Most of you just know me as a bike racer and blogger. But since I graduated college, I have been dedicated to the non-profit field, working in community health and on policy initiatives aimed at expanding health care access for the uninsured and underserved populations. My last day is January 2nd. It is a bit of bittersweet time for me. And given that it is my second to last day at work and the office is completely empty, and I only have a few more files to sort through, I thought I'd take a little time to reflect on my time and use some of my knowledge to cover a topic that a lot of readers might find helpful: finding health insurance!
For the last five years, I have worked at the Alameda Health Consortium in the program and policy department. This is a small non-profit that is an association of community clinic in the county. My work has mostly focused on providing support services to clinics that serve the uninsured population. I have worked on some truly great projects over the years....creating a website, achealthcare.org that provides comprehensive health care information for people in the county who don't have insurance, translated fully in Spanish and Chinese....organizing marches, rallies, and other advocacy events with clinic patients and staff.... creating a partnership with the community colleges to offer continuing education classes to clinic employees....working with primary care provider by offering training in specialty care....lots and lots of data analysis....work with eligibility enrollment systems and programs. And I am sure lots of other stuff.
My health insurance through my work will be ending on January 31st, and I have three options: to enrollment in my employer's COBRA program (which will cost me $380/month), purchase a private health plan, or go without insurance.
Given that I have spent my entire adult life working on issues of the uninsured, the third isn't really an option. Although given the amount of case work I have done and my knowledge of and ability to maneuver the many bureaucracies... I probably am the most prepared to be uninsured!
Anyway, as I am going through the process of purchasing insurance, I thought there may be many readers and bike racers reading this, who were interested in some information. So, I thought I'd provide a rare, somewhat useful blog post.
Finding health insurance, a short guide:
If you are looking to purchase health insurance, I would first direct you to the website: www.ehealthinsurance.com I have looked as several, and I think this is the most comprehensive and best site that compares difference insurance plans. You type in your birthdate and zipcode, and can see a variety of health insurance plans. It is easy to use and you can sort and toggle options in a variety of ways. You can compare things like your monthly premium, deductible, coinsurance, and copays.
If those words are greek to you... a premium is what you pay every month, whether or not you use it. A deductible is how much you pay "out of pocket" until your insurance "kicks in." If your deductible is $1,000, then you most spend that much money before your policy begins. Coinsurance of 30... means that, after the deducible, you pay 30%, the plan pays 70%. Up until your out-of-pocket maximum... meaning, that is most you will ever pay in a given year. Lastly, copay is what you pay at the door of a visit; usually, you have either a copay or coinsurance.After looking at my plan options, I decided to go with a high-deductible plan, as I don't use the doctor very often, and preferred a smaller monthly premium, as I don't have a lot of income coming in right now. I went with a plan offered by Kaiser Permanente, as that is where I have had coverage for the last 8 years. I could have decided to go with a plan offered by Blue Shield, Blue Cross, Health Net, etc. - but I have been in the Kaiser system a long time, and didn't feel like change. I went with the 2700/30 plan, which was a $2,700 deductible, and then a 30% coinsurance, for $149/month. The reason I went with this plan, was because I could also purchase an HSA to cover my expenses.
A Health Savings Account, is a pre-tax account, where you can set aside money to pay for your health expenses. It rolls over from year to year (differing from a Flexible Spending Account that many people are familiar with). In addition to paying my premium, I can also set aside some money to my HSA, that I can use to pay down on my deductible (if needed), and also use for things like dental, optometry and eye glasses, chiropractic, and acupuncture. I wondered if I could use my HSA to pay for my premium...as then I would be able to pay for my health insurance pre-tax. You can only use your HSA to pay for your premium if you are received unemployment benefits. If you are doing COBRA through your employer, you can use an HSA to pay for that as well.
I did a bit of research on HSAs. They are typically offered through banks, e.g. Wells Fargo, Chase, US Bank. Some have start-up fees, some have small monthly fees for administration, some allow you to invest money, some provide interest to contributions, etc. All of them I found offer a debit card that you can use to pay for your expenses. Here is one list I found of HSA administrators. I decided to go with the OptumHealth HSA. After the financial meltdown, I closed my bank account, and enrolled in a credit union... so there was no way I was going to open an account with Wells Fargo or Chase. I don't know much about OptumHealth, other than they support a bike team, so I thought they should get my business! Also, I was very impressed with their packets and information on their website.
If you put $500-$1000 in your HSA, you can that pre-tax, and then can use that for health expenses. (Here is a calculator you can estimate how much savings it would be to you to do this pre-tax) If you don't use it this year, it rolls over. I will prefer to set aside a little bit of money each month to put in the HSA, so if I ever had an accident, then I will be able to use the HSA to spend-down on my Kaiser deductible. It is also kind of nice, because if I go to the chiropractor, accupuncture, or buy some new contacts of glasses, then I can do that all pre-tax. I don't know how much savings that would really be, but I am counting pennies now, so every bit helps!
I did not get denied due to a per-existing condition, but it does happen! Thankfully, because of the Affordable Care Act (e.g. health reform), no one will need to worry about this after this year! But in the meantime, if you get denied, here are your options. The most obvious option is to make an appeal, or apply to another company. But, there is another option.
As part of the Affordable Care Act, each state is required to operate a "Pre-Existing Insurance Plan" where you cannot get denied because of your health status. You have to show proof that you got denied from a carrier. So, keep that letter! The deducibles vary by state, but I believe they can be no more than $2,000. For people age 20 - 35, the premiums are usually in the $150 - $250 range. The above link is the federal government link. For some states, the federal government administers the program, and for others, the states administer it, itself. You might need to dig around a bit. If you are having trouble finding your states info, feel free to email me... bethbikes at gmail.
If you are under 25 years old, you can stay on your parents insurance -- if they have employer-based insurance -- and that might be the best option for you. You should have your parents talk to their employer about this. The amount of cost-sharing might vary.
If you didn't heed anything in this guide, and are still uninsured - a few tips. If you need primary care, you should go to a community health center. They typically have a "sliding fee scale" where you can pay less. Here is a national database where you can search. This might not be the best source for your information, but it is a start.
If you have to go the ER, go to the public hospital. Prices will be less expensive for you, and they are more likely to have charity care programs that deduct your costs. If you have a bill you can't pay, know your rights and your payment options. Here is a website to get you started. Be sure to contact your state Ombudsman. Each state has one and you can file disputes and they will help you negotiate the process. These are all free services, so look into these first.
This will ALL be changing next year... the affordable care act will require everyone to purchase insurance and will offer subsidies and a centralized place ("the exchange") for people to research and purchase insurance. These things are all getting established currently, and enrollment for your new policies will occur this fall. Insurance companies will be required to offer a minimum amount of services, and people will be able to get assistance with their policies, based on their income. Of course, if you receive insurance through your work, not much will change... except that certain employers who offered crap policies will now be required to provide more robust options. Anyway, as more information on the roll-out process begins, I will write a new post to help guide people through the process. I, myself, will be enrolling in the exchange - so I can offer some first-hand knowledge.
That is a wrap
This was probably the most boring blog post I have ever written, but hopefully someone found it useful. If you have questions - please leave them in the comments, as someone else might have the same question, and then I can answer it.
Thanks for reading!