Let's Go Shopping
The individual market includes many high-deductible policies. With health care costs rising, insurers are reducing much "first-dollar" coverage to keep premiums affordable. The result: Policyholders pay more upfront costs before any benefits begin -- $750, say, as opposed to the previously common $250.
We nearly chose Mamsi's Sole Proprietor PPO option, which had decent coverage for a $501 monthly premium ($6,012/year). But considering that we could be on the hook for up to $6,800 more (including a $1,000 deductible) every year in out-of-pocket costs, we picked a plan with a lower premium.
(Illustration by Randy Mays - The Washington Post)
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Health Savings Accounts: Three Scenarios
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Transcript: Cara Jareb, senior benefits consultant for Watson Wyatt Worldwide, will be online to answer questions about health savings accounts and health insurance open season.
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Selection Time (The Washington Post, Oct 26, 2004)
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Early Users of Health Savings Accounts Say So Far, So-So (The Washington Post, Oct 26, 2004)
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The ABCs of Health Insurance (The Washington Post, Oct 26, 2004)
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Options for Individual Coverage (The Washington Post, Oct 26, 2004)
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We opted for CareFirst's Personal Comp policy. Less comprehensive than Mamsi's PPO, the CareFirst policy costs $306/month ($3,672/year) and is fairly typical of what the individual market offers.
The policy picks up 80 percent of the covered costs, after we meet the deductible ($1,000 per family member, or $2,000 for the family overall). We pay 20 percent for most services, including hospitalization, until our out-of-pocket costs reach $2,500 per person or $10,000 for the whole family. The policy picks up 100 percent of costs after that.
The CareFirst plan has a paltry prescription drug benefit -- an annual $500 per person after the deductible is met.
As with most individual coverage, vision and dental is not covered, but you can buy into small discounted provider networks.
Besides the comparatively low premiums, we also liked the plan's broad network and strong coverage for preventive care: Well-child and adult exams and OB/GYN visits cost only $10 each and are not subject to the deductible. (In a typical year, most of our doctor visits are preventive in nature.)
We also felt somewhat relieved that we, unlike most people in the individual market, have a couple safety nets. Should one of us get seriously sick, chances are good that our rates would jump enormously. In that event, we could resume our group coverage through the university -- albeit at full cost and with no tax deduction.
And being Marylanders, we could enroll in Maryland Health Insurance Plan (MHIP), one of the nation's best providers of last resort. So-called uninsurables can get coverage for their conditions, and the rates are better than in most so-called high-risk pools.
Our world would change dramatically should one of us become chronically ill. Our financial security could be at risk, and the entrepreneurial spirit in our family could be quashed.
It's a sad fact that in today's climate, it's health insurance that can stand between many people and their dreams.•
Christopher J. Gearon is a Silver-Spring based freelance writer specializing in health care and financial issues.
