medical insurance

Bye-Bye $485: Day 29

January 31, 2013 By Jeffrey Strain 7 Comments

Reality set in today as I received my monthly health insurance bill: a painful $485. That will be nearly $6,000 a year out of the $17,000 budget or about one-third of all the money I have. This makes it very easy to understand why most people on a minimum wage simply choose to go without medical insurance, and it’s certainly going to make my minimum wage challenge more challenging.

When I started this challenge, I looked at the different health insurance policies. I knew I was paying more than I had to and I wanted to see what else was available out there that might be at a more reasonable price point. Looking at high deductible plans, I could get insurance at about $150 a month. Still quite a bit for someone on a minimum wage, but two-thirds less than what I’m currently paying. Since I am relatively healthy, I could probably get away with a high deductible policy and have some extra money to spend on other things. The reality is that if I have any type of major health issue, I am going to end up losing this challenge no matter what type of health insurance I have.

Even though the savings would likely be much more, I simply wasn’t willing to change my current health insurance for this challenge. I also wasn’t willing to go without any insurance which is what a lot of people on minimum wage do. I personally view basic health insurance as something that is far more important to me than anything I could ever buy. I would give up my car without a thought before I would give this up (which may be something that I have to do depending on how things progress with this challenge).

Even though the health insurance is quite expensive, I feel that I can make the budget work. This choice means I’m going to have to give up a lot of other things I could have used that money for, but I weighed the options and decided that for me, this was the best action to take. What would have been your choice on health insurance in this situation?

To make matters worse, on my way home from Point Reyes yesterday, the clicking clutch came back, and this time louder than before. While I really would like to do some more traveling while I am house sitting, I’m wary that if the clutch goes out while I’m exploring, that could be a very expensive situation to try to resolve since I would be forced to get back to the house no matter what to take care of the dogs, not to mention having to get the clutch repaired in the middle of nowhere. For that reason, I’ve decided to cancel any more travel on this trip (it’s very disappointing that I couldn’t have it taken care of when I went in before travelling here). I’m not real happy about it, but it’s the financially smart thing to do. I will take it in and have it checked out as soon as this house sitting job is over. The good news is that I should be able to get a lot done on my writing over the next few days.

Today’s Spending

Food: $0.00
Car: $0.00
Housing: $0.00
Travel: $0.00
Health: $485.00
Misc: $0.00

Total: $485.00

Total Spending

Food: $21.76
Car: $0.00
Housing: $0.00
Travel: $0.00
Health: $485.00
Misc: $19.00

Total: $525.76

(Photo courtesy of Bill David Brooks)

Preparing to Be Laid Up

December 13, 2011 By Jennifer Derrick 5 Comments

In the not too distant future I’m going to have to have surgery on my foot and ankle. This is going to mean six to eight weeks of essentially being off my feet except for limited excursions to the bathroom and from the couch to the bed. I’ll be able to do some things, but my usual routine is out of the question. When the doctor told me this, all I could think was, “Man, this is going to be expensive.”

It’s not the surgery itself that’s the problem; that’s covered by insurance. Since I work from home, I’ll still be able to earn money. The problem is that I am the one who keeps the house running. Since I work from home I am the cook, cleaner, and minor maintenance person. I also care for the dog and do her grooming to save money. With me laid up, all of that work is still going to have to be done. While my husband can do most of it, it feels unfair to ask him to do everything that I do because he works out of the home ten to twelve hours a day.

With that in mind, I’m spending the weeks before surgery preparing as much as I can so that my recovery time won’t be spent getting take out food for every meal, hiring housekeepers, and paying someone to do all of the work that I usually do. If you’re looking at being off your feet for any length of time, here are some things you can do to make the time easier and less expensive.

Make meals ahead of time

I’m making as many meals ahead of time as I can and freezing them. This way all my husband has to do is come home, pick something, and toss it in the microwave. Beyond that, I’m stocking up on supplies for simple meals that he can make with little effort.

Reach out to family, friends, and neighbors

If you have a supportive community around you, see if any of those people can help you out. A neighbor is going to take care of taking my dog out when my husband isn’t available. A church friend has volunteered to help with some household chores. And many people have promised food for my first few days at home. I’m lucky to have such supportive people around me. Chances are you do, too, but you may have to reach out and let them know you need help. Church or social club members can be valuable resources, in addition to family and friends. Promise to repay the favor someday or help them with something so you don’t end up feeling like a moocher.

Get the house ready

I’m taking care of as many nagging little chores and repairs as I can right now. Anything that’s been on the to-do list is getting done so it’s not hanging over my head and/or getting worse while I’m off my feet. I’m also giving the place a thorough cleaning and clearing out a lot of junk and unwanted items so that I’m not tripping over them and I don’t get the urge to clean after surgery. Having less clutter will also make it easier on those who come to help me.

Educate your helpers

My husband is a great guy, but since I do all of the household related stuff, he’s a little out of the loop as to which product to use for which job, how much laundry detergent to use, and the overall household routine. I’m spending some time now teaching him the things he’ll need to know. This will be wonderful for the days when I’m too hopped up on pain medication to form coherent sentences. I’ve also invited several of my other helpers-to-be over to show them things like where the sheets and towels are stored, where the dog’s leash is kept, etc. so that they won’t need much help from me.

Prepare for entertainment

I’m a very active person and being laid up is going to be boring and lead to some online shopping or lots of nights at the movies if I don’t prepare to keep myself entertained now. I’m loading up my e-reader with free/library books and I’ve got a long list of titles I want on hold at the library. I’ve updated my Netflix queue and made sure that I’ve asked for some new games for Christmas. I’m stocking up on puzzles, free games for my Kindle, and planning some long-neglected writing projects. Since my body can’t be active I’m taking steps to keep my mind active so I don’t just spend days idly surfing the Internet and spending money to alleviate the boredom.

There will be some things that I’ll have to pay to get done. Since I cut my husbands’ hair, unless we can find a way to manage it from my perch on the couch he’ll have to go to a salon. And the dog will have to go to the groomer at some point. However, I’m trying to minimize my recovery time expenses as much as I can by taking action now.

(Photo courtesy of Lauren Powell-Smothers)

Dealing With Your Medical Insurer

July 30, 2010 By Jennifer Derrick Leave a Comment

If you ever face a medical crisis, you’ll be amazed at how quickly the bills mount up, even with great insurance. You could argue about whether insurers are inherently evil, coldhearted, or callous, but the bottom line is that insurers are businesses that want to get the most money they can out of you. Sometimes you will have to pay and there’s no way to get around that. However, there are so many mistakes, wrongly denied claims, double bills, and unnecessary charges at times that you may be able to reduce your bills somewhat, but only if you’re prepared to fight. Your insurer isn’t going to suggest ways for you to reduce your bills and they aren’t going to help you very much. Your insurer hopes that you will just pay the bill. You want to question everything and only pay what you need to. Here are some ideas if you ever need to go to war with your insurer.

Know your benefits before you need them

Chances are your insurer sent you a benefits guide when you got your policy. Chances are that you threw it in a drawer. You need to take it out and read it cover to cover before you need medical care. Read everything they sent you, and keep up when they send you amendments. Know what’s covered and what’s not, know what doctors and hospitals you can use, and know what procedures require pre-approval. You hope that you’re wasting time by reading all of this boring stuff, but if you ever find yourself in the midst of a major medical crisis, all of that knowledge will make things go a lot smoother for you. Just the simple act of telling the ambulance driver to, “Take my husband to hospital X, not hospital Y because that’s where are insurance is accepted,” will make things much more affordable and easy for you. If you don’t read your guide, though, you don’t know what to ask for.

Understand what you must do to get procedures approved

For anything beyond routine and emergency (life or death) care insurers vary widely on what you need to do to get procedures approved. Some simply require your doctor to note that the procedure is necessary. Some require a second or third opinion. Some require waiting periods or other hoops to jump through. Know what you have to do to get approval and make sure you follow those steps exactly. Also keep notes of the steps, dates, whom you talked to, etc. so if there are any disputes you can prove you did what the insurer required.

Be persistent

Persistence pays off in many cases, but it can be hard. You sometimes have to outlast a big, bureaucratic machine and it can be exhausting. If you don’t get the answers or resolution you need on the first call, you need to be prepared to call back again and again, and to work your way up the chain of command. You need to write letters and emails over and over again. You have to keep after the insurance company until you get all of your questions answered and your disputes are resolved.

Enlist your healthcare provider for help

You doctor can be a great ally in your fight. He or she can sometimes step between you and the insurer, offering detailed explanations as to which procedures were performed and why. The doctor can attest that the procedure, drug, or material was required and they can speak to your efforts to get things pre-approved. Some doctors won’t help you much, but if you have one that is willing to step in, their words can be more convincing than yours.

Get organized

Make a spreadsheet or notebook to keep track of everything. Note phone calls, dates, and names of people you talked to so you can reference any promises or disputes. Mark off charges as they are paid (either by you or the insurer) so that you can tell if they reappear. Keep records of everything related to your healthcare and claims so that you always know exactly what is going on and who is getting paid what. Confusion only works in the insurers’ favor. They have huge databases that track everything related to your claims so they always know what’s going on. You should do the same. Keeping good records will also help you at tax time if you end up able to deduct any uncovered expenses.

Understand the appeals process

When you read your benefits guide, pay close attention to the section on appealing. There will be an explanation of what you need to do if you think a claim is wrongly denied or processed. It will spell out how long you have to lodge an appeal and exactly what you must do. Know this process and follow it exactly. If you deviate from their steps, they will only deny you again.

Read every bill and compare them with past bills

When you get a bill in the mail, read it thoroughly. Don’t just toss it on top of the heap. Then get out your older bills and your notebook or spreadsheet and compare them. Look for any charges that keep reappearing after you’ve already paid them. You already paid the bill for the anesthesiologist but look, there it is again. Don’t pay it a second time. Call the insurer, offer up your proof of payment and ask that they stop billing you for that. When medical procedures mount up, it gets harder and harder to detect multiple charges for the same things without good records. So keep your records and constantly compare new charges with old charges.

I’m not suggesting that you shirk any legitimate charges. If you had the service, you do need to pay. However, you don’t have to pay for mistakes or things that were wrongly denied. Insurers are notorious for double billing, overcharging, and denying legitimate claims. Know your rights and fight anything that you think you shouldn’t have to pay. It can save you a small fortune in medical bills.

An HDHP / HSA Could Be Just What the Doctor Ordered

August 30, 2008 By J. Alan Maguire 5 Comments

With the costs of health care rising dramatically every year, both companies and individuals are trying to find ways to lessen the financial pain. One option is a (HDHP) coupled with a Health Savings Account (HSA).

Many of you may already have this option, or your company is rolling this out in the near future. It can help cut costs and boost savings, but it isn’t right for everyone. There are a few facts to consider before deciding what is best for your situation.

HDHP

A High Deductible Health Plan is exactly what it reads like: An insurance plan with a high deductible but a very low premium. It is available to anyone whether you are self-employed or an employee.

Upside: Saving money is a priority for most when it comes to insurance. The money you save by having a low deductible can help you pay off debt, or you can add it to your Health Savings Account.

Downside: High deductible means higher out-of-pocket expenses. For 2008, the minimum deductible for one insured is $1,100 and the maximum is $5,600. For families it is much larger with a minimum of $2,200 and a maximum of $11,200. Quite a bit more than you pay with a regular, low-deductible insurance plan.

Any amount up to that deductible is your responsibility, and there is little to no savings in price as with other plans, though you save money if you use a provider within your plan’s network, if your plan participates in one.

If you have prescriptions, be prepared to pay much more than you would with a traditional plan that just requires a co-pay.

HSA

To be eligible for a Health Savings Account, you must be covered by an HDHP and must not be covered by other health insurance that is not an HDHP. Exceptions to this would be dental, vision, disability and long-term care insurance.

The Health Savings Account offsets the HDHP with tax-free money contributed by you, and possibly your company. You add money to this savings account to save for any of the higher up-front medical expenses like doctor visits, prescriptions, etc. The money you save in this account is tax free if used for approved medical expenses.

The money stays with you and rolls over every year. So the healthier you are the more interest you will earn and the more money you will save. Some employers deposit money into your HSA as well to help with medical expenses.

Upside: You are more in control of your money and medical future. Your money earns interest and rolls over every year. A healthy individual with very little in the way of medical expenses can amass quite a sum of money.

You don’t incur taxes as long as you use the money for medical expenses. After age 65, if you use the money for something else, you just pay the tax, but not the 10% penalty. Think of it as another way to invest in yourself and your future.

Many plans come with a special debit card tied to your HSA account, so it’s easy to pay and cuts down on transfers and paperwork.

Downside: There are limits on contributions to your HSA. For 2008, an individual could contribute $2,900, and a family could contribute up to $5,800.

Taxes apply for any withdrawal from an HSA for non-medical expenses, along with an additional 10% penalty. Once you reach age 65, there is no penalty, but you still have to pay taxes for any non-medical withdrawal.

Moreover, with more control comes more responsibility. Unfortunately, people aren’t always responsible when it comes to saving. If you or a member of your household becomes extremely ill, becomes pregnant, or has an accident, and you haven’t placed enough in your HSA, it may be a longer way to the end of that high deductible than you thought. If you have trouble saving, or think you might not be able to put enough money in to cover the high deductible (especially if you are just starting with your HSA) you may want to look elsewhere.

There is no clear, yes-or-no answer. You have to decide. This can be a viable combo for employers looking to avoid rising health care costs, and it can provide a low-cost insurance option for healthy individuals and families.

Image courtesy of happysnappr