C.F. asks from Arvada, CO on February 27, 2012
Health Insurance - Littleton,CO
I am getting ready to change insurance (health) companies. It will be a private policy as I do not have insurance through an employer. My question is...Is it better to pay a high monthly premium and low out of pocket and co-pays or low monthly oremium and higher out of pocket and copays. I am in good health, see the doctor for occasional sinus infections and minor things like that. I am in rehab physical therapy right know and will need to continue with new insurance. Also, any suggestions for looking into best plan that covers on going medication. I have looked into Kaiser as many people have said it is a different Kaiser than in past, but they still have the "walmart" stigma for health insurance. Any thoughts!?
Thanks for the help!
F.H. answers from Phoenix on February 27, 2012
I'm an insurance agent in AZ. Insurance isn't something you want to take lightly and I would suggest getting advice from someone who specializes in it so you get the best advice. You can google "independent insurance agent littleton CO" to find one in your area. Good luck.
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C.B. answers from San Francisco on February 27, 2012
It really depends on how much you go to the doctor. I recently changed my plan because the premiums were getting too high. I chose a new plan with lower premiums but higher co-pays and out of pocket because (knock on wood) I only go to the doctor at this point for annual check-ups and mamograms. So it's not really financially sound for me to pay more each month when I virtually NEVER incur additional medical costs. I did, however, make sure that the co-pay, and out-of-pocket are an amount that if, God forbid, I had to pay, it wouldn't break me or send us into bankruptcy.
T.K. answers from Dallas on February 27, 2012
depends on how often you go to the dr. I use mine as disaster insurance - just major medical. I have a high deductible. But I belong to a little clinic here. I pay $60 a year and then all my visits are just $60 each. I may only go once every so often, so it works for me.
If you go monthly, It may be cheaper to get a copay, but double check the fine print. The premium is higher and you may only be allowed 4 dr visits a yr. It doesn't justify the higher premium.
B.G. answers from Denver on February 28, 2012
It depends on the insurance- sometimes you can have a high deductible plus a copay that is a fixed amount (eg. $20 every visit) or coinsurance (eg. 20% of whatever the care costs). A lot of plans will have out of pocket maximums, so you dont ever pay more than $5000 or whatever the limit is. My husband's company recently began offering a health savings account in addition to the traditional insurance option- neither is particularly cheap, so we had to do the math to figure out what would be best for our family. Basically we looked at our bills from the last year and what we paid out of pocket, in premiums, copays, etc. and compared the two insurance structures. Then you have to look at how much you want to risk having to pay if something bad happens or you use more care in a given year than you expect. Insurance is really complicated and I would definitely read the fine print or consult with someone who knows about this stuff.
I have Kaiser in Colorado and have been pretty happy with it. I am insured separate from husband and kids, who dont have Kaiser, because it was cheaper to do it this way. Kaiser is nice in that its sort of a one stop shop- you go to doctor, get your prescriptions, have lab procedures all in one place. Plus they have a great website which helps when making appointments, seeing test results, and you can actually email your doctor. That being said- I have never had a major health issue or hospitalization and have concerns about being limited to their network if such a thing happened. A risk I am willing to take for now.
My husband did have to self-insure for a while and Kaiser was the cheapest option, with a pre-existing condition. he had to demonstrate that his condition is being managed and he is compliant with his treatment. He was initially denied by everywhere he applied to, but Kaiser was reasonable when he fought the denials.
J.V. answers from Chicago on February 27, 2012
We do a high deductible. It's cheaper if you don't need insurance, but if you do need it, it tends to cost about the same as the low deductible.
L.M. answers from Denver on February 28, 2012
As some others have said, be careful with an individual policy. Normally they do have a pre-existing medical condition stipulation and may deny your application. Make sure you read all of the fine print so you know what to expect.
Honestly, the type of play you get is dependent on your needs. If you don't go in to the doctors much and you're not too worried of future health problems you can go with the lower monthly premium and higher out of pocket copays. I would advise that you pay attention to what the out-of-pocket maximums are on the plan. If you pay out of pocket up to the out-of-pocket maximum then for the rest of the year you will pay no copays for certain benefits. If you know you will have to access care more frequently, or you just want the peace of mind then I would opt for the higher monthly premium and low out of pocket copays.
Kaiser has changed over the years. It is more cutting edge and offers more in their website - like their electronic medical records/ability to email your doctor, nurses or pharmacists and other options. To clarify, Angelina mentioned that you have to get a referral to a specialist with Kaiser and this is not true. You can self-refer to specialists. It is true that you need to use the Kaiser Permanente network, but you can change doctors until you find one that fits with what you are looking for (after all not all doctors are the same). I like how each medical office has a lot of things under one roof - doctor, lab, pharmacy, xray. To be honest, people either really like Kaiser or they don't. It's different than other carriers, and it can take getting used to.
S.B. answers from Redding on February 27, 2012
Are you sure you can pass underwriting with a new insurance carrier?
As an agent, I never knew of carriers issuing policies for someone currently under treatment. Not to be a bummer, but with individual policies, you can be declined for taking certain medications as the cost of the drugs outweigh the price paid in premiums.
That said, people who rarely use their insurance are better off paying the lower premiums and having a higher deductible. The money they save each month can add up and cover the deductible and copays in many instances.
Because of my health issues, I can ONLY get insurance through an employer and it's better for me pay higher monthly premiums to have less out of pocket for the services I need. That is the best scenario for ME, and it can be different for each person.
You might try looking online for the carriers you are interested in to see if you can access "underwriting guidelines". Some health issues that are current or within the last year will result in automatic declination of your application. Others may say that you have to be sign, symptom and treatment free for a specified period of time.
Things may be different in Colorado, but I would certainly look into whether or not you can pass underwriting before applying.
A.U. answers from Colorado Springs on February 28, 2012
Getting individual health insurance is tricky and can be painful. I recently got individual coverage and learned this. First of all, Colorado has a law where health insurance companies can decline individuals for coverage if they have a pre-existing condition. So, read the fine print. Another thing is some companies have a policy where they won't give coverage to those who have had access to a company plan within the last 12 months (Humana for one). If you go to the doctor more than once or twice a year and you are in rehab, you probably want a plan with a lower deductible and as close to 100% coinsurance as possible once you reach your deductible. Understanding all the wording is a hurdle in getting yourself covered the way you want. Kaiser can be good and can be bad, they are usually HMO's, which means you can only go to their doctors and you have to have referrals for specialists. Their premiums are usually high, but usually there is low deductibles and co-pays. With your continuing rehab, it may be difficult to get your own coverage. If you don't understand all the health insurance information, it may be best getting yourself an agent to help. Agents don't cost a thing, and they can help a ton, especially with a pre-existing condition.