Date registered: Mar 2006
Vehicle: 04 SL55 AMG
Location: Sacramento, CA - US
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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
- $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.