an insurance question for the Americans

Nope, as long as you don't let coverage lapse another health insurance company can't deny you for a pre-existing condition. If you have gaps between employment, you can use COBRA as an extension to prevent a lapse in coverage, or just get your own policy.

It seems most companies just offer policies from one or two health insurance companies.

One interesting idea here is health insurance exchanges which is a way of creating insurance pools outside of employers and would allow individuals greater selection and keep policies regardless of employer. But they seem to have problems getting established.

Not if you want your employer to pay for it. There's plenty of info about exchanges via Google.

Still confused.

Why did employers start paying for insurance in the first place? Why didn't they just allow you to buy the scheme you wanted with your salary (and mandate that everyone bought insurance)?

Do employers get some sort of bulk discount on insurance costs if they can guarantee that they'll supply the insurance company with x number of clients?

We can buy from any insurance company that sells in our state. Some employers - usually larger companies -- offer health insurance as part of an incentive for you to work for them. You don't have to accept what they offer -- you can buy on your own.

Many employers who offer insurance actually offer to pay only a portion of the cost and you have pay the rest. Large employers often can negotiate "group discounts" from insurance companies because they have large numbers of employees who will buy insurance plans. This measn cheaper prices for you and your employer. So if you like an insurance plan offered through your employer, it is often cheaper to buy that then if you buy directly from an insurance company yourself.

If you cannot afford insurance for whatever reason, there are safety net programs that may be able to help you as long as you qualify (and the qualifications are often bewildering to sort through):
-- government-run Medicaid (poor and without insurance).
-- government-run Medicare for older folks.
-- government-run Social Security if you are disabled.
-- State or local government-run free clinics.
-- Charity clinics and hospitals, and other private groups that help those in trouble.
-- Hospitals can't turn you away in an emergency, but you typically do have to pay the bill over time. The bills can be beyond the abilty of people to pay.
-- I've probably missed a few too.

There are people who slip through the safety net, so to speak. Usually these are younger healthy folks who haven't purchased insurance but when they get sick find out they don't qualify for government or a free program for whatever reason. The debate often centers on these folks and whether anyone is responsible for their health care costs other than themselves. Other debates include the general cost of healthcare and drugs.

I am sure I have not described every scenario. The bottom line is that health care is expensive, and the larger debate centers on whether the government should run helathcare for everyone (we pay through our taxes and have to live with what they offer) or whether we should use the free market and be able to purchase any insurance coverage that we personnally can afford - directly from insurance companies or through our employers (but government controls wlll need to be lifted, such as certain state laws that only allow certain insurance companies to sell plans in their state).

I purchase through my employer and have never had a problem keeping insurance when I have changed employers. I'm satisfied with the responses of my insurance company. They have paid out as they said they would, and I haven't had anything denied or delayed (including remi or humira). I do know of folks who haven't had good experiences, but they change companies until they found a better one.

Hope this helps.

For example say one is a teacher who cannot find a job so you become a substitute teacher (a friend had this happen who has another autoimmume issue) ... even if you are able to work a 40 hour week which is not always availible your monthly take home pay is around 1300 dollars, you have no benefits (unlike normal teachers who have usually pretty good benefits such as great insurance to make up for the poor pay).  You can buy an individual plan on your own, but when it costs more then whole entire salary for that month for insurance there is a problem.

To qualify for a lot of gov't programs it appears one must have a net worth no greater than $2000. For Social Security disability one has to be almost bed-ridden. Other clinics and programs qualify according to income related to the Federal Poverty Level.

My insurance is provided as a benefit from my employer. I do have to pay about $37 each payday for my portion of the insurance and that amount is deducted from my payroll on a tax free basis. I hope that helps.

I've been forced to change my GI doctor several times as I changed jobs and was compelled to accept new insurance. Also had to change my GP, my Dentist and pediatrician when the kids were small. The reason you want healthcare insurance from your employer is for the group rate. This is especially important when you have a chronic condition like Crohn's. As far as buying your own insurance; not only is there a huge hole were many don't qualify for medicaid, the premiums,for those with insurance, have risen at such a rate that more and more people are falling through that hole all the time. Those that make the sacrifice and buy their own insurance will often find things like deductibles that take away their rent money or lifetime caps that leave them out in the cold when they get sick. They also find that their condition may be excluded.......
Sure you can go to a hospital but, they will send your bill to collections and bankrupt you. Largest cause of bankruptcies in the US is medical bills. They have been known to dump patients, literally put 'em in a taxi and send them away. Not to mention that if you wait until you need an ER instead of taking preventative care in the first place you are not getting the best care for you or your child. You need to have your cholesterol corrected BEFORE the heart attack. You need the anti-biotic BEFORE the pneumonia.
I have insurance and my feelings on this are mostly aimed at my fellow human beings. I do hope to benefit from legislation that will hold costs down however.

Did I say something political?

Yeah I admit I had a hard time walking that line. Guess I was successful though by your response. We all know how hard it is to get a good GI that you feel comfortable with and while the 1st one I lost I don't miss the two I lost after that I was happy with. I think I am happy now though I suspect he wants to refer me to a shrink sometimes. lol

One more thing about employer insurance is that normally the employer pays the larger share of the premiums.

Ivy, the amount we pay through our employer is just the premium. We still pay co-pays and deductibles. So, on top of my premium I can pay anywhere from $10 - $40 for medication a month depending on whether it is a preferred medication in the eyes of the insurance company. I can get 3 months for the cost of 2 months if I go mail order. I pay $15 to see my regular doc and $30 to see a specialist like a GI. If I have a procedure, I have to pay a certaint amount (I think $200) out of pocket and then insurance covers the rest. Some people have co-insurance where they have to pay a percent.

Group insurance is only available at bigger employers. Usually places that only employee 5 or so people don't offer group. If you have a pre-existing condition you can't just go buy insurance outside of a group and in the states where you can it is very expensive ($1500-$2000/month from what I've heard.) In some states, group insurers have to cover everything no matter what. In others, you can not have more than 60 days without insurance before you start your new job. If you do, they can make you wait 6 months for coverage or for coverage of your pre-existing condition.

If you lose your group plan you can "cobra" it. That means you pay the amount that you AND your employer were paying on your behalf in order to keep your coverage. This can run between $500 and $1000/month on average. If you lost your insurance because you lost your job it can be difficult to afford that.

You can't get "old people gov't insurance" until you are 65 so a lot of people in the 50-65 range have trouble convincing an insurance company to insure them if they don't work for a group insurer. If you have a group insurer you can put your spouse and minor children on your plan and in some states a "domestic partner" - a monogomous b/f or g/f (even if it is the same sex) who you live with. You can not put adult children or elderly parents on your plan.

FitzyK23 said...
If you have a pre-existing condition you can't just go buy insurance outside of a group and in the states where you can it is very expensive ($1500-$2000/month from what I've heard.)

In my state, high-risk pool insurance for somebody (non-smoking male) in their 30s ranges from $298/mo to $118/mo, depending on deductible ($1000 to $10K). For people with lower incomes, rates are lower ($213/mo to $85/mo). Another option for people with pre-existing conditions is group of one (or more) health insurance, but its rates are more than double high-risk pools.