Monday, August 11, 2008

Individual Health Insurance

I'm shopping for health insurance. I got a variety of quotes online a while back, I talked to some agents about it, and now I think I've got it narrowed down. I have good enough health and enough savings that I'm willing to risk getting a little bit sick (and paying for it), but I want to be covered for getting really sick. But I also want the plan to cover routine medical expenses like an annual physical and female-parts exam. It would be great if I had some sort of prescription coverage, as well as dental and vision, but I'm not holding my breath. Here are the three plans. If you have an opinion, I'd love to hear it.

Plan #1
$167/month, plus $15/month for dental (optional).
$2500 deductible, $5000 maximum out-of pocket (pay 20% after deductible).
$25 to see a doctor, $40 to see a specialist.
Free annual female-parts exam.
$15 for a 30 day prescription (so $180 for the year's prescription).
X-rays, labs, and hospital bills subject to deductible.
Vision not covered.
Dental option covers regular maintenance (two cleanings, oral exams, and X-rays), $25 deductible for fillings, everything else isn't covered.
Anticipated costs (year): $2004 premiums + $180 dental premiums + $25 annual physical + $180 prescriptions + $80? vision exam (not covered) = $2,469
Maximum costs (year): $2,3469 anticipated costs + $5000 maximum OOP = $7,469

Plan #2
$157/month
$5000 deductible, $5000 maximum out-of-pocket.
$20 to see a doctor (vision included) for the first 4 visits, after that I pay full price (subject to deductable).
Sometimes X-rays and labs are covered, sometimes not. Hospital care subject to deductible.
Free preventative dental, $50 deductible for fillings, plus 20% co-pay after the deductible. They'll pay up to $500 for dental.
Prescriptions covered
$100 co-pay for ER visits
Anticipated costs (year): $1884 premiums + $60 annual physical, vision, female parts exams = $1,944
Maximum costs (year): $1,944 anticipated costs + $5000 maximum OOP = $6,944

Plan #3
$116/month, plus $15/month for dental (optional).
$5000 deductible, $10,000 maximum out-of pocket (pay 20% after deductible).
$30 to see a doctor, $45 to see a specialist.
$15 for a 30 day prescription (so $180 for the year's prescription).
X-rays, labs, and hospital bills subject to deductible.
Vision not covered.
Dental option covers regular maintenance (two cleanings, oral exams, and X-rays), $25 deductible for fillings, everything else isn't covered.
Anticipated costs (year): $1392 premiums + $180 dental premiums + $30 annual physical + $180 prescriptions + $80? vision exam (not covered) = $1,862
Maximum costs (year): $1,862 anticipated costs + $10,000 maximum OOP = $11,862

It looks like #2 is the best, because it has relatively low anticipated costs and a low out-of-pocket maximum. But there's probably something I'm missing.

There's another plan from the same people as #2:

Plan #4
$175/month
$3000 deductible, $3000 maximum out-of-pocket.
$25 to see a doctor (vision included) for the first 4 visits, after that I pay full price (subject to deductable).
Sometimes X-rays and labs are covered, sometimes not. Hospital care subject to deductible.
Free preventative dental, $50 deductible for fillings, plus 20% co-pay after the deductible. They'll pay up to $500 for dental.
Prescriptions covered
$100 co-pay for ER visits
Anticipated costs (year): $2100 premiums + $75 annual physical, vision, female parts exams = $2,175
Maximum costs (year): $2,175 anticipated costs + $3000 maximum OOP = $5,175

With plan #4, I'd be paying $300 more each year I don't have any unexpected costs, but save $1800 the year I get sick.

I know insurance companies can screw you over (I've seen Sicko), but I don't think that's something I can prevent. If it happens, it'll happen no matter which plan I choose, right? And then I'll be bankrupt.

Questions? Comments? Personal tales of woe? Harangues about how we should have universal health care? Entreaties that I should get a government job and not have to worry about health insurance?

5 comments:

  1. E., we can talk more about this when we meet and I can tell you about my experience, but I have a question:

    For all these plans, are the doctor's visit and prescription coverage fees stated what you pay BEFORE you meet the deductible? Because that's awesome. I have to pay the full price of everything out of pocket, until I meet the deductible -- THEN the plan prices for office visits and prescriptions apply.*

    CT must have better health coverage laws than IL.

    *Also, what I pay for acne care out of pocket doesn't even count towards my deductible, because they consider it a pre-existing condition. I didn't know that when I applied, but now that I know and have the opportunity to switch plans (they make you wait a year) I'm going for the highest possible deductible so I can at least reduce my premium. Oh, and by the way, my premium would have gone up by thirteen dollars a month if I'd stayed on the same plan a second year. Individual health insurance is a crock.

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  2. Yes, those fees are before you meet the deductible. It's a "deductible waived" situation, which makes these plans ineligible for a health savings account, which I had sort of looked forward to. But if having an HSA means I have to pay full price for routine stuff anyway, I think it's worth not having an HSA.

    As far as I know, I don't have any pre-existing conditions. Unless you count a dislike for going to the doctor. I'm pretty sure these plans don't require a preliminary exam (at which they would look for pre-existing conditions).

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  3. Oh, I get it. I have a HSA. It's worth it to me because putting money into it reduces my taxes by quite a bit.

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  4. Can you get a job that has health coverage? Those deductibles are outrageous!! Ours is $200 and we would be screwed if our deductibles were as high as that. We pay $340 a month for health insurance for a family of 4 with a deductible of $200. If Seth were single he would pay $0 a month and if I was not in the picture (just him and the kids it would be $170 a month)
    I vote for universal health care though. At the rate things are going no one is going to be able to afford health coverage.
    Our recent 2 day stay in the hospital cost $10,000 and the bills are still coming in.

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  5. Yeah, my dad's advice was to get a government job. But my current situation doesn't include insurance, and is otherwise perfect. By the way, I picked plan #2. There are other plans with lower deductibles, but higher premiums, and I think with the co-pays for the regular (preventative) visits, I don't expect to need a low deductible. I don't plan to get sick, and if I do, it's more likely to cost a lot more than $5000. I guess at my age and in my situation (no kids and decent savings), I'd rather take the risk of getting sick and having to pay for some of it, in exchange for being able to save on the premium.

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