Slashdot Mirror
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)?"
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.
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.
It's true for the spina bifida surgery (I was tempted to disagree, but I re-checked).
However, this is because the operation is still in a trial phase. It still has to be proven that the intrauterine operation gives a better outcome than a postnatal operation. I guess that all other hospitals around the world are waiting for the outcome - they don't want to be the ones to have performed complex and risky procedures that later turned out to be no better (or worse) than the conventional, tested approach.
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-
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.
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.
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.
If you see everything as black and white ...
I can go to another insurer too. A different public one, or a private one. I can go without insurance if I really wanted to.
I can go to another doctor.
Me too ! I can go to any doctor in the whole country. And some of the neighboring countries, too.
State-run medical care doesn't exclude any of the things you mentioned. It all depends on the details of the implementation. You're at the mercy of what your government provides, including the infamous "waiting list".
You're just replacing one waiting list with another one (ordered by who'll pay the most).
Canada is no panacea either. Here is how Canada works. For the most part things that are common get covered, myself I pay about $100 a month for insurance to the state (provincial level), $50 for my group plan from my employer (a similar non-group plan would cost $300 for my family). My health insurance would be more to the state but because my wife is stay at home we put the kids under her free plan from the state. (For some reason there is no law requiring a family claim together). I think it would be around $200 a month if we claimed together and her and the kids would pay a whole bunch of user fees and lose a bunch of benefits. That is the funny thing, I pay more and am covered for less. Anyway, so how it works is anything that is expensive doesn't get covered, or they don't have enough machines so you merely die on a waiting list rather than getting denied coverage. In anything cutting edge we are far behind the latest technology so that it doesn't cost so much. Basically, health care in Canada is cheap because we ride on the coattails of the expensive US system that develops the technology. And the system weasels its way out of anything expensive that isn't common. Get Cancer in Canada and you will spend $3000 a month buying drugs. The funny thing is its also ripe with corruption and misallocation of resources.
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.