Health Insurance

[wlotus]

I am researching my health insurance options. I am, thank goodness, in good health, with no chronic illnesses which require specialists or regular office visits. I am debating whether to get indemnity insurance which covers hospital services in full ($152.00/month), or an HMO plan which includes Rx coverage and copays for preventive office visits ($350/month).

Right now I am leaning towards the indemnity services, just for the peace of mind in the event of an emergency hospital visit. My internist charges $100 for an office visit, so if I get sick enough to require a doctor's visit, I can handle paying out of pocket to see him and get the rare Rx. (The same for my eye doctor, by the way. As soon as my OB-GYN gets back to her office, I will find out her fees, as well. Planned Parenthood is also an option. I'm overdue for my annual checkups and want to take care of those, soon, since glaucoma and various cancers run in my family on both sides.) I currently have enough Lexapro for another few months, and I can get an Rx from my internist for a renewal, if necessary. I can afford the indemnity insurance on my current budget; the HMO plan will mean an extra $400/month, which will mean burning through my cash reserves a bit faster than I'd anticipated. I'm thinking about indemnity insurance for now, then when my income grows, switching to full-coverage like the HMO plan. (All of my preferred doctors are part of the HMO plan I am looking at, too.)

Any thoughts? I'd be very interested in hearing arguments for paying the extra for the HMO, in case I am overlooking something.

Comments

[chrisfs.livejournal.com]

If you can afford it, I would go for the HMO, but then I like to be fully 'geared up' when it comes to insurance, because you never know what will happen. However, if it means a very tight budget, then I think you you are on the right track with the indemnity insurance, because, in my experience, there's always something that comes along that was outside the budget. Get the HMO when your income increases.

[her-whispers.livejournal.com]

For years I lived with "catastrophic insurance" only. Basically that meant if something major happened (ie:broke a leg, etc.) I was covered, but for the other stuff, not covered. Planned Parenthood (as I found out during this time) can also do GP exams, not just "lady" exams.

I would also look into the cost of your prescriptions. When I was still in pharmacy work, Lexapro did not have a generic and, depending on dosage, can run about $100 a month or more. Though you may be able to get one of those target/walmart things where it's a flat rate per month. With a lot of things I'd recommend you switch to a different drug that does have a generic, but given the class, i'd say just stick with what you already use. Antibiotics generally run anywhere up to well past $200 for one cycle, but you can get amoxicillian for as low as about $12 a cycle (though these days Amoxi usually will require additional dosing, if it works at all).

Personally, having had either no insurance or the "catastrophic" (which sounds a lot like your indemnity), I have to say I absolutely 100% love being back in an HMO. My employer only pays $200 toward our health insurance, which means I fork out an additional $246 per month (pre taxes) toward it, but it's SO WORTH IT to me. I like knowing that if something doesn't feel right, I can go to the doctor without worrying about footing a huge bill.

But, if you aren't often sick and are okay with going to places like PP or clinics for stuff, then I don't see why you shouldn't save the money. But research those prescriptions!

[far-gone.livejournal.com]

I think you have a good plan, for now.

[iswari.livejournal.com]

I would not ever be comfortable without health insurance. If, for some economic reason, I had to go without it, I would be very nervous. This would be one of my top priorities financially; though I surely have used health care services more than you do, you just really never know. If you can't manage the HMO now, I'd switch to it as soon as possible. If you do develop a medical problem, you could rack up a huge amount in bills, even if you don't become hospitalized or reach some point that may be considered a catastrophic loss (if you are talking about the type of emergency plan with a high deductible). Medical costs can add up extremely quickly if something goes wrong.

Is this an individual plan you're looking into? If so, would depression be considered a pre-existing condition? If you haven't had continuous coverage and you get an individual plan (rather than a group plan), they may deny benefits for a year for pre-existing conditions. I would definitely check into this, so you can be clear on your benefits.

[balmofgilead.livejournal.com]

I may be misunderstanding "indemnity insurance" here (I'm assuming it's different from a PPO.) Are PPOs with a highish deductible not an option? With a PPO, you would (I believe--I'm actually going to double-check this soon for myself) get access to doctors' negotiated fees, even before you reach your deductible. Some also offer partial coverage [for example just a $30 or $40 copay] of two or more doctor visits even before you reach your deductible.

I would get a high-deductible PPO and stick (or keep) the monthly difference in savings, to be used toward the deductible in case of medical emergency. (Is the difference actually $400/month? I'm seeing $350 - $152 = roughly $200.)

I think HMOs are good if you use a lot of medical services regularly, but if you don't, PPOs will be cheaper and (IMHO) better because you don't have to deal with the HMO's bureaucracy. It's a little bit of a gamble, but the worst that could happen is that you'll be out the entirety of your yearly out-of-pocket maximum (which is, I believe, usually not more than something like $10,000, at least for the plans I've looked at.)