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!
Andrew Jack says:
I wish I could give you some advice on this but since I’m in New Zealand we get all our healthcare free from Hobbits. I’m yet to turn into a Communist but I’ve been assured that the free healthcare will eventually make me one.
In all seriousness: I hope someone buys the film rights for several of your books for so much money you’re embarrassed to talk about it and insurance becomes a moot point.
September 9, 2013 — 12:16 AM
Donna Marsh says:
Hello Fellow Word-Nerd! 🙂 My name is Donna and I’d be happy to offer some words of calm. Feel free to email me directly if you’re so inclined. My job is as a – wait for it – total NERD – professional problem solver (aka non consultant) at guess where – usually insurance carriers. I’ve worked on staff at Prudential, Aetna, Kaiser Permanente, and Cigna. Wellpoint and United Healthcare toy with me on occasion. So needless to say, I know this stuff first hand. Also I’ve done the whole fast-lane, slow-lane, no-lane thing a couple of times, so I totally hear you on the home front! When my family needed independent coverage, we went with Humana and it was fine. Ironically, I have Humana even now – but through my job this time. Many of my independent friends just have catastrophic coverage. Long story short, it’s all about managing risk (I know you know that) – like would you rather shell out $100 for a sick kid doc visit or have a $5 copay and deal with premiums. What’s important to know (besides the risk thoughts) is t’s not about the company, it’s about the plan. When I was young in my career, I spent many a day getting yelled at on the phone about Aetna sucking. It wasn’t Aetna that sucked – it was the plan the people were on that sucked (in that case, it was chosen by their employer, but that’s another story). Anyway, feel free to lean on me and I’m glad to share whatever I can that may help. Best – Donna
September 9, 2013 — 12:18 AM
Carol McKenzie says:
I worked at an insurance agency for a time, and from what I saw, sometimes it’s more about having a responsive agent who can help you navigate getting decent coverage at a reasonable price and then help you when you have issues with those claims (because you almost always have issues with claims).
Also, not to get too personal, or scare you even more, but pregnancy isn’t covered under all insurance plans. Check to make sure, if that’s anywhere in the near future, that it is part of your coverage. Or check that the company you’re considering offers a pregnancy coverage plan. The catch is, you need to have the plan in place BEFORE Mrs. Wendig is with child. So, you know, no accidents get covered.
Have you checked the Freelancer’s Union? I know nothing about that other than I saw it on a post somewhere and bookmarked it, and saw they offer insurance. For my area (Kentucky) it’s with Golden Rule, which was sold frequently back in Wisconsin (where the previous job was). YMMV.
https://www.freelancersunion.org/benefits/
If anything else comes to mind, when I’m not half asleep, I’ll drop you a line.
September 9, 2013 — 12:23 AM
Ransome Campbell says:
Well having worked in the medical field my entire life. My best advice is if you have a md you. Love esp ob-gyn or pediatrisn find out what insurance they take. The hospital where I work is changing insurances again and my primary care doesn’t take the new one. She is so good however I am willing to pay out of pocket. Plus could you make your wife your assistant and you a llc and get a discount as a business?
September 9, 2013 — 12:27 AM
Sharon Fummerton says:
I don’t know what to advise you because I live in Canada and we have universal health care. So, I know you will do due diligence and research thoroughly. Just make sure you choose insurance that will cover eye and dental care as well.
I share Mr. Jack’s views posted above that film production companies will be interested in acquiring the film rights to your books, especially the ones in series!! 😀
I also hope that your books continue to sell well in e-book or hard cover and/or paperback formats.
One little fact that I’d like to share here: Tommy C. Douglas, a pastor, was the man who led the effort to bring universal health care to Canadians, and it was a real battle. This was during the depression of the dirty thirties. Mr. Douglas has been decades gone, but he still keeps winning a poll regarding who people think is the greatest Canadian. He was the maternal grandfather of actor Kiefer Sutherland.
September 9, 2013 — 12:34 AM
Betsy says:
Hi Chuck,
We’ve had to buy health insurance for years because though both my husband and I work, neither of us gets benefits. He’s an independent consultant and I’m a contract tech writer. We like our jobs and love our schedules, but the insurance thing is terrible. When we first switched from his awesome health insurance when he was a W2 employee to the kind you have to buy as individuals we were shocked at how awful the individual plans are. So we picked a middle of the road plan that costs more than we’d like and covers less than we’d like. I hope things get better in October. We’re in California. Whenever I see articles about Obamacare that say, individual plans could be as high as $X, that is always a lower number than what we are paying now (some of us have pre-existing conditions). We found no good choices, just relatively less awful choices. You can spend a lot and opt for Cobra in the short-term to keep the insurance that you have for a couple of months while you do the research. Your options might change a lot next month or not, but at least you will have more to go on when you make your decision. Cobra’s also good if you know you’ll need something expensive like an MRI. When we had insurance through my husband’s job, I needed an MRI of my shoulder, and it only cost me $25. Later, on the independent plan, one of our daughters needed an MRI of her shoulder, and it cost around $600 because the insurance plan excludes imaging (x-rays, etc.) Also, watch out for the word covered. Some “covered expenses” are counted toward your deductable (ours is $2500 per person per year), so the insurance doesn’t pay any of that category of expense until after we go out of pocket $2500–has to be for the same person. Oh, and don’t bother with dental insurance, it’s much cheaper to pay out of pocket. And always, always ask for the cash discount. You can get that even if you pay with a credit card–it means that you are paying directly and the healthcare provider/dentist doesn’t have to bill insurance and wait.
September 9, 2013 — 1:15 AM
Betsy says:
RE: Pregancy, some states require all insurance companies to cover it. That is the case in California. We didn’t need that coverage, but we got a letter from the insurance company announcing that they would cover it in compliance with a law that went into effect after we had purchased our policy.
September 9, 2013 — 1:16 AM
Shelby Edwards says:
The new health care law starts kicking in this fall — I’d look for the health care exchange in your State. Ours launches in October here in Washington State. Might have some options we didn’t have before.
September 9, 2013 — 1:25 AM
Michael R. Underwood says:
I ditto Shelby. Come October, I’m going to have a long stare at the Maryland exchange options and see if they’re cheaper/better than what I have right now.
Best of luck!
September 9, 2013 — 9:28 AM
Charlotte Grubbs (@literary_lottie) says:
I have Aetna through my mother’s employer (woo coverage until I’m 26 under the ACA!), and they’re *terrible*. Been dropping coverage on (basic, necessary) things left and right and raising the price of copays for office visits. But that just could be because my mom’s employer is kind of a dick.
Also, every person in my family has horror stories dealing with Aetna customer service. Aetna’s been late paying their share of medical bills *multiple* times, to the point where my family has had collection agencies contacting us for unpaid medical bills – bills that *we* had paid our share of, but which Aetna had failed to do so on their end.
I’m not sure how helpful that information is, and to what point the issue lies with my mother’s employer vs. our insurance company, but I’ll just say that we’ve since my mom’s employer changed health insurance providers we’ve had constant problems with service that we never had under our previous insurance policy (through Blue Cross Blue Shield). It’s been one headache after another with them.
And check to see if Aetna will continue to sell independent insurance policies on the state-insurance-exchange where you live. Aetna has withdrawn from multiple state-run insurance exchanges in recent months, from California to Maryland, leaving current policy holders in the lurch.
September 9, 2013 — 1:48 AM
Kay says:
I have an individual policy with Aetna, and so far they’re paying promptly on my current condition, but as Charlotte points out, they’re getting out of the independent health insurance business as of Jan. 1. However, I’d like to add that I’ve had issues with all insurance companies except United (which doesn’t do independent policies in California where I live), including issues with Blue Cross Blue Shield. So I’d say gear yourself up for eventual trouble no matter what you decide to buy. COBRA can be a great deal. I think the federal subsidy has expired, but it’s worth asking about. Your state’s health exchanges might be a place to start–I’ve checked California’s, and it looks as promising as anything. One site that might help you with cost/benefit comparisons:
http://www.ehealthinsurance.com/
September 9, 2013 — 2:43 AM
Maree Anderson says:
*waves at @Andrew Jack from Auckland*
I second Andrew about wishing you multiple TV or film rights options and nice big jaw-dropping payouts so you don’t have to worry about this stuff. Or even better, the US equivalent of a first division Lotto win! (And I gotta say, although the NZ public health system has much to recommend it, after a rather horrendous week-long public hospital experience with my son I’m hoping we can keep up with the private healthcare payments at least until they leave home and are earning on their own. When it comes to my kids, I’d rather go private where possible.)
September 9, 2013 — 2:57 AM
Wendy Christopher says:
As a UK-er I’m probably standing right next to Mrs Useless and shrugging my shoulders at her on this one, but all I can say is that I hope that Obamacare has looked at our NHS model over here and worked out where it’s all gone wrong, so that he knows what NOT to do in order to make his version work the way it should.
Not wishing to beat on the NHS – it does its best where it can, but it’s creaking now. It worked when it first started just after the war, ironically because more people died of more things back then – the technology wasn’t there to save them. Now we can cure so many more things people expect to die from them far less often; fair enough, if we have the *knowledge* to save their lives… unfortunately the *funds* aren’t there to save everyone who can be saved with that knowledge. Then it becomes a lottery – and one where you REALLY DON’T WANT to be; old (as in ‘over sixty’), overweight, a smoker, a drinker, living in a deprived area, poorly educated…
For those reasons I’m tempted to say don’t rely on Obamacare alone. I’m sure he has the advantage of looking at our system and ironing out the flaws for his – but we’ve tried to make it work for seventy-plus years and it’s struggling now, for the very reasons stated above. People I’ve known have died because their hospital simply didn’t have the resources available to treat them.
September 9, 2013 — 3:05 AM
Suzie says:
Having lived in both the UK and the USA I can promise you that the NHS, for all its flaws, is about a million light years ahead of anything the States has to offer.
September 9, 2013 — 6:46 AM
Jessa Slade says:
Check what options will be available in your state under the ACA. I pay my own hit-by-a-bus insurance and from what I can find, allegedly with the ACA, I’ll pay less, with a lower deductible, lower co-pays, and actually be able to — ya know — USE this thing I’m paying for. Without being hit by a bus.
You might also check various writers groups you do/could belong to and see if they have a group plan.
Knock wood you never have cause to find out if the coverage is any good. And congrats on becoming the big bringing home the bacon dude!
September 9, 2013 — 3:07 AM
Laura Russell says:
Self-insuring is a bitch. Given the timing, you might look into COBRA and pay to keep wife’s current plan until Jan 1 when insurance offered under the ‘exchanges’ mandated by Obamacare start. These exchanges are supposed to open on Oct 1, providing details about policies offered in your state. (Insurance is regulated in US by the states.)
If you live in a red state that is punting the exchange to the feds, no early details have been released. If you live in a blue state, many details have already been published- companies, rates, coverage etc.
Given the complexity, the lack of attention to the nuts & bolts for the 30 million odd who need to buy own insurance to comply with ACA is disheartening.
Also, give serious thought to earlier suggestion about forming own company and buying insurance as a small business for you and your wife/employee.
September 9, 2013 — 3:40 AM
Laura Russell says:
Forgot to add: if anything medical is going on at the Wendgighaus, COBRA would be advisable for the months until obamacare starts. New regulation forbids exclusion of pre-existing conditions for policies bought through an exchange- I believe this starts Jan 1 2014
September 9, 2013 — 3:49 AM
Gaye Weekes says:
As (another) UK – National Health Service user with 9 mos of cancer treatment under my belt.. (2 yrs ago) I compared notes with a friend going through the same mill with private health care over here and couldn’t find much difference (apart from not being thrown in a scanner every 5 minutes). Now I know some of you will be lining up beside the MRI with a toothache but hey, that may well be due to fact that they WANT you to spend money or become reliant on drugs. It’s good marketing. I’ll still sing the praises of our NHS but just wish there weren’t so many ‘suits’ involved! Good luck with the research Chuck.
September 9, 2013 — 4:05 AM
Jim Bentley says:
Up sticks and move to the UK. If you don’t mind terrible weather, indecipherable accents (especially in Scotland) and a severe lack of twinkies; the free healthcare we get here is awesome, even if our government is made up of mostly right wing morons.
September 9, 2013 — 4:06 AM
Shay Dee says:
What Jim Bently said!
But seriously, I always thought you were from the UK because of where Angry Robots was based. See, I told you that you shouldn’t make assumptions.
Hats off to the wifey for having so much faith in what you love to do. I’ll admit the prospect would both excite me and make me sick.
September 9, 2013 — 5:38 AM
terribleminds says:
Hey, folks! Wow, thanks for the great info already.
COBRA is not feasible. We got the cost for month-to-month and it is EXORBITANT. Like, easily three or four times what we would pay for independent insurance with a low deductible.
I cannot move to the UK, sadly. 🙂
I have sold some film/TV rights, but I can’t comment on that, yet. (Soon!)
We are currently looking at Aetna primarily for the insurance, but it doesn’t appear as if they have maternity care.
Pennsylvania is, in general, a blue state, but our governor is very, very red — and so we have fewer details about the ACA then we’d like.
— c.
September 9, 2013 — 6:38 AM
Carol McKenzie says:
Ask your agent what types of supplemental insurance the offer to cover maternity. Since Aetna doesn’t seem to have maternity, as you say, your agent should be able to find you some type of coverage.
From Aetna:
Are maternity benefits covered under the Aetna Advantage Plans?
Maternity benefits are not currently available in most states. Complications of pregnancy are normally covered in most states. A newborn is automatically covered under the policy for 31 days and can be added to the policy during this time.
So any additional Wendigs would be covered, which is good. I love the “most states” clause…and that means you, as a consumer, need to look at all the fine print to find out if your state is one of the “most states” in which things are…or are not…covered.
September 9, 2013 — 6:55 AM
terribleminds says:
Actually, SOME Aetna plans do seem to have it? (I’m literally researching now.) The HMO plans cover maternity, though a $600 copay per day. — c.
September 9, 2013 — 6:59 AM
Carol McKenzie says:
According to Aetna’s site, some states have it…and probably some plans. Welcome to individual healthcare in the US. There is no rhyme or reason to any of it. It’s a mess.
And I don’t think Cigna offers coverage in Pennsylvania.
http://www.cigna.com/individuals-families/explore-plans-in-your-state/
September 9, 2013 — 7:03 AM
Carol McKenzie says:
Off topic, I have family asking why I’m researching maternity coverage in the middle of the night…I’m causing some raised eyebrows here.
September 9, 2013 — 7:04 AM
Carol McKenzie says:
http://healthinsurance.aetna.com/media/pdf_plans/PA_Direct.pdf
I’m sure you’ve seen this…the HMO brochure for PA.
September 9, 2013 — 7:27 AM
Shae Connor says:
I’ve had Aetna for (*counts on fingers*) 10-ish years? with three employers, in NJ and GA, with very few problems (and those mostly with providers messing things up). Granted, employer plans are different. I don’t know about the maternity issue; maybe it applies only to certain types of pool plans? I can’t imagine it would be legal for them to exclude coverage entirely.
September 9, 2013 — 7:41 PM
betsydornbusch says:
We now have Cigna, which has been great. I have found generally better coverage for a little less, less paperwork, far fewer mistakes rhan Aetna. They also insured me after my not being insurablefor ten years. We also have used a broker which was great. The hubcap handled it primarily. I can get you more details if you like. We’ve had our own insurance for years.
September 9, 2013 — 6:57 AM
terribleminds says:
Cigna, you say? Thanks, Betsy!
September 9, 2013 — 7:00 AM
terribleminds says:
BAH. No Cigna in PA. Thanks, anyway. 😀
September 9, 2013 — 7:01 AM
Erik DeBill says:
I’m a programmer. I live in Texas and have done a lot of bouncing between jobs for the last 4-5 years. I’ve worked for companies headquartered in Texas, California and Washington and had about 8 different health plans.
What I’ve learned is: never start a high deductible plan late in the year. Make sure you can carry over your deductible spending from one plan to another if you’re not switching at the normal end of plan year. Raise bloody hell if the RX benefits aren’t coming through properly. You may be able to figure out the scenario that lead to my having $20k in out of pocket expenses in < 9 months because of these mistakes.
These days I just go for the PPO or HMO option, even if I think I could save money over the course of a year. Around here an ER visit runs $1200-$1500 dollars, even if it turns out not to be anything serious. That's the kind of thing that can really screw up your expenses for a month so it's just not worth the risk over a PPO.
I think Aetna's the only company I actually had problems with and in my case it was their RX drug provider that fell down on the job and never acknowledged that we actually had a plan. Aetna themselves were OK.
Sadly, it seems like a lot of these companies offer different plans in different states and may even have different operating companies in different geographic areas, so things might be wildly different from state to state. The out of pocket cost for things varies wildly by plan, even within one company, so this might be one of those cases where an agent is warranted.
September 9, 2013 — 7:38 AM
Rachel says:
Ah, okay. So I’m a single person, and I have private health insurance. I pay about 200 a month for it (United) and it would be really great if I got sick more, but my deductible is pretty high (about 1500) so It kind of sucks for preventative care. If I had a growing son and a wife and myself, though, I would expect to reach 1500 pretty quickly within the year.
September 9, 2013 — 7:50 AM
Kristin says:
Wow! That is cheap. I used to have United nut they kept raising my rate until I had to leave. More I have HealthNet and I pay $205 per month with a $3000 deductible!
September 9, 2013 — 11:21 AM
Kristin says:
Ugh. Why won’t I learn to check for Swype errors before hitting send? Nut=but, more=now.
September 9, 2013 — 11:24 AM
Gita8 says:
If you are in PA, then it’s just a hop-skip to Ontario, Canada, where the health care is universal and you can still get NPR on your radio dial. As one who grew up in Canada and got excellent healthcare (as did the rest of my family) I say, why not? Your child(ren) will even be fairly well educated in the public schools.
September 9, 2013 — 7:53 AM
terribleminds says:
Like… MOVE to Canada? Or fly there any time I have a doctor’s appt?!
September 9, 2013 — 8:31 AM
Madeline Ashby says:
Yeah, as an immigrant to Canada, let me tell you that it’s not that easy.
September 9, 2013 — 9:21 AM
Aphotic Ink says:
Yeah. Speaking second-hand, from the experiences of a friend who immigrated: this is NOT that easy.
Also, Canada’s universal health care is great–compared to the current state of the States. It is a steaming hot mess compared to, say, the UK. OHIP (Ontario’s plan), for example, doesn’t cover your prescriptions, regular dental checkups, eye exams, all therapy, or ambulance rides. These things tend to be cheaper in Canada–I have nearly been sick hearing friends across the border describe the cost of their prescriptions, and a mild ambulance ride is cheaper than dinner-with-a-drink-and-tip-for-two–but they are not covered.
There are programs in place if you aren’t making money. There is also some bureaucratic frowning on people who cross the border and then need those programs.
Also, we pay higher taxes.
I do not say these things are bad things, and on balance I would much rather live here than there. But Canada is not the land where all health care flows free and affordable.
September 9, 2013 — 9:54 AM
Susannah (@susannah_scott) says:
*Raises Hand*
Hey there Chuck! Don’t worry, you can do this. I am the health administrator of a small group. We have used an unusual approach to keeping our employees insured for years. You can replicate with your family. It is complicated and takes tinkering–but not nearing as bad as writing the last third of a good story 🙂
I just want to give my quick $.02 on Obamacare . Most of the agents I have been talking with have been gloom and doom. We are all going over the healthcare cliff, and there won’t be ANY health insurance because the poor insurance companies can’t afford to insure us!!!! I just don’t buy this. It goes against basic market principles. If there is a demand for insurance (and they is), someone will supply it. Period.
However, who knows what the exchanges will be? You can’t wait for that. Here is what you can do today.
Shop plans in your area aggressively (either yourself, or with a broad-minded agent). Choose high deductible plans, 5-15K, with similar co-insurance rates, with NO co-pays, and a generic prescription plan only. Do not choose an HSA plan that the company administers.
After you get back screen rates, pick three of the most competitive, and completely fill out 3-5 aps on your whole family. *Big note here, pay attention to the in-network provider list. Less expensive doesn’t help if you have to go to Timbuktu to see a marginal provider. [In the last few years, we have had good luck with plans from Assurant and Starmark in our area]
Select your plan and set up a family HSA at your local bank. Each month, put money into your HSA that you would have normally used on premium. The bank will make you pledge blood to verify the plan is HSA, do the work, it is worth it. The goal is to build up your HSA to offset co-pays and a deductible-busting year.
All this takes a lot of tinkering. At the end of the year, make sure you have reimbursed yourself for all health care expenses, as these expenditures get a tax break. Each year your plan cost will inch up, so that you have to possibly repeat the whole process.
Good Luck and Write ON!
Susannah Scott
In my other life, authoress of Luck of the Dragon, Entangled Publishing (6/13)
http://www.susannahscottbooks.com
September 9, 2013 — 7:54 AM
julie hutchings says:
Frightening indeed. I left my 10 year job 3 years ago after my 2nd baby to spend more time with both my kids and to pursue writing more solidly. My insurance covered my entire family, so that was mindblowingly horrifying. I now have Mass Health, and I have to say, it isn’t so bad. We have the standard plan for my whole family, and the only trouble I’ve ever had with it was that it was very difficult to find a primary care physician for adults, as there’s a quota for doctors with Mass Health patients, and once they reach it they pretty much give you the finger. There’s a bit of paperwork, as with any health insurance, but I quite honestly did not notice a difference from United which I had for a long time and frankly, sucked, to state insurance. I don’t know if PA has a version of Mass Health, but state insurance for me was definitely not a big deal, and I don’t work just to pay for my damn insurance. That’s a dream come true.
–Julie of the Raccoons
September 9, 2013 — 7:57 AM
ddfalvo says:
I hated Aetna for the year we had them. We had PPO and stayed in-network, but they were still a headache. They disallowed or gave us a hard time over treatment charges (check your policy), and they pay the doctor too little–which caused mine to drop them. Customer service was frustrating.
BCBS is only a little better, but more doctors accept them were I live.
The bottom line is you ‘almost get’ what you pay for, meaning if you want great insurance expect to pay a lot.
If you don’t have special health conditions, it’s worth considering a lower cost policy– you’ll save on the premium up front, cover yourself for high risk, and get the pharmacy/doctor discounts. You’ll pretty much pay the complete (discounted) doctor rate yourself this way (because the deductible is so high) but a high premium policy would build that cost in up front, whether you use it or not. Six of these, a half-dozen of those. :/
Best of luck to you!
September 9, 2013 — 8:08 AM
Pat Malone says:
I can speak to Obamacare/ACA, having recently researched it as a possibility for my own family.
If, like South Carolina, Pennsylvania does not have its own exchanges (given red governor), the federally-run exchanges come online in January. Rates will be published on October 1, with an open enrollment period from then through (I think) March, 2014. After that, enrollment is based on “qualifying life events,” like most current employer-provided.
Regardless of insurance carrier, in 2014 all insurance plans will be mandated to cover pregnancy and childbirth, as well as charging the same rates for women as for men (age-graded, but not discriminating against women of child-bearing years).
The exchanges will still be more expensive than employer-subsidized (of course), but premiums are tax-deductible and — in states where rates have been made available — almost universally lower than the current individual markets, sometimes substantially. Depending on household income, there will also be scaled subsidies on the individual-market plans.
Until the rates are available next month, that’s probably still not enough detail, but I hope that’s some assurance.
September 9, 2013 — 8:15 AM
Anita says:
I’m self employed and have always carried an individual policy with Blue Cross Blue Shield. I get more than adequate benefits for a reasonable price. In fact it’s about the same as when I used to work as an employee for a company and got my insurance through them. But because Obama Care ( if I understand correctly) wants to get rid of the pre-existing illness clause, this may actually raise everyone’s insurance premiums a bit. Hope this helps.
September 9, 2013 — 8:18 AM
katie says:
You could also try joining something like MediaBistro and leveraging their group health stuff. I have no idea if it’s helpful or decent or not, just throwing that idea out there.
September 9, 2013 — 8:31 AM
Theresa Meyers says:
Chuck, check with the National Writers Union. They may have a hook up for independent insurance at a group rate.
September 9, 2013 — 9:11 AM
LM Pampuro says:
Chuck-
I confess I didn’t read all the comments or do I know where home base is for you so… Have your agent do a spreadsheet comparing the major options of both plans (primary visits, specialists, ER, etc.) so you can see all the bells ans whistles.
I would also check to see how your state is complying with Obamacare – that might get you decent coverage for less.
BTW-LOVE the blog! Thank you for posting 🙂
September 9, 2013 — 9:15 AM
Jennifer L. Davis says:
I’ve had good luck with Humana – not terrible deductibles with an affordable premium. Take a look on the exchanges once they go up in October, too, might get you some better deals/tax credits.
September 9, 2013 — 9:29 AM
Laura K Curtis says:
I have to say, I’ve had independent insurance now for several years in two different states and it’s ENTIRELY dependent on the state you live in. What Obamacare will mean for you will likely be different than what it will mean for me (again, state-based, but with Obamacare also income-based). You’re lucky to have independent agents–that’s not even a thing here. You just study it all yourself and come up with an answer. Frightening as hell.
Along with whatever other stuff is available, you might want to look at joining the Authors Guild. It’s my next step, since my current insurance has taken an enormous leap in price over the past year. I am waiting until I see what Obamacare has to offer in October before I do that. You might want to hang on to COBRA from your wife’s job until after October, if you can, just to see what the offers are where you live. The Guild has insurance available to its members, and the plans are priced out pretty clearly–again, it varies state to state, but at least for NY they’re very competitive. There’s also the Freelancer’s Union, which had insurance, too, last time I was looking to switch companies. At the time, I couldn’t prove Freelancer’s requirements, but you shouldn’t have a problem with that (I don’t now, but did then).
September 9, 2013 — 9:33 AM
mikes75 says:
Apologies if this is just me stating the obvious, but since Corbett opted to let the Federal Government manage the exchange for PA, healthcare.gov might be your best overall option? They have an easy interface and a live chat option that might be useful in understanding what’s going to be available to you on the exchange now that Corbett’s punted.
September 9, 2013 — 9:37 AM
Matthew MacNish says:
I have a soul-sucking corporate day job, so I can’t help you, but good luck!
September 9, 2013 — 9:45 AM
Janet Harriett says:
I have insurance on the individual market (i.e. not employer-provided since my spouse and I are both self-employed). I suggest getting a responsive and knowledgeable insurance broker who is not a captive agent. Captive agents work for one company, and they’ll find you the best policy *from that company* but aren’t so helpful if your best option is with a different carrier. (Full disclosure: my spouse is an insurance broker for a niche type of health insurance that is not relevant to your current predicament but does give him some insight into how individual insurance works).
We have a high-deductible major medical with an HSA, which we are quite happy with, but then again we do not have to worry about the health needs of a toddler. And, as others have mentioned, if a sibling for B-Dub has not been taken off the table as an option, plan ahead for womb extraction. Under old rules, insurance companies made you wait a full human gestation period for maternity coverage just to make damn sure the pregnancy wasn’t a pre-existing condition. However, as of next month (October), a lot of rules change and no one is quite sure how all of it will shake out.
One thing I would recommend is getting very comfortable talking with your doctor about the cost and necessity of the procedures. My standard lines are “I will do whatever is necessary for my health, but bear in mind I am paying out of pocket for this, so cost is a factor” and “How will the results of this test affect the treatment decision?” It’s amazing how often the answer to the second question is “It won’t”; I usually skip those tests.
September 9, 2013 — 9:52 AM
Nathan Hall says:
Hey Chuck, wish I had some good advice for you but I’m still working full-time for a company right now. I did want to wish you congratulations on getting to a point in your career where you can fully support your family though. That’s awesome dude.
September 9, 2013 — 9:53 AM
TerriKap says:
It looks like you’ve gotten tons of good advice already, but here’s my two sense anyway. I lost my job earlier this year and spent a lot of time looking at options. If you have any groups you are or could be a part of that offer insurance, check them out. Because my dad was military, I’m a USAA member and a lot of people I’ve talked to didn’t realized they offer independent health care. They had really good rates, too. Other than that, just do a lot of research for each company. Side-by-side comparisons are the best, and I know there are websites which will do that. Premiums vs. copays and all that assorted BS. Good luck to you!
September 9, 2013 — 9:55 AM
Justin says:
We let someone else manage our health insurance because, well, it’s incredibly confusing at times even for me an insurance guy. We’ve got Keystone East and the coverage we get is still pretty good. Expensive, but good.
It does keep getting more expensive year over year (about a 9% annual increase for the past 3 years, which appears par for the course from what i’ve seen elsewhere). We also have a $1,000 annual prescription deductible which means we have to pay full price for all our medicine until we reach that annual cap and the insurance kicks in. That bites. But we’re pretty much covered for anything and everything that could happen.
I would see what becomes available to you when the exchanges open up here next month. But from what I gather the rates will be means tested. So if you’re making more the programs assume that you can afford to pay more for those plans. Lower income folks would get subsidies or tax credits or something. You’ll also be able to choose from several different coverage options.
I would choose the deductibles that you know you can live with if you have to use it.
I guess the bottom line is that there should theoretically be some better competition for your healthcare dollars. That has to be a good thing.
September 9, 2013 — 9:57 AM
catyorkc says:
Hey Chuck. 🙂 Congrats to you guys. (meaning, I think you’re coming to these decisions all by choice and choice is good.)
My husband is a T.V. producer/editor. He’s an incorporated business of one. We’ve been playing the independent health insurance game since 2003. The kids and the mister are with Blue Cross Blue Shield of Tennessee. I am on my own ticket (Celtic), because I have a fairly serious pre-existing condition which wasn’t covered BCBS when we last switched insurance. Celtic was one of the only insurance companies that did not ask the questions that would have gotten me booted from the program. That’s one of the fun underwriting games.
But it’s been almost two years since I had a serious attack and I manage all my symptoms as naturally as possible. It was mostly dietary issues, so it was a simple solution, not always easy. I choose to do as much for myself as possible without relying on doctors, now. Insurance is just a safety. I do my own prevention.
Having an insurance broker/agent handling your account is key, so you have that.
If you live in a Republican governed state, I’d think to go with a bigger insurance company who can and will absorb the changes quickly. That’s just because I see a push against health reform here in Tennessee. Like one of your commenters, I’ve been looking at what the Affordable Care Act will do for me, it sounds great but, no offense, I’ll believe it when I see it. This just comes from someone who’s stuck between healthy and labeled. I don’t really know what government health care will *really* get me in Tennessee, quality wise as well as specific coverage, no matter what’s being promised.
My small insurance company doubled their rate on me in the last year because they knew they could. We pay almost as much for my basic insurance as we do the rest of the family, who also have dental.
I’m approaching the end of my wait time where I can answer underwriting questions without saying “hospital” so I’m lucky. So many people are not or have not been. The answer for a long time has been: Don’t Get Sick.
One positive thing I can say about having a condition with the fear of getting dropped and paying out the nose for care… I’ve gotten my act together. I feel far more in control of my health over the last five-six years living with this condition than ever. And I hold to the unpopular opinion that none of us are getting out of this life alive, but at least I can spend more of my days here being healthy and productive.
The name of your post cliches what’s been going on. This is the kind of fear that becomes lucrative. I try not to be afraid now. Not easy, but the more you can control on your own, the better.
Which is why I’m loving what you’re doing with your new series, by the way. Anyone who hasn’t read UNDER THE EMPYREAN SKY should get on that. 😉
Also, yay B-dub! Mom and Dad are ON IT! <3
September 9, 2013 — 10:06 AM
joannehuspek says:
We own our own business, so we’ve always had to provide our own. It’s scary, to be sure. You can research and research (like my husband, who is adept at finding the best deals on everything) but what ends up happening is this: Company A give you a quote that is livable, the second year they raise it a little, the third they jack it up so high you have to look again for a new company. In between, the covered items get more expenses. Our deductible is 10K (each), so basically we have insurance for catastrophes only. Something you can’t do since you have a young child. I don’t know how you do it.
September 9, 2013 — 10:09 AM
Kelly A. Harmon says:
Speaking as someone with (outdated) insurance certification – and real-time corporate insurance experience that’s over a decade old–whatever you do, get yourself (your family) a “catastrophic” insurance plan on the short term while you’re searching for a permanent policy. Catastrophic insurance is high deductible (usually, *very* high deductible) that protects you from high-dollar events. For instance, you’re at a con crossing a busy street and get hit by a bus. You might have a 15-20K medical bill….but at least it won’t be 300k for all that surgery and rehab.
Catastrophic insurance won’t pay for routine doctor visits or well-care…but it’s major piece of mind. Shop for plans: some will cover accidents, some will cover “diagnoses,” some will cover both.
There are some “High Deductible Insurance Plans” out there nowadays masquerading as Catastrophic plans — but they cover routine doctors visits and well care the same as your permanent plan might – at a much higher rate. You’ll pay more for that coverage. They probably aren’t in your best interest in the short term while you’re shopping…but only you can know that…
September 9, 2013 — 10:19 AM
terribleminds says:
Thanks, Kelly. We actually have insurance through the end of October — so far, so good.
September 9, 2013 — 10:27 AM
Gabryyl Pierce (@Gabryyl) says:
Join the Freelancers Union. No dues/fees, great resources and they offer various group health/life/dental insurance.
September 9, 2013 — 10:23 AM
terribleminds says:
They only offer health care if you’re in NY.
September 9, 2013 — 10:27 AM
Elizabeth says:
Our independent policy just sent a renewal…TRIPLE the current cost due to compliance with the new government mandates (new would be nearly 1k per month for our family), with a five-figure deductible. Needless to say, we’re searching out alternatives, including banking what’s not going to well-funded catastrophic illness and accident policies and just paying for the “usual” stuff (and, yes, we’ll be fined for that at some point if the current system stays in place).
Every state supposedly has its (gulp) government offerings (this doesn’t mean your doctors will take that for payment, as far as I know).
If you can find someone who’s a health ins. agent you’ll at least have another perspective worth heeding. If anything brilliant turns up during our search, I’ll pass it along. In the meantime, we’ve been active in contacting our congress-people…
September 9, 2013 — 10:25 AM
Elizabeth says:
Update: re-reading the letter from Humana: the exorbitant (1k) premium figure doesn’t start until January 2015…we can keep our current policy one more year (2014) with a slight increase, up until all the mandates kick in, resulting in the higher price figure.
We currently have a high deductible, which means we end up paying for practically all of our medical procedure on top of maintaining the monthly premium, so we’re still considering changes.
Accident policy (kid breaks arm, etc.) is something we have in place—small deductible to pay if an event occurs. Just wanted to get the right info out there.
September 10, 2013 — 3:23 PM
Aerin says:
I’ve heard very good things about Freelancers Union. There are other collectives that allow small businesses or the self-employed to purchase insurance at a discount as well. Possibly a better option than trying to purchase individually.
September 9, 2013 — 10:25 AM
literaticat says:
I can’t comprehend the folks here who are saying that they have reasonable insurance with a reasonable deductible. In my area, the ONLY option seems to be Blue Cross. The Catestrophic plan, which is hospitalization ONLY, is $162. a month. The next most reasonable plan is 1,300. a month. Whiiiich is higher than my mortgage. (Obviously I can’t/don’t pay that!!)
I am single, in reasonably good health, with no pre-existing conditions, non-smoker. THIRTEEN HUNDO. whaaat. 🙁
September 9, 2013 — 10:28 AM
terribleminds says:
Holy hell that’s a serious jump. We have options here ranging from $300 – $3000, though usually for a reasonable plan it’ll be $700-ish, I think, per month.
September 9, 2013 — 10:30 AM
Laura K Curtis says:
Literati – NY should have some good coverage starting in October from what I’ve been able to deduce. *fingers crossed* That said, for the past few years, I’ve been using http://www.americanmoneyinc.com/ to get health insurance. It’s ONLY available in NY, and the price went up this year to 600pp, but it’s United/Oxford and the coverage is comprehensive. If you’re at all interested, I would be happy to talk to you about it. As someone else said, there’s also Freelancer’s Union. But do wait and see what the state exchanges will look like before deciding. (NY’s exchange page is here: http://www.nystateofhealth.ny.gov/ )
September 9, 2013 — 7:29 PM
Kimberly Gonzalez says:
I’ve never used it myself, but the Editorial Freelancers Association also offers health care options: http://the-efa.org/mem/insurance.php
September 9, 2013 — 10:30 AM
Terri says:
This is all excellent advice. I only have one micro-tidbit to offer. You are eligible for the ACA subsidies ONLY if you buy through your state’s exchange. I know you are doing okay as a word-miner, but with a family of three, you are likely eligible for at least a small subsidy in the first year based on your family’s 2012 income. A little google-fu found this subsidy calculator:
http://laborcenter.berkeley.edu/healthpolicy/calculator/
And a family of 3 with two adults age 40 and one kiddle pays $216/month after the subsidy.
So, come October 01,2013, talk to agents, but only buy through the exchange.
September 9, 2013 — 10:31 AM
Casz Brewster says:
Commented on FB already; however, one thing I wanted to add is that United Healthcare is awful out here in the Pacific Northwest. There’s hardly any doctors in their network, and they constantly found ways to deny coverage, and if you have ANY on-going health needs it’s a real hassle. Since you have a toddler, I would categorize that as an on-going health need. Just my experience with them, it could vary in your area. Out here, they are complete shysters.
September 9, 2013 — 10:34 AM
Sharon says:
Since you welcome word-nerdiness – it’s das Wendighaus. House is neuter in German, instead of male (that’s when der is used). I would be dating myself if I admitted how many years it’s been since I’ve studied a foreign language.
Best wishes on this household change.
When I’m out of work and Cobra either expires, or is outrageous ($1400 for crap benefits, family of 2), I fill out my info on ehealthinsurance dot com to see what can be found. Insurance providers are picky about where they will cover people and the rate.
During my last round of bridge insurance needs earlier this year, I obtained a $500/month plan to cover catastrophic needs. On the phone while confirming data, I was verbally told prices should decline by next year – that was Blue Cross, rather than an ehealthinsurance agent.
No matter which politics you follow, the implementation of the Affordable Care Act should make an impact on availability, deniability, and pricing. I think once the system is known, it will have an impact on people who only hold particular jobs for insurance coverage.
Because there’s too many abnormalities with coverage to risk even changing carriers or thinking your employer will go to bat for their employees (independents doomed). Even with continuous coverage from birth, my teen’s wisdom teeth were declined as a pre-existing condition, and basic preventative dental care did not include x-rays.
September 9, 2013 — 10:36 AM