OT: THIS is out of control - health insurance -any suggestions?

Triathlon Forum
1

I’m in the process of starting my own business and leaving my corporate employer. Everything is going along swimmingly, except for the HUGE issue of health insurance. If I keep my employer’s insurance under COBRA, I pay almost $1,100 a month! If I just go get insurance (like blue cross or something decent) it’s about the same. WTF!?! I thought the whole point of the COBRA legislation was that it would make health insurance more affordable.

I’d like to point out right now that there is NO WAY IN HELL my employer pays that much for my insurance right now, I pay about $250 out of my pocket for a family plan that has been a pain in the ass. Supposedly they match what I pay. Copays are PC - $15 and ER- $50

I know, I know my canadian friends - I don’t wanna hear it. I’m in Texas and I ain’t moving.

2

don’t know what the deal is but…
I work for a university, they pay BCBS TX about $560 a month.

if I was paying myself for it, it would be nearly $1000…why???

3

Probably the best way to do it is to hook up with a large group you may be affiliated with. When I went on my own, the best deal was with my college alumni association. Any alumni from the Cal State system can join. You get a wonderful plan from Blue SHield. We set our deductible real high basically for disaster insurance and payed the visits. Take the difference from the deductible and bank it if you want to pay for the visits-keep it if you don’t use it. Sort of like your own medical savings account. Many professional associations you may be affiliated with have the same thing.

4

I thought the point of COBRA was to let you keep the same insurance that you had with your old employer to eliminate the problem of losing your health insurance if you lose your job. My health insurance is around $1000 month for a family of three so yours does not seem out of line to me unless you are the only one insured. If so, you might want to look at things like your various deductibles and other options that you have (like a PPO) to make the coverage more affordable.

Canadians pay for their health insurance other ways. Like having the same type of people that can decide to have road construction going on multiple parallel roads deciding what health care they can get and when.

5

You are paying what your compnay was paying. Under COBRA, you pay the actual priemum cost plus 2%.

So first thing you should do is be thankful you are leaving a company that is stupid enough to be providing such a gold plated benefit to its employees. Either the company or the benefits will not be around much longer.

Next, call your local chamber of commerce and some other business associations and check out the group insurance plans they can get members in on.

Next, your insurance costs will go down the more of the load (read risk) you assume. Look at higher deductibles and co pays.

Finally, how much do you pay per month to insure your cars? How much more are your kids worth to you than your car? Look at it that way and health insurance is cheap.

6

You can reduce your monthly premium by choosing a plan with a higher deductible. When I was laid off a few years ago and had to get my own insurance, I was blown away by the costs. For my family of 4, we ended up with a $1000 per person deductible ($2000/year max) to lower the monthy cost. It’s a PPO, unfortunately no good prescription plan, and costs $375/month (Maryland). Dental is another $30/month, but it’s an HMO. Still more than what I was paying with my employer (around $250/month), but much better than COBRA. The hardest part is I pay quarterly, so coughing up (saving) the $1000 gets rough.

7

While it’s not the best option, getting just major medical insurance is one alternative. My wife and I had it for a few years when we first got married. It had something like a $3,000 deductible and cost about $100/month for both of us.

8

First thing you need to do is decide what kind of coverage you want and can get away with. Larger deductable etc etc.

If I were a single person, in decent health, making a decent wage in my own business, I’d be looking at major medical only.

Second you need to do some serious shopping around. Typically insurance companies go in cycles, as explained by our broker. They have one year where they are seriously puching to sign people up and there rates are typically lower then. In my experiance as much as 25-30% lower. Over the next 2-3 years tehy slowly hike the prices up until they are outrageous again, again in my experiance typically 10-30% hikes per year. You then have to go shopping again.

Third depending on where you live and what type of coverage you are looking at 1,100 dollars a months is not all that “outrageous” and yes your “ex-employer” likely paid that if they were offering the exact same coverage. Teh key is that typically large companies are very good at hunting out the best deals.

I run a small business and thus health care is a major issue. We are currently paying around 700$ a month for family coverage at the ages of around 45 or so. However a younger single male is only 133$ a month. Our coverage is fairly basic with a fairly high 500$ deductible and co-payment.

My wife is a supervisor at the health department and their medical costs are roughly 1200$ an employee, reguarldess of dependants. But they have very low deductable adn co-payment.

The point is the better coverage you get teh more expensive it is. Major medical you could probably pick up for 80$ a month or so for an individual that’s middle aged. Move up to full coverage high deductable you’re looking at 250-350$ a month. Move up to premuim coverage you’re looking close to 500-600$ amonth for the same individual.

As I said shop around. The last time we went shoping, about a year ago, there was about a 20-25% difference between providers with similar coverage.

“I thought the whole point of the COBRA legislation was that it would make health insurance more affordable.”

No it was to make insurance “transferable”. In otherwords before cobra if you left your employer I don’t believe the insurance compaines had to offer you coverage. So if you had cancer or something they’d drop you like a hot potatoe. Of course that completely sucked because you’re new employer wouldn’t cover you for 60-90-120 days either. So you we SOL. Now they have to offer you insurance.

To step on the soap box a bit. Whether we like it or not, insurance is expensive because of us. We simply can’t expect to have “cradle to grave” coverage and not pay for it somehow. Add that to the fact that people, for the most part, absolutely refuse to take care of their health and the fact that if a doctor makes the slightest error we sue the crap out of them we have only our selves to blame.

~Matt

9

“Canadians pay for their health insurance other ways. Like having the same type of people that can decide to have road construction going on multiple parallel roads deciding what health care they can get and when.”

At least the health care is there when I need it (yes, believe it or not, we Canadians do get care when we need it) and I don’t lose sleep over whether or not I can afford the insurance.

D.

10

The post regarding cost plus 2% for COBRA is correct. If you are a healthy person/family you should look into the Health savings account plans. You could have a high deductible health plan and a HSA savings account that rolls over each year.

Good luck

11

While it’s not the best option, getting just major medical insurance is one alternative. My wife and I had it for a few years when we first got married. It had something like a $3,000 deductible and cost about $100/month for both of us.

I think this is the best idea for MOST people. Especially those of us who take care of ourselves. Keep the money you save in premiums ina savings acct. to cover the deductible. With the monthly premiums you save, you’ll be surprised at how fast you can reach the deductible. Plus, if you don’t need it, you have that money, not the ins. co.

Also, look around for providers that offer “point of service” or “cash” discount. My office will offer 20% discount for same day payment once I restructure my systems. I am required to offer this to all parties paying me if I offer it to anybody… including insurance companies which will not do this. It’s a way of making health care more affordable to people with higher deductibles. The ins. companies pay a lot less for treatments than most cash payers and I think that is very wrong. Plus I don’t have to hassle with billing.

Anyway, probably shouldn’t get started on this this early in the morning.

Lehmkuhler

12

Really, I hear lots of stories about waits for cancer treatment in Canada. Good thing that success in cancer treatment doesn’t drop dramatically the longer you have to wait. And, lots of Canadian doctors staff the ERs Detroit area hospitals in November and December because they have already seen enough patients to earn all that the Canadian government allows them to earn in a year so they cross the bridge and work here instead because they can still make money doing so instead of working for free in Ontario.

Anyone in the US that needs medical care can get it, and the medical care here is far better than anywhere else. If this is not the case, then why do all the leaders of countries that have socialized health care systems come here when they have a serious problem?

13

Over the past 15 years, my family and I have incurred only routine medical expenses such as births, routine dental care etc. The total covered portion of the costs of those services works out to be about 4 times the amount we have claimed the 3 times we have had to make claims on our car and home insurance (2 minor accidents and a roof leak).

Interestingly, our medical insurance costs are just about 4 times what are car and house insurance costs are. Seems like the actuaries are right on the money.

Medical insurance is NOT expensive considering what you get in exchange for purchasing it. The problem is most people think of medical coverage and care as “free.” Until that changes, the medical cost problem will never get taken care of.

14

I used to work for a place that used AdminiStaff. That helped us as a small business…

15

Good observation, good question. I’ve done a lot of investigating into this.

At this stage my slant on the health insurance issue is that is is priced out of the market. I do not have it because it’s cost is not justifiable. It is less expenisve and a wiser financial decision to not pay for it for a number of reasons. While most people disagree, here is my how I am handling it: I looked at the premiums I was paying, about $600 per month for Blue Cross/Blue Sheild. When I had the coverage and attempted to use it there was a $2000 deductable/stop loss per year. I almost never even came close to reaching it. The one year I did make claims related to a G.I. medical problem the claims were denied because they claimed I did not follow the appropriate specialist referral protocol (I saw a G.I. specialist). I had to have my attorney write them a letter to honor the claim, it took 8 months and almost four hours for my attorney to resolve. That is the claim service I got for $600 a month. At a rate of $600 per month with only one claim in the past 18 years I had paid $129,600.00 in premiums. The claim they paid was worth about $900 after I paid my deductable. Even if I had a catastrophic claim, it is unlikely they would have either honored it given their track record (without legal intervention at additional cost) or it would not have been $129,600.00. Had I used the $129,600 in my retirement accounts, it woud have been worth about $170,000+ dollar cost averaged at the rate of return for that period, maybe more.

Basically, to me health insurance is a gamble that I won’t get cancer or have an extremely catastrophic accident. The “peace of mind” it offers is not worth much to me since I have seen their claim performance and it is poor. Basically, to me, it makes little financial sense. Now I put the extra $600 into my retirement account and earn money on it. If I do get extremely sick before I’m 45 (I’m 43 now) then I will have to use that money. At 45 I will buy some insurance since, by then, it is a virtual certainty things will start to go wrong.

16

I think this is the best idea for MOST people.

I agree that just getting major medical coverage is probably the best option for most people who are self-employed or not otherwise covered by their insurer.

The ins. companies pay a lot less for treatments than most cash payers and I think that is very wrong.

You ain’t kidding about that, brother. The insurance companies pay, in my experience, HALF what a cash payer is charged. Crazy. Kudos to you for being part of the solution. Good to know there are doctors out there like you.

17

LOL.
Yeah, the best health care in the world is in USA, just like everything else, right?
You pay more per capita and have the worse health care than Canada.
Go to Tibbs’ Room, there’s been couple of threads recently where this came up.

18

I hear bad things about Canadian health care as well though…

19

“I know, I know my canadian friends - I don’t wanna hear it. I’m in Texas and I ain’t moving.”

OK, so I won’t suggest a move to Canada. However, it is interesting to put some numbers to this. I really had know idea. So it’s about $12,000(US) a year for your coverage. The rough numbers in Canada are that we pay about 30% more in taxes up here and that extra tax, goes to the universal health coverage that ALL Canadians have direct access to. It’s not a perfect system. I paid thousands of dollars in taxes into the system last year, but only went to the Doctor once in 2004( to my GP for a really bad cold). I have heard that per-captia costs for health care are now less in Canada with our public system than in the US though the private insurance system.

Fleck

20

My opinion on this is that HSAs & MSAs are really good. The reason that they are good is that they will hopefully transform the idea of health insurance to what it should be used for instead of what it is used for now. People want to walk in a doctor’s office and pay only $20. It doesn’t matter if they have a paper cut or cancer. HSA’s should transform health insurance back to what it was intended for: you pay for the little stuff and then the insurance company pays for the big stuff aka major medical coverage. One problem is that people with no insurance, malpractice suits, and HMO’s have driven up the cost of regular medical visits if you don’t go through insurance. Doctors and hospitals have to make up the costs of people that skip out of paying. They have to charge more because of malpractice suits. HMO’s have worked out deals where a surgery costs them $3000 where it costs an uninsured individual $10K or more.

See if you know of any professional organizations, local small business organizations, college alumni associations, or anything else that can get you insurance. I would also say go for the major medical coverage and try to save the difference in premiums. If you can get into an HSA or an MSA, I would highly recommend that as well because your contributions are pre-tax, they grow pre-tax, and you can keep them forever; doesn’t matter if you change jobs.

Good luck.