Here’s a thing that’s happening at Der Wendighaus:
I will soon be the sole provider for our family.
*hold for applause and/or laughter*
My wife has been in a year-long extraction from her job — transitioning from full-time to part-time (for the last year) to, come next month, no-time. She’s doing this to spend more time with our son and to allow me more time for my writing career (and further, the costs of daycare are so high it practically eats away the value of having a job in the first place).
This is, of course, terrifying.
Don’t get me wrong — while I wouldn’t call being a writer the most, erm, stable job one would find, I think I’d made a pretty good go of it. Our finances are in good order. I do well as a writer. Not go buy a boat money, but definitely support my family money.
The scary part comes in that we are losing our health insurance.
And it’s pretty good health insurance we’re losing.
Thus I solicit you, THE HIVEMIND, on the subject of independent health care. We’re in the market — we’ve got an agent who is suggesting Aetna and United to us, and we may lean that way, but not before I explore any and all options. Do you have independent health care? Are you willing to talk about it — problems, pluses, costs, benefits and concerns? Can you confidently speak to me about just what the hell Obamacare is going to mean for us?
HALP PLEASE OKAY THANK YOU
*hyperventilates*
Any advice or information you have: I’m listening. Thanks!
Kimberly Gonzalez says:
Also, if you have Dean insurance in your area, they offer plans for individuals — but again, I haven’t looked into this myself so I have no idea what the rates are like. I did however, like DeanCare as a provider when we used them through my husband’s work.
On another note, we once paid slightly in excess of $300/month for insurance through the National Association for the Self-Employed. They hardly covered anything and we were so unhappy with the insurance that we cancelled it after six months (having no kids at the time and being relatively healthy makes that an easier risk to take). The one time a doctor’s visit was covered, we got a letter FIVE YEARS LATER saying “Oops, we should not have paid this claim.” I would not recommend using them, although this experience is from quite some time ago.
September 9, 2013 — 10:45 AM
Bob G says:
My daughter is self-employed and insured (through an independent broker) with HealthNet in southern California. The premiums are mid $200s/month. Seemed high, but then she was hospitalized for 3 weeks last year and had ongoing expenses. Thankfully, well now. They covered almost everything, including all of hospital! She is very pleased with them. Paying a deductible was nothing compared to all the expenses they covered.
September 9, 2013 — 11:05 AM
Betsy says:
Chuck, COBRA doesn’t have to be all or nothing. Your wife could stay on COBRA while you and your son move elsewhere. We did that some years back when my husband was having some health issues, but the rest of us were less expensive to insure.
September 9, 2013 — 11:15 AM
Robert Heaney says:
Went through the same thing twice when we lived back in both NJ & PA. Feel your pain, Chuck. We moved to NC, and the same quality independent healthcare options were far, far cheaper down here. NC. As in North Carolina. The more northerly of the Carolinas. Just saying.
September 9, 2013 — 12:11 PM
Laurie Evans says:
Reading these comments with interest, because to me, this is one of the SKEERIEST things about me being the breadwinner someday. *gulp*
September 9, 2013 — 12:21 PM
Heather says:
Avoid Cobra as if it were an actual cobra. It’s insanely overpriced.
My husband was on unpaid leave from work for like 7 months several years back, and I was pregnant and needed to use cobra (his former employer sued him for a bogus noncompete agreement, and his new employer was forced to temporarily terminate him while we were in litigation–it was awful…) Cobra cost 3x what it would have cost us to buy our own insurance, but since I had a pre-existing condition….
Good luck!
September 9, 2013 — 12:27 PM
terribleminds says:
Well, COBRA may be the only option because hard to get independent health care for a couple-few months only.
September 9, 2013 — 12:40 PM
Michael J Sullivan says:
First congratulations. Second, here’s what I do. I have a good nest egg set aside…just because you need that in writing anyway. But then for insurance I have one of those high deductible major medical policies. So, if I have a sore throat or minor ailment I either pay for it myself or just don’t go. But if I were to come down with a terminal disease I can be guaranteed not to have more than $5,000 of risk no matter what that major affliction might be. It is very cost effective.
September 9, 2013 — 2:23 PM
terribleminds says:
Thanks. Only problem with this is having a wife and a kid means not being comfortable with just catastrophic coverage.
September 9, 2013 — 3:03 PM
Mia Marshall says:
I’m speaking from limited experience, but I’ve been using Obamacare for the past three years and holy hell, it’s the greatest thing ever. I’m a freelance writer/editor with a pre-existing condition. I was turned down by every insurance company in existence and qualified for PCIP coverage that paid for five separate surgeries. So while I have no idea how smoothly the transition to the pools will be in January 2014, all evidence I’ve seen suggests the ACA works and does exactly what it was supposed to–provided my broken uninsured self with good insurance and a reasonable monthly premium. Hopefully, you and yours and healthy and happy with robot parts that will never break down, but if something does go wrong or a pre-existing condition becomes an issue, Obamacare’s got you covered.
September 9, 2013 — 2:56 PM
MelissaClare says:
I’ve had independent coverage for only a few months now, so my experience is limited, but I’d say it’s okay. It’s just me, the monthly rate is okay (under $150), but the “deductible” is $6000. That seems like a lot (it is) but after that, there’s no copays, EVERYTHING is covered 100% (I have, thankfully, yet to test this). It’s an HSA, which means I could put that $6k aside pre-tax to cover unforseen health expenses, which is nice. This is (I think) the better version of what @Michael Sullivan said, above – because the “nest egg” is tax free, and every time you pay for healthcare (best to go to the dr when you need to) it counts toward that deductible (and you get those evil discounts they only give insurance companies). BTW, I’m Canadian, and this system blows my mind. Can’t believe you guys have dealt with it so long. The Canadian system isn’t perfect, but healthcare is a human right…
September 9, 2013 — 3:32 PM
Tisha says:
We have independent coverage because we were tired of getting ass-raped every month with the previous health coverage. After shopping around, we ended up with two different policies. Myself and my son are covered under Humana, with a $5,000 deductible each, and my husband has a policy with Golden Rule, also with a $5,000 deductible. He’s had multiple back surgeries and one bout with kidney stones (oddly enough, this seemed to be more of a problem than all the back stuff).
The monthly premium for Humana is $180, and my husband’s premium is $305. Under our old policy, we were paying $1300+ in premiums every month.
We opened an HSA account and make regular deposits to help pay for any doctor visits, contact lenses, my (ahem) yearly female doctor appointment. If you don’t go to the doc often, this coverage works well, but like you said, with a toddler, this might not work for you.
September 9, 2013 — 3:43 PM
Lisa says:
The good news: You have to cover your asses for a few months – rest of 2013. Easiest way to do this is COBRA, if you had a good plan before and you can afford it – it’s insanely pricy, like $1500/month for 3 people in California pricy holy mother of jesus. You might also get a bare-bones independent plan, or apply for one, just to see what the options are. (Not worth the savings to get an HSA for only 3 months.) Insurance companies can still discriminate against you for preexisting conditions when you buy an individual plan, until 12/31/13. Kaiser generously charged my son and me 20% extra because of preex. conditions, but deigned to accept us. My husband was not so lucky, leaving his options as HIPAA or health roulette.
BUT it all changes January 1. Mid-October the rates will come out, and you can then apply for coverage starting no one can turn you down for, you know, once having an EEG that proved that your migraines were just that, migraines, and not a brain tumor. Or throwing out your back. Or having asthma or kidney stones or a broken leg. Wow.
Here’s the Calif. calculator – there’s a bit of subsidy for families of 3 making up to about 78K/year; without the subsidy, the silver (midlevel) plan, which offers quite good coverage, would be about $770/mo If I remember correctly; that goes down rapidly if you earn less. (CA is way more expensive for insurance than most places – and in the Bay Area, that earnings cutoff = middle-class. Meaning you can eat decently and pay all your bills and have one reliable car but can’t buy a house or save for college or take vacations of more than a weekend.) Contrast that to the $850 that bare-bones-don’t-get-hit-by-a-truck coverage would cost us today *if* they’d even deign to give it to all 3 of us, and you can see why I’m thrilled. There’s also a high-deductible “bronze” plan (IMO, doesn’t seem worthwhile if you can avoid it, as one kidney stone or other simple “incident” can easily set you back $5K+, hitting your deductible limit, and stuff happens if there are 3 of you and one is a child – then again, you may like the challenge of saving money by playing the invincibility odds, or have the cash flow to make it all be fine whatever happens) plus fancy gold and silver options with super-low copays, which don’t seem to offer much “added value.”
http://www.coveredca.com
OK, I’ve gone on a bit. But the exact numbers for your state will become clear in the next month, at which point you do the math and make the decision. And from then on, you can be allowed to buy insurance even if someone you love has a serious injury. Hallelujah.
September 9, 2013 — 4:12 PM
Lisa says:
Oh, by law, in 2014 under ACA all insurance companies will be required to offer those 4 levels of plans so folks can compare apples to apples. Choice becomes more about what insurance your favorite doctor takes, how competent on the business side and/or human the company is to deal with, etc.
September 9, 2013 — 4:16 PM
Linda Coburn (@LCinLA) says:
My husband and I and our 22 year old son have been self-insured for years now. Since we are pretty healthy (no ongoing conditions or medications except blood pressure) we opted to get what we call catastrophic coverage (through Anthem/Blue Cross in California) where we have fairly low monthly premiums with a high deductible – something like $12,000 for the family. This gives us an incentive to eat healthy, exercise, drive safely and do what we can to take care of ourselves. A couple of wellness visits are included for just a small co-pay (including special lady visits) and we are lucky to have a family doctor that doesn’t charge ridiculous rates to begin with. It’s a gamble — and if we were more diligent we would take the savings from the premiums and salt them away in a catastrophe savings account — but it works for us.
September 9, 2013 — 4:32 PM
Chelsea says:
The ACA kind of baffles my headspace, but I’m trying to grasp it. I work at Planned Parenthood, and they’re trying to prepare us for the changes coming up for our patients. One of the trainings we did last month included this video that helped clarify some things for me: http://www.youtube.com/watch?v=JZkk6ueZt-U
September 9, 2013 — 4:33 PM
Lisa says:
Just checked the calculator again. We’d pay $618, all be covered very well, and just qualify for a wee bit o’ subsidy. Counting the days. http://laborcenter.berkeley.edu/healthpolicy/calculator/
September 9, 2013 — 4:49 PM
Marie says:
These comments clearly demonstrate the madness. I have had bad experiences with Aetna. Fairly reasonable interactions with BCBS, although their website sucks supersize. I fully concur with comments made by “Susannah,” especially re setting up an HSA, although naturally most of the commenters make valid points.
This is a brochure prepared by Consumers Union that has the basics of the health premium tax credit, which will be helpful when the exchanges open: http://consumersunion.org/taxcredit/US_2014_EN.pdf
Good luck to you. Good luck to all of us.
September 9, 2013 — 5:54 PM
Costa says:
Avoid COBRA and the Freelancer’s Union insurance. ACA/”Obamacare,” baby. If I hadn’t just gotten Aetna through a new job I’d be using that.
September 9, 2013 — 7:24 PM
Sarah Glenn says:
We did an indemnity program when we had to leave KY suddenly to care for my father. It turned out that the Walgreen’s discount program gave us cheaper meds on everything but brand-name Synthroid, and we couldn’t find many docs in Bumfuck, FL participating the program. You’re probably better off paying for doctor visits yourself and investing in major medical coverage in case there is a Revoltin’ Development.
September 9, 2013 — 7:31 PM
Salomé Jones says:
I’ve been keeping tabs on Obamacare. I think it’s going to be great. I mean, really great. There are a range of plans. For a family of three with a household income of $50,000 it will probably cost in the$300 range. They can’t really tell us yet exactly how much and the prices will vary depending on the state. But the coverage looks like it will be a lot better than most independent coverage you can get now. You might check with http://www.freelancersunion.org/ which has insurance for some areas if you work for yourself, as a potential temporary measure.
I may have to come back to the US next year, so I’ve been reading about Obamacare constantly. You’ll be able to start scoping plans in October for coverage that starts in January. I can point you to answers to most questions you may have about it.
September 9, 2013 — 7:32 PM
Myas says:
One vote for United
September 9, 2013 — 7:43 PM
karaparlin says:
I’ve been worrying about this myself. I’m currently the health care-getter, but I’m looking to build up my freelance business and ditch the day job. Healthcare is the one major concern I have.
September 10, 2013 — 8:12 AM
Lisa says:
I cannot say enough about the HSA- health savings account. Get an agent to help you set this up. You will have an inexpensive monthly plan through a large reputable insurance company, which includes check- ups, and pre negotiated rates for sick visits similar to the co-pay but obviously a few more bucks since you aren’t paying loads of dollars into a big company plan! (We have blue cross blue shield of louisiana) You will have a large deductible, but not unreasonable, ours is $6000 per year. However, the HSA plan is an account you place money in every month, pretax, and you use this when you go to the doctor or buy prescriptions etc…. (You will have a debit card for this account)This money builds up and grows into a health insurance buffer for you so that deductible is a non issue. Unlike pouring a ton of money into healthcare every month and year and it disappears… The HSA is yours and it is sitting there when you need it!!! We are healthy but have three kids who get the occasional virus or “almost broken bone from climbing a tree injuries” and this is the only way to go for peace of mind and complete coverage. Don’t be afraid to make your own destiny even with health coverage for your family! No one seems to discuss the HSA anymore but it is the best way to control your health spending! Seriously check this out!!:-)
September 10, 2013 — 8:55 AM
Mark Carroll says:
Heya, Chuck! I’m a licensed General Lines Producer here in Texas (fancy talk for I know Ridiculous Amounts of Magic Insurance Talk), focused on Healthcare and the ACA, so I’d be happy to answer any and all questions you’ve got. That goes for pretty much anyone, too.
Right now, one of your best stops for basic information is healthcare.gov – it’s got the rundown on the ACA and Marketplace, with easily-digestible information.
Given that your family’s likely going to want to hold out until full ACA coverage, you might want to consider grabbing short-term coverage until January 1st – that way, you can kick in a Marketplace plan and (likely) get cost-sharing and/or subsidies to get the premium cost down.
The basic way subsidy works is like this – you get what’s called the Advance Premium Tax Credit that can be put toward the cost of a premium. You can take it all up front (lowering premiums immediately) or partially, which gets the credit applied at tax time as part of your refund.
Given that you’re a 3-person household, subsidy kicks in at around $82,051 total household income or below. It’s a sliding scale thing, so the closer you are to that rough figure, the less subsidy you’re likely to get…but you’ll still get *some*.
The good news is that every single plan is going to get what’s called Essential Health Benefits, and things like preventive care are covered across the board.
So…anyone else got questions? Need more detail?
September 10, 2013 — 3:06 PM
Cathy Clamp says:
Also in Texas. Right now, I’m covered by my DH’s policy. But before he started this job about 5 yrs ago, I was writing full time and we were both on Blue Cross’s individual plan. Great for wellness stuff like annual physicals and covered the few emergency room things without any fuss. But the deductible was pretty high, so we also had about $5K in savings to cover the in-between stuff.
The one thing I have to say about the new federal plan starting is that we’ve already gotten word from our local doctors is that once it starts, they’re moving to a “cash-only” business model. Sigh… I can’t really blame them. They’re barely getting by now on regular insurance and cash. The new rules will devastate their bottom line. Despite what the press seems to believe, sole practicing GPs aren’t wealthy. They barely make the mortgage and salaries.
I’ll wait and see, but for now I have my fingers crossed DH’s company doesn’t drop spouse coverage. If so, it’s back to Blue Cross. Good luck!
September 11, 2013 — 8:18 AM
rjkeith says:
Obamacare basically means that you will be covered for EVERYTHING you just have to pay a premium. Or a co-pay. I’m not sure which one.
Think Europe’s healthcare system and you have a good idea of what’s going on from the White House, basically the system Obamacare is trying to mimic. Call it Socialism, whatever, I think it’s a great option. Personally, I am covered by the VA because of my veterans status. However, Blue Cross Blue Shield is not a bad way to go if you’re looking for healthcare.
September 11, 2013 — 2:10 PM
Steph Train says:
October 1st, keep your eye on this. They have a handy calculator (from Kaiser) in there as well.
https://www.healthcare.gov/
September 11, 2013 — 4:26 PM
Jay Lake says:
Do you live in a state which is effectively implementing the ACA exchanges (as Oregon is). If you’re living in an obstructionist Red State where the government opposes cost-effect access to healthcare for individuals, the single best thing you can do is move somewhere like Oregon.
September 15, 2013 — 12:17 PM
terribleminds says:
Sadly, I live in a state that will rely on the federal implementation of ACA.
And I would love to uproot the fam to go to Oregon, but, y’know: that’s sorta one of those “perfect world” scenarios.
*paws at a map of Oregon, whimpers*
September 15, 2013 — 1:38 PM
Angela/curiocat says:
check out Golden Rule through United Healthcare. It may be an affordable option.
September 17, 2013 — 11:34 AM
R.L. Weston says:
I second what Steph Train said.
Kaiser calculator: http://kff.org/interactive/subsidy-calculator/
Federal exchange: https://www.healthcare.gov/
For a family of three, if you make between 100% and 400% of the federal poverty level ($19,090 and $76,360) you will receive a premium subsidy. Your maximum expected contribution is a percentage based on your FPL, which is shown on the Kaiser calculator.
For instance, if you made $52,988/yr then your FPL would be 7.18% ($3,802). The remaining portion of the premium ($11,198) would be a tax credit and would be paid directly to your insurance carrier by the federal government. You would end up owing $316/mo.
Plus, supporting the federal exchange takes us one step closer to sweet, sweet, single-payer socialism. Mmmmmm….
September 19, 2013 — 2:05 AM