So what, exactly, is the deal with health insurance?

April 26, 2013 4:48 PM

I get kicked off of my parent's health insurance plan next month. Should I purchase my own plan and if so how and what's the worst that could happen if I don't?

I'm a full-time student, my school does not offer health insurance. I will be looking for a full-time job (hopefully with benefits) in maybe October if all goes well, but what about the 5 months in between?

I'm a relatively healthy woman in my mid-20s. I wouldn't bother with this at all except that I'm on several prescriptions, some of which could get expensive without insurance, and I need doctor visits (mental health related) every 3 months or so. I could try to see my doctor less often and get more refills on my prescription(s), but I'm not sure that will be possible. I also don't know if they offer a sliding-scale for low-income folks. I'd really rather not have to switch doctors if possible.

So basically, what are the chances it'd be cheaper to get my own insurance plan than to just pay for everything out of pocket?

I understand the reasoning behind emergency health insurance etc, although I'm not overly worried, but is there any other reason to get insurance besides possibly saving money?

Also, what is the deal with medicaid? I live in DC and I have no idea if this is an option for me or even really how to go about finding out. Help?


Thanks!

posted by krakenattack to Health & Fitness (15 answers total)

Department of Health Care Finance - District of Columbia, Medicaid Section

Hope that answers some Medicad questions. Others I'm not much help with.
posted by Crystalinne at 4:51 PM on April 26, 2013

Since you have no income, if DC offers need-based subsidized healthcare, you may qualify. NY has a program called Healthy New York that I used when I lost my job because it happened to be cheaper than COBRA at the time. But still, you're looking at like $300 a month, probably. You should call your pharmacy and find out how much your drugs cost without insurance. You will find prices do vary from pharmacy to pharmacy -- not a ton, but I did find like $50 difference between pharmacies when I was without insurance. I'd start here and do some research on your own: http://dc.gov/DC/Health+Reform/Insurance+Coverage+Options/Current+Insurance+Options I don't know if this is technically illegal, but I took a pill 1 time a day and just asked my doctor to write a script for 3 times a day (which is very common for that pill) so I could not need to fill my script for a while when I knew I was going off my insurance since insurance limited me to getting one-month supply at a time.
posted by AppleTurnover at 4:56 PM on April 26, 2013

Remember that there's a risk analysis you should do, too. I'm young and healthy, but I'd have a really hard time knowing that I was one car accident away from crushing medical debt. If the cost is going to be close... you might as well be protected?
posted by you're a kitty! at 5:02 PM on April 26, 2013

You don't want to be uncovered for any amount of time under the current health care laws. It will make getting insurance more difficult. Furthermore, even though you are healthy, you could be injured in a car/bike/bus accident, contract a serious contagious disease, or be a victim of a violent crime. Without health insurance, you could owe hundreds of thousands of dollars for treatment. This is not hyperbole -- it happens to people all the time. "Possibly saving money" does not quite take into account the seriousness of this outcome.

If you can't get medicaid, look into short-term health insurance. Two years ago, I got emergency coverage from HealthNet for about $230 for six months. I could afford it, but I would have put it on a credit card if I didn't have the money. It really is that important.
posted by twblalock at 5:30 PM on April 26, 2013

Yes - do not be uninsured. I'm in my late twenties but would be many thousands of dollars in debt if I had decided to risk it during the past few years despite a generally healthy profile. I wasn't making much money and it hurt to pay for insurance, but it really is not a risk worth taking. I was able to get a basic plan through humana (humanaone) for about $125 a month once my cobra lapsed.
posted by shrimpsmalls at 5:56 PM on April 26, 2013

You can find a high deductible plan that will at least protect you and your family from most of the cost of a catastrophic injury or major illness. A large portion of all bankruptcies are related to healthcare bills - either for the injured or their family members. I"m sure you wouldn't want to put your family in that position. I wonder if they would be willing to contribute to your gap coverage since presumably their premiums will be going down?
posted by Miko at 6:10 PM on April 26, 2013 [1 favorite]

Your doctor will work with you. I bet if you explained the situation, you could get a 90-day stash of meds (I know that's not as long as you want, but would at least give you a buffer).
posted by colin_l at 6:41 PM on April 26, 2013

Interesting juxtaposition of two threads - the OP may care to read the thread above, and ponder on what not getting that jab could lead to.

Car accidents, a slip in the shower, life throws lots of things our way that being young and (relatively) healthy just isn't enough. Try and get some sort of cover, the best you can afford, good suggestions above.
posted by GeeEmm at 6:54 PM on April 26, 2013

Starbucks offers health insurance to part time employees. Alternatively you could move to Massachusetts. More realistically, DC/ Maryland/ Virginia have different health care resources for the low income, so if you are open to moving somewhere else in the DMV after graduation you might want to investigate options for Maryland and Virginia too...

Be careful-- a lot of the lower cost health insurance plans don't include prescriptions and don't cover preexiting conditions.

You can call your current doctor's office and ask how much a visit will cost without insurance. Likewise there are websites where you can price out the cost of your medications without insurance.

I know you said that you don't want to switch doctors, but you might want to consider looking at Kaiser Permanente's options. Kaiser Permanente is an HMO so you have to use their doctors and pharmacy, but it may be one of your lower cost options for the coverage you get. This page might be helpful.
posted by oceano at 8:47 PM on April 26, 2013

what are the chances it'd be cheaper to get my own insurance plan than to just pay for everything out of pocket?

Some of this depends on how you use health insurance and what standards you have for the quality of care you receive. My friend who doesn't have insurance got hit by a car and he ended up in county hospital in an open room with 6 other people, he had to stay forever in a ward that looked a lot like that room that Charlie from Charlie and the Chocolate Factory lived in.

Instead of spine surgery, he got put in a full torso cast because he could not afford surgery. Afterwards, he had to work out a payment plan with the hospital for a $100,000+ bill.

Other than big emergencies, it is really really important for me to have health insurance for things like sinus infections, UTIs and the cold that never ends that might be turning into something worse.

Would your parents help you out with your insurance payments until you got out of school? If you got run over by a bus, would they be the ones helping you to pay off your bills?
posted by dottiechang at 10:48 PM on April 26, 2013

Im about your age. I was briefly uninsured. I got a really bad throat infection and couldn't really swallow.

I went to urgent care, who sent me to the ER. They ended up doing a ct scan, but just gave me antibiotics.

Doesn't sound too bad right?

$4000ish

Do you have 4k you could just blow on some shit like that randomly that you didn't plan on and don't want to? Saving cash to pay random medical expenses is for fucking rich people. I know people who make 250k a year who still have insurance, because fuck that shit.

And all because I didn't want to pay $60 a month for insurance at my job. I'm still dealing with that BS.

Get insurance. Seriously, I can't see it costing you more than packing your bong or whatever else you're spending $250 for six months on right now. Have an iPhone? Yea.
posted by emptythought at 11:32 PM on April 26, 2013

A friend of mine was uninsured and about 25 when he contracted appendicitis. He's paying off his $25,000 appendectomy bill still 4 years later.

Even though medical costs are typically as-much-as-halved when paying cash (if you pay entirely, upfront, or finance it on a credit card), nearly none of us can afford to pay for even half of a $25,000 surgery. He was otherwise healthy, appendicitis is weird that way.

A single night in my wife's hospital typically runs $3,000-$5,000. A simple CT scan I had for some neck pain rain $1,800. A simple blood test with a lipid profile ran $450. Again, these are "retail" rates; your insurance typically knows that down to whatever Medicare is willing to pay out on those items, but if you're uninsured, it IS what will appear on your bill.

There's a reason medical bankruptcy is one of the top causes of bankruptcy in the US. Our healthcare system is screwy and throws you to the wolves if you're uninsured. Don't risk it, and if you're already visiting a doctor for mental health issues, you may be VERY unpleasantly surprised at how much such a visit can cost out-of-pocket, and even more disappointed at the retail price of your prescriptions.

Find an individual plan provider, or seriously look into Medicaid, since if you have no income, you very well may qualify. Don't try to go with NO insurance, in any event.
posted by disillusioned at 3:57 AM on April 27, 2013

My primary doctor is in DC and her office just doesn't take insurance. You can submit the paperwork to your insurance but you pay upfront. A typical visit with blood work usually runs in the 600-700 dollar range. Other tests are usually another 100-200 dollars. My insurance does not reimburse me. Obviously that is the higher end of the scale, and there are doctors with lower cost models (and programs like Planned Parenthood that can do some bloodworm etc.) That said, this is a very expensive city to be hurt in or to need continuing medical care. I would absolutely talk with your doctors and see what the lowest-cost insurance that they'll accept is. Even if it's 200 a month, that would probably be less than the cost of your mental health visits and prescriptions, even barring any bigger issues.
posted by jetlagaddict at 5:28 AM on April 27, 2013

So, everyone so far is assuming you'll be able to GET insurance. Let me tell you a tale!

I have asthma and allergies (pretty severe asthma, really severe allergies), and a history of some other stuff (pneumonia, cysts, mild depression) that was a pain to me but not that hard/expensive to treat, in the scheme of things. Nobody would give me insurance. One place (Humana?) told me that basically if you take more than three prescription drugs on a regular basis (I take 4) they are likely to reject you. One place offered me a high-deductible plan that didn't cover any of my pre-existing conditions for something to the tune of $500 a month. Hahahahaha.

I tell you this cautionary tale because you mention taking several prescriptions and having some mental health concerns, and that combination basically did me in re: individual plans. Maybe you will get lucky or maybe DC has more restrictions about that stuff, but it was hard and it sucked.

Anyway here's what I did. I'm not kidding about this. Like you, I am currently a full-time student. I ended up registering to take one of my required classes through a different university that offers insurance just to get the insurance. The class was awful and getting my home university to acknowledge it was annoying, but hey, if I get in a car accident I won't be in debt forever. (Also I yelled at my school a lot for not offering insurance, because...why.)
posted by goodbyewaffles at 6:26 AM on April 27, 2013 [2 favorites]

Insurance companies are in the business of making money. With a private plan (no subsidy from the employer) the insurance company will be charging enough to cover the cost of your routine care plus the risk-adjusted expected cost of emergency or unexpected care. Since the amount the insurance company pays for your care is a negotiated rate that is usually significantly less than retail, you may find that you save money buying insurance instead of paying out of pocket for your expected expenses. But that is not the real reason for insurance. The real reason is that you can't afford the small probability / high cost catastrophe and they can. I lose money on my home insurance every year but I keep it because if my house does burn down, I can't afford to rebuild it and the insurance company (with the money from everyone else who didn't have a fire that year) can.

One option is a high deductible plan where you still pay out of pocket for routine care but have just-in-case coverage if you end up in the hospital. Since you have insurance, you would still get the advantage of the negotiated rates between the doctor and insurance company even though you would have to pay it yourself.

Second if you have trouble finding coverage, you can use COBRA to stay on your parent's plan for a while. It is usually very expensive but but avoids being without insurance.

By the way, if you go into a group plan such as when you find a job, having continuous insurance coverage means that they can't force you into a waiting period for previously conditions - a big savings that can help offset the cost of the policy in the short term.
posted by metahawk at 1:09 PM on April 27, 2013