Things ARE getting better!

Very exciting news for all California women and parents of children with autism:
I just received a letter from Cigna, my new health insurer as of 2 weeks ago (notifying me of changes to my policy.  My initial reaction was, "Oh god, here it comes, they're already raising my rates and cutting my benefits."  But NO!  This letter was to inform me that "As a result of recently enacted state laws" my benefits were being "UPGRADED"!  Really??
Yes!  Our policy now has to cover all maternity care --- prenatal through postpartum --- the whole thing.  In fact, the Anthem lady was right.  As of July, all California plans have to cover maternity.  Not that I'm interested in having any more babies (I kind of have my hands full, thank you very much!), but as a woman who has had 3 kids during the past decade, I have learned to appreciate this!  Up until now, there were just a small handful of policies available on the individual market the covered maternity, and they were crazy expensive, and going without maternity coverage was a scary alternative, so I think this is very exciting news.
Also, If you have a child with Autism, therapy is now covered with no limits!  This is also huge news to those who have had to pay and pay for such therapies, because not getting your autistic child therapy that could really child his/her life is just not an option.
So yay California!  See?  The healthcare law was a good thing!

What's in your Wallet?

And more importantly, is it perhaps, getting a little stale?  

Since I refinanced our house last year, I've taken on the project of refinancing our LIFE  (see column on why you should change your health insurance policy).  So this morning I gazed down in disgust upon a credit card doing nothing but taking up space in my wallet, and gave it what my dad calls an "order to show cause". (yeah, he's a lawyer).

It's a Capital One card I got back in June of 2001, when the "No Hassle" card was the cool new thing.  You'd earn points for everything you bought, and then you could redeem those points for travel -- any airlines, any hotels, no restrictions.  This was pretty revolutionary at the time, because the only other credit cards offering mile rewards were airline specific.  Well, fast forward to 2012 and this card is pretty much the crappiest mileage rewards card available, yet it's still in my wallet, unused and unloved. 

Why the fall from grace?  Because everyone's offering much better deals now.  Even CapitalOne!  They have cards that give you twice as many miles for every dollar you spend, lower APR's, and lots more perks.  My card is now advertised as the starter card for those trying to build their credit, which means it's for people with bad credit who can't qualify for a better card.  This card is now kind of an embarrassment.  It reflects badly on my image.  But will Capital One ever call me and say, "Ya know, you're getting a pretty lousy deal on that card you have with us relative to what you could be getting with some other cards we offer"?  No.    That would be like saying, "We'd like to make less money off of you."

Why do I still have it?   Change can be scary.  And it's been a busy decade.  Besides, if you keep opening up new credit card accounts every time you see a good deal offered, your credit score can suffer from the "hard inquiries" involved in applying for a card, and if you close accounts you've had for a long time, that can ding your credit score in the "length of credit account" category.   You need a pretty credit score so you can get the best credit card deals, and the best rates on any other borrowing you do, so you have to be careful with this stuff.

The problem with credit cards is that just like wireless carriers or health insurance companies, they keep changing their offerings, and you really need to periodically check and see if you're still getting the best deal available, lest you become that sucker that's still paying twice as much as everyone else for the same thing (a.k.a their favorite customer).

So I cleared an hour to devote to calling Capital One and giving them a chance to offer me something better before I remove their stinky card from my wallet altogether.  I researched a little before hand, and I decided I wouldn't mind having one of those nice new Venture cards they offer.  You know, the ones with the Alec Baldwin ads?  

(ring)

Me:  "Hey, Capital One, I don't use the credit card in my wallet with your name on it because your reward and fee structure is really pretty pathetic compared to other cards, even the ones you yourselves now offer."

CapitalOne:  "Oh, you mean you'd like one of the good cards we offer instead of the crappy one you have now? Well, we'd be happy to upgrade you."

Me:  "Will you make a hard inquiry with the credit reporting agencies?"

CO:  "Nope. It's an 'upgrade', not a new account."

Me:  "Will this count as closing one account and opening another?

CO:  "Nope.  They account will still date back to 2001, nothing will really change except you'll earn twice as many points and pay a lower APR."

Me:  "Do I get the 10,000 points you give new card holders when they spend a thousand bucks?"

CO:  "yep."

Me:  "Will you wave the first year's fee for me like you do for new card holders?"

CO:  "Yep."

Me:  "Do I get to keep my points?"

CO:  "Yep."  

Me:  "Does this card have one of those 'Concierge services' that will accommodate my strange and specific whims?" (click here to read more about that)

CO:  "Yes, and roadside assistance, and extended warranties, and fraud protections, and rental car insurance….."

Me:  …running out of questions… shocked at how easy that was... kicking myself for not having done it sooner.  Wow.  "Ok, thank you, nice Capital One lady."

(click)

Now I'm not endorsing the Capital One card, or any other product  (although this Venture card looks like a pretty good deal).  The point is that you should probably assume no one's offering you the best deal available until you ASK for it.  My wallet will smell much better now, and so will I, as I will no longer have an embarrassing card that tells the world I have bad credit, but will instead have a card that says I am a savvy and confident woman who knows how to force her credit card company to bow down and serve her!  (ok, it wasn't that dramatic, but I'm feeling rather empowered and triumphant at the moment.)  

Roar.

Revisiting the Evil Empire of my Health Insurance

For some time I've had a sneaking suspicion that I'm not getting such a great deal from my health insurer.  Shocking, I know.  Last year, Anthem raised the deductible on my 2500 plan to $2950 (without changing the plan name, of course), and now they announced yet another rate hike, pushing my family's premiums up to $1,350 a month. Our benefits still seem pretty sorry, if you ask me. Now it's no secret that I am not a fan of the American healthcare system, but this is where I live, so what choices do I have?  I decided to apply my undiagnosed obsessive compulsiveness to exploring my options.

First, I needed to better understand the coverage I HAD.  How many of us actually know what coverage we have before we find ourselves with something that's not covered?  We know what we pay, and maybe we know our deductible and co-pay, but that's it.  It turns out that I had some big misperceptions.  To start with, it turns out my plan only paid a percentage of the price for things that are now free!   Hmmmm….

• Myth #1:  Keep your old plan because it's better than the new ones.  After the healthcare law was passed, Anthem kept encouraging me to switch to a new plan, and being a cynic, I took that to mean I should keep my old plan because it contained benefits no longer offered.  Wrong!  Thanks to the new healthcare law, new plans must cover all preventive care at 100%.  That means you can march your children into the fanciest office in Beverly Hills for their annual check-ups and immunizations, and you can get your annual gynecological exams, mammograms, colonoscopies, etc. done by the doctor who takes care of all the movie stars, and if she's in your network, it's all covered at 100%. No Co-pay, no nothing.  For many of us, that's pretty much the extent of our healthcare usage in a year. Kids can't be denied for preexisting conditions (even though they can be rated up).  Adults, of course, can still be denied coverage for preexisting conditions until 2014.  Lovely.
• Myth #2:  Small group plans will give you cheaper rates, so you should form a business and incorporate it, hiring your spouse as your only employee, and then you can get group coverage and save money.  Wrong!  Group rates are more expensive because they have to cover everyone, regardless of preexisting conditions, and if your group is very small, the risk isn't spread widely, so everyone pays more for the same coverage you might get more cheaply in an individual plan.
• Myth #3:  Kaiser is a cheap alternative. Nope!  It was the most expensive of the options I checked.  Why?? According to the broker, it's because their plans cover maternity.  This was one of the reasons I still kept that Anthem plan -- maternity --- and after kid #3 I planned to drop that coverage and get a cheaper plan, but at that point the Affordable Care Act passed, and I couldn't get a cheaper plan even without maternity!  The Anthem rep I spoke with said that as of July, all California plans will have to cover maternity, but no one is saying that publicly yet.  So if you plan to have a baby, you only have to keep an aspirin between your knees (as Foster Friess so elegantly put it) until July.

Since we would be paying over $16k a year in premiums with Anthem, and I don't think we spend anywhere near that much on healthcare services in a year, what if we just "self insure"?  What if we just don't buy health insurance?  Is that such a bad idea?  Why yes, it is a bad idea!  Doctors and hospitals have one rate they charge you when you're uninsured and another rate if you are.  Assuming you have a PPO, a doctor in your insurer's network of preferred providers, might charge $200 for a visit, but you'll end up paying half that much, because the insurer has negotiated a reduced reimbursement rate ("negotiated rate") with the provider.  And like I said above, if it's something preventative, it's free.  Same for hospitals, medications, etc.  Also, what if something really bad happens, like a car accident or cancer? That's when you can really get your money's worth!  You'd spend a lot more than $16k the minute someone needs surgery.  Besides, after 2014 the option of not having health insurance won't be legal.  Or else we think it probably won't, but we're not totally sure.  There's a lot of uncertainty around the health insurance world right now.  In the two years since the Patient Protection and Affordable Care Act (A.K.A. Obamacre) was signed into law, some of it's provisions have already been enacted, while others won't take effect until 2014, unless the courts tear it down, or we will end up with a modified version of it, so any kind of health coverage you get, think of it as a temporary solution while all this is being sorted out.

Ok, so you need some kind of health insurance, but with so many moving parts, comparing plans is simply dizzying.  Deductibles, premiums, co-insurance, prescription drugs…. it's clearly a conspiracy to prevent us from ever trying to change plans.  And what if you make a mistake, and choose a plan that gives you inadequate coverage when you need it?  The fear of making a catastrophically bad choice is kind of paralyzing.   You've learned from car insurance that higher deductibles mean lower premiums, and we want cheap premiums.  But is there any way to prevent those premiums from rising? In California, rates are up 150% in ten years, but that's nothing --- Wellpoint (the parent company of Anthem California) has raised premiums in Maine over 400% since 1999! It turns out that in California, no one has the power to limit premiums, and the insurers can charge whatever they want, raising prices whenever they like.  In 30 other states, that's not the case.  Click here  to read more about this and sign the petition to get this changed!  Let's be clear, the U.S. healthcare system is expensive, inefficient and unfair, and healthcare should not be a "for-profit" business.  I personally favor a hybrid single payer solution, and I believe that is ultimately where we will end up, one way or another.   One proposal is to open medicare to all (HR 676 Conyers medicareforall.org/pages/HR676), and there is also a movement to create a single payer system in California (californiaonecare.org).  

And by the way, Myth #4 is that health insurance companies oppose Obamacare.  They're actually pretty psyched about having all those young, healthy people who never need medical care having to pay them premiums!   

ok, so back to ME and MY problem (because I know you can't stand this suspense another minute).  I figured out that I could probably live with higher deductibles in exchange for lower premiums, as long as I had the benefit of negotiated rates, a low-ish co-pay, a big network of participating doctors and hospitals, and free preventative care.  At most I'll pay a little more for occasionally going to see a doctor outside of my network.  I finally settled on a Cigna plan for my family with a $5000 deductible (for each of us), after which all services were covered at 100%, and the premiums were quoted at $925. They even guaranteed my rates won't go up for one year.  Of course, they rated up my two and six year old kids for the "recency" of ear infections they both had a month ago, so we ended up paying $1,003 (Grrrr).  Anyway, I think this is slightly better than what we had, and I decided to go for it. 

And what if we need some really expensive procedure done?  Maybe a trip to India or Costa Rica will be in order!  Medical tourism is booming.  You will often save 50 to 80 percent, and that's even including travel expenses.  The major insurers are even testing programs to cover overseas healthcare services because it's cheaper for them too.  And what if there are complications?  You buy a medical tourism insurance policy (not covered in my last column on unusual insurance policies) of course!  

So goodbye Anthem, I'll think of you while I'm not spending that $4,200 a year on your premiums.  I'm hoping it was the right thing to do.  Pray for me.  At least this should hold us until we get a single payer plan (or we discover the Mayans were right, and the world comes to an end in December).
Now, can anyone tell me why teeth and eyes are not covered on a medical insurance policy?