Health Insurance

[Xanax 349]

Hi all, thank you for reading and any advice you can give me!

I have not moved yet, still in K1 stage, but I am a planner, like I assume most of us here are.

My partner has health insurance through work, with Aetna Medical PPO, but in my opinion it is fairly mediocre coverage and I want him to change it and for us to have something in the works for when we get married once our K1 is approved (if we can).

I have not read anything good about this company and am so scared that if he gets sick (he has never been sick) he would not be covered and could not afford the out of pocket expenses for something costly like cancer.

My questions are:

1) Is it difficult to get coverage outside of work?

2) My partner pays $350 a month from his wages into his health insurance, does he lose that money if going off a work plan?

3) Can he even leave the work plan?

4) Coming from O/S (Australia) do I need to bring any medical records with me or will a company just cover me if I have nothing pre-existing?

4)a) What if something happened and or I had something pre-existing , would that mean I would have to join a high risk pool insurer?

4)b) Is there a time frame for pre-existing illnesses? IE/ If when I was 2, I had an illness and had it treated would I need to state that as a pre-existing condition ?

** Thanks already to Vanessa who has answered lots of my health insurance questions already! I am just sooo paranoid about health care in the US.

Edited March 23, 2012 by BrittandDan

[Moomin 292]

Its not difficult to my understanding but it's expensive to get insurance when it's not through work. He can leave the work plan if he doesn't want it any longer but suggest you look into the prices and coverage of private insurance before taking that step.

I'm from a country where healthcare/hospitals are free and was baffled about the lack of coverage Stephen's insurance through work provided. But I stopped comparing it to my standards and to US standards instead - it helped me alot.

It's not a requirement to bring your medical records from home country/doctor however it won't hurt you.

[Xanax 349]

it's expensive to get insurance when it's not through work.

He already pays $350 for it, everything that I have looked at is only a little more if more at all and for both of us with better coverage (looking at BSBC).

He can leave the work plan if he doesn't want it any longer but suggest you look into the prices and coverage of private insurance before taking that step.

That's all I wanted to know , and yes we know the prices.

I'm from a country where healthcare/hospitals are free and was baffled about the lack of coverage Stephen's insurance through work provided. But I stopped comparing it to my standards and to US standards instead - it helped me alot.

I have realised that as well.

It's not a requirement to bring your medical records from home country/doctor however it won't hurt you.

The reason I ask this is , how do I prove I do not have anything pre-existing if they don't have my medical records.

[Moomin 292]

He already pays $350 for it, everything that I have looked at is only a little more if more at all and for both of us with better coverage (looking at BSBC).

The reason I ask this is , how do I prove I do not have anything pre-existing if they don't have my medical records.

Then that's up to you. Personally if I could afford it, I'd go with private insurance. My husband got another job in February and it so utterly sucks to wait around 60/90 days to sign up for insurance through work knowing he's not covered(I'm on his insurance too).

I didn't have to prove anything. I have what's known as the step before osteoporosis(osteopenia) and was never asked about any pre-existing condition; only name, address and SSN. I did however inform my family doctor of it without showing any records. If in doubt, ask your insurance company or family doctor. Yours was treated, right? Bring your record so you have it in case you're asked to show proof of you being treated. Anything beyond that, I'd wait around for a more specific answer since we aren't in the same situation.

[anitta 0]

If you get insurance through your husbands work you won't be denied for anything and there's usually

no need for doctor's exam or anything. If you get private insurance you can get denied coverage if you have

something. I'm not sure if they'd require you to have a doctors exam. They do ask you a bunch of questions

when you're applying and you should tell them everything.

We have insurance through my husbands job but I was shopping around for private insurances too. But we would

not have gotten anything better or cheaper.

$350 a month actually sounds cheap, we pay double that for family of 4.

[Harpa Timsah 13,258]

Usually an employer splits the monthly cost of insurance with the employee. So, the insurance that he has costs more than he pays for it, and the employer helps. If he got his own insurance, he'd have to pay all of it. If he got his own insurance he would stop paying $350/month to the old plan; the money doesn't evaporate. It's possible his work offers a different plan too. Don't worry about the preexisting thing. Didn't Obamacare make excluding people illegal anyway? What specifically is mediocre about the plan?

[Xanax 349]

Thanks for your replies so far, Harpa, Moomin, Anitta!

Then that's up to you. Personally if I could afford it, I'd go with private insurance.

I didn't have to prove anything. I have what's known as the step before osteoporosis(osteopenia) and was never asked about any pre-existing condition; only name, address and SSN. I did however inform my family doctor of it without showing any records. If in doubt, ask your insurance company or family doctor. Yours was treated, right? Bring your record so you have it in case you're asked to show proof of you being treated. Anything beyond that, I'd wait around for a more specific answer since we aren't in the same situation.

Thank you for your advice. I hope you are okay?

$350 a month actually sounds cheap, we pay double that for family of 4.

We are a family of 2, that could make the difference?

Don't worry about the preexisting thing. Didn't Obamacare make excluding people illegal anyway?

I think that takes effect in 2014?

What specifically is mediocre about the plan?

The plan is 70% copay (all standalone plans I have seen are 80-100%), there are no other options, only this one plan, there is a $100,000 financial life time limits on claims, doctors visits are a $50 copay, pharmaceuticals they only pay benefits if you buy them online and there is a $20 copay. These are some of the things I do not like.

Edited March 23, 2012 by BrittandDan

[LeftCoastLady 441]

From what you've described of his insurance plan, it actually sounds pretty standard. I pay a bit less per month than your fiancé, but have a higher deductible to meet before the insurance coverage fully kicks in.

How often do you plan on using the insurance benefits? If it's just for the usual annual check-ups and maybe things like birth control pills, you will likely be better off with the plan through his employer. If there are other medical issues, you could find yourself paying higher premiums and co-pays through a non-employer plan that would make any month-to-month savings moot.

Also, while researching, be sure to review the network limitations. If he has a favorite doc already and they're not in-plan on another insurance option, that means changing docs or paying more because the favorite doc is out of the network.

Edited March 23, 2012 by LeftCoastLady

[Xanax 349]

My main concern is if we ever got really sick or when we want to have a baby, 30% out of pocket is a lot, $100,000 maximum what if he needs something major- major open heart surgery and critical care?

Daniel has never been to the doctor and has taken 1 sick day in 5 years.

I guess I just want protection against major things and good pregnancy cover.

Edited March 23, 2012 by BrittandDan

[LeftCoastLady 441]

If you want more than the $100k lifetime maximum, it will cost more. I'm assuming you're speaking in worst-case scenario situations regarding major surgery. Does his employer also offer short-term/long-term disability and/or life insurance? In the event of a serious medical event, those would likely kick in on top of any medical-based insurance plan.

As others have mentioned, be sure to fully research the non-employer insurance options before dumping the employer-sponsored one. You may find the perfect plan with more coverage, but it may come with trade-offs.

[Xanax 349]

Thanks, Leftcoastlady! We definately wont drop our group cover insurance before we have another one and were sure we were covered.

Daniel has those things, short-term, long term disability and life insurance, but again the benefits aren't stellar:

Short-Term Disability - Employee-paid - Plan pays 67% of your annual benefit salary on a weekly basis - Maximum benefit is $300 per week / Long-Term Disability - Employee-paid - Plan pays 50% of your annual benefit salary on a monthly basis - Maximum benefit is $1,000 per month / Voluntary Life and AD&D Insurance - 1X to 5X your annual benefit salary - Maximum $500,000.

I don't know, maybe I am expecting too much? Are these benefits standard?

Edited March 23, 2012 by BrittandDan

[LeftCoastLady 441]

From the plans I've had in the past, yeah, it seems like the standard package for an employer to offer. Not many employers offer fully-paid insurance for the entire family these days. So, that's another thing for him to confirm, would his monthly contribution stay the same once he's married? Make sure you're using an apples to apples comparison when reviewing your options.

That said, depending on your occupation, you may land in a gig that offers a better insurance package for the both of you!

[Xanax 349]

I'm going to go back to school so I don't think Arby's / Outback steakhouse or wherever I end up working part time is going to offer me anything awesome in the way of benefits!

This plan that has all those things is around $350 for a single and for a couple it will be around $668.

I guess the good news is it has dental at 80% and unlimited and optical without a copay.

Edited March 23, 2012 by BrittandDan

[Harpa Timsah 13,258]

I'd check the maternity coverage. Sometimes it is separate from the rest and at least in the last two plans I have had, there has been an emphasis on providing female health care for lower or no cost. My insurance now even has a "healthy pregnancy program." Are you sure you have to pay 30% even for in-network doctors and hospitals? That doesn't seem right. Regarding the 100000 maximum payout, keep in mind that you won't have this insurance you whole life - I am sure you will change your jobs sometime. And by the time he is old enough to be requiring long term care, etc, he will be eligible for medicaid (same for you).

[nickbits 43]

1) Depends if you have a pre-existing condition or other factors. Generally a group plan through work is your best option

2) Depends on the job...

3) Only if you have a qualifying life event (job change, marriage, new child, etc) or it is open enrollment time (usually november)

4) Probably not. But if lie on your application about pre-existing conditions it will probably cause a problem at some point.

4a) Only if you get individual insurance

4b) Depends on the specifics. I would probably list it regardless.

Edited March 23, 2012 by nickbits