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  1. #1

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    Supplemental Health Insurance

    Hi guys!

    It seems like I am always coming to you guys for advice, but here is one of the few places where I can get several points of view and make a decision without being judged and without a bunch of questions from friends and family. So, I thank you in advance for answering my question and for all of the great advice I have gotten from you guys in the past.

    Anyway, my question is this:
    I am working full-time now. Not at my dream job. It barely pays the bills, and I do have insurance benefits. However, they are less than stellar. But, the unemployment rate here is 10% so, you have to be thankful for your blessings. I started this job in August of last year. My deductible (for just myself) was $1500. Even with a couple trips to the ER, some prescriptions, and a couple of doctors visits (which were considered preventative, so they didn't count toward my deductible and a couple others that weren't and I had to pay for them ), I never hit it. And, here we are again in January and I am starting over once again with my deductible, which, has, not surprisingly, gone up to $1600. I do have an HSA that I contribute to (and my employer contributes a pittance to, also). But I am trying to decide whether or not it is worth my getting my own supplemental insurance. And, if so, which companies are worth investigating.

    I am really frustrated with the entire insurance situation, especially since I work for an insurance company (I work with a Medicare Part D plan). I listen to seniors all day long tell me about how they can't afford their medicine, how their premiums are too high, and how the medicine that their doctor prescribes isn't covered by the plan. And I hear the complaints about not getting a raise from Social Security. What I really want to tell them is that I understand, completely relate, and that I don't have a clue as to how to remedy my own situation. I went to the dermatologist a couple of months ago because I have a skin condition (not eczema, but similar and just as uncomfortable since it is most prevalent in my face and scalp) and the medicine that I was prescribed costs $225, which I had to pay for out of pocket because I hadn't reached my deductible (co-pays don't apply)!

    So, I am asking you guys.....is anyone having a similar issues? How are you handling them? Do you have additional insurance besides what's offered at work, and if so, are you satisfied with it? I know that insurance varies from state to state, but I appreciate any advice that you can provide--it will give me a starting point. I go to various companies online and I'm not even sure what I'm reading, which makes it even harder.
    The privilege of a lifetime is being who you are--Joseph Campbell

  2. #2

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    I don't have additional advice other than to say that you should read the fine print *very* closely. Check what provider-network requirements they have and especially whether they cover pre-existing conditions. You should also investigate if they will only cover a certain list of medications.

  3. #3
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    I think that you need to fully investigate what the supplemental policies will and won't pay, starting with if your primary insurance rejects a claim or it falls into the deductiable for the year, will it cover it or does it require that all other deductibles from primary insurance is paid first.
    Also investigate whether or not your employer insurance allows a secondary policy. One company I worked for, if you had an additional policy they did not cover you. And ask what medications/procedures/ED or Urgent Care visits are allowed and when are there any restrictions to those visits. Are you allowed to use any physician or hospital or clinic..All questions to consider.
    I have to have a private pay insurance coverage for several reasons. And chose a mid line deductible ($2,500) Even at that my insurance costs are over $700.00 for just me. Then add in doctor bills and prescriptions...
    There are many "supplemental" insurance plans out there. They will try to convince you that they are cost effective. I am not so sure and if you don't have a medical insurance advocate, it will be hard to determine if it is a good idea

  4. #4

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    If you have (and continue to) contribute to an HSA, I don't believe that you are allowed to have a supplemental policy. We have an HSA and a high deductible health plan, and all the literature we've seen says we're not allowed other policies. On the other hand, the cost of the high deductible policy is usually a lot lower than the cost of a traditional ppo policy, and presumably you can apply the savings to your out-of-pocket costs. At least with our high deductible policy, we do get the insurer's negotiated costs for any services -- but those vary a lot based on type of facility. I just had hand surgery a few weeks ago -- costs were $1,800 to do it at a freestanding surgical center adjacent to the hospital, or more than $7,000 to do it as day surgery in the hospital -- same surgeon; the difference was in the facility charges and ancillary charges. Similar cost differentials in MRI charges -- worth checking around, though it is a pain.

    On the drug front: make sure you ask your doctor(s) for samples, and tell them that you have a high deductible policy -- perhaps there are less expensive alternatives. Dermatological drugs are unbelievably pricey, I know. Also, if you take any name brand drugs, search the manufacturer's website (not a general web search) for discount coupons and rebates -- two derm preps my daughter needed last week both had rebates, one of $35 and one for $30. It all helps. Also, call around on prices -- I find that there is still a pretty significant discount at Costco (where you don't have to be a member to use the pharmacy) vs. RiteAid and CVS.

    I think that preventative care is covered with $0 deductible as of 2011 -- that was a change in the new healthcare law. Take a look at your plan benefits for the new year and see.

    And congrats on getting a job in a very, very tough environment. May it continue and eventually transition into the job (and salary) you're hoping for.

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