Learn Me: Buying Health Insurance

It looks like we have a high probability of Mrs. Deuce taking the road less traveled employment wise in a couple of weeks. This is all very positive for her and the family in general with the notable exception of health insurance. We've been covered under her insurance for the past 17 years on very good plans and have never had to worry about it, so we haven't.
What can you guys tell me about purchasing health insurance on the open market? What is Cobra and how does it work? How do I make sure we don't have a gap in coverage? I know it will be expensive, I'm OK with that, I just want to make sure the family is protected.

Only thing I can answer is Cobra as I've always received insurance through work.

Quick explanation

http://www.bizfilings.com/toolkit/sbg/office-hr/managing-the-workplace/cobra-benefits-what-employers-need-to-know.aspx

Ouch. This is a challenging issue.

So, My wife and son have insurance through the marketplace because the insurance at my job is garbage for families. One observation is the low/medium cost plans on the marketplace are generally nothing more than catastrophic care coverage. If you want anything that resembles a PPO you will be in the highest rung of their offerings. Overall it has been a positive experience.

The main reason my family and I came out ahead is there is a large managed care network in our county. It is a local provider that is a conglomerate of private practices and hospitals (Health First, Brevard). Coverage and physicians have been fantastic, but not all areas have these kinds of organizations. If you do I would call them directly and get a quote for coverage. In our area it was slightly cheaper to go direct than through the marketplace.

Cobra is easy. You leave the job and a week later you have a letter offering Cobra. The letter will detail the FULL cost of the policy of your existing coverage. FULL means it will not longer include your employers contribution. Expect a jump of 100% over what your wife pays per month. The main sticking point is you much fill out the form and submit it with a payment for the first month within a defined period of time(usually 30 days). The check must be perfect with no typos. After that you have a duration that policy is available (12 months?). Payments must be submitted timely and before expiration of policy of they cancel it on the spot. Insurers know that if you are paying for COBRA it is probably because you are planning on using it.

Hope this helps.

Most of my self-employed friends and family are members of not for profit insurance collectives, rather than having a policy with a traditional insurer. Many of them have kids and have had no issues getting reimbursed for procedures/child birth/routine checkups/etc. Most of them are religious based or affiliated around here, but they seem to provide coverage equal to or better than normal insurance for less money. I'd highly suggest looking into something similar based on what I've heard of their experiences.

Thanks for the Cobra explanation. I will have Mrs. Deuce check with the proper HR people once decisions have been made. The current plan is good and the idea is that we will only be without insurance for 3-4 months, so maybe that will be the best option.
So basically I check Cobra prices, check the exchange (or direct to the company) prices, compare benefits and figure out what makes sense? It's really that 'simple'?

Yep, it all about money.
With 4 kids and 2 adults, it will be a lot of money!
If going Cobra, do not miss the window of opportunity. As mentioned, they are required to offer it to you but it is almost as if they don't want you to actually take it.

JohnRW1621 wrote: Yep, it all about money. With 4 kids and 2 adults, it will be a lot of money! If going Cobra, do not miss the window of opportunity. As mentioned, they are required to offer it to you but it is almost as if they don't want you to actually take it.

I think that's more that people are shocked just how much of the cost of their insurance is subsidized by the company for which they work.

Even my previous job where I paid roughly $150/month for my insurance (just for me, single male), the company was paying something like another $295/month.....so not cheap.

And now I work for a huge company and pay something like $35/month for better insurance than at my previous job.

I did an initial pricing on the exchange here in Texas about a month ago and it was about $1500 a month, which is manageable. However I have three kids in braces and orthodontics is covered to some extent under the current plan. I need to figure out what the ongoing costs are and figure that in. We have no regular health costs aside from teeth and eyes and those seem to be the hardest to justify from a cost perspective when going it alone. We have a fairly well stocked HSA that will let us be comfortable with insurance that is pretty much just catastrophic.

My guess is that COBRA will likely not be the appropriate plan for you. I'd be looking at marketplace plans - if it's only 3-4 months I'm speculating that something a step or two up from catastrophic is going to be the best call. It is definitely all about the money, so run the numbers with reasonable assumptions about how often you and your family go to the doctor.

Also, I'm reading between the lines here and presuming that the road less traveled is a new opportunity with an entity that will offer a group health insurance plan after the 3-4 month initial period? If that's the case you can help prepare for the sticker shock by shopping now and having Mrs. Deuce negotiate into her base salary at least part of the cost differential between your current healthcare costs and what you'll be paying for the 3-4 months and beyond. I did that with my job move last year and it helped a lot.

EDIT: just saw your comments about orthodontics - best plan there is to reach out to your orthodontist and explain the situation, and see if you can work a break off the cash price. Dental insurance on the marketplace is worthless (at least for me it was).

As a dentist, I can tell you that unless your employer is subsidizing your dental insurance its not worth buying it on your own. Just set up a Health Saving Acc't and go from there.

As far as medical insurance goes, you just kinda have to decide what sort of exposure you're willing to have, then belly up to the bar and buy the best plan for you and your family.

Thanks guys, this helps me get my ducks in a row. Handling the home financial side of this is my world so Mrs. Deuce can handle the real work.
The funding for this particular adventure requires us to fly solo for 1-6 months. We've prepared for it and the math all works, but psychologically my brain is in constant scream mode.

Oh, boy. I just spent some agonizing hours shopping for insurance a couple months ago so I could fill a book with complaints. I am in a similar situation where premium amount doesn't matter too much. But key takeaway is: if you have any heathcare providers you want to use you need to make sure they're "in-network" for the plans you look at. That includes emergency rooms you might visit and hospitals you might stay at. Family practice doctors, ob/gyns, pediatricians, etc. If they're not in-network, then you're going to end up paying out of pocket and it will not apply toward your deductibles or out of pocket max. And locally the insurance companies have all partnered up with hospital systems so each insurance company only has one hospital system they work with. Obviously that's not for the customer's benefit!

We're in the midst of culberkid # 2 being born (due 4/13!) and had our prior plan discontinued so we had to find new insurance in December. Our OB is not on any plan we could get as individuals. We did not want to change doctors most of the way through a pregnancy, especially since it will be a C-section delivery and this doctor handled the last one for us and did a good job. The doctor's office wasn't being helpful, the insurance companies weren't being helpful, and I was ready to tear my hair out. So I finally talked to the doctor himself during one of our appointments and he said - we'll give you a great cash price. And he did. It's probably less than we would have paid out of pocket even if they had been in network. So it worked out but was a long, difficult process.

Good luck, I hope your local insurance market is less assinine than ours.

Thanks for the tip about in network stuff. There is one hospital that is our "kids are bleeding" go to hospital so I'll make sure they play nice with whoever we go with.

It's tough as a Doc to help patients out with that kind of insurance stuff dculberson. Sometimes I refer patients to specialists, then the patient calls me back saying the specialist doesn't take their insurance.

I'm empathic to that, I certainly don't want them having to pay more than they have to. However I really have no idea what specialists accept what insurance and I can't really have my staff take hours of their time away from their paid duties to research that. I refer based on who I think is best, not who's in network...

Copied here for posterity from FB:

Why is dental insurance such a joke? "Health" insurance: co-pay some number of dollars and whatever the visit requires is covered.

But dental insurance? You need something big and expensive (and necessary, I'm not getting root canals for fun) and your "insurance" has turned into "coupon".

***I say this, literally with a numb jaw from a root canal that after my 50% coupon/insurance still cost me $350. I wasn't planning on another $350 outlay this month and this is gonna make things tight.

Maybe if dental insurance didn't suck so much people would get things done earlier instead of putting it off because they know it's hundreds of dollars.

**** second note, I have good dental insurance. It's just a E36 M3 scam by the money grubbing bastards who run the insurance companies.

I left my employer in December and was in a similar spot. There was an interesting disclosure in the COBRA paperwork to the effect that you may be able to buy similar or more suitable coverage on the open market and to compare the plans available at healthcare.gov, so I did. We found a silver plan that is as good as my former employer's plan at $745/mo instead of $1,000 and took it based on what we needed. There were a ton of choices so take stock of what you need the plan to do and how much financial exposure you can tolerate.

Pay attention to 1) the premium; 2) copays and coinsurance and whether either is before or after the deductible; and 3) OOP max and see which plan best meets your needs. For instance, plan A might have low premiums and low out of pocket max but 30% coinsurance before the deductible and co-pays on everything. Plan B might be a few bucks more but have a fixed copay on hospital admission and only 20% coinsurance, but have a greater OOP max. Plan C might have the highest premiums with low coinsurance and copays and a moderate OOP max.

I COBRA'd the vision and dental for now and took a new health plan. We will be able to obtain employer-sponsored coverage in May and will probably drop the COBRA and govt. plans at that time. Good luck to your wife, you and your family with her new situation.

docwyte wrote: As a dentist, I can tell you that unless your employer is subsidizing your dental insurance its not worth buying it on your own. Just set up a Health Saving Acc't and go from there.

The same advise my dentist gave me when I was getting ready to retire. Even though my employer would subsidize a small part of my dental insurance he recommended not continuing the insurance.

For the next 7 years I kept track of what I would have paid for the insurance and what I would have had to pay for the work I had done. Even though I had a root canal and a couple crowns done I was $1K ahead by not paying for the insurance.

KyAllroad, that's because dental insurance isn't really an insurance plan. It's a defined benefit plan. They'll pay a percentage of a procedure (what percentage is based on what procedure and what plan you have) up to a set maximum a year.

That maximum is quite low, typically $1000-1500 a year. I have to point out that the maximum amount hasn't changed in well over 30 years, while the costs of dental procedures have.

Don't like it? Bitch to your HR! We, as docs, have nothing to do with the insurance plans other than getting screwed over.