Shopping For Health Insurance

I have never purchased my own health insurance, 38 years old and this is the first time I am getting my own. In this post I will torture you with how I went about getting my own health insurance and share my 2-week long experience trying to finalize it.

Overall, the process isn’t as bad as dealing with the IRS but on par with dealing with the DMV. There isn’t a whole lot of paperwork to sign up, which is nice.

Where To Search

I started with healthcare.gov and then tried Kaiser Permanente’s own website and a traditional PPO provider’s website.

I dislike PPO’s, which I’ll get into in just a bit, and since their prices were higher than the HMO’s I opted for Kaiser.

Private insurance groups can offer plans which aren’t advertised on healthcare.gov, though I will get into why this is sort of useless for the majority of us. They are often “catastrophic” plans which we won’t qualify for. 

I didn’t bother contacting insurance brokers because I know that I would never stop getting hounded by them once they got a hold of my information. Dealing with the exchange has already proven to be quite disruptive. 

Healthcare.gov

Healthcare.gov is the home for the healthcare exchange, the birthchild of the ACA. Any insurance groups that participate will be listed on here. 

Overall, the website is very well designed, easy to navigate and you have the option of shopping without entering your personal information on there.

I highly recommend NOT entering your information on there until you know for sure that you want to sign up, because let me tell you, it’s a fucking barrage of phone calls and emails and text messages once you enter your information on that website.

There were only 2 companies in my state, for my zip code, that offered health insurance on the exchange, Kaiser Permanente and Providence. 

You can’t get dental insurance through the exchange, or perhaps you can and I was too dumb to figure it out. 

The cheapest monthly premiums I found on the exchange was somewhere around $230/month.

The terminology is incredibly hard to figure out. There is a ton of jargon and you would think it’s as easy as looking at a glossary but it’s not that simple. It’s all legal jargon, designed quite intentionally to throw you off, forcing you to choose the higher end plans.

Kaiser Permanente

I shopped on Kaiser’s website just to see if other plans were available. I found one that was $220/month, it was labeled as ‘catastrophic’ insurance but frankly it wasn’t much different from the rest of the bronze plans out there.

I decided to sign up for this ‘catastrophic’ plan, went through the application process and got it all done. 2 days later I got a message saying there is a message, I clicked on the message link and got another message to open that said “you have a message”. Enter the twilight zone. 

Needless to say the KP website for signing up for insurance was designed by a 6 yo child. I had to log in manually to figure out what’s going on, basically, they denied my application because I had to meet certain criteria for the catastrophic plan which they somehow didn’t mention on their website when I first applied. 

Look at the highlighted box above, the out-of-pocket max is actually the same as the deductible which isn’t all that different from the cheapest Bronze plan below.

Fine, I applied for the next level up, which was the cheapest Bronze plan available for $228/month, also available on healthcare.gov.

I added a dental plan not so much because I wanted one but the laws surrounding open enrollment are so confusing and vague that I would rather have it than be stuck without one later in the year.

I went with the 80L plan below, since there is “No Maximum” though I’m sure they can deny whatever they want – hopefully it’ll work out well.

I have a some crowns and a bridge that will need some work this year, I doubt I’ll even use the dental insurance since it’s usually garbage, we’ll see. I am fairly certain that I can always cancel the insurance once I figure out the private insurance game. 

Why KP

I’m a fanatic when it comes to healthcare delivery, KP being one of the better ones out there that I’ve known about and personally worked for. 

Too often, in the private insurance world, patients are getting scammed by greedy hospitals, ER’s and specialists. Where a patient needs reassurance, they are admitted for observation. Where they need outpatient observation, they are pushed into having surgery.

HMO’s aren’t always that much better, their cost-cutting antics can put patients at risk in other ways. Thankfully, due to the voices of the patients now readily visible online, fewer such groups are willing to shortchange patients. 

KP seems to do a great job of preventing patients from getting unnecessary interventions, while focusing on generic medication and disease prevention. They also aren’t always trying to force the patient into the doctor’s office, they are happy to manage patients through low-cost options such as having them email their PCP or having them use telemedicine options which are currently free at KP.

Insurance Jargon

Any insurance plan you shop for will have a ton of insurance jargon. It’s not just words which you don’t know the meaning of, it’s how they are strung together.

Sure, I know what the shit a copay is and what coinsurance is, but depending on whether it’s followed by before or after deductible it will make a huge difference. 

Some fields aren’t even filled in. I was using the “compare” tool to look at 3 different plans side-by-side, some columns were empty – open to interpretation, perhaps?

Ponder this, the ACA cleaned up a lot of this terminology bullshit, can you imagine what it was like before? What a fucking mess. A mess that I’m a part of as a physician – that’s almost worse.

It’s quite obvious that this is intentional, not to sound like a conspiracy theorist, but the cheaper plans have so much wording that you forget it’s health insurance you’re buying. The more expensive plans have essentially 2 words, copay and deductible.

Buying On Health Exchange Vs. Directly From Insurer

I view the exchange in the same light as hotels.com and Expedia. Once you purchase something through these 3rd party vendors you are screwed when it comes to making changes – one entity will blame the other and you’ll be stuck in the middle with no recourse.

I decided to buy directly from KP.org because I know that I can go to a physical location and discuss any grievance or confusion I may have.

The exchange also wanted me to prove that I’m a citizen, so they sent me this packet which I had to fill out and send back copies of my passport. I’m not sure if Kaiser will ask me to do the same later, but I don’t care for handling more paperwork.

My Health Care Strategy

I am grateful for the advances that medicine has made, but I’m also not very fond of the FDA or the animal testing needed to advance healthcare for the human race. The medical-legal scene is corrupt and backwards which is forcing some clinicians to practice out of fear.

Currently, I don’t take any medication, neither prescription nor OTC. I consider myself vegan though I don’t care too much about such labels, it’s all fluff in my opinion.

How can you be vegan when you depend on medications, immunization and medical devices, all of which have been tested on animals? It’s silly. But as a so-called vegan who doesn’t want to cause harm to animals, I am not fond of taking medication.

What if I get in a terrible accident? What if I get a chronic illness that needs management? What if I have a disfiguring disease that can be treated? I have no idea what I would do in such circumstances, I’m feeling quite brave behind my keypad right now, thinking that I’m gonna choose my “higher” ground and forgo most medical intervention.

Financially, I’m planning on using telemedicine and curbsiding specialists whenever I need healthcare. Now that I’m barely working, I’ll try to throw a few hours at Kaiser just so that I can still be on the scene should I need a favor from someone.

I just had a conversation with my friend, she is a primary doctor and felt too shy to curbside a specialist in her medical group… that’s strange to me, I almost feel like we owe it to each other to go to one another for help without dealing with insurance and copays and all that jazz.

If I need an expensive procedure, specifically relating to dental work, I plan on shopping around, maybe going overseas where my money will have more buying power. I know some worry about the quality of care, but the same people probably think all HMO’s are bad.

Open Enrollment And Deadlines

Yea, this was a disaster to figure out. I still haven’t figured it out. All I know is that for some reason my insurance won’t start until March 1st. 

The healthcare exchange had January 15th as their deadline. But I guess they can extend it to 1/31 for some odd reason….? Which just means more phone calls and emails from healthcare.gov, since it’s 1/26/2017 as I’m writing this post. 

KP gave me an open enrollment deadline of 1/31 right off the bat, great. My final day of work is 2/4/2017. And no, I wasn’t a slacker, I was just waiting to see if I could find other means of securing health insurance. 

And then there are all these reasons why you can extend it out to March. There are certain criteria you have to meet in order to qualify.

Finally, you can also qualify at any time in the year if you lost your job along with your health insurance. There are other reasons to qualify for health insurance outside of the open enrollment period. 

HSA Option

I was able to get a lot of help from my financial adviser regarding the HSA option. The one company that was recommend was Health Savings Administrators.

What You Need To Know About An HSA

This company is quite transparent when it comes to their Administrative and Custodial fees, the 2 major fees when it comes to having a HSA.

Administrative fee: $45/year

Custodial fee: 0.0625%/year of your HSA balance

In order to qualify for a HSA you must have a HDHP – high deductible health plan, which really isn’t all that high. For a single person, like my lonely self, it’s only $1,300 with an out-of-pocket max of $6,550.

Overall Impression

Though I barely see patients now, I still work for large medical groups who deal with insurance. I’m embarrassed to be a doctor in such systems, I mean that sincerely. It’s not just broken but it’s intentionally misleading, bewildering and fear inducing.

I’m also realizing that the insurance my work provided for me was “worth” at least $700/month. Looking at what a comparable plan would cost, I now have a better understanding of what our employers are spending on our benefits.

Final word, health care isn’t health insurance. I can ALWAYS get healthcare, even if I am not insured. That’s another topic for another day but it’s important to not group these 2 concepts together.