Is Self Insuring a Better Deal overall??~Edited~

I don't have any advice, just wanted to let you know... I am still $11,570 in medical debt from ONE arm break... I just happened to break it in such a way that required surgery and therapy (snapped both bones in my forearm, twisted the muscles all up, and damaged nerves.) This was 4 years ago, and I have been making payments the whole time... I had a savings account for "emergencies" but this completely drained it. My uncle was uninsured for years, then finally got on his fiance's insurance. At his next doctor's visit, he was diagnosed with leukemia and had to start medication for that... which would have cost him $700 a MONTH just for his prescription... not counting his oncologist visits, or any of the other tests and procedures... You never know what will happen.

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Well... we had a "catastrophic coverage" policy last year, and I am sorry to say it absolutely sucked. My husband had surgery rather unexpectedly at the beginning of the year, so we had to pay $3500 immediately. (By the way, the family premium for this policy was nearly $900/month. Thanks, Blue Shield!) So, with the $3500 deductible out of the way, absolutely everything from soup to nuts should have been covered for the rest of the year. Right? WRONG! We still ended up getting hit with all kinds of charges - all of which were supposed to be covered. Long story short, we switched to Kaiser this past January, yet I am still (STILL!) fighting with Blue Shield to get costs covered that they should have covered in the first place. (For instance, they tried to say our daughter hadn't met the deductible, when we had already met the family deductible... they did this for every member of the family.)

However, I must say that I have been very pleasantly surprised by Kaiser. We have had no issues at all in terms of coverage, and the care we've received has actually been equal to what we had with Blue Shield (but WAY easier to get referrals). The cost of Kaiser is about equal to our catastrophic coverage policy with Blue Shield, surprisingly. Just a thought.

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I was without insurance during several periods of my life and found out the doctors, hospitals, and medicines all billed at the cash rate(much higher than an insured person pays). Even with a "cash discount" it cost much more for even a 4 day hospitalization than Cobra did.

My parents Major Medical covers only after they pay $10,000 each out of pocket and the paperwork THEY have to file and refile is a nightmare.
I have developed ongoing medical issues so I would never be without insurance again unless I ran out of money.

If you check on your car insurance and home owner's policies, you might find out there is a medical limit of $500 or $5000 per person, per incident.
They vary. When my husband was hit by an uninsured motorist, we had to hire an attorney to sue our own insurance company for payment. Then our health insurance company decided to bill us for everything they paid out. We cleared $6000 which did not cover our lost wages at all.

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7 years ago we started our own business and immediately just went out and got our own insurance with Bc/BS and it started out at less than $300 a/month for the 4 of us (no maternity). Strickly catistrophic insurance. I love it. We don't run to the doctor for any little thing anyway and we're a pretty healthy group so it was the way to go. We've saved WAY over what we would have to pay out in deductable in the savings every month. We have BC/BS select, but a wonderful agent who can price lots of different kinds. I've had people call me to try and get us to switch, but they can't beat the price for what we've got. The doctors also give us the BC/BS discount when we do go, so we're not paying premium "at the pump" so to speak.

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Why not look into a Health Savings Account instead. You contribute money (tax free) to an HSA and have a higher deductable, but your preventative visits are still covered 100%. Your premiums are much lower every month and the HSA money rolls over the next year. I was against it until we tried it this year. We ended up saving about 3000$ on insurance this year alone. Of course, we don't have any major medical issues and are generally healthy. Look into it!

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I'm in TX also. We own two businesses and have been self-insured or without insurance for 6 years. Most insurances are pretty expensive and cover very little. There are short-term insurances out there. BCBS of TX has one. My personal opinion is that if you are pretty healthy overall and don't expect to get pregnant, just hold off and pray nothing happens until December. If you must go to the doctor, ask the doc to prescribe something that has a generic. Kroger and Wal-Mart fills most generics for less than $10. I always used Walgreens before I knew that. We just got insurance again this year after being without for 2 years. Our insurance before didn't even cover office visits, and we never went really, so we were paying a lot, I mean A LOT, for the 'what-if?' We have BCBS of TX now and have been happy. My son had to have surgery and it was useful. He is also going to the chiropractor and it has been useful for that also. I hope that helps! :)

I wanted to add the following:
The last I checked, and I've done EXTENSIVE research, there was NO private insurance that covers maternity, or L&D in TX. I had one agent tell me they were not legally allowed to cover those things. There are maternity insurances available through private networks, but, my last two were 'surprises' so those did us no good.

Here is a link to the BCBS short-term insurances. They cover hospital things and it is there until the new job insurance kicks in.
http://www.bcbstx.com/coverage/individual/temporary.html

Also, if self-insurance was something you were looking into for the long haul, this is what I have found to be better for my family, since we are so healthy overall. We go with the lower monthly payments, with the higher deductible. The reason is, we pay less per year, and, the insurance is there for the 'what-if' factor. Meaning, I would only have to pay that $10k IF something happened. Otherwise, I would pay the $10k per year if nothing happens, and, have to pay the $2k deductible. Because to get the lower deductible, you pay A LOT more per month. So, we put some in savings to be there for the 'what-if' factor instead of throwing it away to a monthly premium and most likely never have to use it for the major something. This way, we save a lot more IF we do have to use it for that major something. I hope I said this in a way that you can understand. I had an agent explain that to me. I am glad he did. Otherwise I would be throwing that money away monthly and I have never needed it. My son's surgery was outpatient so it was handled differently and we just had to pay a co-pay.
I do suggest contacting an agent. It is free, and, though overwhelming at first, they really do help you out a lot. :)

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THere is such a thing as temporary medical coverage. You buy the plan for up to 6 moths and you have the option of renewing it one time for up to 6 months. Blue cross/ blue shield has one. We bought a policy like this from them when my DH was in between medical coverage. It is very affordable and will cover all the major stuff. It will not over maternity, though. Very few independent medical policies will. Those that do are incredibly expensive.
I had my 2nd baby without insurance and believe it or not, it was cheaper to just pay to have him out of pocket than it would have to go through insurance with all the deductibles and co-pays. The hospitals and drs. give you a HUGE discount if you pay in cash in advance!

Good LUck!

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We've got a high deductible health plan where I work. Essentially coverage applies once we meet the $2,500/per person or $5,000 family deductible. My boss pays for my coverage, but we moved our kiddos over to the plan also when I had our 2nd last year.
It is so much cheaper than the premiums on my husband's low co-pay plan. Any preventative visits are covered- well-checks for the kids, my well-woman, so we just have to pay for any other dr visits and prescriptions.
One benefit to having a high deductible plan is you can set up a Health Savings Account or FSA (I think that's the other program). This allows you to set aside pre-tax funds to use for medical expenses.

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Do your research - make sure you understand the coverages, the exceptions, any lifetime maximums etc - read the fine print and understand that the insurers have the right to change the terms at any time. And as the poster said below there is no coverage for maternity except on a group plan - so make sure you do not plan to get pregnant (and adequately prevent it). If you have access to group coverage I would stick with it - that is by far the best option in the US for health insurance. I do have friends that are self-employed with high deductible insurance (a deductible of $10k per year) but they still have high monthly premiums and co-pays. That is an option if you can have $10k waiting in a bank account solely for payment of the deductible, and if you do not plan to get pregnant, but I would definitely stick with group insurance if you have access to it.

What you described is the way insurance should be used in my opinion. "just for the big things" Unfortunately, insurance has gotten way out of control so I'm not sure how much luck you'll have in finding a policy that covers just the big items. I personally think it's ridiculous for our family to pay $500 a monthly in insurance premiums plus the co-pays for office visits when the uninsured office visit rate would only be about a $200. This past year, we only went to the doctor for our annual check-ups so we paid $6000 for something that should have cost us under a $1000(assuming $200 per visit). I get that I would need to add some cost in for the "big item" coverage, but $5000 a year in case you need something big seems like a huge waste of money? I agree with you that if you can find something like this that it would most definitely save your family money. I think insurance is the biggest problem with this countries health care. If we could get them out of the picture more, then the cost of medical procedures would go down and more people could afford care without insurance. People don't need insurance, people need health care. The biggest reason something like this is hard to find is b/c most families have trouble saving the money, so if you guys are good savers, then go for it. I hope this works out for you!