Jacob's post on his health insurance was pretty eye opening. Proof that one can get affordable health care.
But, like many of the commenters suggested, does anyone do this that has a family, older, sick?
Everyone I've known that fits into those categories is paying a premium close to $1k/month.
Having had two family members in the hospital this year, it was about $8k in charges/day plus lots of other things. Even with great insurance, we paid thousands out of pocket.
Kids will eventually get their own insurances.
Also I think something that's missed is a couple getting two individual insurance plans instead. It would have been more expensive for me to go in under DW's corporate plan. Yet, I think many default to the corporate offer without considering alternatives.
Then there's also Vermont
http://www.vermontforsinglepayer.org/
My high deductible plan is also ~$90/mo at 27 in Texas. When I looked at plans for my partner (same age, male), they were significantly cheaper. But we have no family and are in good health. Mostly, I fear getting hit by a car on my bike or getting injured sailing. Also, I think that it has disqualified me from getting no-cost family planning services which are free in Texas as long as you are uninsured.
Your personal health insurance can go up much faster than the general rate of health insurance inflation.
Apparently many states have regulations that individual health policies can't be cancelled by the covering company (with provisos for fraud, etc...). But the regulations obviously allow the company to cover costs + a profit, and this is done over a particular pool of individuals.
So the insurer creates pool X, lets it fill up with a mix of healthy and ill individuals, and in a few years they close X and open pool Y. Individuals in pool X can't be dropped, but as they get older the health costs increase. So the healthy people voluntarily leave pool X and get into Y (or another pool). The ill people in pool X can't move to pool Y because they now have preexisting conditions. Pool X is now filled with expensive ill people while pool Y is cheaper because everyone is healthy. The prices for insurance in pool X increases faster than Y.
Over time pool X becomes too expensive for the ill to afford.
The moral of the story is if you want to ERE, don't become ill, and don't let your family become ill or you'll get stuck in pool X.
Forgive this novice question... Say I needed a basic, covered, non-emergency, non-life threatening surgical procedure.
Could I just get a health plan, pay the premiums for a month, have $50k surgery and then cancel the plan in a few months?
Haha, sorry... Funny I made it to adulthood knowing so little about insurance.
@JohnnyH
Well, that depends...
If you just happened to have the policy, then subsequently needed surgery, then later cancelled: no problem. The policy will target the date of service. As long as it was within the coverage period, the insurance will pay.
But, if you developed complications or needed follow-up, etc.; any service outside the dates of coverage would be denied payment. So this is not entirely a risk free approach. And it is a one-time opportunity, because any future application for insurance will take into consideration the prior surgery. Obama-care notwithstanding, the prior surgery will probably result in a denial of future coverage.
Now, if you took out a policy contemplating surgery for a pre-existing condition, and the company were later able to determine that you were aware of it (e.g. through evaluating medical records prior to coverage); payment would be denied despite the existence of the policy. The policy would be rescinded; and depending on circumstances, you might face criminal prosecution for fraud. Most individual policies require medical underwriting based on your application. You fill out a long list of your pre-existing medical conditions and attest that you are not omitting anything.
Bottom-line: you really cannot game the system. Just cover what you need to cover to avoid financial meltdown in the event you actually need the stuff.
@dot_com_vet I have a family of 5 with 3 young kids and I have a high deductible health insurance plan, similar to Jacob's. I pay $369/month for the premium. The deductible is $5,400 and, quite frankly, with 3 kids (one with some health problems) I probably end up using most of it, so I probably end up spending almost $800/month all-in. I don't think you can really do much better than that with a family, other than avoiding doctor's visits -- if somebody has better ideas, I would like to hear them.
Thanks very much Maus, very informative to me. Even outside of national laws, aren't there state limits to the "pre-existing condition" look back period?
As soon as you have the surgery once, you now have a pre-existing condition? Even 5, 10 years pass it will still be a factor in obtaining insurance, even in states with these limits?
http://en.wikipedia.org/wiki/Pre-existing_condition
I was able to find this:
http://healthinsurance.about.com/od/healthinsurancebasics/a/preexisting_conditions_overview.htm
"For example: Mike J., a 34 year old man, recently got a new job after being unemployed for almost a year. His new company allows employees to participate in its health plan at the end of the first pay period. Mike has mild asthma and sustained a knee injury playing basketball when he was in his twenties. In the six months prior to the time he enrolled in his employer’s health plan, he had no doctor visits and did not take any medication. He was not subject, therefore, to any exclusion period for his pre-existing conditions. Shortly after he started working, his asthma worsened – he was fully covered for all of his asthma-related care."
This sounds similar to what I was asking. I think as long as one stays out of the no limit pre-existing condition states (Alaska, Arizona, Arkansas, Delaware, District of Columbia, Louisiana, Missouri, Nebraska, Nevada, Oklahoma) and can wait 6-18 months between claims, you wouldn't be denied health insurance and claims for a such a condition in the future?
Assuming Obamacare actually goes into force, this all changes in 2014. Nobody really knows how it is going to shake out.
@JohnnyH
Two things:
1. The example you cite is for someone using employer-based group coverage. Typically, that only excludes pre-existing conditions diagnosed within six months of the onset of coverage. This is quite distinct from a personal policy obtained on the market, say by a self-employed individual or an EREista. In almost every case (but guaranteed issue, which is hugely expensive), the application for a personal policy will be medically underwritten. In other words, it will require at a minimum some type of disclosure form for past medical conditions and may, in some cases, require a physical exam by a doctor (e.g. your BMI is >30). Unfavorable medical underwriting can lead to either a denial of coverage or an offer of Level III coverage (higher premium, higher deductibles, etc.).
2. Obama-care will indeed change much of this if it survives the next election cycle. Already, most states have a guaranteed-issue policy for pre-existing conditions. In California, you can obtain fairyly good coverage but at a price. A 40 y.o. living in the Bay area will pay around $500 per month. Already, lifetime caps have been eliminated from existing policies; so you no longer have to worry that one heart attack or one bout of cancer will wipe out your lifetime allottment of coverage. Beginning in 2014, the exclusion of pre-existing conditions will be eliminated fully for all insurance providers. The one unknown is what universal coverage will cost. If Mass. is used as a model, the premiums for their policies have increased dramatically year-over-year; to the point where the low-income subsidies have become a major burden on the state budget process. Will it be possible that around 2020, Obama-care will mandate coverage but will no longer offer the subsidies? This would basically devolve into a ploy to use the penalty assessment (mostly from healthy, young people who decline to purchase insurance) as a general fund revenue source. Or maybe I'm just cynical.
Anyway, best of luck as you navagate these swamps of despond.
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