You will probably still owe Copay's after your 'max out of pocket' (MOOP) is hit - but no coinsurance or deductible.

copays are generaly around $75 for ER visit and $20-$50 for physician.

Coinsurance is where the big costs are (generally for inpatient stays and out patient surgery) unless you have a MOOP cap.

Would it be my parents fault that I am 19 and didn't really know that Health Insurance is an extremely important thing?

How should I go about getting it? How much should I expect to pay? I am in Michigan, full time college student, good health, low income. I go to a community college and they don't have anything available through the school as far as health, vision, and dental.

As far as insurance I'd actually take advantage of. I'd probably go to the dentist a few times a year, probably get a physical each year, and have my vision test annually (I wear contacts).

Are Health, Vision, and Dental all separate? or can/should I get them in a package together?

Ideally,I'd want really good dental and vision coverage and whatever Health coverage. I don't go to the doctor's office so it'd basically be ICE.

PPC,

They're typically separate. Are you prepared to pay a few hundred a month? If not, why?

Question regarding pre-existing conditions:

I am 21 and on my parents health insurance plan. I graduate in May, and will then be on my own (unless my parents do the COBRA coverage for 18 months).

I was diagnosed with Crohn's Disease (similar to colitis) last summer ('08), and was on major meds and had a major resectioning surgery last October.

I have had no symptoms and have been on zero medication since that time (knock on wood...).

If feasible, I plan on "going pro" for a couple years while saving up money for life/ grad school.

My question is: Will I be able to get private insurance on my own without a job providing group coverage? Am I considered to have a "pre-existing condition" despite having no medical costs related to my condition in over a year?

If necessary, could I go to a doctor or a specialist and have them run tests to prove I was "misdiagnosed"? For those who don't know, Crohn's disease is a set of symptoms more than an actual illness, and the causes are not known. If it meant the difference between being able to be insured or not, I would consider this strategy.

Thoughts?

This is undoubtedly a pre-existing condition.

You had bowel surgery. The proof of your Chron's disease is in your pathology report. You seem to have a misunderstanding of what Chron's is. It is not just a set of symptoms, it is a specific pathologic diagnosis. The cause is irrelevant (it is an auto-immune disease).

I'd keep insurance at any cost. You will definitely be a pre-existing condition, and you run the significant risk of having a large medical bill in any random year.

Does this mean I am uninsurable? If not, what kind of premium can I expect?

Is there some way to stay on the plan I am currently on when I am no longer considered a "student" under my parents plan? Can I just start paying my own premiums but under the same coverage I am currently on a family plan for?

These are questions you should start asking of your current insurance company before your coverage runs out.

I worked in the health ins industry for sometime and will give a brief overview of what I know.

There are numerous plan types, HMO, PPO, POS are the typical ones...this will pertain to what doctor you can see with or without receiving a referral to see a specific one.

First, to use your ins you must make sure to pay your monthly premiums, these can vary widely depending on the coverage, policy and conditions.

The make up of your policy will contain a Deductible. On a family plan you will typically have a family and/or individual deductible. I've seen ded from $0 to has high as $20,000. Once your individual ded or the family ded is met your ins then "kicks in" to you Coinsurance rate, I've seen these rates from 40% to 100%. This is the amount that the ins company will cover of the bill, but remember this only goes into effect after you have paid your deductible for your fiscal year.

On top of that most policy's will have a Out Of Pocket Maximum (OOP), also on a family plan you may have a family and/or individual OOP. The max amount you will have to pay a year towards health expenses. Again, I've seen this from $0 to as high as $100,000. One you meet your OOP you are covered at 100%.

You also have a Life Time Max (LTM) on policy's. These can also very widely. I've seen $25,000 to Unlimited. One you meet your LTM, you will no longer have coverage with that policy.

Coverage Ex:
Jimmy breaks his arm. Cost to fix Jimmy's arm is $10,000. Jimmy's mom has a family ins plan. There is a Family Ded of $1000 and an Individual Ded of $500. Then Coinsurance of 80%. Individual Out of Pocket Max of $2,500. Jimmy has paid nothing towards his $500 ded for the year, nor has the family paid towards the family ded for the year. AKA they have had no med expenses for the year. Jimmy will have to pay $500 to coverage his ded. Then his coinsurance coverages at 80%. So, his bill of $10,000 - $500 (ded) =$9,500 remaining. 80% * $9,500 = $7,600 coverage, leaving $1900 for Jimmy to pay. The $1,900 goes towards Jimmy's OOP. So he only has $2,500 - $1,900= $600 left he has to pay for medical expenses for the year. Jimmy's final total costs are $500 (ded) + $1,900 (coinsurance) = $2,400.

Just change the Dedcutibles, Coinsurance, Out of Pocket Max to figure what your costs will be. It's very person specific. If you go to the doctor a lot for random **** you will want a good plan. If you are buying the ins in case of a car accident, cancer, major emergency then get a high ded plan.

Hope this helped some...sorry if it was confusing.

littleeddy - do you know the rules on continuous coverage?

Say someone had a preexisting condition, and is currently working at a company that provides them with health insurance.

They quit/are fired/laid off/etc, but their new job doesn't start for another 2 months or so.

Questions:

1. Would they be required to maintain coverage between these times to qualify at the new job?

2. COBRA can be elected for up to 60(?) days and retroactively applied. Would being in this COBRA "window" qualify as coverage even if you never elected it?

EDITED to update: It seems there is a 63-day rule where you don't have to worry about continuous coverage. If that is correct, I'd still like to know the answer to question #2. Also, I'd like to add this additional question.

3. Say you're on day #62 of being unemployed. In order to maintain future insurance, can you simply start a new insurance plan on that day moving forward, or would it not help since you were technically still uninsured for the first 62 days and would therefore have to retroactively apply COBRA -and- get a new plan (cobra or 3rd party).

It's rules like these that make insurance so confusing.

Generally at larger companies pre-existing conditions are not an issue either way. At a very small company (I don't know the threshhold) they might be. Whether you had COBRA or not really isn't going to help you in these spots.

Uninsured ER patients twice as likely to die

New study highlights disparity of care for those who don't have coverage

http://www.msnbc.msn.com/id/33971846...h-health_care/

bump, awesome thread

questions after reading most of this thread...

I'm 24, havent had insurance for the past 6 months... I've been a pro/semi pro for the past 2 years, but was in school in NY up until May when I graduated.

I filed taxes with my accountant in April of 09 for the first time. I called up Healthy NY after looking at some of their plans and it looks like I probably won't be able to go through them because I'm not really employed and my accountant filed my taxes as Schedule A(don't really know what that means but it needed to be Schedule C, E or F).

Any ideas where I should be looking to apply for coverage? I'm probably looking for a plan with a decent copay and would not like to pay more than a few hundred a month.

Also I live in NY now but I currently have a FL license. It appears that its much more expensive for coverage in NY. Should I try to apply using my FL address? Or would it be weird if everytime I go for a check up and whatnot they see I'm actually in NY.

Do your parents have health insurance? If you are a 19 yr old full time college student you should be able to be carried on their family policy.

Couple of questions:

Does the insurance company go into your conversations that you have with your doctor? In other words, my doctor sometimes asks me "do you do drugs" and I give him "socially" or "every once in awhile" answer which is basically true. if the insurance company asked me these questions, do I just say I never use tobacco, never use drugs etc?

Also, I recently got a referral from my doctor to go see a psychiatrist for ADD type issues. I went into the office, he gave me the name, probably wrote a few things down, and that was it. I was told that I should just eat the office visit costs (considerable) because they would give the insurance company a reason to deny me coverage. But if the insurance companies go into the doctor's patient file, won't they just see this anyway?

This is all coming up because I am quitting a job which had health insurance and trying to find my own now...