What level of medical insurance should I get?

September 15, 2006 7:40 AM

MEDICAL INSURANCE: I'm getting some for the first time in 8 years. Clearly I should have at least catastrophic, but help me decide whether having more is worth the cost. Also: any opinions about HealthyNY insurance?

This year I'll have a little more money than usual (i.e., I won't be scraping by exactly day-to-day), so it's time to get some (very low-cost) medical insurance. I'm trying to decide whether to have just catastrophic/accident coverage or have basic general coverage. I live in NY and my income is definitely low enough to qualify for HealthyNY (about $180/mo without prescription coverage), but not low enough for Medicare.

I'm female, late 20s, in excellent health except that I'm 30% over my median ideal weight. Low blood pressure, low cholesterol, have never smoked, no drugs & little alcohol, no STDs and very careful about preventing them, very careful/healthy in general. Over my entire life I've had no medical issues, no mental health issues, & virtually no medical expenses (just preventive care plus a few one-time prescriptions for things like chicken pox as a kid). My only risk factor I can think of is that I was exposed to a fair amount of 9/11 dust (but I've shown no signs at all of lung or breathing trouble).

My current preventive-care costs are just an annual gyn exam + pap smear (very cheap at Planned Parenthood) and dental exams. So, under $200 a year.

Also: If I couldn't afford it some months, are you generally allowed to "hop on and off" and just be covered at the times when you did pay that month -- or do you lose your coverage as soon as you can't pay and have to re-apply when you can afford it again?

Thanks for any insights!!

posted by lorimer to health & fitness (9 comments total)

Also, in case it wasn't clear, I have no steady emplyer; my income is all 1099 (freelance). I've looked at the group insurance plans at Freelancers' Union and at the other orgs I belong to; none are as cheap as HealthyNY (except the options that have much higher deductibles).
posted by lorimer at 8:04 AM on September 15, 2006

I also have just answered my own question about "hopping on and off" an insurance plan. Thanks for your patience with my beginner questions.
posted by lorimer at 8:05 AM on September 15, 2006

And, sorry to keep clarifying, but I am not related to the johnasdf post (!). If I were working for someplace that real we wouldn't be having this conversation :)
posted by lorimer at 8:13 AM on September 15, 2006

Ok, here's the thing. There may be months it is hard to come up with $180. But can you afford to get sick?

I assume from the fact that you are doing freelance stuff that you are in a don't-work don't-eat profession. So "I can't afford to go to the doctor let's see if I feel better next week" can easily turn into "Holy crap I'm *really* sick now and looking at spending a week in the hospital." You know as well asI do that taking a day off to see a doctor and get some rest is in the long run more cost effective than losing a week's revenues, let alone paying what a week in hospital costs.

I have not even addressed the fact that you admit to being on the heavy side. That puts you at increased risk for lots of chronic conditions that cost lots of money to manage. Stuff like diabetes (which can result in loss of limbs and sight if left untreated) and high blood pressure (which can result in a heart attack). And I don't know what the rules about pre-existing conditions are in New York.

So my advice is to get health insurance and lobby for universal healthcare.
posted by ilsa at 8:35 AM on September 15, 2006

In order to qualify for Healthy NY, you have to prove that you are employed for X number of hours a week with a letter from your employer, or through pay stubs.

Healthy NY is a program that is run by the state of New York through other health insurance companies -- you get to choose the company, and then you pay them the lower rate. I've been on HNY for the past year or so, and it's just like I have an Empire Blue account (note: without eye care coverage, and definitely no dental). They're terrible about mailing you information (i.e. policy coverage, billing, statements), they can be unresponsive, every time you want to see a specialist you have to go to your Primary Care Provider to get a referral (which costs an extra $20 and extra time spent out of work). It's a lousy system, but as far as I can tell it's as good as you can get in America. Best health care in the world, right?

Also be aware that it takes them forever to update your account. Plan for at least two months from when you apply for Healthy New York to when you're accepted.

I don't remember exactly, but I believe when I looked into it that the difference in costs between just catastrophic coverage and an HMO like Healthy NY was minimal. In general I'd say just go for the catastrophic, but if you're already paying for that, it's probably worth it to pony up a few more bucks and get the HMO. If all of a sudden you need a lifetime of prescription drugs, you'll be covered. Just think of your monthly checks as buying 200 lottery tickets.
posted by one_bean at 8:44 AM on September 15, 2006

As far as payments, they're pretty flexible about when you send in your checks. Eventually they'll cancel your policy, but as long as you send in back payments, they'll re-open it fairly quickly. I know this because, of the ~10 pay periods I've been on HNY, only 1 time have they sent me a bill. A couple of other times it just slipped by and then I wound up at the doctor who told me I had no coverage. My fault for not paying attention, but heads up.
posted by one_bean at 8:46 AM on September 15, 2006

Oh, honey, I know your troubles all too well.

Sometimes it sucks being an American.

I haven't had insurance in 3 years, I keep trying to save up to be able to afford it but never quite getting there. It doesn't help that I have a couple chronic health conditions that no one wants to cover.

Insurance companies are just evil.

That said, BlueCross seems to have a lot of options and varying payment plans. Some are less than $200 a month. You might try looking at their website.
posted by Jess the Mess at 11:36 AM on September 15, 2006

In any case, stay in New York; if you move across the river, you'll find you can't get catastrophic coverage in the Garden State.

I'm not bitter.
posted by bink at 3:24 PM on September 15, 2006

Like you, I've spent years only going to the doctor for a yearly pap smear. Now I go every 6 weeks and need 5 different prescriptions. Things could change for you, too. Hopefully it won't, but one key issue is that if you develop a chronic disease while off insurance, it won't be covered by new insurance. $2400 is a lot of money to pay each year, I know, and it will feel like money down the drain if you remain healthy, but it's probably necessary.

For me, Healthy NY has been a mixed bag. I was on it from Aug - Dec without prescription coverage when I developed Rheumatoid Arthritis. So, thank goodness I was covered, but without prescription coverage I was going to be in trouble. Luckily (ha ha) my husband lost his job so we switched to Family Health Plus. This has been great, because it is free and has a minimul prescription cost. But now we're kicked off that because of a high income and back on Healthy NY. And the prescription coverage is pretty useless because I'll hit the cap after just three months.

I guess one big deciding factor would be to question if you would want to have a baby anytime soon. You'd need to have coverage for at least 2 months before getting pregnant if you wanted guaranteed coverage.
posted by saffry at 2:45 PM on September 17, 2006