Thread: What options do I have for health insurance? Group plan.. etc

Yes I did read the last thread on health care. Total waste of time.. I was hoping to get some ideas on what companies you had have a good/bad experience with. Not endless political ranting.

A statement and then a question: I started my business in 2006 with the intention of working from home for a year or two and then opening a storefront, maybe hiring a few people. 2009 would have been my time to expand except those plans were put on hold for another 3 years due to the economic factors. Things have improved considerably over the last 18 months and I have opened the storefront and hired a helper. My wife has a great job as an Oracle DBA with excellent benefits so this entire time I have been covered on her BC/BS family plan. Now her company has been bought out and they will be going to United Health Care. We may stay with that.. we may not.

Here's the question: How do you small shop owners and lone rangers shop for health insurance for your families? Are there any options for group plans? Are there any health insurance companies you have had good or bad experiences with? Please.. no politics here. Let's talk about insurance plans and experiences, good or bad.

TIA

X

Think about a newbie machinist tasked with selecting the best carbide grade to run.
This decision is child's play compared to shopping for health insurance.

First, the rules vary by state, my experience is in Michigan.
I have used Blue Cross, HAP, and Health Plus. Good and bad in all but I end up going back to BC/BS the most, although overall they are a bit more expensive.

We have a crazy wild choice of plans.

Large group plans are better priced. You need at least two people to get into a group.
I know Husband/Wife operations where the owner will put the wife on under her maiden name as the second person to qualify for the group rates.

The are various organizations that you can join to get into a group under their umbrella.
Some of these seem to exist just to get you insurance, you pay them a couple hundred bucks a year to get access to the system. We belong to the local chamber of commerce for this reason.
The larger the group the lower the rates.

Reviewing plans is nuts without help from someone very into the system in your state.
Lucky for me, little sister used to be a salesperson for one of these companies so she helps me out.
I spend a week every year or two going over options trying to save some money.
When you are done you still do not get a warm fuzzy feeling that you have made the right choices for your workforce.

What really sucks is the tons of fine print and exclusions that you don't realize until people start using the plan. I do not think it is possible for a human being to fully understand what you are buying. Albert Einstein would throw his hands up in the air and say "this is not a solvable problem".

For example, a friend of mine has a rep business basically like yours.
He has a BC/BS plan. It pays 80% on doctor visits.
Then his wife gets cancer and suddenly he finds it pays only on 2 doctor visits per year per occurrence.
So her first 2 times to the doctor are covered. Then nothing, you pay it all.
If she breaks her arm, that is a new occurrence and would be covered, but obviously with cancer you are going to see the doctor more than twice a year.

When selling these plans they don't tell you about the stuff that is not covered. You have to learn to ask about tons of details. (RPM, DOC, feedrate, stepover, material hardness, cast surface skin, machine rigidity, tool hangout, etc. )

Age and health condition of your workforce makes a difference as to which plan works best for you.

If the company pays for it we have to offer the same plan to all full time employes. I don't know if this is fed or state rules. This is to prevent the owner from giving himself a "Cadillac plan" and giving shit to the employes. You may be able to play the game differently for salaried vs. hourly, I'm not sure, I know GM does this.

Once you get to the 50-100 man size most will start looking at being self-insured.
The way this works is you hire BC/BS (or your favorite company) to administer the plan and everybody gets a card so it looks like Blue Cross plan to the employee. You buy limited insurance that does not kick in until you hit some very large number, say $100,000 per employee. Up to this point BC processes the paperwork, negotiates the rates with the care provider and send you the bill to pay. The auto companies are self-insured but to the employee it works just like the conventional health care plan so they see no difference.

Yes, I know, not much help.
Call in your insurance reps, then call in the reps from the companies.
Just like us carbide guys, they will point out the bad things in the competition's plans but not tell you about their own shortcomings. I'm guessing you know very well how this game is played.
Shop, compare, call and ask questions, compare some more. At some point you may well decide that spending a bit more is better than wasting more time on it.

Walking though this minefield makes the rest of my job look easy.
Sometimes I feel like just putting them up on a dartboard and tossing blindfolded would be the best option.
As an owner you won't find anything as frustrating as this. The IRS tax code is dirt simple compared to health care plans in the US.

(Sorry for the long posting)
Bob

Originally Posted by exkenna

Here's the question: How do you small shop owners and lone rangers shop for health insurance for your families? Are there any options for group plans? Are there any health insurance companies you have had good or bad experiences with? Please.. no politics here. Let's talk about insurance plans and experiences, good or bad.

Hey Curtis, Went through this a while ago. Ended up using HSA's, you can get all kinds of quotes online pretty easy. Now we never had to use any of the
insurance side of it, so I really couldn't tell you, but it at least lets you pile pretax-cash away for medical stuff, even if it isn't directly covered by your
insurance, eyeglasses and such...

Final solution. Marry a teacher, though even their insurance is going through the roof. My business partner, and his old lady, premiums, $7k out of the paycheck,
$7k from the school system (itemized on each check stub), and another $10k out of pocket (had a kid, and that was WITH maternity coverage).

You want to speak to an insurance agent regarding the minimum number of people that would constitute a group (it varies). As for United HealthCare vs. Blue Cross, it's like chinese machinery vs. US one. Obviously, each company can sell you different plans that range from barely acceptable to extremely bad (there is no such thing as a good plan now), and prices will reflect it. But I wouldn't even consider United HealthCare.

in my experience, if you can ride with your wife and your employee has insurance elswhwere you are better sitting the game out for now. one of the things I never understood was why a Group was the number of employees a company had on the plan, not what the agent or agency had. in small group its bad bad rates and no leverage for anyone to reduce them ( in most cases ).

I have United healthcare. It's that "Cadillac" plan that Obama hates so much. I do not have to have a referral to see specialists. It pays promptly so providers like it. They don't quibble over my wife's mammograms and such. You could do much worse.

[not had time to read much of this thread yet]


Kenna:

If you are a member of the NFIB you can likely get into a group policy through them.

I don't handle that kind'a stuff, and I don't know if that is who Mamma uses for us or not. ???
But would be werth checking in to.


If you are not a member - you should be lookin' into it....


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I am Ox and I approve this h'yah post!

Ox,

Is joining the NFIB expensive ???
I've heard that joining your local chamber of commerce can also get you into cheaper group rates.
We started looking for insurance a week or so ago, and it's very discouraging. Anything that looks affordable covers nearly nothing. I don't know what's worse, paying through the nose every month for almost non-existant coverage that would leave you in financial ruin if you got sick.......... or paying cash, that would leave you in financial ruin if you got sick.
Not much difference, in my opinion.


Frank

Doos is whatever you can afford or feel it is werth.

Assuming start small, and hopefully you can give more in later years.
Call your rep for details.


---------------

I am Ox and I approve this h'yah post!

Everytime I see these threads, I'm glad its a headache I don't have.

toolcat,

"Obesity in America will be the straw that breaks health care's back. It's funny how us arrogant Americans will eat, drink, and smoke to our heart's content. "Don't tell me how to live my life", is an American right."

IF you are under the impression that ONLY the US is FAT, you should do a Search! We may be % or 3 above the most of the Developed World, but we are y NO means the only fat people in the World. Australia is just a bit behind, us, last I checked, but I never did see if those who ARE fatter, are MUCH fatter.

England I think is within that range, too.We are in a quandary. About 1920 Britain did a survey, and found that the poor, who had less food than the well to do, produced young men, on average, 4 inches shorter, and 40 pounds lighter than those who went to what I think they call "Public School", those for the well off. The determination was they did not have enough people fit for Military Service, too short and underweight.

i do believe that is why they began what they would call Welfare, feed them poor kids in case they are needed when Gordon and Denmark next invade them.

We have little men here, and a great part of their stature is because they were ill fed.

I was about 5'6 when I went to the Marines in 1962. I had NEVER eaten as much as I could, then, it's on the table, pitchers of milk, all the bread I could eat, all the eggs and bacon I wanted, as long as I scoffed it down in the allotted time. 3 months later, I was 4 inches taller. No bullshit! You don't quit growing at 17, which I was.

I came out of Boot Camp, and the guys I had to look up to, I now looked down on.Most of them were going bald, too. So bad. They had really nice coifs, as kids.

TD,

Of course, you are there, and I am here.

" I have United healthcare. It's that "Cadillac" plan that Obama hates so much. I do not have to have a referral to see specialists. It pays promptly so providers like it. They don't quibble over my wife's mammograms and such. You could do much worse."
I am in PA. and I have UPMC, and I have few co-pays. I go to the Doc, none, I go to the Dentist, 20%, I go to the Hospital, None.

COSTS me, 75 per month, I suppose I could not pay that, put that money in the bank and pay out of pocket, as so many of you deem. MUCH better deal if you pay CASH.

I don't go to the Doctor. My bad. I ain't sick, so I don't go. I think my Doctor hates me, BUT, he gats paid so much a year to traet me, and IF I don't go to see him, that is money in his pocket.

HOWEVER, my cousin had knee replacement surgery. Therapy, under UPMC, was free, Doctors send her bills, UPMC sends her "Statements of Benefits". Doctor's charge, 175 bucks, "negotiated discount" , 85 bucks, "We pay 17 bucks", your co-pay, 35 bucks. Your doc got 52 bucks on a 175 buck bill, AND, they are HAPPY to get it.

Of course, the Insurer and the Hospital System are one and the same. It is what I have through my former employer. I probably spent 200 bucks out of pocket in the past 6 or 7 years. Specialist fees and Dental co-pays. Glasses every 2 years, up to 250 bucks.

I am happy with what I have. Cost is minimal.

Somebody up above says employers will only pay so much before they decide to pay the "Fine". The "Fine" does not apply to employers. They can decide to terminate their Insurance contract right now, or at the next contact.
WHEN they do, you have the option to BUY Insurance, OR pay the 'Fine". The first year is 95 bucks, for the WHOLE YEAR. There is not a one of you who would not jump at that. When it takes full effect, the "fine" is 565 bucks, for the entire year of coverage. You are covered, by paying the "fine".

The Insurers are actually telling YOU that they can cover those additional 30 million people for 565 bucks per, yet YOU pay 5 to 10 grand.

Good business, if you can get into it.

Beddy bye. Babysitting tomorrow. Have to spend the WHOLE day with my Grands. Oh, woe, how can I stand that?

Easily. The hard part is getting up in the AM to get there.
George

This is from Nationwide. Medical Mutual Supermed quotes. I'm 31, wife 30, to sons 5 and 1

Copay Plans
Elite 500/1000 w/ Office Copay, Rx $872.62
Elite 1000/2000 w/ Office Copay, Rx $760.51
Elite 1500/3000 w/ Office Copay, Rx $661.74
Elite 2500/5000 w/ Office Copay, Rx $539.25
Premium 500/1000 w/ Office Copay, Rx $813.04
Premium 1000/2000 w/ Office Copay, Rx $709.95
Premium 1500/3000 w/ Office Copay, Rx $619.20
Premium 2500/5000 w/ Office Copay, Rx $506.64
High-deductible Plans
Elite 2500/5000 w/out Office Copay, Rx $544.61
Elite 5000/10000 w/out Office Copay, Rx $435.72
Elite 10000/20000 w/out Office Copay, Rx $388.80

Value Plans
Value Plan 500/1000 $608.85
Value Plan 1000/2000 $510.67
Value Plan 1500/3000 $443.83
Wellness HSA Plans
Wellness HSA 1500/3000 $539.73
Wellness HSA 2500/5000 $397.89
Wellness HSA 3000/6000 $359.29
Wellness HSA 5000/10000 $265.00
Short Term Plans
Short Term 250/5000 $527.89
Short Term 500/1000 $432.00
Short Term 1000/2000 $350.79
Short Term 1500/3000 $73.20 $323.76
Optional Coverages
Dental $60.82
Vision $23.42

Originally Posted by exkenna

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Here's the question: How do you small shop owners and lone rangers shop for health insurance for your families? Are there any options for group plans? Are there any health insurance companies you have had good or bad experiences with? Please.. no politics here. Let's talk about insurance plans and experiences, good or bad.

TIA

X

It might be worth taking a look at plans offered through Costco.

I'm mentioning this because a friend in Seattle got his insurance through Costco. He has a congenital heart condition and was still accepted. This was at least ten years ago and of course things change.

I took a quick look at their offerings which seem to be somewhat limited to only certain states. They mention the typical Costco member as being in the higher income brackets (and presumably healthier??) allowing them to provide the service at lower rates.

847.68 a month for connectcare HSA. This plan has a 5000/yr deductable , company putting in 550 for their monthly contribution

exkenna - I don't want to steal your thread but there are so many of us in your shoes - I wonder if we (the members of this forum) could form a co-op. There are quite a few around and I have looked into them in the past but the ones I have seen have always been very adamant about NO alcohol and NO tobacco. That may not fly in this group because most of us imbibe to some degree but it may still be a do-able proposal. Essentially it's self-insurance so we would need someone to run the group - preferably someone who has been around long enough to have earned the trust and confidence of the members here.

I know there are risks involved but I wonder if we couldn't do this cheaper than what we're paying now. The way it generally works is that the members' premiums are used to cover whatever monthly healthcare costs have occurred in a given month with the overage going into an account that builds to cover catastrophes. Of course whoever runs the program would have to receive his salary from within the proceeds that are raised and the members would have to agree to his salary.

If we had 500 members that would be interested in such an arrangment and each paid $500 per month into the program that would be $250,000 per month. I will come up with some hypothetical demographics of the age and health conditions of the people that I think are on this board and see if I can come up with statistics of what the monthly health-care costs would average for such a group. Then we can go from there if there seems to be any interest.

We are all aware of the problem and it isn't going to go away anytime soon (I would say) and if we are looking to the politicans to fix it we're just kidding ourselves so please - let's not get into the political side of things here. Right now our health care premiums are going to make fat cats fatter. Perhaps there's a way to step off this merry-go-round.

If it's something we think that would be workable I would be willing to develop the idea more fully.

Joe

If that were possible, and it may be... dont you think many of those groups would allready be available to join?

Joe ,
The problem with your idea is that you would not save any money and very likely you would spend more.
As a small co-op you would not have the clout to dictate fees to the hospitals and doctors.
This is why the mega corporations that are self insured job out the administration section to insurance companies. This way the doctors and hospitals have to accept the negotiated fee structures.

Companies like Blue Cross actually do more to keep cost down than anyone in the US.
Talk to some doctors during their "off" time. They all hate the insurance companies, and whine that they have to accept lower fees for services.

A few months ago a major hospital here in Detroit quit taking Blue Cross insurance as they said the rates they were being paid were too low. Both sides started taking out ad time on the local radio stations trashing each other. Eventually they worked it out.

While I'd like an easy scapegoat, and I certainly have no love for insurance people, blaming them is like shooting the messenger.

Now, if you restricted your co-op to single, 20 something, non-drinking, non-smoking, vegetarians, maybe you could save some.
Bob

Originally Posted by Gary E

Joe

If that were possible, and it may be... dont you think many of those groups would allready be available to join?

Yes, and thats why they are.
I belong to one of the oldest Health Care Co-ops in the country, Group Health, which was founded in the late 1940's. It is NOT insurance- no insurance companies involved in any way. Instead, it is member owned, and "we", the members, own hospitals, pay doctors, and in essence, all self insure. Its been around for over 60 years, its solvent and works quite well. Currently there are over 600,000 members.
I much prefer the care and coverage to Blue Cross, which I had before.

The downside is- its not significantly cheaper than other plans. Its better, its more efficient, all the money goes to health care, rather than profits, salaries, or shareholders, but its not some huge savings in cost. Its expensive to run a hospital or clinic in the Pacific Northwest, no matter how you do it.
I feel like I get more for my money than with Blue Cross, but its still a lot of money.

Originally Posted by Joe Miranda

If it's something we think that would be workable I would be willing to develop the idea more fully.

One of the things that is possible is to create an organization in your state where "small groups" can join the organization to make a much larger group. I think right now it is cut by state lines.... but I know eough to be dangerous. I know such an organization is legal in iowa but does not exist.... and I ran out of time to pursue it. I am not 100% positive how much group size helps but it surely can't hurt when shopping.

I think the best way to beat the insurance companies is to be in an individual group such as Christian Healthcare Ministries. Christian Healthcare Ministries: The affordable, biblical solution to healthcare costs

It is a large group of people that pool their money together and no insurance companies are involved. If you have or know you are going to need health services chministries will help you negotiate your pricing with the medical provider/

I personally do not believe the doctors or hospitals are the major problem with insurance. It is the insurance companies that want high salaries and profits for their shareholders.

Both a friend and myself used CHministries and it worked well, I dropped it because I was not longer regularly attending church... a requirement for their system.

Something similar can certainly be set up through machine shops I'm sure.