Choosing a Plan

August 24, 2004 9:14 AM

I need help choosing a health insurance plan. Medica? Blue Cross? COBRA? [more]

I'm self-employed. Currently I'm COBRAing my Medica plan. I can COBRA for 9 more months. I have a $15 co-pay and pharmacy coverage. In the past I've used this insurance a lot for chiropractic appts, as well as general check ups and treatments. It also covered out-patient surgery for me last Dec. The cost: $312/mo.

I've looked into buying my own health plan through either Blue Cross or Medica. There are so many options. I've spoken to reps from both companies and they haven't been much help. I cannot go without health insurance. I am totally confused and I have no idea what to do.

Options:

BCBS - $500 deductible/$1,400 max out of pocket, 80% after deduct. Cost $243/mo.
$1000 deductible/$1,800 max out of pocket. Cost $183/mo.

Medica - $500 deduct/$1,500 max, 80% after deduct. Cost $257.90/mo. $1000 deduct/$2,000 max, 80% (no mental health). Cost $181.30/mo.

Years ago Medica was the way to go because they had such a big network and didn't require pre-authorizations and referrals. It seems that both companies have now evened out and as far as I can tell neither require pre-approvals or referrals. But, I don't seem to get a definitive answer from the reps on that. Also, I can't figure out what is more cost effective? I used to go to a lot of chiro appts, etc, but now that I don't get paid unless I work, I never go to the Dr.

Any advice?

posted by Juicylicious to health & fitness (11 comments total)

I always check up on non-critical services like physical therapy, mental health, chiropractic/massage, and a discount on a health club membership. Things like that are usually the first thing to be dropped when you descend the price scale, even though they're things just about anyone could use to improve their quality of life.
posted by scarabic at 10:02 AM on August 24, 2004

Oh, and check on what you have to go through to get major tests done: MRI, PET scan, etc...
posted by scarabic at 10:03 AM on August 24, 2004

Just went through a similar process myself--I almost hate to say this, but I'd really recommend finding an independent insurance agent. I had to interview 3 or 4 before I found a guy who I trusted, but he was totally worth it (especially being free to me). Here's what you need to be aware of:

1) Most insurance agents work on commission, so they and their agencies basically work for the insurance providers, not for you. Now, for a small plan like yours, the difference in commissions between one plan and another is probably miniscule, so an agent is likely to steer you to one or another out of greed, but there are still potentially higher-level relationships that you need to be aware of. (Some agencies, for example, have deals with providers so that their agencies have incentives to steer business one way or the other.)

2) You can find agents, just like financial advisors, who work on fees that you pay them, instead of commission, but the fees they actually charge almost certainly wouldn't be worth it. Most fee-based agents won't even take you on as a client unless you're going to do a big chunk of business through them, for your sake as well as theirs.

2) One way or the other, a trustworthy agent is going to be able to help you survey and compare a wide variety of providers, plans and configurations. A good one is going to look at any provider you choose, and can help you look at multiple configurations, side-by-side.
My guy helped me compare standard terms across 7 or 8 different providers, and then when we focused on Oxford, ran about 20 different Oxford plans with different deductibles, co-pays, whatever. (He also helped us save money on how we structured the policy--one family policy vs. two individual policies, etc.)

3) Finally, an agent is going to have a relationship with the insurer that can also work to your benefit. We ended up having a timing problem because we were forming a new corporate entity at the same time, and the state paperwork came in late, so we only had a day or two before our COBRA expired to get the new policy in place. Our agent was able to call a woman he knew in the underwriting department, and get our policy rushed through.


So, trust and credibility are critical--don't do this with someone you don't trust, and still be very aware of their agenda, but a good agent can really help. (And no, I'm definitely not an insurance agent. ;) )
posted by LairBob at 10:28 AM on August 24, 2004

_{[Ooops...in (1), "an agent is unlikely to steer you to one or another out of greed"]}
posted by LairBob at 10:29 AM on August 24, 2004

I would first figure out what is important to you...

Do you go to the doctor A LOT? (Then you will want low deductables)
Do you need to see a lot of specialists? (Then a PPO is better-you don't need a referral. Or if you have a easy PCP (primary care physician) who gives you referrals without seeing you...go with the HMO.)
Would you rather pay higher prices for services and medications and get lower monthly premiums? Or pay lower prices and pay more monthly (if you get a lot of meds, then this is better.)
Are your doctors you see in this plan?
Do you need or forsee needing durable medical equipment (Insulin pump, aerosol pumps, oxygen, wheelchairs, etc.), do you see a shrink, do you see chiropractor, stuff like that is critical if you need it...but can be less important if you don't and paying higher prices for those services can save you money in your plan.

I'd figure out what is most important services for you and pick the plan based on that.

Also, I'd do cobra as long as you can. Generally those plans are much better than anything you can buy on your own...but I can't be sure...I've only heard that from others.

Good luck! And be glad you can GET individual medical coverage. If I tried, I would be laughed out of the door.
posted by aacheson at 10:43 AM on August 24, 2004

COBRA is often a better deal because you remain part of your employer's large group plan, and continue to enjoy the volume discount your employer struck with the insurance company.

However, whether you pay for an insurance plan via COBRA or not is no absolute indication of the quality of the plan. It all depends on what your former employer got for his/her employees.

I was unable to swing COBRA the last time I left a job, because the plan was just too damn expensive. It was a fantastic plan, but I simply can't do $400-$500 a month.
posted by scarabic at 10:50 AM on August 24, 2004

Check into establishing a medical savings account(basically a major medical insurance plan and a savings account with no taxes on your deposits, with the deposits used to offset the huge deductible).
posted by dglynn at 4:58 PM on August 24, 2004

Also, if you are on any medications (particularly brand names), get a copy of the insurance plan's formulary and see if they cover yours. You'd be amazed at the oft-prescribed meds they won't cover.
posted by gokart4xmas at 7:23 PM on August 24, 2004

I'd stick with cobra til it runs out, then look for an association or affinity-group thing, along these lines, depending on what you do.
posted by amberglow at 7:39 PM on August 24, 2004

Do you have a pre-existing condition? If so, you are better off with a state high risk pool (here's Connecticut's, many other states have similar programs). You can't be denied coverage; but unless you are a 20-something male you pay a whole lot more than COBRA.
posted by PrinceValium at 7:48 PM on August 24, 2004

Stay COBRA if you can. In the world of buying insurance as an individual, you will almost certainly get taken advantage of: poorer coverage, arbitrary premium hikes, higher rates, no negotiation leverage. But that said...

Look up your state regulatory board. With any luck, they will have a list of insurers, and you can get an idea of relative quality by number of complaints. Just an idea, however, given that nobody goes to the reg board and says stuff like "I love my insurance company!"

Spend some time looking over some insurance ratings. I liked Weiss. Be aware these usually aren't about customer satisfaction so much as financial strength, though.

Consider some combo options -- for example, combining a traditional indemnity plan with a high deductible with coverage from one of the Blues with good first dollar coverage. Or traditional indemnity with a medical savings account.
posted by weston at 4:53 AM on August 25, 2004