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Jeffrey Makiel
01-18-2007, 11:32 PM
My brothers currently have individual health plan policies. They are brutally expensive and cost much more, and have less coverage, than my policy thru my employer. They are each shelling out $5,000 per year for a $10,000 deductible policy with another $5,000 of copay before the policy begins to pay. An individual policy with decent coverage is about $18,000 per year each.

Has anybody heard of a way to join a group or organization that will help get better rates and/or coverage?

-Jeff :)

Curt Harms
01-19-2007, 2:20 AM
Hi Jeffrey

Does the local Chamber of Commerce or trade group offer a group policy? I recall a thread somewhere about this topic. The gist was new policies can start out quite reasonable and quickly escalate over the next few years. Good luck to your brothers. Ed Rendell is proposing state assisted health insurance for individuals & small business in Pennsylvania and additional taxes for firms that don't provide health insurance to employees. It'll be interesting to hear the details, where devils often lie.

Curt

Joe Pelonio
01-19-2007, 8:27 AM
That all varies by state, as not all insurers sell in all states. When we had none I got it through a small business organization I belonged to. Fortunately my wife soon got a job at the local school where we have a much better plan for way less. Here in WA there's now a state sponsored health care plan with some options, that sounds better than what they have now in benefits but a lower premium. Costco sells individual health and dental in California.

Jeffrey Makiel
01-19-2007, 10:05 AM
I also saw the thread that stated that the local Chamber of Commerce may offer a group rate. That’s what prompted my interest and I am hoping to learn more.

I recently seen in the news that Massachusetts is offering a state sponsored plan also and made it a law last year that everyone must have comprehensive insurance. If you are low income, the insurance is subsidized by the State.

Both of my brothers will be 50 years old in 15 months. I checked into AARP and they don’t offer a policy in my home state of NJ.

Our BlueCross/Blue Shield rates are going thru the roof. There has been a 25% increase each year for the past 7 years. To offset the increase, BlueCross/BlueShield is offering higher deductible plans with large co-insurance payments. This year, they are offering a plan that is almost criminal. It does not cover chemotherapy, casts and prosthetics, no prescriptions and has an extremely low maximum cap.

I have a good comprehensive policy that is offered as a group rate thru my employer. I pay 25% and my employer pays 75%. The total cost of the policy is $10,000 per year for individuals. A similar policy is offered by BlueCross/BlueShield. It has a street price of almost $20,000 for individual. It just doesn’t seem very fair. Everybody needs coverage and one does not choose to get sick.

Oh well….Jeff :)

Jeremy Gibson
01-19-2007, 10:28 AM
I can certainly relate to this issue. I left a large employer with great group health insurance rates to be a self-employed consultant. I get a good rate, but now my wife and I have individual coverage. She pays about $100 per month with no coverage for her asthma or any perscriptions. I pay about $150 per month with a $1,500 deductable plus another $500 deductable on perscriptions. Overall, that seems pretty good compared to what you described. I used to describe my first individual health plan as being great if I was decapitated (I have good life insurance ;) ) but useless otherwise.

I think what really irritates me is the exclussions of any and all pre-existing conditions. My wife has asthma that is very well controlled with inhailers, but the insurance company refuses to cover the asthma or related perscriptions. She didn't want asthma at the age of 2, but that's the card she was dealt. It's not even something we can pay extra to have coverage...just too bad, so sad.

I was initially refused coverage for anything related to high colesteral because I'm taking a perscription drug called Niaspan. It was prescribed because my good colesteral was too low, not anything too high. I argued with the insurance company and finally filed an official grievance and sent them a copy of my last blood work. They had no choice but to remove that exclusion in my policy since I did not, nor ever had, high colesteral. If felt so good to "stick it to the man!"

Joe Pelonio
01-19-2007, 11:27 AM
Because of the way insurance companies price premiums with their "pools"
living in a highly populated state is going to mean higher prices, as both the percentage and number of of people with big claims is higher. It almost seems a good reason to move. In this case though, NJ is not that much more populous than WA, but there's also the state regulatory costs added to the health care provider's premiums which may make a difference. New Jersey has the 4th highest Health Insurance rates in the country, per these
stats that I found. They are all too high though!

Lowest (annual/Family):
1.
South Dakota
$5,678.65
2.
North Dakota
$5,713.15
3.
Missouri
$5.790.45
4.
Kentucky
$5,894.18
5.
Mississippi
$5,901.51
6.
California
$5,945.61
7.
Iowa
$5,989.04
8.
Virginia
$6,009.21
9.
Kansas
$6,041.64
10.
South Carolina
$6,083.00

Highest:

1.
Massachusetts
$8,468.86
2.
New York
$8,427.50
3.
New Hampshire
$8,290.90
4.
New Jersey
$8,274.53
5.
Connecticut
$7,597.89
6.
Maryland
$7,268.98
7.
Florida
$7,206.48
8.
Wisconsin
$7,134.04
9.
Pennsylvania
$7,123.71
10.
Texas
$7,047.92

Jeffrey Makiel
01-19-2007, 4:39 PM
Jeremy...New Jersey has a law that states that pre-existing conditions are not covered only for the 1st year of insurance coverage. After that, insurance must cover it. A pre-existing condition is defined as a person knowingly had a condition that a prudent person would otherwise seek care, or was treated for a condition in the previous 6 months. I thought that this was a national requirement now. But I may be wrong.

Joe...those are some interesting facts. However, $9,000 per year does not buy a very good individual policy in NJ. If you have prescriptions (cholesterol, blood pressure, diabetes, etc.), routine checkups with minor tests (blood urine and x-ray), and minor illnesses (flu and viruses), none of these would probably be covered because of a large deductible. These can easily add up to $2,000 or $3,000 of out-of-pocket expenses.

-Jeff :)

Joe Pelonio
01-19-2007, 5:07 PM
I double checked and these figures are averages for that state, and are not up-to-date but a couple of years ago which is the latest data available.