Americans: What is your health coverage?

[Gazpacho]

With all the talk in the Politically Incorrect section as well as the media about health coverage, I'm curious about your current health coverage.

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

Number of people in family on plan, including yourself:

Your monthly contribution toward premium:

Deductible:

Office visits:

Referrals for specialists:

Out of network coverage:

Emergencies:

Prescriptions:

Mental health:

Pre-existing conditions:

Customer service:

Other:

[Aceon6]

I prefer not to provide that much detail, but my employer plays about 60% of the cost of our 1+1 plan that pays 80% for in network services. Preventative services, excluding lab tests are covered 100%. We have a $1,000 deductible and a $4,000 out of pocket max. I have to buy vision and dental coverage separately. Our insurer is #1 in NCQA ratings for 8 years in a row. No problems with customer service.

[Gazpacho]

I'll start. We've been told that there will be "substantial changes" to the plan next year but have only been given small details about them.

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: $226, employer pays rest

Deductible: $1500; co-pays don't count toward deductible. No deductible for prescriptions

Office visits: 50% co-pay

Referrals for specialists: Yes. The only referral I've needed is to a psychiatrist and therapist. It was a breeze to get. Since I don't have a primary care doctor anymore, I went to the urgent care clinic and asked for one. Referrals by the doctors there are accepted by the insurance company.

Out of network coverage: None except for emergencies and in-person pharmacies out of state

Emergencies: $150 co-pay

Prescriptions: $25 generic, $45-60 brand. One change for next year that I know of is that prescription prices will change. I think brand names will go to $60-100 and generics will drop to $20. For some conditions, doctors are required to try less expensive generic drugs first. For gastrointestinal reflux, you have to try four weeks each of two generics, then they'll cover Nexium if that doesn't work. They don't cover any other proton pump inhibitors. I imagine doctors can request an exception to the trial periods.

Mental health: Treated like any other office visit. No limit that I'm aware of. Therapy covered.

Pre-existing conditions: Covered

Customer service:Haven't had any problems so far. They've been quicker with the claims than any other company I've dealt with. There was one incident when one of my drugs became generic. I guess it takes a few months to get entered into their system, so they made the pharmacy fill the non-generic.

Other: A co-worker who had cancer said their cancer coverage is amazing. They even paid for a nurse to visit her home when she was too sick to get out of bed because of the chemotherapy.

The plan does not cover dental. My employer offers a separate dental insurance plan that has basic and extended levels. I pay $28 a month toward the premium for the extended level. It covers x-rays and dental exams with no co-pays and everything else at 80%, including oral surgery. I don't think it covers orthodontics. I haven't used it yet but am told by co-workers that I shouldn't have trouble finding a dentist in the area who accepts the insurance.

[PDilemma]

How you get it (employer, family member's employer, pay individually, etc): Husband's employer. (An "evil" corporation, yet it is the best plan I've had)

Number of people in family on plan, including yourself: 2

Your monthly contribution toward premium: about $225 for medical, an extra $8 for dental and $9.50 for vision.

Deductible: $1500

Office visits: $15 primary care, $25 specialist

Referrals for specialists: Not required in all cases--example I had to see a specialist I had seen 8 yrs ago with different insurance. I did not need a referral as I was an on file patient at that clinic.

Out of network coverage: Not sure off the top of my head.

Emergencies: Also not sure off the top of my head.

Prescriptions: $10 for most generics. Not sure on others.

Mental health: Not sure.

Pre-existing conditions: Covered.

Customer service: Haven't used it yet. Our policy just changed recently--which is why I am not sure about a number of details.

Other:[/QUOTE] Covers preventative care even including full cost of a vision exam on medical insurance. The extra vision insurance helps cover glasses/contacts--we will get about $200 back to cover that which means we'll be ahead about $84 after paying the premium.

[ArtisticFan]

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

Number of people in family on plan, including yourself: Myself and my husband

Your monthly contribution toward premium: $120

Deductible: $500 - this can be lowered if I have a yearly physical, take online classes for any diagnosed health issues, or perform an online wellness screening.

Office visits: $20

Referrals for specialists: $25 copay, but I don't have to have referrals. I can self-refer and have if I think that I need to do so.

Out of network coverage: 80%

Emergencies: $100 for ER visit, but waived if admitted to the hospital.

Prescriptions: 80% (this coverage isn't the greatest for it)

Mental health: 26 visits to a psychiatrist per year at 100% coverage. Some other things that I don't remember.

Pre-existing conditions: I had to show that I was covered prior to this coverage.

Customer service: I have had a few different policies, including personally having to pay it while I was unemployed. This policy has been the easiest to work with overall. They have not denied claims or made much of a fuss about it.

Other: Last year I had to have two surgeries, including one that kept me in the hospital for three days. Once I had paid $3,000 for the year, the insurance paid everything at 100%. Needless to say in those last weeks of the year I was having every test that even might be recommended or required in the near future.

[Gazpacho]

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.

[Karina1974]

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: $25/week auto-withdrawal from paycheck, so $200/month

Deductible: $500

Office visits: $30 copay for office or specialist, IP Hospital is $500, OP Hospital is $100

Referrals for specialists: None required

Out of network coverage: None, but my insurance company has a national network and, thus, access to 550,000+ providers, as per its website. Since I don't travel outside the NY/MA/VT region...

Emergencies: $40/$100 for Urgent Care/ER

Prescriptions: %50

Mental health: Don't know

Pre-existing conditions: Yes, as NY State requires pre-existing conditions to be covered; in fact the Albany Business Journal recently reported that 2/3 of ACA is already mandated in NY State.

Customer service: The one time I had to use my insurance, I had no problems. Just paid out the co-pays. The most difficulty was in convincing my neurologist's receptionist that I didn't need a referral from a PCP, especially for a follow-up visit.

Other: I'll use this to answer Gazpacho's other question. Everybody has the same plan, the only difference is whether you are paying a premium for an Individual or a Family plan, but the coverage is exactly the same.

[maatTheViking]

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

Number of people in family on plan, including yourself:
2.5 (me, my son, and as secondary insurance for my husband)

Your monthly contribution toward premium:
0

Deductible:
0 for in network, 20% for out of network.
about 50% for non-preventive dental care

Office visits:
0 copay

Referrals for specialists:
0 copay - don't need referrals.

Out of network coverage:
80% of cost

Emergencies:
0 copay

Prescriptions:
0 copay for cheapest choice (generics). Maintence medications (more than 3 refills) must be done through special mailorder pharmacy.

Mental health:
not sure, probably 6 consultations?

Pre-existing conditions:
covered

Customer service:
never had to talk to them

options:
we have 4 options.
PPO (the one I have)
Group health (everything covered, only in network) - you get money back here
HSA - some deductible/copay, you and company contribute to HSA
no coverage - you get more money back here.

Other:
180$/year vision covered. One exam, rest can be used towards lenses/glasses.
lifetime 500$ coverage of lasik, means you cant have any vision benefits ever.
Up to 56 PT appointments covered, Dr referred chiropractor covered.
Some dr. referred weight managmenet programs partially covered.

Our plan will change to a HSA next year, with the current plan no longer selectible.
That one will have a deductible/co-pay (preventive care covered), which you can pay from you HSA, I think it is 1200/person, up till 3000/family per year. Think my company will contribute to the HSA also, not sure.
Trying to ignore it and hope they offer another PPO plan on line with what we have, or with a small deductible. A lot of people at te office is mad about the change, as it is an effective lowering of our salaries.
Edited to add: Everyone told me this is pretty much the best health insurance they have EVER heard of in the US. It is slightly better than what I would get from the Danish state (which would only cover 50% of prevetative dental care for over 18s, and only a percentage of prescription meds).
Some of my co-workers are worried that the loss of this particular plan will reduce our competitiveness to attract good candidates.

[Gazpacho]

Our plan will change to a HSA next year, with the current plan no longer selectible.

You're going from this incredible plan to only an HSA? Do you have the option of COBRA if you still work for the place?

A lot of people at te office is mad about the change, as it is an effective lowering of our salaries.
Edited to add: Everyone told me this is pretty much the best health insurance they have EVER heard of in the US. It is slightly better than what I would get from the Danish state (which would only cover 50% of prevetative dental care for over 18s, and only a percentage of prescription meds).
Some of my co-workers are worried that the loss of this particular plan will reduce our competitiveness to attract good candidates.

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?

[danceronice]

Privately purchased coverage, which used to be cheaper until they added a bunch of crap I specifically opted out of when I bought it so I went from a $2500 to $5000 deductible to offset it (neither is a LOT of money from where I'm sitting--I have dresses that cost nearly as much as the $5k--and I know from experience a hospital stay would go past the deductible and into their coverage FAST). Because of the health-care law they had to add in stuff like pediatric care (I don't have children) and prenatal (I don't WANT them) and substance-abuse counseling (I'm not an addict.) I resent having to up my own output because some people can't be responsible for themselves. It's less than $200 a month and includes dental, which I don't use. Doesn't include vision, but Wal-Mart's vision center is pretty cheap.

Yes, I pay everything up to the deductible out of pocket. I think it was like $700 total for an ER visit involving a broken finger, somewhere around $60/office visit, GP or specialist. The really nasty one was about $1300 for labs, which was more just annoying as they were all clean. I get certain discounts because it's BCBS, and after the deductible it's covered in full.

My employer (a public institution) kept as many people as possible on 29 hours a week or less to avoid HAVING to pay for coverage, which I don't really mind, as it meant my take-home was higher. I'd need $5-10 more/hour before wanting them to have to take it out of my paycheck. I lose enough to FICA and state/fed taxes as it is.

[PDilemma]

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.

We can choose from three different providers, but the plans themselves are basically the same in terms of cost, co-pays, etc... The networks are slightly different, but our doctors and my retinal specialist were all in all three networks.

[judiz]

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

Number of people in family on plan, including yourself: 3

Your monthly contribution toward premium: $1,025.00

Deductible: $4,000 family/$2,000 individual

Office visits: $30.00

Referrals for specialists: yes, cost for specialists $50.00

Out of network coverage: none

Emergencies: $100.00

Prescriptions: 15/35/75

Mental health: six visits

Pre-existing conditions: some

Customer service: horrible

Other: not happy but no other choice, no coverage for dental or eye exams

[PrincessLeppard]

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: 0

Deductible: I think it's $600, then 80% for the next $2000? $4000?

Office visits: $35 copay

Referrals for specialists: yes

Out of network coverage: not sure, never had to do this

Emergencies: no experience

Prescriptions: coverage depends. My B/C is not covered.

Mental health: covered

Pre-existing conditions: not covered until 6 months into the plan, I think. I didn't have any, so not positive.

Customer service: meh.

Other: Since I don't pay anything in, I can't really complain a lot. It's good coverage overall.

[Gazpacho]

Mental health: six visits

You may want to check the new terms. A law that went into effect in 2010 says that group plans, if they cover mental health, have to cover it to a similar extent as other ailments.

[Prancer]

My insurance is likely to change next month, but for now:

How you get it (employer, family member's employer, pay individually, etc): Employer-based, through husband's work

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

Your monthly contribution toward premium: $100, give or take a few

Deductible: $1500 per person

Office visits: $20

Referrals for specialists: Not required for most

Out of network coverage: 80%, I believe

Emergencies: $200/20%

Prescriptions: I have four tiers--the number shown is the maximum for each tier: $10/$25/$40/25%

AFAIK, Tier One is generics/preferred drugs; Tier Two is non-preferred or name drugs. I've never gone beyond that.

Mental health: I don't actually know, but I know that we have coverage for therapeutic office visits, rehab stays up to 90 days, and other in-patient treatments.

Pre-existing conditions: Yes to at least some

Customer service: When I can get through to someone, that someone is invariably pleasant and helpful. The website SUCKS. They keep "improving" it in an attempt to get fewer people to call, but nothing works and we all end up calling anyway.

I will say, however, that I rarely have to call, as everything seems to run pretty smoothly.

Do you have options for employer plans, or does everyone who works for the organization have the same plan?: Everyone has the same plan.

Other: We have dental for $8 a month. The dental insurance, oddly, also covers vision. Neither pays very much.

We have been on a lot of health insurance plans over the years, and IME, a whole lot depends on how much of the bill the employer is willing to foot, as employees invariably want to pay less and will if given the chance. Every time the employees have chosen a plan, it has been very low cost up front, but very high cost for those who have health issues.

[Cachoo]

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.

[ArtisticFan]

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.

[Alexa5]

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.

[Rogue]

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.

[Badams]

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.