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Why would any young single adult buy into this plan from Aetna?

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canoeist52 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:27 AM
Original message
Why would any young single adult buy into this plan from Aetna?
Edited on Wed Sep-09-09 10:36 AM by canoeist52
http://www.extension.iastate.edu/4h/Americorps/Documents/ENRMemberKitHealthInsurance.pdf

My 20-yo.'s daughter's situation? just got a job last week. The offer "insurance" at $86. per mo.. With a $2000. deductible and a $50,000. cap. At Mass. minimum wage I can't blame her for forgoing this plan. She'd be the first to sign up for the public plan if it's better than this.
Needless to say she'll be watching Obama's speech tonight!

(If any one from Mass.can answer this question for us; Can she sign up for MassHealth if the company insurance offered is crap? Any help would be appreciated.)
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FLDCVADem Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:29 AM
Response to Original message
1. $50,000 cap?
Benefits cap or out of pocket cap?

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canoeist52 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:34 AM
Response to Reply #1
2. I think it is a benefit cap. I'm still trying to read it.
so many different deductibles. I had to dig deep for this info- company didn't offer any info.
http://www.extension.iastate.edu/4h/Americorps/Documents/ENRMemberKitHealthInsurance.pdf
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:36 AM
Response to Reply #2
3. likely a payment cap.
Edited on Wed Sep-09-09 10:40 AM by Statistical
Most plans have a LIFETIME benefit cap but usually in the $1 million to $5 million range.

Most plans also have a high annual payment cap (i.e $50K). Once you pay $50K in one year all other health care is covered at 100%.

So it works something like this.

For first $2000 she is on her own, plan pays 0% (some plans allow certain preventive visits outside deductible).
From $2001 - $50,000 the plan pays part. Usually an 80/20 split but sometimes 90/10 or as bad as 60/40.
From $50,001 onward plan pays 100%.

As for "why she would buy it?" well if she has no real assets there is no reason.

Any large medical expense and bankruptcy is likely the only option. Even with the plan unless she can pay $50K per year for 3,4,5 years it is unlikely the insurance will save her from BK.

Now someone who has a family, home, some money saved even a crappy plan like this may be worth it.

If it were me, healthy & 20, no assets, no faily I would go uninsured. I did for about 8 years. I think I went to a doctor 3 times. That plan would have been a complete waste.
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canoeist52 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:43 AM
Response to Reply #3
5. thanks for your analysis, Statistical. That's what I thought was the case.
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undeterred Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:48 AM
Response to Reply #3
7. Basically, most health insurance is really about
protecting your assets, not your health.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:50 AM
Response to Reply #7
8. +1. Just like any other insurance. Big reason we need "healthcare reform" not "insurance reform".
Healthcare IMHO is a right.

Insurance on a right makes about as much sense as for profit voting, or freedom of speech insurance.
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SheilaT Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:37 AM
Response to Original message
4. Someone would buy it who
didn't actually read the fine print.

In addition, the company can pride itself on offering health care to its employees, and then put the blame squarely on those employees if they don't sign up.

I'm not from Mass, so I have no clue about the MassHealth thing.
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quiller4 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:44 AM
Response to Original message
6. As I understand it, she can't sign up for MassHealth if she has an employer
option. I'd buy the plan your daughter is offered if I were her. It is much better and cheaper than anything I can buy as an individual and better and cheaper than the employer plans my two 20 something nephews buy. I have a $3500 deductible (although preventive testing like mammograms are exempt from the deductible) and a $35,000 annual (not lifetime) cap.
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JSK Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:52 AM
Response to Original message
9. My daughter's boyfriend thought he had good coverage
through the Blue Cross plan for university students. Then he was diagnosed with bone cancer and went through the $100,000 annual cap in the first week.

100 grand sounds like a million to a naive kid signing up for insurance.

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TheKentuckian Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-09-09 10:54 AM
Response to Original message
10. Sticking low income people with high deductables and co-pays is like charging them for nothing
If someone is scrounging to pay $100 a month to just have some kind of peace of mind they sure as hell don't have a couple of G's on hand or even the ability handle high co-pays. I couldn't afford to go to the doctor with a $65 co-pay and then tackle any medication too on my last plan. I was just paying out about 10% of my gross just in case I had a wreck or something.
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