Health Insurance for the Self-Employed? 462
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)?"
Small business associations (Score:4, Informative)
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
HDHP + HSA (Score:1, Informative)
First off, be sure to crunch the numbers. It's pretty easy to work up a spreadsheet or little program to compare plans. Just input expected Rx costs, clinic visits, hospital visits, etc., and have it calculate how much you'd wind up paying under different plans given different scenarios.
I can't speak to which specific provider is best since from my experience that's pretty localized, but I can tell you that my analysis indicates that for the vast majority of people, HDCPs with HSAs are the best choice. Find a plan that provides preventive exams on the house (this includes well baby care, by the way) and unless you expect to have over a couple grand or so in prescription costs per year, get a plan that doesn't include Rx.
This advice is based on the rates in my area with a $2000/$4000 HDCP plan. Most families at my company will save thousands and at worst will be no worse off than if they had chosen to take the 25% hit and stick with our old plan.
Be sure to build up your HSA account. Remember, you can always move a portion into an HSA investment account (as opposed to the HSA transactional account) and basically treat that money like it's in a 401(k).
Good luck!
Blues (Score:3, Informative)
Re:Quit being moral about it (Score:3, Informative)
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:For better health coverage? (Score:2, Informative)
The government loves telling us what to do and as long as most voters don't disagree vehemently, they will.
On topic, I run my own business, a two-member LLC (my wife and me) doing consulting (mostly Linux stuff) and we are screwed royally as far as insurance goes. We have a child with a disability so: (a) being w/o insurance is not an option, and (b) we get the highest rate they can legally charge us: over $1,000/month. (imagine goatse man here, that's how disgusting it is)
Oh, and good luck with Anthem. They're great! (That's sarcasm...two guesses who my insurance provider is...and the first one doesn't count.)
Re:Baffled (Score:4, Informative)
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.
Re:For better health coverage? (Score:4, Informative)
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.
IEEE (Score:4, Informative)
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
Re:Baffled (Score:2, Informative)
A couple things to consider. - Shop for insurance looking for these items: Are my favorite doctors in net? Pharmacy? Are my drugs covered, must I buy a generic? Is Chiropractic covered? Mental Health?
- 'In Network' is golden. if you prefer to leave the network, you will pay that doctor's standard rate, often even after your 'Out of Network Max' has been exceeded, because Insurance company's set a 'Usual and Customary' (U&C) value for every procedure, and only pay that amount... MDs, since they are discounting services paid for by insurance companies, up their normal rates to cover the difference (if 20% are paying cash, and 80% are paying via insurance 80% of the 'real costs, the 20% are paying for their costs plus paying for the discount given to the 'network' patient)
- If you are young, healthy, good cash flow (real paying jobs) and have good investing habits... do a High deductible PLUS an HSA... and be disciplined to invest the difference in premiums between the low deductible/HMO and the HDHP in the HSA. Your HSA becomes both your rainy day health fund, but if you maintain good health, eventually it kicks into a retirement fund vehicle.
- Look for these perks
-- 100% coverage on annual exams
-- 100% coverage on immunizations for children
-- Nurse Line (avoid unnecessary trips to the doctor)
-- A good web site, that allows you to track your claim history, medical record, has a real procedure cost estimator and a good network physician lookup
Finally,
- Insurance buys you 'insurability', ie, your current insurance must provide you a certificate of coverage which is the chit that gets you into most group plans even if you have a chronic condition. So being continuously insured when you are diagnosed usually gaurantees you if you ever want to switch plans that you can get insurance (albeit maybe at a higher rate, but at that point coverage is important, not price).
Look into using an 'umbrella' company (Score:3, Informative)
What about COBRA? (Score:5, Informative)
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) (Score:4, Informative)
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.
Speaking From (Too Much) Personal Experience... (Score:5, Informative)
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.
Re:How about.. (Score:3, Informative)
besides, in europe you can also go to another insurer if you don't like your healthcare. but all insurers provide basic services by law.
Re:How about.. (Score:4, Informative)
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).
Middle ground sollution? Look at Finland! (Score:2, Informative)
In Finland for example, there is the normal European Union type of healthcare sate, but you also have private doctors, dentists, etc... I know from one of my Ex girlfriends father, that when he needed an immediate hearth surgery, it was arranged that very same day, by the public healthcare channels. They juggle the times to try and give those who need it most service first if there are waiting lists.
When you are in a hurry and need something done now,something not very important for your life, then you go to the private healthcare. That costs you more of course, but you get service pronto.
Otherwise it's mostly better to go through the public healthcare, because pretty much all of it it reimbursed by the state.
It might be a bit harder to get a job due to the "extra" taxation from the American point of view, and yes the extra health security and money from the state for those unemployed are things that make some into mooches. But on the other side, with the EU style of government, Everyone gets superior education, great healthcare, a guaranteed minimum income to survive on and free extra education if want it while you're looking for a job.
That in my book at least outshines anything the USA has to offer. Canada on the other hand, I would actually consider moving there instead of dismissing it out of hand like the USA. No insult meant, but I find living in the USA something I hope I never have to put up with. IMO I think the place would drive me nuts wondering where the hell these supposed "freedoms" are. The USA that the family Bush is trying to create seems like NAZI wonderland to me, that I hope I never have to experience firsthand.
Blacklisted from Health Insurance (Score:2, Informative)
When my father was laid off...no insurance for anyone but my sister, who could purchase it from school. I broke my shoulder, and I am still paying for it (I was at a retail job, no health care plan offered, now I am salaried again and have health care through my employer). Thank goodness he found a job (a menial one at that) and was at the company long enough to get on their plan before my mom was found to have cancer, otherwise that would have broken our family. There would be no way we could have footed that bill.
So, in my experience, if you have a history of needing health care --
Re:Go for the high deductible (Score:2, Informative)
The insurance companies love to use this excuse. Don't buy into it. Where I live (Texas), a law was passed a few years ago that caps non-economic damages (e.g. pain, suffering, emotional distress). This eliminates the insane judgments against the insurance companies. This should have caused insurance premiums to go down right? Think again. Since the law was passed, premiums have gone up, not down.
Re:For better health coverage? (Score:5, Informative)
I call bullshit (Score:3, Informative)
I grew up in the US, lived there for 30 years, but moved to Canada in 1997. The care of me and my family under the Canadian system has been outstanding at every stage, and really points out what a perverse, sadistic farce the U.S. "system" is. In the US, doctors have to have an army of back office monkeys to do battle with the HMO overseers, who fight every step the doctor wants to take.
Here in Nova Scotia, we are charged NOTHING above what we pay in taxes for hospital care, ER care, and office visits. Not One Dime. We don't pay for insurance of ANY KIND for basic medical care. I'll say that again - our monthly cost we pay out of pocket for hospitalization and doctor visit coverage is ZERO.
Examples:
When I went to find my first family practice MD here, I found one within minutes, got in the next day, doc ordered blood work which I got same day, and results came the day after that. By the end of the week I was in his office talking treatment options and getting a prescription. Company drug plan paid for that, but even if it hadn't, the drugs are so much cheaper here than in the US that it wouldn't have been a show-stopper. I paid ZERO DOLLARS for the office visit and lab tests, by the way. In fact, when people in Canada refer to a "health plan" or "health insurance" they are talking ONLY about prescription drug coverage, or coverage which gives them additional amenities, like a private room, or an ambulance with a disco ball and an 8-speaker sound system. In other words, shit you don't need anyway.
In Nova Scotia, my stepdad got a hernia diagnosis, had a CT scan within one week, and got surgery within one month. World-class care facility. In the US, you'd be fighting for insurance company approval for three months, minimum. He got NO BILL OF ANY KIND.
Three times our daughter had to go to the ER when growing up (she's 21 now) she was seen immediately, treated promptly (with tests varying from x-ray to blood work), and we went home with ZERO BILL OF ANY KIND.
My wife last year was feeling dizzy and nauseous one morning, so we took her to the hospital, where she was seen immediately, given an EKG with cardiologist consult, thankfully pronounced okay, and... can you guess? Got NO BILL OF ANY KIND.
Nothing came in the mail, and we didn't have to skip a mortgage payment to afford any kind of treatment or visit.
People here may have minor gripes about the system as it performs here, but these are people with no perspective of how bad it can get - people who have never lived in the U.S. or Calcutta. There are people in the U.S. who would kill to have the coverage that some Canadians gripe about on a daily basis.
If the U.S. insurance industry manages to dismantle Canadian Medicare and turn it into a for-profit system, then Canadians WILL have something to gripe about.
Re:I call bullshit (Score:3, Informative)
Re:For better health coverage? (Score:2, Informative)
I know it is not cool these days, but my father was self employed with 4 kids and we never had health insurance. If we went to the doctor or hospital, he just paid for it. Usually if you don't have insurance but are willing to pay, hospitals/doctors will work with you on price and payment plans. My brother who works for my dad now has two kids and no health insurance.
They tell you that health insurance will save you from catastrophes, but if you look at the numbers, roughly 70% of people who go bankrupt due to medical bills have health insurance. I believe, 70% is pretty close to the number of people who have health insurance. So, if you have a health catastrophe your probably fucked anyways.
Don't listen to me though, I am in the military. Although I have to say, FULL medical coverage for your entire family is NICE, but the lines can be long and seeing a specialist is a pain.
Re:For better health coverage? (Score:3, Informative)
I would like to point out, that anytime you make a bet that you won't get sick, that is a supremely stupid bet, unless it is a very very short term bet. The chance you will need doctor services in the next 10 years is 100%. It's only 'nearly 100%' if you eschew routine things such as yearly checkups.
The problem is that health insurance is being run as an INSURANCE company. The point of society and government is to spread large individual expenses over portions of the population. That road you drove on - you could never pay for it, nor could you and everyone who drove on it pay for it via tolls. Sames goes for healthcare.
Also not every HMO (which is not traditional health insurance - not the same as indemnity insurance) is a for-profit institution.
By the way, I view the health insurance situation in the US as a global competitive liability. The healthcare system reduces individual employer flexibility - you can't just change jobs if you are relying on it for healthcare coverage. Your parting shot in your post was "quit your job and get a new one". Why should one choose their employer based on something tangential as healthcare?
The employer lockin caused by health coverage also impedes the free market of workers. It provides artificial barriers for workers to move from bad companies to other companies or to work for themselves. Strangely enough, you aren't really toeing the standard line of American Entrepreneurialism. After all, isnt the ideal to work for yourself? One that is impossible apparently...
One of the GP posters said that they didn't trust the government to run healthcare, that they would screw it up. Well, certainly with that expectation, yeah they would screw it up. The problem isn't that government screws up everything it touches (it certainly ruined the nuclear weapons programme in the 50s, lost that war apparently), it's just people expect the government to be screwups, thus when they are, people don't complain. After all, the overall health of Canadians with a government run healthcare system is higher than Americans, so clearly the concept of government can't be all that bad - it works for our friends up north, no?