Ask the Readers: How Much Do You Spend on Health Insurance?
Published on - December 16th, 2011 (by J.D. Roth) Behind the scenes, the GRS elves and I have been working to streamline the process for submitting reader stories, guest posts, and financial questions. As part of this, I’ve been reading through every question submitted over the past year. I’ve noticed some patterns.
One topic I’m seeing over and over again is health insurance. We’ve explored health insurance a few times in the past, but we don’t do so often. For one, it’s complicated. For another, it’s boring. But even boring, complicated subjects deserve their day in the sun, right?
Over the next few months, I hope to explore health insurance in a little more detail. Today, though, I thought it would be useful (and informative) to do an informal survey. Today, I want to know: How much do you spend on health insurance?
More specifically:
- Where do you get your health insurance coverage? From an employer? From the government of the country where you live?
- What sort of coverage do you have? Do you wish you had more? Less? What are the pros and cons of your coverage?
- How much do you pay per month? Do you know how much your employer pays? What sorts of co-payments do you have?
I’m especially interested to hear from those who have picked up health insurance on their own. What do you do if you’re self-employed and don’t have access to an employer-sponsored plan? (This is a common question in my inbox, and I know many people are looking for an answer.)
Please note that I don’t want this to turn into a debate over socialized medicine. There’s no need. Instead, this is a chance for folks to compare their situation with others. (Previously, we’ve conducted similar surveys for spending on food, clothes, and gifts.) Now it’s time to share: How much do you spend on health insurance? What kind of coverage do you have, and where do you get it?
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Interesting post, looking forward to seeing the answers! I’m Canadian so I have health insurance from the Ontario provincial government. It covers basic care, emergencies and most of the things I need. I currently don’t pay directly for the coverage as I consider low income as a university student, but support it indirectly through taxes. As my income increases, I’ll pay a health premium based on my income level. Pros, I don’t have to worry about ever not being able to afford medical treatment or how I would pay for an emergency. Cons, unfortunately the Canadian system is struggling with wait times for procedures and it can be difficult to find a primary care physician in some areas.
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An aspect of the Canadian health care system that I don’t often see discussed, and that much more closely resembles the US health insurance market, is catastrophic drug coverage.
Drugs are a major exception to the health care system here in Canada. Although your doctor’s visits, specialists’ visits, etc. are covered, drugs are not normally covered. A patchwork of different plans, private, provincial and federal, are used to cover catastrophic drug coverage (in my case, 20k a year for a single, patent-protected drug, although I’m lucky because the cost could be much higher).
In my case, given all that I had heard about people being bankrupted by catastrophic drug costs, I was surprised to learn that my private insurance actually improves for catastrophic drug coverage. While 80% of my drug costs are covered normally, once I reach over 3000$ in claims in a year, my coverage actually *increases* to 100%.
Apparently about 60% of Canadians are covered by such private plans, and the rest is made up of provincial and federal coverage, or none at all: http://www.parl.gc.ca/Content/LOP/ResearchPublications/prb0906-e.htm
One thing I am very aware of for my own health insurance is that my insurer has put out a warning letter in recent years. If the costs of drugs continues to skyrocket (and apparently 21% of *total* drug costs are for the same five rheumatoid arthritis medications, each at least 20k per year), then they will review the eligibility of those big 5 drugs for future years.
As such, one of our line budget items right now is a small charge to ourselves for my drug costs. Hopefully, if we can build up a small “nest egg” now, the financial pain will be less severe if we get hit with the catastrophic drug costs down the road. No matter how solid our finances now, I think a 20-30k line item in the annual budget will be tough to swallow. That’s (considerably) more than our mortgage.
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I’m a Canadian as well, and I definitely agree with your assessment of our system. While I do appreciate some of the advantages our system has over the one in the USA, I would like to experiment with a two-tier system that would take the strain off of the public sector a little.
Drug reform isn’t big on government’s today list, because all government employees and the their families have great drug plans that usually pay for 90% of the cost (this is what I get as a teacher, and what my parents go because my mom was a nurse – even though dad had his own company).
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That’s something people overlook far too much in Canada. While our basic health care costs are paid for by the government (by way of our taxes), not everything is covered.
A short list of what we have to pay out of pocket or through our own insurance: the costs of prescription drugs, dental work, chiropractic/RMT/accupuncture, depending on the circumstances you have to pay for non-MD specialists (registered dietitians, psychological care).
Basically, taxes pay for the basics – everyone has equal access to doctors and emergency care (in theory), but there is LOTS that we pay for ourselves.
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Here in BC (can’t speak for other provinces) I believe that what you’ve stated about catastrophic drug coverage is partially inaccurate. My understanding is that these kinds of high costs drugs may be covered through the PharmaCare* program, if your doctor follows a set procedure before prescribing them. The procedure basically entails requiring you to try pretty much entails you having to try all of the other drugs that might effect your condition first.
*PharmaCare covers prescription drug costs for BC residents once they have claims over a certain amount in a year. The amount seems to be somewhere between $1500 to $3000 per year, but it depends on income level. However, PharmaCare doesn’t cover all drugs, including some of these crazy biological drugs that cost in the $10s of thousands of dollars.
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I’m Canadian too, Cass. Hospital /Surgical wait times are long here, you’re so right. Without going into all the reasons why that may be, the other side of that coin is that if you present with an emergency (broken bone, car accident and multiple broken bones and internal injuries, ruptured spleen/appendix)… you’re dealt with immediately and your hospital stay is covered.
What a relief that was for me when I spent three nights in hospital for an accident. It would have been a terrible burden financially, otherwise. No idea what it would have cost: ambulance, surgeon, drugs, nursing care for 3 nights…
Aside: have supplemental health & dental (and limited eye care) coverage through my husband’s place of work. That covers 90% of non-emergency, non-hospital-given prescription drugs, for instance. His firm offers a choice of 3 or 4 tiers of coverage, at 3 or 4 tiers of cost.
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Canadian here too.
It’s hard to quantify what I pay for health insurance. A rough estimate of what I pay in income tax here versus what I would pay in an average US tax state might work? I think our level of government services are comparable apart from health care being paid for in Canada.
In Ontario we have a “Health Care Premium” tax levy on top of income taxes as well. According to a tax calculator my marginal rate on my annual income is 43.41%. In Ohio it would be 33.74%. So roughly ~10% of my gross income is spent on health insurance if we agree the primary difference in tax rates is due to health coverage (certainly debatable).
I think as a healthy 30 something non-smoker I’m probably paying more (subsidizing others more) than I would if I had a private policy in the US (especially through an employer).
In the end, if your employment is stable and provides health insurance you’d likely rather be in the US since the hospitals are just plain better by and large (Read that MacLean’s article that lambasts the current state of our health care/hospitals, it’s not just my opinion). But for eveyrone else, it’s better to be here in Canada.
Anecdotally I had lithotripsy last year in Toronto, and while the procedure was expensive and covered, the hospital was dirty, run down, the staff (outside of doctors) were not exactly happy to be there or knowledgeable. Mold, cracked tiles, urine puddles, etc. I really really wanted to be home ASAP.
Contrast that, my sister had her baby in a brand new Texas hospital last year, and it was astonishing. The hospital was clean and beautiful, the staff were chipper and sweet and her room looked like a luxury hotel suite. My sister is not rich either, and has just a basic policy not through an employer (though I don’t know how much she pays).
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For a little perspective, Canada spends approximately 10.5% of its GDP on health care and the U.S. spends around 16%. The U.S. also has a much higher growth rate for its health care costs.
My employer provided plan costs $1150 and provides 85/15 split. In general health care plan premiums have increased around 8% per year for the last 10 years or so. In 2001, the health care premium was around $450.
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We have a longer life expectancy too
I’ve been hearing bad things in the news about some Toronto hospitals lately, but that doesn’t mean they’re representative of the entire city or even the entire province. I’m sure there are run down hospitals in the U.S. just like there are clean, efficient hospitals here in Canada. (Though I suspect most hospitals in both countries are somewhere in between.)
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Hospitals vary widely in both Canada and the U.S. You can’t judge all by one.(I’m Canadian as well, by the way). Ive been in some pretty nice, clean and friendly Canadian hospitals. Yes, wait times can be bad in some places, but I will never ever complain after the experience I had with my mother’s cancer fight. All my siblings and I (and our husbands) put together, could not have afforded the incredible care, treatments and end-of-life help she got. I won’t even mention the kindness of V.O.N. nurses, as I swear those people come from some higher plane of being. Amazing.
Yes, we’ do have to pay for things, and that’s fine. I’m more than willing to contribute. Its totally worth it.
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Canadian, working at a University. My union negotiated a 25/75 split on our medical insurance costs. I pay:
BC Medical (basic med – doctor visits, lab tests, partial prescription costs) = $16/mo
Extended Health ($100 deductible), covers optometry fully, some drug coverage, and ‘alternative health’ (naturopath,physio, massage, nutrition) at $20-30/visit. = $11/mo
Dental Insurance, covers 85% of 2 cleanings per year and 50-85% of dental work (major/minor) = ~$12/mo.
One misconception I often see is that Americans think Canadians have “free” healthcare. Nope. But we do have an amazing safety net, in that low income people DO have free BASIC healthcare… but anyone who makes more than $22K/year pays something and over $30K/yr pays the full premium. It’s very inexpensive compared to many insurance plans in the US ($64/mo single person), but it isn’t free!
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It is almost free at $64 a month compared to our $520.54 per month for family of 2 .
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From an employer, family coverage (no eye or dental) at just under $500 a month.
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Similar situation here. Employer-provided, no eye or dental, I pay $400 a month for family coverage and I have to pay a deductible of $1750 per year, after which I have to pay 10% of covered costs in network. My employer pays about $320 a month for the premium and contributes 1750 a year for the deductible (so the total cost is actually $700 per month with a 3500 deductible).
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My wife and I have individual coverage from our employer (same company, separate coverage). Health + Eye (no dental this year) and it costs us about $50 each a month.
The plans are an HSA PPO with a moderately high deductible.
This is perfect since we’re both young and in excellent overall health. We’re amassing cash in the HSA accounts for when we really need it later in life.
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I pay about $90 a month through my employer and there is a $20 copay to visit my primary care doctor, $10 copay for prescriptions. As a doctor, I just want to add PLEASE DO NOT BE CHEAP WITH YOUR HEALTH INSURANCE!! It may sound like a great idea to go for the PPO with a high deductible because it’s cheaper per month, but you will pay for that decision later a lot of the time. DO NOT GET SUCKED INTO HORRIBLE MEDICARE ADVANTAGE PLANS! They are often offering less than Medicare at only a slightly lower cost. The bad ones make money by cutting you off from care. IF YOU ARE A WOMAN UNDER 40 DO NOT CHOOSE A PLAN WITHOUT GREAT PREGNANCY COVERAGE! Please read about the provider you are choosing on insurance rating sites. When you really need it, you want health insurance that will cover almost any procedure by any doctor you choose. I have seen patients get into serious debt because they needed a surgery and their insurance covered the surgeon, but the anesthesiologist or some other provider was out of network. You cannot afford to go without good health insurance no matter how young, healthy and insurable you are unless you can afford to be crippled by debt after one bad diagnosis. One night in my ED will cost you around $800 minimum. If you are young and healthy and have to qualify for insurance on your own NOW IS THE TIME TO DO IT! Not when you actually need it! Then you will either no longer qualify or pay a huge premium. The same for disability insurance. I pay less than half of one month of my salary for disability insurance and that insures that I will not be bankrupt if I am injured.
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I want to second the disability insurance! A young niece 24 was just diagnosed with a malignant brain tumor. NOBODY should go without disability insurance. Now she is without income, and cannot work for at least several months. And she will never be able to get disability insurance now. She has to move back in with her parents, not exactly much to her delight…
And don’t rely just on disability insurance from your employer, either. When the job ends, so does the insurance. You may not be able to get a policy when your job ends. Get your own policy, and never, never let it go! It is dirt cheap in your 20s.
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If you’re paying too much, you should consider moving to Spain
I have public health insurance (everything except dental), and I pay 45 euro monthly (a bit less than $60) for the whole family. Works like a charm.
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I have a small S corp and being 55 now costs me $2200 a month for my wife and I. BCBS of NC.
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We live in a country with socialized medicine; for this year it’s zero, because we just immigrated six months ago and haven’t had any income. My husband is about to start a new job that pays ~40K (euros), so the “social charges” (equivalent to the Social Security/Medicare/etc. taxes in the US) will come to ~6K. We have five kids, so this is a substantial savings over what we would have had to pay for COBRA in the U.S. (it would have been $1300/month over there). The cost to us is somewhat less than the social charges because those charges also cover things like our version of Social Security–but I haven’t been here long and my command of the language leaves a lot to be desired, so I don’t know what portion of the social charges actually are attributable to healthcare.
Additionally, we do pay copays just like folks with U.S. insurance, but they are pretty low (something like 6 euros for a visit to the doctor, and we’ve never paid more than 5 euros or so at the pharmacy). Still, most people here have supplementary private insurance through their employers to cover copays and things that are not reimbursed very well, like optical and dental care. If we decide to purchase this on the open market (we’re not sure yet if my husband’s employer offers it), it would be 100-200 euros/month for the entire family, depending on the level of coverage.
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I have individual health coverage (high deductible health plan with an HSA) from my employer. They pay the entire premium, and contribute $500 a year to the HSA. The insurance pays nothing (just sets the rates at the same level they WOULD pay vs. self-pay) until I reach my deductible. It pays 90% in-network after deductible of $1250 and 70% out of network after deductible of $2500.
This year, I’ve probably paid $700 towards healthcare (one prescription, got blood work done once, and doctor visits every 3-4 months for renewal.) So I’ve only paid $200 myself, which is more than the amount of taxes I’ll never have to pay on my maxed HSA contributions.
So, works out pretty well as a young, relatively healthy single person with no dependents. Probably a little more inconvenient for some of my coworkers with families.
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I have pretty similar coverage for my family. through my employer. My coverage (and I thought this was true of all HDHPs) includes free preventative care, so all of my 1 yr old’s regularly scheduled doctor visits and immunizations are $0 out of pocket. We each get a free physical, my wife gets a free PAP, and basic blood work is also 100% covered. So it works out OK for relatively healthy families as well.
Including vision and dental, my medical costs are about $2600 a year ($100 every other week). The best part is that my employer kicks in half the deductible to the HSA, effectively a $1500 rebate that we can use for the random prescription, sick visit or OTC medicine (with a prescription, of course), or save for the future.
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We have family coverage from my employer. We pay 350 a month for health and 40 for dental. We have a $30 copay and no deductable. We also have a health savings plan.
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I’m in the US, single, young and in good health with an employer that does not provide health insurance.
I use medical mutual and pay $90/month (including dental but no vision) for a high deductible plan and have an HSA with HSA Administrators that lets me invest in Vanguard funds.
I keep it primarily as disaster insurance as I rarely go to the doctor and my dentist visits are just 2 cleanings a year. I maximize the HSA portion and consider it a supplemental retirement account.
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I have employer provided coverage with monthly payroll deduction of $350 including Med, dental, eye, life insurance, STD, LTD etc. hey also offer HSA program
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I pay about $70 a month for a high deductible plan that only covers preventative care. So if I need to see my doctor for something other than a physical, it’s subject to deductible. Need labs, subject to deductible. Considering this is my first job in healthcare it is by far the worst insurance I have ever had in my life.
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I’ve been self-employed for 15 years. Until 2 years ago, I had a medically-underwritten individual policy with CareFirst BlueCross BlueShield in Maryland. I had very good coverage, but the cost went up considerably every year. The last year that I had my individual policy I paid $400+ per month for my medical policy, and $21 per month for dental/vision.
Two years ago, my husband accepted a job at a local hospital with good coverage at a reasonable price for employees and their family. Our premiums for my husband + spouse is now $150 per month. A considerable savings. I will admit that I was hesitant to go on my husband’s policy since he previously had a history of not staying at a job very long. But, luckily for us, he’s satisfied with his present job and employer.
Having coverage through my husband’s employer has saved me a lot of money per year. Plus, my accountant recently informed me that I can deduct the expense of my portion of his premium payments on my taxes.
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i have employer provided coverage for the family with a monthly payroll deduction of $260 dollars a month including medical, dental, and vision, and life insurance. I have a high deductible account based health plan with an HSA that my company pays the maintenance fee on and contributes $1000 a year. The most out of pocket I can pay in one year on a single family member is 1500 then they cover 100% or for the whole family $3000 then they cover 100%. all preventative visits are 100% covered.
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Ok, you asked for it … I’m a freelancer in NYC. Nowadays, that sometimes means employers hire you “permalance,” so basically I’ve been in the same place for over 3 years but they can fire me at will (they didn’t need me for 3 months this summer) and while they’re required to offer me health insurance after X amount of days, it’s a terrible policy with something like 10k lifetime benefits. Most people I know in this situation buy insurance through the Freelancer’s Union. But I had a book published 5 years ago so could join the Author’s Guild, and can buy a plan through TEIGIT, the teacher’s and entertainer’s guild.
My plan costs me $1047 a month. I choke every time I get the bill. Over 12k a year I could have saved up to buy an apartment, or put towards retirement (because of course I’m paying for my own IRA, too).
My deductible was lowered from 1k this year to $300. I pay $25 per office visit, and about $30 per each med (about $100 a month).
I could buy a cheaper plan, for $899 per month, with a 2k deductible. But I had cancer 5 years ago and this year I’m going to have some follow-up surgery. With the cheaper plan there’s a $500 hospital admission and a co-pay up to a large amount (can’t remember the exact amount) which puts me at over the total for the more expensive plan. Also, I’d have to pay $100 for all imaging, and my experience is I need a lot of imaging. When pricing plans you really need to look at all the stuff they do and don’t pay for and total up best and worse case scenarios.
This year I’m going to look for a “real” job. Freelancing used to make sense because in theory you could make more money, but not anymore. I’m making less per day than I made in the ’90′s, with much higher out-of-pocket costs. And everyone puts their freelancers on a W2, anyways, so in the eyes of the government you’re on staff and don’t get the same tax breaks as a small biz. I want this 12k monkey off my back and am interested in what an employer would pay.
Before I had cancer, I had a cheap health insurance policy with the idea that if I got sick, I’d switch to a better plan. In NY, if you’ve been constantly insured, you can switch even with pre-existings. So that’s what I did. I was young, strong as a horse, vegetarian, racing cyclist, but when your health goes south it can do so really fast. After my initial surgery I was in the ER twice, all in the space of 10 days, on the phone trying to upgrade my insurance plan.
And for anyone who’s never seen a bill for just one round of chemo, it’s $250k.
In a weird way, paying so much for insurance encourages me to use it more, because I figure, “hey, I’m paying through the nose, I’m going to get my money’s worth.”
I’m going to end with a plug for disability. I bought a private plan in my early 30′s for $128 a month (3 mo waiting perdiod), Mass Mutual. I once tried to cancel it but my broker talked me out of it. They paid me $3500 a month when I was sick. If I worked, they paid me a percentage if I made over X amount based on the prior year’s salary. Best buy I ever made.
Hope this isn’t too much info. I go a little nuts on the whole health insurance question. I lived in Canada for a year and still remember the letter my doc sent around at the end of the year asking for a $25 donation to help pay her office costs. That’s the only money anyone ever asked of me. Incredible.
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Thanks for the plug on disability insurance. We each got policies in our 20s, and when my husband was 37 he became permanently and completely disabled with chronic fatigue syndrome. Our private policy really saved us!
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I know there is a higher probability that a working adult will become disabled as opposed to dying. So I know there is a critical need for disability insurance. However, my DH (Dear Husband) is in law enforcement, most insurance companies decline to offer disability coverage for that field. I will have to do some further research to see what our options are, first step would be to maybe check with the union. His job has limited coverage.
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I’m sure laws are different in every state in regards to disability insurance. In my state (PA) I am not able to get disability insurance if I am already covered by my employer.
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Somebody lied to you. You CAN buy an individual policy even if you are covered by your employer. I just called MetLife and asked, and they verified that you can buy a policy.
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I have great insurance now through my employer, but for a while I was only employed part time and for $50 per month I was getting limited-benefit health insurance through my employer. I’m still not sure what the ‘limits’ were. I never got around to reading the paper work thoroughly but I’m pretty sure I was screwed if I had gotten cancer or something similar.
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Also, now that I have a full time job, I contribute $43 twice a month for a ‘PPO’ and my company contributes $151 twice a month also. It’s the most expensive plan they have and it only covers myself.
Also I do not get the non-tobacco user incentive.
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This will be our first year participating in my husband’s firm’s new high-deductible insurance plan. I am keeping my fingers crossed that it is not a HUGE mistake. Last year, for our family of 6, we paid roughly $750 per month for a 100% in-network Blue Cross plan (no dental or eye care). We had no deductible and co-pays of $20-$40 per visit. We also contributed $400 a month to the flex-spending account – this went to vision, orthodontia and out-of-network therapy for one of my children who has OCD. We also contributed $50 a month to a dental plan that subsidizes our visits – since there are 6 of us, it works out OK. In all, we paid over $15,000 in medical expenses last year (though much of it was pre-tax). OY.
This year, our plan will cost $250 per month (no dental), plus an extra pre-tax $450 that will go to our HSA. Our deductible is. gasp. $5200 – and after that, we are covered at 80%. However – after we reach a max of $11,000 (not counting the $250 for the cost of the plan) for the calendar year, we are covered 100% for everything. I figure that even if we reach that hideous max, we will still be in the same ballpark as we were last year. And there is always the chance that we will all be super-healthy and actually end up with money LEFT OVER in our hsa. Time to buy some serious vitamins and a neti pot.
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This is us almost verbatim – family of six with some higher medical costs in recent past switching to an employer-offered high-deductible plan and HSA for the first time – and also very much hoping it’s not a huge mistake
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It’s worked out for us–family of 4. 2011 was the first year we’ve done the high-deductible plan with the HSA. My husband’s employer put $1000 in the HSA in January and our premiums are less than half of what they were. We were nervous going on this plan, but I computed the worst case scenario and the overall cost was about the same as for the lower-deductible plan available to us. So we decided to go for it, figuring that in good years we would be ahead, and in bad years no farther behind. We’ve had some surprises in medical bills this year, but it looks like we’re still slightly ahead of where we would be otherwise.
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Kate and Debbie, I described my plan above, we have family HDHP & HSA and it has worked out pretty well. Even prior to reaching your deductible, you may get an insurance “negotiated discount” on services that can be pretty significant. For example, Labcorp might charge you $300 for basic blood work, but their negotiated rate with your insurer could be $20 to $50 if you aren’t getting anything too fancy. Also you could get some preventative care 100% paid for, regardless of where you are with the deductible.
The deductible can be daunting, but to me, the benefits of the HSA, plus the significantly discounted premium make it a no-brainer, especially if you don’t have any major on-going health problems. Our PPO option had a premium twice as high, with a $900 family deductible, and had the same network of doctors and almost identical coverage (after deductible).
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I have been self-employed for 15 years. My husband has carried our family plan for us during that time. At his previous job (municipal employee) it cost $500.00 a month, one week’s take home pay. Since he lost his job a year and a half ago and has only been able to obtain part-time work, we have the teens on the state’s plan for kids (one will fall off next year when she turns 19 and goes to college) and we pay $80.00 a month for the two of us through the state’s income tiered plan.
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Hi, what state do you live in? Thanks.
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Another Canadian here! I’m glad to see J.D.’s question phrased so inclusively. I’m curious to hear how other countries compare.
My health care is paid by:
1) the government, which doesn’t cover everything but is paid for out of our taxes.
2) my employer’s benefits plan (which I pay 50/50 with my employer) which covers things not covered by the government like most of my dental, some eye care, some specialist treatment like physiotherapy and most medications. If I needed a semi-private room in a hospital or an ambulance, it’s my insurance rather than the government that pays for it.
3) out of pocket for deductibles (the % not covered by my employer’s health care plan) and any alternative or complementary therapies I use. Canada isn’t big on integrated medicine… yet. I have also paid for blood tests not covered by the government.
As you can see, it’s possible for Canadians to spend a lot of money on health care even with a “universal health care” system.
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My husband and I are insurance brokers that specialize in health insurance and medicare supplements. We currently serve North Carolina. We have a HSA with a 10,000 deductible which costs us $316 a month for a family of 4.
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I live in Colorado and have an individual high deductible plan with a $10,000 family deductible. (We are 35 and 37 y.o.) We pay about $150 per month, but our insurance broker told us that it is going to go up to almost $500 per month when our baby is born next month. (We will have to pay the $10,000 deductible out of pocket for my c-section which will be required b/c of a medical condition I have.) For the most part, we’re healthy and so have been okay with our high-deductible plan that has lower premiums, even though we’ll be paying up big time this year. But it sounds like you’re getting a much better deal in North Carolina if you’re only paying $316 for a family of four.
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Family HMO plan though a US employer. Our share is $325 a month. HMO covering visits with in network offices, preferred providers, preferred medical facilities, some preventive dental (cleanings and a couple of simple fillings), and copays for visits and medication and all the good and bad that comes with an HMO.
Above the monthly $325 I have averaged another $100-125 a month in copays for visits, medication, and emergencies over the last couple of years just because of incidents with the family. Knock on wood no major issues, just a lot of physical therapy and a few emergency room visits.
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I pay $120 for medical for 2 people. Plus about $20 a month for dental. It’s Cigna with $20 copays and high coinsurance for hospital stays.
What I like is that my employer started a “employee plus one” covergae choice. It’s much chepaer than “family” coverage.
It’s nice to be acknowledged as a childfree couple or a great option for someone not married with only one kid.
here’s some fun- I clicked “sumbit” and the computer told me “I am posting comments too quickly. Slow Down”!!!
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$39/month, single coverage through employer (public school district), includes dental and medical.
100% coverage for all preventative care.
80% coverage for nearly everything else.
$2000 deductible, with $500 being reimbursed each year.
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I’m in the US: 26, male, single, athletic, non-smoker. I don’t have health insurance currently and haven’t since I graduated college (2007) because the only jobs I can find in my field are contract jobs with no benefits and I can’t get private insurance due to a preexisting condition that runs me a whopping $1000/year for exams and drug costs. I tried to sign up through my state’s PCP plan, but they basically told me that my condition was too minor and their limited funding would be better spent on people with serious diseases. I totally understand that, but it sure does put me in a tight spot. Pretty much all I can do is not get sick until after 2014 and hope the health care bill doesn’t get repealed after the elections.
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Let’s work to make sure it doesn’t get repealed then.
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99% 26 y/o don’t understand this. You need health insurance coverage. There is no option. I am a trauma physician and see young people ruining their life as they have no insurance
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He tried. The problem is that he can’t be insured because of a pre-existing condition. So he is part of the 1% of 26 year olds.
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We are self-employed, no kids, healthy adults ages 46 and 58. We pay $336/month this year with $5,000 annual deductible per person/$10,000 per family, no co-pay for annual physical but have to pay for lab tests out of pocket for the annual physical. Otherwise generally $25 co-pay including annual GYN exam. Interestingly, the high deductible plans had better drug coverage than the ‘normal’ low deductible plans…at least last year when we reviewed in detail.
But we just moved across state lines, not sure for this year – similar high deductible coverage is available where our sister lives 3 counties away, but online that coverage isn’t available here through brokers. ‘regular’ low/no deductible plans are closer to $1,100/month. Something for me to work on – we may keep our other coverage for a while…
Also, we used to have a small business group policy. When we got down to 2 employees, we switched to individual coverage. With a group plan, the insurance company will cover all employees (won’t turn down for most/all health conditions) BUT you pay a higher overall premium for that. For a big business I assume it’s peanuts per person, but for us our monthly cost went from $1,100 to $800/month (at a low deductible plan at the time).
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We have family coverage through my wife’s employer. It is a PPO with a low deductible and $25/$35 co-pays. We do not pay anything –one of the benefits of being a resident.
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Through my employer, I pay $288/month for my husband and me. My employer’s portion is $864. Dental and eye are also included; our deductible is $1500. We have the usual co-pays ($20/dr visit) and pay up to 50% of diagnostic testing until our deductible is met.
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I’m starting to think I’m overpaying.
As a grad student, I have an option through the school that is super cheap, but currently do not use it for a few reasons. So, my insurance is entirely on my own, and I pay a little less than $200/month (rates just changed, so I don’t remember the number). It’s a mid-range deductible, prescriptions aren’t covered, eyes are covered, dental is not. But, all preventative stuff is covered (shots, exams, etc). Emergencies aren’t. Of course, after a lifetime of being well and young, I’ve ended up utilizing it more than I anticipated, and am thankful for it. I would like to switch to my school’s option next year, since ~$100/semester is much better for my grad student salary.
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I’m 29, married, kid on the way. I pay $30/month for an employer plan(I work for a large corporation), with a deductible of $1500, and then pay 20% after I meet that deductible, with max out of pocket of $3000. Preventitive care is covered 100%. Once I give birth I will add the baby to my plan, doubling the deductibles and increasing my monthly costs to $50. I also have an HSA through my job and my employer will contribute up to $850/yr into it for things like not smoking, completing online health questionaires, and getting a basic health screening at work.
My husband works for a small law firm and has a plan through the local bar association. He pays $350/month, but his employer reimburses him for it in full. He has no deductible and a pretty standard copay plan ($20 for meds, $30 for drs visits, $150 for larger procedures, not sure what it is for hospital stays).
So out of pocket we pay $30/month, plus I contribute $100/month to the HSA pre-tax (just increased that knowing the labor/delivery costs are coming next year) plus whatever bills we incur as copays/pre-deductible payments. I hate how complicated everything is…trying to figure out what we have to pay based on what type of procedure it is, where I am in my deductible, and how much is in my HSA is a huge pain.
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I have basic med/den coverage through large group plan @ $ 180 oer month.I am fortunate. What is scary are the many young people in my neighborhood who use the emergency room for medical care. There is just no way they can afford med/dental premiums. Sad.
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I have a high-deductible plan (CDHP) and pay $0 in premiums for the coverage – my employer covers that cost completely.
However, due to the nature of the plan, the first $1,200 in expenses every year is out of pocket (that’s the deductible for a single person plan) and my annual out-of-pocket max is $3,600. We don’t have any prescription coverage through it but medications do count towards the deductible/max.
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My husband and I are in our 50s and own our own business. We recently moved to Mexico, but before that, we were paying $500 a month for catastrophic insurance ($10,000 per year deductible) through United Healthcare/Golden Rule. We paid an additional $65 a month for dental and vision coverage.
In Mexico, the government-sponsored catastrophic plan costs us per year what we were paying per month in the US. We set aside a portion of the difference to self-insure. Since a doctor’s visit here cost about $30, paying out of pocket is doable for the smaller things.
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My employer provides insurance, and I cover my family which includes myself, my spouse, our two children and my step-son. The plan is a Self+Adult+children, with no difference in my cost regardless of the number of children.
Medical is $192.92/month, Dental is $88.90/month and Vision is $16.96/month. I also contributed $500 into a Health FSA account this year, with deductions taken from my bi-weekly paychecks. The deductions are pre-tax, reducing the amount of my taxable income.
For medical, we have deductibles and out-of-pocket maximums per individual and family for in-network ($350/$700 and $1500/$3000) and out-of-network ($700/$1400 and $3000/$6000), $15 copays, and various coverage rates ranging from 100% to 60% depending on the service and whether it is in-network or out-of-network.
For dental, there’s a deductible of $50/indv and $150/fam, and an annual max of $1500. Coverage ranges from 100% to 50% depending on the procedure. Orthodontia is covered at 50% with a $1500 lifetime max for children under 20.
Vision coverage covers lenses once a year, and $130 towards frames every other year, or $125 allowance toward contact lences in lieu of glasses annually. $10 copay.
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I am covered by military health- socialized medicine. We moved close to a base so we could find a doctor that would take us as patients.
More interesting is my extended family.
Brother on high deductible health insurance provided through the state. It costs him 200 a month and is supplimented by the state. He recently had an operation that took seven months to set up because doctors wouldn’t accept his insurance.
Brother-49- who is uninsured. His kids are covered by ex wife who is a nurse at a Catholic hospital that offers great health care at a low price.
Sister who has a chronic illness covered by a 500 a month/ 5000 deductible who is afraid to go to the doctor at all because she might get canceled.
Sister-51- owns a small business with a high deductible program for her and employees (which includes a son-30- in another state that does things for the company) she pays a bit over 500 a month for her coverage- but has a great set of doctors and pays for her employees co pays.
All of my siblings are just holding on until they hit Medicare age for real health care. The question comes- which doctors will even accept them when that happens?
Mom -81-on Medicare- but pays about 400 a month in long term health insurance and 200 a month in supplemental.
When my daughter’s husband got out of the military we paid 2000 for Cobra for four months. They now are covered by his office. 300 a month for a family.
My school district offers teachers with families for 435 a month.
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All of my siblings and my mother got their insurance through an insurance broker. Women are on some variation of Blue Cross.
The largest conversations we have as a group is how our children will survive, or not survive health care costs.my nephew has congestive heart failure. his doctor told him to get a new heart and immediately declare bankruptcy. Az will not cover a heart transplant for a medicaid patient.he is 28 and never had a medical issue before.fortunately he is currently on the payroll of a large corporation who is willing to keep him on the payroll until the new heart can be found.
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My husband and I have a high deductible plan (have to hit $10k before the health insurance company covers anything, but then it covers 100%), and it costs $150/month. We’re young, though, and in reasonably good health. All prescriptions, including birth control, come out of pocket, so that’s about $80/month. I purchased this plan on my own since my husband and I are both self-employed. Wish there were a “self-employed” pool of people we could join for insurance. One major problem I have with the health insurance is that if I get pregnant, it covers nothing. I have to add maternity insurance, which is incredibly expensive, have it for 6 months without being pregnant, and then I can get pregnant. If I get pregnant before those 6 months, it still wouldn’t cover anything. Thanks you, BCBS. I *think* the health reforms might be changing maternity insurance, but I’m not really clear on how.
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Erica–
I was/am in the exact same situation, with basically the same BCBS health insurance plan, as my husband and I are self-employed. We delayed trying to get pregnant for probably about 3 years b/c we didn’t have any maternity coverage,and couldn’t afford a fancier health insurance plan. Finally, as I started to creep into my late 30′s we realized we just couldn’t wait any longer, and we decided to try having a kid anyway– figuring that we’d either bail to our state’s CHP plan (Colorado), which covers pregnant women & children within certain income guidelines, and if that didn’t work, then we’d have to move to a group plan (where they couldn’t reject us for a pre-existing pregnancy), and just pay the very high premiums at least for the duration of the pregnancy.
Well, long story short (sorry if this is TMI but I think it is important), we waited too long, and had a lot of issues with infertility, most likely b/c female fertility just declines a lot in 30s and 40s. It took us 2.5 years to get pregnant– ultimately with quite a bit of medical intervention (all paid out of pocket). Once I was pregnant, I told my insurance broker, and he informed me that, as a part of healthcare reform ALL plans must include maternity coverage– so everyone with insurance is now covered. We ended up staying with our high deductible HSA plan (yes, we will be paying $10,000 out of pocket for the delivery), but I comfort myself with the knowledge that we’ve gotten away with pretty low premiums for quite a few years, and that we’ll have all our medical expenses covered 100% for the rest of the year.
I guess what I’m trying to say is that you probably ARE covered for maternity. You NEED to talk to your insurance broker ASAP. (If they aren’t helpful, find a different one– it can take some searching to find a good one, but it’s worth it once you do.) Depending on your age, please take action and don’t delay your life because of your health insurance coverage, because while you have to be responsible, you also can’t wait forever. And infertility is an expensive form of living hell. Sorry to be so pushy, but I feel very strongly about this, and I know firsthand what a crappy situation it is to be in. If you are in Colorado, or have any questions, respond here and you can PM me. Seriously, our health care system is a mess, but don’t let it rule your life. Been there, done that, and it sucks.
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I pay $262.75 per month (I just checked the statement) for family cover (family of 5)
It covers full hospital (with a small deductible – I think its a max of $250 per year per person) dental, optical and medicines that don’t fall into the govt scheme. GP visits aren’t covered, but the govt scheme refunds a big chunk of that.
My son spent a day in hospital a couple of years ago with a suspected appenditicits and the bill was $1500 – I only had to pay $50.
My other son has had multiple surgeries for a congenital issue and I’ve only ever paid for some small pharmaceuticals.
I pay my insurance myself – its very rare for employers to provide health insurance here; why would they? – and I selected it myself; Ive been with the same fund for years.
I’m in Australia.
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I get a family PPO health plan from my employer. It runs $250 biweekly and includes vision. Our dental is an extra $20 biweekly. Our deductible is $500/indiv $1000/fam and our copay is $30. We contribute to a flexible spending plan to get tax benefits on a portion of the deductible amount and copays.
Our employer actually self-insures, so all of our claims are paid out of his pocket. He recently set up wellness centers at our facilities where we can see a PA or a doctor on certain days without having to pay a copay. This was to encourage preventative care (which actually helps limit his costs).
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This will be a little different….but we are a part of a sharing program. Works a little different than traditional insurance.
We spend $195/ month for my wife and I. In a few weeks, they will pay about $900 for a recent medical bill (the entire amount) my wife had.
If anyone is interested in knowing more, let me know. Sounds like an interesting blog for me to post soon!
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Please post details. We are interested
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Yes, please do.
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Hey Nj…I just did a post on “Alternatives to Health Insurance.” I will soon write on the program I mentioned. However, I found something called direct care homes that can function much like insurance but, in some cases, be significantly cheaper. You still would have to keep a high deductible “traditional” health insurance plan. Make sense?
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I live near Chicago, IL and I work for a grocery store chain. My wife and I are covered under my employer’s plan for health, dental and vision all for $110 a month.
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My husband and I are self employed, late 50′s. We pay $670/month for coverage with a $3500 deductible – no vision, dental or preventative care – with a 70/30 split after that. If we use a provider outside the network, the deductible goes up to $7000.
Like babysteps (18), we discovered that where you live is a big factor in healthcare costs. When we moved to Texas four years ago our healthcare costs almost doubled – and I had to cut back on coverage in order to keep the cost even somewhat reasonable. Previously we paid about $375 for a policy that included dental and preventative, had a $1500 deductible and an 80/20 split
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I have insurance through my employer, and I pay about $150 a month for what I consider to be pretty good coverage. When I was unemployed, I had insurance that was very paltry and pretty much only covered disasters, and with a high deductible. It didn’t even cover routine daily medication. It seemed to me like there were not a whole lot of options out there that wouldn’t break the bank.
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I purchase a high-deductible plan on the open market. I use Regence Blue Shield ((http://www.wa.regence.com/agent/products/individual/).
I believe my deductible is $3000/year, though whether it’s $2000 or $5000 is academic. It’s there for surgery, cancer, a car accident. My premium is $100 (up from ~$70 4 years ago). I don’t smoke.
I’ve done this for years while starting different companies and it’s made a few things clear:
1, A low deductible is rarely worthwhile. I could have a deductible anywhere between $5000 and $0… and would pay over 90% of it in premiums (they were all options presented side-by-side). It’s a bad deal for everyone – the insurer because they have to expect the worst, and me because I’m motivated to spend more.
Many employer-provided services either don’t offer a high-deductible plan, cover enough of the premium cost that the employee doesn’t receive the premium savings, or the premium tax deduction (and non-deductible expenses) makes a high deductible artificially attractive.
2. Almost no one asks how much a routine service costs. I recently chose a new eye doctor. My choices included an optometrist (that is, 4 year degree) for $x and a board-certified opthalmologist (that is, a doctor) with more experience and a thriving practice for 40% less. There’s no relationship to quality, but you have to ask.
3. Patients often expect a lot without being at all interested in how. I was just at the dentist and overheard a loud conversation between a patient and the receptionist about a co-pay that had risen from $20 to $40.
Eventually the dentist got involved and was – amazingly – completely willing to talk through the reimbursement changes that precipitated the higher co-pay. The patient just wanted a $20 teeth cleaning and had no interest in whether the numbers worked for anyone else. (I was paying ~$175 cash for the same service and still considered it a great value.)
Finally, I can’t speak highly enough of the company I purchase insurance through. Imagine Kayak for health insurance, with quotes and comparisons over the web: http://www.ehealthinsurance.com/
Also, if you’re into health policy or making decisions that might affect employees, I strongly recommend “Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation” from the Congressional Research Service. It’s only released to legislators but leaked all over Google:
http://opencrs.com/document/RL33505/
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I totally agree with all your points. Except that I’d like to add out that, in our current health care system, it can be EXTREMELY difficult to find out costs up front, which makes it difficult to make educated, informed choices. It is one thing to find out the cost of an office visit (though even that can be difficult), but for things more complicated, it can be nearly impossible and usually involves being treated like a major “problem” by the administrative staff (in my experience, this tends to be less of a problem with actual healthcare providers.)
I recently considered getting an “optional” diagnostic test, and spent over an hour getting the run around– during which time I surmised that the test would likely cost somewhere between $500 and $3000…. not terribly helpful, and a total exercise in frustration. Perhaps the problem would decrease if more people purchased high deductible plans and thus demanded to know what their services were likely to cost.
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My wife and I are fortunate to work for a company that’s generous in the benefits department. We each have our own plans (health, dental, and vision) that our employer pays for in full in addition to depositing $53 into our individual HSAs each month. We’re both in our 20′s and in good health. (Although we could both be in better shape!)
Just last week we went to the dentist and I had to get three fillings. After insurance I owed $112, which was easily covered by the money I had in my HSA. Neither of us currently contribute any additional money to our HSAs but we probably will soon since we anticipate having children at some point
.
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What company?
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I purchase an individual high-deductible plan ($2500) through BCBS of MI. I’m 36 so it costs me $110 per month right now. I originally purchased this insurance in 2008 and the cost was $85 at that time. I have no dental or vision insurance but do make 2 dental check-ups and a vision check-up each year out of pocket (and cover my expensive contacts/glasses for my very near-sighted astigmatic eyes!). My health and well being are worth it. As a 15 year cancer survivor (who got dropped by my father’s insurance at the time since I missed a semester of college for treatment. thank goodness my parents could afford COBRA, or I might not be here), I appreciate my reasonable coverage and actively care for myself to keep it reasonable for all the routine stuff. I also look at keeping healthy food in the fridge, managing stress and making time for exercise as part of my health ‘insurance’. I think of my BCBS coverage as coverage for the big unexpected injuries or health issues beyond my control not to bail me out of poor health choices down the road.
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In the US, there’s a huge difference in costs and availability of insurance plans depending on which state you live in.
Until last month, we were on my husband’s plan at a major corporation that was generous with benefits. His insurance was free; mine was $150 a month, and everything was covered 100%, no copays.
Now we are on my corporation’s plan: $350 a month, $20 copays, 100% coverage in-network, 80% out of network, $2500 per person deductible, $5000 per year limit out-of-pocket.
I had always investigated buying insurance privately. The lowest cost plan in Massachusetts is over $500 a month. To replicate what we have now with my company would be $1,200 a month. To replicate what we used to have with my husband’s old company is impossible — you cannot buy that quality of insurance privately, period; it is simply not available.
I have a friend in Maine who pays $20,000 a year for insurance for her and her husband, and it’s not good insurance.
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I am a federal employee and have a pick of insurance plans. I personally have BCBS with a Metlife Dental supplement. The premium is $90/pp. My agency contributes about $350.
My partner (unemployed due to medical) has COBRA for $608/month which runs out this year. Overall, in 2011 with ongoing medical bills in the tens of thousands, the premium is worth it once the deductible is met. She is diabetic and is uninsurable due to “pre-existing” condition. So we don’t know what to do except to apply for financial aid from drug companies and health service providers. Wish us luck!
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I thought Obamacare did away with the “pre-existing conditions” exception. I think it is already in effect – no company can reject you because of pre-existing conditions.
Can anyone confirm? Maybe your partner can try looking again.
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Starting 2014
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Most of those protections don’t go into effect until Jan 1 2014. Although I thought as long as you had less than 63 days without coverage out of the last year they could not use the preexisting clause against you? It seems to vary by state and whether you are talking group or individual insurance.
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We have family coverage through DH’s employer and pay about $500 per month for a HMO. His employer pays for Dental, and we pay about $15 per month for Vision. For next year, the premiums are about the same, but the coverage is changing to 90% with a deductible.
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I have a PPO through my employer (no dental, small vision reimbursement). It covers 80% of costs but we hardly ever use it. The good part is that my employer covers all the premiums so I only ever spend money if I’m actually receiving care.
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Individual plan, $188/month, 2500 deductible, the insurance doesn’t cover a lot, I’m in my twenties.
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I’ve been self-employed for thirty years. I’m 57. From 2001-2008 I lived in CA and had Kaiser insurance, $500/month premium. Ripoff! From 2008-Sept 2011 I lived in Nevada, and my high-deductible ($5k) Humana insurance plan (no co-pays, 100% coverage after deductible, includes dental coverage) was $250/month premium. Sept 2011 I moved back to California, with the very same coverage, and Humana increased my premium to $545/month – solely because I’m now in CA. Absolutely absurd.
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