Ask the Readers: What Do You Want in a Health Insurance Plan?
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- Comment #15 Health Care Submitted by Going Broke on March 30, 2010 - 14:15. I'm not sure what is the correct answer. Currently, 30% minimum of my take home pay goes towards paying into our HSA and the premium for my DH. I attempted to get him a separate policy. They came back with a quote of under $300/mo. When I told them he had diabetes (well controlled - meds have been lowered and may be eliminated), hypertension (under control) and hyperlipidemia (under control), they said they wouldn't insure him. No higher quote or anything, just plain "no." He can't get insurance through his work as they don't offer it. Our insurance plan is changing next month to a 20/80 pay and tiered RX. We have a $3,000 deductible each.
I have a chronic genetic disorder. I didn't acquire it through unhealthy living. I was born with it. If I leave/lose my job, I may not be able to get insured again. DH can't get insurance now either. He says to drop him off of my insurance and save $700.00 a month but we can't do that because 1) he'd probably never get an insurance company to cover him again and 2) we'd never be able to pay the healthcare bill if he were to be hospitalized for complications from his diabetes/hypertension/hyperlipemia.
What I'd really like in health insurance is to not have my premium/deductible be equal or more than what is recommended for a person to budget for a house payment (30%).
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rebl I want my health care plan to involve my health care providers and my family -- not an insurance company. #WBAsk
This past week has sparked a lot of debate regarding the health care bill and what people want vs. need in a health insurance plan. All politics aside, we want to know what matters most to you. Portability? Affordability? Quality? If you had to choose one aspect of a health insurance or care plan, what would be non-negotiable?
Our bloggers have addressed the health care issue many times here on Wise Bread. We've discussed why we like high-deductible plans, the truth about dental discount memberships, the health of your current plan, and why you may want to decline your employer's plan.
What are your thoughts? Keep things civil, and tell us what your #1 plan offering would be. If you've blogged about healthcare recently, feel free to link to your post or article! Share your thoughts, either below in the comments or on Twitter, and you could be entered to win one of two Amazon gift cards!
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A catastrophic care plan that includes an annual physical (including all relevant lab work).
I know this may actually be more an issue with doctors and hospitals, but actually knowing the cost before getting a procedure done would be tremendous. I feel like it's always some kind of guessing game!
Agreed 100%. I know it is difficult to give accurate pricing. But they can say okay first we will take xray it will cost this much and next doctor will see xray and consult you and it will cost you this much. If there is fracture then it will be like else it would be like this. But the problem is stupid staff always say WE DONT KNOW HOW MUCH IT COST.....
First, I want a plan that I can understand. Something that makes sense. I want to know how much things cost. I want to understand who I see for what and why and whether I can go see the PT who helped fix my knee. And what's covered and what's not and, once again, why.
Second, I want a plan that's easy to use. When I feel lousy or am facing surgery, I don't want to have to figure out paperwork or referrals or other things I don't really understand (see point 1). And when I'm recovering I definitely don't want to get letters that I don't understand that say that one or more people involved in my surgery may or may not be "out of network" and I may or may not have to pay more money.
Third, I want a plan where things get taken care of quickly. I want to speak to real people when I call. I want them to be able to answer my questions. I want referrals, if they're require, and approvals and everything else to be able to be handled quickly and easily by either me or the people who deal with insurance at my doctor's or PT's or where ever. And, if they're not, I want to understand why not.
Fourth, I want good, quality care by professionals who will take the time to listen to me and answer my questions. And where I don't have to wait an hour after my scheduled appointment time to actually be seen. This is more of a doctor issue, but I wonder how many of the issues with doctors' offices are due to issues dealing with insurance.
I've not had to deal with catastrophic health issues (knock on wood) but I am a 24 year old college and graduate school graduate with my own health insurance. I am about to transfer jobs (better offer at a new company) and I'm terrified that I will have an issue in the first six months of my coverage there, because I have allergies and severe allergy induced asthma. I have tried to stockpile enough medication that I will last the six months of my "preexisting condition" time period without exorbitant costs, but I'm still worried.
I take three prescription medications: two for my asthma and one for birth control. My asthma is a chronic, potentially life-threatening condition that I manage very well with medication and do not trigger with outside sources (I do not own pets or smoke, and I am a little overweight but am by no means obese, and I am working on that). My birth control I use as a means to prevent an even larger, unplanned medical expense, as pregnancy children tend to drain resources pretty quickly.
I visit all of my doctors twice a year: dentist, ophthalmologist, gynecologist, allergist. I screen early and often for the cervical, breast, kidney, and skin cancer that I am genetically at risk for. I do this, like with birth control, to prevent larger, later medical expenses.
I'm not looking for anything crazy. I'm looking for coverage that will help me manage my one chronic illness, and (like ALL medical professionals suggest) screen myself early for diseases I am at risk for. I don't want someone to pay my way for me, but I do think that for the amount of money I pay, I deserve better coverage, and especially do not deserve a six month "preexisting condition" window where I cannot get treatment and could end up in the hospital.
What would really be nice is an affordable plan that covered preventative care (including birth control!). We're currently spending 15% of our take-home pay on a catastrophic insurance plan. It's really painful, especially when it doesn't cover things like flu shots.
A very good quality plan (so I don't have to see second or third rate doctors over and over again) that I can actually understand.
I want to choose the doctors that I think I, or my family, needs to see. I want to follow the medical plans of a trusted physician, not a medical plan that an insurance company has created to increase their profit and marginalize my health care. I want to be able to get 90 day prescriptions filled, instead of just 30 days, because that's what's more affordable and convenient for me. I want to be able to fill the prescription that my doctor actually writes, not turn it in and have the insurance company tell the pharmacy that it wants me to have a different, cheaper prescription medication. I want to go to any pharmacy that's convenient for me, not be forced to go to pharmacies on the insurance companies "preferred list". I want to be able to legally hold any insurance company accountable for attempting to force changes to a plan my physician thinks is best.
What I would love to see is a simple, low-premium, high-deductible catastrophic plan, and then pay for all my routine medical expenses out-of-pocket...but combine that scenario with lowered medical costs that reflect what improvements in research and competition will do sans burdensome regulations, pharmacy kickbacks, and malpractice insurance. I want my health insurance to mirror my car insurance. I pay for my own car repairs and oil changes out of pocket, thank you very much, but I carry insurance just in case of an accident. I want my health insurance to be just in case, but I want the everyday stuff to be more cost effective.
I want an AFFORDABLE plan that covers both basic and catastrophic expenses. I can handle a deductible and a coinsurance amount, but I want my out of pocket maximum to be no more than $5000 in any year. Right now, my out of pocket maximum is $2000 ($1000 deductible and 20% coinsurance up to a maximum of $1000). I love my current insurance, but I fear that it may get pretty expensive down the road.
I would love to see an affordable high deductible health care plan where the deductible is based on an issue. For example, cancer is very expensive over the long run, but most treatments are not terribly expensive. Low enough a $40K cancer treatment might only payout a small amount for those treatments that are expensive.
Plus, I would like the smaller bills that don't meet the deductible to be billed through the insurance to get the lower costs. They are HUGE if you have ever had to pay yourself.
I want health insurance that doesn't exclude pre-existing conditions, covers ALL prescriptions (including birth control), has a low deductible, and doesn't exclude certain treatments--like TMJ-related appointments or mental health counseling.
My ideal plan would focus heavily on preventative care.
I have long believed that my auto insurance company should reward me for doing the regular maintenance on my car. I should be able to submit receipts every year and get some kind of discount for ensuring that I have good breaks, oil changes, safe tires, etc. I'm doing my part to make sure we all don't have to dip into the catastrophic insurance. I'd even be willing to take a (free) annual driver's test in order to get a discount. (But I would never allow a tracking device to monitor my actual miles.)
I'd like an insurance plan to behave similarly. Screenings, blood work, birth control, ob/gyn care, annual check ups, gym membership, dietary changes. I'm willing to invest a lot of effort to take care of myself because that's my responsibility. But the hassle of referrals, authorizations and surprise costs delays me from going in for care when I need it.
I would also really like a payment chart and be able to know ahead of time what my portion of any procedure will be. I probably need knee surgery. If I could go somewhere and find out how much that will cost me, I could save up for it and make it happen. But I've held off for years because a) I didn't want it to be a pre-existing condition and b) I'm afraid of the bills.
Health insurance should NOT penalize women for being female, should NOT give outrageous rates for people with prior conditions, and it SHOULD be equal for all genders and races (although I do agree with penalties for smokers and heavy drinkers...not a "moral" issue, but seriously, that stuff will mess with your health and it's an optional activity). Outrageous co-pays and premiums are also a major thumbs down.
And over weight people and people who sit around and don't exercise. Heck, while we are at it... We should have mandatory, government sanctioned exercise sessions so that all the fat people who eat more than their share don't impose their health risks on us smokers or drinkers.
And how about if your fat is on my non smoking airline seat, you pay for my ride too..
Just a thought..
Do you really think that "Fat People" don't pay more. I know for a fact that they do. Insurance companies charge more for over a certain age, because they are prone to more health issues, charge more for smokers, charge more for women who are childbearing age (yet won't pay for birth control), will not cover you at all if you have hobbies that are considered dangerous - skydiving, etc, and they do in fact charge more if you are overweight, in the case of an independant catastrophic plan I had between jobs, the premium is double if you are 100 pounds or more overweight - and if you lose that weight, you have to keep it off 5 years before they will lower that premium even if you lose it in 6 months. I got that directly from our local Blue Cross carrier.
I would like a health plan that actually covers what is wrong with me. I need a particular surgery - it directly affects my "quality of life" in that if I don't get the surgery, I soon won't be able to eat (chew) food. Seriously, that's a pretty big effin' deal. And no policy I've looked into covers anything regarding the jaw joint unless the problem (and resulting surgery needed) comes from some sort of accident, like a car crash. The fact that my jaw is deteriorating and my surgeon certifies I have to have this surgery .... no one will cover it, so I have to pay the $11K out of pocket. And that's just for one side, eventually I'll have to pay another $11K for the other side when it goes. And I have what is considered a pretty decent Blue Cross plan!
I'm not sure what is the correct answer. Currently, 30% minimum of my take home pay goes towards paying into our HSA and the premium for my DH. I attempted to get him a separate policy. They came back with a quote of under $300/mo. When I told them he had diabetes (well controlled - meds have been lowered and may be eliminated), hypertension (under control) and hyperlipidemia (under control), they said they wouldn't insure him. No higher quote or anything, just plain "no." He can't get insurance through his work as they don't offer it. Our insurance plan is changing next month to a 20/80 pay and tiered RX. We have a $3,000 deductible each.
I have a chronic genetic disorder. I didn't acquire it through unhealthy living. I was born with it. If I leave/lose my job, I may not be able to get insured again. DH can't get insurance now either. He says to drop him off of my insurance and save $700.00 a month but we can't do that because 1) he'd probably never get an insurance company to cover him again and 2) we'd never be able to pay the healthcare bill if he were to be hospitalized for complications from his diabetes/hypertension/hyperlipemia.
What I'd really like in health insurance is to not have my premium/deductible be equal or more than what is recommended for a person to budget for a house payment (30%).
The high deductible plan with a Health Savings Account (HSA) that I've got right now is great. Its got a relatively low deductible for such plans, the HSA funds are tax free to myself, preventative care is free and the insurance premium costs to my employer are well below averages. I get lots of choice in my care and have access to good doctors. Plus the higher deductible and HSA give us more control and accountability for the costs. I guess the only way to improve it substantially will be to make it portable so that I could keep the same benefits even if I change employers or retire early.
+1 for high deductible plan with an HSA. We love ours. Portability is the only thing missing.
My number one offering would be easy to understand with low premiums. It would offer preventive care and cover pre-existing conditions, the main reason I'm unable to get affordable insurance right now.
I would like better coverage for naturopathic and alternative care providers ie chiropractors and accupuncturists.
I want to:
1 - choose my own doctor. I don't want to have to change doctors now that I have found one I really like.
2 - have preventive care encouraged - vaccines, nutrition counseling, regular checkups, etc. It is much cheaper for me to have my medication than a resulting bigger issue, much cheaper for me to be outpatient than inpatient, etc.
3 - put strong limits on malpractice suits. I want to be able to FIND an ob/gyn when necessary, not have them all leave the profession because malpractice insurance premiums are so high.
One of the biggest things to me is good customer service. Having a company be clear about what is covered, etc, would be such an improvement, as would better online and phone systems to have speedy answers. From the business perspective, I get that everything can't be covered/free/etc, but reducing consumer frustration with service would make healthcare a less painful experience for all.
I'd love a vision plan that includes both eye exams and some portion of contacts/glasses.
But generally speaking, a plan that keeps costs as low as possible and doesn't nickel and dime you, not covering things that are actually medically necessary.
Keep demand health insurance simple - for hospitalizations and those with cronic conditions and maybe a check up every year or two. Drs. should not have to deal with insurance paperwork for those who drop in because of minor ailments, pay the bill out of pocket. This would keep costs down because there are too many who are habitually going to the MD for every "hangnail" because it's covered by insurance.
1. the feds to butt out. To late for that now.
I want to be able to choose my doctors, freedom. choice. And low cost. All which we lose now with the federal takeover.
http://republicanleader.house.gov/News/DocumentSingle.aspx?DocumentID=13...
Transparency in policies that are simple and easy to understand, so I know what's covered, what to expect to pay out of pocket, etc.
The ability to speak with a human being quickly when I do have questions about the plan.
Free or discounted preventative care (gym membership, vitamins) or a discount on my premiums for partaking in preventative care.
Knowing the costs of doctor's visits and procedures.
No pre-existing conditions stuff.
Plans that are decided by me instead of my employer.
Plans that have nothing to do with my employer for that matter.
I want single-payer simplicity in which preventive care and diagnostics are 100% covered (to insure we're forced to use it), and catastrophic costs are controlled with a sliding-scale deductible.
Hey,
I know it would cost a ton more initially to offer things like Chiropractic, Naturopathic care etc. These modalities are so beneficial and preventative though. It's proven that people who seek preventative care like these tend to be healthier and in the long term need fewer major surgeries or medical treatments associated with chronic illnesses and conditions.
I remember when the Ontario Health Insurance Plan removed coverage for Chiropractic care. I stopped going because it was now out of my budget and I've definitely noticed a significant change in the way my back feels. Could be other factors, but I definitely felt better when getting monthly adjustments.
Cheers
Primarily, I want my health care plan to involve my health care providers and my family -- not a profit-driven, middleman insurance company.
Why do I have to wait till I'm 65 before I have access to guaranteed health care? The waiting could kill me.
I'm a Canadian, and am very pleased with the coverage I have. However, we do have a two-tier system, even if it won't be called that. Physiotherapy costs for each visit until I'm a senior, the podiatrist visit cost me, seeing the optometrist costs. I know that I am very very fortunate that if I had an acute issue, I could see people and the province health plan would cover it - but I'm in the process of trying to regain the health of my knees, feet, and hips through physiotherapy and orthotics, so I can be more active and perhaps get rid of my metabolic syndrome. It costs money to not muddle along with significant pain which leads to reduced exercise which leads to reduced health which leads to a greater chance of needing emergency assistance for things like heart disease or stroke...
I am imagining city-owned insurances, to help further offset the costs for the 'extras' that lead to improved health. If enough people pay in, then the fees could be fairly low and yet those who need the most assistance can get it and reduce things like ambulance calls and save the city some money.
I would love to see preventative care covered. If I am sick, or getting sick, let me go to the doctor and get better before I am half-dead. Preventative care will allow people to visit the doctor on their schedule, not miss as much work, and will allow Americans to be healthy.
In a word: Portability. To me this means that I should be able to select my healthcare plan myself from anywhere in the country. Each Healthcare Insurance provider can then have a variety of healthcare choices that I can make that are relevant to me. From basic catastrophic care, to wellness visits, to aging related services. The insurance pays for it if I have paid into the plan and I pay for it if its not.
want a plan that is easy to understand, no referrals, no out of network snafu, coverage for annual physicals and lab work. Eliminate the tier coverage for prescriptions. Don't want to worry about what is covered and what isn't. Vision and dental coverage also.
I agree with Arthur above but ALSO want my country's government to STOP printing out so much cash and paying for crap that it cannot afford to pay for on borrowed dollars... The value of the American dollar is THE problem.. It is NOT prices of goods and services going up it is the value of the dollar going down, down, down; so it takes more dollars today to acquire goods and services than it did 5,10,20+ years ago... As long as the cash printing presses roll then it will only get worse... This IS the problem ladies and gents so please get involved by letting your representatives in govt know that enough is enough; don't spend with what you don't have to spend... cheers, kooler
EVERY OTHER large country found a way to do whats right!
WHY CAN'T WE? (and why has our government been so vaugue about everything) Like kids covered until 26, or no Caps, but... no mention that you will pay a lot extra !!!
MY 10 POINT PLAN
1. Single Payer, even if managed by private companies.
2. Controlled regulated medical costs. (or below won't work)
IF a Hip replacement cost $65,000 here and $7000 everywhere
else worldwide with Ntl Care..then we lose.
3. National Plan, BASIC health coverage for all.
Preventative Care, annual checkup is manditory.
Everyone has to pay something, or contribute to
society, unless 100% disabled.
4. ANY doctor, though, system & patients need managed care.
Everyone chooses a primary care doctor. He OK's referrals,
and then you agree or chose your own specialist, or ask
for second opinion. SOME specialist (like chiropractic
dermotologist or gyno might be allowed on your own).
5. Co-pays(small) for preventative. You have to pay something.
When people pay nothing, they do not value & feel entitled.
6. Then you can earn credits to upgrade coverage level with:
Military Service
National Guard
Government Service (pay cuts to private sector norms)
Community Service or National Service
High School Completion & Testing
Higher Education completion & Testing
Vocational Education Completion & Testing
Saving for retirement, IRA and other
Paying your bills, good credit
-or- you can buy riders with money.
7. Medicare rolls into the National Plan, and everyone has
a Primary Care doctor who knows them and their problems.
(right now more than 2/3 of the Medicare dollars spent
are wasted with elderly self directed care VS managed)
Managed is NOT a dirty word. With 16 Medications average,
and multiple conditions, it is only sane to have a main
doctor over seeing the specialists and outcomes.
8. Medicaid rolls into National Plan. Specific guideleine
for health care when very limited circumstance waive
the normal contributions and/or copays. Cost of this
care stays with you, and must be repaid when able.
9. Like it or not there woudl be CAPS & LIMITS on care,
unless you have additional riders to extend these.
10. Lifestyle choices will penalize your coverage above BASIC.
(get real), the majority can not continue to pay for those
whom choose to damage their health AND make no measured
effort to change. (this is norm now for most HMOs)
What if we simply do away with insurance all together. Then the doctors can prescribe the tests they truly find necessary and can advertise their rates for procedures. Then I can see whichever doctor I want, including alternative doctors. The insurance companies are controlling the doctors as well as patients.
Since insurance companies have caused the price of health care to skyrocket, getting rid of them would allow the prices to adjust. Then I can spend my $8,000 annual premiums on prevention. HA.
Nine years ago when I had my son I called the local hospital and said I didn't have insurance. I asked what it would cost to have my child. I was quoted $1,200. When I actually had him and submitted my insurance for payment ~ the bill was $13,000. Some difference. Who are they kidding. We all see through them.
We have the power here. If we collectively refuse to pay them, we are in a position to make serious changes in our health care system. We just lack leadership.
I want the health dollars I'm spending already -- premium, deductible, copays, coinsurance, FSA dollars -- to include any and all health options, including naturopaths, homeopaths, therapeutic massage. Shouldn't our health care dollars be able to go to what keeps us well, instead of only the expensive (and only partially successful) interventions after everything's gone to pot?
Chiropractors used to be verboten by "medical science," now are well accepted because people demanded it. Look at how well they have helped people with acute and chronic problems to get well and stay well.
Trigger point massage has helped me with knee problems that orthopedic doctor just told me I had to learn to live with. Turns out it was referred pain from muscle tightness elsewhere in the body, and monthly trigger point massages keep everything functioning well.
That expensive orthopedist and x-rays and MRIs solved nothing, but they are the only option under so-called "health" insurance!