Life counts as a pre-existing condition, right?
November 21, 2011 10:54 AM   Subscribe

I'm finally in a place where I can afford health insurance (catastrophic, at least) in Washington state. So far all I'm really doing is looking at plans on ehealthinsurance dot com...but if there are things to look out for or better ways to shop, I'd really appreciate the input. I'm healthy but nervous about being ripped off.

I'm a healthy 37 year-old male. Non-smoker, no ongoing health stuff. I'm concerned about dental issues -- I'm pretty sure this pain in one of my molars isn't going to go away by itself -- and I haven't seen a dentist in years because I just haven't been able to afford this stuff.

Now that I'm a little more stable, I'm willing to cough up a couple hundred a month for insurance as long as it'll actually pay. My impression of health insurance, though, is that you pay them for coverage until you actually need something and then they find a way to screw you out of it.

Is there a better way to look for policies than going to websites like ehealthinsurance? Anyone got things I should look out for? I can't afford comprehensive coverage, but catastrophic is better than nothing...isn't it?
posted by scaryblackdeath to Health & Fitness (7 answers total) 3 users marked this as a favorite
Yes, catastrophic is better than nothing, and pairing catastrophic with an HSA is better than that. That way you can still get care if you need it (e.g. non-catastrophies) but you'll at least be paying for it with pre-tax money.

One thing to consider is what your definition of catastrophe is. I mean, obviously, if you got in a car crash and needed $85,000 in medical care and had a high-deductible policy where you paid out of pocket up to a $5000 deductible and then they paid 90% of the rest of the coverage, you'd still be out $13,000 - your $5000 plus $8000. Do you have $13,000? Is there a difference in your life between $13,000 and $85,000? For some people, the answer is emphatically no. Whether a debt is $13K or $85K, the amount is still something they'll never ever have, so it's not worth it to insure to them. Be ruthless when running numbers. At what point, in dollars, do you say "I just don't have it" - and would any coverage you're considering butt up against that number?

Just some things to think about.
posted by juniperesque at 11:11 AM on November 21, 2011

You should see if your State Health Dept. has a list of health providers, or if you are eligible for any group plans like those provided by the Freelancer's Union, for example.

Your health insurance will typically cover extreme dental accidents/surgery, but not routine care such as check-ups or fillings. Dental plans, for whatever reason, are typically riders or add-ons to your regular plan (the same is often true for vision). So, you may need to pay an extra $30 - $50 per month for dental. I was on the fence for paying for dental as well, but I coughed it up. Since then, I have had to go in three times over the past year. Each time I only had to pay a $5 copay. Ignoring dental problems can lead to much larger health issues such as dental abscesses that can move into your sinuses and jaws, for example. I had let a problem go on far too long as well, and luckily it didn't progress that far and I was glad I was able to have someone check it out.

As far as health insurance, you might be able to find a PPO for $350 or so. Once you do, go in and get a physical. You usually are covered for one, and will only have to pay a copay (say, $25 to $35). And once you have coverage, use it. If you have a PPO, scan over the packet you get when you sign up and see what is covered and use it. Get a physical, don't be afraid to visit the doctor if you are sick or something is wrong. Typically, you will only have to pay a copay.

And if you are ever concerned about cost, just tell your doctor or dentist. You don't have to have a procedure that you don't want or can't afford. I had a printed out list of prices for my dental plan the first time I visited my dentist -- he had suggested a new mouth guard which would have been $300. He ended up approving my older guard, and that saved me the money. Be proactive and candid, you are paying for it, so get what you want out of it.
posted by This_Will_Be_Good at 11:14 AM on November 21, 2011 [2 favorites]

Almost all the dental plans at are going to have 6-18 month wait periods for coverage. The more you pay, the shorter the wait period. I had a family policy until last month, when I got a new job that came with corporate paid health and dental. I was paying $75 a month for family dental coverage that did cover checkups from day 1, but had a six month wait on xrays and fillings, and a 18 month wait on anything big like a root canal.

So dental insurance probably is not going to be beneficial to you for anything that needs attention immediately.
posted by COD at 12:35 PM on November 21, 2011

If you are part of an alumni association or a formal club they usually get group rates I would try to get in on that. Way better than individual plans.
posted by ibakecake at 1:55 PM on November 21, 2011

Check your MeMail.
posted by epersonae at 4:39 PM on November 21, 2011

I am insured privately in Washington State through a policy we got through ehealthinsurance. We pay $365 for myself and my husband, and have a $2500 deductible, 75% coverage after the deductible is met, no office or urgent care copay, a $15 generic drug copay or 40% coinsurance on name brand drugs, and a $5000 annual coinsurance out of pocket. The first six doctor's visits are deductible-waived. We've been on it for a year now and it's been OK; we haven't had any really big ticket expenses, but we've had exactly zero hassle in getting the small stuff paid for.

For dental insurance, we maintain a concierge plan through our dentist. It costs us $400/yr for the two of us, and covers (for each one) 2 full exams, 1 set of xrays, any emergency visits, and 20% of the cost of procedures. So basically it pays for all our preventative care and the visit to find out how bad it is when you wake up with a throbbing toothache, and the rest is kind of up to you.

Memail me if you want to know more.
posted by KathrynT at 6:23 PM on November 21, 2011

One thing to keep in-mind when you look at prices at aggregators like ehealthinsurance...The prices they quote are best viewed as "come-on" quotes. That is, they are best-case-scenario numbers that few, if any, people ever actually qualify for. Your actual price can only be determined after filling-in an application and going through the underwriting process. Chances are, your quote will be higher than the figures your see on the websites. Often substantially so.
posted by Thorzdad at 5:42 AM on November 22, 2011 [1 favorite]

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