Gap insurance how-to?
September 15, 2010 12:48 PM Subscribe
My family needs gap health insurance for three months. Confusion sets in almost immediately. Help!
Our health insurance runs out soon, and our new health insurance doesn't start for three months. So we need something to fill in the gap - catastrophic-coverage-only is okay.
Our options seem to be:
1) COBRA-analog: about 2300 for the three months. Pros: our experiences with our current company have been universally good. We trust them not to try to get out of paying on weirdly unethical grounds. Cons: It's a lot of money. We could do it if we had to, but it'd be a big bite out of the family income. Also, we're not big medical-care-users - we really just want to make sure we're covered in case it hits the fan (or the fan hits us).
2) VA health system. Pros: we're pretty sure we're eligible, it's unlikely to cost 2300 bucks. Cons: it's "space available" at our local VA facility, which I guess is less than ideal. We don't know what you do in the event of an emergency.
3) Some kind of private temporary insurance. Pros: Potentially a bit less expensive. Cons: Cost and coverage totally befuddling. Don't know where to start. Brain melting out of ears. Also, we're more than a little scared of the insurance company dicking us around and refusing to pay in the event that something lousy happens.*
Possibly relevant information:
We're in California. We have a kid. We don't have any ongoing health issues that require medication or regular visits to the doctor. My spouse is a recent OIF vet, in the process of being honorably discharged. I don't think we're eligible for any kind of COBRA premium subsidy. I think we are over the income limits for any kind of public insurance in our state. I've called the CA SCHIP people and they were unable to point me in the right direction. Googling for health insurance brokers in my area finds vaguely scammy websites.
Where do I go from here?
*Hey, I read all the questions here about how somebody's insurance company won't pay for their huge crisis, and then all the commenters blame the asker for not reading the fine print. I'm trying hard to avoid such a situation.
Our health insurance runs out soon, and our new health insurance doesn't start for three months. So we need something to fill in the gap - catastrophic-coverage-only is okay.
Our options seem to be:
1) COBRA-analog: about 2300 for the three months. Pros: our experiences with our current company have been universally good. We trust them not to try to get out of paying on weirdly unethical grounds. Cons: It's a lot of money. We could do it if we had to, but it'd be a big bite out of the family income. Also, we're not big medical-care-users - we really just want to make sure we're covered in case it hits the fan (or the fan hits us).
2) VA health system. Pros: we're pretty sure we're eligible, it's unlikely to cost 2300 bucks. Cons: it's "space available" at our local VA facility, which I guess is less than ideal. We don't know what you do in the event of an emergency.
3) Some kind of private temporary insurance. Pros: Potentially a bit less expensive. Cons: Cost and coverage totally befuddling. Don't know where to start. Brain melting out of ears. Also, we're more than a little scared of the insurance company dicking us around and refusing to pay in the event that something lousy happens.*
Possibly relevant information:
We're in California. We have a kid. We don't have any ongoing health issues that require medication or regular visits to the doctor. My spouse is a recent OIF vet, in the process of being honorably discharged. I don't think we're eligible for any kind of COBRA premium subsidy. I think we are over the income limits for any kind of public insurance in our state. I've called the CA SCHIP people and they were unable to point me in the right direction. Googling for health insurance brokers in my area finds vaguely scammy websites.
Where do I go from here?
*Hey, I read all the questions here about how somebody's insurance company won't pay for their huge crisis, and then all the commenters blame the asker for not reading the fine print. I'm trying hard to avoid such a situation.
With the VA, in the event of an emergency they will divert the patient to another area hospital. That hospital is then responsible for letting the VA know the patient is there and coordinating care with the VA. Sometimes, that involves transferring the patient back to the VA when a bed becomes available (in the event of a full inpatient admission). If you are considering the VA, I would suggest contacting the VA Administration and asking them if they have any kinds of exceptions when it comes to what they will cover. For example, will they only cover what they call "service connected" conditions? (Conditions that are related to the vet's time in the service).
For option 3, I think the Yellow Pages suggestion to find an insurance broker is a good one. And unless you are really familiar with the crazy world of health insurance, I wouldn't suggest navigating those waters alone. A good one should be able to answer all your questions and also advise you of situations you probably haven't even considered. Also, fortunately you are just looking for a stop-gap policy for 3 months to cover emergencies, so it's a very temporary situation for you. If you don't want to go the broker route, perhaps calling local HMO's and getting some literature from them on individual policies would be helpful, because HMO's premiums tend (tend, not always) to be smaller. However, then you would be restricted to HMO facilities, so you will want to know what their emergency care policies are in the event that you have to be taken to a non-participating facility.
As an aside, I have worked with health insurance for about 8 years now, and I think it's harsh to blame someone for "not reading the fine print" well enough. The fine print in an insurance contract is really friggin' tiny, and convoluted to boot. I mean yeah, you need to be aware and informed and all that jazz, but health insurance is so unwieldy that it's a low blow to the consumer to just shrug things off and say "your fault, dummy". This is why I think one shouldn't purchase individual health insurance alone. Help is good.
posted by DrGirlfriend at 1:10 PM on September 15, 2010
For option 3, I think the Yellow Pages suggestion to find an insurance broker is a good one. And unless you are really familiar with the crazy world of health insurance, I wouldn't suggest navigating those waters alone. A good one should be able to answer all your questions and also advise you of situations you probably haven't even considered. Also, fortunately you are just looking for a stop-gap policy for 3 months to cover emergencies, so it's a very temporary situation for you. If you don't want to go the broker route, perhaps calling local HMO's and getting some literature from them on individual policies would be helpful, because HMO's premiums tend (tend, not always) to be smaller. However, then you would be restricted to HMO facilities, so you will want to know what their emergency care policies are in the event that you have to be taken to a non-participating facility.
As an aside, I have worked with health insurance for about 8 years now, and I think it's harsh to blame someone for "not reading the fine print" well enough. The fine print in an insurance contract is really friggin' tiny, and convoluted to boot. I mean yeah, you need to be aware and informed and all that jazz, but health insurance is so unwieldy that it's a low blow to the consumer to just shrug things off and say "your fault, dummy". This is why I think one shouldn't purchase individual health insurance alone. Help is good.
posted by DrGirlfriend at 1:10 PM on September 15, 2010
Tricare/VA isn't much fun to deal with, but if they would cover you for this period I would go for it rather than shell out for Cobra. My stepuncle and his wife work for the VA as nurses; my stepfather is a vet. Oh, and I got my tetanus shot from the Coast Guard, but that's just a harrowing tale and not a conflict of interest.
posted by SMPA at 6:49 PM on September 15, 2010
posted by SMPA at 6:49 PM on September 15, 2010
I'll just tell you that $2300 for family coverage for 3 months in California is pretty good. The cheapest family plans I could get for my employees in Northern California were about $1500/Month for a Blueshield HMO and about $1450/Month for a Blueshield PPO with $1000 deductible. The cheapest HDHP plan was about $1150 for plan with a $2500 deductible.
Good luck.
posted by Long Way To Go at 8:48 PM on September 15, 2010
Good luck.
posted by Long Way To Go at 8:48 PM on September 15, 2010
This thread is closed to new comments.
posted by valkyryn at 12:53 PM on September 15, 2010