the Price of Health Insurance from a PPO

When looking for health insurance for myself and my 2 children, I decided on a PPO plan with a $2 million lifetime maximum and a $2,500 deductible. However, we can each have 3 doctor visits per year with a copay of $30, before meeting the deductible. For other services, after the deductible, the insurance covers 70% and we pay 30% up to $5,000 per year out of pocket per family. We have prescription coverage, but there is a separate deductible and they will only cover generic drugs. Our monthly premium is $254 which breaks down as follows:

Adult Female age 53: $108

Female Child age 13: 51

Male Child age 19: 38

Dental Rider: 57

Both children were rated up a bit. In the past, the premiums for both children were the same. But my daughter was recently diagnosed with hypothyroidism so she is at Premium Level 3 and my son had a minor muscle sprain in his back last summer that pushed him into Premium Level 2. I am still at Level 1 (preferred).

This coverage also includes dental insurance, which covers cleanings and check-ups twice a year and pays 50% for most other services, after a $50 per person deductible.

We did not opt for maternity coverage.

Both children were rated up a bit, my daughter due to a recent diagnosis of hypothryoi

I spent quite a bit of time searching for health insurance online. There are many different plans and prices, and it can be quite confusing. I settled on a different policy with the company that we have been insured with for the past few years. Finding basic policy information and prices online was not hard, but getting answers to questions proved difficult. Emailed questions never received a response, and when I called the insurer, I was kept on hold for a very long time. I called at least five times with questions, and several times different reps gave me answers to questions that differed from what I had been told previously.

I finally settled on this plan as being the most affordable, even though it is not the best plan in the world. I would prefer not to have to worry about whether or not a doctor or other provider participates in the plan, but point of service plans have become to expensive for our budget.

That being said, we have always been fairly happy with the processing of claims. They are processed quickly. Also, being a very large company, they have agreements with their providers that result in fairly large discounts. Therefore, even though we have a high deductible, we pay less for most services than we would pay if we had no insurance. (It also takes longer to reach the deductible.)

Searching for health insurance is confusing and time consuming. There are so many plans, deductibles, copays, etc. But each year as you age, your premiums rise, so even if you have a plan today that you can afford and meets your needs, you will probably have to look for a new plan every few years. You will have to decide between PPO, HMO, POS, etc. and choose a deductible, copay and other options. It is a time-consuming process, but you must select the services that best meet your needs.

The best thing to do, I have found, is to get quotes on the Internet. Many sites allow you to input the information about each person who needs coverage, and they then show you the various companies, plans and prices. However, the prices shown are almost always the preferred rates. If anyone has any kind of medical problem, the rates will be higher than what is quoted. In most cases, you cannot know what those rates will be until your application goes through underwriting and a decision is mailed to you.

Remember to be as honest and inclusive as possible when you complete the application. If you leave out any information about a person's medical history, no matter how minor it may seem, even if you leave something out unintentionally, the company may come back in the future and deny your claims retroactively! They usually make your application part of the contract, so you are verifying that he information on the application is true and complete. Should the insurance company discover otherwise, you may have a problem later on.