You might be
lucky. Then, your employer will pay for your health insurance. It might even be
a good health insurance. Of course, there is a down side to it. Once you are
fired, or downsized, not only your credit is severed, but your health insurance
as well. If you are fired, you are not allowed to be sick. So don't quit your
day job, since you'll loose your health insurance.
But I am not
lucky. I need to have health insurance on my own. For that, I need to learn
which insurance is the best for me. True, I am as educated as the next guy, but
I can do some research. There are just a few things one needs to know.
Deductible, co-payments, eligibility and few others. So I am off for the races.
My wife's health insurance is not good enough. It only has 30K annual return,
and I must have 50K. No go. Furthermore, my wife's insurance costs about 300$ a
month for me. It has some good sides. It gives 100% coverage and all
pre-conditions I have.
I am lucky. I
do not have any pre-conditions. I am as healthy as an ox. If it is healthy. So
I need to look for insurance. My university recommended a company. Let's look
at it. No deductibles. That's great. I think. I am not really sure. Then again there
is a 93$ payment every month. That's expensive, right? Not when you compare it
to my wife's insurance. But what about the coverage? Well 90% on most
procedures. That's nice. That's good. A hospital room of a semi-private rate.
And 70% of non PPO.
What's PPO?
Well, each insurance company works with a chain of hospitals and doctors. This
chain is called the PPO. If one goes to a member of the PPO, then it is 90%
coverage, if one goes to non PPO member coverage is only 70%. In order to find
out which hospital and doctor is part of the PPO you need to start yet another
small research. I did not have the energy to look at this company's PPO. Still
a 93$ a month for 90% coverage, is that good? Is that bad?
I continued
searching. The university also tells about four other companies with which one
can have insurance. So, I checked them out. One of them was giving a 80%
coverage in a price much higher than the one recommended. Well, that's not a
choice.
The third company
is way, but way, cheaper. I am talking about 57$ and 69$ a month. Now, since I
am healthy, why not opt for it? The coverage. Well, that's hard to tell. This
company does not work with percentage of the bill the hospital gives you.
Instead, it pays back a certain amount for every little thing. Say, a day in a
hospital room, 1200$. Miscellaneous during hospitalization another 500$ a day,
x-rays 350$ and so on and so forth. But, I don’t know how much a day at the hospital
costs. It might be 3000$ and it might be 1000$. If it is the later amount, then
I need to take this offer. If it is the first amount, then this offer is not
very good. But how can one tell? Should I contact the hospital near by me and
ask them how much a day costs? Come to think of it, that's might not be a bad
idea after all.
Then there is
another company. They use this strange term which caused me to strike them out
immediately. They cover the usual, customary and reasonable costs. And they
only cover 30% of it after negotiations. Negotiations with whom? I was
wondering and about what? Are they negotiating with the hospital about the
price or will they negotiate with me about what is reasonable, customary and
usual? In any case, I was not about to negotiate with this company, reasonable
or unreasobale as it may sound.
And then the last
company. They have both deductible and co-payments. They let me choose how big
of a deductible I want annually, and then the monthly rate is changed
accordingly. If I want 1000$ deductible, I only pay 800$ annually. If I want
250$, I pay 1300$ annually. They also have three types of coverage, silver,
which is the simplest, gold and platinum. Their premium varies accordingly.
Then again they also use the URC as an acronym, it is that common. But, they do
not negotiate and they do not give 90%. They give full coverage of a day at the
hospital. No, I am wrong. They give in the silver plan 650$ per day at the
hospital. In the gold they give full coverage. No, not full coverage but the
Usual, Reasonable and Customary coverage for a semi-private room. In the
platinum they give the URC for a private room. But again, I have no clue how
much URC room costs. And this company is a bit more expensive than the one my
school recommended. But the one my school recommended only covers 90% at the
PPO. So I decided to go with the last company.
I re-read
their benefits and saw that, wait a
minute, they also have a PPO. They give the URC only at the PPO and 80% at
non PPO. But where can I found if they have hospitals in my region as part of
their PPO? And who is their PPO? And what is this company's real name? Because
every company has several other companies which are the local brunches or
insurances in every state. And in every state the one big company has a
different name. and its PPO also have an unknown name, at least I could not
find its name in the insurance company and only a google search led me to find
the name of the of the PPO.
So I looked
for hospitals of that PPO in my region. By now it was 8 p.m. and I was tired
after starting my research at about 11 a.m. A long day of research. By now I've
realized there is no way I would do my insurance today, since I got so confused
from all the facts, different coverages, PPO, coinsurance, deductible, underwritten.
But, then again, I had to find out if my favorite insurance has a PPO hospital
in my region. Since I was tired I did the little mistake of giving the wrong
zip code and therefore for about 10 minutes I was sure the PPO has no hospitals
in my region. If this is the case, then of course I cannot have them as my
health insurance company, can I? Luckily, by the fifth time I ran that search I
found my mistake and corrected it to realize that most insurance company works
with most hospitals in most regions.
So what
should I choose, paying 103$ a month to have a 500$ deductible + a full URC
coverage or pay 93$ a night to have no deductible and 90% coinsurance of PPO
treatment? In the next day I made my decision and fought the different forms I
needed to fill out to have the insurance, which I am not sure I have it, just
yet.
If you want
to compare, in Israel
you pay 3.1%-5% of your income as a health tax. If you do not have a job you
pay flat fee of 92 NIS
(equal to 25$) a month. Everyone is entitled to a not that bad basic coverage. One
can add a second lair of insurance for an additional amount of 10-30$ a month,
which includes the payment for a second opinion, choosing your own doctors in
some places etc. one pays 5$ per quartile for visiting a professional doctor,
unless one has a chronic disease then you do not pay at all, and the waiting time for
visiting certain professions are long while others are short. In any case, last
year I spent around 424$ for my health insurance, and this year I will spend
1200$ on it. I only hope I will not have the occasion to find out if this
insurance gives me better or worse coverage than the one in Israel, though it
sure costs much more.
And one last small thing, in Israel
I did not spent two work days to find out which health insurance I should buy,
only to realize there is no educated way to make such a decision, as I found
out happens in the USA.