Sign me, I hate insurance.
May 5, 2010 2:17 PM   Subscribe

Is it reasonable to search for an alternate for private family health insurance to replace my corporate sponsored plan? What are decent alternatives in Wisconsin?

I am completely fed up with insurance. I have tried various plans but in the end I always seem to end up not being covered and paying out huge sums of money. I either pay a high deductible and don't get covered or pay less up front and more out of pocket and don't get covered. Either way it seems to be a wash. I am tired of doctor bills and crazy high insurance costs. I realize this has been asked before but most of the sites lead me to a 'sign up and fill out all your information so we can have our crack team of telemarketers call you' form, or they aren't applicable to Wisconsin.
Thanks for any help.
posted by mcarthey to Work & Money (8 answers total) 1 user marked this as a favorite
Given that you live in North America, your options on the individual market are almost guaranteed to be even worse than whatever crappy group plan you're getting from your employwer. However, it might be worth calling a couple of insurance brokers and having them run down your options (it's better to do this over the phone or even in person than to try and sort through the scams and telemarketing sources online).
posted by infinitywaltz at 2:46 PM on May 5, 2010

I agree, don't try and purchase this over the internet. Find a well respected independent insurance agent (or better yet, two of them) and have them quote a number of options from different carriers.
As infinitywaltz said, the to replicate the coverage you have with a group plan with a private plan will typically be more expensive.
posted by HuronBob at 3:22 PM on May 5, 2010

Your corporate sponsored plan has to be pretty shitty indeed for you to want to pursue private insurance. I don't know how it could possibly be worth it. We live in Wisconsin, and before my husband got insurance through his job, he had it through Golden Rule (United Healthcare). I can't really say if it's good or bad, since he was healthy enough not to really need it. At least their website lets you call them instead of making you fill out a form to call you.
posted by desjardins at 3:42 PM on May 5, 2010

Best answer: It's almost never a better deal to buy insurance directly rather than take the insurance your employer is offering you. There's two reasons for this:

1. The premiums that are deducted from your paycheck are tax-free, and if you buy directly from an insurance company you will have to pay with after-tax dollars (with a few exceptions). Depending on your marginal tax rate, that means that an identical policy with an identical premium will be somewhere on the order of 15 - 35% more expensive if you buy it directly.

2. The vast majority of employers are actually paying a pretty substantial chunk of the premium cost for health insurance, although you wouldn't necessarily realize this because it doesn't show up anywhere on your W-2. The national average is something like 70% of the premium is paid by employers, and employees are on the hook for the remaining 30%. You may be unlucky enough to be working for an employer that doesn't pay anything towards your premiums, but chances are they are indeed subsidizing it and bringing the cost down from obscenely expensive to just really, really expensive. The average family plan in the United States has an annual premium of over $12,000; if you're paying less than a thousand a month, you're either being subsidized by your employer without realizing it or you're lucky.

So, that's already two strikes against buying it yourself. In addition, if you're set on doing this, you should realize that you will have far fewer consumer protections if you buy insurance directly. In the vast majority of states, insurers are allowed to look at your overall health and pre-existing conditions and choose to reject you outright, to cover you but raise your premium much higher than the standard rate, or to cover you but permanently exclude any pre-existing condition you have. If you're buying a family plan, they may be okay covering some members of your family but not others--they're not necessarily forced to insure everyone or no one. It's pretty rare for people to get what's called a "clean offer of coverage," which means an insurance company agrees to sell you the policy you want for the standard price and no pre-existing condition exclusions. Really, really, really rare, like a third of the time or less.

All in all, it's almost never worth it to turn down the coverage your employer is offering and go it alone in the individual market. There's a couple of exceptions, like if your employer isn't paying any of the premiums (rare), PLUS your marginal tax rate is pretty low so the cheaper premiums more than make up for the 15-35% you're losing to taxes, PLUS you (and everyone in your family) are very healthy and young so you're likely to get a clean offer with a reasonable premium. In that fairly narrow set of circumstances, you might be financially better off buying it directly.

I guess what I'm saying is: don't hold your breath that this is going to be a magic bullet, and DEFINITELY don't fail to sign up for your employer insurance on the assumption you'll be able to find something better. There's no harm in looking around to see if it'd be a better deal but go into it with your eyes wide open.
posted by iminurmefi at 3:46 PM on May 5, 2010

If you drop off your employer's plan to go onto an individual plan, beware that you won't be able to enroll back onto your employer's plan until the next open enrollment period. (This won't apply for certain life situations, like getting married, etc.)
posted by FergieBelle at 4:38 PM on May 5, 2010

Longtime Wisconsin resident here. You have a few options:

1. Find a job based on the quality of their insurance.

2. Become a veteran. Actually the VA does have decent care although the bureaucracy to get that care can be maddening.

3. Be rich enough to afford your own doctor.

4. Become incarcerated. The quality of care may be on the same level as the VA but at least you don't have to pay for it.

Chances are if you do have problems that aren't covered you will not be able to get private insurance on your own at a rate you can afford. I've tried it and was turned down outright by Blue Cross.
posted by JJ86 at 7:50 PM on May 5, 2010

My impression is that the nature of for-profit insurance may make it difficult to find what you're looking for, unless you have a job where your employer is significantly subsidizing your insurance premiums. If most people were getting more benefit from their insurance coverage each year than was being paid for it (whether by the individual or their employer), the insurance companies would lose money. Insurance companies pay large armies of actuaries to make sure that doesn't happen.

Unless you're in a good group plan, and less healthy than the average person in your group, health insurance is, well, insurance -- you expect to be in the negative a small* amount every year, in the hopes that eventually, should something catastrophic happen and you need a zillion dollars in cancer treatments, your insurance will be there for you. (Try as they might to post-claim-underwrite away their obligations in those cases.)

*small is relative to the zillions of dollars it costs to be treated for cancer.
posted by jacquilynne at 9:36 PM on May 5, 2010

Are you eligible for BadgerCare? They have plans for people with and without children. It is worth looking at. From what I understand it is very good coverage.
posted by mjcon at 9:39 PM on May 5, 2010

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