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To: Wyätt Gwyön who wrote (18245)	3/7/2004 2:07:22 PM
From: GraceZ	Respond to of 306849

Are you asking me what kind of plan I have or did you mean to ask MD? She is the one who switched to the major med and MSA. I have a non-HMO, preferred provider, couple plan that was original sold to those needing an independent (non-employer group) plan such as the self-employed. It covers the two of us and would have been transferable to a family plan if we'd had children. It has a $500 deductible per person, with an 80/20 co-pay with a maximum out of pocket per family of up to $2500 per plan year (which can be any 14 month period so you aren't screwed if your medical problem straddles two plan years). It doesn't cover prescriptions because I view those plans as a serious dollar swap. There are numerous wellness exams that it covers with a very low co-pay of $15 that aren't subject to deductible. Emergency care isn't subject to the deductible or co-pay as well. Almost all the care I've received over the last 15 years or so aside from routine exams has been at the ER primarily because I've had very few health problems, but I've had a few bloody accidents requiring stitches, splints and x-rays. Always on a Saturday for some reason when my regular doctor is off playing golf. They also require pre-authorization and a reviewer when certain major medical problems like back injuries come up but for the most part I can decide with my regular doctor when specialty care is needed and where to go. But since I haven't had the experience to test that out, I'm only going from my regular doctor's experience with that provider. You don't really know what your insurance covers until you really need it. one concern i have about major coverage-only plans is that you might not get the network discount, and thus have to pay exorbitant rates for pay-as-you-go expenses. Your concerns are not unfounded. One of the major reasons I keep the Blue Cross /Blue Shield comprehensive plan is while I almost never exceed the deductible, all the bills go to them before I pay them. They then tell the provider what portion of the charges that they wouldn't pay. The provider then reduces the charges to me because almost every single provider in my state has an agreement with BCBS. They do offer a major medical plan, so the same agreements would apply if I switched to that. Switching plans at my age is far more expensive than it would be if I was younger. We pay $4040/ per year, $1010 on a quarterly basis or $336.66 monthly. The premiums started out as $2080/yr 15 years ago. Moved up to $2600 about 10 years ago and then stayed level for almost seven years but rose to the current level over the last three. The good news is that over that time period the IRS phased in full deductibility for self-employed health insurance so my after tax cost for the insurance is $2908, which is far lower than the employer sponsored BCBS plan offered by my husband's employer even though part of the premium would be paid for by the company. I think the reason ours is so much lower is primarily because it's a group of self-employed business people rather than a group of construction workers. Since the costs are shared only among the plan group, not across the entire universe of insured, your particular group can have medical expenses that are higher or lower than the mean. If they are higher, the healthy individuals tend to opt out and find other options while the sickest tend to be trapped as the costs rise resulting in what is called a "death spiral" as the increasing costs are spread over fewer and fewer people. Sounds like you are ready to opt out yourself. Most people don't know how much they pay for their health insurance because they think it is a "free" benefit that comes with their job, but if you are an employer and have ever shopped for these plans you do know just how much less you can pay someone if you provide them with benefits. I'd say people over pay quite a bit for the plans they think are free.