It's that time again. The time I want to go bang my head in the wall repeatedly.
Open enrollment for health insurance.
Not the greatest of topics, but I really am curious what some of you would do.
I'll try & make this a little less painful for you as it is for me, but I am honestly loosing sleep over it. What to do -what decision to make - what plan to go with. It's miserable.
First, I'll remind you - I've worked at my company for over 24 years now... & a few years ago, they took away our health insurance because it was 'costing them too much'... when we all suggested for them to let us pay our whole premium ourselves so the company wouldn't be out a penny. Just so we have a decent plan to deal with. Nope. No go.
So most of the employees are now without insurance at our work (notice I said "most"...don't get me started) & we have to go through this whole nightmare of getting insurance on our own.
It used to be, I could get insurance from a few vendors. I've used Humana, United Healthcare & Anthem... but now, since Obamacare & the nightmare that has been, the only option we have now is Anthem. Every one else pulled out of it. They don't even offer insurance anymore for an open enrollment. How crazy is that?
So... when you have no options, Anthem can feel free to jack up that price & even better? lower the care of the plan.
What are my options? Really - nothing. Get reamed over by Anthem I guess....
Except... I've been looking into Medi-share.
That's a Christian based plan that isn't 'technically' insurance - but works like insurance.
You pay a monthly "premium" (its not called a premium but uses another term in this plan) & you pick a 'deductible' amount - again, different terminology - but the same idea. & once you hit that deductible amount, they say they cover 100% of the medical expenses - as long as you go to the doctors under their network... which is the same as Anthem.
& the good thing, all my doctors are under their network.
As well as all the hospitals around the area.
& remember, with Anthem, I'm not allowed to go out of state for medical help. It all has to stay in-state... which wouldn't be a problem if I didn't work in Kentucky & do so much in Kentucky.
You'd think they'd have rules for people that are so close to state borders... but I guess not.
On Medishare, I can go to any doctor in the network regardless of state.
AND.... if I go with Medi-share, I'll save about $130.00 a month!!!! That's a lot of money.
I almost want to sign up for that & bank that extra $130 in a savings in case something horrible goes wrong - or to help me pay the $2,500 deductible if I needed it.
I'm just scared... Medi-share feels risky. Even though I know it shouldn't. It's just new to me.
The idea that you pay funds & it goes out to pay for other's doctor's bills every month is pretty cool to me- they even send you a statement showing who you paid for so you can even pray for them. I LOVE that...
but Medi-share can turn doctor bills down for payment if it doesn't fall under certain guidelines. Most of them, the ones based on Christian behavior, I'm not concerned about - its the ones that I'm reading about people say they don't pay because they consider it 'pre-existing'.
So here's a little breakdown
$420 a month
$2500 deductible - but once reached, still have to pay 30% up to $6100
Can only stay in state
Does offer a prescription card
$40 doctor visit - $500 ER visit - Specialist, 40% of office visit
Covers Routine exams
$280 a month
$2500 deductible - pays 100% after that (so they say... I'm so skeptical)
Can go to any doctor anywhere as long as in network
Offers a prescription card but its not a lot it offers - a friend told me she saves more using that app Good RX
$35 for any doctor's visit in network - $150 ER visit
DOES NOT COVER ROUTINE EXAMS
Here's the thing too - I've never reached my deductible in the past... oh.... maybe 10 years? Thank you Jesus no need.
I haven't even been to a doctor in the past 2 years for anything other than my routine exams....
which if you notice, it doesn't cover at all on Medishare.
The lady at Anthem told me, if you're going to pay for something, you should get something out of it, huh? ....coming from a insurance company that is great at screwing people over, I had to laugh a little at that comment.
The only doctor's visits I do every year are my OB/GYN visits for my PAP & mammogram - which neither would be covered. Colonoscopies are not covered.
I will say, I did look up how much a PAP & mammogram was out of pocket - it was surprisingly less then I thought it would be.
& sorry, the irony isn't lost on me that a Christian based company doesn't pay for things that an organization like Planned Parenthood does provide for a discount. ... we won't touch that subject... but yeah. Irony.
I just feel like its all a big gamble with your life & health. A huge roll of the dice.
Do I pay the higher Anthem fees & not once again reach my deductible & loose all this money? But stick with a more known insurance?
Or do I try out the Medi-share & see if it works for me & then risk if something happens to me health wise, that they will cover it?
I don't know what to do.
You can ask Ricky - I have asked his opinion about this at 3am when I can't go to sleep over worrying about it.
Is worrying a pre-existing condition?
If so, I'm screwed at either place.
Tell me your thoughts... PLEASE!!!!!!!!!!!!!!!!!!!!!
I'd love to hear them.
Know anyone that has dealt with Medi-share?
Anyone else struggling with health insurance?
Anyone have an aspirin for this headache from all the lack of sleep & head banging on the wall?
The deadline is looming on when I have to decide.... the grip is tightening around my neck... & my wallet.
OMG, we were just dealing with this same thing yesterday and Scott made me watch a 45 minute presentation about health care changes for his company! (just what I wanted to do on my day off..lol).ReplyDelete
Do either of these plans cover both you and Ricky?
It seems like all plans are moving to a deductible these days. Our old one didn't have one but all the new options do now. I told Scott that the only people who really benefit are those that are having major surgery. It's a shame that you have to pay so much per month for the insurance and then you basically have to pay out of pocket for the Dr visit anyway so what's the point?
So if you add up what it would cost paying all your routine visits out of pocket does it still come to less $ then the anthem plan? If so, try the Medi share plan for a year and see how you like it. And if nothing goes wrong, you'll at least have a little cushion of savings (that is if you actually save it..lol).
I don't have any words of wisdom or experience dealing with healthcare, I am consistently fascinated/shocked/a little appalled at the way healthcare works in the US. I hope you are able to discern what works best for your family and put your mind at ease! Good Luck!ReplyDelete
i dont know what all this means since we don't have to do any of that but i do hope that you figure it out soon! good luck!ReplyDelete
Woof. You know I'm right there next to ya on the insurance struggle bus. K owns a business (& someday our plan is to provide healthcare for the guys- but we just can't yet) and I work for a small company that doesn't offer it. I turned 26 last month and had to say "bye" to my mom's insurance and K's private ins. company is not providing in OH after the 1st of the year (Medical Mutual). Plus you saw my b.s. drama on twitter about the canceled policy that never was. UGH. (Hopefully fixing that on Wed.)ReplyDelete
Insurance makes me livid. Honestly, it rubs me a little wrong that Medi-share can tell you "no" based on what they deem cover-able. That said, it's frustrating to have such high deductibles that are never met and the ins. company gets to keep all your money. It's kind of cool that you KNOW Medi-share is sharing the wealth and using your payments to help others.
Question: I know there's a fine for NOT carrying insurance now. (We've had to pay it.) Since Medi-share isn't technically insurance would you be fined for essentially not having any? That might be a cost to consider in the whole thing...
Ugh. Good luck. I'm curious about what you decide to do!
From what I understand, Medishare is considered insurance under the Afforadable Care Act. I could be wrong, but I'm pretty sure.Delete
So many things ... I do Payroll and help out with Benefits so many things were popping into my head while reading this. First of all, I'm pretty sure it's illegal now for a company to provide insurance to some employees but not all. That was one of the things my company had to address. Then, does Ricky's work have insurance that covers spouses (that doesn't cost an arm-and-leg)? I've heard about Medi-share but not of anyone who uses it ... but it's been around for awhile so I would definitely Google to see reviews or if people have left positive/negative experiences about it. While it doesn't cover the annual exams, that $130/month savings would cover it. You can also try it for a year and see how it goes -- you're not locked in for life (hopefully!). Also, there are clinics (not just Planned Parenthood) who provide annual exam services for reduced or minimal cost too and even then, patients don't have to pay if they don't want to (state reimburses the clinic for all costs). I know this because we run one of them. Gosh - so many things. I hope you're able to figure out what will work best for you! I HATE open enrollment.ReplyDelete
I wish I had advice for you! I will just say that I am thinking of you & know you will make the right decision in the end! Good luck.ReplyDelete
I'm so sorry you're having to deal with this. I can't believe your company just straight up cancelled everyone's insurance! I really hope that doesn't happen to me. I do on a rant about the insanity that is the "Affordable" Care Act like every week. It's completely ridiculous for middle-class workers. We pay MORE so other people can not pay anything and go to the dr for free. That's not right. I actually do know a number of people who use Medishare and seem to like it, so I don't consider it insanely risky. You could just try it for a year and see what you think since you're not really tied down to anything. :(ReplyDelete
I am so happy to be moving to Medicare December 1st. But I do help decide on our group insurance at work and I can tell you that even the group plan stinks. Everything has gone up in cost and deductibles. I would ask for some references for the Medi-Share. It does sound like a better product. I thought the ACA took the pre-existing condition problem out of the picture...plus if you have continuous coverage, I don't think they can penalize you for a pre-existing condition. That should be clarified. I hope POTUS-Elect Trump fixes this for everyone! Obamacare is a nightmare.ReplyDelete
Oh geeze. I can't even imagine your stress // worry levels. I just got axed from my parents plan last year & struck it out on my own. Don't get my started how my super fancy work plan is CHEAPER than a very high deductible plan on the open market. I know they're absorbing those costs, but just proves that the ACA is not so affordable. UGH.ReplyDelete
I digress. The two questions I would pose to you...
One - do you have any pre-existing conditions that you know off the bat MediShare wouldn't cover, based on experience of others? If so, then I think the MediShare is a bad idea.
Two - Would you really bank the extra $130 per month & if you hate MediShare could you go crawling back to the open market next year? If so, I say GO FOR IT! You'd have a cushion for paying out of pocket for routine exams (though it's a bummer they still don't cover those) but, not only are they less than you think, the DR's may even give a cash // pay in full discount if you tell them you're paying out of pocket.
If it were me, I think I would try it, as it sounds like you'll likely be better off, but that if not, you'll have a small cash buffer, and at least know your money is helping others. Rather than Anthem, where I'm sure it's just big wigs living it up while you pay $$$ every month.
I literally just dealt with this! For me personally because I have an autoimmune disease, I chose to go with a PPO (Blue Shield) so that I can go out of network if I need to see a specialist. I've never heard of that Christian Insurance company, but the prices sound great. I would try to find someone who uses them and see there thoughts. Also, under ObamaCare preexisting is no longer an issue (or so they say!). Good luck!ReplyDelete
I'd go with Anthem.ReplyDelete
I've heard of Medi-Share but I don't know anyone who uses it. Of course, the lower price is definitely enticing! It's a real tough call. I would also definitely look for reviews of people who have meet the deductible - were all their costs covered afterwards and someone who got seriously ill - did they cover their expenses? And finally - the ambiguity of Medi-Share (to a degree) will that drive you nuts and give you a ton of sleepless nights? Or will it not bother you at all? If it is going to seriously stress you out (and for some it absolutely would), it might not be worth the cost savings either. Good luck!ReplyDelete
I have never heard of Medishare before, but it does sound like a good option. My only question would be if the IRS and government see it as insurance? If not, then you might still get killed with those fees for not having insurance on your taxes? That was the only thing that struck me... pretty much because that's what we debated with my husband. I get insurance for work, but the plan sucks and costs so much for him to join me. We actually looked into him just not having insurance (since some of the time we don't even run things through insurance because it costs more than out-of-pocket). Ugh, this has turned long-winded. Let us know what you decide!ReplyDelete
You and I are like doing the exact same thing right now. Today I circled on my calendar to find a new plan.ReplyDelete
I am like you, being self employed I look for an Individual policy.
I am not familiar with either of the ones you are looking into. But I will say this, just because an insurance lists a Dr as okay to see. Doesn't mean the Dr will actually accept the insurance. A quick phone call to all your doctors offices to double check that they will be accepting the choice your looking into will tell you right then if that (100%) coverage is true or gonna end up being a false.
Trust me on that, I have worked in healthcare a lot and it's pretty common to get a phone call asking that, and it will only take them a second or two to give you an answer that could save you a lot of time and $$ and help you make the decision!
I use Selecthealth, they are a local company. Not Obamacare, but because of Obamacare this year my monthly costs have now gone up virtually 75% and it's insane, I can't afford it.
So yes I am like you I am going to be shopping for a new plan. I am just hoping the same company offers a cheaper version. If not zero idea on what I will do.
On the plus side being a student I get $20 dr visits at the campus clinic for general things.
But because we are forced to have health insurance or pay big and I'm not a young college kid still on mom and dads plan, I get to go healthcare shopping today too.... least favorite thing to do today and I am dreading it and I haven't even started, LOL
My sister is doing it too, she got a letter hers will now cost $1,700 a month, she is going crazy about it and I don't blame her. Her husbands job only allows him to have a policy not the whole family so her and 2 kids for that amount, she's almost going to have to start a new job just to pay for healthcare it's ridiculous, we are all cursing Obama around here!
Because my husband's work doesn't offer insurance at all, we've gone through the Health Marketplace (aka, Obamacare) since August. For me, the nightmare has been in the verification of our income and cutting through all the red tape, but once we got past that point, it's been a good plan for us.ReplyDelete
I read the whole post, but I wasn't sure if you'd looked into that option already (since for us, open enrollment is still going on). If you haven't looked into it yet, it might be worth it.
Otherwise, I'm pretty risk-averse, so I'd probably go for the traditional option even if it costs more. But I'm weird like that :)
I am going to send this to our daughter Rachel. She and Jimmie just made some changes in this arena and are very pleased. I feel your pain! We have Wilson on our plan. Our deductible runs from January through December but our plan renews in July. With the renewed plan comes a higher deductible so just when we think we have paid all we "owe", we owe more. BUT, he is alive and we have not gone hungry. God bless is good!ReplyDelete
MediShare is new to me. We used to have Anthem and simply because it's well-known to me, I'd probably say go with it. Other than that, I am clueless as to what to advise. We have BC/BS and have been very fortunate to have such good coverage that doesn't cost us an arm and a leg.ReplyDelete
Girrrrl I can rant all day about the horrible mess that Obama made for insurance for most of America! Like why I am having to pay soooo much more for mine so others can get theirs for free??? How is that even fair?? I can barely afford my own insurance through my company, so I can't even imagine having to deal with this nonsense. We just got notice two weeks ago that my deductible is going up $500 more dollars next year too. Like WTF?ReplyDelete
In response to your dilemma, I really don't know what I would do because like the election we just had..both are equally terrible options. Do you know anyone who does Medishare? I don't, so I would feel it as more risky as well. And the fact that they can deny whatever coverage they feel like sounds like some BS to me. I would check to make sure you dont have to pay any fines if it isn't considered "insurance." I think that bottom line is that you aren't locked in to either for more than a year so if you are unhappy you can always change next year. But let's hope that Trump does something about this mess so we aren't crying during open enrollment next year, am I right?!
Man so hard to pick! All I know is that after obamacare we all got screwed! AT least that's what it seems. My deductible is so stinkin' high, unfortunately I keep hitting it. This year they're totally screwing us over, we used to be July to July, and this year they changed it to Januray, so we had a plan for 6 months, which of course I incurred cost, which went towards my deductible, and now 6 months later, have to start again, rat bastards. Can't help us out a little?! Hope you get some answers, but considering you don't have many health issues, I would try the cheaper one out, unless you think it will cause you anxiety knowing that your coverage could be crappy if something were to happen. ugh, so hard!ReplyDelete
I'm soooo sorry you are dealing with this like so many Americans! It stinks big time. I know you will make a wise choice. Honestly, I think I'd go with Anthem but weigh the pros and cons yet a few more times and go with your gut.ReplyDelete
Man, that pre-existing thing and the ability to reject random things would make me nervous, but that's just because I had a health problem this year that felt like it came out of nowhere. I am impressed with how small your deductible is on both plans, though!ReplyDelete
I'm sorry, but I have absolutely no help on this subject at all. Except to say, I can't imagine what we would have done this year without our insurance.ReplyDelete
If my husband gets out of the military, insurance is our biggest concern. However, we have "free" medical right now under the military. BUT, you get what you pay for. It's not amazing by any stretch and I don't really have confidence in my/our care.ReplyDelete
ANYWAY. Does your husband have insurance? Or did I miss that part?
There IS no good option, I agree.
Uhmmmm...you know there are A LOT of things I miss about America, but this is not one of those things. Good luck!ReplyDelete
I am sorry I can't help. My daughter is struggling with these same decisions. Fortunately, she has an Advocare business and she is going with their health insurance. I will hold you in prayer as that is the only help I know I can provide.ReplyDelete
Ugh, insurance has truly become a hot mess. I'm not sure what the best option is but like others have suggested, could you try out Medishare for just a year? Good luck with the decision. I know it's tough!ReplyDelete
This is a hard one. Have you seen any reviews on Medi-Share? It seems like a better option. I used to be on a high deductible insurance for a long time because I didn't have any health issue and PAP and OBGYN stuff was covered. Then we wanted to have kids and I went to another plan that is higher premiums with co-pays and I was on that for about 3 years until July of this year. Now I am back on the high deductible one with less premium. I agonized over it too. I am so sorry that I am not help on this topic.ReplyDelete
I may be late to this and you may already have made a decision, but I have been on Medi-Share for 2.5 years and have VERY happy with it. My kids are on it as well and have had NO problems. I have a friend here that used Medi-share before she could qualify for Medicare and ended up in the hospital with a major medical issue..she has nothing but high praise for media-share. hope that helps!ReplyDelete
also medi-share now has eye and dental! I am going to have to change dentists but for the costs I am ok with that. media-share does count as insurance so that is good.Delete
My mother-in-law has medi-share and she loves it. She had surgery about a year ago, and she has nothing but praise for them. I don't know any of her details, but I can find out if you're interested!ReplyDelete