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)?"
Can't help with specifics (Score:2, Interesting)
For yourself you probably can get by with catastrophic coverage unless there's an existing medical condition that you haven't mentioned. And if there is, you're just about out of luck anyway since many carriers won't cover existing conditions. So unless you go to the doctor for anything except the most serious ailments, stick with catastrophic.
Instead of great health coverage for you, get LIFE INSURANCE. You can probably get some cheap 30-year term insurance which will cover your family in case something happens to you. You may want to cover your wife as well in case something happens to her and you need to hire extra help to take care of your kids. This is less common, but no less a concern.
Health insurance for your wife should probably be kept at the same level it is now, if possible. She will need extra care immediately after the birth, but once the first year rolls on she'll get into the swing of things and probably not need any special coverage. I'd argue against catastrophic-only coverage for her since if she gets sick the whole household suffers, so having the ability to go to the doctor for anything questionable will be a good investment, if only for the peace of mind of having that security.
I wonder if there isn't a self-employed plan that covers people just like you already offerred by your local carriers. I'd be surprised if there weren't. But don't kid yourself. It's expensive. You want to go with a carrier who isn't going to drop you the first time you make a claim. That's a local issue that would be well served by some research (like, I suppose, asking us idiots).
Good luck.
Re:Can't help with specifics (Score:3, Interesting)
Don't forget some sort of disability/invalidity insurance (don't know if they've got that thing on your side of the pond, it's the big thing over here in Yurrop). If you can't get that (pre-existing medical conditions and certain professional fields are a factor here), go with accident insurance.
For all the things that don't kill you but make you unable to work.
Re:Baffled (Score:1, Interesting)
Are you trolling or really just that naive? My wife slipped on some ice, and the doctors took her insurance for over $100k. That would have bankrupted us if it had happened a month earlier before her new insurance started with her job with IBM. Never underestimate the greed of doctors. I work with them all day every day (I write medical billing and scheduling software) so I see just had greedy, lazy, and dishonest they are. You obviously have no experience with their type. It's quite an eye opener the first time you see one of them in action when they sniff money.
Re:Baffled (Score:5, Interesting)
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:For better health coverage? (Score:5, Interesting)
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.
Re:Baffled (Score:3, Interesting)
Actually, the nasty thing is that it can also bankrupt you WITH insurance. At a certain point, even 20% of the medical bill will be too much. Especially considering that you're not likely to start working immediately after a procedure that expensive.
Go for the high deductible (Score:4, Interesting)
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.
US Health Care Costs (Score:3, Interesting)
Re:Poor Americans, .. again (Score:5, Interesting)
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.
You get what you pay for (Score:5, Interesting)
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:Baffled (Score:3, Interesting)
My rather extreme example of this negotiated discount:
I have BCBS of NC. My daughter was born 6 weeks early, and in the NICU for 5 weeks 2 days ("apnea of prematurity" meant she had to stay monitored). The hospital bill (not counting the neonatologists) was $58000. They wrote off $52000, BCBS paid their 90% at $5.mumblek, and I paid $662.
So BCBS can get all that care (1/4 of a nurse, 24 hours a day, 37 days), for $6k. I would have had to pay $58k had I not had insurance (=years-to-a-lifetime of bankruptcy). The socialist in me is disgusted that it's that much more expensive to be poor. The poor person in me is glad that I didn't have to pay $6k for my 10%, though.
Re:For better health coverage? (Score:3, Interesting)
Same boat, here's my solution (Score:3, Interesting)
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
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).
Re:Change is needed now (Score:3, Interesting)
Re:Poor Americans, .. again (Score:2, Interesting)
But uhm, to be fair, there is one major downside. It costs the governement A LOT, and we all know where they get their money...
So in conclusion: Move to Belgium! We need people we can tax for our healthcare system.
Re:Blues (Score:3, Interesting)
Wow, having worked in medical research for the last decade I have to admit I'm surprised to find out that private insurance companies are spending so much more on research than the government. It will be news to most of my colleagues, as well.
Of course, like most people, I'm sure you're completely unaware of the fact that Cuba is one of the world's foremost countries in medical research. (No doubt it is because of their cutthroat capitalist medical care market!) One of the wonderful side-effects of our embargo is that American physicians have to get a lot of new medical developments second-hand rather than being able to attend the world-class seminars right next door. But hey, who wants to be saved by a surgical technique developed by communists?
Re:For better health coverage? (Score:2, Interesting)
The point is that ultimately, the single payer system makes the delivery of adequate levels of health care a responsibilty of elected officials, and that matters. You may be able to go from HMO to HMO, but you can't escape the profit-logic that allows, as the surgeon above noted, a high-school graduate reading a script to determine levels of your or your kid's or your parent's care, and by then it's too late. But if my MP doesn't support public health care, we vote the bastard out. My doctor operates with independence, and based on clinical, not financial criteria. And I know many people who have lived in the states all or most of their lives, who know our system and who, as they age, are moving to Canada. Why?
And as an aside, my son had open-heart surgery at age three that would have meant that I would have lost my house if I had had to pay for a fraction of it, as I would have if I were one of the tens of millions inadequately insured or uninsured in the states. It was a condition that we might not have known about, had we not had easy access to health care professionals, connected to world-class teaching hospitals, and with superb surgical and diagnostic factilities. Untreated, he would have keeled over dead sometime in the last 5 years. Not everyone has it so good here (we live in Toronto), but ultimately, no-one here needs to have their child undiagnosed or untreated for serious disease.
While he was in recovery, we met families literally from around the world who had had their kids flown to have similar, and in many cases much more serious cases dealt with, including heart transplants. Free. This was at the expense of the hospital and the Canadian government, with help from aid agencies. That doesn't sound like quite the antiquated, inadequate and over-stressed system that Canadian national health care is usually characterized as, does it?