Help me choose health insurance?

January 2, 2009 12:55 PM

Can you help my wife and I choose health insurance?

I'm shopping for health insurance for my wife and I. I'm looking here for recommendations on good companies and good plans; tips on what to be sure to get and what to avoid; and even "Hey you sound like me, here's what I have and love."

We are 31 and 29, in good shape, and non-smokers. We live in Colorado. She currently does massage but in about three months she'll quit that, we'll move, and start trying to get pregnant. I have a desk job now but when we move I'll be looking to learn a trade - likely I'll be apprenticing as a plumber. We both snowboard now, she more than I.

So considering our current vocations and free-time activites, as well as our planned future situation...

I think we need covered: ER/broken bone, pre-natal and post-natal and possibly delivery. We lean towards home birth, alternative medicine, etc so coverage for that would be great.

I think we don't need: prescriptions, major surgery, mental health.

We might like: dental, vision, chiropractic, massage.

Bonuses would include portability (for when we move (within CO)), and a good range of choice in providers, as well as (in priority order) low premiums, low deductibles, and low co-pays. As befits insurance, this is pretty much just-in-case coverage. We don't really expect to use it much or at all. (Feel free to regale me with evidence that supports other thinking, just please no YOU GOTTA HAVE PSYCH AND MAJOR MED CUZ YOU NEVER KNOW!!1!.)

Thanks so much!

posted by attercoppe to Health & Fitness (12 answers total)

You are looking for private insurance that has no connection to your place of work?
posted by k8t at 1:21 PM on January 2, 2009

PS - if you are planning on pregnancy and kid, get prescriptions covered. Same with delivery - you want a home birth, but what if something goes wrong? What if she needs a C-section? That counts as surgery.

Pregnancy and birth aren't the time to go barebones on insurance. On my SO's awesome insurance we still had to pay a few grand for labor and after. On my crappy insurance it would have been a lot more.
posted by k8t at 1:26 PM on January 2, 2009

Best answer: In my experience, it is *very* difficult to find individual health insurance with maternity coverage. You should really try to get a job that provides group health insurance with maternity coverage.
posted by Jacqueline at 1:42 PM on January 2, 2009

Best answer: Since the maternity/prenatal/postnatal care is the one thing that you're planning on happening, take a look at this report, which compares different kinds of health plans, with a focus on consumer-driven health plans (which are usually low-premium, high-deductible plans), with regard to pregnancy. These plans can offer good care, but there are definite pitfalls - expensive ones - around maternity care.

Disclaimer: I work for the organization that produced this report, but I don't work on the policy side, and had nothing to do with the research or writing of it.
posted by rtha at 1:49 PM on January 2, 2009

I think almost any plan would include major surgery but you certainly want to have it - not likely to need it but there are a number of things that can happen unexpectedly (a car accident or an appendectomy) which can be very expensive.
posted by metahawk at 2:00 PM on January 2, 2009

You really need a good agent for this, not strangers on the Internet... there are so many variables.
Look for an agent who has at least 10 years of health insurance experience. Ask friends/colleagues for recommendations, or use a local Web site with ratings for vendors on it to find an agent.
A good agent will know which companies to match you up with before you start the underwriting process. And he/she will know if the coverage you want is available a la carte as you are seeking.
As an aside... I had a baby about 7 months ago. Pregnancy was progressing well until week 31 when my blood pressure shot up uncontrollably, I went into the hospital for a week and had my baby 8 weeks early. She stayed in the NICU for 4 weeks. Looks like the room/board alone for that stay was $60,000 for the baby. Did I have any idea this would happen to me? None whatsoever, and neither did any of my doctors (including the maternal-fetal specialist following me for my asthma and an electric shock I suffered around week 24). I hate to say it, but you never can tell, and unless you are comfortable going bankrupt because of an unforseen complication to pregnancy--or any other medical event--you should insure for it.
posted by FergieBelle at 2:46 PM on January 2, 2009

ehealthinsurance.com can simplify the comparison process a bit.
posted by skechada at 3:47 PM on January 2, 2009

Best answer: Finding maternity coverage when buying an individual policy rather than through one's work is really hard - and pricey. One way to approach it will be to look at carrying a very high deductible and setting up some version of an HSA. I don't know what's possible in Colorado but the basic idea is that you're setting up your insurance for catastrophes and expecting to pay out of pocket for most minor stuff yourself. You may also find that it's almost impossible to find insurance coverage for alternative birth options. My second and third kids were born at home with midwives. Daughter #2's birth was covered by our then insurance, son's birth (different insurance) was not - but midwifery care is far less expensive than conventional obstetric care. OTOH we were glad to have the insurance available becuase as FergieBelle says you just don't know when a pregnancy will do unexpected stuff - it's not a good time to go without.

You may also want to look into associations to join to get better access to group insurance - a chamber of commerce, alumni group or other trade association are all possibilities to look into.
posted by leslies at 7:40 PM on January 2, 2009

One school of thought is that insurance is to protect you against the risks that you cannot afford to cover yourself - catastrophic events and the like. It's better to increase your deductible to save money, rather than exclude the unexpected events that could leave you bankrupt and homeless.

Besides, excluding the events that have low probability of occurring probably won't save you that much anyway (compared to taking a higher deductible) since insurance premiums are calculated based on risk and probability. It's much more likely someone will fracture their arm while skiing, rather than get into an accident that puts you into ICU for 3 months. So even though ICU would be much more expensive, the risk and cost for the insurance company is greater for covering a fracture.
posted by kaudio at 8:15 PM on January 2, 2009

Another thing to keep in mind about insurance is that it is to cover you against *unforeseen* expenses. That is why it is so difficult to buy individual health insurance with maternity coverage -- you control whether or not you are going to have a baby, so mostly only people planning on having babies would choose buy maternity coverage. Pregnancy and childbirth are also huge risks for the insurer (my broker told me the average cost of a premature baby is $1 million) .

So it makes no economic sense for an insurer to sell you maternity coverage for a few hundred a month when they know that you will rack up at least several thousand dollars (and up to a few million dollars) of medical expenses when you have that baby.
posted by Jacqueline at 8:31 PM on January 2, 2009

Paying for a pregnancy and delivery out of pocket will easily cost upwards of $10,000 at a hospital, and that's assuming nothing goes wrong. The cost will be lower with homebirth, obviously, but plenty of people need to transfer to the hospital unexpectedly. And if something goes wrong with the pregnancy, ultrasounds, amnio, genetic testing, etc. are foolishly expensive, especially on one apprentice salary. I think you need to be looking for group coverage through an employer.
posted by robinpME at 7:45 AM on January 3, 2009

Response by poster: Thanks folks! Some good info here. skechada, ehealthinsurance is where I started, but I wanted some more personal input. That's why, as FergieBelle says, we need an agent - but some preliminary Asking is good too.
posted by attercoppe at 9:00 AM on January 3, 2009