rainbownelle

Okay, forget the pre existings, what about health insurance otherwise? Any recommendations?

I've read the Wiki, which was helpful, but I'm still kinda confused. E.g. is the deductible payable for office visits? Or prescriptions? (Are office visits just like GP visits?)

And all this copay, and coinsurance...scary!

SO CONFUSED

MsElui

i dont get it fully myself - but i have to pay a co-pay of $10 every visit to the doctors regardless of what i do there. sometimes i have to pay more later for certain things (ie childbirth - i have to pay the doctor 20% of his fees for attending - will cost me about $400). Prescriptions vary enormously - I have paid $1 after the insurance bit is covered for pegnancy vits but also $50 for my husbands asthma meds (insurance contributed $50 as well). Helps if you ask the doc for a generic prescription ie ibuprofen rather than the branded Advil.

Mummy in the foothills

OK We bought our own for a couple of years and this is what I figured out.
1 we had monthly payments which were way too high and went up annually
2 The deductible was the amount you had to pay out in co pays before the insurance would cover everything (which somehow still didn't cover everything)
3 the Co pay for us was 20% of a doctor visit so long as we used a doctor that was part of their plan. It was different amounts for lab tests, ER visits, hospital stays.
4 It was all so confusing I was ready to just stop paying it all, I'm sure we were ripped off.

Rete

Alot depends on the insurance carrier and how you obtain your insurance.

For the most part, an HMO has no deductible for general doctor's visit. There is a co-pay from you for each visit and the HMO coverage picks up the rest of the bill.

If you remain in-network using the doctors and medical facilities that except the healthcare insurance you are participating in that is all you will ever pay --- the co-pay.

If you are self-insured, then you will most likely have a deductible and that can run up to thousands of dollars before coverage kicks in and then the doctor and/or medical facility might well make you pay the difference that the insurance doesn't cover.

Tracym

The problem is, every policy is different. You have to look carefully at the specific policy you are considering. What others posted about their actual policy is certainly correct - for them. But very well may not be for you.

For example, policies can have a fixed amount co-pay for Dr. visit (for ex. $20) and this might or might not count towards your deductible. Prescriptions are often separate, and either have their own deductible, or none at all.

Generally, the deductible is the amount you pay before the insurance pays anything. Except... they might just require a co-pay for dr. visits and meds.

Realizing - the above doesn't help much. I'll give you an example of one PPO plan - which is the kind of thing I would look for in your place. With a PPO, you try to use only doctors and hospitals in their network, so I am only going to address that.

Dr. visits - $20 co-pay (that's all you pay for one dr visit)
Prescriptions - $15-$35 co-pay (that's all you pay for each prescription)
Deductible - $500 (the above co-pays do NOT count towards this) so... if you go to the hospital, you pay the first $500 the first time in the year
Co-insurance - 20% - after the deductible, for things except dr and drugs, you pay 20%)
Maximum out of pocket $2500 (once you have paid that much in co-insurance, the insurance pays 100% for th rest of the year)
I don't think co-pays count against the max out of pocket, but I'm not sure

My suggestion would be - why don't you put up a link to a policy you are considering, and we can help you interpret it. You would try to get all the numbers (co-pay, deductible, and max out of pocket) as low as possible while being affordable to you.

Elvira

Just to be clear - the costs you quote would be IN ADDITION to the monthly premiums.......... which are likely to be several hundred dollars, and could even be above $1000/month...

Tracym

Right, of course. Thanks, I was assuming that - but not everyone would I'm sure.

rainbownelle

Wow guys, thanks so much, I'll do some research and show you what I find. I was a bit confused about deductibles and when/how often they were used.

That example policy - who was it with? And how much were the premiums?

Thanks!

Tracym

My husband gets insurance through a professional organization - it is a group plan. Unfortunately, that is not available to people outside the orginazation.

Premiums will vary considerably depending upon a person's age, and can be somewhat higher under some circumstances if a person has pre-existing health conditions (not usual for a group plan, this one is different from an employment based plan).

Sorry, I know that wasn't a simple answer at all - unfortunately, there isn't one.

Michael

If your employer provides a health plan, you do not have any options except to either accept that plan or possibly completely opt out of the plan for an open market plan.

Employer provided plans vary widely in benefits as well as costs.

As an example, currently my brother only receives about $300 per month from the employer to help pay for a Blue Cross PPO group plan. Any premiums above that amount must be paid by him.

On the other hand, the companies that I have always worked for paid the full premiums for the plans for both me and my dependents. Some companies allowed me to choose from a wide variety of plans from PPO, EPO, or HMO plans and were paid for out of a flexible benefits accounts.

naomi

Yeah, every plan out there is different so it's very hard to compare. For example, my employer-based plan is "managed care," and I pay $160 per month for my daughter and myself. My husband gets his own health insurance through his employer as it worked out cheaper that way. Each time I go to the doctor I pay a $10 co-pay, although well child visits don't cost anything. My prescriptions vary depending on the medication. I have pretty good insurance compared to a lot of people. There is a useful article about American health insurance on the Wiki here.
Naomi.

Lothianlad

It's all this US Health Insurance thing which is seriously making me think I should stay here in the UK after all - it seems like a nightmare even trying to understand it all from reading all the stuff in these posts. I'm only 26 so my health is fine but in years to come more than likely it won't be so good and if I ever did get ill in America it seems from what I read here that it's just as likely I'd get a whole lot more ill just trying to understand the healthcare situation over there.

Michael

There is one thing that many US doctors and patients do not understand about the costs of prescription drugs.

Everybody knows that generic drugs can be significantly cheaper than brand name drugs but many people do not realize that many drugs cost almost the same price no matter what the dosage and many of those drugs can be cut in half or even quartered to keep the needed per dosage price down. Since most prescription drug plans require a co-pay (ex. $15 generic and $30 brand for a months prescription), most people do not worry about the cost of a drug other than to use a generic drug when possible.

Since most prescription drug plans would still charge a co-pay of the same amount per month whether the prescription indicates 1 @ 20 mg per day, 1/2 of 40 mg per day, or 1/4 of 80 mg per day, the doctor will normally perscribe whole pills only unless purposely asked by the paitent.

So sometimes you may be wasting your money paying for a prescription drug plan or purchasing the drugs using the prescription drug plan since your drugs could cost you less than the co-pay.

The following are just 2 examples.

http://www.drugstore.com/pharmacy/dr...cor&trx=1Z5007

http://www.drugstore.com/pharmacy/dr...HCl&trx=1Z5007

The first example is simvastatin (brand name zocor) which cost $27.99 per month for 20 mg tablets, $27.99 per month for 40 mg tablets, and $32.99 per month for 80 mg tablets. If the patient needs 20 mg per day, the 40 mg tablet can be cut in half or the 80 mg tablet can be quartered. If the tablet can be quartered, the cost could be about $8 per month.

The second example is Amitriptyline HCl (brand name Elvail). This generic drug is so inexpensive that it would probably be cheaper, no matter what the dosage, to purchase it without using your prescription drug plan (maximum cost of $8 per month at any dosage without the plan). If it is cut, the price can be reduced to as little as $2 per month.

rainbownelle

Okay I found one I like let me know what you think

Details at a Glance

* Plan Type
* HMO
* Office Visit for Primary Doctor
* $20 Copay
* Office Visit for Specialist
* $30 Copay
* Coinsurance
* None
* Annual Deductible
* None
* Separate Prescription Drugs Deductible
* None
* Prescription Drugs
* Generic: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
*
* Brand: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
*
* Non-Formulary: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
* Annual Out-of-Pocket Limit
* Individual:$2,500
* Lifetime Maximum
* Unlimited
* Health Savings Account (HSA) Eligible
* No
* Out-of-Network Coverage
* No
* Out of Country Coverage
* Emergency Care Only
* Find Doctors (Search to see if your doctors are part of this plan's network.)

Physicians

* Primary Care Physician (PCP) Required
* Yes
* Specialist Referrals Required
* Yes

Preventive Care Coverage

* Periodic Health Exam
* $20 PCP/$30 Specialist
* Periodic OB-GYN Exam
* $20 PCP/$30 Specialist
* Well Baby Care
* $20 PCP/$30 Specialist

Prescription Drug Coverage

* Generic Prescription Drugs
* Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
* Brand Prescription Drugs
* Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
* Non-Formulary Prescription Drugs Coverage
* Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
* Mail Order for Prescription Drugs
* Generic: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
*
* Brand: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
*
* Non-Formulary: Full charge for Rx costing $15 or less; the greater of $15 or 50% of charges for Rx costing $15 or more
*
* Days Supply: 30
* Separate Prescription Drugs Deductible
* None

Hospital Services Coverage

* Emergency Room
* $100 Copay (waived if admitted)
* Outpatient Lab/X-Ray
* Lab: $15 Copay/X-ray: $25 Copay
* Outpatient Surgery
* $50 Copay
* Hospitalization
* $300 Per Day, up to $1500 Per Admission

Maternity Coverage

* Pre & Postnatal Office Visit
* $20 Copay
* Labor & Delivery Hospital Stay
* $300 Per Day, up to $1500 Per Admission

Additional Coverage

* Chiropractic Coverage
* Not Covered
* Mental Health Coverage
* $20 Copay

Additional Information

* A.M. Best Rating
* B++pd as of 09/21/2007
* Application Fee
* No
* Electronic Signature for Application Available
* Yes
* Will insurance company obtain and pay for medical records?
* N/A
* Additional information about this health insurance plan is available in the documents below.
Plan Brochure
Exclusions and Limitations




IMPORTANT NOTICES AND DISCLAIMERS

* THE BENEFITS MATRIX IS A SUMMARY FOR INFORMATIONAL PURPOSES ONLY. REVIEW THE EVIDENCE OF COVERAGE AND INSURANCE POLICY (PLAN CONTRACT) FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS, LIMITATIONS, AND EXCLUSIONS. ONLY THE TERMS AND CONDITIONS OF COVERAGE BENEFITS LISTED IN THE POLICY ARE BINDING.
* The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
* The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
* Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
* The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history, the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.

CARRIER SPECIFIC NOTICES, DISCLAIMERS, AND FEES

* Kaiser Permanente offers the first of the month effective date for approved coverage. [/SIZE][/I]

Ray

They are all a damn con anyway

My wife had one for a year ...then got sick costing $25k
they just refused to pay and returned all the premiums she had paid ...