What's the Best Catastrophic?

[HomeService]

somarco, in Texas, we have trouble finding a traditional major med any more, by any company. Most are now cat hospital with some networks for ppo doctors and many exclusions. With outpatient and testing and labs and so on, covered. While they qualify as major med, and they are quite comprehensive, and expensive, they are not like the traditional major med of the 1980's, nor should they be, I guess, because of progression. To get a plan like this, one may look to Humana or maybe Aetna or somebody, maybe Assurant, but that's a about it.

 

[somarco]

in Texas, we have trouble finding a traditional major med any more, by any company.

I have no idea what the TX market offers, but I find it hard to believe that Sti, Josh, Charlie, ExPat and others are selling something other than major med.

When you buy a hospital only plan (such as the Saver plan above) you create a great deal of liability on outpatient care.

Rx discounts aren't worth much when your med runs $3k a month (and some can easily run $8k for one med).

Repeat doc visits for radiation can add up too at $200 a pop.

Adding in PPO discounts through a separate card and throwing in plans that pay for cancer, heart attack, dog bites, etc is just plain foolish. By the time you add in these other so-called coverages you are paying as much as you would for a real major med plan and you don't have 13 different claim forms.

 

[InsuranceGuru]

Adding in PPO discounts through a separate card and throwing in plans that pay for cancer, heart attack, dog bites, etc is just plain foolish. By the time you add in these other so-called coverages you are paying as much as you would for a real major med plan and you don't have 13 different claim forms.

Isn't the claim form issue a pretty moot point today? I mean, really, with all of the automatic claims-filing out there today, what is the problem? The customer hardly has to file a paper claim anymore as it is, and insurance benefit coordination is not unheard of.

I see the point, but I'm having trouble understanding how layering coverages leaves gaps. What one plan doesn't do another plan should do. Am I just completely off-base here in expecting an Accident plan and a Major Med/Cat plan to cover a broken leg with proper benefit coordination on the part of the insurer(s)? What about cancer? A single health plan is going to cover all of the expenses for that?

The more research into this I attempt, the more I find that no "golden egg" policy is going to cover everything. Why waste that much money on a single plan that won't cover everything when you can spend less than that amount on multiple plans? I may seem green to you, but I don't think it's impractical to be thinking about this as a possible alternative. Maybe your experience is different, and maybe your state holds higher standards for insurance companies to offer coverage. I wouldn't presume to know.

It just makes sense to me that "layering" (as you call it) is a sound alternative that falls in line with the very principles of insurance anyway - that being the sharing of risk between an individual and a company (or companies). What are the chances that an insurance company will pay everything through one policy compared to the chances that multiple insurance companies will cover a wider spread of risk in targeted areas of health exposure. I'm just saying that in principle, it sounds pretty sound. Have you even tried layering coverage, or do you just avoid it entirely? And if you avoid it, does any of that have to do with how much you collect in commission?

I just want to understand is all, I'm not trying to pick a fight with anyone.

 

[moonlightandmargaritas]

I see the point, but I'm having trouble understanding how layering coverages leaves gaps. What one plan doesn't do another plan should do. Am I just completely off-base here in expecting an Accident plan and a Major Med/Cat plan to cover a broken leg with proper benefit coordination on the part of the insurer(s)? What about cancer? A single health plan is going to cover all of the expenses for that?

The more research into this I attempt, the more I find that no "golden egg" policy is going to cover everything. Why waste that much money on a single plan that won't cover everything when you can spend less than that amount on multiple plans?

IMHO, the concept of "layering" is a waste of time, effort and money.

If you have a comprehensive major medical plan (GR's HSA100 would be an example), you have everything covered that is medically necessary.

The only one that makes any sense is an "accident plan" (or rider) - but only if there's a larger deductible, and children in the family involved in athletics, etc.) that are likely to make those sorts of claims happen.

 

[somarco]

Isn't the claim form issue a pretty moot point today?

Not with indemnity plans like an accident plan, cancer plan, heart attack plan, snake bite plan . . .

Each one is a separate claim filed (usually by the policyholder) with each carrier. You are not going to find many docs willing to file the claim with multiple carriers.

expecting an Accident plan and a Major Med/Cat plan to cover a broken leg with proper benefit coordination

Most (but not all) of the time the major med does not coordinate with an accident plan.

the more I find that no "golden egg" policy is going to cover everything. Why waste that much money on a single plan that won't cover everything when you can spend less than that amount on multiple plans?

Then sell your layered risk plan and pray that I don't come behind you. Because I will rip it apart . . .

Maybe your experience is different, and maybe your state holds higher standards for insurance companies to offer coverage. I wouldn't presume to know.

I can assure you, my experience is much different. It has been almost a dozen years since I wrote business in TN and even longer since I lived there. I do know the Time, GR & Humana plans offered there are similar to the ones in GA. Can't speak for the Blues.

Aetna probably has more similarities than differences.

What are the chances that an insurance company will pay everything through one policy compared to the chances that multiple insurance companies will cover a wider spread of risk in targeted areas of health exposure.

As Paul said, a plan like the GR HSA 100 will cover more on a large claim than your patchwork policy approach.

Layering works in the WSM business but is totally impractical in individual sales. When you have an unsophisticated buyer and an employer unwilling to belly up to the bar and provide a real plan, you can cobble a piecemeal plan for the R&F employees that will give them some coverage as opposed to no coverage.

That's fine until one of them drives their pickup into a ditch after hitting the bar on payday and then they find out the plans you sold them didn't pay squat.

It has nothing to do with commissions and everything to do with what is right for the client.

Of course some agents are just policy peddlers looking to maximize commissions rather than giving the client what they need.

 

[ABC]

Interesting debate

What I sell as a Cat plan would be a $10,000 deductible HSA plan with a $5 mill max.

I do not sell limited health plans because the purpose of a CAT. plan is to cover you for that $100,000 claim.

I do sell an economy product that does not cover drugs that is very cheap but I would not consider it a CAT plan.


I just had a client in the ICU for 5 weeks. The bill before the discount is $450,000+. I know a lot of agents on here sell limited health plans but I think its a very bad sale.

 

[Crabcake Johnny]

I'd love for someone who designs this crap to get get into auto insurance:

Auto Policy....but then of course you need

engine protection
air conditioning protection (very expensive if that goes)
muffler protection
fan belt protection
body damage protection

Just think of all the things that can go wrong with your car where, God forbid, you'd have to pay for it.

 

[InsuranceGuru]

I'd love for someone who designs this crap to get get into auto insurance:

Auto Policy....but then of course you need

engine protection
air conditioning protection (very expensive if that goes)
muffler protection
fan belt protection
body damage protection

Just think of all the things that can go wrong with your car where, God forbid, you'd have to pay for it.

Body damage is covered under collision if you wreck your car. But that's really an apples to oranges kind of argument.

 

[Crabcake Johnny]

Exactly!!! body damage is already covered. But what we need is a "body policy" so you don't have to pay your deductible and maybe $5,000 extra in cash!

 

[InsuranceGuru]

Exactly!!! body damage is already covered. But what we need is a "body policy" so you don't have to pay your deductible and maybe $5,000 extra in cash!

Okay, I'm obviously being criticized here, so let me first point out that Health and Auto have a very different dynamic at work. Auto insurance covers depreciating property, and you can pay extra to have the coverage that would replace your auto with a similar model that would have been purchased today. Either way, you're working with fixed variables for the most part. The auto isn't going to require more than a given amount to replace at value.

Health insurance covers a variable amount of cost for obvious reasons. A transplant probably won't cost what it costs today five years from now. That's a different dynamic on its own (lest we forget networks, deductibles, and so on). So, comparing one type of coverage with one distinct variable with another type of coverage with a COMPLETELY DIFFERENT kind of variable gets us nowhere. Like I said, apples and oranges.

Now, my case in point. My mother has a combined insurance package of "catastrophic coverage" (that's what they're calling it anyway) with a $5,000 deductible, an accident policy, and a UA Surgical and Medical Expense plan complete with UAPartners. She fell and broke her ankle. An ambulance came to pick her up and took her to the hospital. After everything was totaled up, she had a bill somewhere in the neighborhood of $14,000 to $17,000. The accident policy and the UA plan both contributed their amounts, which paid toward the deductible. The catastrophic picked up what was left over. She paid $100 out of the hospital and another $500 toward the UA deductible. Total out of pocket? $600. True story. Really happened. I make none of this up.

So, I have to wonder, she didn't have to file more than one claim (one was automatically filed in the hospital presumably for the accident and cat plan... as far as I know she just had to file a claim for the UA plan if that wasn't taken care of for her - should have been). And all three plans were with different companies through one agency. I continue to get information here that conflicts with what I've seen in action. My mother pays about $250 a month, is on high blood pressure and cholesterol medications, and she's 62. Imagine what someone in their 30's would pay with the same coverage. No one is telling me where these gaps are... just that "there are gaps when you layer coverage."

I'm hoping someone will be kind enough to clarify in more detail where this creates gaps when you bundle coverage.