Health insurance?

[dory36]

Anyone using Unicare for health insurance? Comments?

Thanks,

Dory36

 

[Mr._johngalt]

Hi Dory! I've never heard of Unicare. Right now we
are about 9 months into my wife's COBRA coverage
from her last job. The premiums are killing us, but
we figure one of 2 things will happen. Either she will
go back to work and provide insurance in that way
(I am uninsurable by conventional means), or we will
be relocated to another state and by virtue of uninterrupted coverage for 18 months will be
eligible for Kennedy-Kassenbaum federal mandated
"portability". If we go this route I am hoping it's
something we can afford. I would be quite content
with a 10,000 to 20,000 deductable. Can't even buy
that on the open market, so we are stuck
for now.

 

[Mr._johngalt]

I would like to hear from those who may have decided to go without any health insurance. Would be especially interested in anyone who has decided to
"game the system" by arranging to be "indigent"
as far as liability for health related expenses. I am
speaking of those who chose to stay in the USA, but
arrange their affairs to make themselves judgement proof. Thanks!

 

[arrete]

DH found the following URL for a company that sponsors a prescription discount card. It is the same company the provides the prescription service for our local Blue Cross/Blue Shield, and I've been happy with them in that respect. The discount count card is mainly for people without insurance, but could be used by anyone with inadequate prescription coverage. Mine tops out at $1500/year, so could be a back up plan. If you have insurance but still might be interested, check out the FAQs at the bottom of the page - there is something in there about that situation.

http://www.advancerx.com/advpcs/prescriptionplan/index.jsp

If anyone knows more about this plan, good or bad, I'd love to hear it.

arrete

 

[John_T]

The vank my wife works for changed insurance company and with the new company to cover me would cost us $374 a month even in a group. Her employer is a small concern with older employees so their cost is high. My wife gets her coverage as a benefit so I went shopping for my own. I so far am enjoying relatively good health and go to the doctor very little. I purchased a policy from Blue Cross Blue Shield with a $2500 deductible with an adequate drug prescription plan for $191 a month. Still cheaper than the price to be on my wife's policy and I feel better knowing I have my own insurance not attached to any employer. It's catastrophic insurance but that's what I feel health insurance is heading for now anyway. The days of companies offering insurance bargains I believe are over. I'd recommend that anone needing insurance check into Blue Cross Blue Shield it may be of help for your insurance need. By the way, I'm 53 and I think the rate I got was fair.

 

[Jack Alles]

Dory36, I am in the Midwest/Chicago Area and Unicare is an option thru my employer. I have Unicare HMO and the provider here is Lutheran General Hospital. The coverage is excellent, deductible more than reasonable, and paperwork is minimal. It is working out very well for me. Jack

 

[Mr._johngalt]

Regular visitors here will recall my struggles with the
health insurance issue. Based on current premiums that I've been quoted, and in spite of some pretty
agressive "doctoring" in years past, I do not believe
the total of my co-pays and premiums (no matter who
was paying) have ever exceeded my expenses in any of my 58 years. In other words, during the times I was
self insured, I would have been way ahead by just
paying everything out of my pocket and going without
insurance entirely (it's a lot of money). Less hassle too! Stuff like that
surely makes it tempting to "roll the dice" and go without insurance for a while. I probably won't do it
but I think about it a lot.

 

[Ted]

As with all other types of insurance, the nature of health insurance is that the average person will pay out much more than they get back, in order to finance the smaller number of people who experience catastrophic expenses. That is, in fact, the whole point of insurance -- not to serve as a slush fund for the routine losses or expenses that everyone can expect, but to protect against truly extraordinary expenses.

Although the insurance industry is competitive, its customers as a whole get back less than they pay in because of the industry's administrative costs. The best strategy for a person to minimize their lifetime insurance costs is to purchase only as much insurance as they need to insure against major catastrophes. Generally this means having high deductibles that spare the insurance company the expense of processing lots of claims. This savings gets passed on to the consumer.

 

[Michael]

I noticed this when pricing policies. If memory serves, for coverage on the first $1000, it actually cost more in annual premiums than the amount insured. From $1000 to $2500 it was about $1 in premium for every $3 in coverage. Over $2500 the coverage per dollar of premium became much higher. I opted for the $2500 deductible. I honestly hope that I never collect a dime from this policy, because that would mean that something had gone terribly wrong that I would need so much costly medical care.

 

[RedOscar]

I'm not quite sure how to address this issue, but one advantage I perceive between being well insured and NOT being well insured is the apparent discount insurance companies receive for services provided.

The service provider presents his charges, and the insurance company pays the UCR that has been agreed upon in contract. It's almost like the difference between paying wholesale and paying retail.

I have had my share of major claims for medical services in the past (car accidents, premature babies, etc.), but have always had the good fortune to be fully covered. However, now that I am footing the cost of insurance out of my own pocket, I am quite interested in how to be a better shopper and get the most for my money. Unfortunately, it is not so easy to get good information in this area. I hope this situation changes soon!

Red

 

[Mr._johngalt]

I have an extremely low hassle tolerance
(one reason I am retired). Aside from the obvious
temptation to "go bare" (saving the premiums),
the concept of eliminating the insurance company
entirely has great appeal. Paying out of pocket for services rendered is a "clean" way to handle this.
Of course, you risk financial ruin. Still....................

In my case, even if my total medical expenses in a given year when I was self insured
exceeded what I would have paid out in premiums and co-pays by a large sum, I would still feel satisfied in
having cut out the middle man. Such is my aversion
to dealing with insurance companies, and indeed,
bureaucracies in general.

 

[Ol_Rancher]

As a retired Texas school teacher, I am covered by a statewide plan called TRS-CARE administered by Aetna. I retired at age 53 years ago. Until the beginning of 2003 my premiums were $273/month for my wife and me, with a $240 deductable. At the beginning of 2003 premiums rose to $550/month. My pension pays $2300/mo. Fortunately, I have a portfolio that is enough to fund our retirement.

My wife is fighting breast cancer and has been since 1996. I retired in 1999 and my wife quit a year later. Our coverage pays for 90% of medical expenses (less co-pays) with a $5000 out of pocket cap. Then it pays 100%. Yes, I feel blessed at having this coverage. Funding this retirement health plan has been an issue in the Texas legislature recently.

I have learned that even with such a good plan, expenses not covered can add up to big money. Travel to MD Anderson Cancer Center in Houston for weeks at a time can burn through a lot of money. At 80% or 90% coverage, a long battle with cancer can leave you broke.

Recently a relative told us to apply for social security disability. We did and discovered that my wife qualifies. The school district we worked for is one of only 10 in the state that took out money for social security. She quit work 3 years ago at age 49 and we figured that she would never see any of the money she put into SS. Now we find out that she will receive over $1300/mo and will also receive back payment to the time she was unable to work... about $16,000. Social Security Disability is based on what you put into SS, not on any assets or other income. People confuse this with the SSI program which is means tested.

I figure that I now owe hospitals in Austin and Houston around $30,000 and counting. But if I send them a payment monthly as low as $50 - $100/mo. , they are quite happy with it. I plan to pay off this debt with the unexpected Social Security payments. My wife was also told that she will qualify for Medicare even though she is 52 years old because her condition ultimately results in death. Her medicare enrollment will reduce our premiums for the retiree health coverage.

My point is, that if you worked for wages during your working years and have a catastrophic illness, social security can and does offer help to the early retiree .. not to be over looked.

 

[Cut-Throat]

Rancher,

Sorry to hear about your Wife's problem

This is very good information. A lot of the posters on this board are preparing for this exact type of calamity and is the main fear of ER's.

It almost sounds like if you are part of the SS system, a catasphrophic medical event is covered. Maybe going without insurance and investing the proceeds to cover medical costs and relying on SS would be a way to go?

 

[Peter]

It almost sounds like if you are part of the SS system, a catasphrophic medical event is covered. Maybe going without insurance and investing the proceeds to cover medical costs and relying on SS would be a way to go?

Hmmm, I wouldn't quite go that far.

Rancher, you have my sympathies regarding your wife's illness. My wife died from cancer (or, more accurately, the treatment) in 1997, after a 13 year illness. She also received SS disability payments and would have qualified for Medicare, once it was established that she was permanently disabled. Fortunately, she had excellent coverage from her last employer, so our out of pocket expenses were quite low.

Anyway, to Cut-Throat's point: you only get these SS and Medicare benefits if you are permanently disabled. Apparently, this means that your medical condition is judged to be terminal - i.e. you are going to die. There are many 'catastrophic' conditions that do not lead to death, and this is why you need medical insurance.

Sorry to take this rather morbid tone, but those are the facts as I understand them.

 

[John Galt]

Just to clarify a little. You could have a "catastrophic"
condition which was not terminal and still collect
SS disability benefits. You would have to prove that you were unable to perform any kind of work whatsoever, due to
your condition. That's difficult in most cases. Also, it's
interesting that initial claims are routinely denied. It's
my impression that those willing to push the hardest
the longest have the best shot at benefits.

John Galt

 

[Peter]

Just to clarify a little. You could have a "catastrophic"
condition which was not terminal and still collect
SS disability benefits.
John Galt

But, it's my understanding that you have to be disabled for some period of time before you become eligible for Medicare, two years, I think. You could chew through a lot of medical costs in that time!

 

[Bob_Smith]

John is correct. SSDI covers those unable to work in any occupation, terminal or not. Medicare starts in two years. Initial claims are often denied. Likewise with the step two appeal. Step three involves an administrative law judge, and it is at that step that many obtain benefits. A lawyer specializing in social security disability is often a good idea for those who don't know the system. This is definitely a fall-back for those who encounter catastrophic illnesses, but the remaining spouse must maintain commercial coverage, eligibility requirements are very stringent, and there's a two year waiting period for Medicare, so it's not a solution to the health care issue for early retirees. It's far too risky to rely upon.

 

[Suzanne]

Does anyone know why on earth the health insurance rates in So. Florida are so incredibly high, or what alternatives I may have? I am a 42 year old professional woman, who recently disembarked from the corporate benefits gravy train, and I am shocked at the amount that self-employed people have to pay for basic medical coverage. I cannot afford entrepreneurship. To be added to my husband's employer's small group policy costs $462 per month (BC/BS HMO) just for me. A high deductible - $2500, $5,000 max out of pocket - individual policy will cost $308 per month just for me. I have NOT been a sick person, do not smoke, and am well within the healthy weight limits. I would appreciate any insights or potential solutions you may offer.

side comment: I often think this situation has a serious chilling effect on the creation of new small businesses.

Thanks,

Suz

 

[John Galt]

Hello Suz. I feel your pain. Florida is a state we seriously considered for our sunbelt relocation
(before we settled on Texas). I too was shocked
at the cost of health insurance there. I am almost 60
with a few chronic problems, so I was at a real
disadvantage. I agree it would tend to be a damper
on entreprenurism. Fortunately, I no longer have to worry about that.

John Galt

 

[farmerEd]

I am currently paying almost $1000 per month for a BC/BS HMO policy for my family of 6....needless to say I spend a lot of time trying to figure out ways to get this monkey off my back....

Anyway, where I live (Mass), there are no cheap insurance plans. In all their wisdom state government has forced insurance companies to include coverage for everything under the sun, and forbid the sale of high deductible insurance policies (so that employers would be tempted to use them). Unfortunately, it means people like me, who WANT a high deductible policy can't get one....

We have been considering a move to Virginia, which is one state that does sell them...even BC/BS has them avaialable. I can get a policy with a 10K deductible for less than 200 per month....anyone know if you can own a house in VA and get your policy in VA, but also spend at least half your time elsewhere? The $800 per month savings would be much better spent buying a second house in VA thant sending to BC/BS...

 

[John Galt]

Hello! I have never been to Mass., one of the few states I've missed. I picture it as kind of a Marxist
state, based partly I confess on who they send to
the Senate. But, I digress. I was faced with the same
problem, i.e. couldn't find (and/or afford) insurance in the
state where I was residing, and yet knew of a nearby
state where I could get cheap coverage. I could have
moved easily but opted to stay put and now have
coverage that we like, although it has loopholes.
My opinion is that your theory would work, but I would
also want a Va. drivers license, voters card, license plates, bank account, etc.
to firm up residency. Otheriwise, you might get your policy and then have it challenged in the
event of a big claim. It's a lot of fussing, but as you point out, for $800 a month it may be worth it.

John Galt

 

[cute fuzzy bunny]

As John says, make sure you firmly establish your place of residence. I read through my old insurance company's terms and conditions, and one is that if it is discovered that any statements made during application (which would include place of residence) that turn out to be false enables them to not only refuse future treatment, but you may be required to pay for any past treatment performed.

Ouch.

 

[LTS]

Dory36-

I have Unicare 2000 for both my (2) kids and wife. I bought it directly as I am not employed at this time and not sure if I will go back, hence my review of this site.
The monthly costs are not low but they are manageable.
I have a high deductible which came into play recently when my daughter fell and broke her wrist. I was getting bills from the ER, the XRAY diagnostic firm and
then the Orthopedist who spent 10 minutes with my daughter and charged us like we were there a week .

In any case, while I had to pay a sizable bill (in total) it was not as high as was billed to me because Unicare would not permit it. In other words, you only pay what they consider appropriate. For example, if the Ortho billed me $2500 and Unicare said the procedure should only cost 1800, then you only are required to pay $1800.
Lastly, if your end up paying $2000 in total bills, you might think that your dedcutible has been met for the year BUT not all of what is paid for goes towards
the deductible. For example, some expenses or portions they don't cover, so you end up having to pay for it with no benefit toward your deductible.

Bottom line is that Unicare was OK to work with and I had used them under a previous employer under a better plan without concern or any problems. Now that I am buying it myself, I am far more sensitive to cost and return. They are a big outfit and accepted in many places but they are big for a reason. Like any HMO or PPO, they dictate what they will pay to the doctors and hospitals and on the other hand, you'll find they don't cover all that you wouild like but the main thing is that you (I) am trying to avoid the catastrophic situation.

Hope this helps.

LTS

 

[dory36]

Thanks, LTS.

Health insurance is not an easy situation for ER. We finally went to a catastrophic plan for my wife, and VA coverage for me. Fortunately(?) I had a service-connected disability that makes me eligible for their full services.

Unfortunately, the fact that so much health insurance is chanelled though employers means that individual coverage is not a very big industry, and there isn't the competition for the customer as there should be. I wish it was like long distance service or cell phones!

Dory36