Sunday, October 18, 2009

Insurance

Let me start this by saying: Cody got a raise. Just enough to bump him into the next tax bracket, not enough to make up the tax difference. This is a negative for us.

We're trying to decide whether or not we should keep health insurance. On Charlotte, absolutely. On us? That's the tricky question. It'll be nearly $5,000 per year through work, with an $8,000-deductible before anything's paid. On top of that, only a percentage is paid. For us, we'd have to spend $12,000 in a year for UHC to cover anything at all.

Adding Charlotte is $1,000 more per year than for the two of us.

Now, exempting the IVF we had, the totals for our medical care over the last five years or so is less than five years' worth of premiums alone. Even counting the midwife UHC's trying to not cover, even covering Cody's possible tonsillectomy (I say "possible," because I wouldn't put it past UHC to try denying that, even though tonsillitis is recurring for him, his only medical problem ever, lucky dog). If we had to pay for all of it out of pocket, less than five years of just premiums. In no year was even spent on our medical care to even touch the deductible, exempting IVF, which is not something that happens out of necessity to staying alive and healthy. If you want to add in the IVF cost, then we're still under the cost of five years of premiums plus deductibles. Only because IVF all happened in one year did we meet our deductible and have anything covered. We are not planning another IVF cycle. Ever. Any further children will be natural, with a chance of as close to 0 as can be for still having ovaries and/or a uterus.

So, since we, medical-necessity-wise, get less out of our insurance than we put in and pay out of pocket, we aren't convinced anymore that it's worth it. This is taking a large chunk of money out of our pockets each more, straining us severely. Starting over again in January, we'll have to pay $8,000 out of pocket before UHC covers anything. If we don't have $8,000 to spend, there's no point to insurance at all.

I know, I know, what about catastrophic events. Well, not only is the chance of those small and care given no matter what in the case of catastrophe, but our insurance has a cap on yearly care anyway.

And the thing I learned about catastrophe the hard way is that not everything is necessarily covered anyway. You may have a half-million-dollar hospital bill and find that $80,000 of that is for uncovered services, or services provided by someone at the hospital who is out-of-network when someone in-network was available. Especially in true emergencies, whoever is nearest and available is the one called to the job. If you have out-of-network coverage, you could find yourself on the hook for 30%, if not 100% of certain services. What's the difference between filing bankruptcy on $80,000 versus half a million? Nothing but the premiums you paid only to go bankrupt anyway. Thank my personal experience ten years ago for finding this out.

I'm thinking that, for us, it might be better to take the money we're pay on premiums for our own insurance and sock that away into savings. With our credit union, it's a great interest rate. And then getting Charlotte private coverage. If our typical yearly medical costs are less than our premiums, and then we'd have to pay a further $8,000, it seems we'd get ahead by saving instead. It's a gamble either way, yes, and there's a much higher chance that we'd spend more money on premiums than we would on care in any given year, which has been the trend.

We have some time to think it over more and decide. Can anyone give us any compelling reasons for KEEPING our own coverage rather than paying as we go from the premiums put into savings? (Again, Charlotte would still have coverage.)

4 comments:

  1. You might want to keep it for a while because what the government is talking about doing will require you to have it or get it through the government which will cost more than having private insurance. So far they say it will cost a family of 4 about $25K a year through the government. With the bill in the Senate if you don't have private insurance when it passes you will be forced into it at more than $6K per person a year.The statistics say that Medicare and Medicaid turn you down for treatment 50% more of the time than private insurace does!Don't forget once your daughter is here your tax rate will change because of the extra deduction.

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  2. We're still leaning toward cutting it. Any changes to insurance at the government level is going to take an incredibly long time, and we need to make our bills and eat NOW.

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  3. The insurance you're talking about is through Apple? That seems like a rather limited plan for such a high profile company.

    I'd recommend keeping it through the end of the year, since you've already met your deductible for the year (I think?). It could also be useful to have coverage in case there are complications from childbirth, for which I think you're at risk. You'll have more information on which to base your decision in a couple of months, anyway.

    After that - well, I spent a few years with no health insurance when I had no or limited income. I paid for doctor visits retail when I had a fever or whatever, plus I paid for a physical once a year, which is more than any insurance ever did. It saved a lot of money.

    One question is how good you think you are at managing your own health. I think if you're smart about it, you can do a lot better job taking care of yourself than the medical establishment can - again, excepting fevers and such for which treatment costs a lot less than insurance.

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  4. The plans with lower deductibles cost a LOT more.

    We can't make any changes until either open enrollment or a "major life event," for which birth qualifies. We'll have 30 days after she's born to make any changes (OE is in November). If we do decide to drop insurance, it'll be definitely after she's born. We'll keep coverage on her, regardless.

    When we did the numbers on how much our care cost this year (if we were to have paid in full, not counting the IVF as that wouldn't have been done and wouldn't result in a medical emergency or other health issue) compared to how much we're paying in just premiums, we were floored at the difference.

    Midwife at home: $2,000
    Includes all pre- and post-natal care through 30 days post
    Cody's appointment with the ear doc: $175
    Antibiotic: $14.99
    The estimate for tonsillectomy: $1,500

    Less than our premiums. The IVF met our deductible, and then some. And now United's trying to weasel out of covering anything else.

    What they've actually covered is less than we've paid ourselves.

    I do think it'll end up saving us money socking the premiums away into a good interest-bearing account.

    I'm very good at managing my own health. Cody's got insanely good health. I've always hated going to doctors unless absolutely necessary, and listen to my body. I shun medications that aren't absolutely needed and prefer homeopathic treatments. Always have, always will. I spent years without coverage before Cody got this coverage with Apple, and somehow managed, and what I spent out of pocket on it was less per year than premiums.

    Yeah, the more I think about it, the less I can justify keeping insurance. It's sad that we qualify as solidly middle class. Just the cost of living is incredible. There's no balance. Yet I know we're lucky in many ways. A decade ago no one would have wanted to be where we are, and now we both have plenty of friends and family who'd give anything to do so "well." Sad how times have changed in this direction.

    Gotta plod on, I guess.

    Also, dress is ready to go. It's incredibly cute.

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