View Full Version : Americans: What is your health coverage?

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07-27-2012, 09:25 AM
On a wing and a prayer right now---I'm in good health but until I am gainfully employed (more than my mother's caretaker) I will be uninsured as the plans that will take me are too expensive. I was able to go to immediate care after a man hit me and totaled my car. His insurance paid the bills for my swollen knee and a few other tests.

07-27-2012, 12:18 PM
Oh, one more question: Do you have options for employer plans, or does everyone who works for the organization have the same plan? For me, everyone who works there has the same health plan, but there are two tiers of dental plans.

I work for a state government. We have many, many, choices. Most are very similar, but there are differences. Soon we'll have to choose again. It is a cumbersome process that has us going to info sessions and choosing from a large benefit book for more than a month. We do it all online, but there have been problems in the past with the system forgetting our information. So that last day we are all rushing to confirm.

07-27-2012, 01:19 PM
Yikes.... a lot of these plans have high deductibles! Bummer.

The basic details I can remember on mine is that for employee plus one is is 170 a month or so.... there is either no deductible, or it is only 100$ for some services. Copays are 20 for primary care and 40 for specialist. No referrals necessary. No preexisting conditions clause. So, overall a great plan. I guess my employer was right when they say it is a pretty good plan compared to others in the market.

07-27-2012, 03:03 PM
I'm very fortunate. My company offers a wide selection of plans. They pay a set amount, and then you can choose, based on what you are willing to pay in addition, a low deductible or high deductible, anywhere from 50% - 100% coverage, prescription coverage, dental coverage, vision coverage, short-term or long-term disability, etc. You can change your elections for each year.

My current plan:

How you get it (employer, family member's employer, pay individually, etc): employer

Number of people in family on plan, including yourself: two

Your monthly contribution toward premium: $82/month

Deductible: $1,000/person; 70% coverage thereafter, with maximum employee cost of $5,000

Office visits: $40 general; annual preventive well-checks are free

Referrals for specialists: Limited requirements

Out of network coverage: 50%

Emergencies: covered

Prescriptions: elected no coverage since rarely required

Mental health: covered

Pre-existing conditions: covered

Customer service: Never had any problems

Other: elected dental and vision coverage; Can contribute to a pre-tax flex plan if expect expenses.

07-27-2012, 03:51 PM
How you get it (employer, family member's employer, pay individually, etc):Husband through work

Number of people in family on plan, including yourself: 5

Your monthly contribution toward premium:I'm not sure. It isn't cheap, but it's a lot better than a lot I've heard.

Deductible:I think I read $1,500?

Office visits: $20.00

Referrals for specialists: I don't need one.

Out of network coverage: No.

Emergencies: $75

Prescriptions: Really cheap. Sometimes as low as $3.00. A whole glob of insulin for me is $20.00 co-pay and testing strips are no charge. Although I have to go through that soul-sucking company, Liberty.

Mental health: No idea.

Pre-existing conditions: Covered, thank God!

Customer service: Basically garbage. Well, once you get to an actual human being they are pretty great. But getting to a human in enough to test out their policy on mental health.

Other: I have pretty good insurance through my husband and I'm really thankful for it. I've been without insurance, and it's not fun.

07-27-2012, 03:56 PM
Oh, one more question: Do you have options for employer plans, or does everyone who works for the organization have the same plan? For me, everyone who works there has the same health plan, but there are two tiers of dental plans.

IIRC, we have 3 carrier choices, each of which has a minimum of two options (hi/low deductibe, PPO or full option). I think I had 8 choices total.

07-27-2012, 07:25 PM
I am confused about pre-existing conditions. I thought the HCA mandated that pre-existing conditions be covered immediately. But apparently only if you have continuous coverage (moving from one plan to another).
If you scroll down to Current pre-existing condition exclusion regulation (http://en.wikipedia.org/wiki/Pre-existing_condition), it gives individual state legislation regarding pre-existing conditions.

When it comes to plans, if your employer or spouse's employer offers 3 or 4 tiers of coverage, I recommend reading the benefits thoroughly, looking at your medical bills/expenses for the last 2 or 3 years before selecting one.

The cheaper in premiums vs.high deductible or other coverage may not be cost-effective. The lower deductible and better prescription plan may not be worth the higher cost. It maybe that the previous year's medical expenditures were extremely high and you think that it is better to have the lower deductible - but the previous year was an unusual one.

I do think that more and more businesses have started to move from offering 2 or more plans in an effort to contain the business' costs.

07-27-2012, 08:13 PM
You're going from this incredible plan to only an HSA? :eek: Do you have the option of COBRA if you still work for the place?
Yes, this is the best health plan I have ever heard of in the US. I was going to ask whether you work for the military.

Bad bad move on the part of management. This will not only reduce competitiveness for candidates, though I guess so many people are desperate for a job and will take anything, but it will also make current employees unhappy and lower morale.

Why don't they switch to a plan like the rest of us have in which you pay part of the premium?

I dont work in the military :)

We are not only getting the HSA, we also have the other options, still.

the HSA is not 'just' ans HSA - I don't fully understand it, but I *think* what will happen is that
-preventive care is covered 100%
- everything else has a large deductible/copay?
- some or all of that cost is offset by our employer ontributing to the HSA for us
- there is a max out of pocket cost, which I can't remember is higher or lower than the maoney the company contributes.

I frankly havnt read all details, hoping it would go away :slinkaway

In the end I think what will impact the most is that we now have to worry about whether the providers use the right code for preventive care and so forth.

Unfortunatly, even if we could get it under CORBA, obviously the plan is ridicoulsly expensive

I think part of the reason it is changing is the following experience I had while pregnant:

- we could do this test, it is a little expensive, but it may be in the risk groups since you both are caucasians. It will tell about this genetic disorder - you cant really do anything about it, but it can be nice to know. You can call your insurance to see if they pay for it
- I have XXX insurance
- oh, lets do everything then

... yeah, they might not be too happy about that attitude.

07-27-2012, 08:44 PM
With regards to the HSA - be sure you know what the regs are. If you don't have the money in the account, you can not spend it. So even if you have a pay check deduction and your employer pays in the same amount that it would have with a PPO and you have a FLEX CHOICE plan, you are not able to use the account until it reaches the amount of the medical bill.
As an example - the plan - HSA my son elected to do in 2012 had has limited prescription coverage, not until the deductible is met. He had a flex choice spending account in 2011 which he could get reimbursement as soon as the money was needed as long as he had not exceeded the amount that would be in the account at the end of the year. So January 15th, my granddaughter is put on pulmocort 2 times a day. When they went to pick it up, it was $400 - which was not in the HSA account at that time. You can imagine that $400 in the middle of January, when the Christmas charges were coming due, was not the best timing.

07-27-2012, 09:03 PM
How you get it (employer, family member's employer, pay individually, etc): Employer

Number of people in family on plan, including yourself: Just me

Your monthly contribution toward premium: $17.46/mo

Deductible: $0

Office visits: Primary care physician-$10, Specialists $20, Hospital $100/D, max $200/admission

Referrals for specialists: Yes, but I have an HMO. Not necessary with non HMO

Out of network coverage: No

Emergencies:$135, waived if admitted

Prescriptions: 30 day $8.50/20.00/45.00 (generic, tier 2, tier 3)
90 day $17.00/40.00/90.00

Mental health:I believe so.

Pre-existing conditions: Yes

Customer service: it's fine

Other: Max benefits = unlimited, chiropractic $80 or $10 copay - whichever is less, labs/xrays $5-10, etc.

Dental coverage is free to employees, vision is $75/year (don't currently have vision)

The only negative with out insurance is that spouses can only be covered if they work part-time or are required to pay more than 50% of the premium.

We have a choice of about 6 different health plans: 1 basic plan, 2 HMOs, 1 PPO, and 2 CDH plans with HRAs. I have an HMO because it's inexpensive and the copays minimal (routine care is free). I don't go to the doctor often so a plan w/ deductible wouldn't make sense (I'd never meet it). The same Rx plan is included with all health plans at no additional cost.

All in all, my employer pays about 94% of total health insurance coverage.

07-27-2012, 09:03 PM
thanks numbers, I need to look out for that. Everything for the upcoming year is selected in November every year, where they also give us all the detailed information. I will read closely.

07-29-2012, 02:11 AM
I don't have health coverage. At least not right now. Once the school year begins and I've finally started attending classes at the University, I'll have unlimited free visits to the MD at the Student Health Center. There is a student health plan available that I am considering which would make prescriptions pretty close to free, but I need to make some extra cash to afford it, because you have to pay it as one lump sum each semester or annually. Needless to say, I don't have $1,400 lying around at the moment, so I may have to skip it.