Agency Health Insurance?

NedRN · Dec 30, 2015

As a general rule, agency health insurance is crappy. The plans were obtained before the ACA went into effect for lowest possible cost. "Reasonable rate" is a big red flag, real insurance costs real money. Examine closely.

romey · Dec 30, 2015

Thanks NedRN! I have been on staff since before the ACA, just did a quick search and got a little sticker shock! I notice that the exchange website is quoting rates specific to a geographical area. How does this work for the traveler who may require health care services away from home? I realize that you're not an insurance agent, just wondering if you would care to share your view as a consumer? (always a more valuable insight in my opinion!)

NedRN · Dec 30, 2015

Exchange rates are geographically based as costs do vary from place to place. Factors are usually competitive, and often there are effective healthcare delivery monopolies in given areas. Sometimes those monopolies are beneficial, like Kaiser in California, but more often they are not. Insurance companies can also be competitive, or not. Have negotiated good contract rates, or not. There are a ton of variables, but none of this really addresses your question, which is portability of insurance with good in-network availability and good contracted prices.

That is something you have to examine in addition to cost with every policy. Even very large insurance companies will have local plans and much wider plans. Restricting the area of service allows them to better predict the cost of your (actually the group) healthcare over time with the local variables known. Given that most agencies are looking for lowest cost policies, they are less likely to have a nationwide PPO (which is what you really want).

I have an Anthem (BCBS) private plan from several years before ACA with available docs and services everywhere. It has been sort of grandfathered in from year to year with no promises I can keep it but has some features the ACA backed into all policies such as no lifetime limit and a couple of annual freebies. For whatever reason, the cost per month has almost doubled since I first purchased it, yet it is still cheaper than the federal exchange plans in my state. It has a huge deductible so I'm paying for all services I receive, but at contracted prices. For example, a month ago I broke my collarbone and had surgery. Billed costs were on the order of close to $30,000, but the price I paid under $3,000 for xrays, anesthesia, facility, and surgeon fees. That is the difference between negotiated contracted prices and the ridiculous no-insurance prices that some people end up paying or going bankrupt. To me, insurance is worth it just to get the good prices, and for catastrophe care (like getting Hep C and needing a liver transplant). Of course, it is now required to have insurance by the ACA and enforced by the IRS.

So you can shop policies, both from travel companies and the exchange, and see if you can find a decent PPO with wide coverage. Local coverage in-network only is perhaps not the worst thing you could have as generally for anything major, you will be returning home anyway. Just requires a bit more planning about where and when you access healthcare. Even if it is not a PPO, if you establish a good relationship with your primary care docs office, especially if they are responsive to email, you can get your needs quickly met despite not being a PPO.

If you have employee health insurance now from a hospital employer, you can consider COBRA to hang on to it for up to 18 months after you leave the job. The sticker shock you will have to pay of the full cost of good group health is high, but to some degree, you get what you pay for. If you find an agency with a good policy, likewise you can consider using COBRA to keep your agency options open and flexible, and make sure that every year that you take an assignment with that agency again for another 18 months of insurance.