What's the Best Catastrophic?

[InsuranceGuru]

So, people probably define "catastrophic" in different ways. I'm interested in the type of "catastrophic" plan that offers a $1M, $3M, or $7M life-time limit to cover severe hospitalization but doesn't really make you pay for all the extraneous doctor/pharmacy co-pays and the like.

I'd like a bit more information on Catastrophic plans as well (what they generally should cover and what they usually won't cover other than Dr. and Pharma). They're like M.M. in respect to the fact that these plans do cover the big threats, correct?

Also, what kind of price range are you seeing with these plans? Are they low enough in price to remain affordable or leave room for supplemental insurance? Any loopholes or catch-22's that customers should know about? Any suggestions on Carriers for the Catastrophic plans? Thanks!

 

[somarco]

$1M, $3M, or $7M life-time limit to cover severe hospitalization

$1M is inadequate. $3M is OK for most situations.

If you are suggesting hospital only coverage you are missing the boat. Those policies will cover, at best, half a large claim.

Most carriers offer cat plans, especially those who have HSA qualified plans.

Time & World have plans with a $25k deductible. I have a few folks who want such plans and don't care about the fact they are not HSA qualified.

SIR's over $10k are not good values. You save a little on premium but not enough (in my opinion) to offset the additional risk.

A good cat plan should be all inclusive. Doc, Rx, hospital, etc.

If you are going to add supplemental coverage you and/or your client don't understand the need.

 

[InsuranceGuru]

$1M is inadequate. $3M is OK for most situations.

If you are suggesting hospital only coverage you are missing the boat. Those policies will cover, at best, half a large claim.

Most carriers offer cat plans, especially those who have HSA qualified plans.

Time & World have plans with a $25k deductible. I have a few folks who want such plans and don't care about the fact they are not HSA qualified.

SIR's over $10k are not good values. You save a little on premium but not enough (in my opinion) to offset the additional risk.

A good cat plan should be all inclusive. Doc, Rx, hospital, etc.

If you are going to add supplemental coverage you and/or your client don't understand the need.

I guess I don't understand why a Catastrophic Hospital-only plan would leave someone with half the hospital bill or more... or are you talking about a Scheduled Expense plan like those that UA offers? If you have a Cat plan with a $3M limit, no doctor visits or pharma, and a deductible somewhere between $2,000 and $5,000, how does the plan leave someone with that kind of share of the risk? The company isn't paying the more extraneous, day-to-day costs of smaller claims so sure, you'll need some kind of accident plan and under-age gap plan in place to take care of it.

In my case, I'm not interested in having Dr. visits covered. I really never go to the doctor unless I'm on my death bed anyway, and I'm young, so until I'm in my 30's, I don't think I need a prostate exam. And at least in my area, most physicians cut you a break if your insurance doesn't cover doctor visits. I can just tell them I'm not insured for Doctor visits and I usually get their discount rate anyway. I would think I'd need a combination of plans suited for covering the extreme hospitalization costs if I'm in an accident, get deathly ill, or contract cancer/have a heart attack.

I had in mind the Golden Rule Saver80 or the HSA equivalent. I'm more interested in combining a catastrophic with a Gap plan that pays toward the deductible. Colonial and UA offer one, only UA's plan isn't available in my state yet. Colonial's has a maximum benefit of $3,000 available. Also have a UA Cash Cancer plan (which I think is a steal - I'll never end up paying the full benefit amount in premiums if it remains at this rate) and thought I'd package all of it together as one possible option for people looking to save money while having enough coverage to protect them from catastrophic financial loss. I'm also looking into Disability Income and Long Term Care plans, but I'm primarily asking about Catastrophic plans at the moment.

And maybe people here who have been doing health insurance longer than I have may not agree with me here... but I see no benefit for anyone staying on one single insurance plan that is supposed to pay for "almost everything" health-related. If I've got a Catastrophic plan with a Gap benefit, a small AD&D, some kind of dread disease coverage (C.I., Cancer, w/e), Disability Income, LTC, and Life Insurance with an Accelerated Benefits Rider, there's not much I can think of in the way of financial loss that isn't covered - and for about the same as a good Major Medical that almost covers what this package covers.

Maybe people can save more money by playing hopscotch with their M.M. carriers or raising their deductibles, but I just see that as increasing your risk if you become ill and suddenly don't qualify for a M.M. because of a pre-existing condition. Then you're stuck with what you bought last, which was probably the plan offered by the lowest bidder... and we all know how that goes.

With the package I'm thinking about, the premium is a little more stable as well. Because only two of these plan types are actually step-rated (or based on attained age - whatever people call it), the total premium for the package doesn't increase as much as one major med policy would. I think it just makes more sense to combine plans in a "portfolio." This way, even if you get a job with benefits paid by your employer down the road, you can simply drop the Cat plan (about 50% of the premium anyway) and keep the rest.

The rest of the plans presumably remain stable as they're issue age (though I know they can change if the insurance company has to change rates across the board). For a young guy like me, it makes more sense for me to pick and choose my benefits and get them early to offset what this kind of coverage (if it's even available in one large plan down the road) would cost me ten or twenty years from now.

Sorry for the long-winded response. I was just asking about the Catastrophic portion of this.

 

[HomeService]

The problem here is that catastrophic has changed in meaning over the years. When I was a newby in the mid-1980's, it meant something totally different than it does now. In the 1980's you could get a Major Med and it was all inclusive and it was considered catastrophic and good for the small stuff- as well. Because it had like a $250-500 deductible, then a co-pay, then 100% up to a million. Doctors, outpatient, inpatient, tests, all covered.

Now, cat plans may exclude doctors coverage and outpatient because they may begin with a 25K deductible.

The major med has largely been replaced by a hospital plan that has a ppo network for doctors included, but with much verbage as far as exclusions. Therefore, you buy a cat, you get all those exclusions, plus a big deductible. Physicians Mutual has a fairly nice cat plan in most states, but it is expensive. World has a better premium.

 

[GreenSky]

Chemotherapy is catastrophic but is not done in a hospital inpatient setting. Same with dialysis.

A hospital only plan is a waste of money.

Several years ago (okay, 30) my wife could access student health while at UCLA. It had a maximum benefit of $50,000 including major medical. I then purchased a catastrophic plan with a $25,000 deductible paying 80%. I think it cost something like $125 for year and they even paid me 40% commission! Back then, you could have a brain replacement for $100,000 so between the two plans, I felt secure.

Rick

 

[somarco]

I don't understand why a Catastrophic Hospital-only plan would leave someone with half the hospital bill or more...

I did not say a hospital only plan would only pay half the hospital bill. Read my response again.

I'm not interested in having Dr. visits covered.

Then you only want half a plan.

I really never go to the doctor unless I'm on my death bed anyway,

You are thinking like a consumer, not like a knowledgeable agent.

I had in mind the Golden Rule Saver80 or the HSA equivalent.

Junk. Might pay half your bill if you are lucky.

combining a catastrophic with a Gap plan that pays toward the deductible.

Waste of money.

You would be better off getting a full benefit HSA or a copay plan with a high deductible.

If I've got a Catastrophic plan with a Gap benefit, a small AD&D, some kind of dread disease coverage (C.I., Cancer, w/e), Disability Income, LTC, and Life Insurance with an Accelerated Benefits Rider, there's not much I can think of in the way of financial loss that isn't covered - and for about the same as a good Major Medical that almost covers what this package covers.

More junk.

You really don't understand major medical, do you?

With the package I'm thinking about, the premium is a little more stable as well. Because only two of these plan types are actually step-rated (or based on attained age - whatever people call it), the total premium for the package doesn't increase as much as one major med policy would.

That is a layered risk approach. It has some application when dealing with uneducated, low paying workers and does have some merit on the premium side. But it also creates a lot of holes and extra admin (filing claims with multiple carriers) that most people won't do. People complain enough about claim adjudication with a major med. Why complicate their life (and yours) by adding on 2, 3, 6 different plans all with their own claim form?

The major med has largely been replaced by a hospital plan that has a ppo network for doctors included, but with much verbage as far as exclusions.

Major med has been replaced by these junk plans only by agents who are chasing a buck, and buyers who are uninformed.

 

[somarco]

Back then, you could have a brain replacement for $100,000 so between the two plans, I felt secure.

So how is that replacement brain working for you?

 

[GreenSky]

So how is that replacement brain working for you?

I actually got a deal. Apparently someone named Abby Normal died and I got that brain.

Rick

 

[somarco]

Apparently someone named Abby Normal died and I got that brain.

Abby Normal huh?

Great knockers.

 

[GreenSky]

Abby Normal huh?

Great knockers.

Vhy Tank You!

2nd greatest comedy movie after Blazing Saddles.

Rick