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johnydecali

Health Insurance

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johnydecali
Hey all...
 
 
So I've been running around with no health insurance, I was supposed to get insurance from work but the boss changed his mind about offering insurance... In California we have open enrollment till Jan 15th, 2017 (the date got extended), I'm shopping around and was wondering what type of health insurance do other people have.
 
I'm looking at:
[ul type=disc][*]Kaiser's HSA Bronze 60 HDHP: $309.38 per month/$5,500 annual deductible/40% after deductible for office visits, xrays, outpatient surgery, etc.[*]Kaiser Deductible Bronze 60 HMO: $311.83 per month/$6300 annual deductible/first 3 office visits $75 for primary care, $105 for specialty care/100% up to the annual out of pocket maximum for inpatient hospital care.[*]Kaiser Deductible Silver 70HMO 1750/40: $406.24 per month/$1,750 annual deductible/$40 for primary/specialty care visits and test, $60 for xrays/30% after deductible for inpatient hospital care. [/ul][div]
Any suggestions? I'm looking to not pay more than $425 a month. I grew up with Kaiser so it's what I'm familiar with but open to other coverages. [/div]
 
 
 

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Zephyr
I've had HMSA / Blue Cross Blue Shield all of my life and have done fine with it. I have a "grandfathered" individual business plan that covers medical/dental/vision. The new plans offered through HMSA for individuals are all Obamacare plans and you have to get vision / dental / medical all in separate plans as they do not have a "combo package". I prefer a slightly higher monthly payment with lower deductibles and co-pays when possible for all insurance. It only takes one bad day to blow through all of the money that you "saved" by having a lower monthly payment. In the end I would compare the various options that you have available versus what you are comfortable paying. Some people figure that they'll never need the "extra" coverage and go for bare bones / lowest monthly payments. Others who may have had a bad day such as kidney stones or something similar may opt for a more comprehensive plan knowing that just one stay at the hospital could be the equivalent of a brand new FZ07. A big factor for me was the primary care physician. I had a specific doctor that I wanted for my primary care physician and he was not available through Kaiser locally, so that pretty much sealed the deal for me when choosing between Kaiser and HMSA. Best of luck to you.
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Beemer
Eastern Kayaker
+1 what zephyr stated above. Also, besides the primary care doctor, verify any specialists you use are available with your plan. Some plans have in-network doctors and out-of-network doctors. Verify your primary care doctor and any specialist you use are in-network, if your plan is a network type plan. You will pay more per visit if the doctor is out-of-network. Check deductibles and percentage you are responsible to pay for each plan you review.

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Simbadc650
I lost my job and had medicare for the longest time, they decided to drop me since i collect to much on edd then went to covered California. Covered CA said I did not make enough to be on covered CA, so been given the run around for 2 months. Had to get a lawyer and finally set up with Covered CA Kaiser silver 80.
 
Moral of the story don't get dicked around!

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rick
Ditto to Zephyr's reply.
 
I fell from the 4th rung of ladder in 2001 and landed on a wooden floor (with some give), flat on my side with a Maglight aluminum flashlight in my pocket on that side, Doh!. The result was surgery to bolt the head (aka, ball) of my femur back on. 3 large, expensive screws i have to this day.
 
I'm pretty lucky in that I work in a major University with a medical school and associated hospital system that has its own insurance business. Sh-t happens fast and gets real expensive even faster. Can't even imagine having to pay that hospital bill out of pocket - those were some pricey 90mm screws. It would cost me more now (healthcare costs/deductables etc. in the 7,8 years before ACA (2011) went up nearly 40 percent) , but back then it was pretty much no charge.
 
Think if I were to lose my insurance, I'd not risk riding (or climbing ladders for that matter) until I had.
 
BTW, my boss of 25 years is a trauma surgeon. He knows I ride and still play on ladders. We don't talk about either - though i do get to hear in research conference after conference at how everyone over 50 is more likely to have worse outcomes when it comes to trauma.

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pattonme
If you have to pony up that kind of scratch before the insurance company starts to pick up the tab, then it's a joke to call it insurance. Look for short-term accident/trauma insurance. Typically only good for 6 month terms. Many of the big names have short term plans while there are also specialists who mostly focus on that market. Here's one.
 
https://www.uhone.com/Quote/PlanDetails/?ProductType=SHORT%20TERM
https://www.ehealthinsurance.com/short-term-health-insurance
 
One can hope (dimly) the new administration will bring criminal charges against the medical cartel industry for it's rank violations of the Sherman and Clayton acts. In no other economic activity can you do what the industry does and not IMMEDIATELY go to prison.
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rick
Our extreme malady care is 2nd to none, but sadly, as much as we have to pay (and ours is pretty much the most expensive health insurance in the free world) it would bode better if our life expectancy wasn't only 34th or so - behind a lot of countries we would consider 3rd world. Maybe it's just as well we don't do much better at math anymore.

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pineappleunderthesea
At one of my previous jobs, the company wasn't doing well and they put us all on a high deductible plan, something like $2000 out of pocket and then 70% paid until you hit $5000 (after that it was all covered). Unfortunately for me, that's when we started having kids, so I was writing $1000 checks left and right.
 
All this to say that it depends what you think is coming up in your life, if you're not planning anything major then high deductible can be OK. But if you're having kids, for the love of money you better get something good since the bills just add up and add up!
 
As an aside, with companies now giving you less and less options for health care, I wonder what the breaking point will be for people to start asking for a national health care system...

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pattonme
Up to the 60's (early 70's?) it was cash on the barrel head and prices posted. A 3 day birth stay in a private room back then adjusted for inflation was something under $2k. Cost growth got stupid as soon as everybody stopped price shopping because "somebody else" was paying the tab. Look at the Surgery Center of Omaha. Prices for major operations posted on the door, and a fraction of what the "bill" would be if you had it done at a cartel hospital. Terminate the cartel and prices would come down 60-80 percent practically overnight. Doctors would rather eat than starve waiting for that elusive customer to pay their sky-high ask. Then medical insurance would be for the really big stuff - actual outlier events. If your house or car insurance covered windows, siding replacement, roof tiles, boiler and major appliance maint or replacement, tires, and oil changes, can you surmise what the premiums would be?
 
The medical cartel is destroying the country by sucking up ~17% of GDP. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
That's insane. Every state, every municipality, every pension that includes medical benefits, even the national gov't has but a few years before they are all good and bankrupt. And it's all because of healthcare prices.
 
Recent post on significantly ineffective US healthcare expenditure vs other countries.
http://www.visualcapitalist.com/u-s-healthcare-system-global-outlier-not-good-way/
 
 

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rick
Yep, we pay 100-150% more. We do have a "for profit" health system after all.
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timjh
 If your house or car insurance covered windows, siding replacement, roof tiles, boiler and major appliance maint or replacement, tires, and oil changes, can you surmise what the premiums would be?
Of course there's more to it than that.  Folks do buy that sort of car or home insurance and it's expensive but not outrageous. 
The big difference is that when repairs get too expensive it's easy for the insurance company to total the car out and give you a check to buy a new one.  Instead, we have TV telling patients they should demand a $50k drug that improves median survival from only 6 months to a whopping 9 months (with severe side effects).  Other countries have less trouble saying "Sorry, you're too old/sick/young/useless to justify that expense."  We're learning, though.  Some university hospitals refuse elective surgery to smokers.
 
N.B.  My numbers on that TV example may be off a little, but you get the idea...

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