Health Insurance Advice

[GlockSpock]

Seven months ago I started my first professional job and also got married in the same time frame. My company pays for my health insurance (BlueCross Blueshield). I also have the opportunity to pay for my wife to have the same insurance. So, I have been. It's roughly $360 a month. However, a conversation with an older friend last night made me question if I am paying too much. Just getting started in the professional field and having never paid any health insurance premiums, it was very easy for me to not question the rate and just go with it. It is easy to assume that you are getting a good deal. It makes sense to me though that since family coverage in the company is a flat rate, the larger families and unhealthy families have to be subsidized by the young married couple with no kids and no health problems.

 

My friend felt like I should be able to shop around and get insurance off the street for my wife for probably less than half what I am paying right now. She is in her early twenties and as healthy as a carrot. Does this sound right to everyone?

 

What health insurance advice does everyone have?

[peejman]

Seven months ago I started my first professional job and also got married in the same time frame. My company pays for my health insurance (BlueCross Blueshield). I also have the opportunity to pay for my wife to have the same insurance. So, I have been. It's roughly $360 a month. However, a conversation with an older friend last night made me question if I am paying too much. Just getting started in the professional field and having never paid any health insurance premiums, it was very easy for me to not question the rate and just go with it. It is easy to assume that you are getting a good deal. It makes sense to me though that since family coverage in the company is a flat rate, the larger families and unhealthy families have to be subsidized by the young married couple with no kids and no health problems.

 

My friend felt like I should be able to shop around and get insurance off the street for my wife for probably less than half what I am paying right now. She is in her early twenties and as healthy as a carrot. Does this sound right to everyone?

 

What health insurance advice does everyone have?

 

 

$360/mo additional for her or total for both of you?  That does sound a little high, but not terrible.  Its very difficult to compare rates without all the details .... deductibles, copays, percent coverages, out-of-pocket limits, provider network, etc.  I think mine is about $320/mo for the family.  Feel free to shop around, but I doubt you'll find similar coverage for much less. 

 

And yes, the healthy people subsidize the sick ones.  That's how insurance companies make money.  It's also one reason why I switched to an HRA type plan.  If you're not familiar, the cliff-notes version is that they give you a lump of money to spend on health care.  What you don't spend rolls over to the next year and they give you another lump.  So it can add up after a few years.  If you spend more than your lump, it goes back to a typical 80/20 type plan. 

[UncleJak]

You should always shop around.  My employer pays 100% of my insurance and the family coverage varies depending on how many children.  Shop around and if $360 is a good deal, keep it.

[10-Ring]

There are so many variables when it comes to insurance.  If you have BCBS you probably have a pretty decent policy.  It won't hurt to comparison shop but don't just look at the price, look at what you are getting as well.  Pay attention to what each policy will pay towards surgeries and whatnot.  Take into account any potentially dangerous activities that you participate in.  

 

Take myself for example.  A few years ago I had what I thought was a decent policy.  I had a motorcycle crash and got to test the insurance.  Turned out that my insurance only covered about 60% of my associated medical bills leaving me with a fortune to pay out of pocket.  Looking back I would have paid another $20 a month to have more coverage, which I decided that I didn't need when I purchased my policy.  Look at it like this, I know they are taking a chunk out of your paycheck for insurance, but if you have a good policy that $360 a month could mean the difference down the road of bankrupting your self versus being financially secure should you or your wife be involved in a serious accident.  

 

You could come out ahead now but if curtain climbers and old age are in your future $360 a month for health insurance will look like a deal. Check out some competing policies and let us know what you find out.

[GlockSpock]

$360 is just for her. I understand about the different coverage rates and deductibles making the difference.

 

It's also one reason why I switched to an HRA type plan.  If you're not familiar, the cliff-notes version is that they give you a lump of money to spend on health care.  What you don't spend rolls over to the next year and they give you another lump.  So it can add up after a few years.  If you spend more than your lump, it goes back to a typical 80/20 type plan. 

 

This sounds very interesting. 

 

I'll definitely shop around, and to keep things simple I'll make the request to have them quote me with benefits being equal. 

[Guest PapaB]

My wife has to buy her own insurance and just got done looking at policies. $360/month isn't a bad price for decent insurance at all. My wife pays more than that for her BC/BS. Here's a hidden problem most people don't know about. Ask the insurance companies which country their claims group is in. My wife worked at a company that provided health insurance through a fairly well known company. They moved their claims to South America and everything had to be mailed there. Sometimes she would have to submit things 3 or 4 times and wait months for payments to start. Healthcare providers don't care about any insurance problems you might have, they just want their money (and I don't blame them).

[Dennis1209]

I've had Blue Cross / Blue Shield for many years. I've got Standard Option family and it's about $13,000.00 per year so a few hundred bucks a month more for the addition of your spouse sounds right.

 

You may want to talk to your HRMS and ask if you can go through them and get the family option and that would also include any children you may have or adopt in the future.

[LawVol]

Like yours, my employer pays my premium, but the spouse or family plan comes out of my pocket.  I have gone back and forth between having my wife and kids on the employer plan and private plans, and, in my experience, the employer plans seem to cover a lot more and jerk you around a lot less.  Also, keep in mind that your premiums come out of your check pre-tax for an employer plan.  You will already have paid tax on dollars you pay private policy premiums with.  

 

Check out TRH if you want to look into private plans.  Family coverage is fairly inexpensive for my wife and girls, but it does not have a prescription plan (other than prescriptions being subject to deductible).  The tax issue makes the savings over the employer policy much less significant, though.

 

Personally, I'd be OK with $360 for coverage under the employer plan.  Family coverage under my employer's plan is just shy of $1,000/month.

[Guest ThePunisher]

Take the employer coverage while employers are still able to offer health care coverage.

[GlockSpock]

Take the employer coverage while employers are still able to offer health care coverage.

 

I have been. Been paying it ever since I started as a full-time employee. I won't be quick to make any decisions. I did contact TRH to see what they have to say. I have a feeling that in the grand scheme of things, $360 is probably a good amount to pay. I think I could certainly pay a whole lot less...for a whole lot less coverage. 

[Guest 6.8 AR]

Get whatever good coverage your employer will provide. After 2014 it won't matter. Obamacare will change everything to the

point there probably won't be much to Blue Cross/Blue Shield, other than a facade. Get the best value for your family until

then. That's not scare tactics, but the law, as it is.

 

I guess my "cadillac plan" is among the cheapest, for the time being, about 200/month and little out of pocket. I won't have it

next year, though.

[GlockSpock]

Get whatever good coverage your employer will provide. After 2014 it won't matter. Obamacare will change everything to the

point there probably won't be much to Blue Cross/Blue Shield, other than a facade. Get the best value for your family until

then. That's not scare tactics, but the law, as it is.

 

I guess my "cadillac plan" is among the cheapest, for the time being, about 200/month and little out of pocket. I won't have it

next year, though.

 

Unfortunately I am not as familiar with healthcare as I am some other aspects of our world. I know Congress and the President rushed a huge bill through congress that not a single soul knew everything it consisted of. I haven't taken the time to research all of it because frankly it just infuriates me more. Without going into too many specific details, what is the gist of what will happen in 2014? Any good links to read?

Edited February 7, 2013 by CZ9MM

[Sam1]

Seven months ago I started my first professional job and also got married in the same time frame. My company pays for my health insurance (BlueCross Blueshield). I also have the opportunity to pay for my wife to have the same insurance. So, I have been. It's roughly $360 a month. However, a conversation with an older friend last night made me question if I am paying too much. Just getting started in the professional field and having never paid any health insurance premiums, it was very easy for me to not question the rate and just go with it. It is easy to assume that you are getting a good deal. It makes sense to me though that since family coverage in the company is a flat rate, the larger families and unhealthy families have to be subsidized by the young married couple with no kids and no health problems.

 

My friend felt like I should be able to shop around and get insurance off the street for my wife for probably less than half what I am paying right now. She is in her early twenties and as healthy as a carrot. Does this sound right to everyone?

 

What health insurance advice does everyone have?

 

 

I've got BCBS as well, and do not care how much they charge, I'll never switch. in 2011 I was in a bad bike wreck, racked up over $190k in bills the first 24 hours, subsequent surgeries and therapy, we're around $600k now total. Out of all of that, it has cost us right at $10k out of pocket, we never even reached the catastrophic annual limits. (this is with the basic option as well, we have the cheapest plan they offer - which is still about $300/month). We have never once had a single billing issue and have literally a file cabinet drawer full of bills. Every doctor we have wanted to go to loves BCBS because they know they'll get their money without any issues.

 

You have to weigh the options that are specific to your situation, but personally, I would not use another provider even if their plan only cost $5 a month.

[Guest ThePunisher]

Without going into too many specific details, what is the gist of what will happen in 2014? Any good links to read?

Obamacare becomes law of the land when it comes to healthcare. Obamacare is all about destroying the best healthcare system in the world, and taking control of everything in everybody's life. Your healthcare costs will skyrocket, and the quality of your healthcare will diminish a thousand fold. You will feel like prisoner with little or no hope to living a quality lifespan.

[maroonandwhite]

Obamacare becomes law of the land when it comes to healthcare. Obamacare is all about destroying the best healthcare system in the world, and taking control of everything in everybody's life. Your healthcare costs will skyrocket, and the quality of your healthcare will diminish a thousand fold. You will feel like prisoner with little or no hope to living a quality lifespan.

Wow... I feel like I need a hug now or something. :rofl:

[atlas3025]

I work in my company's benefits department, and deal with employer group insurance for about 95% of my day.  I hear from our employees all day about how their friends at other companies tell them they are paying too much for our insurance.  What I usually find out is that the friend was comparing their 2012 rates to our 2013 rates, or a High Deductible Policy to a low co-pay plan.  In exactly none of the cases I have ever come accross has it been an apples to apples comparrison. 

 

The rates for insurance are sky-rocketing, because medical costs are sky-rocketing.  With Obamacare, plans are now mandated to cover all this shit that costs a ton of money at 100%.  A huge piece is also that they have to cover an employee's kids til they are 26 instead of the previous ages of either 19 or 23.  You know how much more it costs to cover a 25 year old than a 22 year old?  Diabetes is tremendously expensive to treat and has a tendency to show up in the mid-20's instead of the early twenties. 

 

Anyway, a lot of the mandates don't go into effect until next year, but some companies (like mine) have already worked them into the plans so that the jump in premium cost isn't as dramatic when it happens. 

 

:rant on

 

People have a rude awakening coming.

 

They tend to think the bigger and better their company is, the cheaper the insurance should be.  That is not the case.  The HEALTHIER their company's insured employees are, the cheaper the insurance will be.  If you work for a tech company, you have a lot of lard-asses (like me) who sit in front of a computer all day.  They tend to marry people like themselves, and have kids that are like themselves.  Tech companies make a lot of money, but not enough to pay the medical bill for plans comprised entirely of asthmatic diabetics with high cholestorol and ulcers.  Our company also has a TON of former and retired military who tend to be healthy...but they are on Tricare, and so don't pay into the health plan that families of diabetics are on.  Trucking companies have bad rates too as truckers tend to be pretty unhealthy.  You can think your way through any company profile and do the math. 

 

We switched to a High Deductible plan this year, so people have been used to paying a $20 co-pay for their Concerta, Novolog, and Lipitor...now they are having to meet a $2k or $4k deductible first, and so are having to pay the full retail prices.  They are stunned.  They call me and complain that they never paid attention to medicine and Dr costs before and that isn't fair...which is about the time I make the point that for that exact reason, insurance plans are going broke.   Because they never paid attention to those costs before...they just paid their little co-pay and had another donut. 

 

People are now having to choose now between little Johnny's ADHD medication, their Bacon and Cheese Omlet Dessert, or the buying the newest Smart Phone with Quadraphonic Blaupunkt.  Tough choices, I know. 

 

:Rant off

[GlockSpock]

I've got BCBS as well, and do not care how much they charge, I'll never switch. in 2011 I was in a bad bike wreck, racked up over $190k in bills the first 24 hours, subsequent surgeries and therapy, we're around $600k now total. Out of all of that, it has cost us right at $10k out of pocket, we never even reached the catastrophic annual limits. (this is with the basic option as well, we have the cheapest plan they offer - which is still about $300/month). We have never once had a single billing issue and have literally a file cabinet drawer full of bills. Every doctor we have wanted to go to loves BCBS because they know they'll get their money without any issues.

 

You have to weigh the options that are specific to your situation, but personally, I would not use another provider even if their plan only cost $5 a month.

 

 

I have no reason to dislike BCBS currently. The only real comparison shopping I am doing here is seeing if I can get my wife covered by BCBS with the same medical/dental benefits for cheaper than $360. I know I could save several hundred per month if I wanted to go cheap on the benefits, but I am not willing to do that. I am just checking to see if I could save a hundred or so and keep the same benifits. I seriously doubt it.

[Sam1]

Unfortunately I am not as familiar with healthcare as I am some other aspects of our world. I know Congress and the President rushed a huge bill through congress that not a single soul knew everything it consisted of. I haven't taken the time to research all of it because frankly it just infuriates me more. Without going into too many specific details, what is the gist of what will happen in 2014? Any good links to read?

 

The short version is 2014 starts the major provisions; businesses being penalized for not offering health plans if they have 50 FT employees or more, individuals get penalized if they don't buy coverage (this fee goes up over the next few years to astronomical amounts trying to force people into the government provided system).

 

2018 is the bad one when they start charging a 40% tax on plans over $10,200 for individuals (this is employer + individual cost), $27,500 for families. That's why you see the extra box on your tax forms this years showing how much the employer pays towards your plan too. We're being told it's not being taxed, but the law itself says starting 2018, we go from paying zero tax on them, to paying 40%.

 

That's just a sliver of the 13,000 pages... people are still discovering stuff every day hidden inside it, so it may be another year or two before they find everything.

[GlockSpock]

They tend to think the bigger and better their company is, the cheaper the insurance should be.  That is not the case.  The HEALTHIER their company's insured employees are, the cheaper the insurance will be.  If you work for a tech company, you have a lot of lard-asses (like me) who sit in front of a computer all day.  They tend to marry people like themselves, and have kids that are like themselves.  Tech companies make a lot of money, but not enough to pay the medical bill for plans comprised entirely of asthmatic diabetics with high cholestorol and ulcers.  Our company also has a TON of former and retired military who tend to be healthy...but they are on Tricare, and so don't pay into the health plan that families of diabetics are on.  Trucking companies have bad rates too as truckers tend to be pretty unhealthy.  You can think your way through any company profile and do the math. 

 

This is the main reason I wonder and hope perhaps I can keep the same amount of coverage for my wife while reducing the monthly premium I pay. My company pays for me, so that is no issue. However, I feel that my wife is much healthier than the average health of the people of the company I work for. But I'd still have to factor in that currently it is paid for before taxes are taken out. Someone correct me if I am wrong, but 12x360=4320. Is that $4,320 income that I am not currently taxed on, or taxed at a lower rate? In that case, if I started paying for it out of pocket, that would be $54 more tax liability I'd have per month? So instead of beating the pricepoint of $360, it'd be more like the pricepoint of $306?

[2.ooohhh]

Give me a few days and I'll put together what I used to expain it all to the wife, it's about several hours of lecture video and presentations from here at work. It goes into the healthcare law from all angles, some are actually good, many are bad. As atlas pointed out the status quo wasn't working and something had to change, that's a given. Honestly the insurance companies and healthcare providers should have self regulated to improve both healthcare efficiency and outcomes, they didn't. The patients should have taken personal responsability for their own health and eat relatively healthy and work out, they didn't. I don't agree with many points in the new plan, but I'm glad to see the change I just think it was in the wrong direction.

 

The disconnect from cost of care to the consumer is what started all of this, the last thing we need to do to fix it is lower the cost of care.  :rant:

[atlas3025]

Unfortunately I am not as familiar with healthcare as I am some other aspects of our world. I know Congress and the President rushed a huge bill through congress that not a single soul knew everything it consisted of. I haven't taken the time to research all of it because frankly it just infuriates me more. Without going into too many specific details, what is the gist of what will happen in 2014? Any good links to read?

 

The gist of Obamacare is that it makes it impossible for private insurance companies and self-insured employers to price thier plans competitively with the government option...because the government doesn't have to make a profit, or even break even (see current government for evidence of the second point).  They can offer the same coverage for much cheaper because they can print up money to pay for the losses.  Self-Insured companies and insurance companies can't do that.

 

When private insurance can no longer compete, everyone will move to the government plans giving control of the healthcare system entirely to the .gov.  Once the government is reponsible for paying for your health care, they have the "right" to tell you what type of risky behavior you can engage in, and what kind you can't.  If you eat that pizza, you are increasing your medical costs, and since the gov pay those costs they can forbid you to eat the pizza...among other things.

[Sam1]

 

I have no reason to dislike BCBS currently. The only real comparison shopping I am doing here is seeing if I can get my wife covered by BCBS with the same medical/dental benefits for cheaper than $360. I know I could save several hundred per month if I wanted to go cheap on the benefits, but I am not willing to do that. I am just checking to see if I could save a hundred or so and keep the same benifits. I seriously doubt it.

 

Just be cautious when considering a change - I'm in no way a medical billing expert, but we've dealt with more than most people will in their lives. Here's an example:

 

BCBS basic says you have a copay of 15% on procedure ABC

BCBS standard says you have a copay of 10% on procedure ABC, but you also have an annual deductible of $750 for that type of procedure. So you will pay 100% of procedure ABC until the $750 deductible is met, then you will pay 10% after that.

- This is why the basic plan (cheaper one) is almost always better for people, although it costs a few bucks more for something, you have no copays and you save $1000-$2000 just over the plan costs themselves (which more than supplement the % differences)

 

Next, BCBS (either plan) says you pay 15% of the fee schedule for that procedure ABC. GEHA says you pay 12% of the fee schedule for that same procedure, but GEHA's negotiated fees may be 50% or 100% higher than BCBS, so that 12% copay ends up costing you much more out of pocket.

 

Although BCBS is pretty much universal, you still need to research at the nearby hospitals and see which one they prefer, and which one your family dr. prefers. Heck, call up your dr. and tell them you are contemplating switching and ask them if they can explain the differences that they see on a regular basis, those are the real experts on this stuff.

 

Maybe atlas also has some more information on the provisions area, but I do not. This is only what we have checked into and experienced personally

 

* one last thing, BCBS also covers emergency transport. The 12 minute med-evac ride to UT Trauma cost $18,000, some health insurances will not cover that.. It cost us a $150 copay thank goodness. Almost every hospital also has their own life star, or airevac policy you can buy for like $50/year, that is a highly recommended plan if your insurance doesn't cover it.. This is hugely popular with motorcycle riders, but not so much for regular joe's, not sure why.

Edited February 7, 2013 by Sam1

[Guest ThePunisher]

Wow... I feel like I need a hug now or something. :rofl:

Get your hugs now, because Obamacare is gonna feel like getting a kick in the a.. everyday the rest of your life. Edited February 7, 2013 by ThePunisher

[atlas3025]

Give me a few days and I'll put together what I used to expain it all to the wife, it's about several hours of lecture video and presentations from here at work. It goes into the healthcare law from all angles, some are actually good, many are bad. As atlas pointed out the status quo wasn't working and something had to change, that's a given. Honestly the insurance companies and healthcare providers should have self regulated to improve both healthcare efficiency and outcomes, they didn't. The patients should have taken personal responsability for their own health and eat relatively healthy and work out, they didn't. I don't agree with many points in the new plan, but I'm glad to see the change I just think it was in the wrong direction.

 

The disconnect from cost of care to the consumer is what started all of this, the last thing we need to do to fix it is lower the cost of care.  :rant:

 

In the debacle that is American Healthcare, everyone is to blame.  2.ooohhh is right.  Dr's and pharma companies charge more than the market will support because there is no true market, and they jack up their rates/rpices to pay for mal-practice insurance and frivolous lawsuits, and to have a big tax write-off for the piece of their bill that the insurance won't pay.  The insurance companies won't pay Dr's and pharma what they charge because the rates are artificially jacked up, and they argue with the patient about what they will cover.  The patient doesn't pay any of the true costs (only the teenie co-pay) and so don't practice good consumerism (hence the broken market), then they jump on board to sue a Dr or Pharma whenever they can (at the Trial Lawyers behest) so the Dr and Pharma have to have raise their prices...

 

The piece that has always been missing is the patient's input and responsibility.  Healthcare went out of control about the time insurance became common because it shielded the patient from the consequences of thier actions.

 

I will temper all this by pointing out as bad as it is, we have the best doctors and medicine in the world.  Even the poorest among us can get medical attention.  We have incrediby high standards and expectations as Americans, which is why we are the greatest nation the world has ever known.  But I was in bed last night thinking "man, I wish I had more/nicer stuff", then it occured to me that as a middle-class American, I have it better than 99.9% of the population of earth since the beginning of time.  If I earned minimum wage, I would only be in the top 99.7%.

[Sam1]

This is the main reason I wonder and hope perhaps I can keep the same amount of coverage for my wife while reducing the monthly premium I pay. My company pays for me, so that is no issue. However, I feel that my wife is much healthier than the average health of the people of the company I work for. But I'd still have to factor in that currently it is paid for before taxes are taken out. Someone correct me if I am wrong, but 12x360=4320. Is that $4,320 income that I am not currently taxed on, or taxed at a lower rate? In that case, if I started paying for it out of pocket, that would be $54 more tax liability I'd have per month? So instead of beating the pricepoint of $360, it'd be more like the pricepoint of $306?

 

Right now health premiums are deducted pre-tax, so you pay nothing on them.