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Ideal Insurance

Typically we try to not inundate readers with the same question, but Melissa's is specific and nuanced enough that we thought it would benefit others.  Where can Melissa find the right insurance plan?

I'm in the midst of changing the health insurance plan for my daughter and myself. I'm self-employed and my husband's plan is pathetic, not to mention insanely expensive, so the kiddo and I currently have the highest level individual coverage plan through Kaiser which we barely ever use. This is such a waste of our money. My ideal plan would look something like this...

  • western medical emergency insurance plus coverage of dermatology
  • natural healthcare coverage for naturopaths, acupuncture, etc.
  • dental

Am I dreaming? Do any of you have experience navigating individual plans? I can't imagine I'm alone in looking for this. Maybe what I need to do is get just emergency insurance and then pay out of pocket for the rest. (?) Ugh. It's overwhelming and I keep putting it off. Then we get our bill and I freak out thinking what we could have done with all that money. The insurance industry is disgusting. But that 's not my point... Folks, we need your help here. Thank you very kindly!

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regence blue cross blue shield offers what I consider to be reasonable prices for family and individual plans, and you can add dental for $25/person/month, although you can only go to willamette dental (not our favorite, I actually just dropped the dental coverage so we could go somewhere else). there's no coverage for alternative care, but you could go with a higher deductible plan for emergencies and pay for that out of pocket.

From everything I've heard, unless you foresee major dental issues, it is not worth is to pay for dental insurance. You'll pay a lot more in the long-run than you would for typical services needed.

I suggest that you check out the new High Deductible Plans and set up a Health Savings Account. We recently were faced with very similar circumstances and the math works assuming that you can pay for your first few thousand of expenses per year. The monthly payment for our family (father and 3 kids) went from $870/month at Kaiser for the everything plan to $133/month with a $5200 deductible. Sounds crazy but the math actually works out similar if you apply the savings from your monthly payment toward the deductible. And the best part is that you can apply your non-traditional care toward the deductible (acupuncture, chiropractic, etc.) which is where we spend most of our medical dollars. I'm not sure how to find them as a self insured person because we got this through my husbands work. The other interesting thing about the HSA is that is also an investment vehicle by putting money into the HSA account to pay for your medical expenses. The account grows without taxes like an IRA. You can choose to use it to pay your expenses or simply sit on it and let the investment grow tax free every year. Bit of a loophole in the system but one you can take advantage of if you have enough flexiblity in your cash flow.

You might look at ODS. Our family is currently on Kaiser, but we are about to switch to ODS and both our pediatric dentist (which we currently pay out of pocket for) and our naturopath (which we also pay out of pocket for) both participate with ODS.

We also just started with an HSA (Health Savings Account). We are paying around $250 a month for a family of 4 with a deductible of $5000. We contacted Dean Adkins of Insurance NW. 503-590-9178 or dean.adkins@comcast.net He was great! He sent us the following info. on HSAs. Very interesting!
"The best development in the health insurance field for many years are plans structured to include a Health Savings Account (HSA). The Health Savings Account structure can sound a little intimidating at first but the concept is sound and really not too complex. There are 2 components, an insurance policy and a related savings account. The insurance policy functions similar to a "traditional" insurance policy, but because it meets Federal guidelines you are allowed to establish a special savings account. The concept is to keep more of your money in your pocket/control. It is the only plan that you can benefit from without being sick or injured.

For comparison; a traditional Blue Cross plan with a $500 deductible would cost $548 per month. An HSA with a $3,000 deductible through Assurant Health would run $258 per month. If you put $290 per month into your HSA the cash flow each month would be exactly the same. However, at the end of the year on the Blue Cross plan you would have $0 in your account and probably some additional out of pocket expense for services below the deductible level. With the HSA plan your account would have a balance of $3,480 and tax savings of roughly $1,148 for a net upside of $4,628. Of course that example assumes that you have no medical expenses. Let's assume that you develop chronic headaches and visit the doctor's office 3 times before he recommends an MRI that costs $1,000. With Blue Cross you would pay $25 per visit, the first $500 of the MRI, and 20% of the remaining $500, a total of $675 out of pocket. With the Assurant HSA plan the doctor visits would run about $60 per (after PPO discount) and the MRI (a covered expense but below the plan deductible) would cost $1,000, a total of $1,180. ($505 more than the Blue Cross coverage) If you reduce the net upside of the HSA by the $505 of additional expense in this example the HSA plan still keeps $4,123 more in your pocket. If you had a major illness that came to $50,000 the Assurant coverage would still be a better plan.

Out of Pocket Expense on $50,000 medical bill

Assurant Blue Cross
Deductible + 75/25 to $2,000 max $5,000 $4,500 Deductible + 80/20 coinsurance to $4,000 max
Annual Premium $3,096 $6,576 Annual Premium
Total out of pocket $8,096 $ 11,076 Total out of pocket

In healthy years you enjoy tax breaks and accumulate savings in your account, in a worst case scenario you would still be thousands ahead. The HSA money is available for nearly any medical expense you deem worthy (including dental and vision) without tax consequence. Deposits up to $5,650 per year are allowed by the Federal rules. The premium and HSA deposits are 100% tax deductible."

you can always go to ehealthinsurance.com for options with a detailed list of what it covers. it'll give you a list of insurance companies that meets your need and lets you compare what they have to offer so that you have more options to choose from price deductibles and all.

thank you all SO much for this help.

ODS + an HSA looks good. time to go do my own research...

be well!

This is great info. I just quit my job and will COBRA for awhile but probably will need to explore something more cost effective. Besides the net-referral and the person listed above, any other places that make sense to start? As an individual person can I just call one of these companies and get a plan going?

regence has the best plans around in terms of coverage -- bcbs plans tend to be that way. just watch out of you have pre-existing conditions -- as a self employed purchaser of private insurance, you can get turned down for *any*thing.

i'm self-employed too, and did COBRA for way longer than i could afford because i was pregnant and had other health issues. DH and i wound up doing a quick-and-dirty impromptu weddin' for the health insurance -- how utterly romantical, huh?

When I purchased an individual plan several years ago, the agent I dealt with was Holly Worthington. She emailed me lots of comparison charts so I could pick the right policy. holly@austin-worthington.com is her email.

Thanks for the referral! I contacted Holly Worthington and she was a tremendous help. I recommend her to anyone looking to switch insurance plans. She really held my hand through the entire process, even staying late at work to thoroughly answer my questions.

You should fly over to Australia if you want insurance plans that don't disappoint. The options are limitless here, and all at affordable prices.

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