Want to drop firm's BCBS for independent BCBS policy...am I missing something?

[Anonymous]

We currently have a high deductible BCBS plan through our firm. $13K annual premium with $6K deductible. Last year out of pocket was $5K so we paid $18K total.

The BCBS site offers tons of independent plans, which seem similar in coverage, i.e. lifetime maximum is unlimited. I found one high deductible that is $5K annual premium with $5K deductible or $10K for out of network. If our bills average $5K again this year, we save $8K. And, even if we max out the $10K deductible, we've still only paid $15K, which is $3K less than this year.

Has anyone done this? As a partner, the firm doesn't subsidize health for us, but this seems like a no-brainer on paper. Is there a reason not to go this way?

[Anonymous]

sometimes there are issues w/ covering prexisting conditions due to the change from group to individual plans. Read the docs carefully, some individual insurance plans won't pay anything for 6 months etc...

[Anonymous]

Risk is pooled in large groups so your premiums are lower. We are self employed and had a private policy with Aetna. Aetna f*ckec us. They didnt honor things stated in the policy. When i appealed and won they doubled our rates. We had $15k out of pocket on top of 2k a month premium.

We recently moved to a small group policy BCBS high deductible plan like you have. When dealing with insurance companies, there is safety in numbers. I would get a HSA to go with your high deductible policy. Would never advise a
private policy if you have other options. Unless of course you are friends with health care lawyers.

[Anonymous]

Anonymous wrote:sometimes there are issues w/ covering prexisting conditions due to the change from group to individual plans. Read the docs carefully, some individual insurance plans won't pay anything for 6 months etc...

Yes you have to list every issue you have ever had treatment for...broken leg to sinus infection. If you lie about anything, they will drop you. They have relaxed some of the preexisting rules but you must list anything you think might be preexisting, which will raise your premiums. (see the catch 22 there?!)

[Anonymous]

Agree with the above posters. I went from company coverage to individual when I started my own business. I had to list every doctor I saw within the past 10 years. I was listed high risk because I had allergy shots within that time. I had no other medical issues other than seasonal allergies. My premium was $450 per month for individual.

[Anonymous]

Check to see if the individual policy you are looking at is medically underwritten, e.g. you have to get a physical or provide medical records and that affects premium, and they can raise your premiums if you get sick. I thought that most individual policies were like this, so the premium they list on the website to get you to inquire about the policy is for someone with nothing pre-existing, but if you have anything they may charge you a higher premium. One exception is Kaiser Permanente, you are either accepted or not, the premium is the same for everyone based on your age (so all 35 year olds with family coverage pay the exact same premium). We had an individual policy with them for a while (for our whole family) that was significantly less expensive than family coverage through my DH's company; and the coverage was very similar. So, it absolutely can be cheaper to purchase an individual policy than to buy insurance through your company if what your employer offers is not subsidized ... especially if your company/firm is small, they charge more for small groups and they may do partial medical underwriting on a small group and charge a higher premium for everyone if there is one person with a chronic condition, for example.

Just make sure that if you needed/wanted to, you could get back on your employer's policy, and find out what types of events could qualify to get you back on it or whether you would have to wait for the open enrollment period (usually once a year). If someone in your family got sick and your premiums on the individual policy went through the roof, you would want to have the group coverage. At least until 2014, which is when, barring an adverse Supreme Court decision or a legislative reversal, the Affordable Care Act kicks in to prevent such shenanigans.

[Anonymous]

OP here. Thanks for all the quick, helpful replies. I'm convinced. I'll stay with group coverage. But, I should do the HSA. I've been too lazy to do anything with extra paperwork, but will begin 2012.

[Anonymous]

If you are in MD, your BCBS plan is likely governed by state law, but if you switch to an independent plan it won't be covered.

[Anonymous]

good luck qualifying if you've ever had anything wrong with you, ever. Or are even a tiny little bit overweight.

[Anonymous]

Anonymous wrote:We currently have a high deductible BCBS plan through our firm. $13K annual premium with $6K deductible. Last year out of pocket was $5K so we paid $18K total.

The BCBS site offers tons of independent plans, which seem similar in coverage, i.e. lifetime maximum is unlimited. I found one high deductible that is $5K annual premium with $5K deductible or $10K for out of network. If our bills average $5K again this year, we save $8K. And, even if we max out the $10K deductible, we've still only paid $15K, which is $3K less than this year.

Has anyone done this? As a partner, the firm doesn't subsidize health for us, but this seems like a no-brainer on paper. Is there a reason not to go this way?

Well, that $5k premium is best-case scenario from an underwriting perspective. It's not unlikely that your premiums will be higher. I mean, at $5k last year, you're not exactly strangers to the doctor's office.

[Anonymous]

Anonymous wrote:If you are in MD, your BCBS plan is likely governed by state law, but if you switch to an independent plan it won't be covered.

That's backwards. Employer group plans are governed by ERISA, with some state laws filling in the gaps. Individual coverage is governed by state law.

[Anonymous]

Aetna screwed us over, too. They flat-out refused to pay for an $800 medical bill because they claimed my child needed to prove that she did NOT have a pre-existing condition. Despite sending in documentation several times, they claimed they never received anything and refused to pay up.

[Anonymous]

Anonymous wrote:Aetna screwed us over, too. They flat-out refused to pay for an $800 medical bill because they claimed my child needed to prove that she did NOT have a pre-existing condition. Despite sending in documentation several times, they claimed they never received anything and refused to pay up.

Aetna did not want to cover my pregnancy. They claim they sent me the wrong policy and I had no maternity coverage. We were basically in a situation where suing them would cost us more than paying for a c-section. I went through their appeals process and wrote a persuasive letter.

[Anonymous]

Our private BCBS coverage (family)costs 26k per year. Make sure you really understand the costs.

[Anonymous]

I did the same thing- thought I was saving a bunch on a comparable plan. Then my husband got sick and needed chemotherapy, and it turned out BCBS had buried in the plan yearly and lifetime maximums for drugs that was ridiculously small, and much much lower than the big-print maximums for general coverage. They ruled that the chemotherapy was considered a drug and refused to pay for it. We were screwed, and ended up having to have my husband quit his job and be declared indigent so he could qualify for medicaid to get treated. It's a nightmare- you are much better off with a group plan, and a group administrator to fight for you when something goes wrong.