I'd really rather just move to France, but c'est la vie.

October 11, 2007 8:34 PM

My individual health insurance premium has more than doubled. It's so crazy expensive that I can't afford to ever go to the doctor. I need to change my plan or find a new one. Advice?

Okay, so I have a Blue Shield Individual PPO with $700 deductible. When I first got it, the monthly payment was under $200. Suddenly I look up and it's $550 a month! Yikes! WTF? Nobody else I know pays that much. Is that normal?

I found out that I can change my deductible to $2000 & that would cost me less on premiums (but more out of pocket), or I can switch companies. But I don't know. I talked to a broker who said that I could stick with Blue Shield or go to some company called Nationwide for a cheaper plan. But I'm not familiar with that company... so that makes me nervous. Plus I have to be careful... I have pre-existing conditions. Back injury, bad ear, etc. I'm currently in Tier 2 with Blue Shield, which isn't too bad, but if I change too much of my plan I'm worried that they'll look closer at the pre-existing conditions and put me into a lower tier (ie, charge me more).

I am horrible with this kind of thing and I don't really know much about how this stuff works. I just know I'd like to be able to afford to live AND go to the doctor. Thoughts?

posted by miss lynnster to health (23 comments total)

Nationwide is a large, reputable insurer. I have no experience with their health care plans, but I have family members who have their auto and/or property plans and are quite happy with them.

You should investigate any pre-existing condition exclusions before you switch carriers. Or, you can look into changing plans with the same insurer - exclusions may not apply in that case (but you should also check first). I have Blue Cross/Blue Shield PPO through my employer and I am very happy with them, so much so that I would continue with an individual policy if I were to leave my employer.

I'd call Blue Shield directly and ask them about options. Perhaps there are tweaks to your plan that would adjust the premiums.
posted by bedhead at 8:43 PM on October 11, 2007

On one hand, there may well be a cheaper option out there for you.

On the other hand - this is, in fact, exactly why we're having this loud national argument about health care.
posted by Tomorrowful at 8:46 PM on October 11, 2007 [1 favorite]

Seconding the advice to call your insurer directly. Ask them why they doubled your premium, and if they don't have a logical-sounding answer, try to negotiate. And, good luck!
posted by amyms at 8:53 PM on October 11, 2007

I found it incredibly convenient to get quotes from ehealthinsurance.com. You fill in some info about yourself and they show you cost and plan coverage for several insurance providers in your state. You can then compare those quotes with your current provider's plan and cost.
posted by exphysicist345 at 9:04 PM on October 11, 2007

At my last job, my evil employer made me pay for my own health insurance (I was the only one who had to do this, and also the only female employee, but that's a whole 'nother story). Anyway, because of that I was always aware of the premiums. Mr. Adams and I were the only two on the policy (Blue Cross PPO), and at the time I left the company (in 2003) my monthly premium was $799. This was a group policy, $500 deductable, $20 co-pay on prescriptions. Blue Cross is one of the few health insurers that will cover folks with pre-existing conditions, though, so it's a necessary evil. But their rates are crazy insane.
posted by Oriole Adams at 9:35 PM on October 11, 2007

I did call. They said that it was raised costs of health care. They said that my policy was just an expensive one. They said that $700 is super low of a deductible so I should change my plan. Doesn't seem that low when you're the one paying the $700 of course.

Funny you say that about Blue Cross... they turned me down which is why I got this Blue Shield policy in the first place. That was prior to my pre-existing conditions. They turned me down because my doctor gave me a sample of Claritin once. Because my head was stuffed up. Just a sample. Nothing more.

And trip & a half, trust me I feel the same. More than you know. But I won't go into that total derail of my own post.
posted by miss lynnster at 9:48 PM on October 11, 2007

Health Net in CA will let you switch to a plan with a lower premium (read: less coverage) without medical underwriting, maybe Blue Shield will do the same. I can't imagine them changing your tier unless you ask them to re-underwrite you; that's the whole point of insurance. Also, no harm in getting quotes from other insurers.

World-class healthcare is expensive, no matter who's paying for it. Sure, $7000+ per year is a lot of money, but it's very doable if you consider your health a priority.

Run the math, figure out how often you go to the doctor and what it would cost on each plan.
posted by trevyn at 9:50 PM on October 11, 2007

My company is about to go through open enrollment. In a conversation with our broker, he mentioned that blue shield and blue cross will often double their rates year over year, whereas Aetna and others will *only* go up 10%. I suggest you look at Aetna or similar carrier. Also check and see if your state/city/small business association/alumni group has some group insurance you could join to group buy insurance. Its much easier if you can be part of a risk pool, as opposed to on your own.
posted by zia at 10:13 PM on October 11, 2007

Last year when I ruptured my eardrum while overseas, my dr. appts in Austria cost me $60 a visit with no insurance. My dr. in Greece was $9. After returning home, I was billed $5000 by American doctors within a period of 3-4 months. And that was with insurance and not including my premium. And they FIXED NOTHING. They were just maxing out my benefits by juggling me from doctor to doctor and test to test. Soooo, I really would rather not go into how "do-able" American healthcare prices are if you don't mind.* I'm just trying to handle my out of control insurance problem.

Keep the practical recommendations coming, though. They're great. :)

*Sorry, but medical expenses have broken me more than a few times in the last ten years so it is bit of a sore subject for me.
posted by miss lynnster at 11:01 PM on October 11, 2007

Wait, if you have a 700 dollar deductible how were you billed 5000? I'm really confused by that. It seems that your insurance company is quite useless, then, and there would be no reason for you not to switch to a higher deductible, or maybe even catastrophic insurance?
posted by sondrialiac at 11:25 PM on October 11, 2007

Because after you pay your deductible, they only pay a percentage of stuff when you go to hospitals and specialists and have MRIs and CatScans and hundreds of allergy patchtests and junk. And they only pay a percentage of medications that are not available in generic (generic is $10, and my prescription for Ambien alone cost me $100 before it recently became available in generic). And why the Hell am I defending my doctor bills?

Moral of the story is that it would've cost far more otherwise so I am asking for help to remain well-insured but make my premiums more manageable. If you're confused then maybe you should answer a different question, as I'm confused enough on my own.
posted by miss lynnster at 12:29 AM on October 12, 2007

The problem (other than the USA's 3rd-world healthcare system) is that you are one - you have no bargaining power. I think you should be looking for a ways to benefit from the buying power of a collective with muscle.

For example, Costco offers health insurance to member businesses for (last I heard) around $200 for benefits that would probabyl cost you $500+ on your own. I think that means that if you don't already have your own business, register one, have it join Costco, and buy insurance for its employee through them.
posted by -harlequin- at 12:39 AM on October 12, 2007

Remember that in most cases, if you have the insurance with the ~20% co-payment, the amount that you pay is typically 20% of the "allowable" charges, not the "actual" charges. This can provide you with substantial cost savings.

For example, our doctor's office told my partner to go the ER last month because he had breathing difficulties and his throat was closing up. We just saw a bill a couple days ago, showing that the hospital charged over $1000 but insurance allowed less than $200. After the insurance payment, they were going to charge him $34. In his case, he's on Medicare/Medicaid, so he told the hospital to submit the balance to Medicaid.

I've had similar experiences with my insurance, which I pay $469/month for "last-resort high-risk pool" coverage with a $2500 deductible. Even when I am fully responsible for the charges (which I hate) I get the benefit of paying the "allowable" charges instead of what's on the bill. Compare that to paying MSRP for a car versus negotiating a lower price, except in this case the insurance company has negotiated the price for you.

This doesn't help with your high cost of coverage, of course. But it may console you somewhat if, in your plan, you get medications with just a co-payment (in my case $20) rather than paying full price or if x-ray and lab expenses are not subject to the deductible, or if you can go to an "in network" doctor for a set fee ($30 for me) instead of paying his MSRP.

Not that I'm satisfied paying $469; I'm looking for less expensive coverage, too. But I know that with my two prescriptions alone plus a couple of doctor visits a year, I probably come close to breaking even on my premiums versus what I would be liable for if I had no insurance.
posted by Robert Angelo at 4:58 AM on October 12, 2007

lynnster: I just went back and re-read the part about the $5000 of doctor bills. Damn -- you have my sympathy and empathy. I can't imagine what they would have tried to charge you if you'd had no insurance at all. You have a right to be angry.

I wish I had more practical advice. I'll be watching this thread to see what sorts of answers you get, since they may help me, too.
posted by Robert Angelo at 5:04 AM on October 12, 2007

I have no helpful advice other than to confirm that Nationwide is definitely a real and solid company. (Just make sure you fill in your medical history correctly.)
posted by fidelity at 8:01 AM on October 12, 2007

I see that you're in CA, Miss Lynnster. Check out Kaiser. It's kinda self-serve, but professional and available and affordable. When, several years ago, I switched from my former employer's plan (also Kaiser) to my own individual Kaiser plan, they tried to exclude me due to pre-existing conditions (I'd had a couple of subcutaneous lipomas removed). I appealed the decision and they signed me right up.
posted by notyou at 8:09 AM on October 12, 2007

I was going to suggest investigating Kaiser as well. I was quite happy when I was insured through Kaiser (in San Francisco). If you're a self-directed kind of person, they're great.
posted by otherwordlyglow at 9:33 AM on October 12, 2007

Thirding Kaiser. They can be a bit bureaucratic, but being insistent goes far. Having everything in-house is a huge plus, and I was always able to get appointments in a reasonable amount of time.
posted by oneirodynia at 9:36 AM on October 12, 2007

Your broker should be able to find out what premiums you'll have to pay with all your preexisiting conditions before you let your current insurance lapse. You don't have anything to lose by applying around.

You might also try a low deductible, limited policy, combined with a very cheap, very high deductible (like $10,000) "catastrophic" policy. Whether or not that will work for you depends on how your medical visits tend to go.

I've had good luck with Kaiser, too.

As a tangent, if you have anything but Kaiser, you might want to find out what your policy's max is. A friend's brother got in a terrible car accident and it turned out his Blue Cross only covered $1 million. Period. He ripped through that in the first month or two of ICU, and now his family's destitute, including parents and siblings, and he's still in no shape to work, and may not ever be.
posted by small_ruminant at 9:50 AM on October 12, 2007

Couple of suggestions. First, you say that you're terrible with this stuff--if you'd like to remedy that (and I really encourage everyone who tries to find insurance to be knowledgeable about their state's laws, because in this sort of situation knowledge will save you a lot of time spinning your wheels), you can check out this set of consumer guides to getting and keeping health insurance. There's one for every state, and it goes over what the applicable laws and protections you have for health insurance in language that you can understand. (It's put together by the Georgetown Public Policy Institute, which is a very reputable group that studies health insurance policy.)

It looks like California isn't a state that forces insurance companies to insure anyone who asks (rats!), so there's a couple of other tacks I would take.

1. Have you considered managed care? Particularly given your experience with going to the hospital and getting nailed by cost-sharing, a *good* managed care plan might be just the ticket. I'd particularly consider Kaiser; my experience with them has been quite good, and all their doctors are staff doctors, so there's generally not a problem getting in to see a doctor or getting referrals when medically necessary. You can check out comparisons on the quality of care between all HMOs in California at the Department of Managed Care. Premiums tend to be lower and cost-sharing is much more manageable.

2. If you can't get health insurance through your job, see if there are trade associations or professional groups you can join and access group health insurance through. For example, do any of these associations look like they'd fit your job? They may offer access to cheaper, group-rated insurance where your pre-existing condition wouldn't be such a problem. If you don't see one there, spend some time on the internet looking around for an association that is related to your job, then contact them and ask if they can share any ideas about how their members got health insurance.

3. Hopefully this won't offend, but in case it's of use to you or someone looking at this later, if you're really stuck and your current premiums get too out-of-control, check out state resources for high-risk (usually referred to as "medically uninsurable") people and for low-income people (Medicaid--called Medi-Cal in California--is available to low-income people who fit certain criteria in every state, while each individual state may also have other insurance expansion programs that let people below a certain income access the health insurance market).

Good luck. I hope you find something that works for you better than what you have now. Any way you can get access to group health insurance is probably the holy grail, as that would make your concerns about pre-existing conditions irrelevant and would almost certainly be cheaper. An individual plan through an HMO would be my choice after that. Whatever you do, just don't drop your current insurance without getting approved and enrolled in another plan--right now, as long as you've had insurance continually for a while, plans are limited in how much they can exclude reimbursing you for pre-existing conditions. If you have a gap in insurance, they can exclude a whole bunch of things for up to a year.
posted by iminurmefi at 9:54 AM on October 12, 2007 [2 favorites]

Oh, and to follow up on -harlequin-'s suggestion about getting health insurance through Costco--that's almost certainly "small group" insurance, which only covers business from 2-50 people. So it's probably not as simple as registering yourself as a business.

However, if you are self-employed and you work with anyone that you'd want to incorporate as a business with, you'd be able to get access to that small group market, which unlike the individual market in California is guaranteed-issue (so they have to sell you plan, and can't turn you down for any reason). That's a more extreme suggestion, but depending on your work situation, it's an option to consider.
posted by iminurmefi at 10:04 AM on October 12, 2007

Hearing that Miss Lynnster was turned down by Blue Cross leads me to believe that the Blues must have differing rules from state to state, which I was completely unaware of. Anyway, one of the main marketing points of Blue Cross of Michigan is that they accept and cover all pre-existing conditions. I'm guessing they advertise this in order to pre-explain their sky-high rates.
posted by Oriole Adams at 10:18 AM on October 12, 2007

Oriole, it's not that health plans* have differing rules from state to state (although they very well might), it's that states have differing rules. Laws about who plans must cover (that is, whether they can turn people down who apply for coverage), what they may charge people, whether they're allowed to exclude pre-existing conditions and if so for how long, and whether they can vary rates in the individual market based on age or health condition are all determined by the state. Some states are much better places to be if you're applying for individual coverage, while other states really suck.

*Interestingly enough, Blue Cross / Blue Shield is not a single nationwide company; it's actually a federation of independent health plans that franchise the name (like McDonalds!). Which is really weird to me.
posted by iminurmefi at 10:30 AM on October 12, 2007