford $ 1800 a MONTH for family coverage.

So what good is keeping the coverage you have if you can't afford it?

 

[bettymae1121]

My employer provideds excellent insurance. No deductable, my only co-pays are $10 for a doc's visit and $50 for an ER visit. I pay $5 per prescription (even name brand). My DH's $500 a month insulin? We pay $5! They cover 100% of everything else, no lifetime limit. My boss's husband died suddenly after a brief illness. The total bill was $500,000. She paid about $200 out of pocket, the insurance picked up the rest, she didn't even have to fight over anything, they just paid.

I pay $180 a month for DH and I. My employer picks up the rest, which is $1800 per month! That's right, my insurance plan costs $21,600 per year for two people!

You won't be able to get me to leave this job for anything in the world! Even if my plan is considered one of the "Cadilac Plans" under the new legislation and is taxed, I still come out ahead if DH or I get sick.

 

[Mommee]

Be careful of the preventive care. I switched to a more expensive policy through Anthem because it supposedly covered most preventive care. I went in for a physical, had my blood pressure taken as usual, and my blood pressure was high. As a result, Anthem treated it as a diagnostic appointment. I challenged it and was told basically that they would never pay for preventive care, such as a physical or mammogram, unless there was no diagnosis of any problem. In other words, if I were perfectly healthy, they would pay. If anything was coded on the chart because something was observed or detected (and doctors will code it every time they can because that affects their payment), Anthem will not pay. So basically I paid substantially more for a preventive care policy which has covered nothing over the last year (I have a high deductible).

We had this happen when dd was born (different insurance company, though). At her first well-child visit, the doctor said her weight was too low and she would need to come in for weekly weight checks. The insurance company said the visit didn't qualify as a covered well-child visit because the doctor found something wrong.

 

[Ava]

We had this happen when dd was born (different insurance company, though). At her first well-child visit, the doctor said her weight was too low and she would need to come in for weekly weight checks. The insurance company said the visit didn't qualify as a covered well-child visit because the doctor found something wrong.

We had something similar. Our DD was in NICU for 3 days after she was born, so she had to go in for weight checks every other day until she got back up to birth weight. The insurance didn't consider a weight check to be a well-child visit, so we had to pay our 20% co-insurance for them. Thankfully she was back up to birth weight by 8 days old, and one of the visits in that first week was billed as a well-child visit, so we only had to pay for 2 weight checks.

Our insurance is pretty good. We pay ~$225/month for the 3 of us, my employer pays ~$600/month. We have a $300 deductible per person, $7500 yearly OOP max for the family, $15 co-pay for primary care, $30 for specialist. Co-insurance is 80/20. Generic prescriptions are $7.