Health Insurance

[96SC]

 It is not uncommon for a single 25 year old to get personal medical insurance for about $1200 a month premiums.  

Our 25 year old son has personnal medical insurance and it's about $100 per month.  $1200??  Like spa searching...shop around.

[Brewman]

You need to compare apples to apples.  
 A comprehensive health policy that has low deductibles and co-pays, and 100% coverage after deductibles are met, and has coverage for prescription medication, eye glasses, dental, etc...
 will be much more expensive than say a major medical policy that has a high deductible and requires the insured to pay 20% of the bill AFTER the deductible and copay, and offers little or no benefits for anything other than a major event like surgery.  

 Nothing wrong with either policy, it's a simple matter of what level of financial risk you wish to address.  

It's a lot more complicated than just tossing around monthly premium figures around.
 
Absolutely shop around.

[imp etc]

Brewman,

Yes of course there are big differences, but I think you've made a couple of big assumptions. I didn't want to go into the nuts and bolts of my plan, just give a suggestion and a way for Brookenstein to get a quote for her particular situation. For instance, the plan I have does have a reasonable annual out of pocket maximum, after which everything is covered.

It does seem to me that a 25 year old in decent health should not have to make what amounts to a mortgage payment (in many markets) every month, on the Off Chance that they might get sick or have an accident.

[Brewman]

I don't believe I was making any assumptions.  Appologies if I came off that way.

What I was trying to say was that we need to look at what we're getting for our money.  And decide if we can live with that level of coverage.  
  That doesn't even take into account the impact that underwriting as on the premiums.  

 Someone young and healthy can probably assumet the risk of a simpler policy- someone with a family (Like mine) could go to the poorhouse without a comprehensive policy that has a high level of coverage.  Which can easily run into the many hundreds of dollars per month or more depending on all sorts of variables.


 Like any insurance, it's all about risk.  And being able to afford the premiums.

[imp etc]

. . . a major medical policy that has a high deductible and requires the insured to pay 20% of the bill AFTER the deductible and copay, and offers little or no benefits for anything other than a major event like surgery . . .  

Sorry I must have been "in a mood" yesterday and read that as an assumption.

You're right, everybody's situation is different.

Insurance IMO is a betting game - you bet you'll get sick, and the insurer bets you won't. Unfortunately in many cases when they think they're about to lose, insurers can change the game or pull their chips off the table entirely. But that's a tangent for another day

No hard feelings and apologies back atcha.

[Brewman]

No hard feelings at all.  Don't worry about it.

Good discussion stems from those with differing opinions.
 8-)

[dkersten]

So what are you getting for $100 a month or $400 a month for your family?  I would imagine major medical only with personal deductibles at around $2000 or $3000 and family deductibles at $6000 or $8000..  I also imagine this is strictly medical with no dental or eyesight..

Dont get me wrong, major medical is the bare minimum anyone should have considering ANYTHING involving a hospital can drive you into bankruptcy.  A friend's daughter fell at the school yard and broke her arm.. cost was $4800 to set the bone and put on a fiberglass cast.  Same friend needed braces for one daughter.. cost was $18,000.  Another friend shot himself in the chest.. cost was $498,000 for 4 months in the hospital.. he had to pay that one after the insurance didnt cover it.. My uncle got thrown from a horse about 5 years ago.. broke his neck and he is in a wheelchair now.. initial hostipal stay with surgeries was around $750,000.  My mom's second open heart surgery cost around $200,000 ($50,000 was doctors cut, rest was hostipal).  41 year old employee had to have 3 stints replaced around his heart.. 45 minutes in a cath lab.. cost was $23,500.  Those are just a couple examples.. Oh.. how about this:  My last child (seven years ago) cost $14,000 for delivery and one night stay, no major complications, wife and baby home within 24 hours of delivery.  (child 18 months earlier was $8,000).

Around here, an emergency room visit with only a nurse seeing you and taking vitals and releasing you is around $300.. add xrays and it goes up a couple hundred.. add an IV and it goes up.. add a catscan and it goes up another $600.. Go in for a simple kidney stone and walk home with a $1200 bill.. thats all out of pocket costs on a major medical plan..

A 28 year old friend in excellent health was quoted $1200 a month for full medical with $400 personal deductible, co-pays for every visit, full eyesight and full dental coverage.  Dental was standard 80/20 with deductible and eyesight was $300 per year allowance.. max out of pocket was $1000 for year with 100% coverage after that.  This is about as good as insurance gets, and was typical of what I saw around here from businesses back in the 90's.  Yes he could have shopped around and probably could have gotten that coverage for less, and a young healthy person has no reason not to go for minimum coverage.  But I think it is important to see the difference between premiums in good insurance and poor insurance.  Keep in mind, I am not an insurance expert by any stretch, but I have had a little experience from all facets starting as a single person to a parent with mutiple children, and including as a small business owner providing benefits for 95 employees.

My advice to the OP here is to go to work for a huge corporation that is filled with young healthy single people that are all in the insurance plan.. that way you will get really good insurance for practically nothing, assuming the CEO doesnt just pocket the money.  Of course, they will fire you once you are 40 because you will no longer have the efficiency of the 20 year old that will work 15 hours a day and show up the next day ready to go..

[imp etc]

So what are you getting for $100 a month or $400 a month for your family?  I would imagine major medical only with personal deductibles at around $2000 or $3000 and family deductibles at $6000 or $8000..  I also imagine this is strictly medical with no dental or eyesight..

Well not quite, and of course I hope I never get ill or unfortunate enough to prove you wrong . . . however my plan has a $1500 deductible with an annual out of pocket max of $3500. Let's even add in the premium I do pay ($2400/year), plus the MAX $350 I pay per year for contacts and glasses (exams included). I'm doing the math here and it looks like worst case I'll pay $7500/year for medical coverage and treatment.

Now being 43 if I went for deluxe private insurance route, my guess is I'd be paying significantly more than your 28-year-old's $1200/month or $14.4K annually, just for the privilege of being insured.

Again, heavens willing, that's the worst that can happen financially at least, and I get to pay my other bills with the other $7K. Whoa that's a lot of dental work, or even almost enough for a hot tub!  

[Brookenstein]

Sorry, I dissappeared for a bit, it has been busy and I sometimes forget to check this the BS section when I check the boards real quick.  For those PMing me, I'm not ignoring you or being rude, but ever since the upgrade it is hit or miss for me being able to send PM's 9/10 times I get an error message and my message gets deleted and doesnt send.  Anyway, I thank you for the information.

So... here is an interesting update.  We got an email from corporate yesterday.  They are dropping our current provider for 07 (J has worked there for going on 10 years and have always had Mutual of Omaha and provided less and less coverage each year) and they are switching to Great-West.  We will have a choice (first time ever) between a PPO and a CDHP.  We have not been given details on either plan, just a preview/explanation of the CDHP and I'm guessing we will stick with the PPO, but I will have to see the details first.  Fingers crossed in network deductables are less than $500, copays are less than $30, they cover more than 65% in network, and scripts are less than $30 and all will be good.  

[Brewman]

We just got the details on our benefits for 2007,and they once again chipped away at what used to be premier coverage.  
 They used the same old excuses about medical costs spiraling out of control, blah, blah, blah.

[Brookenstein]

I'm a little worried because they haven't released any of the details of the plan they are so 'excited to announce'.   In the FAQ there was some mention of prescription coverage and it sounds like that is getting more expensive for formularies (we already pay $30) but generics may be less.  None of our scripts ever seem to be generics so I'm not sure what we pay for those.  It said something like you may want to talk to your dr about other medications that may be cheaper...  I'm a little nervous, but hopeful.  It also said our dental is suppose to be improving... if we now have orthodontic coverage I will be a little POd given I just spent $1100 on a retainer that gets delivered Monday that wasn't covered at all.  Oh well.

[badval]

I work for a Fortune 50 corp & ours has gotten progressively worse each year.  Cost is higher & coverage is lower.  This year it's getting worse - if your spouse is employed & can get coverage at work (no matter how crappy or costly it is) they have to use it or you pay an extra ~$25/month to keep them on yours.  Of course co-pays for everything keep edging up along with annual deductables & out-of-pocket max's.

We have a lot of "choices" as far as plans, levels of deductables/co-pays/prescriptions/etc, but in the end, they all suck.  What I really hate is every year or two we change carriers completely, so you have to check out each doc in each plan to make sure you don't have to switch.  It's insane.

5 yrs ago, I had my tonsils & adnoids taken out, septum reconstructed, & a tissue reduction in my sinuses.  They did all 4 procedures at the same time & I stayed in the hospital overnight.  It cost me out of my pocket a grand total of $35 - $20 for the initial doctor's visit + $15 for 2 prescriptions they sent me home with.  With the coverage we have now, I'd end up paying well over $1,500.  Yet today's coverage (thru the same employer) costs me 2x more per month than what i was paying then.

[Brewman]

That procedure you had done probably costs thousands more now than it did 5 years ago, too.  We've been struck with double digit increases in medical and drug costs for many years now.  Amazing when the rate of general inflation has been under 5% per year for quite a while now.  What gives?

[Cgy_Spa]

Forgive my ignorance, but as a Canadian I have to ask how you all afford premiums and medical bills like this.  Is everything (mortgages, cars, etc) really that cheap down there?  Last census info I saw, we have a higher average earnings, public (minimal cost) health care, and yet residual income appears similar.  What gives?

[Brewman]

I think that depends largely on the individual.  
 In my case, my employer deducts my health insurance premiums from my paycheck, and the deduction is pre tax-meaning that the premium comes off my pay before they calculate my federal, state, and social security witholdings.  So that offsets the premiums by maybe 20% - 30%- the amount I contribute to my 401K plan is treated the same way.  
 So I learn to live on my net pay.  We also have an flex medical spending account we can fund thru payroll deductions, which is also treated pre tax.  That money can be used to pay whatever insurance doesn't cover, plus a wide variety of other medically related things like glasses, or contact lens chemicals, etc....  
That money has to be spent each year.

 I don't know anything much about Canadian health care- but who actually pays for it?  Is it thru some type of taxes?  Maybe income, or national sales or excise tax?
 I've heard stories where people from my state travel to Canada to purchase prescription drugs because they are that much cheaper than here.  
 I'm curious to know how that works too- are the drug companies charging US pharmacists more, or do our Pharmacies have higher mark ups, or is you Government subsidizing drugs?  
  
In Minnesota our health care is among the best in the world- people from all over the world come here for treatment, but it sure isn't inexpensive.

Wonder why it's so expensive here, but cheaper elsewhere?