Ask Slashdot: IT Contractors, How's Your Health Insurance? 468
An anonymous reader writes "In the tech industry, as the economy continues its downturn, IT folks in my circles who were either laid off or let go are turning to contract work to pay their bills. Layoffs and a decline in tech jobs has affected older IT workers the most. Many of us find it more lucrative and enjoyable in the long run and leave the world of cubicles forever. However, there is much to be said for working for a large company or corporation, and health insurance is one of the benefits we value most. But what happens to those who find themselves in this position at mid-career or later in life? Hopefully they have accumulated enough savings or have enough money in an HSA to survive a major medical emergency. Unfortunately, many do not and some find themselves in dire straits with their lives depending on others for help. I have been working IT contracts mostly now for the past 11 years and I've done very well. I belong to a group insurance plan and the coverage is decent, but as I get older, premiums and copays go up and coverage goes down. If you work contracts exclusively, what do you think is the best plan for insurance? Any preferences?"
Re:The only choice is to vote DEM / obama (Score:0, Informative)
Critical illness (Score:4, Informative)
Treat insurance as insurance, not as a health care account, buy critical illness with a high deductible (maybe 10-20K), but make sure it covers 5-10 years of your expenses for sure. For the normal every day stuff just pay out of pocket.
Re:Critical illness (Score:4, Informative)
Wrong. You'll pay several times more out of pocket than an insurance company would pay, because of their quantity discounts. It is NOT a competitive free market or anything of the sort. It's monopolies all the way down, and they have the literal power of life and death over you, and they use it.
the no pre existing condition/ no drop rule + exch (Score:5, Informative)
the no pre existing condition/ no drop rule and exchanges (not tied to jobs) is a big boost.
Just buy insurance...it's honestly that simple. (Score:5, Informative)
I contracted for 2 years. During that time, I purchased health insurance for myself, wife and 3 children from a health insurance company. It's actually really easy. I comparison shopped online, picked an insurer with a plan that had good coverage at a rate I could afford, called them up and bought a policy. The insurer did a check of our medical histories, which took about a week, and involved them calling doctors. Fine. The policy took effect about 2 weeks after the medical checks were complete.
I was paying about $300 / mo for myself, wife and my 3 kids - and that includes a kid with autism, which the insurer could not turn down, thanks to the Affordable Care Act (GObama! Sorry, had to :) ). They did charge me $10 extra a month for my autistic child, but that seemed more than reasonable to me. $300 / mo might seem high, but it's only about $50 more than what I pay when getting insurance through an employer. The copays were competitive ($10 prescriptions, $30 doctor visits and such). The other deductibles, co-insurance, etc were a bit higher, but not insanely higher than what you'd see through a plan from an employer.
There was one thing that stunk about the plan, though - if my wife got pregnant, the insurer would drop her coverage. That sucks. In fact, I couldn't find a single insurer that would cover pregnancy - nor would they cover things like IUD, birth control pills, etc. Basically everything you'd typically associate with a woman's health was completely not covered, which is ridiculous.
Once the Affordable Care Act goes completely "live" in 2014, though, insurers won't be able to deny women health coverage if they're pregnant, and they'll have to cover basic women's health care. Anyhow, wasn't trying to make this a political statement, it's just interesting how broken the current system is for women.
Re:Best Preference (Score:5, Informative)
Have UK Citizenship
Or Canada, Spain, Mexico... a lot of countries offer varying degrees and types of nationalized healthcare. The United States stands alone in being the only G8 country that lacks it.
Re:Just buy insurance...it's honestly that simple. (Score:4, Informative)
Mine's outstanding, but... (Score:4, Informative)
Re:Critical illness (Score:5, Informative)
Wrong [kevinmd.com]:
Re:Critical illness (Score:5, Informative)
Unless you ask for cash discounts before receiving services. Then you will pay about what the insurance companies do.
They love cash, they also love to not have to bill insurance companies.
Re:The only choice is to vote DEM / obama (Score:3, Informative)
You fail at logic. You think that it is OK for people to have a "choice" to not buy insurance and must live with the consequences, but note that you would not be able to buy insurance if you lost your current coverage.
Yes, perfectly healthy people below age 50 may have a choice. Many others, who don't have a perfect history of health don't actually have a choice if they lost their current insurance. You admit that you are in this position.
So, yes, many people have a choice to not buy insurance. Unfortunately, many others do not have a choice to buy insurance.
Re:The only choice is to vote DEM / obama (Score:2, Informative)
Car and house insurance are there to cover your liabilities to OTHER people. The latter is the result of you entering into a contract with a bank. The former is a miserable stupid failure and is really no great argument in favor of the state forcing you to buy insurance.
Plus IT IS THE STATE. That little detail really does matter. There are some things that states get to do that the feds don't. That's how the rules were set up.
Ignoring the rules is just stupid and the Congress should no more be above the law than you should be.
Re:Best Preference (Score:4, Informative)
or Italy, Belgium, Israel, Norway, Denmark, Sweden, Switzerland, Netherlands, Japan... ...Kuwait, Austria, Finland, Slovenia, Ireland, Portugal, Iceland, Cyprus, Hong Kong, Singapore, Spain, France, Bahrain...
Re:Best Preference (Score:5, Informative)
My mother actually traveled to Canada for cataract surgery. She was no longer a Canadian citizen, but she was eligible as a recipient of the Canadian equivalent of Social Security.
She could have had it done under Medicare, but would have had to cover huge co-payments.
Re:Best Preference (Score:4, Informative)
As they say in Wikipedia, attribution required. While there's a lot online about Green's fight with cancer, I can't seem to find anything resembling the 9-month delay.
This sounds like a typical internet meme. While you often hear Canadians complain about delays, it's always for stuff that can wait, not for something that's likely to kill you soon. Of course, by the time this is filtered through the right-wing blogosphere it's "we're going to have to let you die because we don't have enough beds."
Re:Best Preference (Score:4, Informative)
Knee replacement surgery is a bad example to prove the superiority of the American health care system. It proves the opposite. You shouldn't rush patients into surgery. Canadian doctors say that the long waits are a benefit of their system -- they give people a chance to find out the facts and decide whether the treatment is a good thing.
First of all, most of the people who get knee replacements are in their 60s or 70s, so in the US they get it under Medicare -- single payer health care.
Second, Total knee replacements are the fastest-growing and most expensive surgeries in Medicare. Doctors are rushing patients into knee surgery who shouldn't have it. So this is free-market medical abuse on steroids. (In fact steroids turned out to have some bad outcomes.)
TKR isn't trivial. It's among the most painful procedures in medicine, and if the patient doesn't complete painful physical rehabilitation, the replacement won't work. They usually use Oxycodone for a month or two, but this being the US a lot of surgeons under-dose and leave the patients in pain that drives them to tears (read Jane Brody's account of her own TKR in the New York Times). It's several days in the hospital, a week in a rehabilitation center, a week to a month at home in bed, and 3 to 6 months before you've recovered the function you started with. Then you start to improve, and after 6 months to a year most people can walk and stand again.
But many people don't. About 15% of TKR patients have permanent moderate to severe pain that can't be cured. They're worse off for having the surgery. Some of them get surgery because they're using a cane as a result of their surgery wind up in a wheelchair. What are the risks? Nobody knows for sure because surgeons have been replacing knees without doing good outcome studies. Countries with national health care systems do outcome studies. Denmark is doing a big randomized study, so we should know the outcomes in 10 years.
In Denmark, the current practice is that they don't give TKR until the patient has tried less drastic measures for 6 months and they haven't been adequate. The first step is to lose weight, down to a body mass index of 25 ideally. They also give them exercise/physical rehabilitation and non-steroidal anti-inflammatory drugs. People who are overweight or obese have a worse outcome after surgery, and in some cases, after weight loss, exercise/rehab, and NSAIDs, they don't need surgery after all. Why go through all that pain, bed confinement and risk when you can get the same results without it?
Overtreatment is endemic in US health care. Look at the fastest-growing, largest Medicare expenses besides hip and knee replacement. According to a series of articles in the New England Journal of Medicine, CT scans (another big money-maker for doctors and device companies, a major growing expense for Medicare) are widely overused and a major cause of cancer (about 1/10,000 major CT scans result in an additional cancer, more for CT scans of children). Erythropoietin, a drug that stimulates the growth of red blood cells, was the Medicare/Medicaid's single most expensive drug (=profitable for drug companies and doctors), used in kidney dialysis, and after they finally did the research, it turned out to be actually killing people at the high (profitable) doses they were using. Hormone replacement therapy for post-menopausal women actually turned out to be a major cause of breast cancer in the formulations they were using. There was a significant bump in the breast cancer incidence curve because of these heavily-promoted estrogen drugs.
The Canadian health care system has quality as good as ours, costs them half as much, and the tradeoff is that they do have to wait longer (and sometimes don't get advanced procedures that we get here). They have their flaws. But it's not the backward third-world system that conservatives (Google "Manhattan Institute) would have you believe.
Here's a couple of interesting stories on the Canadian system.
Re:Best Preference (Score:4, Informative)
Actually, you don't want the UK for anything urgent. In the UK, unless you're willing to pay for a private clinic, you'll usually need to wait at least 6 months before you can see a specialist.
[citation needed]
Two NHS anecdotes of my own:
I had a pain in the left side of my chest while running. Looked at the NHS direct web site, which told me to call an ambulance. I didn't, but I went to A&E soon afterwards. Within 5 minutes I was being interviewed by a nurse, and within 20 minutes I was on an ECG. Within 2 hours I'd had a chest X-ray and a second ECG. Happily I was given a clean bill of health -- the pain was just caused by muscle tension. But I was astonished by the rapid and thorough response.
More recently, a couple of friends noticed a mole on my back which they thought I should get checked out. I phoned for a GP appointment, and got one 3 days hence. The GP referred me to a consultant dermatologist. That appointment was about a week later. I got to the hospital 10 minutes early, and was seen 5 minutes early. The consultant gave me a thorough examination and recommended a biopsy. I had to take a form to reception -- where there was no queue -- and made an appointment for the biopsy scraping, 1 week later. Again I was seen on time, treated with immaculate professionalism. A couple of days later the test results came through the post -- all clear.
I appreciate some people have had bad NHS experiences, and of course we must relentlessly maintain/improve standards. But mostly I sense that people in general are pleased with the NHS. In particular, I'm of an age where lots of my friends are having babies, and not one has complained about NHS maternity care.
Also you say "for anything urgent". My sense is that the NHS is very good at prioritising. If you find yourself waiting, it's because someone with a more urgent need has taken precedence. For example, with my chest pain, I jumped a queue of bleeding but stable A&E patients.