I'M SO EXCITED I COULD JUMP!! (yeah right
I signed up for insurance today. It was so cheap, I signed up for the top plans. Health AND DENTAL. And I can totally afford it. My doc office co-pay is a flat . After I've spent 0 on that co-pay, I don't have anymore co-pays. (as long as I don't excede ,500 in a year...hmm that's an AWFUL lot)
The rest of the stuff I'm no 100% on. Since you all are so smart, I'm gonna post it, and have you help me figure it out! :) Ready? This is how the sheet reads:
Hospital Inpatient:
Calendar Year Deductible: 0
Coinsurance: 50%
Calendar Year Max: ,500
*so I pay half the bill, until I hit 0, then they pick up the full tab, and then if I hit ,500, I pay all of it?
Hospital Inpatient Benefit Limitations:
Room & Board: 0 per day (ick, thats so low)
Private Duty Nursing: per day
Physicians Visits: per day (are you kidding?)
Surgeons Fees: ,500 per year (thats a joke)
Anesthesiologists Fees: 0 per year (eehh)
Other Hospital Services: ,500 per year (haha)
*so lets just stay away from me having to STAY in the hospital. Whew. Are they serious??
Supplemental Medical Benefit:
Lifetime Maximum Benefit Per Person: ,000
Coinsurance: 80%
*I have NO idea what that one means.
Outpatient Services:
Calendar Year Deductible: 0
Coinsurance: 70%
Calendar year Maximum Benefit Per Person: ,500
Physician Office Visits: Co-Pay
*I *think* I get this one, I stated it above, correct me if I'm wrong
Prescription Drug Benefits:
Monthly Maximum Benefit:
Generic/Brand Drugs Co-Payment: /
*Hmmm not sure about this one..this sounds like it could bite me in the butt somewhere down the line...
So that's it. Wheeeee I'm not gonna post the dental, because my teeth are amazing and I won't be going unless I have an emergency. It's not a spectacular plan, but it helps.
For those of you who know: No, I can't add Justin. He can start his own plan in May. May 1st, I believe. Unless we get married before then. Don't go there. LOL But thankfully, it's affordable (WAY) so it won't be a big deal to have two single plans. :)
YAY I'm just so stoked!!
I am so glad that you finally got ins. I wish I could help you figure it out but it might as well be in a foreign language! I am just happy for you that you can finally get some relief from the pain and get joint damage under control.
jamie
Thank you so much. I can't really go home and do a happy dance and bounce around and talk about it, because I know that Justin is upset that we're still waiting for coverage for him. I don't want to hurt his feelings. So I'm going to party here. Hehehe
I've waited what feels like AGES for this. I'm just so excited. I'm going to call tomorrow to make an appointment. I'm nervous!! Eeek!!
I hate to rain on your parade, I really do, but I think you might be mistaken on your interperation of "Hospital Inpatient". I've been researching health care plans because I go on Medicare in May (I'm disabled). On the hospital inpatient I believe it goes like this:
0 deductible means you pay the first 0. After that you pay 50% of all remaining charges to a total of 00 per year, which is the maximum they cover per calendar year (Jan-Dec.) If you go over 00 for the year, the rest is on you.
Outpatient services: you pay the first 0, then you pay 70% of remaining charges until you reach 00, then you pay everything above the 00.
I'm really sorry to tell you this, but if it is written the way you wrote it I am sure that's what they mean.
I would strongly suggest you call and verify the benefits on this plan.
Outpatient services, as I understand it, is if you have surgery or a procedure done in hospital or surgi-center and are released the same day.
Dr visits are co-pay per visit.
Be sure to have the person presenting the plan, explain benefits fully, so you understand them. Sometimes their terminology can be confusing.
Good Luck, Sweetie! I'm glad you at least got a policy so you can see a doctor!
Hugs, Nini
PS Please let me know what you find out. Ask about lab work, X-rays, Mri's, etc, too.
I think you have misunderstood the insurance. Or, I'm wrong. I hope I'm wrong.
Let's just take the hospital one....you pay the first 0. That's your deductable. After you hit 0, you pay 50% of the hospital bills. That's your co-insurance. As soon as you pay 00.00 out of your pocket, they will pick up the 100%
Outpatient - you are responsible for 70% of the bill. So think about it, you have an outpatient service and the bill is 00.00 Your portion to pay is 0, and the insurance company will pay the 0.
Your medication - for a generic, and for a branded name is good, however they have capped you at a month. If you have no prescription plan now, at least this will help. It doesn't allow for much though.
I do hope I'm wrong, but please, please, please....call whomever you signed up with and get the correct answers. As far as a office visit copay...on some plans, there is a one shot deal of a copay. This is the first visit, the office visit. After that, you're co-insurance and you pay whatever percentage your plan allows. It appears you have STEEP co-insurance.
This certainly isn't a top plan, it's cheap because this kind of insurance plan is made for someone that is healthy and most likely won't be going to doctors too often.
Katie - you need to find out more about the supplemental medical benefit. That piece of this pie is very important. When does it it kick in - after you have reached your ,500 maximum benefit for the year?
Otherwise, sweetie, I think you are going to need to use this policy as a stepping stone. It doesn't cover very much "Supplemental Medical Benefit:
Lifetime Maximum Benefit Per Person: ,000
Coinsurance: 80%"
Not sure what the Supplemental Medical Benefit encompasses but Lifetime Maximum Benefit only ,000?
The other Calender year maximums also seem low. Perhaps I am not reading this right??
No, I know it's all pretty crappy, but like I said, at this point something is better than nothing. I guess I'll call them to clarify everything.
Karen you're right, now when I switch jobs, and insurance, they can't deny covering my RA. Wheeee.....
Like I said, this isn't a career.
Katie, you don't even have to wait until you switch jobs. Since you are so young, and not overweight or have heart related issues like high blood pressure, you very well may be able to get a better policy on your own - even though you have RA, while you are still at this job.
Educate yourself on this policy first, work within it's boundries, and then you can build off of it. My daughter who is your age got a very affordable policy by checking ehealthinsurance.com and shopping the different policies available. There are other websites and resources also. You have a lot more doors open to you than us old, fatties the insurance companies don't want to touch!
When you change jobs, if your new employer offers health insurance for employees, you shouldn't have to worry about not being accepted because of a pre-existing condition. With group plans, they take everyone. It would be very important to find out when their plan would become effective for you, however. Hopefully you won't go someplace where you have to wait another year! If that's the case, you would have to keep this plan under COBRA (which really doesn't make a lot of sense) or purchase a short-term plan to cover you in the interim. Lots to think about, I know, but you know you always have all of us to chime in and offer our advice and suggestions - whether you want them or not!!!
Thank you mommy!!!!!Katie, at least you will be able to see the doctor, and for co-pay per visit. That's a plus.
And like Hillhoney said, later you can get a different policy, either on your own or from a future employer.
Believe it or not, my husband and I currently pay 65 per month for our health insurance, just for the two of us. Of course, we are a good deal older than you. The only reason I got a new policy in January, is because our old plan stopped insuring the group I had to join in order to even get insurance. Because of that, some insurance companies had to offer us a "guaranteed issue" plan. The Feds require this, so people who lost insurance thru no fault of their own, are still able to get a policy.
If not for the guaranteed issue plans, I wouldn't have insurance. No one would insure me, if I had to apply through underwriter for a new policy. Just too many health issues and no one wants to take a chance.
I'm so glad my Medicare starts in May! That will save us about 0 per month and a bunch on prescriptions. I am signing up for one of the other insurances you can get, that are through a Medicare-approved provider. I pay nothing except the .50 that we must pay for Medicare, Part B. That comes right out of my Soc. Sec. check.
Sorry I got off track
Good Luck, Katie. No matter what, at least you have insurance, and can go see a doctor when you need to.
Hugs and Blessings,
Nini
The way it is written up is confusing and could be interpreted different ways. Have them give you an example for each case. It is a pretty poor insurance plan. But it does get you past the pre-existing milestone. I paid for a pretty sorry insurance plan for a year just to get past that and it was worth it because the next year so much more was covered.
Also, keep in mind that even though they don't cover much, you should qualify for a lot of patient assistance programs because your insurance is so poor and your income is low especially when applying for Remicade help, etc.
It is a big step. Researching all your options is really important so that you don't get bit my a big bill. For instance, these plans usually do a lousy job of covering Physical Therapy. In that case, you might want to ask what they would charge you for self-pay. In one case, it was actually cheaper than my coverage's co-pays and then I could continue it as long as I felt I needed it. So, I did it for 6 months instead of the 2 months that the insurance would have ok'd.
I think shopping around would be an excellent plan. You already know what some of the procedures and meds are that you are going to need. Now find out if you can go to the web site to look at their drug formularies, ask your doctor when you see him to look into what the insurance will cover regarding Remicade -vs- Enbrel, etc. Also, be sure to ask for generics when they write your prescriptions.
Your prescription coverage is really, really low. That is one that you might want to beef up. There are plans like CareEntree, AAA, etc. that have insurance discount cards. Sometimes, it is cheaper to use one of those.
But this plan gets you foot in the magical door. I am so happy you finally are in. Now please get an appointment.
The drug thing doesn't bother me as much.....There ARE ways around that stuff now.
Okay, I did a little checking and this is what I found out. You need to have 18 months of continuous coverage before the HIPAA law comes into play. At that time, you could then use the law to help you get an individual policy, which would provide better coverage, if you need to. It would, however, probably be expensive because of your JRA. The only states that you would be able to be insured with an individual policy before that 18 month period would be NY or NJ, because of their individual state laws. Group insurance through an employer is always going to be your best option.
The key here is that now that you have it, it is critical that you keep insurance coverage. If you are looking for a new job, I would look at the benefit plan as the most important part of the compensation offered. And if there is a long waiting period before insurance is available to you, keep this policy active through COBRA.
I'm anxious to hear what you learn about the supplemental portion of your policy. It is so important that you know what your coverage is and how it works, so that you don't get into a position where you owe far more than you thought you would after getting lab work, xrays, etc.
It is a step in the right direction. The perscription coverage is pitiful. With the extremely high co-pays I wonder if you will be able afford enough treatment to get your premium back. Do be very careful about using it because you could wind up with huge bills.
Everybody is right about the HIPPA thing and pre-existing conditions. It is way better than none at all.
Consider looking for a better job....
Sorry Katie but I disagree with Hillhoney's pre-existing but I hope I am wrong. I used to be a Medical Claims Examiner for 9 years with Blue Cross. Even if you join a group insurance you will be considered a late entry and pre existing conditions may apply. Alot of times, insurance won't pay for like the first year or two or they set a limit to pay on. Sometimes, they also may be a rider on a policy and not cover a certain condition at all. Ck it out further but like you said at least you have some coverage. Better than nothing.
Good luck
CinDee
From what I understand -
If you DON'T have ins, and you are trying to sign up for ins: with a pre-exsisting illness, the ins company will tell you that you can't have seen a doc for anything related to it in the X number of months prior to signing up, or they won't cover anything related to that condition for X number of months. The time frame varies.
When switching jobs, as long as you keep continuous(sp) coverage, they cannot deny you coverage for a pre-exsisting illness, because well...they can't. Hahaha that's just what I've been told. I'm not sure.
But that's the word on the street....
I did NOT get to call and ask questions today, and the reason for that is another story ENTIRELY. Let's not go there. We'll just say that one day I'd like to take a couple of my co-workers on a very very very very long camping trip that doesn't involve a tent or a compass or sleeping bags, just a shotgun.
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