I want to buy Health Insurance for me, my wife and my kid. I live in Minnesota. I can spend about $500-$600 monthly for Insurance. What all I should look for? It is so confusing. PPO, Deductibles, Coinsurance, and all these plans... I know only a little, and it is very hard making a choice. Please Help!
Insurance - 4 Answers
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1 :
Insurance, of course, involves risk. If you are willing to spend 7200.00 a year for health insurance, you can get a pretty decent plan. First and foremost, go with a company you have heard of. Ask for proof they are an A rated company with AM Best. Your deductible is the amount you must pay before the policy pays for anything. Co-insurance, usually 80-20, means the insurance company pays for 80% of incurred medical expenses. You pay 20%. All plans have a maximum out of pocket you will have to pay before the plan pays 100%. PPO networks are doctors and hospitals that insurance companies have an agreement with to pay pre-negotiated rates. If you go outside the network, you'll still be covered, you won't get the same amount of coverage. DO NOT BUY AN HMO PLAN!!! Buying an individual plan, don't worry about Co-pays at the doctors office. This is an added expense to your premium and the additional premium is not worth it. Make sure your plan covers prescription drugs. There is usually a 500.00 deductible on name brand drugs Ultimately it is a decision you have to make based on risk. If you go to the doctor once a year, consider a high deductible plan(5000.00 - 10000.00). If, say cancer, runs in your family, consider a lower deductible(2500.00 - 500.00) Don't buy your plan to cover trips to the doctor!! Buy to CYA in case you or your family needs hospitalization.
2 :
Well you can throw out what the previous answerer said because they clearly don't know the Minnesota marketplace. The Minnesota market is dominated by the big three Managed Care plans (HMOs): Blue Cross Medica Health Partners Among them, they have more than 90% of the market. They are going to be the cheapest. Everybody else is going to be more expensive because they don't have enough market share to get the same provider discounts as the Big 3, thus meaning they can't pass along the discounts to you in the form of lower insurance premiums. Now here's the bad news. If you don't get coverage from your employer's offerings, you are not going to have enough money in your budget to afford health insurance. $500 per month will not cut it. If you don't have an employer sponsored group plan that they are paying part of the premium, you are going to have to find coverage in what is called the "individual market" which means you don't get a group discount and worse.....you have to pay 100% of the premiums. Typical family plan coverage in the individual marketplace in Minnesota runs more than $1000 per month. You are probably going to be best served by buying an HSA or Health Savings Account. It has two pieces....a High Deductible Health Plan (HDHP) and a cash account. You should pay the premiums on the HDHP and stash as much cash as you can into the cash account. Routine preventative care is provided by the HDHP with just a small copay. When you get sick and need to be seen by a provider, you pay cash out of the cash account until you hit your annual deductible at which point the HDHP takes over. Each year you don't spend the money, you can roll it over to the next year and so on and so on. Because the cash account can grow to be substantial if you don't use it, you will have enough eventually to begin putting it into decent returning investment vehicles and get more bang for your buck, so to speak. Eventually, you may work for an employer that will contribute an annual amount to your cash account, this will roll over from employer to employer because you own the account, not your employer. You can take out the cash for medical expenses tax free and when you turn 65 you can convert the account to a retirement account and spend the money on whatever you want and pay only your post retirement tax bracket rate on the accrued gains. But because you are paying your own cash for your care, you are likely going to shop around a bit for providers who give good care but don't charge an arm and a leg for it, which makes you a smarter health care consumer and lowers the overall cost of health care to the rest of us. HSAs are sold not only by the Big Three Health Plans, but by a number of competitors including traditional indemnity health insurers (like Aetna, Assurant, etc.) and even banks and other financial institutions. HSAs really are the wave of the future and you are getting in early....so consider yourself lucky and take advantage early on.
3 :
I work for a health insurance company and I will tell you where insurance companies make their money...when you don't use your insurance. I'm not sure what the cost of the plans you looked at are (or why that other person said not to go with a HMO) but if you and your family are overall healthy then an HMO is probably your best and cheapest way to go. HMO means that you will have a primary care doctor or general practioner who will have to refer you to another doctor for "specialty" issues they can't/don't deal with. Example a cardiologist or dermatologist. You would go to your primary doctor for sick and routine physicals. The only downfall to this type of plan is that they are your PRIMARY CARE doctor and can chose who they will refer you to; most doctors will give you a few choices and may even take your suggestions if there is a doctor you would like to see but this all depends on the doctor. Some doctors are part of "groups" and will only refer you to someone in their group and this is generally something the doctor has agreed upon when joining that particular group. So your best bet is to ask if you have a doctor in mind of who you'd like to select. These plans you will usually pay a copay (say $15/$20 for office visits) and thats it but alot of companies are now offering plans that come at a cheaper cost to you but you pay a deductible or have coinsurance for certain services say lab work or x-rays as an example. If your family don't frequent doctor's offices or emergency rooms I think this it the best bet. (its what I have) With a PPO plan you don't need referrals to specialists and usually has 2 levels of benefits. In network and Out of network. In means you are seeing a doctor that is a PPO provider out of network you can see anyone who is not a PPO provider but at a higher cost; usually a deductible and coinsurance. These plans however usually cost more than an HMO plan. Important things to know... Deductible- you are responsible for paying this amount before your insurance will pay for anything. (usually more for a family, example $1000 per family member or $2000 family maximum so you would not have to pay more than $2000/no matter if there are two people on your plan or four; this is per calendar year so it would start again the following year). Some company offer high deductibles which you may want to be leary of because it will be like not having insurance at all! Coinsurance- cost sharing with the insurance company (80/20, 70/30) it all depends on the plan you chose but they will pay the higher amount. Copay- how much you pay per office visit (whether it be mental health or a regular office visit) Some plans contain a combination of the three...just look at the plans and ask for a breakdown of anything you're not sure about. They should be happy to explain any questions you have about what you're paying for. Feel free to email me if you have any other questions.
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