Health Insurance

Question: It is open season for health insurance, and I am considering BlueCrossBlueShield Options Blue. Has anyone had experience with them that you could share with me? Has anyone had experience with High Deductible Health Plans with Health Savings Accounts? Here are some answers from the trenches: I haven't tried Blue Cross but I have applied to a Liberty Health drug plan. If the applicant has a pre-existing condition, they won't pay out. Now, I am very wary of health plans. Hopefully, someone else will have some better advice. ********** I have a high-deductible ($5K) policy with Blue Cross Blue Shield (BCBS). BCBS is all I could get as a self-employed person in Indiana. I'm not thrilled but it's better than nothing. It's a preferred provider setup, which means when I needed a specialist I had to drive 1.5 hours to the nearest big city because none of the local docs were "preferred." They also increased my premium with no valid reason as soon as they found out I saw an oncologist--it turns out I'm fine, but apparently if I once had something worthy of an oncologist's concern, I'm forever marked. Finally, they refused to pay for Vioxx, but I guess that's not an issue anymore! Even though I have a high deductible, I do get price breaks on almost everything, which helps. And the premiums are still pretty low -- a little over $100/month. ********** I currently have BCBS Options Blue in Illinois through a state-run group. I have multiple health problems and am a heavy insurance user (thus, the state-provided group....I can't get "regular" health insurance). Though my premiums are high (but, I've discovered, not really out of line with friends in our age group who also have a health history...and I have a low deductible), I have been extremely happy with my plan. In fact, it's perhaps one of the best I've ever had....wide range of doctors and facilities (including all of my current providers, which I've never experienced before) and, because it's BCBS, there seems to be coverage wherever I travel. I have not yet hit a city where I could find a facility or a pharmacy. When choosing a health plan, ask a million questions! There may be a better plan based on your health history. But I wouldn't hesitate to recommend the program you're looking at if Minnesota offers the same type of coverage as Illinois. ********** Actually, unless you are covered under a group, pre-existing conditions are usually not covered. Depending on the pre-existing condition, they may even decline to cover you! I used to have Blue Cross, as part of a group, and never had problems with their plan. ********** I've used Anthem BCBS individual health insurance for the past six years. They actually -- at least here in SW Ohio -- now have specific sales people for the individual market, so it's obviously a group they are targeting. I was told by one of those sales reps -- who I met at a networking meeting -- that the insurance I have is the same as the health insurance benefit Anthem offers its employees. The cost of it has gone up over the years -- what hasn't? But it has not risen in price as outrageously as some other health insurance has around here. What matters a good deal, according to this rep, is the age at which you start buying this insurance. In other words, someone just starting to buy the insurance who is my current age is probably going to have to pay more for it than I do now. This has something to do with risk factors. Because I have a history with Anthem, the insurance co. is better able to assess my risk. And, because I started buying it when I was younger, my risk was lower then. Someone new, even though we may be the same age now, is more of a risk because the insurance co. has no historical info on that person. Obviously, your age, condition, and the state where you live will affect your personal costs. ********** I have an individual plan through BCBS-Texas called Advantage PPO. The coverage has worked very well for me. The big disadvantage is the continually increasing premium prices. Right now I'm in the process of investigating options for changing plans within Blue Cross because my premium is going up again, and my deductibles are already huge. In all other ways -- service, coverage, quality of providers in the PPO network, etc. -- I've been very happy with Blue Cross. Also, FWIW, I had a minor pre-existing condition that had caused problems with other carriers (e.g., insisting on attaching a rider or turning me down altogether), but which wasn't an issue with Blue Cross. ********** For about 10 years, I've had individual BCBS-Missouri for my health insurance carrier. I learned the hard and expensive way to ask if there's a "better plan for me." After several years of high deductible ($2,000 or so), no claims because I was healthy and never met the deductible, but up-creeping premiums, I reached my budget limit in mid-2001. When I inquired about a lower-cost option, the representative told me about the Alliance program. The deductible is lower ($500) and the premium was the same or maybe a tad lower, too!! Why they didn't suggest this program when I started with BCBS, I'll never know. You have to be fairly healthy to qualify, and I did. I had to complete a new health history and application form, and the conditions they won't pay for changed somewhat -- pretty much they won't cover anything you have been treated for in the past. However, the previous restriction on back trouble went away because I hadn't put in a claim for it for several years. Now, BCBS is covering chiropractic visits for me. And I had wonderful coverage for my breast cancer treatment (2002). Of course I can't change insurers because of the illness, but I'll get Medicare in a couple of years, so I have to tough out the rapidly increasing, huge premiums until then. There's another program in Missouri -- RateSaver -- that has a high deductible and covers only catastrophic health care (hospitalizations, what they used to call Major Medical). It's worth looking at to see if it would save you money. Consider items such as drug benefits. If an insurer offers "good" drug benefits, that might outweigh a higher premium, for example. Drug benefits vary all over the place. If you are changing from company or group benefits to an individual plan, you'll likely be surprised, and not in a nice way. Advice to all -- Watch your health insurer like a hawk. Check every statement and every doctor bill very carefully. You'll find that the doctor's office lists things differently from the health insurer's statement. Ask for explanations of anything you don't understand. Protest (diplomatically) when you get denials or improper amounts. Billing is a nightmare for everyone, patients and doctors alike. For example, it took me over a year to get one set of bills straightened out. Health Savings Accounts (HSAs) became available several years ago. The reviews are mixed. Many companies that will let you set up an HSA will also charge high fees, and the investment vehicles do not pay very much interest. You might do better to set something up on your own, investing that money in a mutual fund or reliable stock. Please do some research in unbiased places before you jump into an HSA. Consumer Reports might have a comparison. ********** My family has been on the individual BCBS Select Advantage PPO plan in Texas for about 3 years now. We have been very happy with them except for their rising costs. We are currently considering another plan within BCBS. Our current plan is very rich and is costing about $900/mo., increasing to $998 in December. We are going to the BCBS Select Choice PPO with a higher deductible ($1000 instead of $500), and we will reduce our cost to $560/mo. The Select Choice plan is still a very rich plan, and it provides a higher maximum lifetime benefit and a higher yearly benefit. Why it is almost half the price I have no idea. We haven't investigated other providers. Even though we are all healthy, we have been to doctors in the past, and the whole process (having them assess our health, providing all the records, dealing with potential riders/exclusions) scares us. I am self-employed, as is my husband. Insurance is a big issue for us. We have a hard time understanding why everyone can't be part of a feature-rich group plan. ********** OK, now for another angle: Why are we all so convinced that we absolutely MUST have insurance? Since leaving my former job, where my half of the monthly insurance premiums was somewhere around $450 (the other half being paid by my employer), I have tracked my ongoing medical expenses, to see if I really need medical insurance. You know what? I've decided I don't. Now, lest you all think my family and I are all extraordinarily healthy with perfect vision and perfect teeth, let me tell you, we're not. I am a diabetic, so I have ongoing, regular medical expenses. Many insurance companies would not touch me without a "pre-existing condition" exclusion (meaning I would still have to pay all expenses related to my diabetes out my own pocket). We do not skimp on going to the doctor when we need to, nor the optometrist, nor the dentist. We all wear glasses, and we've had our share of dental and medical problems. And guess what? Even with all of our regular and other expenses, it still averages to less out of pocket than the amount I paid when I was insured and paying copays. That's right: My average monthly medical/dental/eye expenses over the past two years have actually been LESS than what I was paying in insurance premiums and co-pays. So, who needs insurance? I think the whole insurance industry monster has duped us, folks. And what's more, I think they are one of the major reasons medically related costs are skyrocketing. (I'll spare you all that particular diatribe.) True, my one big concern is "What if something major were to come up?" I do worry some about that. But, on the other hand, I've been told (rightly or wrongly) that hospitals cannot refuse to treat you as long as you are willing to make regular payments, so I guess I just trust that if/when the time comes, it will work out. Maybe pie-in-the-sky, but the truth of the matter is that I really cannot afford the hefty insurance premiums PLUS the increasing copays PLUS the regular out-of-pocket expenses from pre-existing condition exclusions PLUS all the other things the insurance companies refuse to pay (and the huge deductibles). So I am, by choice, uninsured -- and convinced I am really better off for it, believe it or not. ********** On this same note, be careful who you identify as a doctor. I used a naturopath for a few years as my primary care physician. She did regular acupuncture that helped allergies among other things. One underwriting company disqualified me because her files listed "liver blockage," a common Chinese diagnosis associated with allergy treatment. They thought I had liver problems. I now no longer consider her a "doctor" when it comes to insurance applications. I will only list MDs I've seen. Let the buyer beware - insurance companies do not understand or recognize alternative providers -- so don't even give their information. ********** Blue Cross options may depend on your state. I used Blue Cross Blue Shield in Massachusetts. It started out fairly reasonable, but, as always, the prices rose. I now use Health Choice in Maine, managed by Anthem (which also provides Blue Cross). It is still a little more expensive than Blue Cross in Mass. I prefer Health Choice, because I do not need referrals. I have a high deductible ($2200), which works because I use it up with some expensive medications. I love that they pay 100% after reaching the deductible. There are never co-pays on meds or office visits. I don't like that they don't pay for meds up front; they reimburse for them. Also, next year they plan to offer a health savings account (HSA) for self-employed people, which helps with taxes. With the premium and deductible, it will really help with taxes, I'm sure. For HSA information, see http://www.treasury.gov/offices/public-affairs/hsa/ and www.hsainsider.com. P.S.: Pre-existing conditions ARE usually covered if you are still on a health plan when you apply for a new plan. I think this is controlled by state law. ********** On the subject of not needing insurance...What if you get involved in an accident? What if you fall down and break a leg? What if your wife has breast cancer? What if your kids contract some disease for which long aftercare is required? Can you afford to pay all medical costs associated with those medical events? Insurance will pay for a large portion of those (very large!) medical bills. Same principle applies to your car insurance, your homeowner's insurance... if your car gets totalled, are you gonna be able to purchase another car? If your car burns down (remember, we lost 2K houses here a year ago), can you rebuild? ********** And just how do you think healthcare facilities can afford to treat you in the event of a catastrophic illness or injury? Because you (and others like you) are subsidized in my high rates. I appreciate the fact that insurance is expensive, but it is not unnecessary. The best thing you could do is to buy a cheap indemnity or major medical policy that covers catastrophic events and continue to pay for your drugs and office visits out of pocket. In fact, I think all of us should pay as much as we can out of pocket rather than relying on insurance for reimbursement. Insurance should be used when we can't afford to pay. If everyone used it this way, we wouldn't have the insurance/healthcare problems we do. ********** [the no-insurance guy responds] Believe me, I share your concerns. But, as I indicated in my earlier post, as far as the medical expenses go, I will let the medical personnel do what they must -- be it as the result of an accident, a major illness, or what have you -- and then proceed to pay it off for however long it takes. It can't be much worse than paying off a mortgage, can it? To balance things and respond to your other concerns, I do have auto insurance (for one thing, it is required by law in the state of Ohio), and I also carry some forms of homeowner's insurance that would take care of those things if something catastrophic were to happen to me or my wife. But those forms of insurance, much as I abhor and deplore their necessity, are much more affordable than ANY kind of medical insurance would be. I have yet to find a major medical or catastrophic plan that was any more affordable than a comprehensive plan--OR that would cost me less than what I am currently paying out of pocket. True, it is something of a risk to be without medical/dental insurance. But the truth of it, I believe, is that it is nowhere near the risk we've been led to think it is by the medical insurance machine. Don't kid yourself: They're not in it for altruistic reasons. They're in it to make money. And if you want to know the horrible, ugly truth, the amount of money they make is truly obscene. (If I wanted to get rich and had absolutely no moral scruples, I would become an insurance magnate.) They can afford to treat me, because I am willing to pay for it myself, however long it takes. It may take me the rest of my life to pay it off, but I am willing to pay for it myself, and not expect somebody else's insurance to pay for it for me. I'm not asking for charity or a free ride. Therefore, I am not imposing on you OR your high rate subsidies. YOU are not going to pay for my medical care. I will. In fact, I contend that it is precisely *because* the majority of us have been so brainwashed and duped as to think that we absolutely MUST HAVE this kind of insurance that has led to the deplorable high rates and high costs associated with medical and dental care today. That, and the ridiculous amount of litigation in this country. As far as buying a "cheap indemnity or major medical policy that covers catastrophic events," if you know of one, I would like to hear about it. I have done a lot of checking, and I have yet to find anything that I would consider *affordable,* much less *cheap." If you know of something affordable (and by affordable, I mean $100 a month or less), then I would love to hear about it. Otherwise, I will remain uninsured (medically) and trust to my Creator. ********** As irritated as I get with them from time to time, I think that Kaiser Permanente (KP) works for us both for those in groups and those covered as individuals through one of KP's plans. ********** I considered Kaiser, but I really hated it when I had it. I was constantly given medication by one doctor that conflicted with the medication given by another. I had really long waits to see a doctor, and with triaging, sometimes couldn't see one at all. The only good point was that the premiums were lower than any of the 80% companies. My husband likes Kaiser, however. I don't think they'll take me after the second cancer. ********** You may want to check with your tax professional, but I believe that health insurance premiums are or soon will be 100% deductible for us small business persons.