I hate entering the health insurance world
March 9, 2010 5:44 PM Subscribe
I don't foresee a healthcare bill passing anytime soon. I just became ineligible under my mom's Medicaid since I turned 19, and I realised—I'm pretty sickly. I need doctors and dentists and the rest of it. What should I do?
I just went to Anthem's website and the cheapest plan I could find was $120 a month, and I could barely understand their terms (I mean, I never had to do this before). I don't even make $120 a month (I live at home).
We've been going to free clinics, but they can only cover so much (I'm thinking like school nurse—if it's too hard or requires too much, you're out of luck). I also want to see an orthodontist and they're not free.
So...should I wait (I heard this nebulous bill might cover me under my mom until I'm 26, which would be amazing)? Or should I start looking for a plan now? How should I look? Should I get a short-term plan? Should I keep going to the free clinic? If I need a plan, I want one that covers a lot of stuff—I'm not worried about being covered if I get hit by a bus.
Also...what the heck is a deductible? As far as I know, it's what I have to pay before they start to pay. But I am not paying $10,000 before they pay—this doesn't seem just; I can't afford this crap.
What's an "out-of-pocket" maximum?
I live in Roanoke, VA.
I have to add the obligatory I might just have to move out of this wreck of a country.
I just went to Anthem's website and the cheapest plan I could find was $120 a month, and I could barely understand their terms (I mean, I never had to do this before). I don't even make $120 a month (I live at home).
We've been going to free clinics, but they can only cover so much (I'm thinking like school nurse—if it's too hard or requires too much, you're out of luck). I also want to see an orthodontist and they're not free.
So...should I wait (I heard this nebulous bill might cover me under my mom until I'm 26, which would be amazing)? Or should I start looking for a plan now? How should I look? Should I get a short-term plan? Should I keep going to the free clinic? If I need a plan, I want one that covers a lot of stuff—I'm not worried about being covered if I get hit by a bus.
Also...what the heck is a deductible? As far as I know, it's what I have to pay before they start to pay. But I am not paying $10,000 before they pay—this doesn't seem just; I can't afford this crap.
What's an "out-of-pocket" maximum?
I live in Roanoke, VA.
I have to add the obligatory I might just have to move out of this wreck of a country.
welcome to being an adult...it sucks...
For $120 per month you're getting pretty basic coverage, probably high deductible (what you pay before the insurance will kick in) and high co-pay (your portion of every bill)... Out of pocket max is just what it says...when you hit a certain point with the copay and deductible, the insurance should cover all the rest....
Sounds to me, given what you describe, you'll need to up the income somehow.. a full time job (I'm assuming health issues don't prevent that).. I'm thinking that's your first priority...
keep using the free clinic as much as you can....
posted by HuronBob at 5:50 PM on March 9, 2010
For $120 per month you're getting pretty basic coverage, probably high deductible (what you pay before the insurance will kick in) and high co-pay (your portion of every bill)... Out of pocket max is just what it says...when you hit a certain point with the copay and deductible, the insurance should cover all the rest....
Sounds to me, given what you describe, you'll need to up the income somehow.. a full time job (I'm assuming health issues don't prevent that).. I'm thinking that's your first priority...
keep using the free clinic as much as you can....
posted by HuronBob at 5:50 PM on March 9, 2010
Have you made sure you don't have an option through school?
posted by chesty_a_arthur at 5:53 PM on March 9, 2010
posted by chesty_a_arthur at 5:53 PM on March 9, 2010
Here's a page with links to PDFs about Medicaid in Virginia. They might help a little, but maybe not if you're still living with your parents and they're claiming you as a dependent.
If your mom's willing to cover you under her plan, I believe most allow people to cover their children until they graduate from college (although I'm in MA where things suck slightly less, so that might be incorrect for the rest of the country).
posted by oinopaponton at 5:54 PM on March 9, 2010
If your mom's willing to cover you under her plan, I believe most allow people to cover their children until they graduate from college (although I'm in MA where things suck slightly less, so that might be incorrect for the rest of the country).
posted by oinopaponton at 5:54 PM on March 9, 2010
(disclaimer: you very well may not qualify for Medicaid, but hey, it's there, might as well take a look)
posted by oinopaponton at 6:01 PM on March 9, 2010
posted by oinopaponton at 6:01 PM on March 9, 2010
Get a part-time union job, at a grocery store or somesuch, that includes medical insurance. It might not be the best coverage, but it's something.
posted by davejay at 6:02 PM on March 9, 2010
posted by davejay at 6:02 PM on March 9, 2010
Response by poster: Think_Long: You are a student, correct? You are required to provide proof of insurance upon registration for next semester, so you will need it by registration time. Does your university or college offer a student health plan? It would be paid along with tuition, so loans can cover it
I didn't even think about this—I just emailed the school I am planning on transferring to about whether financial aid would cover their student insurance.
I will have to find out if my mom even has insurance; I don't think she does. I was living off Medicaid; I'm jealous of the kids who get insurance through college.
posted by lhude sing cuccu at 6:05 PM on March 9, 2010
I didn't even think about this—I just emailed the school I am planning on transferring to about whether financial aid would cover their student insurance.
I will have to find out if my mom even has insurance; I don't think she does. I was living off Medicaid; I'm jealous of the kids who get insurance through college.
posted by lhude sing cuccu at 6:05 PM on March 9, 2010
Best answer: A deductible is what you have to pay before the insurance pays. Some things do not require a deductible. An out-of-pocket maximum is the maximum you would be required to pay. An annual limit or lifetime limit is the most the insurance company would pay, ever.
For example, you might have an insurance policy that offers $50 doctor visits, $5000 deductible with hospital bills covered 80%, and a $1 million lifetime limit. This would mean (in general terms):
- If you go to the doctor for a checkup or whatever, you will pay the doctor $50. The insurance pays the rest of that bill.
- If you go to the hospital, you will pay the first $5000. After that, you will pay 20% of the bill and the insurance will pay 80% of the bill (more or less, as some things during your hospital stay may be covered differently or not at all).
So, let's say you are klangklangston with that coverage. His bill so far is $50,000. He would pay the first $5,000 (his deductible), which brings the total to $45,000. Then, he would pay 20% of the $45,000, which is $9,000. So, the total out-of-pocket cost for him, for the $50,000 hospital stay, is $14,000.
posted by Houstonian at 6:08 PM on March 9, 2010
For example, you might have an insurance policy that offers $50 doctor visits, $5000 deductible with hospital bills covered 80%, and a $1 million lifetime limit. This would mean (in general terms):
- If you go to the doctor for a checkup or whatever, you will pay the doctor $50. The insurance pays the rest of that bill.
- If you go to the hospital, you will pay the first $5000. After that, you will pay 20% of the bill and the insurance will pay 80% of the bill (more or less, as some things during your hospital stay may be covered differently or not at all).
So, let's say you are klangklangston with that coverage. His bill so far is $50,000. He would pay the first $5,000 (his deductible), which brings the total to $45,000. Then, he would pay 20% of the $45,000, which is $9,000. So, the total out-of-pocket cost for him, for the $50,000 hospital stay, is $14,000.
posted by Houstonian at 6:08 PM on March 9, 2010
Best answer: Here in Roanoke, New Horizons Health Care Center is a sliding-scale medical practice, and Carilion also has a sliding-scale charity care clinic. Virginia Western has a student dental hygiene clinic. Orthodonics aren't usually covered by even really good insurance policies though.
posted by headnsouth at 6:08 PM on March 9, 2010 [1 favorite]
posted by headnsouth at 6:08 PM on March 9, 2010 [1 favorite]
If you do get insurance through college, it probably won't cover much unless you only go to the student health clinic. I know you said you "want a plan that covers a lot of stuff," but so does everyone. Good insurance plans aren't that easy to come by, and many people end up getting multiple insurance plans to try to help cover their medical expenses. You pretty much have to be either in the military or a government employee to get good insurance.
As headnsouth suggested, you can usually get free or cheap dental work done at dental student clinics. The catch being of course that dental students are doing the work.
posted by Lobster Garden at 6:12 PM on March 9, 2010
As headnsouth suggested, you can usually get free or cheap dental work done at dental student clinics. The catch being of course that dental students are doing the work.
posted by Lobster Garden at 6:12 PM on March 9, 2010
Oh, and just to give you an idea of costs, my crappy student insurance comes to about $90 a month.
posted by Lobster Garden at 6:15 PM on March 9, 2010
posted by Lobster Garden at 6:15 PM on March 9, 2010
Oh, and for reproductive health care (not just pregnancy/contraceptive/STD stuff, but annual checkups), don't forget about Planned Parenthood. They do great work, even if you do sometimes have to walk by screaming protesters.
posted by oinopaponton at 6:15 PM on March 9, 2010
posted by oinopaponton at 6:15 PM on March 9, 2010
Your biggest problem is that you don't have any money (I know, duh right). If you don't make $120 a month you can't afford anything, never mind health care / insurance. You need some sort of income, even as a student you can work a part time (or even full-time) job.
posted by ghharr at 6:20 PM on March 9, 2010
posted by ghharr at 6:20 PM on March 9, 2010
Best answer: Wrt. dental care - the insurance system is in even worse shape than regular health insurance.
I'm sure you are already doing all that you can to keep healthy... right? Do not neglect your teeth. Orthodontics is all well and good, but the fundamentals are good dental hygiene. Brush your teeth twice a day. Floss every single day. Learn proper brushing and flossing technique, otherwise you might not be getting the full benefits, and even causing harm (overbrushing etc.). Good dental health is important for your overall health, not just your teeth, but your cardio-vascular system as well, plus more. And it'll save you money in the long run - I neglected my dental health when I was young, and so far spent north of $40K on dental care trying to fix the damage. Seriously, don't neglect your teeth.
Learn all about proper diet and exercise and a healthy lifestyle. The best cure is not nearly as good as prevention. First and foremost, do all in your power to stay healthy. Others here will give you more advice regarding the insurance issues, but I figured it won't hurt to emphasize the basics. It'll be rewarding not only in health, but in finances. And my apologies if I'm preaching to the choir here.
posted by VikingSword at 6:24 PM on March 9, 2010
I'm sure you are already doing all that you can to keep healthy... right? Do not neglect your teeth. Orthodontics is all well and good, but the fundamentals are good dental hygiene. Brush your teeth twice a day. Floss every single day. Learn proper brushing and flossing technique, otherwise you might not be getting the full benefits, and even causing harm (overbrushing etc.). Good dental health is important for your overall health, not just your teeth, but your cardio-vascular system as well, plus more. And it'll save you money in the long run - I neglected my dental health when I was young, and so far spent north of $40K on dental care trying to fix the damage. Seriously, don't neglect your teeth.
Learn all about proper diet and exercise and a healthy lifestyle. The best cure is not nearly as good as prevention. First and foremost, do all in your power to stay healthy. Others here will give you more advice regarding the insurance issues, but I figured it won't hurt to emphasize the basics. It'll be rewarding not only in health, but in finances. And my apologies if I'm preaching to the choir here.
posted by VikingSword at 6:24 PM on March 9, 2010
Best answer: Also, even if health care reform passes many of the provisions will probably not go into effect for several years, so you can forget about that.
posted by ghharr at 6:26 PM on March 9, 2010 [1 favorite]
posted by ghharr at 6:26 PM on March 9, 2010 [1 favorite]
You should be aware that medical insurance will very likely not cover dental. If you want dental insurance, you'll have to buy that separately. However, individual dental insurance is very often not worth the cost. You'll pay quite a bit of money in premiums, and you're unlikely to need that much care. I'd suggest that instead of dental insurance, you commit to saving a set amount of money per month (the money you otherwise might have spent on dental insurance premiums), and then use that to pay your dental costs out of pocket. I've also never heard of any insurance, dental or medical, covering orthodontia unless it's to fix a problem caused by an accident or something. Braces, for example, are pretty much never covered. So again, plan on saving up for that.
posted by decathecting at 6:40 PM on March 9, 2010
posted by decathecting at 6:40 PM on March 9, 2010
I would also look into whether or not your school actually requires health insurance. I live in a rather poor area and many of my [community college] students don't have health insurance, and neither did I for about 8 months, and though this is all anecdotal it didn't seem to be a problem.
posted by LokiBear at 6:52 PM on March 9, 2010
posted by LokiBear at 6:52 PM on March 9, 2010
Frankly I think all of those uninsured (myself included, as my Assurant individual coverage went up 150% in December, and I never even used the damn thing) need to organize and put pressure on our representatives. It's not a short term fix but definitely a long term one -- and might be one possible "out in left field" option for the OP. I don't know, however, whether any organization is even representing this cause.
posted by crapmatic at 7:06 PM on March 9, 2010
posted by crapmatic at 7:06 PM on March 9, 2010
Look for info on your state's insurance options here.
If you're poor enough, you might qualify for Medicaid, but I'm not sure how that works if you're a student.
At a lot of schools, you can use the school's health clinic for free, even with no insurance. Fees are built into your tuition for his at many colleges.
$120/mo is pretty cheap for health insurance premiums. I paid that much for insurance through my employer and they subsidized most of the premium. If your plan is $120/mo, it's going to be very basic and probably have really high deductibles and copays. However, most of the time, some insurance is better than none.
posted by ishotjr at 7:58 PM on March 9, 2010
If you're poor enough, you might qualify for Medicaid, but I'm not sure how that works if you're a student.
At a lot of schools, you can use the school's health clinic for free, even with no insurance. Fees are built into your tuition for his at many colleges.
$120/mo is pretty cheap for health insurance premiums. I paid that much for insurance through my employer and they subsidized most of the premium. If your plan is $120/mo, it's going to be very basic and probably have really high deductibles and copays. However, most of the time, some insurance is better than none.
posted by ishotjr at 7:58 PM on March 9, 2010
*and when I say might qualify for Medicaid, I really mean might, because from the people I've talked to, it's really hard to get it unless you have minor children. But, if you have serious enough health problems, there may be other state-subsidized options out there (see the website I listed).
posted by ishotjr at 7:59 PM on March 9, 2010
posted by ishotjr at 7:59 PM on March 9, 2010
Join the military--they cover medical, dental, tuition, room, board, et al. And don't forget the free exercise (PT) and nutrition (galley/mess hall) program you get!
posted by MsKim at 8:03 PM on March 9, 2010
posted by MsKim at 8:03 PM on March 9, 2010
Get a part time job at Starbucks. They offer health insurance to PT folk.
posted by spinifex23 at 8:51 PM on March 9, 2010
posted by spinifex23 at 8:51 PM on March 9, 2010
Best answer: spinifex23: "Get a part time job at Starbucks. They offer health insurance to PT folk."
20 hours a week or more before you're able to avail yourself of their insurance plan at Starbux...
posted by dancestoblue at 9:13 PM on March 9, 2010
20 hours a week or more before you're able to avail yourself of their insurance plan at Starbux...
posted by dancestoblue at 9:13 PM on March 9, 2010
There's a lot of good advice here, but I would like to add that if you are newly in this position, you can reach out to doctors that you were a patient of, explain your situation (that you will be paying out of pocket) and see of they can give you a break on the office visit cost. This worked with my obGYN when I was uninsured. (my mother uses the same obGYN and I have used this doctor for years, otherwise I would have gone to planned parenthood which has great docs - i used to volunteer for PP).
What will cost you an arm and a leg is any outside lab work. If you require a blood test or anything of that sort, Lab Corps and such will charge you out the ass if your doc's office outsources said lab work. Consider looking for a doctor in a clinic or hospital that can see patients and will have a direct connection to a lab to negotiate costs.
posted by WeekendJen at 1:51 PM on March 10, 2010
What will cost you an arm and a leg is any outside lab work. If you require a blood test or anything of that sort, Lab Corps and such will charge you out the ass if your doc's office outsources said lab work. Consider looking for a doctor in a clinic or hospital that can see patients and will have a direct connection to a lab to negotiate costs.
posted by WeekendJen at 1:51 PM on March 10, 2010
This thread is closed to new comments.
posted by Think_Long at 5:49 PM on March 9, 2010