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Insurance

I'm looking at individual insurance policies. It's great fun, let me tell ya. I'm trying to decide if it's worth it. Here are the main points:

* Will I be able to afford to keep up payments if I lose my job before Cory gets one? (That's hard to say; I don't know how much unemployment I'll be getting. We have some money saved up, but we'd also have to deal with rent and all that other stuff coming out of savings.)
* Should I choose the cheaper catastrophic plan (in which around 60% of the bill is paid by insurance)? Or should I spend more money per month and go for something that will pay 100% after a copay? (We don't go to the doc very often but we both need our eyes and teeth checked. So I guess that answers that one, really - the cheaper one is better for us.)
* If I have complications during pregnancy and birth, will the insurance cover me only if I get pregnant after I've enrolled? (I'd think probably; I just don't know what the wait is, or if a hospital transfer during labor is counted as an emergency room visit or a maternity stay. I'd have to call the company...)

I'm thinking it might be doable. Hmm.

Comments

( 8 comments — Leave a comment )
eris_devotee
Mar. 30th, 2009 08:56 pm (UTC)
Under the 1996 HIPAA rules, pregnancy *cannot* be considered a pre-existing condition.
rivulet
Mar. 30th, 2009 09:02 pm (UTC)
True, but there are loopholes - for instance, it only applies to group health plans, and I'd be buying an individual plan. And there are grace periods once you switch individual plans, or go to a group plan from an individual plan, etc. I'd have to read up more on the laws by state and chat with the companies I'm considering to see what they have for grace periods.

Also, since I'm planning on using a midwife for prenatal care as well as the birth, I'm mostly concerned about whether an emergency transfer would be covered.
eris_devotee
Mar. 30th, 2009 09:07 pm (UTC)
Do you have coverage right now?
rivulet
Mar. 30th, 2009 09:08 pm (UTC)
I don't; my employer ended everybody's coverage at the end of November, with no option for COBRA or anything.
outtajo
Mar. 30th, 2009 11:44 pm (UTC)
This is what I was going to chime in with. Unfortunately, there are loopholes galore and not only may an individual policy not cover pregnancy, but you may not be able to get insurance at all for any number of completely insignificant reasons (pregnancy being one of them, but I'm assuming you're not currently pregnant).

Were you unable to get COBRA due to the small size of your company? Because I'm pretty sure you're eligible if your company has more than 20 employees.

We just did a brief about this at work not too long ago...
rivulet
Mar. 30th, 2009 11:52 pm (UTC)
Nicoal and I were chatting earlier about all of the reasons providers will refuse individual health plan service; she told me Ravi couldn't get it because he'd broken his pinky a few years ago! So I'll definitely not be surprised if we're denied coverage even though we're both pretty healthy. No, not currently pregnant; I wanted to be sure about the insurance before I started TTC because although I'm not that concerned about having a difficult pregnancy (and I want to do it all with a midwife anyway) I would hate to have an emergency and not be covered.

I was unable to get COBRA because my company was in financial trouble so they stopped health insurance completely. We had around 100 employees that were all laid off in mid-November, and then towards the end of the month we were told they were canceling the insurance as well as COBRA. (I had to tell our lone COBRA ex-employee about that when he came in after it was canceled to pay for his next month - that was not fun.) It would have hurt to have to do COBRA anyway; my company paid for 100% of my medical/dental insurance which was almost $300/month.
outtajo
Mar. 30th, 2009 11:56 pm (UTC)
The whole individual market is so jacked (and this is why we need, at the very least, a public plan, ala Medicare-for-All -- but even better ... single-payer!). Just be careful if you do decide to buy individual insurance. There was a news story a couple of weeks ago about a guy who was an on individual plan and paid in 6-month chunks. It wasn't until he was diagnosed with something serious, however, that he learned that not only was he paying in 6-month chunks, but that he was also insured in 6-month chunks. Meaning that although he believed he was continuously insured, his illness was pre-existing (because it started in the previous 6-month period and ended up not being covered at all. *sigh* Our health system blows.

Are there patient advocates who help people with these sorts of things? Even though I work in health policy, I would have no idea where to begin finding a reputable and affordable individual plan...
rivulet
Mar. 31st, 2009 12:03 am (UTC)
Wow, that's scary. I wish they were at the very least regulated so that every company was the same as far as what you can expect. But insurance companies kind of seem evil sometimes, with what they're willing to do to get your money and also keep from having to help you out when you have problems. Like a huge scam that nobody fixes!

I was planning on talking to someone at the company that I like best to ask all of these questions, but I couldn't possibly think of all of the contingencies and loopholes so hopefully I can ask around and see how other people like their insurance companies. I'm not sure if there are advocates. Maybe I could contact the hospital in town and see if they know.
( 8 comments — Leave a comment )