How to choose comprehensive health insurance plan?

December 4, 2007 12:43 PM

What should I do about the drastic increase in my freelancer's health insurance?

I've had health insurance covered by HIP through Freelancer's Union in NYC. Freelancer's Union is switching its plans to Empire and raising their premiums significantly with little change in their offerings. Members have until 12/31 to choose a new plan or will be uninsured come 01/01/08.

I checked out eHealthInsurance and found what appears to be a better deal on individiual insurance from Atlantis.

Quick comparison:
Empire through Freelancer's Union: $382.63/mo
Atlantis through eHealthInsurance:$308.18/mo

Neither has a deductible for in-network care. The doctor visit copays are slightly lower with Atlantis. Empire has a $50 deductible for Rx which Atlantis doesn't have.

I feel like there must be a catch or fine print I'm missing as it seems odd that a group plan wouldn't offer a better deal than an individual one. Is there something I'm missing? Do individual plans skyrocket after a year? Is Atlantis a shady company? Are there a limited number of specialists on Atlantis? Is there some unspecified waiting period that I should know about?

I am in my 30s and healthy. I do not qualify for Healthy NY. I am looking for the most affordable plan re: premiums, co-pays, prescriptions that includes full coverage for hospital stays (deductible/co-insurance plans for hospital stays seems too financially risky).

posted by annabellee to health & fitness (6 comments total)

Your second link doesn't work. Do you have the actual name of the plan from Atlantis? Is it one of the ones on this page?
posted by iminurmefi at 12:50 PM on December 4, 2007

The Atlantis plan is the HMO Low Option 20 plan on this page.
posted by annabellee at 1:12 PM on December 4, 2007

Currently.
posted by decathecting at 1:26 PM on December 4, 2007

Well, the thing that immediately strikes me is that the Atlantis plan is an HMO, and the Empire plan is a POS. That means that if you go out of network in the Atlantis plan, it won't be covered at all (unless pre-approved by the plan, and you can bet that happens very rarely unless they literally don't have anyone in their HMO that is the type of specialist you need). On the other hand, a POS is like an HMO in that you need a referral from a gatekeeper--your primary care physician--in order to pay the lower "in-network" costs, but if you choose to go to a physician out of network without a referral (called a "self-referral"), you'll still get some coverage, in the form of a deductible and co-insurance. (Notice how the summary of benefits for the Atlantis plan doesn't have the extra column for "out of network"? That's because services aren't covered at all out of network.)

So, the upshot is that you need to feel really good about the providers in Atlantis' network, because you'll be pretty locked-in. You can probably call them up and ask for a list of providers to make sure there's some in your area, and in particular enough specialists if you regularly visit one (like a dermatologist if you often have to get suspicious moles removed). Usually, I'd direct you here to compare the relative quality of physicians, but it looks like Atlantis is either so new or so small that they don't have any current data. Personally, that would make me a little bit wary, or at least warrant some further research.

Also, I'm assuming that the quote you got through eHealthInsurance explicitly includes a prescription drug coverage rider for Atlantis? Because it doesn't look like prescription drugs (other than contraceptives) are covered at all under the plan you mention, which is definitely a pretty significant cost if you get ill.
posted by iminurmefi at 1:42 PM on December 4, 2007

There is a prescription rider for Atlantis and the fees are identical to the Empire plan (non-forumulary drugs are $10 less with Atlantis).

I do not plan to go out of network as long as there are plenty of docs on the Atlantis plan. (My long-time PCP accepts Atlantis.)
posted by annabellee at 1:49 PM on December 4, 2007

With any route that you go, it would be worth looking up the local emergency rooms that you'll be covered at, and carry some documentation about that - maybe get a bracelet, as you might not be conscious, or at least not totally up to speed if you're in an ambulance and emergency room bound. Staying alive is good and all, but out of network emergency room visits can be bank breakers.
posted by nobeagle at 4:39 PM on December 4, 2007