Health care outside the veal pen
Tuesday, July 10, 2007
A few months removed from the simplicity of employer provided health care, where the sum total of many people's medical insurance experience consists of complaining about the increase in premiums every fall and occasionally switching doctors when the medical plans are changed, my wife and I now find ourselves lost in the labyrinth otherwise known as the U.S. private health care system trying to select a new plan that we won't come to regret a year or two down the road.
It's a good thing they have that COBRA health care continuation program.
After living in a veal pen for twenty years it'll take you at least a year and a half to figure out how to fend for yourself in an increasingly complex world of increasingly complex choices that somehow only seem to benefit those in the health care industry and that small percentage of the population with serious medical conditions.
For most of the healthy people in this country, we'd probably be far better off if we were forced into some sort of a plan where the only recourse was to complain loudly about the system.
The alternative - being inundated with a bewildering array of choices and options and fine print and caveats - leaves you convinced that even if you could devote every waking hour to analyzing all the options available, you're still going to end up choosing the wrong plan.
Carried to its logical conclusion, the number of choices available in the Western world for all manner of consumer products will probably, at some point, cause all economic activity to cease, except of course for government and those companies toiling to provide an even greater selection to the consuming public.
If anyone has any advice on scoring some reasonably priced health insurance in California, please post a comment or send me mail.
Thanks.
9 comments:
It gets worse if you move from one area of the country to another one.
You have to reapply even though its the same insurance company. Insurance companies have subsidiaries in different parts of the country and usually don't have national coverage that carries over . If your health situation has changed (e.g. heart condition) in the meantime, reapplication will require that the new policy not cover the condition. Yet the insurance premium goes to the same company address as before.
Johann
your screwed now.....you should have stayed in the pen
Check with your local chamber of commerce if you haven't already. They may have or at least know about a local group plan for small businesses and the self employed.
Tim,
During my for 25+ years as a contract coder I've relied on the BC/BS individual plan. Higher deductible, but reasonably priced for good coverage.
Personally I'd love to find a good plan with a *really* high deductible -- 10K? -- in return for lower premiums.
Tim,
When I left the veal pen, I did my 18 months of COBRA for around $900/month for my whole family. It was a great plan and aside from my $35 office copayments, I never had to shell out a dime, even for the births of my two children, one with some complications.
When COBRA ran out, that's when I found out how tough it is to get good insurance on your own. I went to eHealthInsurance,com which was very helpful on comparing plans, and finally settled on Blue Shield Active Start Plan 35. I traded off higher deductibles and coinsurance for a lower premium and lousier coverage. For example, childbirth expenses are not covered on this plan, but since I've got two kids, and I'm done, I'd rather save the money. Each family member gets his/her own policy and premium; the four of us together total about $600 now. Whenever anyone goes to the doctor, it's not only $35 office copay, but coinsurance on any lab work, usually another $50 billed afterwards.
The application process was the hardest part. It takes several weeks to get approved. Make sure you get a certificate of coverage from your previous employer. They will also make you sign an authorization for release of all of your medical records from the past few years to decide if you need to pay more money. My 18-month old daughter was treated for two ear infections in her first year, and they found out about it and deemed her a higher risk, so she was assigned to "Tier 4" instead of "Tier 1" like the rest of us, and pays almost double, around $200 per month.
When you have a job at a company with a good group plan, life is good, because it takes 10 minutes to fill out the form and enroll in the plan, no more questions, and they pay the premium. On the other hand, when you try to get coverage on your own, you go through several weeks of fax machine hell and wind up getting much less value than you get with a group plan from your company.
Going without coverage is not an option; you can't take the chance that you or someone in your family will rack up some huge medical bills. But after going through the process, you might be ready to vote for Hillary and call Michael Moore your new hero.
Re: michael moore and hillary, I wouldn't want to throw the baby out with the bath water so to speak. But there are definite problems today with how to allocate limited health resources which continually are getting costlier due to medical advances and aging population.
Allowing health insurance companies to create shell companies with limited geograhic extent and schemes such as these should not be legislatively tolerated. However, I don't see Hillary and either party passing any laws that would incrementally help make the system more equitable and efficient.
Johann
Thanks for all the help everyone.
That’s why its time to move out. New Zealand has impressed the hell out of me. You get in much faster, you talk to the doctor longer, the visit cost the same as a co-pay but with no monthly fees. Top this off with lower income tax and you can't beat it. My daughter just got sick with the flu, we called in and got a visit in 15 minutes, the cost was $10usa and the wrote a prescription to use if she still had a fever the next day. She did and the medicine cost a total of $2usa. An American doctor I met over here said she moved because the HMO's screw doctors, she is no longer double booked, and works normal hours not 24hours on call. She thinks she has much more freedom to do what is best for the patient in the NZ system.
I think the high deductible plans are the solution too, especially if you can combine it with tax-exempted health spending accounts that roll over year to year. Really, you don't want insurance for maintenance events that are predictable. In aggregate, it would be cheaper just to pay the health provider directly and cut out unnecessarily administration costs. A lot of the best docs with full practices have stopped taking insurance altogether anyway. Key here is providers that do take insurance need to make their rates for patients without insurance similar to or less than their rates for patients with insurance.
Insurance is for unplanned, difficult to predict events. What we typically have instead is for profit socialized health care.
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