I learn something new from every person who story I publish here.
Gary Warner is a 33 year old financial consultant in Fresno, with a wife and 2 kids ages 10 & 7. It's pretty standard procedure for financial consultants like Gary to work in offices with other consultants, but to be an independent contractors. As gary puts it: "You give up certain things (like health benefits), but gain free time and control over your schedule."
Until a couple of years ago Gary, like most of the consultants in his office, had a spouse with insurance, but when Gary’s wife quit work...the search began. Read on...
Gary went right to the Internet. [Actually he had helped his mom line up group coverage for her small business using HealthyConcerns.com's sponsor eHealthInsurance.com before, so he was familiar with it.]
But this was the first time he had to search for coverage for his family.
Gary admits right up front that cost (or rather low-cost) was the "main driving factor." They wanted major medical. They were willing to have some limits, but didn't necessarily go for the cheapest coverage.
And here's where I learned something that might help me:
After Gary had done his initial search and narrowed it down to five possible plans, he noticed two different plans from Blue Cross had decidedly different prices, even though the cheaper one had the lower deductible. Once he reviewed the 1-page summary for each plan he realized that all that was missing from the cheaper plan with the lower deductible was maternity and well-baby coverage.
Bingo! Since he and his wife are done having kids, he felt perfectly fine giving up that part of the coverage and getting much more economical premiums.
I had no idea such differences existed. The more I write this blog the more I feel like a pretty stupid consumer when it comes to health coverage. Now, besides looking into dropping my dental plan, I should look into this too.
Gary had only one hiccup along the way. His first choice plan, HealthNet, disqualified him because he had allergies! I find this surprising because i suffer from allergies too and never would have expected it to be a disqualifying condition. Pre-existing? OK. Disqualifying? And Gary admitted he did take the rejection personally at first. He was just a bit upset. I would be too.
When Gary called eHealthInsurance.com they told him that many carriers have no issue covering allergies, but in fact it was his allergist who steered him toward Blue Cross.
Other than that hiccup Gary really liked that his health care search was quick, easy and cheap. He could compare plans side-by-side. And once he decided, he applied and had his health cards within two week, as did other people in his office who took his advice and did the same thing.
Gary identifies himself as a conservative, and thinks that peoples' perspectives on health care come down to what side of the political spectrum they find themselves on. They "stick with the team" as he put it!
Being a conservative his first reaction is that people should be responsible for their own health coverage...neither the government nor employers should be required to provide. But he stumbled where just about everyone stumbles when I brought up my buddy JB...whose one pre-existing condition is having her rejected repeatedly for any kind of coverage, even coverage that excludes that condition. That just doesn't make sense to him or me.
See, again those of us on opposite sides of their political spectrum can find common ground...if we're not always so worried about sticking with our team.
But hey, I'm just glad I interviewed Gary, so I can go see if I can give up that maternity and well-baby coverage!
Health insurance is a maze and eventually, like after 30 years or so of helping others find the coverage they need, you think you have learned it all . . . but you haven't. Deductibles & copays are just the start in weighing the advantages of one plan over the next. To really evaluate a plan you need to know
1)What the exclusions are
2)How their pre-existing condition clause reads
3)Who is in (and out) of their network
4)What the waiting periods are for certain conditions
And these are just the contractual provisions. To fully evaluate you also need access to the carriers underwriting manual, rate guide and rate history. And don't fail to take into account hidden providers in planning your coverage.
The time to find out how good (or bad) your coverage is would be BEFORE you have a claim, not afterward. Of course knowing the in's & out's, especially with regard to underwriting, is a good thing to scope out before you apply.
Your search becomes much more challenging once you have applied to a carrier and then were rejected. Most applications ask if you have ever been denied coverage. Answer yes and your search just went up a notch or two.
This is not like picking out a can of soup at the grocery store. You need to ask questions. More specifically, you need to ask the RIGHT questions.
Posted by: Bob | May 11, 2005 at 03:55 AM