Check my health insurance plan for Evil

evilmrhenry

My health insurance is dropping me at the end of this month. (Non health-related reasons.) I've found another plan for $88/month, but health insurance companies have a "reputation", so I want someone to look at this who isn't out to screw me. I'm specifically wanting to know if there are any gotchas in here.

I don't have any health problems with ongoing expenses. Young male, my limit for health insurance is around $100/month.

GroupHealth Balance 2500 Catastrophic Plan

Details at a Glance

* Plan Type
* POS
* Office Visit for Primary Doctor
* $30, deductible waived
* Office Visit for Specialist
* $30, deductible waived
* Coinsurance
* 40% after deductible
* Annual Deductible
* Individual:$2,500
* Separate Prescription Drugs Deductible
* None
* Prescription Drugs
* Generic: Not Covered
*
* Brand: Not Covered
*
* Non-Formulary: Not Covered
* Annual Out-of-Pocket Limit
* Individual:$8,000
Does not include deductible
* Lifetime Maximum
* $2 Million per person
* Health Savings Account (HSA) Eligible
* No
* Out-of-Network Coverage
* Yes (Details in plan brochure below)
* Out of Country Coverage
* Emergency Care Only. Paid as out-of-network benefits
* Rate Guarantee
* July 1-June 30 View Detail
* Find Doctors (Search to see if your doctors are part of this plan's network.)

Physicians

* Primary Care Physician (PCP) Required
* Yes
* Specialist Referrals Required
* No

Preventive Care Coverage

* Periodic Health Exam
* $30, deductible waived
* Periodic OB-GYN Exam
* $30, deductible waived
* Well Baby Care
* $30, deductible waived

Prescription Drug Coverage

* Generic Prescription Drugs
* Not Covered
* Brand Prescription Drugs
* Not Covered
* Non-Formulary Prescription Drugs Coverage
* Not Covered
* Mail Order for Prescription Drugs
* Not Available
* Separate Prescription Drugs Deductible
* None

Hospital Services Coverage

* Emergency Room
* $100 Copay + 40% Coinsurance after deductible
* Outpatient Lab/X-Ray
* First $500 covered in full, then deductible and coinsurance apply
* Outpatient Surgery
* 40% coinsurance after deductible
* Hospitalization
* $100 per day up to 5 days per admit + 40% coinsurance after deductible

Maternity Coverage

* Pre & Postnatal Office Visit
* Not covered
* Labor & Delivery Hospital Stay
* Not Covered

Additional Coverage

* Chiropractic Coverage
* $30, deductible waived; 10 visits combined for both in- and out-of-network per calendar year
* Mental Health Coverage
* $30 copay, deductible waived

Additional Information

* A.M. Best Rating
* NR-5 as of 03/29/2010
* Application Fee
* No
* Electronic Signature for Application Available
* Yes
* Will insurance company obtain and pay for medical records?
* N/A

MagicToaster

The fact that it doesn't cover brand name drugs and generics kinda sucks. Also, it has no dental or vision coverage, which kinda sucks too. Check to see if your physicians accept that plan.

I'm sure you can find a better plan.

My company also sells these really cheap plans, but in a single year the price went from $60 to $120 due to rises in premiums and operational costs. The rates on these plans tends to go up after a while, keep an eye on this.

Cauld

40% coinsurance means you pay 60% of the bill after the $2,500 deductible. I wouldn't call that spectacular in any way.

Your max annual out-of-pocket is $8k. So for any bill under $2,500 you pay it all and for any bill between $2,500 and $16,250 you pay $2,500 + 40%(cost - $2,500). Anything over $16,250 you pay $8k.

My math could be wrong though, I'm pretty tired.

Edit: All my math was for 60% coinsurance, so it's wrong and I don't feel like fixing it right now. You get the idea though, there's not much your insurance will really help you with.

Void Slayer

wait... if I read this right for the emergency hospitalization or surgery is you would pay $100, then the next $500 would be covered, then you would be on the hook for the next $2500(if it was the first thing this year) then they would cover 40% of anything above that. So a $10000 emergency room visit would cost you $6800. Unless this is cheap as hell monthly payments it is terrible.

Medical insurance is generally suppose to protect you against these types of giant costs. I am probably reading his wrong if someone understands this better.

Edit: beat to it with a better explanation, not as bad as I said but still kinda crummy.

wogi

Um, that plan is pretty far to the evil side of the scale.
You pay for your own drugs - all of them - (note that my relatively simple, small prescription for xyzol is 114 dollars) you pay for most of just about everything else. $88/month is a little pricey for a plan that has you paying for so much. This wont ever be much of a help to you. Your out of pocket expense is still pretty high.

Shop around more.

evilmrhenry

Alright, useful information. How about this plan? It includes drug coverage (I hope), a lower coinsurance, and a lower max per year. (Coinsurance looks like the percent I pay.) It's $105/month instead of $88, but that's fine.

Also, I don't have a doctor now, so I'm not worried about doctor-insurance compatibility.

WiseEssentials Rx $2500
Details at a Glance

* Plan Type
* PPO
* Office Visit for Primary Doctor
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible
* Office Visit for Specialist
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible
* Coinsurance
* 25% after deductible
* Annual Deductible
* Individual:$2,500
* Separate Prescription Drugs Deductible
* None
* Prescription Drugs
* Generic: $15 Copay ($3000 maximum per calendar year). 30-day supply
*
* Brand: Discount Program
*
* Non-Formulary: Discount Program
* Annual Out-of-Pocket Limit
* Individual:$7,500
Includes deductible
* Lifetime Maximum
* $2 Million per person
* Health Savings Account (HSA) Eligible
* No
* Out-of-Network Coverage
* Yes (Details in plan brochure below)
* Out of Country Coverage
* Yes. Call for details
* Find Doctors (Search to see if your doctors are part of this plan's network.)

Physicians

* Primary Care Physician (PCP) Required
* No
* Specialist Referrals Required
* No

Preventive Care Coverage

* Periodic Health Exam
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible
* Periodic OB-GYN Exam
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible
* Well Baby Care
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible

Prescription Drug Coverage

* Generic Prescription Drugs
* $15 Copay ($3000 maximum per calendar year). 30-day supply
* Brand Prescription Drugs
* Discount Program
* Non-Formulary Prescription Drugs Coverage
* Discount Program
* Mail Order for Prescription Drugs
* Generic: $40 Copay ($3000 maximum per calendar year). 90-day supply
*
* Brand: Discount Program
*
* Non-Formulary: Discount Program
*
* Days Supply: 90
* Separate Prescription Drugs Deductible
* None

Hospital Services Coverage

* Emergency Room
* $100 Copay (waived if admitted), plus 25% Coinsurance after deductible
* Outpatient Lab/X-Ray
* 25% Coinsurance after deductible; No charge for Preventive Screenings
* Outpatient Surgery
* 25% Coinsurance after deductible
* Hospitalization
* 25% Coinsurance after deductible

Maternity Coverage

* Pre & Postnatal Office Visit
* Not Covered
* Labor & Delivery Hospital Stay
* Not Covered

Additional Coverage

* Chiropractic Coverage
* $25 Copay, deductible waived, 12 Visits Per Year
* Mental Health Coverage
* Outpatient:
First 6 visits PCY: 25% Coinsurance, deductible waived
Additional visits: 25% Coinsurance after deductible
Inpatient: 25% Coinsurance after deductible

Additional Information

* A.M. Best Rating
* A- as of 06/16/2010
* Application Fee
* No
* Electronic Signature for Application Available
* Yes
* Will insurance company obtain and pay for medical records?
* N/A

Thanatos

Are you anything other than a healthy 18-to-30-year-old? Do you have any assets you need to protect? Do you have a family (like, wife and/or kids)?

If your answer to all of those questions is "no," you should seriously consider whether health insurance is worth it at all. There's something to be said for not having a coverage gap, but there's also something to be said for not flushing $1200 a year down the drain.

evilmrhenry

Thanatos wrote: »

Are you anything other than a healthy 18-to-30-year-old? Do you have any assets you need to protect? Do you have a family (like, wife and/or kids)?

If your answer to all of those questions is "no," you should seriously consider whether health insurance is worth it at all. There's something to be said for not having a coverage gap, but there's also something to be said for not flushing $1200 a year down the drain.

Let's go with "assets I need to protect". Not a lot, all things considered, but $1200/yr still looks reasonable.

Deebaser

The utility of HSA eligible plans for health individuals is based entirely on how much more than the premium can you really afford to sock away.

Can you afford $200-$300 a month? Because on top of the premium you should really set aside a few hundred bones to lay towards your deductibles and coinsurance BEFORE you actually need services.

The good news is that if you open up an HSA all that money gets taken out PRE-tax and you can use it for any health insurance expenses, whenever.

And don't consider the plan with no Rx rider, medications are fucking expensive and you will eventually get dicked over, hard.

Kakodaimonos

There is a cap on HSA contributions for the year. It's $2000 for the entire year. But you can carry over the HSA from year to year.

Darkewolfe

Thanatos wrote: »

Are you anything other than a healthy 18-to-30-year-old? Do you have any assets you need to protect? Do you have a family (like, wife and/or kids)?

If your answer to all of those questions is "no," you should seriously consider whether health insurance is worth it at all. There's something to be said for not having a coverage gap, but there's also something to be said for not flushing $1200 a year down the drain.

This is awful advice. Get a cheap plan and keep from going uncovered for a stretch. Thanatos is generally full of bad advice.

ceres

Darkewolfe wrote: »

Thanatos is generally full of bad advice.

No.

Crius

The standard office visit rate for the first plan:

* Office Visit for Primary Doctor
* $30, deductible waived

Looks a bit better than the second:

* Office Visit for Primary Doctor
* First 6 visits PCY (shared between all Office visits and Preventive Exams): 25% Coinsurance, deductible waived

Unless an office visit generally costs less than $120 total.