Family insurance individual vs. through job

My husband gets a family plan and I've never been denied coverage. In fact, I've never had to ask questions or anything. Now life insurance is another story.

It's a question your husband needs to ask at work, every insurer is different and has a different arrangement with the employer. Generally the larger the employer the more perks to the employee from the health insurer because they want the contract. Small business doesn't have the same power, until 2014 when the playing field gets leveled.

I have never heard of family plan. I've only heard of private and group. Private is what you get when you don't get a job and it's definitely a lot more expensive and denies people. Group plans are through a job and they do not deny and they offer coverages as determined in the paperwork your job gives you upon hire. A group plan is definitely better (unless you're paying 1,000s a month). You could never afford a private plan that gives comparable insurance to a group if you weren't a millionaire :) just my experience.

Thank you so much for your replies so far.

I heard cobra is in the 4 digit dollar number. My plan is a good one with lots of premiums so my costs wouldn't be clear.

So even if the group plan through his job is only HMO instead of PPO does it cover my meds and yearly colonoscopies?

I feel like just giving up. F this disease.

The 1st thing to check is that the group plan of your husband's new employer does indeed offer spouse coverage. Most do, but good to check.

Then look at what the benefits are, and any restrictions. Most group plans do not distinguish employee vs family member once there is coverage, nor do group plans typically have pre-existing exclusions. In some states they cannot by law.

There may be a 60 day period after employment before the group plan kicks in. Also, if your husband initially enrolled as employee-only, then sadly it may not be possible to add you until next years enrollment window (often in late Fall).

You may need cobra to bridge. It would be whatever you currently pay + whatever you employer pays. There should be some info on you employer's HR site about how much premiums are and how much the employer covers. This will be cheaper than a comparable individual plan, and there is no waiting period.

You could opt for a less comprehensive individual plan to try to save money, but you may not be able to obtain individual insurance, or would have to go to a high-risk pool. Also this would be a new policy and there are typically 6-month exclusions for pre-existing conditions.

The issue of your husband's new HMO vs your current PPO could actually work out well. Sometimes specialist appointments and diagnostic procedures (like scoping) has longer waits at an HMO, but you already have a diagnosis and a treatment plan. You primary care in the new HMO would likely just prescribe the meds of your old treatment plan while you were waiting for a specialist appointment.

The HMO might have a different prescription formulary, or have policies that you try cheaper drugs before name-brand ones. But that would happen with any new insurance - not just with HMO. In my experience, larger HMO often have better prescription coverage. Typically flat co-pays instead of 25% or 35% copays.

Lots to check out, and definitely expensive to be sick. These worries are just part of the current healthcare system in America. Some things like high-risk pools and per-existing limitations are improving with the Affordability Act, but private for-profit companies are still in the mix, and the quickest road to profit is to place barriers between you and expensive care.

Good luck

Post Edited (DBwithUC) : 5/20/2013 8:44:12 AM (GMT-6)