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Health Insurance for the Self-Employed?
SharkJumper writes "Looks like this question has been asked before, but might be due for an update. I'm a self-employed programmer who is about to become a father. Previously, my family's insurance has come through my wife's employer, but she is eagerly looking forward to being a stay-at-home mom. We must look for that elusive low-cost insurance in order to enable her to do this. Losing her insurance is not a huge loss as, due to failed negotiations, the hospital in our city (3rd largest city in the state), along with most of the doctors that refer to it, is dumping the network (largest in the state) that our insurance uses. On the individual coverage plan front, my research shows story after story of deception, fraud, and general run-around or obfuscation by most of the major players and nearly all the minors. With all of the bad experiences out there, I've yet to see a good review of an insurance company. What does the Slashdot crowd use and recommend? Company and plan-type? PPO? HMO? HDHP + HSA (High Deductible Health Plan + Health Savings Account)?"
Move to Europe... or Cuba ;-)
----------------------------------- My Other Sig Is Hilarious -----------------------------------
But you'll need a plan that has a low co-pay for doctor visits since you will take your kid just about all the time for everything from his/her first sniffles (OMIGOD TB!) to fevers (OMIGOD FLU!) to standard vaccinations (OMIGOD YOU'RE GOING TO STICK HIM WITH A NEEDLE!). The cumulative costs of a high co-pay is going to eclipse the savings you'd see with that sort of plan. The higher-cost low co-pay plan pays off in the long run with kids.
For yourself you probably can get by with catastrophic coverage unless there's an existing medical condition that you haven't mentioned. And if there is, you're just about out of luck anyway since many carriers won't cover existing conditions. So unless you go to the doctor for anything except the most serious ailments, stick with catastrophic.
Instead of great health coverage for you, get LIFE INSURANCE. You can probably get some cheap 30-year term insurance which will cover your family in case something happens to you. You may want to cover your wife as well in case something happens to her and you need to hire extra help to take care of your kids. This is less common, but no less a concern.
Health insurance for your wife should probably be kept at the same level it is now, if possible. She will need extra care immediately after the birth, but once the first year rolls on she'll get into the swing of things and probably not need any special coverage. I'd argue against catastrophic-only coverage for her since if she gets sick the whole household suffers, so having the ability to go to the doctor for anything questionable will be a good investment, if only for the peace of mind of having that security.
I wonder if there isn't a self-employed plan that covers people just like you already offerred by your local carriers. I'd be surprised if there weren't. But don't kid yourself. It's expensive. You want to go with a carrier who isn't going to drop you the first time you make a claim. That's a local issue that would be well served by some research (like, I suppose, asking us idiots).
Good luck.
A while back, on the radio (WTOP in the Washington, DC area), they played an advertisement for a small business association, or something like that. One of the benefits of joining was that they had offered a group health plan to the member companies.
... that might've been what I remember. As does NFIB ... just type 'small business association' into your favorite search engine.
I don't know for sure if it was specifically a small business association, or that's what I just remember it as, or if it was a local or national thing, but you can try asking around. (or someone else might be able to follow up with some knowledge of these sorts of groups)
A quick look online suggests that the ASBA has some sort of discount on health insurance
Build it, and they will come^Hplain.
"Betcha ten grand I won't get sick this year."
groupthink: It's good for self-esteem.
I use public health services, specifically, medicare in Australia. It costs 1.5% of my taxable income and I don't really have any choice in the matter. Yes, I'm happy to be 'forced' into paying for it. It pays for the poor sods who otherwise could not afford health services. Things are fine for me now , but for all I know, one day I might be one of them, so I'm happy to pay. For that 1.5%, minor stuff - setting bones, stitches, emergency visits, overnight stays,etc, it's pretty much free. For 'serious' visits to the hospital (surgery,etc) , you generally end up having to pay. But it's certainly not "sell the house, and the car, and the kids" kind of pay.
What? Your country doesn't really do public health schemes anymore? Oh, I'm sorry to hear that.
From what I can see of the American system from this side of the pond, it's one giant complex ripoff.
Thought about emigrating to somewhere with decent public health services?
You are in a twisty maze of processor lines, all alike.
There is a lot of hype here.
You have read some news in some newspaper about some shady goings on at every insurance company?
Oh My God.
Who cares? Just pick the one that gives you the BEST HEALTH INSURANCE PLAN for the LEAST MONEY. Why does that have to be so difficult? Ask your doctor which one he would choose, and just go with it.
In the UK, our Professional Contractors Group has just negotiated deals with a leading health insurer or two. I haven't seen the details yet, but it seems relevant to this discussion.
Are there no similar organizations in your country doing this kind of thing?
Note to ACs: I won't mod you up, even if you are being funny or insightful. So take a chance! It's not real life!
"If it sounds too good to be true, it isn't."
Ask your doctor which one he would choose, and just go with it.
The answer will probably consist of the plan that makes him the most money.
Simple Answer: Over the course of your working career, let's say you save $1,000,000. That's great, if you don't have any major problems until well into your career. But what do you do if you get into an accident, or get ill, and need to spend a few hundred thousand early on, before you've saved it?
You either go into debt, if you have enough credit, or you carry insurance to pay for it. A savings plan with a high-limit credit card used just for healthcare emergencies and a health insurance plan are basically the same thing, financially. You'd have to do some analysis on the CC interest rate - savings interest rate vs the insurance premiums to figure out which one costs less. I predict they're both excessively expensive, though.
Congratulations on becoming a father !
I take it you haven't been smacked with a six-figure medical bill yet.
I would also guess that you're not too old, and in fairly good health.
Seriously, how dare you call yourself the "best country in the world" if you don't even have nationally implemented healthcare?
Europe, glorious old lady that she is has long ago implemented the National healthcare to make sure that
A; Everyone has access to proper healthcare.
B; Everyone automatically pays into the healthcare fund so it can be maintained
C; Good quality in healthcare is guaranteed by state checkups.
In those days there were no "private" health insurance companies, but look what trusting in those has brought you? Deception, Fraud, and general run-around or obfuscation from most if not all of the private insurance companies.
IMHO, healthcare is not, and has never been something companies should be in charge of. A companies purpose is to make money. The state however, if it's run by others then the idiots running the American state, should be more interested in keeping it's taxpayers ALIVE and healthy so they can work and pay taxes next year.
First, you are about to find out just incredibly broken our health care system is. I doubt if you will get private insurance, as they are denying older applicants out of hand, and if you have ANY problem forget about it.
Many states have an expensive health insurance pool that has high deductible insurance that will only take care of you in catastrophic conditions. If you go for the low deductible, expect to find very high premiums and equally high copays.
With the high deductible plan you can start a health savings account (who has money to save these days?), but that may be your best option.
Most important, keep your coverage with your wife current as long as you can as you may get your prexisting conditions covered without a waiting period.
In my circumstance at least, I have found that health insurance companies have no reason to want to insure anyone that may be a liability down the road. I do not see a political solution to this, as congress is corrupt. The best they could do was pass a bill that made it hard for sick people who got burried by medical bills more difficult to declare bankruptcy. And another program that was essentially a handout to drug companies that foisted a compkicated hard to use drug plan onto seniors. That's all they have done. This last congress was the most do-nothing congress ever. It seems the only thing they had time for was to take bribes from abramoff and hit up underage pages for sex and try to cover up the trail later. The health care industry is not much better with their costs outpacing inflation 3 to 1 at least.
I know neocons are not going to like what I'm about to say, and how important that it is fighting alquaida over in Iraq blah blah blah, but the fact is with what we have spent on this war to knock over a tin horn dictator I bet we could have paid for everybody's current medical expenses in the US, let alone making it affordable.
If you're healthy and have job, you probably will not won't give what I have to say a second thought. But if your sick as I am and can't find coverage or a doctor, you know how bad it is. If your self employed doubly so. Even if you do have coverage, you have got to be noticing how your insurance premiums are getting more expensive and its covering less, your deductible is more, and prescriptions are through the roof.
But the greatest crime of the Iraq war is that it has taken attention completely away from the health care crisis. I have talked to my politicians to no avail. Gratefully though, a challenger for state office DID talk about it and it got him elected.
We had no business screwing around in Iraq (esp. with the WMD big lie) without taking care of our own at home first. It's that simple. If things aren't working for you, it's important to let your politicians and everyone around you know how you feel. Only this way will there be hope for change.
BTW, make sure that the high deductible health savings account pays for 100% above a certain point. 80%, and you still could (likely)lose your shirt if you get sick.
That's right.. Setup a savings account, and put your money into the bank account.
So the first year you start this your daughter is diagnosed with leukemia. Millions of dollars in treatment ensue.
How much did you put away in a year?
The company I work for currently has a fairly rich plan (low copay, low out-of-pocket max) but we're facing a 25% increase in premiums next year so I've been tasked with finding alternatives that don't break my coworkers' banks. My company foots a good portion of the bill, so I can't say for sure that this works best for the self-employed, but FWIW..
First off, be sure to crunch the numbers. It's pretty easy to work up a spreadsheet or little program to compare plans. Just input expected Rx costs, clinic visits, hospital visits, etc., and have it calculate how much you'd wind up paying under different plans given different scenarios.
I can't speak to which specific provider is best since from my experience that's pretty localized, but I can tell you that my analysis indicates that for the vast majority of people, HDCPs with HSAs are the best choice. Find a plan that provides preventive exams on the house (this includes well baby care, by the way) and unless you expect to have over a couple grand or so in prescription costs per year, get a plan that doesn't include Rx.
This advice is based on the rates in my area with a $2000/$4000 HDCP plan. Most families at my company will save thousands and at worst will be no worse off than if they had chosen to take the 25% hit and stick with our old plan.
Be sure to build up your HSA account. Remember, you can always move a portion into an HSA investment account (as opposed to the HSA transactional account) and basically treat that money like it's in a 401(k).
Good luck!
No. Pretty much any large surgery can get pretty close to that (especially in the US). If it's anything that requires some sort of specialist (cardiology, neurology, oncology), the price tag will start in the six-figure realm and go up from there.
> do you have AIDS?!
Are you trolling or really just that naive? My wife slipped on some ice, and the doctors took her insurance for over $100k. That would have bankrupted us if it had happened a month earlier before her new insurance started with her job with IBM. Never underestimate the greed of doctors. I work with them all day every day (I write medical billing and scheduling software) so I see just had greedy, lazy, and dishonest they are. You obviously have no experience with their type. It's quite an eye opener the first time you see one of them in action when they sniff money.
I would guess the latter. It's easy to be naive (and easy to get really good-sounding health insurance) if you're young and healthy. Take one of the two away, and hell breaks loose.
I use an HMO program offered by my state's BlueCross BlueShield company. It's the same plan they sell to employers, but with me paying the full premium. It's not cheap (and for someone with a family it'd be even less so), but it's... affordable, and in the few years I've been using it, it's been a lot easier to budget the monthly premiums than it would have been to pay the medical bills I've had, and definitely made my recent visit to the ER less stressful, knowing I wouldn't have to pay for it.
http://alternatives.rzero.com/
What happens if you need to draw 10 years worth of money from your fund when you only been saving a week?
thank God the internet isn't a human right.
1. I'm young and healthy but I can see the PP is an idiot.
2. Never mistake malice for incompetence.
Global warming is a cube.
Here's a good reason why you can't:
The insurance companies negotiate with all of your providers, including some you're not even aware exist, for lower rates. And while you can do some negotiation yourself, that is a very difficult thing if you're lying on a stretcher unconcious.
At my most recent physical, the lab billed $900 for all of the tests. The insurance company paid $300 and the rest was the "negotiated discount".
The medical system in the US is fundamentally flawed, and facing it WITHOUT insurance could easily bancrupt you.
Your local Chamber of Commerce may offer a group health plan to its members. It'll probably be a better rate than you could get on your own.
Actually, the nasty thing is that it can also bankrupt you WITH insurance. At a certain point, even 20% of the medical bill will be too much. Especially considering that you're not likely to start working immediately after a procedure that expensive.
Slashdot is international. Health insurance (in the US, at least) is regulated state-by-state, and priced at that level or smaller.
You really just need to look around, make sure you find a company that isn't fly-by-night, preferably with an agent who wants to help you.
Also, look at any organizations you belong to - IEEE, ACM, etc - some or all of them may have health insurance programs. Since you don't have an employer but don't have an income, around here that means you're probably a consultant. Is there a consultant's organization (national or local) that you can join? They probably have some discount program.
Or think outside the box. The lady who cuts my wife's hair also works part time at the local grocery store, because part-time people at the grocery store can get benefits, and that's the primary reason she works there. I've heard that's true at Starbuck's and Home Depot, too, but you'd need to check.
The preferred solution is to not have a problem.
Buying insurance just on your own is expensive. There are various parameters you can fiddle to help (e.g. register kid and parents separately, though this means you don't share a deductible; set your deductible as high as possible -- here the highest I could get was $5000/yr, which really ends up being more like $10K), but it's really expensive -- we were paying about $300 a month and were in perfect health -- that was almost 4K + deductible per annum.
(it's even worse for a small company under 25 employees!)
If you're a member of the IEEE or any other "entrepreur" association you qualify for a group policy via them. That's usually a good deal. For example a quick search of "self-employed association" just showed as its first hit an association that offers health insurance. I have no connection and won't shill for them by including the URL.
If you live in CA I hear Kaiser is quite good though I've never used 'em myself.
Good luck. You'll find a lot of "well baby" visits will be needed in the first year or so. Well, at more than you need as an adult anyway. The insurance companies usually subsidise them because it's cheaper to catch something in the bud.
And finally, in all seriousness, consider moving to my home country, Australia. There's a preference for computer programmers under 40, and it's a great place to be or raise a kid. (though I live in California right now myself...)
Oh and have fun. One thing to be careful of / manage: I basically didn't work for the first couple of years after my kid was born and again when he was perhaps 4-6. That was really great. Try to find a way to balance the time with the family with making sure there's some regular income!
I'm pretty young and I don't want to face the conclusion that my health will fail one day, my naive self tells me that humans are stronger than needing constant doctor supervision. The price of that supervision, even with a good healthplan, damned high. Ugh. People like me die painfully and slowly I guess. I have to think about 'preventative maintenance' in a whole new life-threatening way ;D
You negotiate insurance discounts while on a stretcher?
I thought most people negotiated insurance policies while not in critical condition.
Apology to Ubuntu forum.
Yep. "I want 50% off everything, or I'm going to die right here."
Congratulations, you're the first embarrassingly naive person to respond to this thread. Google health insurance horror stories.
Here's a tip. Save.
I hope you have a lot of money saved up. Heart attack: over $10k including drugs, a few days in ICU or the coronary care unit, and an angiography. Oh, and if you need bypass surgery, the going rate was around $35k last time I checked. So we're up to about $45k. We're still not talking about the $200 in medication you'll be spending every month, plus the semi annual visits to your cardiologist at around $300 each, and the yearly stress test, etc.
How much did you say you have saved up? Make sure you don't have a heart attack at 40 years old or you are screwed.
Seven puppies were harmed during the making of this post.
Before you drop your wife's insurance let me tell you what I am currently finding out the hard way. You will be hard pressed to find an insurance policy on a pregnant woman. Group policies can be more forgiving, but so far everyone I've talked to says it is a 'pre-existing condition' and they won't cover my 7-weeks pregnant wife. If you are going to get a policy, your wife can't deliver for 11 months from the date the policy becomes effective or it's not covered.
I just got out of the Air Force and am now working as an independent contractor. Tricare does have a COBRA-type polkicy I can get but it's very expensive. I can't just get the coverage for my wife, I have to be on the policy, so I'm having to pay about $2200/3 months for it. At least it comes in 3 month chunks, so I won't have to carry it longer than I need it.
If there weren't that program available to me, I don't know what I'd do. In Georgia where I live there is a Medicade program for pregnant women, but I make too much money to qualify for that. If you make more than $1600/week with a family of 4 (they count the unborn) you make too much. My wife had to have a c-section last time and I saw the bill Tricare got. For everything throughout the pregnancy they paid out over $60k.
I have heard that if you can't get coverage and you talk to OB docs, they can usually work with you and sometimes you can end up paying less than if you had insurance. I have not looked in to that yet. Good luck!
I'd recommend a high deductible plan if you're self employed. You should already have money saved up to weather the rough times, so just add some more to cover the deductible. The amount you save is significant. The baby will most certainly have you going to the doctor a lot. I've used eHealthInsurance myself, and my only complaint is that the fine print is hard to find or not available until after you purchase a policy. But the policies they offer are from the major carriers.
For the record, the place I got in trouble was picking the cheaper plan and then getting a physical. Burried back in the fine print was a clause that they don't cover anything preventative, but that wasn't obvious when I was ordering the plan or looking through the main section of the booklet. Had I clicked a link to the provider's comparison of all their plans, it would have jumped out like a sore thumb. Personally I think it borders on criminal when a company doesn't make it obvious where you risk owing a lot of money and what coverage is missing that many others would frequently include.
And a final note, always get the price an uninsured person will be responsible for up front for everything! This is what you'll be stuck paying when the insurance company says they aren't responsible, and you should be able to afford it. My family's neighbor (a doctor), myself, and many others agree, the medical system in the US is broken. Insurance is complicated, costs are going up, and lawsuits are giving insane sums of money for just about anything. My biggest peeve is that you aren't told how much you owe until a month after the procedure is done. Admittedly this is a service and things may fluctuate when you find a problem, but every doctor uses charge codes and their office knows their fee for that code, and the insurance companies know what they have agreed for those codes. But no one will tell you those numbers until after you've had the service. Congress would do a lot for people by requiring every insurance provider to publish how much they cover and what the patent is responsible for on a standard list of charge codes, and make it available before signing up for that coverage.
Congratulations, you're the first embarrassingly naive person to respond to this thread. Google health insurance horror stories.
I didn't find any horror stories of people bleeding to death while shopping for a good health insurance policy.
You shop for health insurance before you're in an accident.
Why is this so hard to understand?
Apology to Ubuntu forum.
Note that the original post was not about negotiating with the insurance company, but with the service provider (doctor, hospital, etc).
Join the IEEE.
:).
They have some good group deals for insurance setup just for cases like yours. They also have group life and a few other things that might be of interest.
Oh, and its a good organization to boot
One should not theorize before one has data. -Sherlock Holmes-
You know, one of those where it's recognized that decent healthcare for everyone is a good thing.
It's quite silly, the way you do it in USA. It prevents people from acting rationally, to the detriment of all. (it's the same in *parts* of Europe, you guys aren't alone about it.)
For example, a friend of mine (living in the USA) is currently at home (watching his baby) while the mother works. He works a little evenings and earns a little extra for the family, but little enough that he was still health-insured trough his wife.
Then he got offered a larger position. He had to turn it down. It'd have put him above the limit where he'd need his own health-insurance, so in the end he'd have ended up working *more* and getting *less*, which is nonsense.
Everyone is a loser in this scenario:
Stupid. Very stupid.
It should pay to work. Putting someone in a situation where they get *less* for working *more* just serves as an insurance that these people won't, infact, work more.
There's similar mechanisms in welfare-programs too, where you earn $100 more and get $150 less from welfare. The effects are similar. (it'd have been different if you'd earned $100 more and as a consequence gotten $50 less from welfare, that'd have been fine)
Agreed. I have worked in health insurance for 4 years, and I've posted on other threads that I am now a major 'consumer' of health care.
A couple things to consider. - Shop for insurance looking for these items: Are my favorite doctors in net? Pharmacy? Are my drugs covered, must I buy a generic? Is Chiropractic covered? Mental Health?
- 'In Network' is golden. if you prefer to leave the network, you will pay that doctor's standard rate, often even after your 'Out of Network Max' has been exceeded, because Insurance company's set a 'Usual and Customary' (U&C) value for every procedure, and only pay that amount... MDs, since they are discounting services paid for by insurance companies, up their normal rates to cover the difference (if 20% are paying cash, and 80% are paying via insurance 80% of the 'real costs, the 20% are paying for their costs plus paying for the discount given to the 'network' patient)
- If you are young, healthy, good cash flow (real paying jobs) and have good investing habits... do a High deductible PLUS an HSA... and be disciplined to invest the difference in premiums between the low deductible/HMO and the HDHP in the HSA. Your HSA becomes both your rainy day health fund, but if you maintain good health, eventually it kicks into a retirement fund vehicle.
- Look for these perks
-- 100% coverage on annual exams
-- 100% coverage on immunizations for children
-- Nurse Line (avoid unnecessary trips to the doctor)
-- A good web site, that allows you to track your claim history, medical record, has a real procedure cost estimator and a good network physician lookup
Finally,
- Insurance buys you 'insurability', ie, your current insurance must provide you a certificate of coverage which is the chit that gets you into most group plans even if you have a chronic condition. So being continuously insured when you are diagnosed usually gaurantees you if you ever want to switch plans that you can get insurance (albeit maybe at a higher rate, but at that point coverage is important, not price).
The original poster was suggesting just saving money and paying cash for services instead of getting insurance.
And you can negotiate with providers before you receive services to lower their prices if you're paying for it out of pocket. i.e. if you don't have insurance.
My point wasn't about negotiating insurance policies, but negotiating the actual price of specific services, which, as I pointed out, can be problematic in some circumstances.
He was talking about the advance negations that insurance companies make with providers that cover payments for a broad range of procedures. Insurance companies (like the hypothetical individual he was talking about) don't negotaite those while in critical condition. Of course, what is more likely is that the individual (again, who is NOT currently in critical condition) would negotiate with an insurance company that already has negotiated discounts.
The little barb about difficulty of negotiating while in critical condition was irrelevant.
Moron.
Apology to Ubuntu forum.
Also known as "employer of record" - they exist for independents who need "big corp" sorts of benefits like access to health insurance. Here is one that I haved used in the past - MyBizOffice. Despite the stupid, formerly-trendy name, they are one of the largest out there and do a pretty good job of things.
When information is power, privacy is freedom.
Whatever, you guys are assholes though. Or you're totally cool, like 'too cool for school' style. Pathetic. I may have no experience with doctors on my own dime, but atleast I am not an asshole, there ain't no cure for that and if there was medicare wouldn't cover it! :D
I hope you all go through long malpractice suits that don't end up working in your favor. Blam!
Read your own signature and apply it to other people's posts (oh, and add "and try to understand" after the "read" part). It would save you from some embarassment.
..this one (congratulations by the way :) being a daddy is awesome), your choices will be limited because maternity coverage is sparse and expensive. I recommend that you contact *several* health insurance agents (the ones who shop around for insurance for you like they would for a company) and ask them all to look for the plan you need. This at least will save you from having to figure out which plans are out there, which ones cost what amounts, which ones cover these features, yadda ^ 3. I was doing this myself until very recently. It was expensive, but manageable.
:). Some advice there too ;), (1)Prince Lionheart Bear (yes, stupid STUPID name, but it makes a womb-like/white noise sound and if the baby wakes up it starts again), (2)Aquarium rocker (trust me), and the greatest of all time (3)Motorized swing. I still open the toy closet once in a while to blow that bad boy a kiss.
Good luck with the little one
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You're still missing the point.
Insurance companies, in advance, negotiate discounts.
The comparable action for an individual (which is of course impractical) is to negotiate, in advance, discounts, while not in critical condition.
So if you were to go without insurance, then you would instead be calling all these hospital to arrange advance discounts -- not in critical condition.
There's a reason why that wouldn't work -- it's impractical and hospitals couldn't justify the expense of negotiations for just one person. The reason it wouldn't work has NOTHING to do with difficulties in negotiating while in critical condition.
The reason I belabor this point is because on another health insurance thread, a moron kept switching between talking about paying the hospital, and talking about shopping for insurance, when you'd be in critical condition in one but not the other, which made it impossible to rationally discuss the issue with him. So, I have to be careful that people don't continue that error.
Apology to Ubuntu forum.
No, it won't.
Apology to Ubuntu forum.
I joined NASE (National Association of the Self Employed) and had a plan through MEGA which was basically just a major-medical plan. It didn't cover basic stuff, but would cover a big accident or something. I'm not saying this is your best option, it's just one I happen to know about.
It wasn't that expensive, but then I was single. I think you're in for a rude awakening, either way.
this sig has been rated E for Everyone.
"How much did you say you have saved up? Make sure you don't have a heart attack at 40 years old or you are screwed."
Sounds like an incentive to stay healthy, don't you think?
... that your government bullies you into a health insurance that doesn't pay when it really matters. I see so many people posting how good they feel that the state provides insurance for them. You obviously haven't been chronically ill. My wife suffers from CFS (or by whichever name you want to call it), and since it's not a well-defined illness with known causes, the insurance doesn't cover shit. Yet I can't even get out of paying the monthly rates, because the law demands that I'm insured. I'd actually have saved a lot of money if I'd just paid doctors directly these past few years, because as it stands I have to pay insurance that I don't use and doctors.
It's a great system in so many cases, except for the unusual ones that need the most attention.
Even if your wife leaves her job, she (and the family, if you have a family policy) can stay on her former employer's health insurance for 18 months under COBRA. But they can charge you the actual cost of the policy plus two percent. (Meaning if she currently plays 80% of the cost of the policy through deductions and the company pays the other 20% percent, after you go on COBRA you'll pay the 80% + 20% + up to 2%. The HR department of her company can tell you the COBRA rates.)
After the 18 months of COBRA runs out, the insurance company is required to offer you a non-group policy that is not medically underwritten. I think they usually call this a HIPAA policy. This will probably be more expensive than the policy you get through COBRA, but you can't be denied for pre-existing conditions.
It's been a while since I've read the DOL publication on COBRA, so follow the link above to verify that none of the details have changed.
Your local small business association or Chamber of Commerce should have plans that you can buy under. It may be more expensive than you expect, because you'll be paying the FULL bill, not just the part that an employer makes an employee pay, but it's worth it to have a "name brand" insurance carrier.
HDHP + HSA is the way to go if you are at all heathy and fiscally prudent. Low deductible insurance is a money loser. With a low deductible, you are all but guaranteed to pay more in premiums each year than you would by saving the money and paying from savings. The tax-deferred/tax-free nature of the HSA makes this even more true.
Also, the HSA regs give you tax advantaged savings based on the money you put into the HSA (not the money you take out of it). Check with your accountant, but I believe that nothing in the IRS regs says you must pay for all healthcare expenses with HSA money. Yes, you can't use HSA money for anything but healthcare (unless you are over 65 or disabled), but that doesn't imply that you can't use non-HSA money for healthcare costs. An HSA is a great way to build more tax-deferred savings if you've hit the limits on other tax-deferred savings programs.
Two wrongs don't make a right, but three lefts do.
A while back the WSJ published an article on where US health care costs go. Around a third of the costs went to two places - lawyers and terminal care. Medical procedures don't always have a happy ending. All too often - when they don't have a good outcome, Americans tend to sue. The last stages of life in America are very expensive. Most Americans die in a hospital attached to tubes and instruments. And this doesn't count costs like defensive medicine (too many tests to avoid potential litigation). So more use of hospice services and real tort reform would go a long way to lowering costs of health care. Of course this would negatively impact profits at commercial hospitals and income of trial lawyers. Don't expect action from either political party any time soon.
[Insert pithy quote here]
Some people become no longer healthy despite their best efforts. Are you telling them to just kill themselves by not seeking medical help?
"Instead of great health coverage for you, get LIFE INSURANCE. You can probably get some cheap 30-year term insurance which will cover your family in case something happens to you. You may want to cover your wife as well in case something happens to her and you need to hire extra help to take care of your kids. This is less common, but no less a concern."
Shame that life insurance is now the new health insurance.* I'd recommend a good policy (READ THE FINE PRINT!), coupled with a health savings account (keeping in mind that you have to use all the money in a year or lose it). Also she may have sick/vacation time due that's paid. Exercise all your options. You'll need it.
*You can borrow against the cash value and pay it back as needed.
Have your wife get a part time job with the post office or some other government job where she would get government benefits which usually come out ahead of what the private sector offers.
Unfortunately, I have way too much experience with health insurance, so here's my suggestions.
1. Extend your wife's plan with COBRA even after she quits at least until your baby is born. Do this, even if that means traveling further because your closest hospital is no longer in network. My first child required an emergency C-section and a few days in the neonatal ICU. He was almost 11 pounds at birth and there was no way he was coming out through the in door, so to speak. The bill was pretty amazing, but I didn't have to pay much out-of-pocket. So, if there are additional expenses related to your child's birth, at least you won't be completely screwed. On a side note, my son ended up with cerebral palsy, possibly due to decisions made by our doctor and his team. Learn up front about what can go wrong, and don't assume the experts are paying close attention to your wife/child.
2. Never go without health insurance and life insurance. I was 33 years old and my wife was pregnant with our third child when I found out I had testicular cancer. I caught it before the cancer had spread, but I still required one minor and one major operation, all kinds of diagnostics, and years of follow-up. My bills, way back in 1994, were well over $100K. My insurance at the time covered almost all expenses. Because I had life insurance, I had one less thing to worry about. Without life insurance, I probably would have died simply from stress.
3. If you have pre-existing conditions, you really need some type of group plan. Individual insurance plans are out of the question if you have any kind of serious pre-existing condition (cerebral palsy, testicular cancer, etc.). I know, because I tried this route. I pay around $10K per year for medical/dental at my current company. I thought that was a ripoff until I tried to get insurance on my own. Your only reasonable way to get health insurance is to be in some kind of group plan where your risks can be spread across a large pool of individuals. Even then you may have problems if you have any coverage gaps or you aren't going into a large enough group plan. If you have no pre-existing conditions and are healthy, the medical savings plan along with a high deductable plan is a cost-effective approach.
4. Without health insurance, you pay much higher rates for the same procedures/care. I recently had a 4-day stay in the hospital (as a result of the cancer surgery 10 years earlier). The unadjusted bill was 3 times the amount of the adjusted bill. Without insurance, you get the unadjusted bill and no expert on your side to help negotiate the bill down.
Hopefully your luck will be better than mine when it comes to health. However, I can say that insurance has saved me from financial ruin on more than one occasion. More important, insurance allowed me to make career and life decisions (like having more than one child) that I may not have made if I was paying out the ass for the rest of my life due to one bad medical experience.
I wish I had an answer for our country's current medical insurance problem. I don't think a government-based single-provider solution is best, but I think government may need to help fund large group plans that are affordable for the tens of millions of americans that want insurance but can't afford it. The uninsured are driving up costs for the rest of us by waiting too long to get care, and then entering the system directly through hospital emergency rooms. I'm encouraged by the pay-as-you-go clinics that are popping up at Wal-Marts and elsewhere for non-emergency care. It costs a lot less to pay $25 at a clinic to have your kid checked out than to wait until your kid is seriously ill and then take him/her to the emergency room.
Best of luck with your new family.
I know it's not all black and white but there is, as always, a middle ground here.
In Finland for example, there is the normal European Union type of healthcare sate, but you also have private doctors, dentists, etc... I know from one of my Ex girlfriends father, that when he needed an immediate hearth surgery, it was arranged that very same day, by the public healthcare channels. They juggle the times to try and give those who need it most service first if there are waiting lists.
When you are in a hurry and need something done now,something not very important for your life, then you go to the private healthcare. That costs you more of course, but you get service pronto.
Otherwise it's mostly better to go through the public healthcare, because pretty much all of it it reimbursed by the state.
It might be a bit harder to get a job due to the "extra" taxation from the American point of view, and yes the extra health security and money from the state for those unemployed are things that make some into mooches. But on the other side, with the EU style of government, Everyone gets superior education, great healthcare, a guaranteed minimum income to survive on and free extra education if want it while you're looking for a job.
That in my book at least outshines anything the USA has to offer. Canada on the other hand, I would actually consider moving there instead of dismissing it out of hand like the USA. No insult meant, but I find living in the USA something I hope I never have to put up with. IMO I think the place would drive me nuts wondering where the hell these supposed "freedoms" are. The USA that the family Bush is trying to create seems like NAZI wonderland to me, that I hope I never have to experience firsthand.
I am a surgeon, and it sickens me what the HMOs often do to patients. They send patients to me, and then won't even let me take an X-Ray. So then they have to take a prescription, go to their gate keeper MD, fight that paperwork, get the X-Ray at another location, and then bring it back to me. Worse is if they deny it, then I have to fight it out with some high school graduate, reading a script, as to why this person needs an MRI.
Now it's 2-3 weeks later. Often the X-Rays are lousy, not the right ones, etc. If they have a broken bone it means that I'll have to re-break it to set it straight. If they have a tumor, then that's just another 3 weeks that it has a chance to metastasize.
If an HMO patient has a broken bone, then I have to use heavy plaster casts, instead of light fiberglass, because what the insurance pays me means I'll actually lose money on the fiberglass cast.
HMO's are O.K. if you don't get sick - do yourself a favor and get a PPO.
..........FULL STOP.
I'm on a mailing list for people who have/had the kind of cancer I had. I've noticed a definite trend between the Canadian and US list members (there are only a couple from anywhere else). The Canadian members, with only one exception I've seen so far, have to wait about two to three months between diagnosis and starting chemo.
In the US, the average wait is under a month. I personally went from the xray where they looked for pneumonia and instead found tumors, through the scans, biopsy, and blood tests and all, to my first chemo treatment, in two weeks flat. It turned out my cancer had already metastatized and was trying to take over my lungs; if I'd had to wait 2-3 months for chemo I'd be dead. Now, I'm assuming that places like Canada and the UK aren't going to make someone wait if it is life-threatening like that, but the fact remains that cancer spreads and gets continually harder to treat. In the case of the type I had, a month is unlikely to make a difference in staging, but three months certainly could. And being a higher stage means you have to get more treatment, which (aside from costing your government/insurance more money) puts you at higher risk for secondary problems later.
Overall, even though my insurance wasn't great and I still had to pay 20%, I'm glad I was at least able to get timely care so that it didn't get any worse. And many of the hospitals were happy to write off the 20% as a charity writeoff; public hospitals are required to do so many of those a year anyhow. (Unfortunately, my main oncologist, with whom I had the biggest bills, wasn't one of those, so I do still owe quite a bit that I'm slowly paying off. But it's not wreaking financial havoc or anything.)
Warning: Apple/Nintendo fangirl. Likes her electronics cute & cuddly. May be rabid.
Some other jerk ass big wig brokerage whipped my boss's company for the right to do their stock plans. Argh. :(
--- Grow a pair, liberals... stop letting the Republicans bully you!
You may find that your best bet, for the first 18 months, is to pick up the COBRA-act mandated insurance for which your wife should be eligible. And then try to find your way through the thicket. It used to be that associations could get good deals; and the bigger the organization, the better the deal (e.g., the New York State Small Business Association had a better deal than the local Chamber of Commerce, for the same insurance).
It gets worse if you are a subchapter-S corporation: as owner, you can't deduct your premiums unless you jump through hoops, and then can deduct only part.
Good luck.
With three surgeries, 8 chemo treatments, and 50 radiation treatments, I've only accumulated $6000 worth of treatment and drugs. And that includes the $100 a pop pills. My insurance has dropped my out of pockets to about $300 for everything, including my perscriptions. My daughter's birth cost us $5000. And at $350 bucks a month for my insurance, and at my age of 27, you KNOW they still make a ton of money, even if you do get cancer on them (which is impossibly rare at my age).
108 months (9 years of paying insurance) * $300/month = $32,400 - $6000 - $4000 = $22,400 I'll never see in benefit.
The BCAA has a very nice extended medical plan. I'd imagine the AAA has one too; that would be non-extended as there's no real public medical in the US. And being a society instead of a for-profit corporation, it'll actually be good for members, not just institutional investors.
Erm... apparently not in California... Check their website, it might be different for your zip code.
Now I do have savings, as well as a mortgage. Still not nearly enough to pay for what cancer would have cost me. Unless you've already had a chance to save up quite a lot of money, I'd never recommend anyone cancel their health insurance and depend on savings.
Warning: Apple/Nintendo fangirl. Likes her electronics cute & cuddly. May be rabid.
The harsh reality of this is you really only have two choices:
As the father of a two year old, my wife and I realized that the best choice for our daughter was for both of us to keep working. Day care is expensive, but it is tax deductible. We can provide for the family very well, and have very affordable health insurance.
They usually team with some of their members who are Insurance Brokers to offer Group Health/Dental/Life.
A nominal annual fee for membership, networking opportunities, and access to reasonably ( for some values of reasonable )... Such a deal!
Technology -- No Place For Wimps! Grateful Dead and Jerry Garcia Chatroom -- http://www.wemissjerry.org
Check out: http://www.washingtonpost.com/wp-dyn/content/arti
A friend of mine got hit by a car, lost a leg and almost died. The bills to date are over USD 250K, not counting the prosthetic leg and rehab.
putting the 'B' in LGBTQ+
While I'm not loving the health care system at large, I'll save the debate for others who are more passionate about it.
I like my PPO, no referrals needed, wide coverage in my geographic area and traditional insurance (20/80) when I'm out of network etc.
As a self employed coder myself, I worked with my Insurance rep to get on a PPO plan with Blue Cross & Blue Shield of IL, It's not cheap - but it's cheaper than COBRA from my old employer. It's slightly better than catastrophic coverage and I opted for a high deductible which keeps it all in check and it covers my wife and two kids too. It ends up costing me about $4,500/year vs. COBRA which was running $10,200/year. My coverage isn't as good (no vision or dental and my deductible is higher) but rarely do I need $5,000+ of dental and vision work in a single year so it's still better to pay out of pocket on that.
My advice to you is to contact your insurance agent - you probably can talk to who ever setup your liability insurance to get the name of someone to use if you went with cut throat auto insurance. My local Nationwide rep has been very helpful.
AF-Design, web development.
I agree. The health care system is totally broken. My family is blacklisted from buying insurance privately. Both my parents had cancer, and so had their parents. No one in my immediate family can purchase health care , as no company will accept the risk. The only way any of us have any health insurance is through employers, as no employees can be denied under a company plan.
/you/ can not get it. Your employer can get it for you, but you can't. I hate insurance companies. (I used to work in a large insurance company, and have had great coverage -- and have also not been able to get coverage.) Many people in the USA trash the idea of a state health care system, but they have not had the displeasure of not being /able /to be insured.
When my father was laid off...no insurance for anyone but my sister, who could purchase it from school. I broke my shoulder, and I am still paying for it (I was at a retail job, no health care plan offered, now I am salaried again and have health care through my employer). Thank goodness he found a job (a menial one at that) and was at the company long enough to get on their plan before my mom was found to have cancer, otherwise that would have broken our family. There would be no way we could have footed that bill.
So, in my experience, if you have a history of needing health care --
|plastic....or gasoline?|
It is SO MUCH More cost effective, recovery times are shorter, and everyone seems happier all around, excepting the surgical team, of course...
Technology -- No Place For Wimps! Grateful Dead and Jerry Garcia Chatroom -- http://www.wemissjerry.org
I think the only way to get insurance if you are self-employed (and blacklisted) is to start a company, purchase insurance for the company, and hire yourself. More books, more cost. :-/
|plastic....or gasoline?|
I have no idea how good they are but I often see ads here in NYC for Freelancers Union, it looks like something that could help you. Good luck!
My quit her public school teaching job a month before we got married, and we considered getting the COBRA coverage for that one month gap. The cost was like 10 times what she had been paying out of her paycheck when employed. Unless you're making well over $100,000 gross yearly, you're gonna get raped.
But hey, that's the price for choice, right?
Blar.
1st, know your state insurance laws well. In most states, the insurance companies are required to fund the state "high risk pool". In return for their contributions to the high risk pool, many states have little, if any, regulations on the decisions of insurance companies to deny individual coverage. As opposed to company insurance plans, where there are federal and state regulations requiring insurers to provide coverage, there are no such guarantees for individual plans. There is an incentive for insurance companies to deny individual coverage for almost any reason and force people into the "high risk pool", where they will end up paying far more for insurance. Since the pool is funded by the insurers, you essentially become their client either way, but you will pay them far more if you can be sent to the high-risk pool. My own experience is a perfect example of how screwed up our system is for individual insurance. I used to own a small computer reselling/consulting business. I decided to change careers and went back to school. I applied for individual insurance coverage from the same insurer with whom I'd had coverage when I was in business and answered everything on the application truthfully. You must list every doctor you've visited for any reason and I listed a Chiropractor I'd visited a few years before for a slipped disk and a doctor I'd visited when I had a cold and was prescribed antibiotics. When I received word back from the insurance company, I was informed that due to a "pre-existing condition" (visiting the chiropractor) that I would have to sign a waiver agreeing they would NOT provide any insurance coverage for my: Back, Neck, or Spine for any reason. If I refused to sign the waiver, then I would be referred to the High-Risk pool. Despite repeated letters from my Chiropractor stating that he had not diagnosed me with any condition, that I had a temporary discomfort years ago which he was able to fix completely, the insurance company would not budge. The insurance company also looked up the list of medications I was prescribed from the other doctor I'd visited for sinusitis. In addition to antibiotics, he prescribed Allegra (which is now available over-the-counter without a prescription). Although I have no history of allergies, nor have ever been diagnosed with allergies, they required me to sign an additional waiver stating that they would not provide any coverage to me for allergies. Since I do not have allergies, I considered this waiver unimportant to my overall health, but the back/neck/spine could be a serious issue someday if I were ever in a severe accident where any part of my central nervous system was affected. I researched our state insurance laws and found that there is absolutely no expiration for the length of time an insurance company may exclude coverage and that they may call virtually anything at their discretion a "pre-existing condition". In our state the only recourse is to go to the high-risk pool or get on a company or association's insurance plan. Individually insured have no protections from the systemic and routine abuse by the insurers. My advice is to research your laws carefully and if you find that you have no legal protections on an individual insurance plan, then you need to hide everything you can from the insurer when you apply. Don't tell them if you've been to a Chiropractor, don't tell them if you've been to the doctor for a routine cold. The only things you should be honest about are genuine pre-existing conditions you have, not things that were 1-time office visits, since they'll use that to unfairly deny you coverage or force you into a high-risk pool. It's just you against them in the world of individual insurance, and you've got to protect yourself since the state's won't do it for you.
-- I'd give my right arm to be ambidextrous
Go ahead and get into a serious accident with an uninsured motorist who then declares bankruptcy. Seriously, the last auto accident in my family ran up an 85k dollar tab. It's not as uncommon as you think.
Not trying to be a dick, but your youth and genetics are not the only variables dictating the need for coverage.
My rather extreme example of this negotiated discount:
I have BCBS of NC. My daughter was born 6 weeks early, and in the NICU for 5 weeks 2 days ("apnea of prematurity" meant she had to stay monitored). The hospital bill (not counting the neonatologists) was $58000. They wrote off $52000, BCBS paid their 90% at $5.mumblek, and I paid $662.
So BCBS can get all that care (1/4 of a nurse, 24 hours a day, 37 days), for $6k. I would have had to pay $58k had I not had insurance (=years-to-a-lifetime of bankruptcy). The socialist in me is disgusted that it's that much more expensive to be poor. The poor person in me is glad that I didn't have to pay $6k for my 10%, though.
Hi!
Check this one out: http://www.ibx4you.com./ I am employed at a company that does not pay benefits and I pay 122.00 per month and get 25.00 co-pays. Hospitalization is 100.00 per day to a maximum of 500.00. This is for an individual. I am not too certain about families but this coverage was better than the one I was getting from a previous employer.
Or move to Canada...
You don't say what state or commonwealth you're in. I gather there is a state-related medical insurance in MA. The rest of the country, you're pretty much ool. Further, the insurance companies will target you to be screwed.
Lest you think this is all ideological, let me give a specific instance that affected hundreds of thousands: in FL, the state's "insurance regulators", in late 2003 allowed a ->35%45%- increase. If you do the math, this makes a ONE HUNDRED PERCENT INCREASE. (My premiums went from $373 to $525 to what would have been $755, had I not dropped with the last increase.)
Save *any* kind of corporate or organizational insurance you can.
mark "or sit in at your Congresscum's office until they start
pushing and voting for single payer, like the rest of
the first and second world"
this is /. Don't most of the people here still live in their parents basements? Ipso facto most of the people here are still dependents riding along on their parents insurance... not to mention internet bill. (note this does include myself... sad sad sad)
Move to a moder, civilized country like Canada, where there is public health insurance.
These are my friends, See how they glisten. See this one shine, how he smiles in the light.
The last several plans I have had include a "max out of pocket" clause that limits the total expenditure to something like $2-3000 per person per year. This certainly adds up, but even at the relatively high co-pay rate of 20% that you mention it is not like one faces imminent bankruptcy with a major illess. I don't know how common they are, but if there are plans out there that have no max out-of-pocket limit I would stay away.
I think it's unwise to assume it's your wife who "gets" to stay home with the baby. Have you considered being the at-home parent and possibly hiring a part-time nanny in the future so you can get some work done?
No, it's not just your wife's decision. Also don't underestimate your ability to cope with a small child. It's a skill that can be learned, rather quickly when necessary.
My wife and I were contemplating the same scenario as you describe. However, it was just too risky, because I was not well established enough consulting to pay health insurance for family, as well as the load of other expenses. A catastrophic health event makes it too risky if you're not paying for truly good coverage. I suggest a group plan through your wife's employer as the best and safest for a family. PPO's are most expensive, but still the best in flexibility. Many HMO's are very good. You will pay ~$2000 - $6000 out of pocket per year likely, but that is much better than the alternative.
The merits if stay-at-home vs daycare...that's for another topic...
...but the European model is no better. I think the problem with US health insurance is that so much of the financing of it is an ugly kludge to work around income tax.
First, it's given as an employee benefit rather than paying cash so that the employer contribution is not taxed. But that ties you to an employer, because there's usually a waiting period before benefits (including insurance) kick in at a new job. Paying the full price to extend the previous coverage those couple months is no fun.
Second, "flex plans" are an obvious hack around income tax. But again, it's under the employer's control, so you are not at liberty of changing jobs without risking your health savings. I know, I've lost a substantial chunk that way.
Third, the reason that medical care has gotten so expensive is that for the most part insurance pays it, and since we don't pay the majority of the premium ourselves, why not go in for every little sniffle? There's no incentive not to try to get more out of the system than you put into it.
Pay employees cash, make them fully responsible for their own care, and you'll see them make sensible use of medical resources. Prices will come down, guaranteed. Yes, some people will elect not to get insurance and that's not a bad thing! It may be the smartest decision for them.
The problem is that we are taxed on income, and even legislators are smart enough to realize that diminishing someone's ability to take care of his health is idiotic, so they finagle all the gimmicks to get around it. But putting a band-aid on a broken system doesn't work. It would be so much easier to simply get rid of income tax! Spend your own money as you wish without gov't skimming an arbitrarily-sized chunk off the top. Tax consumption (sales) instead, to promote savings and investment (wealth building), which would get help reduce the insane amounts of consumer debt that plagues most Americans now. Plus, think of all the bureaucracy that could be eliminated and all the wasted hours of tax preparation that would be regained. That's three very obvious (and very large) points for simplifying the tax system.
And before people start screaming "regressive tax! what about the poor?!", all you have to do is exempt food, clothing, and medicine from tax. Gov't should not be in the business of making your life harder for you to maintain, so the essentials are given a pass. The poor (or anyone) could live truly tax free if they wanted to live a subsistence existence.
Constitutionally Correct
That's what I hear. Its hard when you're young, to justify something like that, even if it is probably the most important thing you can do and should need no further justification. I guess by the time you're done 'pushing your luck' its too late and you're totally screwed, I really don't want that at all. But, its that typical insurance thing, ya know, you don't feel you need it if you haven't had to use it in years and if you just keep it around and never use it then you wasted money. I'm not a "peace of mind" type of person, so I don't get a warm cozy feeling knowing a doctor will help me in case I'm dying. Though I definitely should. It's not like cars where you legally need it to drive, so I am hopelessly unmotivated.
It is probably because of my age but I have looked deep into health insurance plans, and unless I want to quit working on my own and go slave at some factory, I have to pay such an outrageous price. A considerable amount of my earnings, as if fucking taxes didn't get enough! (and they definitely DON'T if you ask them...shhhh) I'm sure you have no difficulty understanding why someone young and healthy wouldn't go out and find a health insurance plan, and why they wouldn't want to work in a factory. Understanding it certainly doesn't mean you agree with it. Who really is able to answer these Healthcare questions for sure? Army soldiers can't even get coverage when they come home! That's the whole reason to join the Army and they get shafted! So, what the hell does a self-employed person do? He pays up BIG time, or he joins the local chain gang. I don't like those options, but they don't require me to like them, they just require my blood. Depressing thoughts. I guess, like so many in my position, I've been putting it off indefinitely.
I don't believe it matters why you lose coverage -- I know it works equally well if you are laid off or quit, or go part-time and lose full-time benefits.
Usually this COBRA isn't a bad deal because companies are able to shop around, but you still might do better with other options. The main trick is to become part of a group. Some places there are local software developers associations, and membership in these could qualify you for the group rate (I think this was true back when I looked into it in WA state in the late 90's). If you're not part of a group the cost is usually higher or the benefits less. I think this is because a larger fraction of individuals sign up for insurance when they know they're going to need it to pay for something in the near future.
The other important thing is don't let your insurance lapse. It might seem like not a big deal to quit your old insurance and risk a few months before you get something new, but in many cases when you start up insurance after a period of not being insured, the insurance will refuse to cover pre-existing conditions for a long period of time. (Meaning it might not help much to wait to get insurance until after you've been diagnosed with cancer.)
Caveat: I'm not a health care or insurance professional; this is all from my personal experience so if somethng I've written prompts you to make a decision, please double-check with another source. Also I think laws related to this are different from state to state, so there's a big possibility that things will be different where you live from where I live.
One of the big ones is that a very small number of people spend an ASSANINELY LARGE AMOUNT of money. Some people are on drugs that cost $400,000/year.
As long as we are unwilling to say "You know what, it's too expensive to keep you alive", a lot of people are going to die because they can't afford to subsidize the healthcare costs of the extremely sick and therefore can't get even basic healthcare.
We need insurance plans that cap maximum expense - so you can sign up for death if you catch something that's going to cost 3 million to fix so you can survive the far more likely chance you get a disease/injury that costs $40,000 without going bankrupt.
paintball
I faced a similar situation. After some research (I used extendbenefits.com but there are many) I settled on a high deductible hsa compatible plan from aetna. I use an hsa so it ends up being reasonably priced on a monthly basis, but getting to the $10K deductible hurts. Fortunately (?) my wife had a minor procedure this year so we got to the deductible sooner rather than later. But paying out that $10K is no fun. My HSA only earns 4% which is better than nothing but I'm holding out for Fidelity or some major brokerage to start offering an HSA where I could actually make some money. They (Fidelity) said 2006, but that looks unlikely now.
As others have pointed out, going without insurance isn't an option. The carriers all negotiate rates which you won't get if you are uninusred. So for instance a simple CAT scan will run you $1500 if you don't have insurance vs. $500 if you do. It's a scam, but in this case you can only fight city hall if you have lots of $$ in your pocket.
Good luck. Whatever you do, don't become uninsured. The rules change if you do.
- IRS Announcement 92-16; I.R.B. 1992-5 (regarding premium deductibility--hard to find the exact text online, I have it as a PDF)
- IRS Notice 2005-8 (regarding HSA contributions)
To summarize, we have the company pay the premiums directly and report the value in Boxes 1 & 14 of the W-2. It is therefore subject to withholding, but not FICA (Social Security & Medicare). We then individually recoup the withholding taxes via the applicable Self-employed health insurance deduction (which is "above the line").Convoluted, yes, but it eliminates all taxes on our health insurance premiums.
I work for a university. The heath plan through the university cost over $800 a month for my wife and three kids. It works out to over $10,000 a year. Even then there were non-negilgable out of pocket expenses (co-pays, deductibles etc.) Who spends that on health care? We dropped the plan and picked up the "saver 2000" plan from Unicare. It costs us $450 per three month period, or less than $2000 per year. It is a very stripped down plan - basically $2000 deductible and $5000 out of pocket maximum per year. You see - even in the worst possible year, it saves me money. One downside is that we go to the doctor less b/c each visit cost us our own money. More bad news is that they do not cover maternity at all. No prenadal visits, no laybor and delivery. These alone can be upwards of $15,000 per kid. We used a mid-wife and home birth for our last two kids (and the one on the way) which only cost $2000 per kid. Statistics show home births are safer anyway. My guess is that there is no cheap way to get heath care in a society where everyone expects to get the latest and greatest (expensive) care when they become terminally ill and people expect huge payouts when doctors make mistakes. The system just costs too much.
many state schools have cheap health insurance for students... so cheap that tuition+health insurance may be less than finding your own insurance :) You also might find someone called a 'health insurance broker' they can shop around multiple plans... in LA they're in the phone book.
There are 10 types of people in this world, those who can count in binary and those who can't.
As much of this is regulated at that level. In my state (in the north east), insurance companies are required to provide single payer hmo/ppo type policies at rates which are "approved" by the state. Lest you think that keeps the costs down, you are wrong - these state agencies are basically a rubber stamp when it comes to rate increases. My premium for a basic HMO with a well known company increased a very consistent 15-17% per year every year after my COBRA ran out. This past year, after my renewal premium hit $590/month I found (through the chamber of commerce) an association which basically amounts to a front to provide lower cost insurance. In fact, you become a union member and as such pay union dues as part of your monthly premium (in fact, in my case I'm in a sub of a Teamsters union so dont *uck with me!). I now have coverage from a different name brand provider at about $100 a month less. My one disappointment has been the drug benefit which is not as good and results in slightly more out of pocket. I figure by the time its all said and done I'll likely save about $700 bucks. Not a ton, but heck its money.
I'm covered by my wife's plan. I highly recommend it.
Yes, that's the real question isn't it? It is moral for the richest nation on earth to let her people die because they can't get care they need?
Why are people dieing this morning in Los Angeles? Why will someone die tomorrow afternoon in Hartford? Both in cities where there are stocks of advanced drugs and CAT scanner and NMRs available? Just because they're not on a friggin' list.
Don't get me started. We have no business lecturing the rest of the world about a GD thing until we get it right here.
Join a company like IPS http://www.iprofessional.com - they are a group of consultants who submit all their "employees" as a group to health insurance companies, and get group rates (a little cheaper than if you go it alone).
I've been thinking about this for a while. I know it sounds crazy, but come join my company. I'm an independent contractor as well, but I'm incorporating as of Jan 1st strictly to take advantage of group health care rates for me and my family. One of my first thoughts was that there have to be other independent IT contractors out there who are in the same boat I'm in. If we cooperate and work together, we can each continue to do our own thing but get better benefits out of it for the long term.
Just funnel your work through the company and for a modest percentage of gross revenue, we'll...
* Get you in on the group healthcare plan and rate (Anthem PPO)
* Handle your invoicing and accounts receivable for you
* Let you manage all of your incoming revenue and disperse it (legally) as you see fit from your own internal holding account:
* Calculated payroll including federal/state witholdings
* Expense account for whatever you need to reimburse yourself for (equipment & such)
* Pay full healthcare benefits pretax
* Simplify your taxes come tax time by providing a W-2 instead of having to itemize and report a schedule C for business profit and loss.
* Try to toss each other some business when we can.
The beauty of the arrangement is that you continue to do your own work for your own customers, but have the convenience of a business behind you (and some legal protection as well). Perhaps down the line we can look at adding other benefits like a 401K plan.
If you're interested, just follow the link in my sig to my lame-ass website and hit that contact us form or email me at gunfighter AT gmail DOT com.
-- Stu
/. ID under 2,000. I feel old now.
I think accepting COBRA for your wife is probably the best option right now. If you're relatively healthy you may explore getting catastrophic insurance for you from one of the online brokers e.g. eHealthInsurance . They make it easy to compare quotes from different providers. I picked BlueCross BlueShield of Illinois because of their reputation and affordable rates. This insurer gave me a free membership in a dental discount plan. My local dentist charges 10% - 20% less with this plan. They also gave me a discount card for medications but I haven't used it yet. Also, self-employed insurance might be tax deductible for you. Look at line 29 on 2006 Form 1040. Line 25 on 2006 Form 1040 deals with health savings accounts. This might be a good option for you as well. Download 2006 Form 1040 instructions from IRS.gov. Good luck.
You wrote, "It should pay to work. Putting someone in a situation where they get *less* for working *more* just serves as an insurance that these people won't, infact, work more." I 100% agree.
Please remember those words next time we all jump on the bandwagon to "tax the rich" more.
Instead of "health care" and "working", insert "start new businesses" and "providing jobs". It's the same thing. When you tax the rich, you provide LESS incentive for people to get out there and create businesses and jobs. Why bother to start that new company and make that extra $50K next year if you KNOW they are going to tax the crap out of it and you'll wind up taking home less money than if you never started it at all.
And keep in mind, your definition of rich and Congress's definition of rich are not the same. When you and I say rich - we are talking about the millionaire types. When Congress says rich, they mean anyone above the poverty line. Keep that in mind too...
This year I found myelf in he same boat. My wife and I are mid-fifties and so far healthy save for he usual small stuff. We went with a 5K deductible with HSA policy from Humana that costs about $750 per month. Yikes! Well - about a month ago I woke up one fine morning with a detached retina. Just happened. Who knew this was possible but it is and it's not that uncommon. So there went the $5k deductible. It's pretty much a wash though since a $1500 deductible would have cost about $2400 more per year. If the RD hadn't happened the gamble would have been a winner. Best of luck making this choice. Peter
I'm in the same boat. Been there for years, and it's frustrating.
/month. This will save you about $300 per month which you can use for medical expenses when you need it. If your family is reasonably healthy, you shouldn't have $300 /mo that often (but it will happen sometimes - so be prepared). In the end you come out better because you get to pocket the money you budget for medical expenses if you don't use it.
Ideal: put $10,000 - $15,000 in the bank for emergency use and go with a super-high deductible ppo. Your rates will be low, maybe about $150
Next best thing: I went with Farm Bureau (www.fb.com) - I'm not a farmer, but they help self-employed people get insurance. The rates were the most reasonable I could find, and there was a person I could go talk to. They also do retirement planning and other types of insurance - most importantly, they have good rates on long-term-disability, which you should definitely have if you're self employed and you care about the long-term needs of your family. They also have life insurance at fair rates, but I got a better rate through my home/car insurance company (allstate).
If you live in Houston, Texas try Your Doctor Program(tm) http://yourdoctorprogram.com/ They provide access to doctors by e-mail or phone, a wellness program and a secure essential medical record online for a low monthly membership fee. As well, they are geek friendly. -- IV
http://www.LinuxMedNews.com Revolutionizing Medical Education and Practice.
I use an "Umbrella Company" known as MyBizOffice for all my contracting. MBO holds the contracts, then employs me to service the contracts. As an employee, I am provided health insurance. How does this work? When $$$ come in to MBO to pay me, they take their nominal fee off the top, then put the money in my "fund". Health insurance comes out of that fund. Then when I want a pay check, I tell the online system to cut me a check, and both the employee and employer portions of the tax come out of that fund, along with my net pay.
... but they make benefits as well as a W2 employment history (very beneficial when buying a house, etc.) available to me.
Sure I have to pay MBO a small fee to do this
They've also got a 401(k), and an expense reimbursement system that makes it easy to pay for things pre-tax.
I definitely recommend looking at MyBizOffice or their competitors... I researched competitors in 2002, but decided on MBO and have stuck with them.
-jbn
In Maryland, the local BlueCross (CareFirst) offers a sensible individual plan for only $80 / month. The only issue with it - very small drug coverage ($500 / year):
www.carefirst.com
When I left my full time job to start my own company, I had initially resigned myself to paying the $1200/month for COBRA (I have family coverage) but I decided to look for quotes on a group policy so that I could provide health insurance to any possible employees.
The coverage I ended up getting was from Harvard Pilgrim of New England. The coverage itself is *excellent* $10 copay, $50 emergency, no coinsurance, and only $680/mo for family coverage which includes maternity. Single coverage is $240/mo. I'm told that group policies have some additional benefits over individual coverage, such as not being legally allowed to drop you for health problems, and not being allowed to raise the rates exorbidantly. Rates went up approximately 8-10% at my 2 year renewal this fall.
I used the same insurance agent to arrange all my business insurance, and did not negotiate directly with the health insurance company.
My business is based out of New Hampshire, which may have specific laws that protect small businesses. The Agent that I used was a company called Kahlan Insurance based out of Concord, NH.
-matt
I'm the owner of a one man S-corp and have been on my Wife's University plan for the last few years. She's leaving the job to work on family business, and we're losing the coverage. Humana (via COBRA) wanted a MINIMUM of $1000/mo to cover us and our daughter! I figured I'd have to find something else, and we ended up getting coverage thru Kaiser Permanente for $390/mo with a $3K max out of pocket per person. Its the best deal I could find, and it covers maternity - most plan EXCLUDE maternity.
Dunbal-
It's worth it. Consider the alternative: death.
I consider myself lucky to have the option you denigrate.
There is a single-payer universal health-care system that covers 100% of the people for all the covered procedures. Period.
Lots of good comments and suggestions. I notice costs vary widely around the country. Just to aid comparison.
1. I pay $135 month for $5K deductible at age 57. Every five year increment goes up a few bucks. Every year the whole grid goes up a few bucks. "Full" insurance with a small deductible and small co-pays would be about $550/month. Rationale: At $550/month that's, umm $6600/year. $135 is $1620. If I get 'really' sick, I break even. In any case it would appear this is a lot less expensive than some of you are paying for a similar $5K deductible.
2. Several people seem to think voting Democratic or moving to Canada/Britain/etc. will solve the problem. Does anyone really think nationalized health care will give us a BETTER system? Do you REALLY want Hiliary calling the shots here? Just look at our military or the VA system. The VA, if you can get on it, is totally free. I won't say it's a bad system, but let me say this. My father was on it. I thought it was a good deal at the time. But had he been on medicare plus a supplemental he could have used local doctors instead of the long ride to a VA facility--and he just might still be alive today. I dunno, it's hard to figure it out in hindsight, but I wish we had the option of doing his health care over again the other way. He DID get a free slot in the wall at the Veteran's Cemetery, though.
3. The worst problem, imho, is that we've messed up by insisting health care be part of employment. Now people think employer-paid insurance is a "right" and will strike if the employer wants to reduce some costs with a co-pay. Insurance companies have lept on this, too because by and large if you are working, you are healthy. Really sick people can't hold a job. It's in insurance companies' best interests to further such a system. People keep working in terrible jobs just to keep insurance. I have a buddy who could otherwise retire. I say to him, "Why not?" and he always says, "Insurance." Now that sucks.
4. Health care is not in the Constitution. On the one hand we demand government be responsible and take care of every individual every time he has a cold and winds up going to the emergency room for it, stupidly. We are so risk averse that we blame anyone we can for anything that happens to us. Government is a prime target, but so is anyone, including McDodalds with hot coffee. Then we turn around and say, well, government should not invade my privacy (which isn't exactly in the Constiution either.) The thing is, we have INVITED government into our lives on a very personal basis, then wonder why it is there. You can't expect government to NOT be in your life if you won't take responsibility for your own life in the first place.
I would prefer government NOT be in my life, or there as little as possible. I will trade that for taking responsibility for my own health and my own life. Just get out and leave me alone. We'll all be better for it.
How about a moderation of -1 pedantic.
Unfortunately this is a much more complicated issue than it should be. But this is what I learned in the process of providing medical insurance for my family . First of all, I live in Colorado, so some or none of this might be applicable to your situation. Right now, for my family of four, we pay about $600 per month for medical insurance.
We chose not to purchase a maternity coverage rider for our policy. As of a couple of years ago, it was going to cost an extra $250 per month. You could only add or drop the maternity rider once a year at the renewal date for the policy, and even then the maternity rider only provided 50% coverage with a $500 deductible. We didn't think that was even decent coverage for the price, so after crunching the numbers we chose not to get the maternity rider despite planing for a second child. BTW, we had different medical insurance and maternity coverage for our first child.
What I learned when crunching the numbers was that many OB/GYN will give you a substantial discount if you prepay. IIRC the discount was almost 50%, so we paid the obstetrician $2500 at the beginning of my wife's visits. The major hospitals in Denver will actually compete for your business and will also give substantial discounts, again, I think almost 50% off. We had to put down a 50% deposit one month before our baby was due. I think the hospital total for my wife was $1700. But that number is definitely on the low side. This was my wife's second pregnancy, she did natural child birth, had no epidural, and she only stayed one night because she wanted to get home and away from the nurses who can actually be somewhat annoying if you're committed to breast feeding your baby. I think getting an epidural would have added $800-1000 to the total. But there's the risk of complications and that can cause the cost to skyrocket.
The one thing I found out was that once the baby was born, he was covered on his own policy rather than the maternity rider and so we would have had our normal coverage for any complications after the birth. Check on that because I'm sure that varies from policy to policy and there could be loop holes where you get screwed.
During my wife's pregnancy we had to pick up all the lab work and ultrasound costs. There was no discount for lab work, but the cost of lab work is insignificant relative to the rest. We also found that there's a lot of lab work that you really don't HAVE to do, but most people do when they're not footing the bill. For example, we chose not to do the triple screen test. With my wifes' first pregnancy we did the triple screen, it came back with a high probability of down's syndrome, she had the detailed ultrasound, and then an amniocentisis. The baby was fine. The second time, we decided it wasn't going to do anything but stress us out if it came back bad again, because we weren't going to abort the child and my wife didn't want to do an amnio again. As an aside we've met a bunch of people who've had bad triple screens since then, but they're child has been perfectly fine, so keep that in mind. We were able to get substantial discounts when paying in cash for ultrasounds. I think normally it would have been about $400, but was discounted to $270.
Anyway, I guess what I'm trying to say in as many words as possible, is that it is possible to get substantial discounts when paying cash. It's obviously a gamble, there could be complications, but way the cost versus the benefits of insurance.
This probably varies from state to state, but at least in NH the cost difference between the high-deductable plan and the $20 co-pay plan was about $40 a month - from about $480 to $520 for a family of 4.
Not worth it.
We were on BCBS, switched to MegaHealth to get pregnancy coverage on our schedule (BCBS only lets you change one or twice a year and the date keeps changing - call every month if you plan to do this) and are switching back to BCBS for better rates and a much lower billing error rate.
Oh, and the NASE salesman who sold us the MegaHealth plan lied through his teeth. Read all 25 pages of legalese to verify salespeoples' claims.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)
If you're in the U.S.A., have your wife work up until the point she physically cannot work. Then she should go on FMLA leave for the full 12 weeks. This will give you 12 weeks to remain on her insurance. Then, she should return to work for whatever minimum length the employer requires so that you do not have repay any large sums she might owe to the health insurance plan since she wasn't working. Then she should resign and try to get the family on COBRA for the max length. If she got short-term disability insurance through the employer, she should use that too as pregnancy is considered a short-term disability and will extend her overall time off before having to return to work to simply quit. You should join some type of national professional or fraternal organization as well. You can usually get onto their group healthcare plans for cheap.
1) Purchasing power: even if you have a 5K deductible, you can often make up for the cost of your premium in the discounts you receive for services. Providers often charge the uninsured 3X to 10X more for services compared to the rates that insurance companies negotiate with providers. Think of it as a Sam's Club membership for health care.
2) Tax free out of pocket: The HSA is a way to make your "out-of-pocket" medical expenses pre-tax (not sure if you can pay premiums pre-tax, though). Even better, you can keep unused money in the account at year-end, and take the account with you if you leave the plan. If you don't use a lot of services/drugs, you can put the unused money in a money market and let it grow tax free. This accumulation can be used as a rainy-day health fund, or give you flexibility to raise your deductible and lower your premiums.
3) Catastrophic coverage: When shopping, be sure to look at the maximum out of pocket, in addition to deductible, benefits, etc. This is a way you can have some piece of mind that you will not be hit by more than $X in out of pocket expenses in a given year. Note: this is not your deductible. After your deductible, you still pay co-insurance or co-pays.
When shopping for a Plan, your state insurance commissioner is a good source of information regarding complaints, litigation, etc. Organizations like NCQA and URAC also provide 3rd party quality ratings for insurers and providers.
They are independent, non-profit, don't accept advertising, etc., etc. Your subscription may be tax-deductable, but consult your beancounter.
Let's be pragmatic here. In all likelihood you'll end up divorced, there's nothing wrong with giving it your all but the odds really are stacked against you. The alimony and child support you'll pay is based off of what she makes.
Now, have your wife take here maternity leave or FMLA which protects her from being fired. After her leave is up, she can go back to working. Your health insurance problems become kinda mooted.
Some call me bitter or jaded, I call it experience. You probably won't take my advice. When you don't, one day you'll look back and say "Damn, I wish I listened to that gringo guy; he was right."
Yes, I am a smart ass; it's better than the alternative.
This is actually the interesting thing about American healthcare. I just left a job with a healthcare provider. From what I can tell from my ~3.5 years working in the industry (albeit in an IT role), the whole medical costs issue has lent itself to a snowball effect. Large Insurer #1 negotiates a 30% discount. Large Provider #1 isn't making as much money as it used to, so they increase costs by 5%. A year or two later, Large Insurer #1's contract is up, and because they are so big and have provided so many referrals to Large Provider #1, they are able to renegotiate for a 35% discount and other benefits such as set rates for things such as certain procedures or certain medicines. Large Provider #1 needs to increase revenue again so they decide to increase costs by 5% again, hoping that they can make up the money from Smaller Insurer #'s 1, 2, & 3. Ad infinitum.
Two other points:
1) The larger the claim, the more likely the insurer is to deny payment to the provider on some grounds. The insurer will look for something -- anything! -- to deny payment or further tie up the claim. Once a claim enters the appeals process, it's not uncommon for the insurer to be able to negotiate an even larger than normal discount on that particular claim. A 90% or more discount on a 7-figure claim isn't unheard of.
2) Hospitals hate Medicare patients. They actually tend to lose money on Medicare patients. If you're on Medicare, don't be surprised if you get the shaft. Yes, by law the provider has to give you treatment, but you can be guaranteed to get nothing but the bare minimum.
Lastly, once again I want to assert my disclaimer that I worked in an IT role, so my understanding isn't as thorough as those people whose job it is to negotiate those contracts and negotiate those payments on those claims.
If Murphy's Law can go wrong, it will.
http://www.asbaonline.org/ Some goverments provide group insurance for small business owners. Various small business associations provide group coverage. The group coverage is not cheap, but the coverage is better since you are pooled. Pooled coverage makes is much more difficult for your insurance company to arbitrarily raise premiums or drop your policy. In the end, you are probably looking at $300 - $1000 per month (tax deductable), but you will have coverage for your entire family that is equal to insurance from a company. There is also dental, vision etc. The other thing that is key is disability insurance. Most financial people think this is as important or more important for self-employed people. Most of the orgs above provide disability as well.
Also, you get a better tax benefits on the health coverage if you are incorporated.
You're not really in Canada, are you? I suspect you're some Karl Rove wannabe, spreading FUD, sitting in his mom's basement eating doritos and playing video games. You're carrying water for the private insurance industry, which is scared shitless by the notion of single-payer, and you're probably doing it for nothing. Quite sad, really.
I grew up in the US, lived there for 30 years, but moved to Canada in 1997. The care of me and my family under the Canadian system has been outstanding at every stage, and really points out what a perverse, sadistic farce the U.S. "system" is. In the US, doctors have to have an army of back office monkeys to do battle with the HMO overseers, who fight every step the doctor wants to take.
Here in Nova Scotia, we are charged NOTHING above what we pay in taxes for hospital care, ER care, and office visits. Not One Dime. We don't pay for insurance of ANY KIND for basic medical care. I'll say that again - our monthly cost we pay out of pocket for hospitalization and doctor visit coverage is ZERO.
Examples:
When I went to find my first family practice MD here, I found one within minutes, got in the next day, doc ordered blood work which I got same day, and results came the day after that. By the end of the week I was in his office talking treatment options and getting a prescription. Company drug plan paid for that, but even if it hadn't, the drugs are so much cheaper here than in the US that it wouldn't have been a show-stopper. I paid ZERO DOLLARS for the office visit and lab tests, by the way. In fact, when people in Canada refer to a "health plan" or "health insurance" they are talking ONLY about prescription drug coverage, or coverage which gives them additional amenities, like a private room, or an ambulance with a disco ball and an 8-speaker sound system. In other words, shit you don't need anyway.
In Nova Scotia, my stepdad got a hernia diagnosis, had a CT scan within one week, and got surgery within one month. World-class care facility. In the US, you'd be fighting for insurance company approval for three months, minimum. He got NO BILL OF ANY KIND.
Three times our daughter had to go to the ER when growing up (she's 21 now) she was seen immediately, treated promptly (with tests varying from x-ray to blood work), and we went home with ZERO BILL OF ANY KIND.
My wife last year was feeling dizzy and nauseous one morning, so we took her to the hospital, where she was seen immediately, given an EKG with cardiologist consult, thankfully pronounced okay, and... can you guess? Got NO BILL OF ANY KIND.
Nothing came in the mail, and we didn't have to skip a mortgage payment to afford any kind of treatment or visit.
People here may have minor gripes about the system as it performs here, but these are people with no perspective of how bad it can get - people who have never lived in the U.S. or Calcutta. There are people in the U.S. who would kill to have the coverage that some Canadians gripe about on a daily basis.
If the U.S. insurance industry manages to dismantle Canadian Medicare and turn it into a for-profit system, then Canadians WILL have something to gripe about.
I'm single and left my job for a year-long consulting position and after shopping around I settled with a high deductable PPO. I was not worried about the $2500 deductable since I was getting paid a fair amount. I was more worried about catastrophic illness that would require a hospital stay or surgery. This plan covered up to $5 million dollars. I rarely see the doctor and I only needed a safety net just in case.
Cost was about $130/month. Cobra would have been about $300/month. I kept my dental Cobra because it was a better plan than what BlueCross offered.
There were two choices. 1. Short-term temporary insurance you can renew every 6 months, but you can renew only once - which was cheaper (2 million cap). 2. Long-term insurance, month to month which is what I picked (5 million cap).
The difference (according to the insurance broker), was that if you get sick on the short-term insurance, they can refuse to renew at the end of the term.
I'm in California, so there is a law about pre-existing conditions where the insurance company must cover it if you get insurance within a certain time period. So, don't decline the Cobra insurance until you get the new insurance. Cobra lets you signup retroactively for at least a month after termination, so you can decide to get Cobra if the new insurance declines coverage. The insurance company granted coverage within 2 days of my online application with a 25% premium over their advertised rates for a minor existing condition.
As for your wife, I would try to get the new coverage first and if they decline coverage, go the Cobra route. Since you know she'll be giving birth, you might be better off going for a lower deductable or an HMO. Also you'll need to get health insurance for the baby.
First a story about a baby, then a suggested book and some links.
"Sally" knew there was something wrong with her second child soon after he was born. Every so often he'd stop breathing, but never when the Medical Doctor was around. The kid was always cranky. One day while Grandma was watching him, he stopped breathing and turned blue, and Grandma called the ambulance. Sally was like, "thank goodness, maybe they'll FINALLY believe me!" The doctor prescribed a "slant board". Every night for about six months she strapped baby to the slant board. Eventually he "grew out" of the respiratory distress, and the slantboard too.
As the years started to go by, the ear infections started to add up. I guess they were almost constant. Eventually they sent him to a specialist, who decided to chop out the tonsils and adenoids. I guess he was 3 years old or so at the time, and the surgery mostly ended the ear infection cycle. The timetable's not mine, so I don't remember when the hole in the eardrum occurred - perhaps it was pre-surgery, perhaps it was post.
Fast forward to 2005. Sally was dating my father. The son had recently been hauled out of school on a stretcher, because one of his friends had introduced him to Tequila. I suggested a course of action a couple times, but they just ignored me. I begged, I pleaded, but as the year went by, nothing was done. I think his weight started to balloon upwards at this time - he's 5'10" or so, and over 300lbs.
At the marriage I told my "stepbrother" that I thought he'd benefit from some CranioSacral Therapy. A month or two later I set him up with a guy whom I'd had some experience with. Took him over, introduced them, left, came back, paid the guy myself. He liked the experience, and has been back several times. As we were driving away, he noted how he hadn't realized how tight he was on the drive over, but what a difference it was now that those layers of tension were gone.
Ear Infections and Respiratory Distress are red-flags indicating that Osteopathic Manipulation would be beneficial. I knew this because my ear infections have cleared up since I started getting worked on a year and a half ago.
In chapter 2 of Andrew Weil's Spontaneous Healing, Dr. Weil talks about meeting Robert Fulford, D.O., and how Dr. Fulford had remarkable success with children's chronic health complaints. Ear infections usually resolved after two or three visits. Hyperactivity and other "behavioral disorders" frequently resolve themselves when abnormal pressures in the brain are taken care of.
My doctor was good friends with Fulford (took over his practice in Ohio, before following him to Arizona), and told me the rest of the story of how Dr. Fulford got dragged out of his Tucson retirement. Dr. Fulford had a pediatrician friend, and one day the friend was losing a baby to respiratory distress. Nothing the pediatrician did made a damn bit of difference. Dr. Fulford was called in. He put his hands on the baby; five minutes later: *poof*, all better.
Dr. Weil witnessed Fulford's remarkable healing touch, and even experienced it himself when his jaw was knocked out of alignment. He tried - begged and pleaded - to get his fellow M.D.s to witness for themselves the Osteopathic difference, but they mostly weren't interested.
See Lew Rockwell's Medical Control, Medical Corruption for a good take on how "medicine" got so fucked up. Summary: Doctors wanted a monopolly to raise their incomes, Rockefellers wanted more business for their pharmaceuticals. AMA lobbied to shut down the private medical schools, Carnegie and Rockefeller "endowed" the remaining medical schools to indoctrinate teh doktors in pharamceutical-based medicine.
100 Years of Medical Robbery and Real Medical Freedom are also good, and get into how insuran
Learn the rules so you know how to break them properly.
www.teslabox.com
http://www.consumerreports.org/cro/health-fitness/ health-care/hmos-vs-ppos-905/overview/index.htm
- OP AC
Congrats!
= HealthIns
My wife and I have been insured for the last three years through the National Association for the Self-Employed who has a policy for its members through Mega Health and Life. We pay about $170 a month for insurance to cover both of us with a $3000 deductable and no maternity cover. We are both just under 30 without health problems. When we decided to have a child she joined her employers insurance program which costs around $200 a month just for her and would be over $600 a month if I was added.
We plan to add our baby to her work policy and see how much his bills are. We probably will switch to a health savings account policy. On an average year we spend less than $500 on health care and more than $2000 on insurance. But as others have pointed out the insurance protects us from that $100K+ bill if something goes wrong.
You can get a quote for Mega online at http://benefits.nase.org/show_benefit.asp?benefit
You didn't say which state you live in, which makes it hard to give specific answers; check your state insurance commission's web site; many states provide information about carriers.
First, make sure to maintain your wife's current insurance for at least 30 days after she has given birth--more, if she has complications from the pregnancy or birth; it's going to be hard for you to find insurance that will take on a woman in late pregnancy, or one which will cover complications before six months after the birth. Afterwards, I'd say that PPOs are the best compromise if you can afford them; if not, pick the best HMO you can find. HSAs and FSAs are a gamble, though they can save you taxes; only gamble if you can cover your bet, which probably means a household income of over $50,000 or more. Dental insurance isn't usually worth it; pay out-of-pocket for routine care and borrow for large expenses instead. Remember that health care expenses are tax-deductable and keep track. Don't forget disability coverage and life insurance--you will have dependents and you have to provide for their care if you are disabled or die.
None of these are cheap. Don't be cheap--the number one cause of bankruptcies in the USA is unexpected medical expenses.
the National Association of the Self Employed has Health Insurance offerings for it's members. It kind of acts like a large company by joining everyone in the association into one large plan, and thus they can have leverage to keep the costs low. At least that's the theory. That is the Insurance I use right now, and it seems to stay at a reasonable cost. That kind of sounds like an answer to what you are asking about.
1) You and your wife each sign up for a 1 credit flower-arranging class at your local community college. Pay for the student insurance for each of you and for any children. This will cost you something like $1,000 per person per year, and provides moderate coverage with a rather low cap (often $100,000). You also get access to the student health center, which takes care of the checkups and the well-baby vists and such at a very reasonable cost. Plus, you get to learn flower arranging or auto repair! This is a good option for the young and healthy. Be really compulsive about brushing your kid's teeth, since these policies don't cover dentistry.
2) If you are a born-again Christian, look into Medi-Share. It's not insurance, and there are no guarentees of anything, but it might be just what you need. If you aren't a Christian, look elsewhere.
See what I've been reading.
I also recommend IEEE for group insurance. Another caveat - last time I was in their plan, you had to have been an IEEE member for 2 years before being eligible. That is one of the reasons I keep my membership current.
Steve Cline http://www.clines.org, http://www.objectbap.com
Seriously. Especially if you are a consultant and can work remotely atleast some of the time, you can keep your US bill rate but live in India for about 1/10th the cost of living including health care costs which are soooo loooow you dont even need insurance!
You need a major medical policy. These are available through most professional organizations. You can probably get one through your homeowners insurance agency, though you will pay less if part of a larger group. That'll take care of the big stuff. They typically have a $750.00 deductible per claim. Expect it.
Next, you need to open a medical saving plan. See your accountant for detials. Details are also available on the IRS website. Good luck finding it.
Put a fixed amount each month into the account, use it sparingly for the first part of the year. More liberally in the latter part of the year. This will give you around the same coverage you get from an insurance program. Cost is also similar. Don't be afraid to ask doctors for a cash discount. Insurance companies often only pay doctors about 3/4 of what they bill, as limited to 'fair and reasonable'. They also take several months to pay. Some doctors will let you get by with around 50% if it's cash up front. If they won't play, consider finding another doctor.
It's what I did when I had my own one man engineering office opened. You need to be very sure that you don't use the medical account for anything but medical, dental, medication or vision costs. You can then deduct the full cost from your income before taxes.
As an alternative, check out the cost for COBRA coverage on your wife's current plan also. That can be extended for up to 2 years. You pick up all of the premiums though. Expect it to cost you around $750 per month. YMMV
Good luck on your new adventure.
Everybody knows 3 people with my name.
Before you leave your plan, there are a few things you should know. These are based on my own experiences with private health insurance (through Continental General) last year.
1] Your wife has a pre-existing condition. You need to know what your state's laws are regarding this; companies can (and do) sell policies to people when those policies will not cover any of their medical expense, and most of the time the people who are selling you the policy (who work on commission and are generally ignorant of insurance law) will not tell you this even if you specifically ask. For instance, I last year bought private coverage the same month my previous (student) insurance expired. At the time I had a slight fever which I believed to be the flu. I asked the person who sold me the policy whether this could in any way affect my coverage and he said "no." That was a lie, and I should have had the policy reviewed by a lawyer.
2] Your private insurance, if they pay your medical expenses at all, will only pay them after repeated appeals and legal badgering. This will take at least six months and in my case took nearly a year. In the meantime you will be responsible for your medical bills, which if left unpaid will go to collections and destroy your credit rating. Private insurers will almost always deny the first claim you make for any procedure or expense, since a percentage of claimants will elect to pay out of pocket or large creditors will reduce the total medical bill in an effort to collect what payment they can. This means that, after your wife's pregnancy, you will have to individually appeal every medical expense she incurrs at least once and probably twice. This will take a phenomenal amount of time and will require the services of a lawyer (probably about ten billable hours).
3] Regardless of the laws in your state and regardless of the insurance company's conduct, you do not in most cases have the practical option of civil litigation. The insurance company will deliberately make litigation as time-consuming and expensive for you as possible even if they are clearly in the wrong. Litigating any case will cost you at least $30,000 per year and take at least eighteen months; if the judgment is in your favor, there will be at least an additional two to three years of appeals. Even if your case is clear cut, you still have perhaps $100,000 on the line, and you will still in any case have to pay some portion of your medical bills for the several years of appeals you have ahead of you. In my case, it was faster and cheaper to negotiate a reduced payment plan with the hospital than it was to get my payment from an insurance company that was clearly in the wrong and clearly broke one or more laws.
Long story short, do not think that the threat of civil or criminal litigation will get your insurer to abide by the terms of your contract when it is not in their immediate interest to do so.
My advice right now is:
1] Talk to a lawyer to find out the prevailing laws and practices in your state so that you can make sure your wife's policy will cover her pregnancy and its aftermath. When you are reviewing policies from different companies, discuss them with with a lawyer to get an idea of how that policy's exclusions and limitations are interpreted according to your state's law. If you choose to buy a policy from a private insurer, exercise your policy in a way consistent with these exclusions and limtations. This may mean asking for specific documentation from a doctor to supplement your or your wife's medical records, for instance, or for your doctor to specifically note that a treatment was (or was not) for a specific condition (while doctors have standardized codes for these, it is important that they not be revised at a later date to fit an excluded condition; e.g. if you have any kind of pre-existing condition at all, your doctor should specifically record where possible that physicals, treatment, and so forth are not related to that condition).
2] Expect stick
You never know who will get one.
Because the man's wife already has insurance, it is most likely ILLEGAL for other insurance companies to declare a condition as pre-existing and not provide coverage. I had atopic dermatitis treatments that had to get transferred between a couple of insurance companies, all of them covered it without a quibble, and my Dr. always told me he didn't care what they said, once you have insurance, another insurance company cannot just not cover what the first insurance company is assisting you on.
Since I'm not a lawyer, I want to add that the two states I dealt with were Oregon and Washington (just in case it is a state law)
A lot of the advice you're getting here may not apply to your situation, based on what state you live in. I'm assuming you're a US resident.
% 20health%20insurance%20rates%20june%202005.pdf
The pdf below is a good starting place to get an idea of how you will be rated, what your renewal will be, pre-existing condition limitations, etc.
http://www.nahu.org/legislative/charts/individual
nahu.org is a pretty good site for researching this kind of thing.
The purpose of all insurance is to protect against risk. It is the nature of insurance that some people pay more in premiums than they get, and others get more than they pay. But insurance only works well if there are a lot of members and the risk is spread between low risk and high risk people. In this country, you can go without any health insurance if you don't think you need it, unlike car insurance, which doesn't make a lot of sense to me. You can get rear-ended in a motor vehicle and you are supposed to always have insurance to cover it and passenger injury, or you can get rear-ended physically and catch some very serious infectious diseases like AIDS (it is world AIDS day today !), but apparently society accepts that you may not be covered in that case. However, if you get something like AIDS and have no insurance, you will be left in a sorry state and to die if you can't afford to pay for your own care in full, which almost nobody can once they become disabled. As to signing up for death, people can already sign up for it if they want, they always have the option of not getting care, but usually they don't do it by choice but because they have no other option.
Oh, and health insurance premiums are already much higher for people who can't tolerate high levels of risks and only want low copays, or for those who have pre-existing conditions and can still get insurance.
-- Julien Pierre http://www.madbrain.com/blog
There is also free medical for low income and freeloader types. Most places will not turn you away either.
Tell that to the well-funded hospital that wheeled me out in the rain in the middle of the night with a shattered leg. I had been rushed to ER from an auto accident and was delirious from concussion and pain, and probably misspoke my social security number. Before I had even been given painkiller, the billing dept had incorrectly decided I did not have insurance and was to be sent home.
When I asked how they could just put me out, they replied that legally they had to "stabilize" me, which they had done by stopping bleeding and giving me a painkiller. They wouldn't even give me an extra tablet for when the pain would return in 6 hours. I guess I should be grateful, they gave me a pair of crutches to hobble out on.
Of course, when my ex called the next morning, screamed at them and gave them my SSN, they suddenly called back, concerned about my health, and reprimanding me for leaving the hospital. Apparently, they were now worried that I could lose my leg (besides internal bleeding and clotting dangers). I keep hearing about how no one is turned away from hospitals in America (usually by the American right-wing claiming it's the "freeloader Mexicans" ruining the invisible hand of their perfect healthcare system) but I will tell you when your life is on the line, you better have a really good health insurance plan and a really good lawyer, or else.
Lies about crimes
Insurance isn't meant to be used for routine services. You don't buy auto insurance expecting it to cover oil changes and new tires. Why should a health insurance policy cover routine physicals.
Insurance is supposed to protect you from unforeseen disasters.
I have a high deductible PPO. It costs me $50 per month and I pay everything up to $3,500. Then they pay everything up. If I'm in a major accident or get cancer, I'm in pretty good shape.
I don't want to pay $300+ per month for a policy that pays for annual physicals when an annual physical cost $250 max.
As a result of the lower cost, I've now saved more than my annual deductible. Focus on getting an insurance policy that is that -- and insurance policy and save the difference in premium so you have enough to cover the deductible and pay routine expenses when you need it.
That said, when my wife and I were planning on having a baby, I compared a few plans and picked one that had a higher monthly fee and a lower deductible. As soon as the baby was born, we switched back to a high deductible plan. For that year, there was a point where the lower deductible and higher monthly fee made sense for us because it was a planned "procedure".
HSA's are cheaper and more flexible than your typical HMO/PPO healthcare plans
t hIns/MSAs.html
http://www.forhealthfreedom.org/Publications/Heal
your logic might be correct if we don't investigate why those drugs cost $400k/yr.
Check it out:
http://www.freelancersunion.org/
They started this in New York for people in just your situation.
Do what you can, with what you have, where you are.
My friend is having a C-section today because her baby is breach. If you can explain to me how to deliver a breach baby without killing it, I'm all ears.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
I agree with what you say, but the big difference here is that there are no waiting lists.
It depends on where you live, what kind of service you need, and what kind of insurance you have. Waits of 4-8 weeks to see specialists aren't necessarily uncommon anywhere, though more common some places than others. Inferior insurance has the consequence that some practitioners/suppliers are less willing to treat you or supply state of the art care, even if you can negotiate cash discounts and save up the payment -- which obviously results in a wait -- or work out a payment plan. If you *do* experience any difficulty with payment, you can be sure you'll wait in other ways, specifically while you have to clean up your credit record in order to make any purchase regarding financing.... or, alternatively, accept the higher rates and wait longer to pay off your purchases.
There is also free medical for low income and freeloader types. Most places will not turn you away either.
Emergency facilities are required not to. Physicians offices aren't, but will sometimes negotiate with you, but they're almost always quite limited as to what they can actually do for you there in-office in terms of testing and treatment. To get those things, you usually have to go to a larger facility, some of whom will indeed turn you away if you can't make payment at time of service, and almost all of the rest will bill the hell out of you at rates up to double what they'd charge the insurance company. Medicaid is a crapshoot unless you're a child or willing to actually voluntarily reduce your income to qualifying poverty levels.
None of this is speculation. It's personal experience, mine and others. It also shows up in statistics relating bankruptcy to medical expenses and the growing number of uninsured.
I understand single-payer and state-subsidized care isn't all kittens and pretty flowers. But my experience without employer-sponsored care leads me to believe there are quite likely as many problems with our vaunted mess here.
Tweet, tweet.
Kaiser is 170 a month for their top plan. I'm buying individual, though small business rates are a bit less.
Of course, I'm not yet 30, so that helps. =)
I think the highest Kaiser goes is around 600 a month or so for the top bracket?
Sorry to say, but the IEEE just started backing out of their group
insurance plan, by reducing benefits to existing members and closing it to new applicants...I just got the announcement last week.
Anyway, you had to be a member for 2 years before you could apply...
Things to beware of:
(1) Some of these "plans" are *not* insurance. They are essentially negotiated prices for certain services. This is not altogether unhelpful
(2) Some of the plans offered through associations are insurance, but (a) the associations may not independent associations.. some (particularly NASE and AAS) actually so closely tied with insurance underwriter UICI that they may as well be marketing vehicles for the company and (b) the insurance plans have woeful gaps, including poor first dollar coverage and what amounts to no practical out of pocket limits.
You are probably better pursuing membership in a well-known genuine professional association like the ACM or IEEE and seeing what they offer rather than generic business associations.
Tweet, tweet.
Does anyone really think nationalized health care will give us a BETTER system?
The term "nationalized health care" essentially conjures images of an entirely nationalized industry of health care providers. That indeed is quite unlikely to work. A single-payer system -- nationalized *insurance*, if you will -- on the other hand leaves market forces in play, since providers still compete for health care dollars, and not only quite possibly would work well here but has been demonstrated to work well elsewhere. Shortfalls in providers (in Canada at least) appear to be more readily attributable to decisions from medical associations and education institutions to reduce the number of new practitioners trained than from dictation of supply from the insurance system.
Do you REALLY want Hiliary calling the shots here?
"Hiliary" didn't propose either single-payer care or a nationalized health care industry. The Clinton Health Care plan essentially would have helped subsidize private HMOs while requiring employers to provide insurance to employees. Public requirements, private providers -- certainly something that's been proposed for all kinds of potential solutions to problems, from Republicans as well as Democrats. The plan was very different than some of its most vocal opponents painted it as. That said, it likely would have been a mitigated success at best and a disaster at worse, and there are plenty of other options which appear to be more sensible and less complex. High-access health care != Hiliary.
Tweet, tweet.
You're an ignorant ass. And you do not appear to be able to read - as the original poster mentioned ("[W]e are charged NOTHING above what we pay in taxes for hospital care..."), we all realize that our taxes cover this and most of us are happy to pay it, when we see the US alternative, people paying $1000/month only to see their coverage cancelled or claims denied, declaring bankruptcy and losing their home or life savings just because someone got sick, "pre-existing condition" bullshit, and the like. The taxes I pay here in Canada are nothing I'd consider outrageous, in fact, when doing a total cost accounting, I actually PAY LESS in taxes than I would at the same income level in the US. Plus, at least we are getting something for our money - a better life expectancy and a far lower infant mortality rate, for starters, and for a lot less money than the US system spends. Who's got the inefficiencies, again?
How's that for a slap in the head? You really need to lay off the Faux News propaganda.
Did you know that the the entire healthcare system of nation of Canada is run at a smaller budget than *just one* US state's insurance company - Blue Cross Blue Shield of Massachusetts? 30 million people are served well in a system that has ZERO marketing costs and a LOT lesss bureacracy drag.
Enormous inefficiencies arise in for profit healthcare systems - marketing (the biggest, since all the insurance companies have to fight for customers), armies of claims deniers on the insurance company side, and armies of approval personnel on the doctor/hospital side. Perverse incentives, where an HMO or insurance company can increase profits by doing only one thing - denying claims and denying care.
Go back to bed, O'Reilly.
Why not? They'll negotiate with you. In fact if you can pay them promptly, they'll cut you a better deal than they'll cut any insurance company.
I've had enough trouble negotiating with them when they bill me incorrectly -- seriously, a recent merry-go-round took me six months of active efforts to resolve. I've asked for discounts for paying *before* service. No dice. I'm glad other people have better luck, and I certainly think there's no point in trying to mandate negotiation away, but there's no reason to assume that all or even most hospitals are reasonable when negotiating with individual customers.
Tweet, tweet.
They cost that much because they treat life-threatening diseases only a small number of people have and they still cost billions of dollars to develop.
It's the product of federal incentives that encourage companies to spend a lot of money developing drugs that benefit only a few people.
And on top of that, the drug companies pervert the process. Even with insurance, most people can't afford these drugs, so in a free market, no one would buy them, helping keep insurance costs down. The drug companies realize this, so what they do is set up and fund charities that pay for the patient portion of the drug costs, so the insurance company still gets the 80-90% of the money from the insurance company.
Ultimately, what usually happens is everyone at the company where this person works loses health insurance because the cost of covering the one person are too much for either the employer or the employees to handle.
paintball
You sure it has nothing to do with the continual bombardment of advertising these companies pull?
I've got this feeling that buying up hours of air time each day, on every channel, to the point where half of all commercials are insisting you need to ask your doctor about overpriced not-wonderdrug #42, isn't cheap.
One of linked stories is about someone who had problems with Mega. Apparently the big issues are that they don't have an out-of-pocket maximum, and that they have per-day maximums that are too low to be useful.
The other problem is that there have been allegations by some that the NASE is deceptive, in presenting themselves as an independent organization when they mainly sell Mega insurance. I really haven't looked into any of this myself, but you should be aware of it and do some research if you're dealing with them,
Many of the rules regarding health insurance are state-specific. Georgetown University has published consumer guides for each state. They're very helpful and available here:
http://www.healthinsuranceinfo.net/
Sent from my iPhone
It's sad, isn't it?
What will it take to get us all upset about this - scratch that, everybody IS upset about this. What will it take for us to band together and DO something about this? An online petition that everyone signs and an automated email heads off to that persons political representative? Surely, the representatives would be flooded and HAVE to do something.
I just started a business (read about it on my blog ) and was looking into this.
n surance/hr_commercial_plan_2006.htm
The best resource I've found so far is: http://www.usnews.com/usnews/health/best-health-i
I personally have had a HDHP Plan from Blue Cross Blue Sheild of GA with a 2600 deductable and 100% in network co-insurance past that with an allowance for preventative care.
My mother in-law, who works in benefits for a major national organization, recommends the simplicity of a highly rated HMO like Kaiser if you can find one locally.
--Michael
Want to see every step I took to start my company? http://www.rowdylabs.com/blogs/pitchtothegods
that a good majority of Americans don't like having the government telling us what to do, and this includes how we take care of our body and our health.
This would be funny, but only if it were true. If people really thought that way then they'd never put up with the government demanding what drugs they can and can not take or use. The people let government dictate what they can do with their bodies., even what drugs they can't take for medical treatments. All anyone has to do to find out this is true is to use hemp, aka marijuana, during treatment for say cancer.
because the state is not dictating how health care is conducting itself,
See above.
FalconShould there be a Law?
You DO NOT get what you pay for in the US for-profit system, which, by the way, I am opposed to. My wofe died of cancer this year. She was barely in her 30s. I had access, via my company, to the finest PPO providers. I was paying almost $5,000 a year for this policy. Despite having the best coverage the company offered, I ended up paying well over 10,000 out of my own pocket for things that should have been covered. What's the fracking point of having insurace if not everything is covered.
I got wise after a few visits after getting bills for crap that should have been covered. I started requesting itemized bills from every provider. Guess what? The hospitals and doctors ARE out to screw you if you do not pay attention to your bills.
The hospital stay before my wife died sent me an itemized bill for crap like "mucous ecovery system -- $129" Guess what that was? A fracking box of Kleenex they gave her at her bedside. They charged her over $500 for a couple of doses of readily available prescription sleeping pills that would have costed less that $50 even without insurace.
My wife has been dead for months and I'm still getting bills. They send them to her, and the sad point is, they should know she's no longer alive. I sent everyone death certificates to try and avoid aying the bills the cheap insurance companies would not pay, but they still try and fight me to get money. For-profit medicine is evil, period. Healthcare is a basic human right. Now, alot of you who have never gone through what I have will poo-poo my assertions, but trust me, when the chips are down, the insurance companies will not even try to help you.
A corporation is a legal entity... a legal individual... who's sole purpose is to do what is best for that corporation
While a corporation is a legal entity the purpose of one is not to do what's best for said corporation. Corporate charters were originally granted to allow a number of individuals to pool their expertise, money, and other things together for the, here's the key phrase, "common good". However as Thomas Jefferson warned, a Corporate Aristocracy has basically taken control of government.
FalconShould there be a Law?
I work in London, England; 5.67 percent of my gross pay is deducted as national insurance. If I wasn't earning, I wouldn't have to pay.
My father's retired, age 74. He developed a severe heart arrhythmia and was taken to the local accident and emergency department at 3am, blue lights flashing, where he was given a couple of shocks with the paddles. He was stabilized overnight and spent four days in the CCU on a heart monitor. Then he was transferred to a London teaching hospital where they implanted an ICD. He was home the following day.
Total cost to him? nil. Total paperwork? nil. Free healthcare at the point of need.
Insurance companies do cap expenses.
Look closely at your policy. It probably has a maximum lifetime payout.
Looking at ehealthinsurance.com (not affiliated, just using them for numbers), a healthcare plan for two 20-somethings with two young children in my area would be $170/month, with 20% copay, $5000 yearly deductable per person ($10k max), and has a $5,000,000 per person lifetime limit.
The cheapo government insurance for the poor can be much more nasty. ISTR someone (vague for their privacy) being kicked off MinnesotaCare in the fall of the year for exceeding the yearly spending limits (less than $10k or $20k for prescriptions and health aids).
Dude, i want what you're smoking. you think anyone ('sides yourself) is stupid enough to think anything's free? I think he mentioned paying taxes?
IEEE has closed their group health plan to new subscribers, and is looking for a way to end the plan altogether. If you aren't already a subscriber to the plan, then even if you've been an IEEE member for years, you won't be able to join the plan. I'm already in it, and got a certified letter from them a couple of weeks ago, explaining the major changes that they're making in the plan this year, to try and keep it solvent; closing the plan to new subscribers was one of those changes.
I encourage you to read the fine print -- your spouse may be covered. However, she may need to work until delivery. And I mean *until delivery*.
While living in the US, I became pregnant with our first child. Even though I was working full time and insured, my pregnancy was not covered because I became pregnant during a three month 'grace period'. Apparently the 'grace period' was for the insurance company, not me or my baby.
To make a long story short: I arrived at work at 8:15 AM the day before my due date. Had several meetings and a minor router hardware install. I left to drive myself to an ob-gyn checkup at about 4PM. My water broke on the way (yes, it is possible to drive while in labour. No tickets, either.) I delivered my son later that night and went home the next day. Due to lack of planning, spouse missed much of the fun. Poor guy.
I was able to get all my costs covered by showing that that abnormal braxton-hicks contractions and precipitous labour (yup, that quick) occured due to stress and inadequate working conditions. Took six months, but we got it through.
kid seems to be okay... other than being a typical smart-aleck geeklet.
Not sure if this will happen to you as well. I was an expectant father and looking for health insurance as well, and I am self-employed. When I called around for quotes I was told the US requires health insurance companies to give insurance to babies covered by their parents insurance when they are born regardless of what health issues they may have. Splendid! What a decent concept.
So, because of that legal requirement no health insurance company would give me coverage as they would not take the unknown risk of what my baby might be born with. I could not get coverage. My baby was born fine and healthy and I ended up being able to tag along on my wife's school coverage.
By way of trying to answer the actual question asked, I'd very much like to hear what people think of a service like http://mybizoffice.com/ -- specifically for independents rather than small businesses, and for people who have zero time or inclination to go hunting and managing health insurance and crazy accounting with the IRS.
Good, bad, other similar services to compare?
I'm in a somewhat similar position myself and have found that health insurance isn't the only coverage that can be tough to purchase. With any type of insurance, there are a *ton* of options--to say nothing of the multitude of different insurance companies. Multiply that x100 for home owners insurance. Think you've got everything covered? Think again. Better read the fine print. Thrice.
In a way, I'm glad I'm still with the same company for my auto insurance since I began driving nearly 20 years ago. At least that's one less thing to have to find. That said, as for *finding* health insurance, I began my quest for health insurance on AlliedQuotes.com, and ended up choosing an insurer from there.
One suggestion that I came across in my research--perhaps there in fact--is to make a written list ahead of time of what you want from a health insurance provider. Makes sense. And it actually helped me rule out the things I *didn't* need and get to the right plans faster.
Running 'Nix is like owning a Lightsaber. It's "a more elegant weapon for a more civilized time."
as I'm not a US resident (or citizen), but I would like to stress the importance of having SOME health insurance, as well as some loss of income insurance.
I'm a semi-self employed. I own a small consulting company, about four employees myself included, I usually generate most of the income. You will notice that the difference between that and self employment is mostly that I have three other sallaries to take care of besides my own.
On March this year I was diagnosed with a Hodgkin's lymphoma. As far as cancers go, this is nothing going. A bit of chemotherapy, a bit of radiotherapy, and it's usually gone. As far as anyone can tell, I'm already out of it.
BUT
For almost half a year I was not much more than a useless wreck. Chemo once every two weeks does not leave you too much time in which you can work, and it takes over a month to mostly recover from the radiotherapy.
While cancer may seem like an extreme case of "what may go wrong", it is very far from being the only thing that can go wrong. Other things may include a traffic accident, breaking a hand (or even a finger, when computer programming is involved), not to mention things like neocleosis, all of which can take you out of the work cycle for months.
Luckily, the national health insurance in Israel is great, and I paid almost nothing for my treatments (I think less than $100 all told for 2 CTs, a PET CT, a few X-Rays, an ultra-sound, 4 ABVD treatments and 17 radiotherapy sessions). Not less luckily, Lingnu (my company) was managed well enough to be able to function almost without me for those past months. We managed to pull it off without losing customers and without letting any of the employees go.
The thing is, being lucky is nice. Stacking up the odds in your favor is even nicer. Get a good insurance.
Shachar
P.s.
Yes, I realize that your question was "I want an insurance, which one is good?".
There are many regional differences.
IANAL but write like a drunk one.
In the UK and Germany you can choose who your doctor is and can request to move to a different specialist if you don't like the treatment.
In recent legal rulings it has been found that not allowing this would breach human rights legislation.
IANAL but write like a drunk one.
As you said there are waiting lists in order to receive treatment, some of them are unacceptable but some of them are perfectly bearable. But it is a system that overall is fair to all and that will treat you promptly whenever possible.
The matter of fact is that if you get sick you get treatment.
If you are rich enough nothing stops you to pay for treatment yourself (there is a parallel system of private doctors and hospitals) and many companies offer health inssurance policies that help cover the cracks of the state provided service or when you want to get some tratment faster.
The "everything I want" is not strictly correct, but is mostly true since most people demand only what they really need.
The "unlimited quantities" is not necessary, you want to get better after all. But if you have a cronic disease you will be looked after, sometimes with carers visiting you at home. Of course the system has failings, but this is immensily better thatn to leave people to their own devices.
The disadvantages are waiting times for some operations and treatments, doctors having little time to evaluate patients (the typical appointment lasts a few minutes), overcrowding in some hospitals.
But this is in the UK, others countries (like France, Germany or Spain) have a better reputation regarding their health services.
During the Margaret Thatcher government (of "there is no such thing as society" fame ) investment in any socialized service was virutally stopped ("buses are for losers" according to her), so the failings of the current service are directly attributable to her.
The current government has tried to put this right, the improvement of the Health Service is what kept the current government in power in spite of their misguided support of the Iraq debacle.
IANAL but write like a drunk one.
I moved to England from the US about 1 1/2 years ago, and work for a company that sells private health insurance.
Even though we could get it at a discount, lots of employees don't bother, because, as one manager said, "Why pay for something you don't need?"
So far, I really like the NHS.
1 - My GP is required to see me the same day for an appointment. In the US, I was lucky if I could see a doctor the same week.
2- The one time I had to see a specialist (a gyn)my waiting time was less than I would have waited in the US (and it was defined as a non-emergency situation.)
3 - Un-complicated pregnancies are cared for by midwives, not doctors, leaving gynaecologists to specialise in taking care of women who are actually sick.
4 - Doctors sometimes make home visits.
5 - After you have a baby, a heath visitor makes periodic visits to your home to check on you and the baby and teach you anything you might need to learn.
6 - BIRTH CONTROL IS FREE!!!!!!!!!!
7 - If you have a medical condition, you get special treatment for it. For example, because I have asthma, I get free flu vaccinatinos and periodic asthma checks. And I get letters inviting me to the vaccinations and the checks; I don't have to even think about them.
8 - UK doctors don't have pens and prescription pads with drug company logos. In the US, a dermatologist prescribed me a very expensive medication for a skin condition. My doctor in the UK told me I could use an inexpensive, over-the-counter medicine instead. The OTC medicine is more effective.
"The reason for this is not understandable to the human mind." - IT helpdesk assistant
If you're starting a family it will probably relieve stress if you add private insurance to the universal public healthcare. I've just switched to Bupa since my employer offers a great deal on them but I know VHI's web site better. Just based on what you said, their top level package will run you about EUR 140 or so a month. That includes the 10% online discount.
Obviously I'm assuming you live in Ireland. If you live in another developed nation, you should look into the options there. Unless you live in the USA, but no person who cares about their family's health lives there, do they?
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First off, in the US, a national government instituted heath care system would be unconstitutional. In other words, it's not allowed.
Secondly, government is the LEAST efficient way of doing anything with the exception of maybe defense.
Third, the high cost of health care is BECAUSE of excessive government regulation. It takes over 10 years and billions of dollars to bring a single drug to market due to the FDA (which by the way is also unconstitutional).
Fourth, we are NOT Europe, and damn proud of it!
So to recap - the free market will provide the best solution in most cases, and government is the cause, not the solution, to most problems.
Libertas in infinitum
A, in my original post I ESPECIALLY noted tat I was talking about CENTRAL EUROPEAN and NOTRTHERN EUROPEAN countries. Don't give comments unless you properly read a post dude.
And about the smoking, A, nothing but cigarettes, and B, none of your business.
I can personally speak about my first GF in Finland, her dad needed a his heart fixed to, it took them LESS THEN 24H to get him into the operating room after diagnosis was made.
So it looks like I'm not the only one who "hasn't done his research" as you claim.
Me flamebait? Sounds more like you're a bit on the nationalistic side there. Your first bit of answer goes beyone me tough. I've never heard of ANY CENTRAL or NORTHERN European countries doing anything like that.
Ignoring the national health care debate...
You have two distinct issues:
1) Maintaining health coverage for your wife during the pregnancy and shortly thereafter.
2) Maintaining health coverage permanently.
For 1):
Encourage your wife to keep working (and coverage) as long as possible. See if she can take an extended maternity leave with or without pay, but with medical coverage. Don't have her tell people she's planning to quit, lest she be put on a shortlist for layoffs. When she does leave, suck it up and pay COBRA until you are firmly ensconced in a new plan.
Don't let coverage lapse at any time for either of you.
For 2):
HDHP + HSA is an excellent option for you. It is, as far as I can tell, a fabulous giveaway for the self-employed rich. As a matter of fact, I'm planning to use it for my not-rich, day-job self, as my company allows me to waive coverage for such a plan.
Group Health has such a plan, that for me *alone* will cost about $100/month. This is about 1/4 the cost of their normal plans. I'd imagine that almost every health insurance company has a similar plan.
Fund your HSA to the fullest (the amount of the deductible). If you don't use it, you can roll it over *forever*. If you do use it for health care costs, it's tax-free *in* and *out*.
A final option I haven't sufficiently investigated is group coverage through a professional society. I keep my IEEE membership up to date just for the option of switching to their coverage should it become necessary (and the professional resources it provides are excellent, too).
You have obviously not seen any pediatric orthopaedic offices/clinics. Plaster is still the most widely used casting material for pediatric fractures. Fiberglass tends to be used in non-displaced fractures because it's more difficult to shape. If you're not an orthopaedist, then your opinion/observation doesn't amount to much. Your eye does not see what your brain does not know. I use them routinely on kids, and plaster rolls are still commonly sold in every country.
Often, plaster casts are covered in a light layer of fiberglass to toughen them up to withstand the massive destructive energies of 7-12 year old boys.
..........FULL STOP.