Gambling on health?

November 15, 2006 9:27 PM

I haven't been to a doctor in ages. Would going under my current insurance plan be a gamble?

After going several dumb years without health insurance, at age 24 I found an agent and signed on to a Tonik "Calculated Risk Taker" plan early this year. In the intervening time, I've had several friends and a few relatives diagnosed with forms of cancer. This really got me paranoid and dreading the idea of going, since I don't take great care of myself.

I'd discussed with my agent early on the limitations of the plan -- he said since it's generic RX only it wouldn't cover chemo drugs if I got cancer or something else requiring brand-name RX.

I guess what I'm asking is... should I upgrade my plan before (finally) going to the doctor?

posted by evil holiday magic to health & fitness (8 comments total)

Dude, look, you're 24. Unless both of your parents had cancer or you work in a coal mine, your odds of having cancer are so unbelievably close to zero they're not worth considering.

Now stop making excuses and GO.
posted by mkultra at 9:47 PM on November 15, 2006

mkultra - I'm also considering other things that might require brand RX, things outside the coverage to look out for, and other aspects of family history (mom's got MS, takes brand-name drug Copaxone), so I'm interested in the less optimal scenarios.
posted by evil holiday magic at 9:54 PM on November 15, 2006

OK, let's say you do have a disorder or disease. You haven't been feeling bad, so anything you've got is in early stages which means it's either too early to detect or tiny and easier to kill.

Holding off on going does not prevent the disease, it just prevents you from knowing about and doing something about the disease.

Other things that would require a brand RX are going to be giving you problems already. Do you have any symptoms?
posted by Pollomacho at 10:28 PM on November 15, 2006

OK, let's say you do have a disorder or disease. You haven't been feeling bad, so anything you've got is in early stages which means it's either too early to detect or tiny and easier to kill.

O.k. I'm no doctor, but I've worked in enough situations to know this is completely false. People can and do find out they're seriously, and in some cases fatally ill without 'feeling bad'.

I'm sure at 24 you're probably fine, and I'm not trying to scare you. But not feeling bad doesn't promise you anything.
posted by justgary at 2:02 AM on November 16, 2006

What mkultra said. Break it down:

*You are worried about going to the doctor in case you have a serious illness which might require treatment you're not covered for.

*So you're not going to the doctor

*So you're not getting any treatment.

Anyway, you're basically worrying for nothing. You have no particular reason, at age 24, to expect that you might have a serious illness (it happens, but it doesn't happen THAT often). Go to the doctor and have a checkup, for heaven's sake.
posted by different at 2:14 AM on November 16, 2006

More likely than finding out you're sick, you'll learn about your cholesterol, body mass index, diabetes risk. You may get some lifestyle recommendations ("lay off the butter," "exercise more," etc.)

At 24, unless you're obese it's unlikely that you'll be off the charts in any of these areas. But there may be hints of problems yet to come. By getting screened now, you can get the information you need to make intelligent lifestyle choices and life a healthier life for decades to come.
posted by croutonsupafreak at 6:48 AM on November 16, 2006

I would definitely upgrade my plan just on general principles. You never know when something might happen and there are very few medical conditions that are both serious and can be treated using only generic drugs; if a condition can be treated with only generics, then you can probably afford to pay for it without insurance in the first place (think Wal-Mart and its new $4 generics policy). If you are in your twenties and feeling fine and have no ongoing health problems or risk factors then now is the best time to get good insurance at a reasonable price; the patient I just described is the kind of non-user of health care that insurers are looking for. If, on the other hand, you develop some serious health problem before you get good insurance, the you fall under the dreaded "pre-existing condition" clause and obtaining health insurance becomes both much more difficult and much more expensive.

If you are looking for affordable insurance, a couple of options that you might want to look into are limiting your coverage to major medical/catastrophic only and opening a medical savings account if that is an option. Remember that the main reason for health insurance is to protect you against the financial effects of something like a cancer diagnosis (where treatment can easily run into the hundreds of thousands of dollars), not to pay for something like treatment for a cold.
posted by TedW at 6:50 AM on November 16, 2006

I am going to amend my answer some based on a little research. The Tonik plans you mentioned actually look pretty good for the people they are targeted for. The one glaring exception is the generic-only pharmacy coverage. For most conditions that is fine, but since you are concerned about cancer, that could be a problem. While there are relatively few cancers that 20-somethings are at risk for, there are some; breast and testicular cancer in particular happen with some frequency in young adults. Without knowing your family and medical history no one can evaluate that risk for you. It would seem to me to be reasonable to take advatage of your current coverage to go to a doctor and discuss these concerns with him as well as develop a relationship that you can use in the future. Based on your risk for developing a serious illness in the next few years, you may or may not want to opt for a more generous insurance plan.
posted by TedW at 7:02 AM on November 16, 2006