Insurance Dilema, could use advice

[teddi]

Ok. Here our situation.

DH's new job covers 100% of his insurance. ZERO for kids or spouse.
He now has Kiaser again and it costs his work $227 a month.

Well, I got the rate info from my job- CalPERS (california public employees). The monthly rate for just ME for Kaiser is MUCH higher $389. That's just the negotiated rates (why calpers has such crappy rates I don't know).

Me and kids are on a private plan offered thru Kaiser that ends next June. My policy is $156 a month. Decent coverage, $20 co pays, etc. The kids, we were just under the income guidelines this year, are $24 a month! That's fantastic. Their coverage is AWESOME, $10 co-pay and even gives them Dental coverage.

The problem is, my plan WILL end as of the end of next June. Then I HAVE to get group coverage (my work or DH's). I say HAVE to because I've already been turned down for a private pay plan. Thank HG for that, I now have a health history that puts me out of the running.

Under my insurace, accounting for 50% benefits (as I work half time). My monthly plan to cover me and the kids would be $1120 a month. For me alone, it's going to be $431/month. My employer will only give me $445 a month toward insurance. If I DECLINE medical coverage, I get a "pay out" of $210 a month. For now, I'm taking the pay out. That extra $200 pays our current bill. But next July, when I use the medical insurance my work will ONLY pay enough to cover me.

Bottomline, it would cost $675 more a month to cover the kids thru my work. It would cost $396 to cover the kids thru husband's work. We cannot keep them on the $24 a month plan, as we will be over income.

We're over income for Healthy Families and the such.

What to do? I've always had the kids on Kaiser. So honestly, going elsewhere is scary and new.

Kiaser has a private pay plan that is $226 a month. Ok, that's almost affordable ... BUT... this is the "$1,500" deductible plan. That would mean, we'd have like "emergency" coverage. I'd be under stress to NOT take the kids to the Doctor.... forgo uneeded Rx's, labs, xrays, etc. Oh and hospitalization? $500 a day. Very scary.

Should I keep shopping for other providers? Get a better quote? Or just get more expensive coverage for $400 a month that I could actually use?

Any other ideas? What about AFLAC? Does that act as a supplemental insurance?

I heard from my former clinic co-workers there's something called "Healthy KIDS". Which is designed to be some kind of group insurance for those over income for Healthy Families. I can't find ANY online info about this.

[aaronsmommy]

I have a higher deductible plan and it took a bit of getting used to, but I realized that paying a couple hundred extra each month for a better plan added up pretty fast. BUT, there are only 3 of us, so probably fewer visits, and our finances are recovered from hg and unemployment, so it doesn't hurt so much when we get a bill. You could always put the extra premium money away each month and save it for those visits so the money is there. Regular kids visits for an ear infection or such are probably not too expensive (it's the tests that seem to add up fast).

An individual PPO plan is typically cheaper than an HMO/Kaiser because of the deductibles and such. I'm sure you could find a ped you like outside of Kaiser, but I know my husband (who had Kaiser his whole life until 5 years ago) still gets confused and flustered about PPO insurance, and the bills. His keeps asking if I need to go to the doctor how do I do it? Uh, just choose a doctor and go.

What really matters though is your out of pocket maximum - how much you might have to pay before the insurance covers everything. If this would send you reeling, don't get that plan. It's important to know though what counts toward the max (my hospital copays didn't).

An AFLAC policy that could help out would be the "hospital income insurance" that pays you when anyone in the family is hospitalized.

Maybe the Healthy Kids is a county program? I know Santa Clara has a program like that.

[PamelaRose]

I don't know, but insurance sucks. I told you last night how my insurance coverage was changed to exclude coverage for anything coded "routine" other than cancer screenings at the clinic. They paid for my pap smear, but not the pelvic exam to get it. Something not right there...

Since the kids are so little yet, I'd probably go with one of the plans through work that does not have such a high deductible. You're going to be stressed enough if the kids get normal kid illnesses without worrying about paying for visits out-of-pocket, and as Aimee said, some things aren't even counted toward your deductible--we learned this thanks to HG. I know it's overwhelming to think of changing doctors, and I remember how upset I was when DH's old company insurance and the clinic we use were in a showdown and it looked like we'd have to change clinics, but in the end I would have done it for the sake of my kids and our finances. We have AFLAC through dh's work, and the policies are pretty specific as to what they'll cover--more for emergency kinds of situations. Hope you can figure something out!

[aaronsmommy]

Pamela - next time when you go in, make sure you tell them you get cramps, or your periods are heavy, or irregular, or something, and make sure the doctor doesn't code it as a routine visit.

[krdoty]

You said the existing plan will run out next June. Do you have to make the decision now to get the kids onto one of your work plans? I didn't see anything to indicate whether your kids have any medical conditions that require close monitoring or monthly medications. Don't forget to consider those costs in the monthly totals.

I would not go with any insurance that would make necessary or even tempting to not take your children to the doctor due to money concerns. I would plan to put the kids on whichever of your work plans that will be cheapest when you consider copays and medications. In the meantime, keep looking for other plans right until the time you have to make a final decision.

**My apologies if I asked about something you included. I'm reading and responding between plays of the football game.

[PamelaRose]

Yep, Aimee - It's odd how I always have vague symptoms of another ovarian cyst around the time I'm due for a check-up........

[mrsbigdog]

Teddi,

I totally understand your situation regarding insurance. My husband is a salesman and throughout our entire marriage he's probably only had employer sponsored insurance for a total of 2 years. I've always had to make sure I had a job that offered insurance. Right now he is running his own business and so we have no health insurance through work. I'm only working part time and could probably get on the employers plan but it would cost us about $800/month for the family. My husband is uninsurable if we try to purchase a plan ourselves and since HG I'm not sure where I'll stand.

Right now we qualify for state health insurance for families but if we really earn enough income to pay our bills we will lose that and either way we are now earning enough that we will drop off in February so I've got to find something!

I don't think our household will survive me going back to work full-time just to get insurance and truthfully with health ins cost/childcare/other expenses I'd probably make less than I do with this part time job now.

Does your husband's employer not even have a plan that allows the family to get coverage if you pay the additional expense yourself? I didn't know anyplace offered employee only and didn't allow you to add family members if you were willing to pay.

Obviously we can't live without insurance but I have no idea what my family is going to do after Feb so I'm kinda in the same situation as you.

Let me know what you work out - maybe it will work for me too (LOL).

Donna

[teddi]

I've done some more researching.

Kendra- no, I don't have to add/make any changes to either Hubby's or my work insurance UNTIL next year, June-ish, when our current policies run out. I'm just really wanting to research AHEAD of time and make sure I look at things from every possible way to make sure I make the right decision.

Pamela, what you said really resonates. I would rather have stress of a bigger monthly bill than the stress of trying to talk myself of not taking my kids to the Dr. Oh and then there's Kaylie. It's ALWAYS Kaylie. At her rate, I guess I can count on annual ER trips. Plus, with the girls, when one gets sick- the other one does too! I've definately ruled out the Kaiser high deductible plan. I might research other options.

I am decided, I ran the numbers everywhich way, and it's to my benefit to USE my medical group coverage. It's also Kaiser and the coverage is even better than my husband's... $10 co-pay. IF I got pregnant, that's the coverage I'd want to be on.

Donna- I am 99% sure we CAN add the kids to DH's policy and like you said pay the diff out of pocket. Looks like that option will cost about $400 a month out of pocket, BUT it's good insurance. HMO, no deductibles, $20 co-pay, etc. Right now that's looking like our best bet, plus, I *think* at least the amount we pay if it comes off his paycheck, should be PRE-TAX, so, that there saves us 15% income tax on that amount we'd spend.

Bottomline for us, I need to be strict with the finances. If we keep uneeded spending down , and pay off the cc bills, then, fingers crossed & hoping for a 5% raise for hubby.... we should be able to absorb about $400 a month.

Aimee- I googled and found the Santa Clara thing. I also found where the legislative changes to Healthy Families were made (just haven't found it to read it)... and I know Solano County is set to start accepting "healthy kids" (from my friend in the clinics who does the medical billing). But no details yet.

[tlm5999]

Insurance has been one of the few times when I am very glad we are poor. DH works for a family business and has no insurance at all, but if anything happens on the job they will cover everything out of pocket. The kids have state covered health insurance that covers everything, and I have the same insurance when I am pg and they will cover any bills three months prior that are approved and for two months after delivery. They have been wonderful with the HG and I know we couldn't have made it through without it. If something ever happens to DH or to myself when not pg we'd be screwed.

[krdoty]

Bottomline for us, I need to be strict with the finances. If we keep uneeded spending down , and pay off the cc bills, then, fingers crossed & hoping for a 5% raise for hubby.... we should be able to absorb about $400 a month.

Do either of your benefits packages allow you to set up pre-tax deductions for healthcare or childcare reimbursement accounts? That's another way to maximize the tax benefit of the money that you make. The only down side is that it's a "use it or lose it" proposition so you have to really crunch the numbers to set aside the right amount. But if it's available, definitely take advantage!

I've also found lots of little ways to save money because that's the only way we can afford for me to be a SAHM. I'd be happy to discuss those things further if you want me to go into more detail.

[teddi]

Do either of your benefits packages allow you to set up pre-tax deductions for healthcare or childcare reimbursement accounts? That's another way to maximize the tax benefit of the money that you make. The only down side is that it's a "use it or lose it" proposition so you have to really crunch the numbers to set aside the right amount. But if it's available, definitely take advantage!

Yes, both our employers do allow the medical insurance (monthly) premiums to be deducted pre-tax. Took DH's employer A MONTH to get back to me with that answer (I asked when I first started the thread). This would not be done as a "irs flex savings account" though, this is simply a pretax payroll deduction (which is better than the flex savings option). Ironically, the flex savings explicity DO NOT allow us to use the savings (and they have an annual max of $3600 a year) toward the insurance premiums! Like that makes any sense at all!

So, for now, it looks like that may be how it ends up, about $400 a month, but at least, pre-tax. I will continue to shop around a bit though.

[teddi]

Aimee- Oh also, found out more about the Healthy Kids program. Only about 6 or 7 counties are doing it right now. And it is an increase from the Healthy Families guidelines- those cap at 250% of federal income/poverty guidelines. The KIDS program ups it to 300%. Contra Costa county, my county is not participating. From what I recall only Northern CA counties were participating. The income guildelines are actually identical to the Kaiser Kids program.