Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

I'm super dumb when it comes to health Insurance, anyone feel like helping me out?

Anonymous
Posted by Anonymous
  • 10 Replies

I am on the hunt for health Insurance.

I am young (30) have no health problems, no pre-existing conditions, and no family history of anything serious that i know of. No cancer, no heart disease....nothing. I don't smoke.

What i want, is to just be able to go to the Gyno, the Dentist & get a annual check up. Would rather not have to pay co-pays. I'm not worried about getting in a serious accident tomorrow...so i guess a high deductible is OK? I don't know...

I don't know what HMO, PPO, POS or Co-Insurance is. I thought co-insurance was a co-pay, but i think i was wrong about that...

Can anyone enlighten me on finding the best insurance for what i need? I feel like everyone i have talked to on the phone confuses me more & just tries to convince me to pay more monthly..

Thank you in Advance!

Posted by Anonymous on May. 24, 2013 at 6:13 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 6:15 PM

BUMP!

chaslee
by on May. 24, 2013 at 6:19 PM

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.

Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 6:33 PM

No...not through work.

My boss offered to either give me a raise or pay my insurance...which i think she should do both. I just have not had the balls to tell her this...I am a complete push over unfortunately. So, i have been researching insurance plans...i thought maybe i'd just get my own insurance & take the raise.

I need to go to the gynocologist...and i need at least a yearly check up. I guess i'd be OK with paying for a dental cleaning out of pocket.

I have a Mirena IUD that needs to be replaced soon & when i called to ask how much it would cost out of pocket, i almost fainted. I got it inserted when i had Insurance through work 5 years ago...I honestly had no idea what kind of insurance i was getting other than it was BCBS & i did not pay any co-pays.

I don't even know how much it was costing me...lol...i know, not good.


Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.



Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 6:33 PM


Also, thank you SO MUCH for answering!!!

Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.



Anouck
by Gold Member on May. 24, 2013 at 6:41 PM

As was mentioned before, dental is usually  not included with health insurance, but you can get dental insurance fairly cheaply (like, $200 a year or less). This will cover regular check-ups with no or very little co-payment.

For health insurance, PPO's tend to be a lot more expensive, so you should be looking for HMO's. The lower your deductible is, the higher the monthly rate will be. I have health insurance through work now, but before that I was doing the BCBS thing for my entire family. I believe I paid about $200 a month for mself. I didn't have a co-payment for my annual check-up, but I never used the OB/GYN portion, so I'm not sure what my co-payment was there.

chaslee
by on May. 24, 2013 at 6:44 PM

Your welcome... :)

Do you work full time?  Is it a company or a private employer?  Just wondering because if she is willing to put you on a company plan and you pay the entire premium it may cost you less. Also, I think it is effective in all states now that if an employer has more than five employees that work full time they MUST offer insurance.  They don't have to pay for it, but they do have to offer it.

I would need to see info on the plans you are considering to really give you any information.  It is really hard to determine what some of them are actually saying.  Some pointers... Don't go with a plan that has a high deductable.  Even if it has a small co-pay you would be better off with a lower deductable plan.  Also, look at the out of pocket maximums.  An out of pocket max is the total amount that you can pay during a year before the insurance will cover you at 100%  It includes deductables but sometimes does not count co-pays or prescriptions.

Another option, since you don't really go to the doctor that often, is to do a health savings plan.  See if your employer would offer that to you, the funds are deducted from your check pre-tax and you can use them to pay for your visits.  But keep in mind that whatever you haven't used at the end of the year, you will most likely not get back. And the year is not 12 months from the time you sign up, it is a set time depending on your companies annual enrollment period.

Edit to add:  With health savings plans, the entire amount of money that you would have deposited into the account is available to you right away, so say you need to have your Mirena out, set that as the total amount you want to deposit into the account during the year, and it is available to you right away, before you make all those deposits.


Quoting Anonymous:


Also, thank you SO MUCH for answering!!!

Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.





Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 6:44 PM


Thank you! Hearing about other folk's & their insurance stuff helps! I really appreciate it!

Quoting Anouck:

As was mentioned before, dental is usually  not included with health insurance, but you can get dental insurance fairly cheaply (like, $200 a year or less). This will cover regular check-ups with no or very little co-payment.

For health insurance, PPO's tend to be a lot more expensive, so you should be looking for HMO's. The lower your deductible is, the higher the monthly rate will be. I have health insurance through work now, but before that I was doing the BCBS thing for my entire family. I believe I paid about $200 a month for mself. I didn't have a co-payment for my annual check-up, but I never used the OB/GYN portion, so I'm not sure what my co-payment was there.



Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 6:55 PM

yeah...the whole out of pocket thing confused me.

I was looking af a few plans that had deductibles between 5500 & 10,000, no co-pays, covers presription. And they range from $70 - $200. Humana seems to be the cheapest, but i feel like i am not understanding the fine print...

The smaller deductibles were too expensive for me, above $150. I am super poor right now. Well...my bills are paid & i am eating, so i guess i cannot say i am super poor. I just don't have much extra at the end of the month.

I work 30 hours a week, she is a private employer. She 1099's me...but in all accounts, i should acually be considered an employee. When i looked at the department of labor site & went through the check list clarifying whether or not i should be taxed as an employee or subcontractor it said i am totally an employee. Another thing i am going to have tyo grow balls with & talk to her about.

She owns a building company...everyone else is a subcontractor. I am her office manager.

What are the down sides of having a high deductible?

I just want regular preventative care....gyno visits are considered preventative care right?


Quoting chaslee:

Your welcome... :)

Do you work full time?  Is it a company or a private employer?  Just wondering because if she is willing to put you on a company plan and you pay the entire premium it may cost you less. Also, I think it is effective in all states now that if an employer has more than five employees that work full time they MUST offer insurance.  They don't have to pay for it, but they do have to offer it.

I would need to see info on the plans you are considering to really give you any information.  It is really hard to determine what some of them are actually saying.  Some pointers... Don't go with a plan that has a high deductable.  Even if it has a small co-pay you would be better off with a lower deductable plan.  Also, look at the out of pocket maximums.  An out of pocket max is the total amount that you can pay during a year before the insurance will cover you at 100%  It includes deductables but sometimes does not count co-pays or prescriptions.

Another option, since you don't really go to the doctor that often, is to do a health savings plan.  See if your employer would offer that to you, the funds are deducted from your check pre-tax and you can use them to pay for your visits.  But keep in mind that whatever you haven't used at the end of the year, you will most likely not get back. And the year is not 12 months from the time you sign up, it is a set time depending on your companies annual enrollment period.

Edit to add:  With health savings plans, the entire amount of money that you would have deposited into the account is available to you right away, so say you need to have your Mirena out, set that as the total amount you want to deposit into the account during the year, and it is available to you right away, before you make all those deposits.


Quoting Anonymous:


Also, thank you SO MUCH for answering!!!

Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.







chaslee
by on May. 24, 2013 at 7:04 PM

Yes, one gyno visit a year is considered preventative/routine care for a woman.  The only problem with the high deductibles is that if you do get into an accident or have a procedure done you have to meet the deductible before the insurance will pay any of it.  So... if your birth control replacement removal is not considered a part of your routine visit it will cost you out of pocket to have it done regardless of the insurance.  So, you basically end up paying for insurance that is of no use to you at all.  kwim?  Yes, they do cost less, up front, but you pay about the same over the course of the year. 

So... call the insurance providers that you are looking at and ask them specifically if that procedure will be covered as preventative or if you will have to meet the deductible first.

I really do think that the HSA may be your best bet.  (Health Savings Account).  I would talk to your employer about that. 

I don't know anything about 1099 stuff, so I really have nothing to offer there.


Quoting Anonymous:

yeah...the whole out of pocket thing confused me.

I was looking af a few plans that had deductibles between 5500 & 10,000, no co-pays, covers presription. And they range from $70 - $200. Humana seems to be the cheapest, but i feel like i am not understanding the fine print...

The smaller deductibles were too expensive for me, above $150. I am super poor right now. Well...my bills are paid & i am eating, so i guess i cannot say i am super poor. I just don't have much extra at the end of the month.

I work 30 hours a week, she is a private employer. She 1099's me...but in all accounts, i should acually be considered an employee. When i looked at the department of labor site & went through the check list clarifying whether or not i should be taxed as an employee or subcontractor it said i am totally an employee. Another thing i am going to have tyo grow balls with & talk to her about.

She owns a building company...everyone else is a subcontractor. I am her office manager.

What are the down sides of having a high deductible?

I just want regular preventative care....gyno visits are considered preventative care right?


Quoting chaslee:

Your welcome... :)

Do you work full time?  Is it a company or a private employer?  Just wondering because if she is willing to put you on a company plan and you pay the entire premium it may cost you less. Also, I think it is effective in all states now that if an employer has more than five employees that work full time they MUST offer insurance.  They don't have to pay for it, but they do have to offer it.

I would need to see info on the plans you are considering to really give you any information.  It is really hard to determine what some of them are actually saying.  Some pointers... Don't go with a plan that has a high deductable.  Even if it has a small co-pay you would be better off with a lower deductable plan.  Also, look at the out of pocket maximums.  An out of pocket max is the total amount that you can pay during a year before the insurance will cover you at 100%  It includes deductables but sometimes does not count co-pays or prescriptions.

Another option, since you don't really go to the doctor that often, is to do a health savings plan.  See if your employer would offer that to you, the funds are deducted from your check pre-tax and you can use them to pay for your visits.  But keep in mind that whatever you haven't used at the end of the year, you will most likely not get back. And the year is not 12 months from the time you sign up, it is a set time depending on your companies annual enrollment period.

Edit to add:  With health savings plans, the entire amount of money that you would have deposited into the account is available to you right away, so say you need to have your Mirena out, set that as the total amount you want to deposit into the account during the year, and it is available to you right away, before you make all those deposits.


Quoting Anonymous:


Also, thank you SO MUCH for answering!!!

Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.









Anonymous
by Anonymous 1 - Original Poster on May. 24, 2013 at 8:29 PM


Yeah...sorry about the 1099 thing, i think i was just venting about that...

I will try & talk to them again & be more specific with my needs. I really appreciate all your help :)

The first time i got the IUD implanted, my insurance didn't cover it. But, my gyno made up some health reason implying that i needed it for medical reasons & then my insurance agreed to pay for it all. Not sure if that was right of my Dr. to do that, but it was very helpful...

Quoting chaslee:

Yes, one gyno visit a year is considered preventative/routine care for a woman.  The only problem with the high deductibles is that if you do get into an accident or have a procedure done you have to meet the deductible before the insurance will pay any of it.  So... if your birth control replacement removal is not considered a part of your routine visit it will cost you out of pocket to have it done regardless of the insurance.  So, you basically end up paying for insurance that is of no use to you at all.  kwim?  Yes, they do cost less, up front, but you pay about the same over the course of the year. 

So... call the insurance providers that you are looking at and ask them specifically if that procedure will be covered as preventative or if you will have to meet the deductible first.

I really do think that the HSA may be your best bet.  (Health Savings Account).  I would talk to your employer about that. 

I don't know anything about 1099 stuff, so I really have nothing to offer there.


Quoting Anonymous:

yeah...the whole out of pocket thing confused me.

I was looking af a few plans that had deductibles between 5500 & 10,000, no co-pays, covers presription. And they range from $70 - $200. Humana seems to be the cheapest, but i feel like i am not understanding the fine print...

The smaller deductibles were too expensive for me, above $150. I am super poor right now. Well...my bills are paid & i am eating, so i guess i cannot say i am super poor. I just don't have much extra at the end of the month.

I work 30 hours a week, she is a private employer. She 1099's me...but in all accounts, i should acually be considered an employee. When i looked at the department of labor site & went through the check list clarifying whether or not i should be taxed as an employee or subcontractor it said i am totally an employee. Another thing i am going to have tyo grow balls with & talk to her about.

She owns a building company...everyone else is a subcontractor. I am her office manager.

What are the down sides of having a high deductible?

I just want regular preventative care....gyno visits are considered preventative care right?


Quoting chaslee:

Your welcome... :)

Do you work full time?  Is it a company or a private employer?  Just wondering because if she is willing to put you on a company plan and you pay the entire premium it may cost you less. Also, I think it is effective in all states now that if an employer has more than five employees that work full time they MUST offer insurance.  They don't have to pay for it, but they do have to offer it.

I would need to see info on the plans you are considering to really give you any information.  It is really hard to determine what some of them are actually saying.  Some pointers... Don't go with a plan that has a high deductable.  Even if it has a small co-pay you would be better off with a lower deductable plan.  Also, look at the out of pocket maximums.  An out of pocket max is the total amount that you can pay during a year before the insurance will cover you at 100%  It includes deductables but sometimes does not count co-pays or prescriptions.

Another option, since you don't really go to the doctor that often, is to do a health savings plan.  See if your employer would offer that to you, the funds are deducted from your check pre-tax and you can use them to pay for your visits.  But keep in mind that whatever you haven't used at the end of the year, you will most likely not get back. And the year is not 12 months from the time you sign up, it is a set time depending on your companies annual enrollment period.

Edit to add:  With health savings plans, the entire amount of money that you would have deposited into the account is available to you right away, so say you need to have your Mirena out, set that as the total amount you want to deposit into the account during the year, and it is available to you right away, before you make all those deposits.


Quoting Anonymous:


Also, thank you SO MUCH for answering!!!

Quoting chaslee:

Not going to confuse you with HMO, PPO and POS stuff... Co-insurance is usually if you have two insurances, one is the primary and the other is the co.  Doctors will file claims with both and the co will usually take care of overages.  For what you are wanting an HMO or PPO should be fine, provided you see doctors in-network with PPO.  Usually they fully cover one visit per year for free, depending on the insurance. 

Are you getting this through work?  Health insurance usually does not cover dental, that will be a seperate plan.  What you need to look at is deductable.  If you would like to PM me with specific questions that might be easier, I am in the insurance field.











Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)