Can anyone recommend a health insurance plan in WA?

[longamkl]

We have to buy individual coverage (ie. not group) and I am completely disgusted with our insurance company. We have fairly expensive coverage for our twin babies - it's called comprehensive coverage and has a deductible of $1,500 each. They have just denied coverage of our 9 mo well baby care checkups. They say that we get just $400 per year of preventative care and silly us, since the babies were born in late Sept. of last year, we've already had a 3 mo and 6 mo checkup this year therefore no more coverage for us. In my mind, I would have expected that if they weren't going to cover something, at least it would apply towards our deductible, but they say it doesn't even count towards that. It's just not covered at all. I don't see any rhyme or reason to what does count towards a deductible on a given plan and what doesn't.

I can't believe that they are so short-sighted that they would prefer to cover sick baby expenses than cheaper well baby checkups. This coverage is $184 per month per baby. We have already cut my husband and I back to catastrophic only coverage in order to try and keep our costs below $600 per month. Does anyone have any advice?

[kijip]

WA State? Individual plans in WA state are truly difficult to come by at a reasonable price for a reasonable amount of coverage. Until somewhat recently, it was actually impossible to purchase an individual plan in WA state. Plans are available now but usually are essentially catastrophic plans or have very high monthly costs. There is a reason you see a lot of fantastically educated persons working part-time in WA state at a grocery store, Starbucks or Costco if their spouse does not have insurance.

We found, in the 11 months or so between jobs while my husband was in a school program (now he gets benefits from working pt) that a catastrophic plan for the family was the way to go. It was cheaper to pay for routine medical than to pay for comprehensive insurance and then we were covered beyond $4000 100%. We could have perhaps gotten our son (who was 3 at the time) on WA state's SCHIP program (I worked at a non-profit with no medical offerings and we were right at the cutoff income wise) but never got around to it and we were able to pay for regular visits, dentist etc ourself just fine. For dental we used the County system which was lower cost.

Have you investigated if their well baby etc could be covered by First Steps or a similar program? The income limits are moderate and the monthly cost to you modest. While Basic Health is pretty much shut to new families, First Steps for kids is still available. If you can't afford what you pay now, look into that.

What is your insurance plan in the future (ie will you likely be eligible for a group plan through an employer in the future?) If so, then a catastrophic plan now may be the best bet. If maintaining continuous insurance coverage for a pre-existing condition without any prospects for a good group plan, then keep them in a comprehensive plan now and not a catastrophic plan.

You can price plans on ehealthinsurance.com....that is were we bought ours for that year, it was $104 for the family IIRC and through Regence.

[longamkl]

Thank you so much for your reply and insights. I have never heard of First Steps. What is it? Also, what is County dental?

My husband works across the border in Canada and we don't expect that to change. I hope to continue to stay home with the babies so there is no prospect of a good group plan.

I have looked at ehealthinsurance.com but like I say, I don't see how to compare one plan against another when you can't tell what would apply towards a deductible and what wouldn't. Regence is who we currently have.

[kijip]

Thank you so much for your reply and insights. I have never heard of First Steps. What is it? Also, what is County dental?


A number to call for stuff in your county:

WithIn Reach Family Health Hotline at 1-800-322-2588


In case you qualify for SCHIP and there is space:

http://hrsa.dshs.wa.gov/CHIP/Index.html

More SCHIP (Apple Care for Kids) information: http://hrsa.dshs.wa.gov/applehealth/am_i_eligible.shtml The income for a family of 4 is $66K and that would be a $60 a month.

First Steps is for lower income individuals for baby and child health services. But come to think of it it would only cover your kids till age 1 and they must be older than 9 months now.

Most WA counties have health and dental clinics that are run by the county or are contracted by the county. I am not familiar with the border counties (I am in Seattle) but ask about them when you call the WithIn reach number. The services are often sliding scale but even if you are at the top income scale, they are cheaper than other providers and we found the dentists terrific. I have a friend that works at one and they encourage people of all income levels to come there because it helps keep them open and is a win-win (they get the "full" fee from some families and you get lower cost fees).

[Momof3Labs]

As far as getting health insurance that covers stuff like well-baby care, that isn't cost efficient for you. The insurance will assume that pretty much everyone will use the well baby benefit, so will charge at least the cost of your well baby visits, plus any expense loads or agent commissions on top of that.

The good news is that well baby visits drop off dramatically after the first year, and even moreso after the second year, so it is really only a short-term problem that they have a limited benefit on your policy. I'd stick with a plan that works best for your family long-term and not focus just on paying well baby visits. But definitely investigate other resources for reduced cost vaccines and such.

[DebbieJ]

But definitely investigate other resources for reduced cost vaccines and such.

Our township offers vaccine clinics several times a year. You might find something like that.

[vonfirmath]

As I recall, independent health care plans in WA dramatically dropped when WA started adding on things they must cover in the plan, and things they could not refuse to cover a person because of.

A friend of mine works PT at Safeway, and stopped being a SAHM to go back, when this happened and their health care plan left the state.

[longamkl]

I did try calling Within Reach but it seems we are just beyond the income limits for their programs. They referred me to the State Health Insurance Commissioner and they were the complete opposite of helpful.

Respectfully, it doesn't really help me to know how the state got into this situation - I can't even vote to try and enact change. I do appreciate the insight that it just may not be cost-effective to try and cover these typical checkups and that we may just have to grin and bear it for the next couple of years.

Is there anyone else out there who has experience with an individual health plan in WA state? Thank you for reading my story.

[kijip]

I did try calling Within Reach but it seems we are just beyond the income limits for their programs. They referred me to the State Health Insurance Commissioner and they were the complete opposite of helpful.

How much is just a little? Because once you apply certain things can be deducted from your income. It may be worth applying to see.

My only private individual insurance experience in in WA state is, like I said, with a catastrophic/high deductible only plan. Basically we paid for anything preventative out of pocket and it did not apply towards the deductible. Only emergency and specialist stuff applied to the deductible. It was through the same company you are using now. Basically we knew we had to budget for the preventative stuff and then be ready for up to $4000 in out of pocket expenses if the need arose.

Alternately is getting a part-time job that would get you access to a group plan. But then you are paying in time and not in dollars.

Also, I have heard that Group Health plans are cheaper now and that the quality of care has risen. We have avoided them for a long time but I am hearing more and more good things recently. Also, we chose their birth center for F's birth based on it's excellent reputation for being mom and baby friendly (even though we are not members).

[kijip]

As I recall, independent health care plans in WA dramatically dropped when WA started adding on things they must cover in the plan, and things they could not refuse to cover a person because of.


That happened a number of years ago. Private plans are back now, we have a different insurance commissioner now. But the plans are really not that great. But it's more than was available before- literally there were NO individual policies available for several years.