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post #11 of 23 (permalink) Old 12-06-2006, 03:13 PM
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Oh I hit it many times. A year ago they pulled big ol rusty nail from it, the year before that I had wood splinters, the year prior to that one of my plate screws got loose, and two years before that I had a titanium plate with a glass window installed after a lobotomy that went wrong. This year I hit it with a plank that at first would not budge after I temporarly installed it to take further measurments.
This weekend I am framing the first floor bathroom and I will be using my new nail gun
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post #12 of 23 (permalink) Old 12-06-2006, 03:23 PM
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HSA plans are one way to go. There are ups and downs to HSAs though so you may want to really look into them before jumping on an HSA.

Kaiser is a love 'em or hate 'em company. The major upside is convenience as everything is in one location (eye, pharmacy, labs, etc). The quality depends on where you're at (they're quite good in my city).

The first thing to look at is deciding if you want an HMO or a PPO. If you don't know the difference, a simple explanation is that a PPO allows you to go to any specialist you like without a referral from your primary doctor. The major downside is dealing with deductibles and having to keep track of what your varying costs which can change, depending on the treatment/service.

An HMO works with what's known as a "gatekeeper". You visit your primary physician for everything (except your wife's GYN) and they will decide if you should see a specialist, and if so, refer you to one within the network. Financially, HMOs are quite a bit more expensive than PPOs (when buying individual - through group they're cheaper). The reason is that your out of pocket per visit costs are generally much cheaper. For instance, if you get sick, you will pay $10 for the visit, and $5.00 for your medication. That's it. Tests won't usually cost you anything extra.

No matter what type of plan you have, make sure you pay close attention to the coinsurance and out of pocket max. These are the two costs that usually bite people. Your coinsurance is the percentage that you are responsible for after the deductible has been met, up to the out of pocket max. Here's a quick scenario:

You haven’t been to the doctor, so you haven't yet paid your $1000.00 deductible. You end up going to the ER and get admitted for 6 days. The total bill is $120,000 (actually cheap for 6 day stay if surgery is involved)

So, you pay the $1000, but your coinsurance is at %50 with an out of pocket max of $30,000

Total: $120,000
- $1,000 Ded
= $119,000 - remaining cost
$59,500 (your %50 coinsurance obligation)
= $29,000 - your actual financial bill based on the Out of pocket Max.

The other thing to look out for is the lifetime max, which is simply the amount the insurance company will pay out over your entire life. I usually recommend at least $2 million.

As for group coverage, there's a couple of options. Depending on your type of business, there's sometimes alliances that can pool together to get a larger group policy at a discounted rate. You may also qualify for a small business plan for just yourself and your wife. Rates are often higher than individual, but again, it's usually because of a guaranteed issue clause.

Companies will underwrite quite differently when it comes to pre-existing conditions. In KY, Anthem will do exclusion riders on many pre-existing conditions.

For individual, you should expect to pay anywhere between $150, up to $500 per month, but the average good plan is around $300. That's assuming your wife is also 40 yrs old and neither of you smoke.

Last edited by Prana25; 12-06-2006 at 03:35 PM.
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post #13 of 23 (permalink) Old 12-06-2006, 04:05 PM Thread Starter
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My wife is 41 and I am 43 she doesn't smoke and I started smoking those black and mild/mild cigars when I finally got the last kid grown and out of my house before that I never smoked and now I have been known to be seen with a beer in my hand I guess I'm screwed but I will try anyways thanks for all the help.
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post #14 of 23 (permalink) Old 12-06-2006, 04:33 PM
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Ok - because you said you're in central KY, I just based it on Marion County, although KY rates do fluctuate depending on county so these are rough numbers

Male - 43, tobacco user
Female - 41, Non-tobacco

Company: Humana
Plan Type: PPO
Deductible: $2,000 (Family: $4,000)
Coinsurance: 0
Office Visit: You pay nothing after deductible
Monthly Premium: $213.75
Out-of-Pocket Limit Family: $4,000 - Includes deductible
Lifetime Maximum: $5 Million per person


Company: Anthem
Plan Type: PPO
Deductible: $2,500
Coinsurance: 20%
Office Visit: $25
Monthly Premium: $305.14
Out-of-Pocket Limit Family: $9,000 Includes deductible
Lifetime Maximum: $5 Million per person

Company: United Healtcare
Plan Type: PPO
Deductible: $2,500
Coinsurance: 0
Office Visit: You pay nothing after deductible
Monthly Premium: $230.68
Out-of-Pocket Limit Family: $5,000($2,500 per person) Includes deductible
Lifetime Maximum: $3 Million per person

Unless you have health history (don't post anything here, of course), you're better off on an individual plan vs. small business. A small business plan will easily run twice the amount.

PM me if you have any specific questions or anything regarding a private nature.

Last edited by Prana25; 12-06-2006 at 04:36 PM.
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post #15 of 23 (permalink) Old 12-06-2006, 05:14 PM
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^^^^^^

Are those monthly premiums for the couple or per person? If its for the couple it's way cheaper than the UK.
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post #16 of 23 (permalink) Old 12-06-2006, 05:19 PM
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Move to Canada. My total family premium is employer paid at $170USD per month. Of-course, taxes are higher, but on the other hand, most BW OT posters do not live here...
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post #17 of 23 (permalink) Old 12-06-2006, 05:23 PM
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^^^^^^

Are those monthly premiums for the couple or per person? If its for the couple it's way cheaper than the UK.
That's for the couple. Rates here in the US vary drastically depending on what state you live in. In NY, the coverage easily runs $1000 for one person and that doesn't cover regular doctor visits.

One example I'll give people (being in CA) is a simple rattlesnake bite. Without insurance, a normal bill would be $250,000.00. Each vile of the classic horse based anti-venom is about $10,000 each. It usually takes 15-20 viles. (They're coming out with cheaper anti-venom that only runs about $2k each).

Last edited by Prana25; 12-06-2006 at 05:29 PM.
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post #18 of 23 (permalink) Old 12-06-2006, 05:29 PM
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^^^^

When I lived in NY I had Blue Cross/Blue Shield for the whole family, but it was paid for by my company and I can't remember the premiums. It covered everything though and I was very happy with the scheme.

Here in London I'm with BUPA and it's £1400 ($2750) per year just for me!

Last edited by deathrattle; 12-06-2006 at 05:32 PM.
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post #19 of 23 (permalink) Old 12-06-2006, 05:32 PM
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Oh yah, group coverage is great. Very cheap (as most employers pay around 80% of the premium) and everything is usually covered. It's very rare that I'd ever recommend someone drop their group for individual.
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post #20 of 23 (permalink) Old 12-06-2006, 05:35 PM
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^^^^^^

No, it wasn't group-it was just for me. My office manager had his own scheme and the pee-ons didn't get cover. Part of my contract was complete medical ins. for my family.
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