Medical Insurance - Another Bigger Problem!!

[Cut-Throat]

If you do manage to secure Medical Insurance at an affordable price, he next question is how much would your medical bill have to be before you'd use the insurance.

From what I understand, if you ever submit a claim, the insurance companies will raise your future premiums to the point that you wished you'd never submitted the claim in the first place.

All this is making self insurance seem like a possible alternative.

 

[unclemick]

After being self insured for eleven years - given the posts on this subject - looking for decent insurance coverage would probably make me sick enough to need it.

Still 5 yrs to Medicare.

 

[Peter]

If you do manage to secure Medical Insurance at an affordable price, he next question is how much would your medical bill have to be before you'd use the insurance.

From what I understand, if you ever submit a claim, the insurance companies will raise your future premiums to the point that you wished you'd never submitted the claim in the first place.

All this is making self insurance seem like a possible alternative.

This may vary from state to state, but my understanding is that in California, your premiums cannot be increased above the level charged for the age/location group you are in. This applies no matter how many claims you make.

In other words, it's NOT like car insurance ...

 

[cute fuzzy bunny]

Thats correct, its by age bracket in CA.

I've got a policy with blue cross of california that costs $85 a month. Theres a $1000 deductable, after that its 80/20 with my out of pocket max being either 2500 or 3500, I forget which. Everythings covered after that. No coverage for doctors offices, no prescription drug coverage, annual physical with a nurse practitioner for $25 for a basic, $75 with full blood tests and whatnot. I get any doctors services at the BC/BS rates, which is a lot lower.

Basically catastrophy coverage. I've never broken a bone or had a major illness, and the only thing i've ever had prescribed was prednisone for poison oak and simple antibiotics that I probably didnt need. My dads 70 and has the same medical record.

I had been using Kaiser Permanente for HMO coverage, which was $150 when I signed up 2 years ago, then went to $199, then to $218 this year. At 150 and even 200 I was willing to pay for the full coverage. Over 200 I needed to reconsider. Kaiser did give me very good service right until the end. Took them a month to photocopy my medical records and send them to blue cross. I'm not a big fan of "dont let the door hit you in the ass on your way out" customer service.

 

[sgeeeee]

This may vary from state to state, but my understanding is that in California, your premiums cannot be increased above the level charged for the age/location group you are in. This applies no matter how many claims you make.

In other words, it's NOT like car insurance ...

The same thing is true in Arizona. When I was researching medical insurance for myself, I did notice that it was not true for all states.

 

[John Galt]

I think you guys are referring to HIPPA. This is a federal law which REQUIRES all states to mandate your
insurability under certain conditions. Also, the states
have their choice of 3 or 4 (I've forgotten the details)
systems to accomplish this. I looked into states where
we thought we might end up, but decided we could not
pay the premiums in any of them. I think the law
may be generically called the health care portability
act. Anyway, I came, I saw, I passed.

John Galt

 

[cute fuzzy bunny]

If I recall correctly, at least for california, HIPPA provides a transition whereby if you are on group coverage, including COBRA, HIPPA requires that the insurance company cover you on its individual plans with no potential to turn you down. This would work well for my fiancee because she has some occasional asthma...should she decide to join me in being a bum, she could get cobra coverage and then BC coverage via HIPPA and BC cant turn her down or charge her more than the standard individual group rates.

The rates I'm talking about in CA are for standard individual plans from Kaiser and BC of CA. Of course this is with no preexisting conditions and i've been insured continuously through my life...I think the latter is important in agreeing to accept you, that way if something major is 'discovered' in the first year or two the current insurer can go after the prior insurer for part of the treatment costs.

 

[BUM]

No matter how we justify your positions; either buy a ton of insurance and sleep peacefully, or go naked and hope for best...we are all going to get sick and die. If I was only thinking about myself, I'd roll the dice. But who would be willing to subject a spouse to such risk? A bout with most cancers would wipe out most self-insured's assets. Then what? One illness cancels out several years (or decades) of savings.

My father's badly broken leg landed him in the hospital for 6 days. He only has medicare. Not near enough to cover the stay. He is sweating it out big time. He procrastinated too long in buying a supplemental policy. Its still on his desk unsigned. At 70 yrs old he may never fully recover, both physically and financially.

When I pull the pin and retire, hopefully next year, I want this base covered.

Bill

 

[Martha]

Insurance is available in some states through risk pools if you have a chronic condition that otherwise makes you unisurable. The listing of the states with links is at www.selfemployedcountry.org/riskpools/states.html. I am a Minnesota resident and they have one of the the best plans. The cost is calculted to be 125% of market rate. Of course, not a lot of people want to retire and become a Minnesota resident (high income taxes and the winters are rough). However, we can travel in the winter time and Minnesota taxes buys us a lot of services.

 

[astroboy]

I know my wife and I will have to get our own private health insurance after my post-retirement company benefits ends and I figure that to cost about $1000/mo, but my question is how much you save when you turn 65 receive Medicare. I know there are gap and supplementals but I would think that even with these, you still save compared to regular private insurance.

 

[ESRBob]

Has anybody looked into or gotten one of the new Healthcare Spending Accounts (HSA) and High Deductible medical insurance that goes with it? I found a site, www.msainfo.net that has a fairly good explanation of these new (tax deductible and low-cost) plans. I think they are especially good if you are relatively healthy.

I think the same pools rule works that they can't throw you out for claims, you'd just pay for the initial claims yourself every year which lets you basically self-insure the little stuff, and insure only the big stuff. A nice blend! when my the company i founded stops covering me (part of the deal when i let the venture capitalists get rid of me years ago and started my ER!) i'll definitely look into these puppies.

bob

 

[unclemick]

? What if your only income is stocks and bonds - can you still get an HSA?

 

[unclemick]

I.e. what is 'self employed' under HSA rules?

 

[wabmester]

I think HSA income is the same as IRA income. I.e., only "earned" income qualifies.

FWIW, I haven't been able to find an individual insurance plan in my state (WA) that qualifies for a HSA. Hopefully, they'll show up soon.

 

[John Galt]

I have wished several times that I could make an
IRA contribution. Alas, I have no earned income. If I
could I bet I'd come up with all kinds of tricks.

Back to medical insurance. The regulars know from previous posts what a struggle that's been for me.
I've been covered continuously since I ERed, but
sometimes at ridiculous prices for questionable coverage. I'll bet I've been with 6 or 7 different companies
in 10 years. Right now we pay a reasonable charge
but have some "holes" in the coverage. Just sweating it out
until medicare (5 more years).

An observation. I know genes have a lot to do with
health and longevity. I would caution against
assuming too much just because your parents
and/or grandparents happened to reach a ripe old age.

John Galt

 

[Jarhead*]

Astroboy:

Medicare and a supplement currently will cost about $200.00 a month. With both of those, you are pretty much covered for any situation. Hope that helps.

Jarhead

 

[Martha]

An observation. I know genes have a lot to do with
health and longevity. I would caution against
assuming too much just because your parents
and/or grandparents happened to reach a ripe old age.

John Galt

I know many people who assume they will live to 90 or 100, even though life expectancy isn't close to that. My father died at 63, his dad died at 99. My mother died at 39. Both her parents outlived her, well into their 90s. I assume nothing. That is why I would like to retire early.

Martha

 

[John Galt]

Hello Martha. You are right to "assume nothing."
Prepare for the worst and hope for the best.

John Galt

 

[Billy]

Hi all,
Here's an interesting approach I found in a letter to the editor in the Naples News. It makes sense to me.
http://www.geocities.com/ba264/medical_letter_to_editor.htm

Billy
Web-site www.geocities.com/ba264

 

[John Galt]

Hi Billy. Yep, interesting, but probably doesn't mean much for the rest of us. Taking a couple in their 70s
who appear to be flourishing and assuming their
system would work for others is a bit simplistic IHMO.
I was most interested in their doctor who retired at age 87. Now that is truly remarkable. Hard for me to
understand. Must have enjoyed his work or had no
outside interests. And of course some people believe
it's their duty to serve their fellow man until they drop.
Still................87

John Galt

 

[Billy]

John,
I agree, one size doesn't fit everyone, but IMHO, folks here in the US are over medicated, no matter what their age is....how's the ad go? "Ask your doctor".

Now, about retiring at 87? who knows, but I often wonder what keeps Bill Gates motivated.

Billy
Web-site www.geocities.com/ba264

 

[John Galt]

Hi Billy! Guess I would agree about the
"overmedicated" part. I tend to watch this carefully
in my own case as everything you swallow is having some effect somewhere, and often not that whcih was
intended. I personally knew 2 people
who took lots of pills and felt just awful. They went
off cold turkey and got better immediately.

John Galt

 

[Billy]

Hi John,
I think that's the point of the letter...right?

Hey if it worked for these folks...it might work for others. I doubt many doctors would agree.

And don't you just love those ads "call your doctor" like YOU could EVER get through to them...at least in the states.

Billy
Web-site www.geocities.com/ba264

 

[John Galt]

Yeah and when you have a health problem, you want
instant action, or at least I do. Don't you love it when
you call in for an appointment and the girl says the
first opening is next November? Here is a real life story.
I wanted an appointment with my ENT guy. Hadn't acually been to see him for several years, but I looked on
his business card and called the appointment desk
(this was last Friday). The person on the phone takes
some info (which they already have) and says "Our
first opening is July 21st." If I had a serious problem, I could be dead by then. Soooooooooo, I called his
office directly and talked to someone who knew me.
Bottom line; I made an appointment on Friday and got
in the following Monday (3 days).
Wealth, knowledge and all that stuff is helpful but only
being unwilling to give up is unstoppable. Most folks think I'm pushy, but I get what I want most of the time.

John Galt

 

[unclemick]

I agree the first line of defense is to try and stay healthy. After that, you're stuck with the system where you are at. My mother's Medicare Supplement is no longer adequate(I admit to being asleep at the switch) and the SO's(she's got a UAW auto union pension) medical coverage has eroded over the last ten years. This is a area that requires - now that I woke up - probably constant/on going attention and reminds of going back to work - like it cuts into my ER time and I don't like it.