Insured

One of the scarier things about being self-employed is the necessity to be self-insured.  For all of our adult lives, we’ve had health care coverage provided by our employer.  In recent years, we contributed to the cost, but it was fairly nominal, and the benefits were comprehensive and very good.

After my husband lost his corporate job in July 2009, he started his own business in order to work as a contractor, and we had government subsidized COBRA coverage (thank you federal government for something) until October 2010.  At that point, we had to pay full price to maintain our coverage – $1,192.36 per month – until January 1, 2011, when the COBRA coverage would no longer be available to us at any price.

So last month, we initiated the process of getting independent health care through Blue Cross Blue Shield, the provider we’ve had for lo these many years.

Welcome to the real world.

Yes, BCBS does often independent health care plans.  Yes, we qualify to convert directly from a group to individual plan.  But none of the plans provide anywhere near the kind of coverage we got in the big company group plan.  The deductibles are triple and quadruple what we’ve been paying, the out of pocket maximums 10 times what we’ve had in the past.

Youch.

The whole thing necessitated a sea change in the way we look at insurance.  The only difference in each of the three individual plans offered by “Big Blue” was the annual deductible.  All other coverages stayed the same – except, of course, for the monthly premium.  For instance (and forgive me for all this detail, but there’s really no way to even talk about insurance without going into some amount of excrutiatingly boring detail) we could get a $1500 annual deductible for $1,110/month; a $2500 deductible for $750/month; or a $5000 deductible for $450/month.

Our first thought was “$5000 deductible?? No way!!”  But then we started doing the math.  If we chose the $1500 deductible plan, we’d end up paying Blue an extra $500 per month in premium costs alone.  Over the course of 12 months, we’ve already paid them $6000.  Why not keep that money in our own pocket until we need to use it?  Maybe we’ll continue to be lucky, and our medical costs will be minimal.  But if not, that $5000 will be in our bank account instead of the fat coffers of the insurance company.

Our generation was one of the first that grew up with health care, and we’ve certainly gotten used to going to doctors whenever we needed to without worrying about how to pay for it.  Luckily, we’ve never needed to use our benefits for much.  In the past five years, I’ve probably been in a doctor’s office less than a dozen times.  I think one of the problems with insurance is that, over time, it lulls you into a false sense of entitlement.  I know lots and lots of people- particularly elderly people- who dash into the doctor at every little twinge.  If they had to hand over a $100 bill each time they went in, I suspect they might think twice about it.

I’m no fan of  the modern medical profession, and I’m becoming even less a fan of modern medicine in general.  I think our health care is far too specialized, much too focused on invasive and expensive treatments, and entirely too profit oriented.  And I think the health insurance industry is at the root of a lot of those ills.  Nothing about the current health care reforms addresses a major problem in health care – curbing costs.  And I don’t think any politician will ever address that issue because they’re too indebted to the insurance and pharmaceutical lobbies.

In choosing the highest deductible plan for our individual insurance policy, we felt as if we were taking a tiny bit of power back into our own hands, power that the insurance and medical bureaucracy has been wielding over the little guy for much too long.

And that was good medicine.

 

Advertisements

13 thoughts on “Insured

  1. Yep- I went with the big deductable too. It just made more sense. I think when you are ‘self insured’ whether it is paying for your own or just trying to stay as healthy as possible through eating right and keeping fit, you tend to think two or three times about whether you really ‘need’ to see a Dr. or not. Two and a half years ago I had to have emergency surgery with NO insurance. I was able to make financial arrangements to reduce the amount owed to a reasonable level, and am paying for the rest over time (almost done). A bit of a scary situation to be in, but there really was no choice, and I found everyone to be very kind and considerate about my situation, helping me to work things out.

  2. It’s those big, unplanned for things that make insurance a pretty necessary evil. And you’re right that part of “insuring your health” means taking care of yourself – body, mind, and spirit. It all works together.

    Hope you stay healthy this year 🙂

  3. Thanks for posting this! I work in the school system and my insurance is unbelievably inexpensive and excellent, which I don’t usually appreciate. Every time I talk about leaving, my husband complains about what health insurance would cost through his company.

  4. the thing is that health is unpredictable and fate can turn quickly with costs rising up highly without any impact of your own. My best friend just got diagnosed with cancer, my dad suffers parkinson and had a major brain surgery 2 years ago, I’ve had 3 surgeries over stupid silly cysts over the last 2 years…none of those avoidable.

    I’m so glad to be fully insured by the government paid by my taxes.

    • You’re lucky to have a good government run health care system. Our country fights that on every level, but things are really broken already here in terms of health care, and we need to do something to fix it soon.

  5. Oh, healthcare. I never understood the fuss until I moved to the US. In Germany, where I grew up, healthcare is mandatory and decentralized. Monthly deductibles can be high but at least you can stay with the same insurance company irrespective of your employer. In the UK the government runs healthcare so it’s funded through your taxes. The quality does suffer as a result (old hospitals and equipment, underpaid staff, long waiting lists for investigative procedures and surgeries) and whenever possible people opt for private insurance (often a perk offered by employers). But at least everyone is covered and people don’t have to make the choice between seeing a doctor and putting food on the table. I am worried about what will happen to us when we no longer have insurance through our employers. What you describe gives me some hope at least but it seems ironic that at the time in your life when you are likely to need it most it also becomes more challenging to afford coverage.

    By the way, my husband, who has managed hospital budgets and now works in medical devices, says there are two major reasons why health costs in the US are so atrociously high compared to other western countries: 1) the government regularly defaults on payments for things like Medicare and hospitals are forced to receive only a fraction of what is owed and thus need to redistribute costs; 2) litigation. Especially the latter is a huge factor impacting a medical company’s bottom line due to immense legal expenses. I thoroughly despise the litigation mentality in this country but as long as you have lawyers running this government I don’t see many changes here, either.

    • Kerstin, thanks so much for sharing these insights. I too hate the litigation mentality that I’m sure is responsible for not only outrageous costs, but sometimes egregious testing and procedures. And defaulting on payments is surely a huge problem, especially when costs are so high. A great big vicious circle, isn’t it?

  6. Years ago I went without health insurance because it was beyond my means. It was a scary time. Because I’ve been self-employed for years I’ve had to supply my own insurance. Now that I’m married, my husband’s work plan covers me too – what a relief! Medical insurance is horrifyingly expensive and intimidating. I’m sorry you’re caught in this mess. It’s one of the uglier aspects of modern life.

  7. Our family has run the gamut in regards to health insurance. Dad is the most fortunate. He has Blue Cross Blue Shield through a former employer that covers 20% and Medicare covers every dad-blamed thing else under the sun. He’s grinning like a fat and happy opossum. It’s the one thing we never have to worry about as far as he’s concerned. But no long-term care insurance.

    I’m very fortunate. My husband’s previous employer covers most of our insurance. It’s $2,500. out of pocket for both of us combined, and I never complain about it. Believe me, we know how fortunate we are – especially considering recent revelations about my heart. We could never cover those expenses.

    My sister had the $5,000. deductible plan. I’ve since given a great deal of thought to her subsequent choices as a result of the high deductible. She was not one to go to the doctor excessively, but when she was 63, she started having some issues with digestion. There was no reason to believe it was anything other than your garden variety indigestion. It got worse when she was 64, and she had some tests that her doctor recommended. The results didn’t reveal much, and she paid out of pocket. She was so close to 65 and medicare, she waited for the more expensive tests. Of course, she had cancer and it was in the fourth stage when they found it.

    My brother is 63, self-employed and has tremendous, debilitating and chronic health issues that have made numerous operations essential, and there will surely be more in the future. He pays $2,400. a month(I’m not sure of his deductible). He’s thrilled to have any kind of insurance.

    This was a post that applies to so many people, Becca. Good on you for tackling it. You’ve made informed choices, and I’ve no doubt they are the best ones for your situation. I’ve never known a time when Dad didn’t say “That insurance thing is a racket – highway robbery!” Ironic that he ended up with the best coverage of anyone on the planet.
    Bella

    • Thanks for sharing your family’s stories. There is the temptation to put off health care when you know you’re going to have to pay for it. I’m already facing that, because I don’t like doctors much anyway. I know I have to be careful, or I could wind up like your sister. Thanks for reminding me to be sensible–not penny wise and pound foolish as the saying goes.

      Our parents generation often does have the best healthcare, as mistrustful as they are about it. My father in law thought it was communism – but then, he thought everything was a communist plot 😉

  8. Rick has $5,000 deductible. It’s a good thing since he rarely gets sick. And if he does get hurt, it’s usually more than five grand (which isn’t good; in fact, it’s really bad, but it’s covered.) I, on the other hand, meet my deductible (150) in the first month or so of the year. And I so worry about the folks who don’t have insurance at all… I was so relieved that the health care bill allows Greg to stay on his mom’s insurance till he’s 25 — another year. Or is it another three months? Oh, help….

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s