Medical Insurance, What do You have?

OK the company I work for merged with a HUGE international company, so you would think that the new health benefits in January would be cheaper? No they are not. I cannot believe a company that is located in 300 countries doesnt' have cheaper healthplans than what I have now.  So i have to decide between United Healthcare (HMO) which is more expensive or Kaiser, is another option.  A more expensive option than that is Aetna HMO.  EPO's/HMO's only, I can never afford a PPO again. They have a drug plan that is only affordable if you buy 3 months via mail order on ALL drugs. Any opinions on Kaiser? It's further away for me to travel, but I could get significant savings with Kaiser.  Will they prescribe any pain meds if needed? I have to make this decision by next week so any opinions would be appreciated.  I have been told that if you are healthy, Kaiser is fine, but don't get sick.  Please help!

I'm on my husband's insurance. He took a new job last year, and I was so thankful. His old company's employee contribution was going to go up from $300 to $750 a month! The benefits weren't all that great either. He got a new job offer right about the time we found out about the increase. It's much cheaper now, and our benefits are awesome.

I hate this time of year because most companies do open enrollment, and you get to see how much it's going to go up. Even his went up a little bit.

Jenn, do they offer any other HMO's?

I'm in the San Diego area, and while I complain about my insurance (Health Net), and it's not cheap (around $350 a month just for me), I am getting older and I have a nasty disease history. And so far, aside from charging way too much for the Humira, they've been great about covering everything. And the Humira is just because of the way their drug formulary is written up (selft injectable vs. infusion).

They have limits on some things like my ostomy supplies, and my wound vac that I had for 2 months, but overall, it's way cheaper than a PPO and I've had tons of tests and hospital stays.

My sister-in-law has Kaisar and while she says she likes it, she had a neck injury and had to wait months, go through physical therapy (even though they weren't sure what was wrong) before they would approve an MRI. I think Kaisar is great as long as you don't need frequent tests and care. Seeing a specialist isn't always easy, and you won't necessarily see the same one. At least that's how it seems to be down here, it may be different up in LA.

If I were you, I'd get whatever insurance covers Cedars Sinai. Call them and ask what they take and compare it to the list you got from work.

I am in Northern CA now, I moved up from LA and it's been hell ever since! Thanks for your imput.

Hi Jenn, I have United Healthcare and am quite happy with them.
They pay for my Remicade infusions at 100%.

Wow, I'm so surprised. I had UnitedHealthcare through my husband's job and the ONLY hospital and 80% of the doctors in this county won't take it. It was very difficult during the time I was undiagnosed. I had my surgery 3 counties away. Then my husband and I started our own business (which we love!) and had Cobra for a while (awfully expensive) until we could find a new insurer. Every single one we talked to refused to cover anything having to do with Crohn's disease. They don't cover the B12 shots, GI visits, hospitalization or drugs. I spend about $500 a month just on meds and I haven't seen my GI in over a year because of this. They recently dropped my kids and still it costs over $450 a month for my husband and me. (and not much for me unless I break my arm or something)

We are now looking AGAIN for an insurer. *sigh*

Just remember your going to have much more limitations with Kaiser. I have never liked their plan at ALL! I was miserable with them many years ago.

My daughter lives in the Bay area of California and just

switched to Kaiser in Sept. because of a job change.  She has to use their doctors and facilities but that didn't seem to bother her. She's already had 2 crises. The first right away, an emergency visit due to a cat bite and the second, she let one of her prescriptions run out.  She got in right away to see a new specialist.  I have no idea about coverage but I my thinking is so far, so good   

Kaiser sounds so tempting. Paying $20 for a 100 day med supply vs paying $125 for a 90 day supply through mail (waiting 2 weeks) order sure sounds better. I would have to travel furhter for doctor visits, but still the savings is significant with Kaiser. I go to doctors at UC Davis Medical School and I looked up some of the kaiser doctors and they all went to UC Davis. Ugg. I don't know what to do, I have a few more days to decide. Thank you guys!

If you are getting on a group plan and they have to accept you either way, why don't you call each plan and ask them your specific questions? Write down who you speak with and if anything is a deal breaker for you get it in writing so you don't get burned later. If you speak w/ an insurance agent the company may be bound by what the agent tells you. If you just talk to a random call center rep this is probably not the case. Most also have a disclaimer when you call that what you are told over the phone is not a "guarantee of benefits."

I have Group Health which is a sister company of Kaiser and so far so good. I have to agree with the person that said that it depends on the facility. I go to the facilities on the Eastside Bellevue/Redmond because they seem to have better customer service skills than the one in Seattle. It also depends on the provider in that my PCP believes in integrating western and eastern medicines together and my GI is straight western.

I am not on remicade yet nor humira so I haven't been through the hoops to get that approved, I agree to call customer service and ask them questions on drug formulatries etc. FIND OUT WHAT THE GROUP number is for your work BEFORE you ask them however because the coverages and limitations for each company are wayyyyyy different depending on the individual contracts. Then use that to weigh your decision.

Good luck =0)

Jen good for you for trying to be an informed patient. Hopefully what info you are receiving is helping point you in the right direction at least where to start...

Randynoguts.... thanks for sharing that info regarding group health HMO. I JUST watched Sicko the movie and it scared the crap out of me. I never had to think about a claim never being covered because I never had anything chronic aside from asthma. I will be as dilligent as Jen in my next job. Oh and Jen the reason why I told you to look up the group number was cause a few years back I worked for Premera Blue Cross as a customer service rep and it was amazing to see the differences one group coverage had over another. One would assume they would be all the same but that is how the company saves money when they sign up for insurance.... the exclusion riders.

THe Blues of MA. Used to be the The Blues of NH. It is a PPO and expensive