How does this health insurance plan sound...?

[Spot In The Sky]

So Im quitting my job to do the hike so I wont have any health insurance. I went on to eHealthInsurance and found a couple of plans, I was confused and called and had it cleared up for me and i THINK this plan mostly makes sense for me...
Its Aetna for $116 a month. Id only have it for about 7 months, the time from I quit my job to the time I hope to finish the trail (June - end of Dec).
I have to pay all doctors visits full cost and prescription meds full cost BUT in terms of a copay for a major incident I pay $3,000 and then they cover the rest.
The other plans I looked at which were a LITTLE cheaper had a good copay for doc visits and specialist visits but since Ive know Ive had this trip coming up Ive seen all the doctors I needed to as well as specialists so I dont see myself needing those services- these plans that have a good copay for dr visits have a much higher amount that I need to pay in case of a major incident, like 5,000-7,000.
So for $116 a month the only service Ill really need is that $3,000 upfront payment in the event of a crazy issue, otherwise i wont be using much of the health insurance.
Is this a good idea or am i forgetting something?

[Mrs Baggins]

We did the same thing in 2007 and covered our son as well, who was still in school at the time. We bought it for 6 months and paid $900 for all 3 of us. My husband's company (he was on leave of absence) would have let us keep the company's coverage - - at a cost of $7000. We have no medical issues, see a doctor maybe once a year, and only needed catastrophic coverage, not co-pays and all the rest. Our son is now 23 but couldn't afford the coverage his job offers so he went back to eHealth and got just what he needed for less $100/month thru United Health.

[Spot In The Sky]

We did the same thing in 2007 and covered our son as well, who was still in school at the time. We bought it for 6 months and paid $900 for all 3 of us. My husband's company (he was on leave of absence) would have let us keep the company's coverage - - at a cost of $7000. We have no medical issues, see a doctor maybe once a year, and only needed catastrophic coverage, not co-pays and all the rest. Our son is now 23 but couldn't afford the coverage his job offers so he went back to eHealth and got just what he needed for less $100/month thru United Health.
Was his plan sufficient for him? Did he run into any trouble?

[Mrs Baggins]

Was his plan sufficient for him? Did he run into any trouble?

No problems at all. There are so many companies to chose from and we just made sure to pick one that was well-known and had excellent reviews from other users. For the one our son has now he also made sure his own doctor accepted the plan. He never has a med issues but there's always that unforeseen car accident or cancer (God forbid). We are all life-time non-smokers and take no Rx meds for anything, so that helps keep the costs down. As for not having co-pays, it's always been our experience that when we tell them we are paying for something ourselves the price drops by as much as half since there's no hassle or expenses dealing with an insurance company. Same with dental care.

[tlap]

That seems like a reasonable plan. Aetna is reliable. Just be sure to include the cost of a couple of office visits and some RX money into your overall thru hiking budget, just in case of the unexpected. I would hate to see anyone's hike run out of funds over an infected blister or needing meds for Lyme.

[Ankle Bone]

Some things to consider

Check the lifetime max on benefits. It should be at least $1Million. If not, they won't cover anything beyond their stated lifetime max which is not good. Very easy to run up a $1 million claim.

Are you limited to which doctors/hospitals you can use? Could be an issues since you will be in rural areas. You'll want freedom of choice to go to any or most hospitals.

Do you have an pre-existing conditions? If so, these may not be covered, although the new health care bill has addressed this to where it may be less of an issue.

If you're healthy, you're better off with the type of plan you have noted, and thus "self-insure" the little stuff and have the insurance company for big stuff, if it happens. COBRA would be at least $450 a month. :(



"And all my friends turned out to be Insurance Salesmen" John Prine

[Toolshed]

So is this a PPO or an HMO. I am assuming a PPO. What AnkleBone states is right. Aetna will have both in-network physicians, specialists, labs and hospital facilities and then the same for out of network.

Please re-read your policy - The fact that you pay $3K and they pay the rest has me a bit concerned.. You state this is a per incident deductible that you have to meet.. so you get hurt, the facility bills Aetna $15K for your cost of care - Aetna has an negotiated rate of say $4,300 for a specific DRG in which you were admitted - and they pay $1,300 and you cover the remaining $3K... of which the facility will bill you for.

Does this policy have an Out Of Network Rate? Or is it simple a traditional indemnity plan but with no co-insurance structure?
A question to ask and get (in writing) - if you break a bone and get treated in Podunk at an Out Of Network (OON) facility, What will your deductible be and after your deductible, what will your co-insurance be. Typically for OON it is 50%. You should check to make sure that this is not the case and that In Network coverage and Out Of Network coverage are the same.

The next question to ask - If you go home or continue your hike and receive continuing treatment at another facility, is the cost of care covered by Aetna or do you need to shell out another $3K for the new facility, even though it is continuing treatment.

Aetna does have a pretty exhaustive network of facilities, but you should get a copy or download a list of covered facilities - There are always exceptions..

There was a 9 year contract dispute here in Lehigh Valley (Which is very, very close to the trail) between LVH and Aetna that locked thousands out of obtaining covered care within Lehigh Valley Health & Health Network and forced them to other small hospitals.
Good Luck!!!!

PS - One more bit here -If you are dealing with a sales person, do not beleive what they say - Get it in writing. Every SIC office is full of complaints from folks that start off "... The sales person said not to worry, I would be covered if this happened, but the claim was denied and they won't cover it...."

[Snowleopard]

The Health Reform Act may help you now. Since you're 25 you can be covered by your parents' plan till you turn 26.

This year, allows young adults to stay on their parents’ health care plan until age 26. (This
applies to all plans in the individual market, all new employer plans, and existing employer
plans if the young adult is not eligible for employer coverage on his or her own. Beginning
in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.) This will help cover the one in three young adults who are uninsured.
http://www.whitehouse.gov/files/documents/health_reform_for_young_adults.pdf
http://www.healthreform.gov/
If that doesn't help you, the plan that you're getting may be OK. As Ankle Bone says, you're self insuring the little stuff. The little stuff can be expensive, but that's probably thuosands not hundreds of thousands. In a worst case scenario the new health care bill will help.

[Ankle Bone]

Anklebiter?

The Tool is correct. If it's a PPO, pay close attention to the network vs non-network coverage, and check out the network list.

[Toolshed]

Anklebiter?

The Tool is correct. If it's a PPO, pay close attention to the network vs non-network coverage, and check out the network list.
Sorry - I went back and corrected it LOL.......

[Ankle Bone]

Sorry - I went back and corrected it LOL.......

Toolshed:

I would do the same to mine, but don't know how! :)


I have enrolled in a sarcasm management course. Hope for quick results....

[Roland]

Toolshed:

I would do the same to mine, but don't know how! :)


I have enrolled in a sarcasm management course. Hope for quick results....


The option to edit is available to donating members, only. You can find more information here (http://www.whiteblaze.net/index.php?page=donating_member).

[Spot In The Sky]

So is this a PPO or an HMO. I am assuming a PPO. What AnkleBone states is right. Aetna will have both in-network physicians, specialists, labs and hospital facilities and then the same for out of network.

Please re-read your policy - The fact that you pay $3K and they pay the rest has me a bit concerned.. You state this is a per incident deductible that you have to meet.. so you get hurt, the facility bills Aetna $15K for your cost of care - Aetna has an negotiated rate of say $4,300 for a specific DRG in which you were admitted - and they pay $1,300 and you cover the remaining $3K... of which the facility will bill you for.

Does this policy have an Out Of Network Rate? Or is it simple a traditional indemnity plan but with no co-insurance structure?
A question to ask and get (in writing) - if you break a bone and get treated in Podunk at an Out Of Network (OON) facility, What will your deductible be and after your deductible, what will your co-insurance be. Typically for OON it is 50%. You should check to make sure that this is not the case and that In Network coverage and Out Of Network coverage are the same.

The next question to ask - If you go home or continue your hike and receive continuing treatment at another facility, is the cost of care covered by Aetna or do you need to shell out another $3K for the new facility, even though it is continuing treatment.

Aetna does have a pretty exhaustive network of facilities, but you should get a copy or download a list of covered facilities - There are always exceptions..

There was a 9 year contract dispute here in Lehigh Valley (Which is very, very close to the trail) between LVH and Aetna that locked thousands out of obtaining covered care within Lehigh Valley Health & Health Network and forced them to other small hospitals.
Good Luck!!!!

PS - One more bit here -If you are dealing with a sales person, do not beleive what they say - Get it in writing. Every SIC office is full of complaints from folks that start off "... The sales person said not to worry, I would be covered if this happened, but the claim was denied and they won't cover it...."

Wow these are great points- thank you so much for that.
The plan I looked at is a PPO, which I am understanding to be better than an HMO. The continuing treatment is a great question that I will definitely look into.

[Appalachian Tater]

Basically you are purchasing a catastrophic plan. Make sure that it pays full costs after the deductible and not just a percentage or portion (such as "reasonable and customary" or other tricky wording) and that in an emergency it will cover admission to any hospital as well as out-of-network doctors.

[foxtimothyj]

Has anyone been through a similar situation?
Wife and I are going to pack everything up and ditch our apt when the lease ends. We are leaving our jobs and will try to find something cheaper the COBRA. So until we are done, we have no official address... Is this a requirement in order to get Short term health ins? Should we apply under our current address, or under parents address where we will be fowarding our mail etc?