Do you go without health care coverage (US)?

[KikiSashaFan]

I read these stories and am extremely grateful for our universal health coverage in Australia.

I was just going to say next time I hear someone complaining about the system here in Canada I'm going to smack them...and if they need a Dr because of it, it'll be free

[iamawake2]

I work for an doc and I have no healthcare coverage. I am his only employe. i am self-supporting. My boss offered $100 towards catastrophic insurance. It had a $10,000 deductible. I suggested a small increase in the amount he was offering for a better plan but he chose not to go for that. I have 6 days vacation per year. Nothing else. It's depressing. I've decided to look for another job. A job without healthcare just doesn't cut it.

[Anita18]

Usually that is only possible for very low prescriptions.

I won't even traumatize you all with what lenses alone cost for me.

Try me. I think each lens cost more than my frames, and I didn't go for cheapo frames.

[MacMadame]

Isn't that determined when you get hired? So, if you have a job that terms your insurance on the last day of the month that you left the company, that wouldn't change for you, only for those newly hired, if they change the policy?

Nope. Unless you are in a union or otherwise sign a contract when you start the job that spells these things out, companies can and do change their benefits policies all the time.

[BittyBug]

And reading this thread I'm struck again by how bizarre it is that American's health coverage is pegged to their employment.

^This. It is just so wrong and completely at odds with how just about every other developed nation approaches the situation.

[nubka]

I just shelled out $2,800.00 dollars last month for two hearing aids. I have otosclorosis in both ears (my right is almost completely deaf.) My husband is retired military, so we have Tricare insurance. They wouldn't pay even a dime towards my hearing aids.

Oh sure, they will pay for Viagra so some guy out there can have his "quality of life," but I guess being able to hear dosen't fall under the quality of life catagory...

Tricare won't pay for hearing aids even if the person is active duty. That's just not right.

[milanessa]

Tricare won't pay for hearing aids even if the person is active duty. That's just not right.

And that's not true. Here is Tricare's policy. Unfortunately, it still doesn't help you since your husband is no longer active duty.

http://www.tricare.mil/Factsheets/vi...eet.cfm?id=349

[FiveRinger]

^^Medicare won't pay for it either unless it is being taken for some other reason than sexual dysfunction. It is commonly prescribed for certain heart conditions. Then again, after using the little blue pill you might develop a heart condition, if you know what I mean.

[AxelAnnie]

Nope. Unless you are in a union or otherwise sign a contract when you start the job that spells these things out, companies can and do change their benefits policies all the time.

Well, as a small business owner, and one who is committed to (and does) provide full health care coverage to all employees (even part time), I just wanted to say that I don't know what "companies" you are referring to? Employers or insurance companies.

We have never made any changes in our employees coverages. Anthem and Kaiser (whom we use.....and employees get a choice) change stuff all the time. Costs have gone up (18% on my Kaiser last year) and benefits get cut.

Personally I wish we had real competitive coverage....where I could shop in other states, and buy a package that I want and that is appropriate. I pay just south of $1100.00 per employee in insurance costs. There is no portion paid by my employees.

I live in the wine country, and the hospitals and clinics here are maxed with undocumented workers. I wish everyone would simply get a grip.

1. Employers pay everyone an above board living wage (That message is for you Mr. Grape Picker wine maker
2. Employers provide health insurance for their workers and their families.
(I know my wine just got more expensive)
3. Save a fund so you are not squished with a co-pay.


Just those three things would in my humble opinion greatly reasonable healthcare coverage for all American..

As to undocumented workers.......GEESH....this is not rocket science! Get them a worker's visa,pay they a decent wage and provide health care and education. My friend Sandra and I could bet this up and ready by fall.

I am being tongue in cheek.......but not that much

[nubka]

And that's not true. Here is Tricare's policy. Unfortunately, it still doesn't help you since your husband is no longer active duty.

http://www.tricare.mil/Factsheets/vi...eet.cfm?id=349

My husband was the one who talked to Tricare a few months ago, and told me that active duty wasn't covered either. He must have misunderterstood them.

It's always so much fun being corrected. Thank you.

[vesperholly]

Personally I wish we had real competitive coverage....where I could shop in other states, and buy a package that I want and that is appropriate.

That's one thing that drives me nuts about the US system. There is NO competitive choice for many, many people. My company used to offer a bunch of different plans. In 2008 when the economy tanked, they put everyone on ONE plan and we had no choice - if we wanted insurance, this is it. If I turn down my company-offered plan, my state won't cover me. Where else am I supposed to "shop" for insurance - private companies that cost six times as much? How is that truly a reasonable option? And furthermore, what kind of incentive does my insurance have to treat me well if they know I can't take my "business" elsewhere?

It's all so backwards.

[MacMadame]

Well, as a small business owner, and one who is committed to (and does) provide full health care coverage to all employees (even part time), I just wanted to say that I don't know what "companies" you are referring to? Employers or insurance companies.

I was responding to the comment that surely employers can't change the rules as to when your benefits expire when you leave the company and they have to honor whatever was in effect when you were first hired. They absolutely do not have to do that unless there is some sort of explicit contract requiring it.

And, I didn't say it, but IMO a company would be dumb to put that sort of thing into a contract if they didn't have to. As you point out, insurance companies change what they offer a company, so a company needs to be able to adjust to that.

[Quintuple]

Re: Vision

Go to Costco to get an exam (for the same rate you'd pay with VSP coverage), then go to zennioptical.com for $8 glasses.

Re: PCIP:

Well I never thought I had some large pre-existing condition ( swimmers ear when I was a kid!!!) so I ignored this tidbit from "Money" magazine but now I will check:

"If private insurance is a no-go, you have two government-based options. Anyone can get coverage via his/her state's high-rish insurance pool--you'll pay about 150% of the cost of an individual policy (see healthcare.gov) or a similar backstop.
Thanks to health reform, those who have been uninsured for the prior six months will qualify for their state's Pre-Existing Condition Insurance Plan (pcip.gov). The program, intended to bridge the gap until options are introduced in 2014, will cover you for rates similar to those that healthy people pay in your state (a 50-year-old in Minnesota, for example, would pay $220.00 a month.)

I don't think this applies to me but perhaps does to others posting here. I do need to find out exactly why I was turned down on the reasonably priced plans.

I live in CA, and I'm not sure if it depends on if the pre-existing condition has other programs tied to it, but my friend does have a pre-existing condition, was encouraged to apply for and get denied by private insurance, apply for PCIP, and then have those premiums paid by another public program due to low income. It does have a $2500 out of pocket max though.

My previous employer in CA covered from day 1 with 3 options: Kaiser HMO, Aetna, and ... Blue Cross? At the time, Kaiser was still working from its reputation as being a completely ghetto, dismal service.

My current employer only has 2 options: Kaiser HMO, or UHC EPO or PPO. The difference is drastic though. You're eligible to enroll the first day after the first full month you're hired (carefully worded; for example, if you were hired December 2, you'd be eligible for insurance on February 1). But Kaiser HMO is fully funded, does not take into account pre-existing conditions, and after 18 months of company COBRA after separation, you're eligible for Cal-COBRA. UHC, however, has a 12 or 18 month exclusion for pre-existing conditions (which everyone has, c'mon), and it doesn't sound like signing up for the HMO in the meantime counts as the exclusion period. Nope, you're doomed to paying for 12 or 18 months (they won't say which) of insurance *without* having your condition treated (which makes no sense). The only way around this is to have 60 days of creditable coverage. So if you're in between open enrollment periods, and you really want UHC (for the network, I suppose), you're forced to take the HMO for at least 60 days, hope the timing works out, then switch, and have the exclusion period waived. So in a way, the exclusion period is pointless. Either you have it waived due to previous coverage, or you sign up and have your condition go untreated. Who would do that? Oh, and after COBRA eligibility on UHC, one would not be eligible for Cal-COBRA. And Kaiser's getting better. So who (with a pre-existing condition) in their right mind in my company would not sign up for Kaiser? Maybe there's something I'm not getting.

So in the case of my friend in the company, get this, it's strategic to apply for private coverage, get denied, go on PCIP, switch to Kaiser before open enrollment due to a life event (switching from private insurance is a life event), then switch to UHC at open enrollment after 60 days of HMO coverage. Unless the PCIP is considered creditable coverage of course, but the benefits department can't answer that for him.

*****

Another ghetto hint: If you grind your teeth due to stress from health care costs, forget that $695-for-a-custom-mouth-guard-even-with-insurance crap. Go to a sporting goods store and get a moldable wrestling mouth guard for $1.99. Way better than even the $30 ones at the drug stores. You can close your mouth and talk on the phone from bed and nobody would be able to tell the difference!

[jenniferlyon]

For years my husband and I had catastrophic coverage only. The irony is that he is a physician but he mostly worked locum tenens without benefits and I was a student.

All I have is catastrophic coverage with a high deductible. Three times in the past two years I've been sick enough to need medical care, but went without it. I simply cannot afford to get sick.

[Gazpacho]

For a while, I had to go without coverage because no insurer would insure me given my medical history.

[BaileyCatts]

I called a place yesterday and filled out an application so its in the process of being reviewed. If I call and withdraw my application or tell them I don't want it anymore without them investigating (or whatever it is they do with all that info it took me like 45 minutes to answer all the questions) and that way they cannot "deny me" (I'm figuring based on my weight)?

Can I do that? Call them back and tell them I withdraw my application, without it having to go down as THEM officially denying ME? Does that make sense? Can I do that without giong on this list they all check that says I was denied?

[Debbie S]

^ I guess you could, but not sure how that would benefit you. If there is a reason an insurer would turn you down, they would do it regardless of whether you've been denied previously. OTOH, each company has its own policies, so there is a chance that what might mean rejection for one co might not for another. You'll never know unless you try.

Upthread, someone suggested you call Humana and talk to someone about your rights under health care reform to buy new coverage. At least get a Certificate of Creditable Coverage, b/c that may help you get ins if you are denied, or get a pre-existing exclusion waived.

It may be that Humana or another co may not offer individual policies in your state. That's their right. If you run into that, try another co.

[Cachoo]

Re: Vision

Go to Costco to get an exam (for the same rate you'd pay with VSP coverage), then go to zennioptical.com for $8 glasses.

Re: PCIP:



I live in CA, and I'm not sure if it depends on if the pre-existing condition has other programs tied to it, but my friend does have a pre-existing condition, was encouraged to apply for and get denied by private insurance, apply for PCIP, and then have those premiums paid by another public program due to low income. It does have a $2500 out of pocket max though.

My previous employer in CA covered from day 1 with 3 options: Kaiser HMO, Aetna, and ... Blue Cross? At the time, Kaiser was still working from its reputation as being a completely ghetto, dismal service.

My current employer only has 2 options: Kaiser HMO, or UHC EPO or PPO. The difference is drastic though. You're eligible to enroll the first day after the first full month you're hired (carefully worded; for example, if you were hired December 2, you'd be eligible for insurance on February 1). But Kaiser HMO is fully funded, does not take into account pre-existing conditions, and after 18 months of company COBRA after separation, you're eligible for Cal-COBRA. UHC, however, has a 12 or 18 month exclusion for pre-existing conditions (which everyone has, c'mon), and it doesn't sound like signing up for the HMO in the meantime counts as the exclusion period. Nope, you're doomed to paying for 12 or 18 months (they won't say which) of insurance *without* having your condition treated (which makes no sense). The only way around this is to have 60 days of creditable coverage. So if you're in between open enrollment periods, and you really want UHC (for the network, I suppose), you're forced to take the HMO for at least 60 days, hope the timing works out, then switch, and have the exclusion period waived. So in a way, the exclusion period is pointless. Either you have it waived due to previous coverage, or you sign up and have your condition go untreated. Who would do that? Oh, and after COBRA eligibility on UHC, one would not be eligible for Cal-COBRA. And Kaiser's getting better. So who (with a pre-existing condition) in their right mind in my company would not sign up for Kaiser? Maybe there's something I'm not getting.

So in the case of my friend in the company, get this, it's strategic to apply for private coverage, get denied, go on PCIP, switch to Kaiser before open enrollment due to a life event (switching from private insurance is a life event), then switch to UHC at open enrollment after 60 days of HMO coverage. Unless the PCIP is considered creditable coverage of course, but the benefits department can't answer that for him.

*****

Another ghetto hint: If you grind your teeth due to stress from health care costs, forget that $695-for-a-custom-mouth-guard-even-with-insurance crap. Go to a sporting goods store and get a moldable wrestling mouth guard for $1.99. Way better than even the $30 ones at the drug stores. You can close your mouth and talk on the phone from bed and nobody would be able to tell the difference!

Quintuple was your name Sherlock in a previous life? Kudos to you for wading through all of the confusing (deliberate I'm sure) info to try to find the best option. And God help those who can't make heads or tails or it. Is anyone not with Kaiser?

[danceronice]

No, though I have a high deductible (which works until doctors want to play pincushion and which is why I'm not going back for ANOTHER round in May. If something was wrong with the last ones, call me. Otherwise, NO.) I still pay WAY less than I did under the Massachusetts system, where with mandatory coverage my premiums went through the roof. (I don't blame Romney, he was dealing with the dictators for life in the assembly and laws that already made it borderline-impossible for any insurance companies to do business competitively. And at my income level I wasn't eligible for state aid unless I produced a few bastard children to care for.)

[Cachoo]

I called a place yesterday and filled out an application so its in the process of being reviewed. If I call and withdraw my application or tell them I don't want it anymore without them investigating (or whatever it is they do with all that info it took me like 45 minutes to answer all the questions) and that way they cannot "deny me" (I'm figuring based on my weight)?

Can I do that? Call them back and tell them I withdraw my application, without it having to go down as THEM officially denying ME? Does that make sense? Can I do that without giong on this list they all check that says I was denied?

I don't know the answer to this: I hope someone else here does--I would call just to hear what they have to say about that.