Choosing a Health Plan

[tsipple]

OK, it's that time of year again, and I'm confused. I'm 35 with no medical problems and no prescriptions. I have these choices:

Lowest Cost
Empire Blue Cross/Blue Shield PPO
Humana Health Plan
UniCare

Medium Cost
Blue Cross/Blue Shield HMO

Highest Cost
UnitedHealthcare POS

I can keep my doctor if I stay with the highest cost plan or switch to the Empire Blue Cross/Blue Shield plan. (Not that I've seen my doctor much.) However, the Blue Cross/Blue Shield plan has a $1M lifetime maximum, and I'm not sure I like that idea if lightning strikes, so to speak.

Anyone know anything about UniCare or Humana? Any advice? Thanks.

[Blackadder]

1. Health

Go for whichever plan offers the best ability to select your own doctor/hospital, even if it means you have a higher co-pay or deductible. We have a PPO which offers some of the very best hospitals as its providers, which has been a blessing recently. My 18 year old son fractured his spine in April and we have medical bills well over $200,000 so far, but with our insurance we owe "only" about $15,000. Not bad considering he had one of the nation's best spine surgeons operate on him. When a major accident or illness occurs you want to be able to go for the very best treatment wherever it is, without a fight with the insurance company.
Another thing we never really looked at - if you have children or are planning to, see how the insurance will treat the child when they turn 18 or 19. Our insurance will only continue to pay for our son's treatment as long as he is a full time student. Another spinal cord patient was covered under her mother's policy until she either marries or walks again. Its a Catch 22 for us - he could only get treatment if he was well enough to go to college! Fortunately he was able to go...

[ikojo]

2. Blackadder, is your son disabled or on disability now?

Did the spinal injury happen before he turned 18? Was he placed on disability before 18?
I don't know what the laws are everywhere but I was of the understanding that as long as a child was considered disabled BEFORE his/her 18th birthday they could still be covered under the parent's group health plans. You may want to speak to a benefits rep at your employer or with the insurance company.
There are just some things the insurance companies don't want people to know and will divulge only when the right questions are asked.

[Blackadder]

3. insurance

Thank you for the suggestions - in his case he was 18 at the time of the accident and the insurance would have ended at 19 if he did not go to school full time. I did speak to one of the benefit advisors ( who overall were actually wonderful) and said I thought it was silly he would only be covered if he was well enough for school, but thats the way this policy is set up. It didn't matter anyway because no one could have stopped him from starting at Yale - he'd gotten his acceptance just a few days before he fell and the thought of going off to school, even in a wheelchair, kept him working in rehab!

[ikojo]

4. If you can afford it and if you travel a lot I would go with

the POS option. Most POS (Point of Service) plans offer both in network (primarily HMO) and out of network benefits. With most straight HMO plans if you go out of the HMO service area charges are not covered because the provider does not participate in the insurance plan. Also, with some POS plans, if you want to see a specialist you do not need a referral (a permission slip from your internist) to see him/her. You just make the appointment. It does offer a lot of flexibility to the insured person that is not available under other, more restrictive plans (which is why they tend to be cheaper).
Also, if you do take the UnitedHealthcare POS call the insurance company an ask them about reciprocity. UHC is a HUGE insurance company and they have HMO networks all over the US. Ask them what would happen if you were out of town, say in St Louis and you were treated by a UHC participating physician in St Louis, would that claim be considered in network since that physician is part of the UHC network in St Louis? Or would it be considered out of network since he/she is not part of the UHC network in New York (I am assuming New York because one of your options is Empire Blue Cross)? I know some Blue Cross Blue Shield plans have a reciprocity agreement for BCBS members treated out of town. The person at UHC should know what reciprocity means.

[BiggJawn]

5. Blue Cross?!?!?!?!?

You can get Blue Cross and you're asking US what you should go with?

Wish I could get Blue Cross again...

[MUAD_DIB]

6. Never, never, never, ever

go with MEGALIFE!

What a P-O-S they are!

[Nikia]

7. I was covered under Blue Cross/Blue Shield as a kid

From what I understood, it was pretty good insurance. I always received good medical care from the doctors of my families choice, including specialists. It seemed to cover pretty much everything without having to suffer with a problem for a while before a test was done. I don't know how things are with it now, but it was good at least until a few years ago.