We need to buy Healthcare. How should we go about this?

March 4, 2013 8:34 AM

My family needs medium-term health insurance, and we're not really sure where to start or what type of plan would work best for us.

My wife, 18 m/o son, and myself just moved back to our home-city (Portland, Oregon) from a year of living in the Northeast (Portland, Maine).

We had been planning to move back at the end of this year, but our timeline got accelerated by our savings being decimated by some car-repair bills, and an emergency-room visit for the kid and wife (even after insurance, it was really expensive for us). This was compounded by the fact that I was never able to find full time work, and my hours had just been reduced to the lowest level for me not to qualify for unemployment. We cut our losses and moved back to the Portland, Oregon area and are staying with family to get back on our feet.

The good news is that my wife got a very, very well paying job (for us and our history) working for a neighboring county (she works in mental health). This job is great for her in every respect; it pays well, she works with people she knows and likes, and even qualifies her for loan forgiveness after 2 years of working there (which will be a godsend for our finances). However, due to some licensing hiccups and the way the job is structured, she won't be eligible for health benefits until October of this year. The good news is that those benefits are incredibly lucrative as well (and are issued through Providence, if that matters at all).

I got a job offer working with a new company in my field, that has potential, but isn't making a ton of extra money; I make enough to cover daycare costs, and save a little bit on the top of that. I don't get benefits at this job. I'm also not completely tied to this job, and would gladly take another one if it would drastically improve my family's situation. It's a job I know and I am good at, and down the line, might have some financial perks.

That's the situation.

We're wondering what on earth we should do for insurance. We do not qualify for Oregon Health Plan, because we both found jobs so quickly. As far as our medical needs, we still need to take the kid to regular checkups to make sure he's on track for development, getting vaccines, etc. My wife and I also have a couple minor health issues that need maintenance and prescriptions (but we can pay these out of pocket, they're not expensive).

Our options as we see it are:

-For me to find a different job with benefits.
-To purchase our own health plan (which would probably be a Providence plan, so we wouldn't have to switch doctors & specialists once my wife's insurance kicks in).

What would the pros and cons of each be? We've never been in this situation and could really use some guidance.

posted by furnace.heart to health & fitness (5 answers total)

I'm not in Oregon, and insurance availability varies from state to state, but generally speaking it would be cheapest to have employer-sponsored benefits. Insurance that you purchase as an individual is nearly always much, much more expensive.

Depending on your income, your child might be eligible for a state-sponsored Medicaid program. Often states have different rules for uninsured kids that may allow coverage for yours even if you and your spouse are not eligible for Medicaid.

It's a sad state of affairs, but as of 2013 it is not financially feasible for most families to purchase insurance in an affordable way on the "open" market. For comparison, I have a few self employed friends who are healthy, with no chronic health problems or daily prescriptions. Those friends still pay $400-$600 per month just to insure themselves with a plan that has a high deductible and high coinsurance. YMMV in Oregon, but probably not by much.
posted by little mouth at 10:11 AM on March 4

Do you see specialists routinely? Like, how much do you expect to be using this insurance between now and October? Because it might make more sense to ask your PCP and any other provider you see regularly what kinds of insurance they accept. They probably accept more than just Providence.

You should probably contact a licensed health insurance agent and get a quote. If it's prohibitively expensive, then maybe it makes more sense for you to find a different job; if it's more reasonable than you thought, maybe it makes more sense to just pay up for six months.
posted by mskyle at 10:30 AM on March 4 [1 favorite]

Cost of insurance varies so much by state that you need to research the actual costs or have an insurance broker do it for you. (My spouse is self-employed and our costs are not nearly as bad as what little mouth describes. We live in a state that is consumer-friendly as far as insurance goes. It's still costly, though, and a bill that has to be paid. And we're in our 30s -- if we were older it'd be more expensive.)

You only need coverage from now until October. It would be awesome if you could find a different job that offered immediate coverage, but that might be difficult. It seems that many jobs have some sort of waiting period before insurance kicks in. There's your con for that plan. So I think the first thing to do is to find out what it would cost you to insure your family under different plans, and do a full-cost comparison for each. Maybe look at getting regular insurance for your kid, and a catastrophic or high-deductible plan for you and your wife?

(Your job - is that a regular job or are they 1099'ing you as an independent contractor? If it's a 1099, then you could claim the self-employed person health insurance deduction for 2013 if you choose to buy health insurance for you and your family.)

I'd just call a broker in your area and talk to them about your needs. You could also see if ehealthinsurance.com can give quotes for Oregon.
posted by stowaway at 10:43 AM on March 4

Perhaps accident only insurance until October? You can probably put off non-emergency care until then.
posted by Michele in California at 8:04 PM on March 4 [1 favorite]

Don't forget about the gap. If you go for 63 days without health insurance, and then you get insurance, you will be subject to all kinds of pre-existing condition exclusions on your new plan. Which means that your new plan might not be as wonderful as you think it is if it won't cover your existing issues. Your child should be not subject to the pre-existing clause, according to the latest Affordable Care Act info.

Look into all your options about Medicare and/or Cobra from your/wife's last job, special programs in your area, etc. If nothing works out, then talk to a broker and see what has the cheapest premium, which is usually the highest deductible, just so you have some kind of insurance and avoid the gap. You might be lucky - I was able to get a cheap plan with a REALLY high deductible, but it also included free annual checkups and 3 doctor visits per person at a very low cost.

Also - it doesn't cost you anything to talk to a broker. If he can't find you a plan that works for you, just say thank you and hang up. But if he can, then you're all set.
posted by CathyG at 11:58 AM on March 5