Health insurance plan plus critical illness/emergency insurance? Umbrella insurance any advice?

[es1967]

Well we have just switched my DS and I off our BCBS group coverage  to an individual plan w BCBS.   My husband has a company and we have been paying $1500/m for our insurance which IMO is crazy.  I spoke w an agent (not BCBS)and he said you can buy critical illness/emergency insurance for about $70/month or less.  This fills in the gaps that your original policy does not cover.  I think its called umbrellla insurance.  I am most worried about possible emergency room visits w my daredevil  6 yr old. The deductible is 5K per person.  Anyone have this type of umbrella insurance in addition to their regular health insurance policy?

thanks

[goldfishkate]

You probably don't need it and it is most likely going to be a waste of money. I'm an HR professional and the biggest mistake I see employees making is not purchasing high deductible health plan (HDHP). I'm not an expert on individual plans, nor do I know the specifics of your plan, however I would skip the Gap coverage. If you have high or low medical expenses a HDHP will save you money. If you have moderate expenses, you will break even. Chances are the gap coverage is still going to leave Gaps. Be sure to read the fine print and consider the amount you're paying in verses your likelihood of actually using the benefits. $70/mo is going to cost you $840 a year. You can also open an HSA and direct part of your earnings into the account pre-tax or as a tax deduction. You might also qualify for assistance through your local hospital to pay a portion or all of your medical bills. Many hospitals also allow interest free payment plans. My husband and I have had a HDHP for the past 4 years and I love it. The first year was really scary because I kept thinking of all the unknown but we saved a couple thousand in premiums. Also, skip the hospital unless it's a true emergency and go to urgent care instead. I encourage you to go past your emotions and comfort zone and look at the ROI of Gap coverage when making your decision.

[es1967]

Thanks Goldfishkate for all your info.  I know its hard to get past the what ifs!  We've had numerous trips to the emergency room when DS was younger so I am basing it on that.  I think the gap insurance is actually less and I am going to find out more details from a friend who bought it.

Like you said who knows what the fine print says.  The BCBS plan I have is only $250 a month for both my son and I .  Yealry stuff is covered at 100% .  Co pays are around 40 for Dr, 75 specialist and $100 for urgent care, emergency room you just pay whatever they chg.  This is what scares me. There was a plan that capped the emergency room care at $300 per visit , had some dental benefits but was $100 more per month and I was debating it.  The ded was higher.

[iowaorganic]

I wouldn't spend $840 on the what if we go to the ER.  Assuming he doesn't have a condition that makes it such.  If it is for stitches and whatnot I would just set aside that money so you can just write out a check.  I would also recommend price checking ERs because the prices vary quite a bit.  The one I am happiest with is also $300 to walk in rather than $1000 at the 2 other closest ones to me.  I don't know if it works the same if you have health insurance- but I get a 20% discount for paying right away in full since we are uninsured.  I get the same at the dr for immediate pay- but that I know they don't do if you have insurance.  So really I would just save some money for the random ER visit and not have a separate policy.

[SunRise]

Another toot for PromptCare ; half the wait / half the price.  Prompt care is meant for stitches, cuts, dog bites (unless you are mangled), ear infections (on the weekend, when doctors office is closed), etc.  Emergency is meant for disasterous accidents / broken bones etc. Promptcare will send you to emergency, if that is where you should be.

When I had insurance, I had cut my finger in a blender and went to prompt care. I was sent to emergency because the catastrophic insurance I had didnt cover promptcare visits. I ended up sitting in emergency waiting room for 4 hours waiting - by that time, the shock had gone and I was ready to walk out and put a bandaid on my finger.  Had I known, I would rather have paid 75$ dollars at prompt care, then wait for 4 hours and have my insurance billed 300+ dollars.

[es1967]

Thanks for all the tips.  We have an energency room just down the street but I am going to locate the closest urgent care facilities in the area.

Edited by es1967 - 5/19/12 at 5:11am

[yellow73]

I'm not an insurance expert, but just wanted to share my story.  We have a good plan (BCBS actually) through my husband's job, and last fall my 5 year old broke his arm in a freak fall at the park. It was scary to look at, totally hanging at this crazy angle, but didn't break the skin or actually need surgery to fix.  They did need to use general anesthia to set it though (and weren't completely sure at that point if it would need a pin...this bone looked snapped in two to me!)  

Anyway, even with our awesome plan we paid something like 20% of the grand total of $15,000.   I was completely shocked at how much it can cost for a freaking broken arm!!! That included ER, xrays, anesthia(sp?), check-ups, casting, etc...but we didn't even spend a night in the hospital.  Healthcare is scary expensive sometimes!

[knittyrobin]

Just wanted to add in our experience.  We have a high deductible plan plus an HSA through our credit union and have been SO happy with this arrangement.  It was $1200 a month to insure our family of three and we still had to pay huge co-pays and 20% of everything.  We did the math and found that even if we met our deductible, it would be cheaper to to the HD/HSA.  It's important to have the HSA so the money is there if you need it IMO.  It keeps accumulating over time though so, for example, for this baby we have a couple years worth of savings in the HSA to pay for our midwife etc.  

We also found it is almost always cheaper to get medical care as a "self pay" patient and get any "cash at time of service" type discounts using our HSA at the time we see the provider rather than let it go through our insurance.  A lot of labs have "indigent patient" programs for self-pay people.  Some doctors offices will also have programs that help out.  You can also call around.  We decided to do a  twenty week ultrasound this pregnancy and I found a $200 range of prices for exactly the same ultrasound.  

Do know also that by federal law, high deductible plans have to pay for well care completely just like all other insurance.  So my husband's annual, my pap, our kids well child checks, those are all free.  Each state also has laws about what has to be covered.  In ours, maternity care and birth control have to be covered--not for free, we still have to meet the deductible--but that means that maternity care and birth control actually go towards our deductible now whereas they didn't a couple years ago.  So if something goes terribly wrong and we end up meeting our deductible with this baby, I can get an IUD covered at 80%.  :-)  If not, I've already shopped around and will be going to Planned Parenthood as they have a grant to get them cheaper.

[es1967]

My friend has a HDP thru Humana.  All she does is complain about how awful it is.  I guess with her plan you even have to pay for bloodwork whereas w the BCBS plan I got its all covered as long as you go to a quest lab.  Its the one I always go to anyways.  I almost took a humana plan but then our pedi said he was not taking it anymore.  I'm glad I didn't.  My neighbor also has a HDP.  Her DH got some kind of weird infection on this leg.  He was in the hospital for days.  It cost them alot.  She also started a savings account for healthcare.  We just have a hard time saving anything these days. Things are really tight w this economy.  My Dh is still on the group BCBS plan b/c when we wanted to switch we went for an annual checkup and it came up he has kidney stones, enlarged thyroid, heart issue etc etc.  After all the tests the only thing that came out was that he does have kidney stones.  All else was fine.    Hopefully, when this group is up for renewal we can lower him to a less expensive group plan.

[es1967]

Originally Posted by knittyrobin 

Just wanted to add in our experience.  We have a high deductible plan plus an HSA through our credit union and have been SO happy with this arrangement.  It was $1200 a month to insure our family of three and we still had to pay huge co-pays and 20% of everything.  We did the math and found that even if we met our deductible, it would be cheaper to to the HD/HSA.  It's important to have the HSA so the money is there if you need it IMO.  It keeps accumulating over time though so, for example, for this baby we have a couple years worth of savings in the HSA to pay for our midwife etc.  

We also found it is almost always cheaper to get medical care as a "self pay" patient and get any "cash at time of service" type discounts using our HSA at the time we see the provider rather than let it go through our insurance.  A lot of labs have "indigent patient" programs for self-pay people.  Some doctors offices will also have programs that help out.  You can also call around.  We decided to do a  twenty week ultrasound this pregnancy and I found a $200 range of prices for exactly the same ultrasound.  

Do know also that by federal law, high deductible plans have to pay for well care completely just like all other insurance.  So my husband's annual, my pap, our kids well child checks, those are all free.  Each state also has laws about what has to be covered.  In ours, maternity care and birth control have to be covered--not for free, we still have to meet the deductible--but that means that maternity care and birth control actually go towards our deductible now whereas they didn't a couple years ago.  So if something goes terribly wrong and we end up meeting our deductible with this baby, I can get an IUD covered at 80%.  :-)  If not, I've already shopped around and will be going to Planned Parenthood as they have a grant to get them cheaper.

My friend who has Humana does the same thing and pays cash at time of service.  She says its always cheaper.  I asked my pedi's office and they said they chg $100 for an office visit w/o insurance and the copay w my new plan is $45.

[knittyrobin]

Sorry.  I should probably clarify.  You commented on the $1500 a month being ridiculous...which I agree!  Ours was $1200 a month.  By switching to insurance with a $5800 deductible, we are paying only $400 a month.  That's $800 a month savings.  We put some of that into an HSA account and use the rest towards whatever we need to. Even if we end up paying the $5800 deductible, we're still paying less than we were with those crazy high premiums.  Here's the math we did:

Cost of "normal" plan: $1500 for you or $1200 for me a month minimum if you never use it=$18,000 a year for you or $14,400 for me

Cost of HSA plan: $400 a month if we never use it= $4800 a year (we save $9600 in a year) and if we meet our deductible of $5800 (total cost in a "bad" year $4800 of premiums plus $5800 deductible=$10,600) it turns into a "normal" plan and covers everything like a normal plan does, in fact in our case it becomes the same plan as the "normal" plan, we just have a higher deductible to get there.  So worst case scenario, we're still saving $3800 just on the insurance premiums in a year.

So.  The HSA plan is ALWAYS less expensive for us.  If we don't meet our deductible (which we never have), it's much much cheaper.  If we wanted we could get that emergency umbrella coverage you mention above but since that sort of coverage, at least that we found, doesn't pay for our usual stuff (UTIs, pregnancy, sinus infections), we decided it wasn't worth it.  We shop around for medical care because that's just plain more money we're not wasting.  Yes, we pay out of pocket...but we're paying for what we actually have done instead of what the insurance company is afraid we might have done.  If we were old and sick and so forth it would be different.  Even paying for our pregnancy labs, midwife birth (at a birth center or at home) and an IUD this year and my son needed an ultrasound of his kidneys and my hubby tweaked his back and needed a prescription and I'm on thyroid replacement, unless something unforeseen happens, we still won't meet our deductible, which means we're way ahead financially.  Our plan actually has an extra perk that for every year we don't meet our deductible, the deductible drops the next year for the same premium.  

As mentioned above, preventative care is covered at 100% so we don't pay for our well visits, vaccines, annual screening, labwork, etc.

[es1967]

Thanks so much for the explanation. That is very helpful. Is your deductible per person? or per family?