ScriptUO
General => Off Topic => Topic started by: Endless Night on September 28, 2011, 06:04:15 AM
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I'm in the market for a new family Health Insurance plan in Florida. I figure id go with one of the bigger names, all i really want is a cheap as possible price and 100% coverage for serious illness/accident/hospitalization 5-10k deductible ok. Dont mind if that means i have to pay almost 100% for regular visits.
Companies i'm looking at so far listed below, anyone have any recommendations, watch out fors, or other info I would greatly appreciate it as its defiantly a confusing mess...
Blue Cross Blue Shield
Humana
Aetna
United Healthcare
Cigna (not sure on this one)
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The only one that I have experience with on your list is Blue Cross Blue Shield. I have had them for the past 9 years and have never had any problems. I have an HMO plan and my healthcare premiums/coverage is pretty nice with my job. Not sure what other information I can provide but if you have a question I will do my best to get an answer.
Good Luck!
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Blue cross blue shield is THE insurance co our state and the state below offers it's employees. I can't say how good it is since i never had to use it during my stint with the state. I assume it's good since 2 states go with it.
Side note: Have you checked places like Aflac and some of the car insurance places that have moved into health care like Nationwide, State Farm ect?
I would avoid Allstate at all costs since they're going under fast.
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I carry an AFLAC supplemental dental insurance that I very much enjoy. I got the plan awhile back knowing that my daughter was going to need braces. Our dental insurance with the state covers 2 cleaning a year with no out of pocket expense. When I go to the dentist for cleanings I end up getting a check in the mail from AFLAC. So... in a way it is like getting part of my premium back for nothing :)
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What are peoples average costs of insurance... currently getting ours via my wife job, and they switched and costs increased massively I think we are getting reamed... 2 adults 2kids, cost $805 calender month in premiums 12k deductible, and basically pay for every visit on top until reach deductible. This seems a little insane .. basically almost 0 coverage until paid out 21.5k then 100% coverage if covered. I'm suspecting that the principles of her company are getting kickbacks somehow on this thing.
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What are peoples average costs of insurance... currently getting ours via my wife job, and they switched and costs increased massively I think we are getting reamed... 2 adults 2kids, cost $805 calender month in premiums 12k deductible, and basically pay for every visit on top until reach deductible. This seems a little insane .. basically almost 0 coverage until paid out 21.5k then 100% coverage if covered. I'm suspecting that the principles of her company are getting kickbacks somehow on this thing.
I am stunned. How can the average family afford this stuff?
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What are peoples average costs of insurance... currently getting ours via my wife job, and they switched and costs increased massively I think we are getting reamed... 2 adults 2kids, cost $805 calender month in premiums 12k deductible, and basically pay for every visit on top until reach deductible. This seems a little insane .. basically almost 0 coverage until paid out 21.5k then 100% coverage if covered. I'm suspecting that the principles of her company are getting kickbacks somehow on this thing.
I am stunned. How can the average family afford this stuff?
if your in shock with that dont look at my property tax and 3x home insurance bill (general, flood, hurricane)
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It sounds like you have what we call here a "Quality" health plan that you are able to pretty much go to any doctor of your choosing and any hospital? These plans are typically outrageous and the costs/deductibles you are facing are seriously insane.
Let me ask you this - Have you thought of going to an HMO plan?
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Property Tax is what it is and a matter of owning the land but I'm not shocked that it is higher than should be. Thankfully in my part of Canada flood and hurricane insurance would be a true waste of cash. I've thought about getting secondary Dr. coverage but the public system is not that bad and will do the trick save for something odd ball happening but our tax level is high.
I have a client who lives in a town called Slave Lake which a third of the place burnt to the ground ealier this year, the story he has told me about dealing with the insurance companies has made me review my policy a few times. Tough to read but worth the time, I was shocked with what I thought was covered but was really not so.
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Let me ask you this - Have you thought of going to an HMO plan?
I actually shifted from a PPO to an HMO and really like it. For general medical, it's pretty good.
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Let me ask you this - Have you thought of going to an HMO plan?
I actually shifted from a PPO to an HMO and really like it. For general medical, it's pretty good.
That price im paying is for a HMO ... or one of these new classes open access .. anyway sucks.
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Let me ask you this - Have you thought of going to an HMO plan?
I actually shifted from a PPO to an HMO and really like it. For general medical, it's pretty good.
That price im paying is for a HMO ... or one of these new classes open access .. anyway sucks.
I've never purchased my own insurance privately, I've always used what I have at work. By the sound of it your wife's sucks, might as well not even use it for crying out loud!
I can at least tell you about my experience using my current company. We have an Aetna PPO here at work and it's pretty reasonable to use (and costs aren't too, too bad overall). I'm paying $216 every two weeks for two adults and 2 kids (they recently started seperate pricing for 1-2, 3-5, etc). I also get a discount for being a non-smoker. The company is probably picking up about the same amount as I am on the premiums so we'd probably be looking at just under $1000 per month if I had to pay for it myself.
Use of the insurance is ok. My deductable is $450 per person with a $900 family maximum as long as I'm in-network. If I go out of network this increases to $1250 per person with a $2500 maximum. There are plenty of "in-network" providers here with the exception of Dental so I go out of network for that. I don't have to have a primary physician, I can go to who I want when I want. Co-pays are $35 for office visits with this plan which can definitely add up.
I offset my Insurance costs with a FSA. If you aren't doing this already you really should be. I max it out every year (max is only around $2500-$3000, I don't remember exactly). With Aetna as the manager of my FSA everything ends up being automated, no forms to fill out as long as I go to an in-network provider the reimbursements from the FSA come automatically which is very, very convenient. As I'm in the %35+/- tax bracket this ends up saving me well over a thousand dollars annually for doing almost nothing.
Anyhow, probably nothing too helpful - nothing more than an average, corporate health care plan.
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The PPO program at your company doesn't sound bad. It is pretty comparable to most plans with large employee bases. The deductible isn't outrageous. The copay is a little high but still better than paying for the entire bill each visit.
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The PPO program at your company doesn't sound bad. It is pretty comparable to most plans with large employee bases. The deductible isn't outrageous. The copay is a little high but still better than paying for the entire bill each visit.
Yeah, they give us 2 options - Basic and Enhanced. The Basic option has lower premiums but higher co-pays and deductables and the Enhanced is the opposite. When you do the math the additional premiums of the Enhanced tend to be high enough to make the Basic option a better fiscal choice as it would be very difficult to hit enough co-pays to offset the additional costs of Enhanced.
There is also the HSA option for you thrifty, investor types ;)
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EN,
I read your question and thought I should give you as comprehensive an answer as I can in 25 minutes:
1. All of the companies you mention are "reputable" and well financed. They all will have questionable claims payment reputations depending on who you talk to and what sort of service.
2. The key is to find out what providers in your area are taking, specifically the providers you and your family use. Almost everyone takes BC/BS Anthem, but you want to check. You don't want to switch companies and then find out your kids doctor and your wife's OB are not in their plan.
3. With regard to HMO/PPO etc, these plans are trending toward each other with respect to the service offering. This means these designations mean less and less and your best bet is to go "in network" on either plan type. Refer to #2 above.
4. The Average cost of a family health insurance plan is $15,000 annually. You can get them for less, and it is likely that a plan like the one you are considering should cost less than that. The actual cost will depend on the experience of the group at your company. Young groups that don't have health issues generally pay the lowest rates. Older, fatter groups tend to pay a lot more. The premium for your group is calculated each year in large part based on their claims experience.
5. If you go individual plan, you can save money if you maintain a relatively clean claims experience. The downside is that you will lost coverage for pre-existing conditions in most states for adults. Since Sep of 2010 pre-existing conditions for children cannot be the basis of excluded coverage. If you and your wife have no history of re-curring illness, this is a reasonable route to consider. In most instances an illness will not be considered a "pre-existing condition" unless you have experienced it in the last 18 months. However, the carrier can still consider it in their premium analysis. IF YOU HAVE PRE-EXISTING CONDITIONS I STRONGLY URGE YOU TO AVOID INDIVIDUAL PLANS IN STATES THAT ALLOW EXCLUSION OF PRE-EXISTINGS.
6. The real benefit of a group plan is two-fold. The first benefit is that as long as you had prior coverage and meet the eligibility requirements, you will be accepted to the plan with coverage for pre-existing conditions. The second benefit is that every member of the group pays the same fixed rates by election type: indivual, family, etc. The downside is for healthy people in plans with people who are less healthy -- which may be the case for your plan.
7. I have access to a BC/BS plan for small business that has fixed pricing no lifetime max, $400 deductible, $2,000 annual ind OOP, and includes a prescription plan that puts your cost for most drugs at 10% of actual cost. This plan costs just under $12,000 a year for a family regardless of health inventory as they don't require one. The drawback to the plan is that it is a bit higher than average cost for individuals $580 a month, and you have to have a minimum of two non-owner employees to join the plan.
8. Things to look at in your plan:
Lifetime Max: The trend it toward having no maximum, but I still see plans with a $250,000 max, which I think is criminal. A typical lifetime max is $5M to $8M. No max is preferable.
Individual/Family OOP: The OOP (Out of Pocket) is a maximum you will be required to pay in a single year through deductible and co-pay before services are paid 100%. Lousy plans never go to 100% coverage and should be avoided. There is usually both an individual and a family OOP maximum. Sometimes there is no family max, in which case the max is the individual max times the number of family members. I prefer a plan with both defined. Individual OOP ranges from $1,500 to $5,000 and obviously lower is better. Typical Family OOP are three times the individual OOP.
Provider Co-Pay: It is nice to have a co-pay for visits if it is in the alternative to the deductible, but its really a toss up. Compare what you are likely to do vs. the overall cost of the plan.
Deductible: The deductible generally applies to routine service, but not ER visits. Once its paid, you are reimbursed on a co-pay basis until you hit the applicable OOP maximum. If you have an 80% coverage plan before OOP is met, that means you pay 20 cents on the dollar until the OOP is reached, then you pay nothing. Deductible is one piece of your calculation when determining the annual cost of the plan. If you have kids count on blowing through several thousand dollars in services on routine dr. visits. A lower deductible isn't necessarily better -- especially if you put it together with a high OOP maximum.
Prescription Plan: Most health plans include prescriptions. If you take regular medications find out what the actual cost of the medication is. Most plans have a tiered co-pay that increases for medications that they assign to higher tiers. Insurance companies often make premium back by charging you a minimum co-pay that is often more than the cost of generic medicines. If you can find a plan that bases your Rx price on the price of the med, these are usually favorable.
9. Try to calculate an annual use cost for your family for any plan you look at. This will include the annual cost of the policy plus the amount you project to spend for deductibles, co-pays and whatever else you are gong to be stuck with. Taking a higher deductible to lower your premium may be a dollar to dollar trade-off that you don't want to make. Its all in the details.
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What are peoples average costs of insurance... currently getting ours via my wife job, and they switched and costs increased massively I think we are getting reamed... 2 adults 2kids, cost $805 calender month in premiums 12k deductible, and basically pay for every visit on top until reach deductible. This seems a little insane .. basically almost 0 coverage until paid out 21.5k then 100% coverage if covered. I'm suspecting that the principles of her company are getting kickbacks somehow on this thing.
wow. when i got a job right out of college, i contributed like 70 bucks a month towards a policy that gave me dental (50 co-pay) and health (10 dollar co-pay) and covered like every prescription under the sun. it sounds like her company doesnt contribute at all to the policy, which is crap. after law school i intend to insist that my health coverage be non-contributory from my end.
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Good luck with that Newsman. Most law firms don't pick up 100% of the cost of healthcare, just like most companies. The trend is for companies to pay less and less of their employee's health insurance costs. It is now rare for a company to pay 100%. The employer decides what to pay and the balance is paid by the employee up to 100% of the cost.
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Most of the time policies aren't too bad for the actual employee. It is when you start to add your dependents that they begin to really scale up the cost and hammer you.
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Good luck with that Newsman. Most law firms don't pick up 100% of the cost of healthcare, just like most companies. The trend is for companies to pay less and less of their employee's health insurance costs. It is now rare for a company to pay 100%. The employer decides what to pay and the balance is paid by the employee up to 100% of the cost.
I've always found employers to be willing to give me what I ask for, or an alternative that is mutually acceptable for both of us.
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My wifes company does subsidize her potion of our costs, they just dont subsidize the rest of the families costs.
For me thierfor we will probably leave her covered on company plan and pay the additional over company covered costs. And my self and kids will get independant converage. The prior plan they offered was approx $150 a month less but had a deductible of $1000 and a co-pay of 20%, present one is co-pay is 100% until deductible met.. which in reality means insurance only covers after you paid out 21k.
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My wifes company does subsidize her potion of our costs, they just dont subsidize the rest of the families costs.
For me thierfor we will probably leave her covered on company plan and pay the additional over company covered costs. And my self and kids will get independant converage. The prior plan they offered was approx $150 a month less but had a deductible of $1000 and a co-pay of 20%, present one is co-pay is 100% until deductible met.. which in reality means insurance only covers after you paid out 21k.
I prefer the 20% copay over the flat $35 I have today, most office visits or "specialist" visits run about $100. Last year I paid %20, this year I'm $35 - thats a damn hefty jump.
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I prefer the 20% copay over the flat $35 I have today, most office visits or "specialist" visits run about $100. Last year I paid %20, this year I'm $35 - thats a damn hefty jump.
Just to give you an idea, my kid's specialist visit runs $7500 per 20min checkup once every 3 months. One a year they do extended testing which hits $13k.
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I prefer the 20% copay over the flat $35 I have today, most office visits or "specialist" visits run about $100. Last year I paid %20, this year I'm $35 - thats a damn hefty jump.
Just to give you an idea, my kid's specialist visit runs $7500 per 20min checkup once every 3 months. One a year they do extended testing which hits $13k.
Well that's certainly not what I'm talking about!!! But dude, what kind of specialist does your kid need? That sounds way scary man!!
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Pediactric Cardiologist for a really minor condition. The Doc is WORLD reknowned though.
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realistically, assuming i go on to marry my current girlfriend, my insurance costs will still be low because she's going to be a doctor in a couple years.
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Please avoid Aetna. They've been screwing my family for 30 years. Dad got hurt on the job and hasn't been able to work in three decades. According to documents we've seen as part of many, many court cases, Aetna received 4M dollars from his company in the 80s for Dad's care and have fought us tooth and nail over ever doctor's visit since. We never saw a dime.
&*%ing bastards.