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)?"
For better health coverage? (Score:1, Insightful)
Re:Quit being moral about it (Score:3, Insightful)
Poor Americans, .. again (Score:4, Insightful)
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.
Change is needed now (Score:5, Insightful)
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.
Re:Go public. (Score:1, Insightful)
I imagine they'd probably kick you out again pretty damn promptly.
Incidentally, this idea that decent public services == pandering to lazy people is a pack of lies and bullshit spread by selfish people who object to being made to help those in need. In Britain, for example, we also have public healthcare and reasonably generous unemployment benefits... but the unemployment handout is called "jobseeker's allowance", and there's a very good reason for that: if you can't prove you're looking for work (and willing to take any work that comes your way), you stop getting the money. If you lie about looking for work to make the money keep coming in, you are likely to be caught out when you're called in and asked to provide evidence for your claims, and then you go to prison. (Where you don't get raped, because Britain is a civilised country, but you also don't have a particularly pleasant life.)
And I rather like this system. It's really rather pleasant to be able to go and see a doctor and have the first question you're asked be "how can I help you?", not "how are you going to pay?". And I'm getting all this without even having to be oppressed by an evil communist regime! Isn't real-life socialism wonderful? And how different it is from the propoganda you Americans get fed by your corporate slavemasters!
Couple of suggestions (Score:4, Insightful)
(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 (Score:5, Insightful)
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!
Re:Blues (Score:5, Insightful)
Re:Blues (Score:3, Insightful)
Quite a few of them. All it takes is cancer, or a heart attack. Two of the top killers in industrialized nations.
How about.. (Score:4, Insightful)
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:
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:Baffled (Score:3, Insightful)
Insurance companies, in advance, negotiate discounts.
The comparable action for an individual (which is of course impractical) is to negotiate, in advance, discounts, while not in critical condition.
So if you were to go without insurance, then you would instead be calling all these hospital to arrange advance discounts -- not in critical condition.
There's a reason why that wouldn't work -- it's impractical and hospitals couldn't justify the expense of negotiations for just one person. The reason it wouldn't work has NOTHING to do with difficulties in negotiating while in critical condition.
The reason I belabor this point is because on another health insurance thread, a moron kept switching between talking about paying the hospital, and talking about shopping for insurance, when you'd be in critical condition in one but not the other, which made it impossible to rationally discuss the issue with him. So, I have to be careful that people don't continue that error.
Re:For better health coverage? (Score:2, Insightful)
I realize that you would get better rates if you were hidden in a large employee pool, which is why I like the idea of socialistic baseline care(the US is filthy rich, we can afford it), it makes the cost sharing pool as large as possible.
Re:Blues (Score:3, Insightful)
Why not? They'll negotiate with you. In fact if you can pay them promptly, they'll cut you a better deal than they'll cut any insurance company. Insurance companies have a nasty habit of holding onto payment well after it's due. If you can get cash in hand or even set up a payment plan with the hospital, they'll take it at a great loss (compared to their asking price). They won't advertise that because then the insurance companies wouldn't think they are getting a deal.
This would be like making it illegal to negotiate on new car prices. Sure the car dealer has a high MSRP, but you're a fool to pay it. Our insurance system has it's problems, but hospitals and doctors being free to negotiate prices isn't one of them.
Re:For better health coverage? (Score:3, Insightful)
Frankly, I'm lucky I could even get insurance. The government, through threat of force, has to make insurance companies cover us. Because the CEO and BoD for Anthem, et. al., look at (as you said) "large, probable expenses" and essentially say, "we choose not to insure your son, let him die, it's not our problem" except the laws of the land say, "no, that won't do" and require coverage...but only if you know the hoops you have to jump through to get accepted. Forgive me for seeing that as dispicable.
Do I trust the government to run socialized health care? NO. They screw up most things they put their grubby paws into. Frankly, I don't know WHAT the solution is. Thank God I'm not in charge because I'd probably royally screw it up for the entire nation.
Re:For better health coverage? (Score:5, Insightful)
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).
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.
Re:Blues (Score:3, Insightful)
That's my take on socialized medicine: my tax rate could go up quite a bit before I'd end up paying as much more in taxes as my health insurance costs. Heck, it could probably double. I'd probably be actually financially better off with socialized medicine, and we wouldn't have these worries.
There are lots of reasons insurance is expensive. (Score:5, Insightful)
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.
"What he said" mostly, but.... (Score:4, Insightful)
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:How about.. (Score:1, Insightful)
Now, if you are an American who has insurance, the US system works pretty well. Depending upon your insurance, you should get quick access to any treatment and drugs you need. However, one of several things can happen in this situation:
1) you have a co-pay that can be between 5% and 20% (in my experience). Suppose you have a catastrophic injury or sickness - that can cost $1 million really fast, and you're on the hook for up to 200k of it. I have a friend whose parents were wiped out by her father's 2 heart attacks.
2) You may be dropped by your insurance company if you become expensive. Sure, they'll cover the bill for your suddenly-discovered chronic illness. But if they find an excuse to drop you (and in some states they don't need an excuse beyond "we want to"), you can be left without insurance and it will be impossible to find new insurance because of your existing condition.
Finally, there are the working uninsured Americans (I'm unfamiliar with Medicaid so I'll ignore that for poor folks and seniors). Sure, these people can go to the emergency room and get treated for acute problems. They can't get basic healthcare though. Good like getting checkups for your kids, or a prostate test that might save your life.
The Canadian system? Universal - everyone has access to everything. Unfortunately this means everyone actually uses everything. There can be waits depending on what you need. It takes me about a month to get an appointment with my family doctor for something non-urgent. My daughter's broken leg? In and out of the emergency room in a couple of hours. My father's urgently leaded angiogram? Took about a week. Cost him nothing. A good friend was in a horrific car accident with her 3 kids. She works a low paying job and in the US she would not have had insurance. Here, the 10+ surgeries were free, the 18+ months of therapy were free. Is it perfect? No, but I'll accept a little personal inconvenience in exchange for not leaving my fellow citizens to fend for themselves.
Re:I call bullshit (Score:1, Insightful)
The mental overhead of not only being sick, but having to fight tooth and nail get your insurance company to pay its share, is draining a lot of people in the US who *have* insurance, and thought they were covered.
Sounds like BC is heading down that road, and if so, good luck to you.
Re:For better health coverage? (Score:3, Insightful)
A corporation is a legal entity... a legal individual... who's sole purpose is to do what is best for that corporation (and in modern America, this is to make a dollar value profit). Its purpose is not to do what is best for any other individual (shareholders are by extension a part of the corporation). It is by nature a sociopathic entity. It cares about others only if they help the corporation to get what it needs. Now while corporations keep us employed, which is a good thing, they are not benign friendly entities who care about us. Call Ronald a clown and he'll likely rip your heart out.
You want something that is socialistic, something that likes to work with society and help others, specifically your kid in this case, but you want it delivered by something that is a sociopath. While I am not a doctor, I think you might be developing some sort of self induced bi-polar disorder by the forced realization that corporations while an important part of a capitalistic society, are not about benefiting a society in a 'humanistic sense'; only themselves. It is a kind of symbiotic thing.
For you, a possible solution would be to make the argument to the (sociopath) corporate sector of society (since you prefer them to run the medical system) that your kid will ultimately be able to output more dollar value in productivity for the corporations than the money they will put into him/her. While you quite rightly love your child, a sociopath does not, and will not ever. They need to see some benefit. That is their efficiency. And if you cannot make this proof, don't be surprised if they don't care to help you out. It is not in their interest.
I know this sounds harsh, but it seems to me that as how you seem to prefer sociopathic medicine over social medicine, you probably wouldn't give a rat's ass about a decent society if you didn't have a crippled child and extra medical bills because of him/her. So my suggestion is to stop your hand wringing, revel in the system you prefer, and quietly eat the cost. Too easy. It is one or the other. You either want society's input and the slight inefficiency that it brings (and I am not convinced government handling contributes any more ineffiency than corporate profit making/taking does), or not. And if you do want it, would you want it still if you didn't have the added cost of a disabled child (take a cold hard look). Are you really just like the corporations? All efficiency and no heart. I am making no judgement here, this is how they work. And that is why they have to be forced to provide you insurance even with the added cost. You know they wouldn't even do that if they could get away with it.
Don't get me wrong, I believe for the most part, the way our capitalistic western society operates seems to work quite well (though there is always room for improvement)... sociopathic corporations and all. The biggest problem I have with social programs is that they are often screwed up by the amnesty international crowd (e.g. in Canada when they tried to make chronic welfare victims put something back into society by sweeping the streets a couple of times a week, this was shot down as some sort of human rights violation... bullshit if you ask me). However, I believe in some cases social values are required. Medicare is one area. I think we should look to parts of Europe and other places that have integrated public/private health care (this brings in more government control than in the United States) as they seem to be working better than either Canada's system (which has too much government control) or the United State's (which has too little). I have been in both of the latter two's systems, and they desperately need some sort of help... especially Canada's (mainly because most Canadians are in a state of denial about it... more money won't help).
I find it hard to understand people who want it all but don't want to pay the cost. Or want it all because they realize that the system they asked for just turned around and bit them.
Re:I call bullshit (Score:3, Insightful)
I doubt that BC would go down the path of US-style multi-payer health care. I'd say alberta is the most likely province to do so.
But in BC, it is true, if you are wealthy you are expected to pay into MSP (medical services plan) - this essentially acts like a healthcare premium in the US. There is usage fees (co-pays), which does suck, but the argument was to reduce medical overusage and waste (parents taking children to the doctor just for a cold, etc).
I doubt that the BC population would allow the dismantling of the healthcare system - most the country regards medical care as a basic human right. The only people that disagree are neo-conservatives who want to introduce an American-style "free" market system. My suspicion is that the people arguing for this are hoping to form their own Canadian HMOs and rape the living shit out of the country. Every dollar in a healthcare system not spent on Doctors or actual real medical care is wasted.
Insurance or Prepaid Meidcal (Score:2, Insightful)
Insurance isn't meant to be used for routine services. You don't buy auto insurance expecting it to cover oil changes and new tires. Why should a health insurance policy cover routine physicals.
Insurance is supposed to protect you from unforeseen disasters.
I have a high deductible PPO. It costs me $50 per month and I pay everything up to $3,500. Then they pay everything up. If I'm in a major accident or get cancer, I'm in pretty good shape.
I don't want to pay $300+ per month for a policy that pays for annual physicals when an annual physical cost $250 max.
As a result of the lower cost, I've now saved more than my annual deductible. Focus on getting an insurance policy that is that -- and insurance policy and save the difference in premium so you have enough to cover the deductible and pay routine expenses when you need it.
That said, when my wife and I were planning on having a baby, I compared a few plans and picked one that had a higher monthly fee and a lower deductible. As soon as the baby was born, we switched back to a high deductible plan. For that year, there was a point where the lower deductible and higher monthly fee made sense for us because it was a planned "procedure".
Read This Post! For Profit = Evil (Score:2, Insightful)
I got wise after a few visits after getting bills for crap that should have been covered. I started requesting itemized bills from every provider. Guess what? The hospitals and doctors ARE out to screw you if you do not pay attention to your bills.
The hospital stay before my wife died sent me an itemized bill for crap like "mucous ecovery system -- $129" Guess what that was? A fracking box of Kleenex they gave her at her bedside. They charged her over $500 for a couple of doses of readily available prescription sleeping pills that would have costed less that $50 even without insurace.
My wife has been dead for months and I'm still getting bills. They send them to her, and the sad point is, they should know she's no longer alive. I sent everyone death certificates to try and avoid aying the bills the cheap insurance companies would not pay, but they still try and fight me to get money. For-profit medicine is evil, period. Healthcare is a basic human right. Now, alot of you who have never gone through what I have will poo-poo my assertions, but trust me, when the chips are down, the insurance companies will not even try to help you.