John Bruh Posted February 22, 2011 Report Share Posted February 22, 2011 I do not currently have health insurance and it's not offered by my employer. What do i need to know about buying insurance. I'm 23, my son is 2 next month. I'm looking for a lower deductable, 1000-2500. I've been finding celtic, united one, and anthem for 120-200. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 example 1 CeltiCare Preferred Select PPO 100/0 Plan Not Yet Rated Overview Optional Benefits Customer Reviews Information below describes the in-network coverage for this plan. The amounts shown are your share of the costs for covered benefits. Details at a Glance Plan TypePPO Office Visit for Primary Doctor$15 copay (2 visits - primary and specialist combined). 3+ visits No charge after deductible Office Visit for Specialist$15 copay (2 visits - primary and specialist combined). 3+ visits - No charge after deductible CoinsuranceNone Annual Deductible Family:$5,000($2,500 per person) Separate Prescription Drugs Deductible$500 deductible for Brand and Non-Formulary Only. See brochure for additional RX option Prescription Drugs Generic: $10 Copay Brand: $40 Copay ($10 Copay +100% cost difference between brand and generic if generic substitute available) Non-Formulary: 30% coinsurance Annual Out-of-Pocket Limit Family:$5,000($2,500 per person) Includes deductible Lifetime MaximumUnlimited Health Savings Account (HSA) EligibleNo Out-of-Network CoverageYes (Details in plan brochure below) Out of Country Coverage Emergency Care Only. While traveling for up to a maximum of 90 days; Paid at out of network benefit level Rate Guarantee 12 months. View Detail Find Doctors (Search to see if your doctors are part of this plan's network.) Physicians Primary Care Physician (PCP) RequiredNo Specialist Referrals RequiredNo Preventive Care Coverage Periodic Health ExamEligible Expenses covered 100% (no deductible) Periodic OB-GYN ExamEligible Expenses covered 100% (no deductible) Well Baby CareEligible Expenses covered 100% (no deductible) Prescription Drug Coverage Generic Prescription Drugs $10 Copay Brand Prescription Drugs $40 Copay ($10 Copay +100% cost difference between brand and generic if generic substitute available) Non-Formulary Prescription Drugs Coverage 30% coinsurance Mail Order for Prescription Drugs Generic: $25 Copay Brand: $100 Copay Non-Formulary: 30% Coinsurance Days Supply: 90 Separate Prescription Drugs Deductible $500 deductible for Brand and Non-Formulary Only. See brochure for additional RX option Hospital Services Coverage Emergency Room$250 additional deductible per visit (waived if admitted) plus annual deductible Outpatient Lab/X-RayNo Charge after deductible Outpatient SurgeryNo Charge after deductible HospitalizationNo Charge after deductible Maternity Coverage Pre & Postnatal Office VisitNot Covered Labor & Delivery Hospital StayNot Covered Additional Coverage Chiropractic CoverageNo charge after deductible. Covered up to $500 per person per year. Mental Health CoverageNo Charge after deductible Additional Information A.M. Best RatingB++ as of 02/19/2010 Application Fee No Electronic Signature for Application Available Yes Will insurance company obtain and pay for medical records? Yes Additional information about this health insurance plan is available in the documents below. Plan Brochure * Exclusions and Limitations * 183/mo. http://www.ehealthinsurance.com/ehi/ifp/all-plans Quote Link to comment Share on other sites More sharing options...
2pointslow Posted February 22, 2011 Report Share Posted February 22, 2011 Go with anthem, they are decent. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 Insurance Plan Benefit Details *Please read legal disclaimers at the end of this printout. Talk to a live representative at 1-800-977-8860 Monday-Friday 5am-9pm PT. Sat & Sun 7am-4pm PT Live chat is also available at our website at http://www.ehealthinsurance.com 24x7. Your Quote Summary and Quote Number: Coverage for: Applicant (M/23), Child (M/1) State / Zip Code: OH / 43062 County: LICKING Coverage Start Date: 03/01/2011 Quotes generated on 02/22/2011 $138.26 Monthly Cost CeltiCare Preferred Select PPO 80/20 Plan Not Yet Rated Overview Optional Benefits Customer Reviews Information below describes the in-network coverage for this plan. The amounts shown are your share of the costs for covered benefits. Details at a Glance Plan TypePPO Office Visit for Primary Doctor$15 copay (2 visits - primary and specialist combined). 3+ visits 20% Coinsurance after deductible Office Visit for Specialist$15 copay (2 visits - primary and specialist combined). 3+ visits 20% Coinsurance after deductible Coinsurance20% after deductible Annual Deductible Family:$5,000($2,500 per person) Separate Prescription Drugs Deductible$500 deductible for Brand and Non-Formulary Only. See brochure for additional RX option Prescription Drugs Generic: $10 Copay Brand: $40 Copay ($10 Copay +100% cost difference between brand and generic if generic substitute available) Non-Formulary: 30% coinsurance Annual Out-of-Pocket Limit Family:$9,000($4,500 per person) Includes deductible Lifetime MaximumUnlimited Health Savings Account (HSA) EligibleNo Out-of-Network CoverageYes (Details in plan brochure below) Out of Country Coverage Emergency Care Only. While traveling for up to a maximum of 90 days; Paid at out of network benefit level Rate Guarantee 12 months. View Detail Find Doctors (Search to see if your doctors are part of this plan's network.) Physicians Primary Care Physician (PCP) RequiredNo Specialist Referrals RequiredNo Preventive Care Coverage Periodic Health ExamEligible Expenses covered 100% (no deductible) Periodic OB-GYN ExamEligible Expenses covered 100% (no deductible) Well Baby CareEligible Expenses covered 100% (no deductible) Prescription Drug Coverage Generic Prescription Drugs $10 Copay Brand Prescription Drugs $40 Copay ($10 Copay +100% cost difference between brand and generic if generic substitute available) Non-Formulary Prescription Drugs Coverage 30% coinsurance Mail Order for Prescription Drugs Generic: $25 Copay Brand: $100 Copay Non-Formulary: 30% Coinsurance Days Supply: 90 Separate Prescription Drugs Deductible $500 deductible for Brand and Non-Formulary Only. See brochure for additional RX option Hospital Services Coverage Emergency Room$250 additional deductible per visit (waived if admitted) plus annual deductible Outpatient Lab/X-Ray20% Coinsurance after deductible Outpatient Surgery20% Coinsurance after deductible Hospitalization20% Coinsurance after deductible Maternity Coverage Pre & Postnatal Office VisitNot Covered Labor & Delivery Hospital StayNot Covered Additional Coverage Chiropractic Coverage20% after deductible. Covered up to $500 per person per year. Mental Health Coverage20% Coinsurance after deductible Additional Information A.M. Best RatingB++ as of 02/19/2010 Application Fee No Electronic Signature for Application Available Yes Will insurance company obtain and pay for medical records? Yes Additional information about this health insurance plan is available in the documents below. Plan Brochure * Exclusions and Limitations * Quote Link to comment Share on other sites More sharing options...
04silvrz Posted February 22, 2011 Report Share Posted February 22, 2011 what ever you do, get some freaking insurance! couldn't imagine not having it. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 Go with anthem, they are decent. they seem to cost more and not cover the same. Like celtic has office visits for $15. My son will have to have these as well as I want to get a regular exam often now. Anthem wanted like 35% after deductable. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 what ever you do, get some freaking insurance! couldn't imagine not having it. yeah i've been lucky not have any real major healt stuff. It cost me 2500 last year w.o insurance so once i get it ill pay less than that normally lol. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 also what is coininsurance. most plans im looking at are 20%, some are 0% Quote Link to comment Share on other sites More sharing options...
04silvrz Posted February 22, 2011 Report Share Posted February 22, 2011 i pay like 80 every 2 weeks for mine. It include lots of extra critical care stuff, and like some aflac type thing. That's just for me though. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 i pay like 80 every 2 weeks for mine. It include lots of extra critical care stuff, and like some aflac type thing. That's just for me though. who's it through? Quote Link to comment Share on other sites More sharing options...
04silvrz Posted February 22, 2011 Report Share Posted February 22, 2011 Blue Cross Blue Shield Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 it looks as if the first two have limits on doctors visits. this one doesnt. Insurance Plan Benefit Details *Please read legal disclaimers at the end of this printout. Talk to a live representative at 1-800-977-8860 Monday-Friday 5am-9pm PT. Sat & Sun 7am-4pm PT Live chat is also available at our website at http://www.ehealthinsurance.com 24x7. Your Quote Summary and Quote Number: Coverage for: Applicant (M/23), Child (M/1) State / Zip Code: OH / 43062 County: LICKING Coverage Start Date: 03/01/2011 Quotes generated on 02/22/2011 $211.40 Monthly Cost Freedom Choice $2,500 Not Yet Rated Overview Optional Benefits Customer Reviews Information below describes the in-network coverage for this plan. The amounts shown are your share of the costs for covered benefits. Details at a Glance Plan TypePPO Office Visit for Primary Doctor$25 Copay Office Visit for Specialist$25 Copay Coinsurance20% after deductible Annual Deductible Family:$5,000($2,500 per person) Separate Prescription Drugs Deductible$250 deductible per person (3 persons maximum) Prescription Drugs Generic: $15 Copay Brand: $25 Copay plus 20% coinsurance Non-Formulary: $25 Copay plus 20% coinsurance Annual Out-of-Pocket Limit Family:$4,000($2,000 per person) Does not include deductible Lifetime MaximumUnlimited Health Savings Account (HSA) EligibleNo Out-of-Network CoverageYes (Details in plan brochure below) Out of Country Coverage No. While traveling on business or for pleasure outside the United States for less than 90 days, charges incurred for services or supplies that would have been covered in the United States will be covered. Find Doctors (Search to see if your doctors are part of this plan's network.) Physicians Primary Care Physician (PCP) RequiredNo Specialist Referrals RequiredNo Preventive Care Coverage Periodic Health ExamNo Charge Periodic OB-GYN ExamNo Charge Well Baby CareNo Charge Prescription Drug Coverage Generic Prescription Drugs $15 Copay Brand Prescription Drugs $25 Copay plus 20% coinsurance Non-Formulary Prescription Drugs Coverage $25 Copay plus 20% coinsurance Mail Order for Prescription Drugs Generic: $30 Copay plus 20% coinsurance Brand: $50 Copay, plus 20% coinsurance Non-Formulary: Not offering Days Supply: 90 Separate Prescription Drugs Deductible $250 deductible per person (3 persons maximum) Hospital Services Coverage Emergency Room$100 Deductible plus 20% coinsurance after deductible (waived if admitted) Outpatient Lab/X-Ray20% coinsurance after deductible Outpatient Surgery20% coinsurance after deductible Hospitalization$250 deductible per confinement plus 20% coinsurance after deductible Maternity Coverage Pre & Postnatal Office VisitNot Covered Labor & Delivery Hospital StayNot Covered Additional Coverage Chiropractic Coverage20% coinsurance after deductible, 10 visits per year Mental Health CoverageInpatient Treatment: 20% coinsurance after deductible + Limited at $250 a day. Outpatient Treatment: 50% Coinsurance after deductible + Limited to a $25 per visit. Substance Abuse Coverage Inpatient Treatment: Not Covered.� Outpatient Treatment: 50% Coinsurance after deductible + Limited to a $25 per visit. Out-of-Network Coverage Out-of-Network Authorization Required No Out-of-Network Deductible 5000/15000 Out-of-Network Coinsurance 60% Out-of-Network Out-of-Pocket Limit 8000/16000 Additional Information A.M. Best RatingA+ as of 12/23/2010 Application Fee No Electronic Signature for Application Available Yes Will insurance company obtain and pay for medical records? Yes Additional information about this health insurance plan is available in the documents below. Plan Brochure Exclusions and Limitations can anyone give me any info on these? Quote Link to comment Share on other sites More sharing options...
Supplicium Posted February 22, 2011 Report Share Posted February 22, 2011 Ive had good luck with Assurant Health Quote Link to comment Share on other sites More sharing options...
iwashmycar Posted February 22, 2011 Report Share Posted February 22, 2011 also what is coininsurance. most plans im looking at are 20%, some are 0% I think coinsurance is the amount you pay. Generic: $15 Copay Brand: $25 Copay plus 20% coinsurance Non-Formulary: $25 Copay plus 20% coinsurance Annual Out-of-Pocket Limit Family:$4,000($2,000 per person) So maybe if you get a generic prescription, youll pay $15 plus 20% of the cost?? My guess is insurance will only pay 100% once you hit the high deductible or that out-of-pocket limit (unless there is an "after deductible" coinsurance). Again, just my guess. Im sure someone will chime in I've been looking around for something for my fiance to bridge the gap until her Grad School starts / and we're married Quote Link to comment Share on other sites More sharing options...
6 Speed S4 Posted February 22, 2011 Report Share Posted February 22, 2011 I have medical mutual through work its a 70% coverage type plan just for me. Its like 17 bux a week. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 I have medical mutual through work its a 70% coverage type plan just for me. Its like 17 bux a week. my insurance would be cheaper if i didnt have my son, but I'm getting it mainly for him so it doesnt matter. Quote Link to comment Share on other sites More sharing options...
AudiOn19s Posted February 22, 2011 Report Share Posted February 22, 2011 You should always consider worst case scenerio to see if it's worth picking a better plan. For 8 years we had an 80/20 plan through Anthem that met our needs for the most part. We never really looked at what total out of pocket would be NOR read the fine print, it was the option that best met what we thought were out needs at a reasonable price through my employer. In '09 when my wife was diagnosed with cancer we quickly realized how short our insurance coverage falls when there's a major life event that happens. All in all between stuff that wasn't covered, total out of pocket caps, etc I was out of pocket >$15k in less than 6 months in '09. It's the reason I no longer have a bright red car in the garage We're still fighting with the insurance company 2 years later over bills that they still do not want to pay and have another $4-7k looming that we may have to pay before the whole ordeal is through. We switched to Anthem but through her provider now to a plan that coveres 100% of everything, only out of pockets are office visits and perscriptions. It's ~$500 a month for just the two of us but it's a necessary evil now that her good health will never be a certanty. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 You should always consider worst case scenerio to see if it's worth picking a better plan. For 8 years we had an 80/20 plan through Anthem that met our needs for the most part. We never really looked at what total out of pocket would be NOR read the fine print, it was the option that best met what we thought were out needs at a reasonable price through my employer. In '09 when my wife was diagnosed with cancer we quickly realized how short our insurance coverage falls when there's a major life event that happens. All in all between stuff that wasn't covered, total out of pocket caps, etc I was out of pocket >$15k in less than 6 months in '09. It's the reason I no longer have a bright red car in the garage We're still fighting with the insurance company 2 years later over bills that they still do not want to pay and have another $4-7k looming that we may have to pay before the whole ordeal is through. We switched to Anthem but through her provider now to a plan that coveres 100% of everything, only out of pockets are office visits and perscriptions. It's ~$500 a month for just the two of us but it's a necessary evil now that her good health will never be a certanty. now like what your talking about the 80/20 70/30 etc. The 20% meaning coinsurnance? Quote Link to comment Share on other sites More sharing options...
Smokey Posted February 22, 2011 Report Share Posted February 22, 2011 now like what your talking about the 80/20 70/30 etc. The 20% meaning coinsurnance? Yes. If you have 80/20 coverage and have $10K in bills after you have already met your deductible, that makes you liable for $2000 Quote Link to comment Share on other sites More sharing options...
AudiOn19s Posted February 22, 2011 Report Share Posted February 22, 2011 Yes. If you have 80/20 coverage and have $10K in bills after you have already met your deductible, that makes you liable for $2000 Correct...and most of those clearly state their out of pocket max which seems kinda low. Ours was like "$8750" or something like that but we only had an initial deductible of like $1k. so right there combined you're at $10k. Add up all the Dr.'s visits at $30 a pop, the stuff that wasn't covered by the insurance and all of a sudden the bills are out of control. Here's a good "for instance". Yasmin has her surgeries done (yes two because they didn't get all the cancer tissue the first time) and the Surgeon was in-network, however the surgeon's assistant was NOT in-network. We challenged the decision on the part of the insurance company to not cover the assistant's costs. They came back and covered some of them but not all leaving us with a bill to pay. It's really all a big billing game with everyone in the medical community. We got alot of stuff that was not initially covered eventually paid for, some of it not, some of it was waived. It all adds up in the end though rather quickly. Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 so if at all possible i want coinsurance to be 0% correct. I've never had to deal with this and i dont want to be in a bad situation if something drastic were to happen. Quote Link to comment Share on other sites More sharing options...
Guest Spam Posted February 22, 2011 Report Share Posted February 22, 2011 ^^^ Dont we all Quote Link to comment Share on other sites More sharing options...
AudiOn19s Posted February 22, 2011 Report Share Posted February 22, 2011 so if at all possible i want coinsurance to be 0% correct. I've never had to deal with this and i dont want to be in a bad situation if something drastic were to happen. Yes and no. You just need to evaluate what works best for you. We knew there were risks with the 80/20 that in the event of a major issue we would be responsible for a really big bill, but we always looked the other way thinking that would never happen to us. It really was financially taxing when we had to face it. As long as you're aware of what it's going to cost you if there's a major medical event in your future and are aware of that possibility you just have to determine what's the best solution for you. Certainly an 80/20 is worlds better than not having any insurance at all. I think our combined Monthly bill previously was like $160/ month for our health insurance. Paying $500 a month now frustrates the hell out of me. Quote Link to comment Share on other sites More sharing options...
kirks5oh Posted February 22, 2011 Report Share Posted February 22, 2011 i'd gladly pay the larger monthy bill for good insurance with small copays. like andy stated, one big health bill can set you back financially in a huge way. we don't have that option at my current job and it sucks. with 3 small kids, we hit the deductible ($2500) within a couple months---one e.r. bill, and you're halfway there. kids get ear infections, strep, etc. my advice is to pay as much up front monthly, and not worry about paying huge copays/deductibles when your kid gets sick. all kids get sick, and they get you, and everyone else in the house sick. either way, get insurance asap. good luck Quote Link to comment Share on other sites More sharing options...
John Bruh Posted February 22, 2011 Author Report Share Posted February 22, 2011 so I just talked to a rep at einsurance. I can get a full 100% plan with 2500 deductable for 203/mo with a $35 co-pay. Quote Link to comment Share on other sites More sharing options...
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