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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)?"
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.
While a humorous comment, it highlights what makes the American health care system so unique. We are so fiercely independent, 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 system allows for many benefits as well as problems. The most visible problem is the ever-increasing cost of health care, and the number of people like yourselves who are falling through the cracks because good health insurance is only available through employers who can command group rates. On the flip side, because the state is not dictating how health care is conducting itself, American health care is a hot-bed of new procedures and techniques that push the limits of health care because people are willing to pay for an unproven technique even if it has even a small chance of success if the alternative is not acceptable. For example, the second son of a friend of mine was diagnose with Spina Bifida and instead of accepting that his child would be born paralyzed, was able to find a surgeon who was willing to perform surgery on the child while he was still in the womb! (notice that of the four hospitals in the world that perform this unique and complicated surgery, all of them are located in the United States)
As a graduate student, I am faced with paying for a cut-rate, we-don't-pay-for-anything-unless-you-get-hit-by-a- bus student plan, or a much more expensive individual plan. There are very few national health care providers, and you would be well suited to search for and find a regional health insurance company. In the mid-west, I have been leaning towards Anthem as my insurance provider, and hope to have a plan from them to help me start off the new year.
I haven't lost my mind!
It is backed up on disk...somewhere...
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.
I agree with what you say, but the big difference here is that there are no waiting lists. I moved from UK to US, my family health issues are addressed immediately here. My friends and family in the UK get stuck on waiting lists with can be for months.
Another difference is doctors here make a fortune, just like lawyers. Whereas those in the UK can work 80 hours a week for a middle income. Medical professional are also broken down into an infinite number of specialists here, there's little need to muck around with general practitioners, if you do, you'll get referred to a specialist pretty quick.
There is also free medical for low income and freeloader types. Most places will not turn you away either. If you call up front, you'll be asked about insurance. Even when you receive huge bills, you can make small monthly payments to pay it off. Children without medical cover may be covered by the state, so if you have a young kid and a big bill, yet have no insurance, and if your income is low enough (which is less than something like $50-60k I've been told) the state will pick up the tab.
It's not all doom and gloom like you think it is. Yes, there's a huge amount of profiteering, a bill will be for different values depending on payment, and insurance companies waste a huge resource avoiding payment, you really have to be on the ball even with cover. The real issues are for the long term sick, rather than fixing up a damaged body part.
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 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).