Catastrophic Care medical insurance for me and kids?

[pammysue]

DH got a new job where he is basically self-employed with a relatively small health insurance allowance. DH has some major medical issues (diabetes, high blood pressure, multiple meds, a major stroke 4 years ago) so it is not possible for him to be without medical insurance. 

The boys and I are very healthy however. We very rarely visit the Dr.: once a year at the MOST for me and 2-3 times for the boys outside of well visits. Both boys are at an age where I am fine going without well child visits and we won't be getting  them anymore vaxes. 

I am very laid back about illness. I believe that fever is a good thing, antibiotics generally not necessary and the body can heal itself from most minor illnesses. I generally wait a while before seeing the doctor and have a pretty good understanding of children's illnesses.

DH and I are debating about whether it is more cost effective to get him a full coverage plan and the boys and I catastrophic care and pay out of pocket for visits and meds. 

Thoughts??

[its_betty]

You just need to do the math. If something happened, what's the largest deductible you can handle? Can you afford to pay a percentage of care AFTER the deductible is paid (if someone is hospitalized or has other expensive bills)?

We are in a similar situation. Dh is currently on COBRA and will need to get insurance that covers multiple doctor visits, lab tests, and prescriptions, and good dental. Ds and I are ok on a high deductible, lower benefit plan: I save about $250 a month in premiums over a better plan. For that $3000/year, I figure I can pay fully for a few extra doctor visits in the unlikely event that we need them, for the occasional blood test, and for my relatively low cost medications. If there is an emergency room visit or hospitalization, we can afford to pay the full deductible. (We could even pay it twice if someone has an injury or illness that spans 2 insurance years.) I made sure to get a plan that pays 100% after the deductible, because if someone ran up a $100,000 or more hospital bill, it would be very hard for us to pay 20 or 30%.

When I was sorting through plans, I did some research on my own and then used a private insurance broker. She didn't charge me anything: she is paid by commission from the insurance company. (Her commission didn't affect my rate at all, as far as I could tell from my research.)

[zebra15]

What betty said.  Can you afford to pay for a  broken bone? 

There is a huge difference between a quick trip to the urgent care and a trip to the emergency room.

Last October my son had streph, that we got treated as soon as I realized what it was, it turned out he was allergic to the RX (which he was prescribed many times over the past years) so we went back to the urgent care and then were sent to the emergency room.  From there we was DX with scarlet fever.  Less than a week later he was still sick and we ended up back at the urgent care, getting more RX and different creams to help with the Scarlet fever.  The rash from SF took about 3 mos to finally go away.  I think the whole fiasco billed insurance upwards of 7k, most of which was the emergency room and multipule labs. 

Now DS can not have penicillin OR zithromax, this greatly limits his Antibiotic choices and the ones he can have tend to be costly. 

Needless to say....I definately couldn't do a high deductable plan for ds or myself.

[NightOwlwithowlet]

Could your children qualify for the state insurance plan?   It varies from state to state, but some states have high income caps, especially for a family of four.  Where we live the income limit for a family of three is around $60,000 dollars.  You have to pay a monthly payment, which varies, but there are no co pays, no deductibles, and vision and dental is covered. 

[SunRise]

Originally Posted by NightOwlwithowlet 

Could your children qualify for the state insurance plan?   It varies from state to state, but some states have high income caps, especially for a family of four.  Where we live the income limit for a family of three is around $60,000 dollars.  You have to pay a monthly payment, which varies, but there are no co pays, no deductibles, and vision and dental is covered. 

This. We are in NY state and my two kids are on the healthy ny kids plan (chp). Every kid qualifies, regardless of the parents income, on a sliding scale. At the highest end, one would pay $182 / mth / child.

I have catastrophic insurance for myself.  (I'm self-employed and had private insurance for several years and each year the cost went up 200 dollars. I finally downgraded because the monthly cost was atrocious.revolting.) I'm 44 and healthy and rarely go (haven't gone since I switched to this insurance, but it has only been 8 months), but one "incentive" for downgrading was that the catastrophic still covered an annual mammography. And, from what I understand w/ my coverage, if I go to my doctor and need physio therapy, for instance ... if I go to the hospital to get the physio, then it is covered under catastrophic insurance. If I choose to go to a private clinic for physio then I pay for it. p.s. the catastrophic insurance I have has also gone up 100 dollars, and I anticipate an increase each year with this as well. until the reform kicks in.