Health Insurance for the Self-Employed?

SharkJumper writes "Looks like this question has been asked before, but might be due for an update. I'm a self-employed programmer who is about to become a father. Previously, my family's insurance has come through my wife's employer, but she is eagerly looking forward to being a stay-at-home mom. We must look for that elusive low-cost insurance in order to enable her to do this. Losing her insurance is not a huge loss as, due to failed negotiations, the hospital in our city (3rd largest city in the state), along with most of the doctors that refer to it, is dumping the network (largest in the state) that our insurance uses. On the individual coverage plan front, my research shows story after story of deception, fraud, and general run-around or obfuscation by most of the major players and nearly all the minors. With all of the bad experiences out there, I've yet to see a good review of an insurance company. What does the Slashdot crowd use and recommend? Company and plan-type? PPO? HMO? HDHP + HSA (High Deductible Health Plan + Health Savings Account)?"

Re:For better health coverage?

While a humorous comment, it highlights what makes the American health care system so unique. We are so fiercely independent, that a good majority of Americans don't like having the government telling us what to do, and this includes how we take care of our body and our health. This system allows for many benefits as well as problems. The most visible problem is the ever-increasing cost of health care, and the number of people like yourselves who are falling through the cracks because good health insurance is only available through employers who can command group rates. On the flip side, because the state is not dictating how health care is conducting itself, American health care is a hot-bed of new procedures and techniques that push the limits of health care because people are willing to pay for an unproven technique even if it has even a small chance of success if the alternative is not acceptable. For example, the second son of a friend of mine was diagnose with Spina Bifida [wikipedia.org] and instead of accepting that his child would be born paralyzed, was able to find a surgeon who was willing to perform surgery on the child while he was still in the womb! [fetal-surgery.com] (notice that of the four hospitals in the world that perform this unique and complicated surgery, all of them are located in the United States)

As a graduate student, I am faced with paying for a cut-rate, we-don't-pay-for-anything-unless-you-get-hit-by-a- bus student plan, or a much more expensive individual plan. There are very few national health care providers, and you would be well suited to search for and find a regional health insurance company. In the mid-west, I have been leaning towards Anthem [anthem.com] as my insurance provider, and hope to have a plan from them to help me start off the new year.

You get what you pay for

I am a surgeon, and it sickens me what the HMOs often do to patients. They send patients to me, and then won't even let me take an X-Ray. So then they have to take a prescription, go to their gate keeper MD, fight that paperwork, get the X-Ray at another location, and then bring it back to me. Worse is if they deny it, then I have to fight it out with some high school graduate, reading a script, as to why this person needs an MRI.
Now it's 2-3 weeks later. Often the X-Rays are lousy, not the right ones, etc. If they have a broken bone it means that I'll have to re-break it to set it straight. If they have a tumor, then that's just another 3 weeks that it has a chance to metastasize.

  If an HMO patient has a broken bone, then I have to use heavy plaster casts, instead of light fiberglass, because what the insurance pays me means I'll actually lose money on the fiberglass cast.

HMO's are O.K. if you don't get sick - do yourself a favor and get a PPO.

Re:For better health coverage?

Canada is no panacea either. Here is how Canada works. For the most part things that are common get covered, myself I pay about $100 a month for insurance to the state (provincial level), $50 for my group plan from my employer (a similar non-group plan would cost $300 for my family). My health insurance would be more to the state but because my wife is stay at home we put the kids under her free plan from the state. (For some reason there is no law requiring a family claim together). I think it would be around $200 a month if we claimed together and her and the kids would pay a whole bunch of user fees and lose a bunch of benefits. That is the funny thing, I pay more and am covered for less. Anyway, so how it works is anything that is expensive doesn't get covered, or they don't have enough machines so you merely die on a waiting list rather than getting denied coverage. In anything cutting edge we are far behind the latest technology so that it doesn't cost so much. Basically, health care in Canada is cheap because we ride on the coattails of the expensive US system that develops the technology. And the system weasels its way out of anything expensive that isn't common. Get Cancer in Canada and you will spend $3000 a month buying drugs. The funny thing is its also ripe with corruption and misallocation of resources.

Re:For better health coverage?

Except that isn't true.

It's true for the spina bifida surgery (I was tempted to disagree, but I re-checked).

However, this is because the operation is still in a trial phase. It still has to be proven that the intrauterine operation gives a better outcome than a postnatal operation. I guess that all other hospitals around the world are waiting for the outcome - they don't want to be the ones to have performed complex and risky procedures that later turned out to be no better (or worse) than the conventional, tested approach.

Re:For better health coverage?

Actually I don't listen to talk radio, mostly because radio talk show hosts are there to entertain you and they do so by espousing their view on different subjects, without regard to the facts. In academia, what we learn is based on studies and fact, and exploration of ideas and questions about what we observe. While we may have opinions about why things are as they are, those opinions may drive us to study why we think what we think, and explore other options in coming up with a reasonable conclusion.

There are many factors that are contributing to the increasing cost of health care in the United States, however medicare and medicaid are not reasons why Joe Citizen is paying more for health insurance. As those are government programs, the taxpayer is paying for any fraud. If you are talking about Medicare Part D, and the federal government not being able to directly negotiate drug prices, of course they don't negotiate drug prices, that is the job of the health insurance companies who operate under the Part D rules, they directly negotiate with the drug companies so that they can offer a drug plan that is less expensive than the other Part D plans, so they can attract the seniors, disabled and the poor to their plan! The more they attract, the more clout they have, and the lower the price they can get from the drug companies. Medicare is only reimbursing the health insurance companies depending on how many people have signed up for their plan. For every person they have signed up for their plan, they get a set amount of money from the government. No more or no less than any other health insurance company.

Part D is a good plan that utilizes the skill-set of an established industry, and doesn't mandate government control over the pharmaceutical industry. As a result, government spending for this program has been much less than originally estimated. Because of Part D more senior citizens, disabled, and poor are able to receive prescription drugs for chronic problems. Also, Part D has been able to actually lower the cost of health care for this particular group of people (compare Part D plans to other prescription drug plans).

If we had a coherent national health system, costs would be much more reasonable.

Depends on what you mean by a coherent national health system. Hilary Clinton proposed a coherent national health system in the early '90s but there was too much resistance to the idea. If you mean a nationalized system like Canada or the United Kingdom, the lower cost comes at a loss of growth in development of new procedures and techniques. Consider my earlier example, where if my friend had been in a country with a nationalized health care system, his son would have been born paralyzed, and the government would have had to pay for his care for his entire lifetime. Without investment in new techniques and procedures, he would not have had the opportunity to walk or care for himself. Surely a smaller investment up front is better than a lifetime of costs? However, developing those techniques and procedures can be very expensive, and it is very hard to justify those expenses in a nationalized health care system when the primary focus is on keeping costs low, and utilizing proven techniques and procedures rather than experimental ones.

While every business is in business to make money, most would take the 2% over cost that medicare and medicaid grant over the alternative; patients without the means to pay for their own health care who default on payments, or declare bankruptcy. There are a lot more stakeholders involved in the United States health care than just insurance and pharmaceutical companies.

Small business associations

A while back, on the radio (WTOP in the Washington, DC area), they played an advertisement for a small business association, or something like that. One of the benefits of joining was that they had offered a group health plan to the member companies.

I don't know for sure if it was specifically a small business association, or that's what I just remember it as, or if it was a local or national thing, but you can try asking around. (or someone else might be able to follow up with some knowledge of these sorts of groups)

A quick look online suggests that the ASBA [asbaonline.org] has some sort of discount on health insurance ... that might've been what I remember. As does NFIB [nfib.com] ... just type 'small business association' into your favorite search engine.

First things first

Congratulations on becoming a father !

Poor Americans, .. again

Seriously, how dare you call yourself the "best country in the world" if you don't even have nationally implemented healthcare?

Europe, glorious old lady that she is has long ago implemented the National healthcare to make sure that
A; Everyone has access to proper healthcare.
B; Everyone automatically pays into the healthcare fund so it can be maintained
C; Good quality in healthcare is guaranteed by state checkups.


In those days there were no "private" health insurance companies, but look what trusting in those has brought you? Deception, Fraud, and general run-around or obfuscation from most if not all of the private insurance companies.

IMHO, healthcare is not, and has never been something companies should be in charge of. A companies purpose is to make money. The state however, if it's run by others then the idiots running the American state, should be more interested in keeping it's taxpayers ALIVE and healthy so they can work and pay taxes next year.

Re:Poor Americans, .. again

I agree with what you say, but the big difference here is that there are no waiting lists. I moved from UK to US, my family health issues are addressed immediately here. My friends and family in the UK get stuck on waiting lists with can be for months.

Another difference is doctors here make a fortune, just like lawyers. Whereas those in the UK can work 80 hours a week for a middle income. Medical professional are also broken down into an infinite number of specialists here, there's little need to muck around with general practitioners, if you do, you'll get referred to a specialist pretty quick.

There is also free medical for low income and freeloader types. Most places will not turn you away either. If you call up front, you'll be asked about insurance. Even when you receive huge bills, you can make small monthly payments to pay it off. Children without medical cover may be covered by the state, so if you have a young kid and a big bill, yet have no insurance, and if your income is low enough (which is less than something like $50-60k I've been told) the state will pick up the tab.

It's not all doom and gloom like you think it is. Yes, there's a huge amount of profiteering, a bill will be for different values depending on payment, and insurance companies waste a huge resource avoiding payment, you really have to be on the ball even with cover. The real issues are for the long term sick, rather than fixing up a damaged body part.

Change is needed now

First, you are about to find out just incredibly broken our health care system is. I doubt if you will get private insurance, as they are denying older applicants out of hand, and if you have ANY problem forget about it.

Many states have an expensive health insurance pool that has high deductible insurance that will only take care of you in catastrophic conditions. If you go for the low deductible, expect to find very high premiums and equally high copays.

With the high deductible plan you can start a health savings account (who has money to save these days?), but that may be your best option.

Most important, keep your coverage with your wife current as long as you can as you may get your prexisting conditions covered without a waiting period.

In my circumstance at least, I have found that health insurance companies have no reason to want to insure anyone that may be a liability down the road. I do not see a political solution to this, as congress is corrupt. The best they could do was pass a bill that made it hard for sick people who got burried by medical bills more difficult to declare bankruptcy. And another program that was essentially a handout to drug companies that foisted a compkicated hard to use drug plan onto seniors. That's all they have done. This last congress was the most do-nothing congress ever. It seems the only thing they had time for was to take bribes from abramoff and hit up underage pages for sex and try to cover up the trail later. The health care industry is not much better with their costs outpacing inflation 3 to 1 at least.

I know neocons are not going to like what I'm about to say, and how important that it is fighting alquaida over in Iraq blah blah blah, but the fact is with what we have spent on this war to knock over a tin horn dictator I bet we could have paid for everybody's current medical expenses in the US, let alone making it affordable.

If you're healthy and have job, you probably will not won't give what I have to say a second thought. But if your sick as I am and can't find coverage or a doctor, you know how bad it is. If your self employed doubly so. Even if you do have coverage, you have got to be noticing how your insurance premiums are getting more expensive and its covering less, your deductible is more, and prescriptions are through the roof.

But the greatest crime of the Iraq war is that it has taken attention completely away from the health care crisis. I have talked to my politicians to no avail. Gratefully though, a challenger for state office DID talk about it and it got him elected.

We had no business screwing around in Iraq (esp. with the WMD big lie) without taking care of our own at home first. It's that simple. If things aren't working for you, it's important to let your politicians and everyone around you know how you feel. Only this way will there be hope for change.

BTW, make sure that the high deductible health savings account pays for 100% above a certain point. 80%, and you still could (likely)lose your shirt if you get sick.

Blues

I use an HMO program offered by my state's BlueCross BlueShield company. It's the same plan they sell to employers, but with me paying the full premium. It's not cheap (and for someone with a family it'd be even less so), but it's... affordable, and in the few years I've been using it, it's been a lot easier to budget the monthly premiums than it would have been to pay the medical bills I've had, and definitely made my recent visit to the ER less stressful, knowing I wouldn't have to pay for it.

Re:Blues

Except many people have varying concepts of affordable. I have kids so the BCBS plans for a family run in the range of $600 (barely covers anything) to a typical co-pay 100% plan you'd find at most corporations which runs almost $1100. That's over $13,000 a YEAR for health coverage. It's pretty scary when you're paying as much for health insurance as you are for your mortgage. Healthcare in this country is broken. We spend insane amounts on all the bean counters whose job is specifically to figure out how NOT to cover something and then blow hundreds of BILLIONS of dollars on a war fought over a lie and yet universal healthcare is some sort of evil that we can't afford. I know catastrophic illnesses can cost a lot of money. But over the course of, say, 20 years while your kids grow up, how many people are going to even come spent more than 25% of the $260,000 they pay in premiums. I also think it should be illegal for hospitals and doctors to 'negotiate' rates with insurance companies. Why does being self employed, poor, or a small business owner mean you have to pay 2-3 times more for services than someone who works for IBM? Everytime I see those EOBs where 50-75% of the cost is 'negotiated away' - we're all human - if they can survive charging $300 for a procedure, it should cost $300 for EVERYbody, not just people stuck in cubicles. And for those of you who will scream 'I don't want to pay for other people's healthcare in a universal system' you're naive. You already do. Besides that - you're supposed to be all 'support the small businesses' well, healthcare costs are a HUGE expense for small businesses. Imagine how many more would thrive if they didn't have such a disadvantage compared to medium or large size businesses? Good luck finding coverage you can afford. You're going to need it. Like the previous poster said - you almost HAVE to have the co-pay plan with young kids - the doctor visits are frequent. You're pretty much stuck.

There are lots of reasons insurance is expensive.

One of the big ones is that a very small number of people spend an ASSANINELY LARGE AMOUNT of money. Some people are on drugs that cost $400,000/year.

As long as we are unwilling to say "You know what, it's too expensive to keep you alive", a lot of people are going to die because they can't afford to subsidize the healthcare costs of the extremely sick and therefore can't get even basic healthcare.

We need insurance plans that cap maximum expense - so you can sign up for death if you catch something that's going to cost 3 million to fix so you can survive the far more likely chance you get a disease/injury that costs $40,000 without going bankrupt.

Couple of suggestions

Buying insurance just on your own is expensive. There are various parameters you can fiddle to help (e.g. register kid and parents separately, though this means you don't share a deductible; set your deductible as high as possible -- here the highest I could get was $5000/yr, which really ends up being more like $10K), but it's really expensive -- we were paying about $300 a month and were in perfect health -- that was almost 4K + deductible per annum.

(it's even worse for a small company under 25 employees!)

If you're a member of the IEEE or any other "entrepreur" association you qualify for a group policy via them. That's usually a good deal. For example a quick search of "self-employed association" just showed as its first hit an association that offers health insurance. I have no connection and won't shill for them by including the URL.

If you live in CA I hear Kaiser is quite good though I've never used 'em myself.

Good luck. You'll find a lot of "well baby" visits will be needed in the first year or so. Well, at more than you need as an adult anyway. The insurance companies usually subsidise them because it's cheaper to catch something in the bud.

And finally, in all seriousness, consider moving to my home country, Australia. There's a preference for computer programmers under 40, and it's a great place to be or raise a kid. (though I live in California right now myself...)

Oh and have fun. One thing to be careful of / manage: I basically didn't work for the first couple of years after my kid was born and again when he was perhaps 4-6. That was really great. Try to find a way to balance the time with the family with making sure there's some regular income!

IMPORTANT

Before you drop your wife's insurance let me tell you what I am currently finding out the hard way. You will be hard pressed to find an insurance policy on a pregnant woman. Group policies can be more forgiving, but so far everyone I've talked to says it is a 'pre-existing condition' and they won't cover my 7-weeks pregnant wife. If you are going to get a policy, your wife can't deliver for 11 months from the date the policy becomes effective or it's not covered.
I just got out of the Air Force and am now working as an independent contractor. Tricare does have a COBRA-type polkicy I can get but it's very expensive. I can't just get the coverage for my wife, I have to be on the policy, so I'm having to pay about $2200/3 months for it. At least it comes in 3 month chunks, so I won't have to carry it longer than I need it.
If there weren't that program available to me, I don't know what I'd do. In Georgia where I live there is a Medicade program for pregnant women, but I make too much money to qualify for that. If you make more than $1600/week with a family of 4 (they count the unborn) you make too much. My wife had to have a c-section last time and I saw the bill Tricare got. For everything throughout the pregnancy they paid out over $60k.
I have heard that if you can't get coverage and you talk to OB docs, they can usually work with you and sometimes you can end up paying less than if you had insurance. I have not looked in to that yet. Good luck!

Go for the high deductible

I'd recommend a high deductible plan if you're self employed. You should already have money saved up to weather the rough times, so just add some more to cover the deductible. The amount you save is significant. The baby will most certainly have you going to the doctor a lot. I've used eHealthInsurance [ehealthinsurance.com] myself, and my only complaint is that the fine print is hard to find or not available until after you purchase a policy. But the policies they offer are from the major carriers.

For the record, the place I got in trouble was picking the cheaper plan and then getting a physical. Burried back in the fine print was a clause that they don't cover anything preventative, but that wasn't obvious when I was ordering the plan or looking through the main section of the booklet. Had I clicked a link to the provider's comparison of all their plans, it would have jumped out like a sore thumb. Personally I think it borders on criminal when a company doesn't make it obvious where you risk owing a lot of money and what coverage is missing that many others would frequently include.

And a final note, always get the price an uninsured person will be responsible for up front for everything! This is what you'll be stuck paying when the insurance company says they aren't responsible, and you should be able to afford it. My family's neighbor (a doctor), myself, and many others agree, the medical system in the US is broken. Insurance is complicated, costs are going up, and lawsuits are giving insane sums of money for just about anything. My biggest peeve is that you aren't told how much you owe until a month after the procedure is done. Admittedly this is a service and things may fluctuate when you find a problem, but every doctor uses charge codes and their office knows their fee for that code, and the insurance companies know what they have agreed for those codes. But no one will tell you those numbers until after you've had the service. Congress would do a lot for people by requiring every insurance provider to publish how much they cover and what the patent is responsible for on a standard list of charge codes, and make it available before signing up for that coverage.

IEEE

Join the IEEE.

They have some good group deals for insurance setup just for cases like yours. They also have group life and a few other things that might be of interest.

Oh, and its a good organization to boot :).

How about..

How about moving to a civilized country ?

You know, one of those where it's recognized that decent healthcare for everyone is a good thing.

It's quite silly, the way you do it in USA. It prevents people from acting rationally, to the detriment of all. (it's the same in *parts* of Europe, you guys aren't alone about it.)

For example, a friend of mine (living in the USA) is currently at home (watching his baby) while the mother works. He works a little evenings and earns a little extra for the family, but little enough that he was still health-insured trough his wife.

Then he got offered a larger position. He had to turn it down. It'd have put him above the limit where he'd need his own health-insurance, so in the end he'd have ended up working *more* and getting *less*, which is nonsense.

Everyone is a loser in this scenario:

• The family doesn't get the extra income.
• The employer doesn't get the extra work done. (atleast not by the person that was his first choice)
• The insurance-industry covers both today, paid for by his wifes employer, the two of them wouldn't actually be *more* sick if he worked more.
• The state (and thus indirectly all projects that benefit from tax-money) don't get the extra tax-money thay he'd have paid if he worked and earned more.

Stupid. Very stupid.

It should pay to work. Putting someone in a situation where they get *less* for working *more* just serves as an insurance that these people won't, infact, work more.

There's similar mechanisms in welfare-programs too, where you earn $100 more and get $150 less from welfare. The effects are similar. (it'd have been different if you'd earned $100 more and as a consequence gotten $50 less from welfare, that'd have been fine)

Re:How about..

I know why you think that, but it's not a "good thing", for a simple reason: What if you don't like you're health care? I can go to another insurer.

If you see everything as black and white ...

I can go to another insurer too. A different public one, or a private one. I can go without insurance if I really wanted to.

I can go to another doctor.

Me too ! I can go to any doctor in the whole country. And some of the neighboring countries, too.

State-run medical care doesn't exclude any of the things you mentioned. It all depends on the details of the implementation. You're at the mercy of what your government provides, including the infamous "waiting list".

You're just replacing one waiting list with another one (ordered by who'll pay the most).

Look into using an 'umbrella' company

Also known as "employer of record" - they exist for independents who need "big corp" sorts of benefits like access to health insurance. Here is one that I haved used in the past - MyBizOffice. [mybizoffice.com] Despite the stupid, formerly-trendy name, they are one of the largest out there and do a pretty good job of things.

What about COBRA?

Even if your wife leaves her job, she (and the family, if you have a family policy) can stay on her former employer's health insurance for 18 months under COBRA [dol.gov]. But they can charge you the actual cost of the policy plus two percent. (Meaning if she currently plays 80% of the cost of the policy through deductions and the company pays the other 20% percent, after you go on COBRA you'll pay the 80% + 20% + up to 2%. The HR department of her company can tell you the COBRA rates.)

After the 18 months of COBRA runs out, the insurance company is required to offer you a non-group policy that is not medically underwritten. I think they usually call this a HIPAA policy. This will probably be more expensive than the policy you get through COBRA, but you can't be denied for pre-existing conditions.

It's been a while since I've read the DOL publication on COBRA, so follow the link above to verify that none of the details have changed.

HDHP + HSA (and don't spend the HSA money)

HDHP + HSA is the way to go if you are at all heathy and fiscally prudent. Low deductible insurance is a money loser. With a low deductible, you are all but guaranteed to pay more in premiums each year than you would by saving the money and paying from savings. The tax-deferred/tax-free nature of the HSA makes this even more true.

Also, the HSA regs give you tax advantaged savings based on the money you put into the HSA (not the money you take out of it). Check with your accountant, but I believe that nothing in the IRS regs says you must pay for all healthcare expenses with HSA money. Yes, you can't use HSA money for anything but healthcare (unless you are over 65 or disabled), but that doesn't imply that you can't use non-HSA money for healthcare costs. An HSA is a great way to build more tax-deferred savings if you've hit the limits on other tax-deferred savings programs.

US Health Care Costs

A while back the WSJ published an article on where US health care costs go. Around a third of the costs went to two places - lawyers and terminal care. Medical procedures don't always have a happy ending. All too often - when they don't have a good outcome, Americans tend to sue. The last stages of life in America are very expensive. Most Americans die in a hospital attached to tubes and instruments. And this doesn't count costs like defensive medicine (too many tests to avoid potential litigation). So more use of hospice services and real tort reform would go a long way to lowering costs of health care. Of course this would negatively impact profits at commercial hospitals and income of trial lawyers. Don't expect action from either political party any time soon.

Speaking From (Too Much) Personal Experience...

Unfortunately, I have way too much experience with health insurance, so here's my suggestions.

1. Extend your wife's plan with COBRA even after she quits at least until your baby is born. Do this, even if that means traveling further because your closest hospital is no longer in network. My first child required an emergency C-section and a few days in the neonatal ICU. He was almost 11 pounds at birth and there was no way he was coming out through the in door, so to speak. The bill was pretty amazing, but I didn't have to pay much out-of-pocket. So, if there are additional expenses related to your child's birth, at least you won't be completely screwed. On a side note, my son ended up with cerebral palsy, possibly due to decisions made by our doctor and his team. Learn up front about what can go wrong, and don't assume the experts are paying close attention to your wife/child.

2. Never go without health insurance and life insurance. I was 33 years old and my wife was pregnant with our third child when I found out I had testicular cancer. I caught it before the cancer had spread, but I still required one minor and one major operation, all kinds of diagnostics, and years of follow-up. My bills, way back in 1994, were well over $100K. My insurance at the time covered almost all expenses. Because I had life insurance, I had one less thing to worry about. Without life insurance, I probably would have died simply from stress.

3. If you have pre-existing conditions, you really need some type of group plan. Individual insurance plans are out of the question if you have any kind of serious pre-existing condition (cerebral palsy, testicular cancer, etc.). I know, because I tried this route. I pay around $10K per year for medical/dental at my current company. I thought that was a ripoff until I tried to get insurance on my own. Your only reasonable way to get health insurance is to be in some kind of group plan where your risks can be spread across a large pool of individuals. Even then you may have problems if you have any coverage gaps or you aren't going into a large enough group plan. If you have no pre-existing conditions and are healthy, the medical savings plan along with a high deductable plan is a cost-effective approach.

4. Without health insurance, you pay much higher rates for the same procedures/care. I recently had a 4-day stay in the hospital (as a result of the cancer surgery 10 years earlier). The unadjusted bill was 3 times the amount of the adjusted bill. Without insurance, you get the unadjusted bill and no expert on your side to help negotiate the bill down.

Hopefully your luck will be better than mine when it comes to health. However, I can say that insurance has saved me from financial ruin on more than one occasion. More important, insurance allowed me to make career and life decisions (like having more than one child) that I may not have made if I was paying out the ass for the rest of my life due to one bad medical experience.

I wish I had an answer for our country's current medical insurance problem. I don't think a government-based single-provider solution is best, but I think government may need to help fund large group plans that are affordable for the tens of millions of americans that want insurance but can't afford it. The uninsured are driving up costs for the rest of us by waiting too long to get care, and then entering the system directly through hospital emergency rooms. I'm encouraged by the pay-as-you-go clinics that are popping up at Wal-Marts and elsewhere for non-emergency care. It costs a lot less to pay $25 at a clinic to have your kid checked out than to wait until your kid is seriously ill and then take him/her to the emergency room.

Best of luck with your new family.

Same boat, here's my solution

I'm in the same boat. Been there for years, and it's frustrating.

Ideal: put $10,000 - $15,000 in the bank for emergency use and go with a super-high deductible ppo. Your rates will be low, maybe about $150 /month. This will save you about $300 per month which you can use for medical expenses when you need it. If your family is reasonably healthy, you shouldn't have $300 /mo that often (but it will happen sometimes - so be prepared). In the end you come out better because you get to pocket the money you budget for medical expenses if you don't use it.

Next best thing: I went with Farm Bureau (www.fb.com) - I'm not a farmer, but they help self-employed people get insurance. The rates were the most reasonable I could find, and there was a person I could go talk to. They also do retirement planning and other types of insurance - most importantly, they have good rates on long-term-disability, which you should definitely have if you're self employed and you care about the long-term needs of your family. They also have life insurance at fair rates, but I got a better rate through my home/car insurance company (allstate).

"What he said" mostly, but....

Lots of good comments and suggestions. I notice costs vary widely around the country. Just to aid comparison.

1. I pay $135 month for $5K deductible at age 57. Every five year increment goes up a few bucks. Every year the whole grid goes up a few bucks. "Full" insurance with a small deductible and small co-pays would be about $550/month. Rationale: At $550/month that's, umm $6600/year. $135 is $1620. If I get 'really' sick, I break even. In any case it would appear this is a lot less expensive than some of you are paying for a similar $5K deductible.

2. Several people seem to think voting Democratic or moving to Canada/Britain/etc. will solve the problem. Does anyone really think nationalized health care will give us a BETTER system? Do you REALLY want Hiliary calling the shots here? Just look at our military or the VA system. The VA, if you can get on it, is totally free. I won't say it's a bad system, but let me say this. My father was on it. I thought it was a good deal at the time. But had he been on medicare plus a supplemental he could have used local doctors instead of the long ride to a VA facility--and he just might still be alive today. I dunno, it's hard to figure it out in hindsight, but I wish we had the option of doing his health care over again the other way. He DID get a free slot in the wall at the Veteran's Cemetery, though.

3. The worst problem, imho, is that we've messed up by insisting health care be part of employment. Now people think employer-paid insurance is a "right" and will strike if the employer wants to reduce some costs with a co-pay. Insurance companies have lept on this, too because by and large if you are working, you are healthy. Really sick people can't hold a job. It's in insurance companies' best interests to further such a system. People keep working in terrible jobs just to keep insurance. I have a buddy who could otherwise retire. I say to him, "Why not?" and he always says, "Insurance." Now that sucks.

4. Health care is not in the Constitution. On the one hand we demand government be responsible and take care of every individual every time he has a cold and winds up going to the emergency room for it, stupidly. We are so risk averse that we blame anyone we can for anything that happens to us. Government is a prime target, but so is anyone, including McDodalds with hot coffee. Then we turn around and say, well, government should not invade my privacy (which isn't exactly in the Constiution either.) The thing is, we have INVITED government into our lives on a very personal basis, then wonder why it is there. You can't expect government to NOT be in your life if you won't take responsibility for your own life in the first place.

I would prefer government NOT be in my life, or there as little as possible. I will trade that for taking responsibility for my own health and my own life. Just get out and leave me alone. We'll all be better for it.

Re:Quit being moral about it

It's not such a wonderful plan if the insurance company tries to weasel out of paying valid claims. Some companies will tell you to fuck off, and if you don't like it, file a lawsuit.

Re:Baffled

Here's a good reason why you can't:

The insurance companies negotiate with all of your providers, including some you're not even aware exist, for lower rates. And while you can do some negotiation yourself, that is a very difficult thing if you're lying on a stretcher unconcious.

At my most recent physical, the lab billed $900 for all of the tests. The insurance company paid $300 and the rest was the "negotiated discount".

The medical system in the US is fundamentally flawed, and facing it WITHOUT insurance could easily bancrupt you.

Re:Quit being moral about it

Just pick the one that gives you the BEST HEALTH INSURANCE PLAN for the LEAST MONEY. Why does that have to be so difficult?

Spoken like someone who hasn't tried to choose a healthcare plan lately. Dude, my company gives us 6 plans to choose from and even then it's hours and hours of comparing fine print to see what they do & don't cover and for how much co-pay in each and every case. You have to be a really good number cruncher to be able to figure out the best choice for you AND you have to be a great prognosticator of your future health. And I'm single. I can't imagine how much harder it would be if I had a wife and newborn to worry about.

Oh, and the reason it "has to be so difficult" is because the companies purposely make it difficult. Their beancounters figured out long ago that the harder they make it to decipher the plans, the fewer claims they get because their customers can't figure out if they're covered or not, or how to file claims, or whether they can appeal denials of coverage. It's a serious racket. So let's not act like this is child's play.

Re:Baffled

Here's a tip. Save.

      I hope you have a lot of money saved up. Heart attack: over $10k including drugs, a few days in ICU or the coronary care unit, and an angiography. Oh, and if you need bypass surgery, the going rate was around $35k last time I checked. So we're up to about $45k. We're still not talking about the $200 in medication you'll be spending every month, plus the semi annual visits to your cardiologist at around $300 each, and the yearly stress test, etc.

      How much did you say you have saved up? Make sure you don't have a heart attack at 40 years old or you are screwed.