Health insurance

[cjparker0110]

So she is paying $580... I see BCBS offering plans from $70-$220... why not just look into one of those??? Downside to that?

In the process of changing insurance she should be sure to look into a few things:

1. Compare not just the monthly cost, but also out of pocket expenses/dedictibles. A lower premium is of no benefit if you have to pay thousands of dollars in deductibles before the insurance kicks in.

2. Look into which providers accept that particular insurance. Many providers are dropping certain insurances (especially state ones, but also just regular ones) because they get paid less for services than from more expensive insurance companies. BCBS is one that I've seen a few clinics drop in the last several years. Our Dr. was considering dropping it at one point because it was paying about 10% less than everyone else.

3. Be sure to see what the annual caps are on the insurance plan, as well as what things it will cover. While we all hope to be healthy, there is always the issue of emergencies...that is why we need insurance. Pointless to have something if it won't cover a basic surgery and hospital stay.

All insurance changes should be made carefully and with caution. You're stuck with it for a year so don't do it unless you know it's the right one for you.

 

[lanejudy]

Your right. Sorry I wasn't clear. My bad. For all doctor visits its $65 co-pay. Adds up quick if we have 2-3 visits a month.

To answer your question, in my experience, $65 sounds like a high co-pay for an office visit. The PPO plans I've seen had office visit copays in the $10-$40 range. As a PP mentioned, there are different plans with different co-pays, co-insurance and/or deductibles. Maybe your plan doesn't have a deductible so it has higher copays. There's almost always a trade-off. I agree with PP that when looking at insurance options it's important to look at the whole picture and not just one component.

 

[Gracie09]

It doesn't hurt to check. But federal poverty level for a family of 2 is $16K. IL covers up to 300% of the FPL ($48K). I also think her child support would be included.

http://www.allkids.com/income.html

Looks like she could just squeak in at 50k. It would be for a plan with a $40 premium per month. It does not appear that child support counts toward income, alimony does, but not child support. There would be $10 co-pays for doctors visits and some co-pays (under $10) for drugs.

 

[havaneselover]

http://www.allkids.com/income.html

Looks like she could just squeak in at 50k. It would be for a plan with a $40 premium per month. It does not appear that child support counts toward income, alimony does, but not child support. There would be $10 co-pays for doctors visits and some co-pays (under $10) for drugs.

If you are bored, you can do a pretend application and be told you likely won't get assistance based on the information provided by the OP. Also according to the agent manual child support is counted as income (although $50/month looks to be exempted). Again, it's worth checking out but I doubt it will pan out.

Also, it appears if the child has had coverage in the last year, the income requirement is much lower.

 

[tvguy]

That is about the going rate here for a dependent through a private employer.
How much is it through the Illinois health exchange? (The Illinois run Affordable Healthcare Act insurance system)
https://getcovered.illinois.gov/en

Okay, I am used to be ignored, but the whole idea of the Affordable Healthcare Act was to give you one place to go to find all your options for healthcare, and any subsidies you might be eligible for.

 

[paladin]

I am sure she has probably checked on this, but just in case she hasn't - Have her check if work offers a Self + One, instead of a Self + Family as the Self + One is generally less expensive.

 

[DVCcurious]

I may get flamed for this but....

I don't understand why anyone pays for health insurance now. If you get it cheap through work then sure go ahead and get insured. But if you have to pay more than $400 per month I think you're a sucker. What are the odds you're actually going to use $5000 worth of care in a year? Besides, the insurance companies have to take you if you get sick. Just buy insurance when you need it then drop it when you don't anymore.

I know people are going to say this is irresponsible, blah, blah, blah. But you gotta look out for #1 here. You're not part of the 1% so you can't afford the insurance. Wait until you need it before you buy it. Buying insurance when you're not sick or injured is a sucker's move.

A single mom making $50k per year has much more important things to spend the money on than health insurance.

 

[Gracie09]

I may get flamed for this but....

I don't understand why anyone pays for health insurance now. If you get it cheap through work then sure go ahead and get insured. But if you have to pay more than $400 per month I think you're a sucker. What are the odds you're actually going to use $5000 worth of care in a year? Besides, the insurance companies have to take you if you get sick. Just buy insurance when you need it then drop it when you don't anymore.

I know people are going to say this is irresponsible, blah, blah, blah. But you gotta look out for #1 here. You're not part of the 1% so you can't afford the insurance. Wait until you need it before you buy it. Buying insurance when you're not sick or injured is a sucker's move.

A single mom making $50k per year has much more important things to spend the money on than health insurance.

If you have kids the odds you are going to use $5000 a year in health care is high. My dd1 as an infant needed up in the er, followed by a week in the hospital due to rsv. Well over $5000 that week alone. Then there was the er trip due to coxsaxki. Then the multiple ear infections. The next year she broke her wrist. The year after bronchitis and pneumonia. My other dd tend to be healthier but she split her head open and the er and plastic surgeon (it was a head wound). $5000 right there. This isn't counting the normal check ups and immunization etc. your attitude is a huge contributing factor into why healthcare is so expensive. If you end up in the er with a heart attack, broken limb, cancer, etc, you don't get to just get health insurance at that point. You might be lucky and get charity care (paid for by the money of people who have health insurance) or Medicaid if your income is low ( 0paid by tax dollars) but likely you would be facing tens of thousands if not hundreds of thousands of dollars of bills. Medical debt is the number one reason people go bankrupt in the U.S.

 

[Judique]

[QUOTE="tvguy, post: 54688406, member: 58756".[/QUOTE]
deleted

 

[PlutoPony]

I don't understand why anyone pays for health insurance now. If you get it cheap through work then sure go ahead and get insured. But if you have to pay more than $400 per month I think you're a sucker. What are the odds you're actually going to use $5000 worth of care in a year? Besides, the insurance companies have to take you if you get sick. Just buy insurance when you need it then drop it when you don't anymore.

Right now all insurance plans are required to cover pre-existing conditions - that's a provision of the ACA for all insurance, not just ACA policies. However, IF the ACA act is ever repealed/gutted/whatever you want to call it, watch for this provision to be discontinued by insurance companies. And if it is, NOT having insurance until you need it is becomes a huge issue.... because if you don't insure and find out you have a health problem, insurance will NEVER cover it. It becomes a pre-existing condition. So it will be a HUGE RISK to not insure if pre-existing conditions are not covered down the road. Just something to keep in mind....

 

[crisi]

If you have kids the odds you are going to use $5000 a year in health care is high. My dd1 as an infant needed up in the er, followed by a week in the hospital due to rsv. Well over $5000 that week alone. Then there was the er trip due to coxsaxki. Then the multiple ear infections. The next year she broke her wrist. The year after bronchitis and pneumonia. My other dd tend to be healthier but she split her head open and the er and plastic surgeon (it was a head wound). $5000 right there. This isn't counting the normal check ups and immunization etc. your attitude is a huge contributing factor into why healthcare is so expensive. If you end up in the er with a heart attack, broken limb, cancer, etc, you don't get to just get health insurance at that point. You might be lucky and get charity care (paid for by the money of people who have health insurance) or Medicaid if your income is low ( 0paid by tax dollars) but likely you would be facing tens of thousands if not hundreds of thousands of dollars of bills. Medical debt is the number one reason people go bankrupt in the U.S.

Even if you don't have kids - I fell in my kitchen from a stool and hit my head earlier this year. I have a girlfriend who spent six weeks in the hospital with a sudden onset respitory infection - one day she was fine, the next in an ambulance. There isn't always time to get insurance if you get ill or have an accident.

 

[PatMcDuck]

My daughter lost her medical insurance under DH, her Dad, at age 22. He is retired from a union, and they have decided to not extend coverage to older adult children. (loophole in the law allows employers to exclude retirees kids). She worked part time. I decided to spin her off, no longer claim her as a dependent, and get her Obama care insurance, based on her income. She has finished school, still working PT while she looks for a FT job, now 23. Her insurance is around $125 a month, not Medicaid, it is Horizon BC/BS, no deductible, $10 copays. It is not as good as ours (me and DH) but to add her to ours would have been almost $1000/month more, double what we pay.

 

[smadath]

[QUOTE="DVCcurious, post: 54690017, member: 470958" Besides, the insurance companies have to take you if you get sick. Just buy insurance when you need it then drop it when you don't anymore."/QUOTE]

No, insurance companies can't deny pre-existing conditions. But, they do not have "to take you if you get sick." They can't deny when you enroll for pre-existing conditions. But, you have to apply during the enrollment period (usually October/November) to be covered for the year. If you're sick at the time, no problem. If you opt to not enroll, then get sick in January, you're out of luck until the next enrollment period, and you are on the hook for all expenses.

The exception is if you have a "life change event" like getting a new job, a wedding, new baby, etc. Then you can change/enroll in insurance.

 

[smadath]

Deleted. (oops!)

 

[DVCcurious]

[QUOTE="DVCcurious, post: 54690017, member: 470958" Besides, the insurance companies have to take you if you get sick. Just buy insurance when you need it then drop it when you don't anymore."/QUOTE]

No, insurance companies can't deny pre-existing conditions. But, they do not have "to take you if you get sick." They can't deny when you enroll for pre-existing conditions. But, you have to apply during the enrollment period (usually October/November) to be covered for the year. If you're sick at the time, no problem. If you opt to not enroll, then get sick in January, you're out of luck until the next enrollment period, and you are on the hook for all expenses.

The exception is if you have a "life change event" like getting a new job, a wedding, new baby, etc. Then you can change/enroll in insurance.

Let's all agree on the ground rules here. The OP is looking at 400 per month for insurance for her kid. So if she doesn't have insurance and has a $5,000 health care bill during the year she is in the same financial position with or without insurance. The only benefit having insurance would give her is if her family has a major issue that costs more than $5000 in a year.

Now to the point of the person above. Yes you must enroll during open enrollment UNLESS you have a life change. So if you don't get insurance and you come down with a serious illness where you will go bankrupt if you have to pay out of pocket just change jobs and then apply for Obamacare. Problem solved. Remember the ground rules: you're committed to 5k per year with or without insurance. So a major medical issue by definition has to be signifcantly above $5k per year. If you have a 30k medical problem it's well worth your trouble to switch jobs to get on Obamacare and save that 30k.

Only a sucker pays $5k per year for insurance. Over 10 years you'd spend $50k!!! Sure it's possible you COULD have a serious issue and end up hospitalized., but what is probability you will end up with a bill more than $5000? Not very likely. You also could get struck by lightning or win the lottery. Those are all about equally likely outcomes with having a major medical issue (>10,000 in cost) in any one year.

I'm 40, my wife is 40. Outside of her pregnancy and giving birth we've never spent more than a few hundred dollars in any one year on medical care in our entire life.

Insurance company stock prices are up 500% since Obamacare was enacted because Obamacare is a good deal for the insurance companies, not the consumer. Follow the money to find out who the winners and losers are.

 

[smadath]

DVCcurious, Yes, that scenario would work. However, I'm not sure that at the time of a catastrophic illness or injury someone "just" wants to find a new job. Or wants to end their source of income just to get insurance. They may have seniority built up that they don't want to lose...

So, while that is an option, it seems pretty extreme and risky, and another headache at a time that is already stressful.

 

[tvguy]

DVCcurious, Yes, that scenario would work. However, I'm not sure that at the time of a catastrophic illness or injury someone "just" wants to find a new job. Or wants to end their source of income just to get insurance. They may have seniority built up that they don't want to lose...

So, while that is an option, it seems pretty extreme and risky, and another headache at a time that is already stressful.

Yes, risky. But it was one of the arguments opponents of ACA made, because there are people out there who did not want any health insurance. They know if they get sick, a hospital cannot refuse to treat them. They know they are gambling, and may have to file bankruptcy if they are wrong. I know people who choose to pay the penalty rather than buy insurance, because the penalty is less than buying insurance.

 

[Gracie09]

Yes, risky. But it was one of the arguments opponents of ACA made, because there are people out there who did not want any health insurance. They know if they get sick, a hospital cannot refuse to treat them. They know they are gambling, and may have to file bankruptcy if they are wrong. I know people who choose to pay the penalty rather than buy insurance, because the penalty is less than buying insurance.

So far the penalty is less. It increases every year and you still have to pay out of pocket for health expenses

 

[Gracie09]

Yes, risky. But it was one of the arguments opponents of ACA made, because there are people out there who did not want any health insurance. They know if they get sick, a hospital cannot refuse to treat them. They know they are gambling, and may have to file bankruptcy if they are wrong. I know people who choose to pay the penalty rather than buy insurance, because the penalty is less than buying insurance.

And these are the people that greatly contribute to rising healthcare costs. If they file bankruptcy because of medical bills, who do you think gets left hding the bag for the bills? The hospital who passes the costs onto the other patients/insurance companies.

And hospitals only have to cover your emergency care. So you break your leg, they will cast it but follow up is on you. Same with cancer. Diabetes etc etc. they get you stable and ship you out.

 

[Gracie09]

Let's all agree on the ground rules here. The OP is looking at 400 per month for insurance for her kid. So if she doesn't have insurance and has a $5,000 health care bill during the year she is in the same financial position with or without insurance. The only benefit having insurance would give her is if her family has a major issue that costs more than $5000 in a year.

Now to the point of the person above. Yes you must enroll during open enrollment UNLESS you have a life change. So if you don't get insurance and you come down with a serious illness where you will go bankrupt if you have to pay out of pocket just change jobs and then apply for Obamacare. Problem solved. Remember the ground rules: you're committed to 5k per year with or without insurance. So a major medical issue by definition has to be signifcantly above $5k per year. If you have a 30k medical problem it's well worth your trouble to switch jobs to get on Obamacare and save that 30k.

Only a sucker pays $5k per year for insurance. Over 10 years you'd spend $50k!!! Sure it's possible you COULD have a serious issue and end up hospitalized., but what is probability you will end up with a bill more than $5000? Not very likely. You also could get struck by lightning or win the lottery. Those are all about equally likely outcomes with having a major medical issue (>10,000 in cost) in any one year.

I'm 40, my wife is 40. Outside of her pregnancy and giving birth we've never spent more than a few hundred dollars in any one year on medical care in our entire life.

Insurance company stock prices are up 500% since Obamacare was enacted because Obamacare is a good deal for the insurance companies, not the consumer. Follow the money to find out who the winners and losers are.

According to Forbes and the bookings institute, starting in 2015 the average American will pay $10000 in health care costs (not insurance premiums but cost of actual healthcare) annually. You are making many assumptions - first a person with a major health issue is not going to change jobs. Most employers don't provide sick time right off the bat. So how are you going to keep that new job and go to the doctors visits? Second you are assuming they could find one making enough money and health insurance. I am sure the op has considered this option.
I have insurance on my car, my house, my life, my kids lives, my husbands life etc etc. in all likelihood I will use little of the insured value of all these things, but if I have to I dare say it's worth it. You may feel health insurance is for suckers but you are relying on the public to bail you out if you get in over your head.

And to the pp who was concerned about maximums on policies, under aca there are none.