Why America needs a health insurance plan or how to choose a health insurance

This one is a guest post by G. Enjoy.

You might be lucky. Then, your employer will pay for your health insurance. It might even be a good health insurance. Of course, there is a down side to it. Once you are fired, or downsized, not only your credit is severed, but your health insurance as well. If you are fired, you are not allowed to be sick. So don't quit your day job, since you'll loose your health insurance.

But I am not lucky. I need to have health insurance on my own. For that, I need to learn which insurance is the best for me. True, my Ph.D. is in communications, but I can do some research. There are just a few things one needs to know. Deductible, co-payments, eligibility and few others. So I am off for the races. My wife's health insurance is not good enough. It only has 30K annual return, and I must have 50K. No go. Furthermore, my wife's insurance costs about 300$ a month for me. It has some good sides. It gives 100% coverage and all pre-conditions I have.

I am lucky. I do not have any pre-conditions. I am as healthy as an ox. If it is healthy. So I need to look for insurance. My university recommended a company. Let's look at it. No deductibles. That's great. I think. I am not really sure. Then again there is a 93$ payment every month. That's expensive, right? Not when you compare it to my wife's insurance. But what about the coverage? Well 90% on most procedures. That's nice. That's good. A hospital room of a semi-private rate. And 70% of non PPO procedures.

What's PPO? Well, each insurance company works with a chain of hospitals and doctors. This chain is called the PPO. If one goes to a member of the PPO, then it is 90% coverage, if one goes to non PPO member coverage is only 70%. In order to find out which hospital and doctor is part of the PPO you need to start yet another small research. I did not have the energy to look at this company's PPO. Still a 93$ a month for 90% coverage, is that good? Is that bad?

I continued searching. The university also tells about four other companies with which one can have insurance. So, I checked them out. One of them was giving a 80% coverage in a price much higher than the one recommended. Well, that's not a choice.

The second company is way, but way, cheaper. I am talking about 57$ and 69$ a month. Now, since I am healthy, why not opt for it? The coverage. Well, that's hard to tell. This company does not work with percentage of the bill the hospital gives you. Instead, it pays back a certain amount for every little thing. Say, a day in a hospital room, 1200$. Miscellaneous during hospitalization another 500$ a day, x-rays 350$ and so on and so forth. But, I don’t know how much a day at the hospital costs. It might be 3000$ and it might be 1000$. If it is the later amount, then I need to take this offer. If it is the first amount, then this offer is not very good. But how can one tell? Should I contact the hospital near by me and ask them how much a day costs? Come to think of it, that's might not be a bad idea after all.

Then there is another company. They use this strange term which caused me to strike them out immediately. They cover the usual, customary and reasonable costs. And they only cover 30% of it after negotiations. Negotiations with whom? I was wondering and about what? Do they negotiate with the hospital about the price or will they negotiate with me about what is reasonable, customary and usual? In any case, I was not about to negotiate with this company, reasonable or unreasonable as it may sound.

And then the last company. They have both deductible and co-payments. They let me choose how big of a deductible I want annually, and then the monthly rate is changed accordingly. If I want 1000$ deductible, I only pay 800$ annually. If I want 250$, I pay 1300$ annually. They also have three types of coverage, silver, which is the simplest, gold and platinum. Their premium varies accordingly. Then again they also use the URC as an acronym, it is that common. But, they do not negotiate and they do not give 90%. They give full coverage of a day at the hospital. No, I am wrong. They give in the silver plan 650$ per day at the hospital. In the gold they give full coverage. No, not full coverage but the Usual, Reasonable and Customary coverage for a semi-private room. In the platinum they give the URC for a private room. But again, I have no clue how much URC room costs. And this company is a bit more expensive than the one my school recommended. But the one my school recommended only covers 90% at the PPO. So I decided to go with the last company.

I re-read their benefits and saw that, wait a minute, they also have a PPO. They give the URC only at the PPO and 80% at non PPO. But where can I found if they have hospitals in my region as part of their PPO? And who is their PPO? And what is this company's real name? Because every company has several other companies which are the local brunches or insurances in every state. And in every state the one big company has a different name. and its PPO also have an unknown name, at least I could not find its name in the insurance company and only a google search led me to find the name of the of the PPO.

So I looked for hospitals of that PPO in my region. By now it was 8 p.m. and I was tired after starting my research at about 11 a.m. A long day of research. By now I've realized there is no way I would do my insurance today, since I got so confused from all the facts, different coverages, PPO, coinsurance, deductible, underwritten. But, then again, I had to find out if my favorite insurance plan has a PPO hospital in my region. Since I was tired I did the little mistake of giving the wrong zip code and therefore for about 10 minutes I was sure the PPO has no hospitals in my region. If this is the case, then of course I cannot have them as my health insurance company, can I?

Luckily, by the fifth time I ran that search I found my mistake and corrected it to realize that most insurance company works with most hospitals in most regions.

So what should I choose, paying 103$ a month to have a 500$ deductible + a full URC coverage or pay 93$ a night to have no deductible and 90% coinsurance of PPO treatment? In the next day I made my decision and fought the different forms I needed to fill out to have the insurance, which I am not sure I have it, just yet.

If you want to compare, in Israel you pay 3.1%-5% of your income as a health tax. If you do not have a job you pay flat fee of 92 NIS (equal to 25$) a month. Everyone is entitled to a not that bad basic coverage. One can add a second lair of insurance for an additional amount of 10-30$ a month, which includes the payment for a second opinion, choosing your own doctors in some places etc. one pays 5$ per quartile for visiting a professional doctor, unless one has a chronic disease then you do not pay at all, and the waiting time for visiting certain professions are long while others are short.

In any case, last year I spent around 424$ for my health insurance, and this year I will spend 1200$ on it. I can only hope I will not have the occasion to find out if this insurance gives me better or worse coverage than the one in Israel, though it sure costs much more. And one last small thing, in Israel I did not spent two work days to find out which health insurance I should buy, only to realize there is no educated way to make such a decision, as I found out happens in the USA.