Lifetime maximum is it enough?

Question

Hi I'm looking for health insurance, I'm a 27 year old female, someday wanting to have children (maybe in 3-4 years) and apart for the HMO and PPO, the main difference between Kaiser and Blue Cross is maternity (covered by Kaiser and not Blue Cross) and the lifetime maximum which is a huge difference 5-7 million for Blue Cross and unlimited for Kaiser this is my main concern not so much the maternity stuff right now. Is 5-7 million enough to cover something like cancer, or a really bad car accident, or something very serious that could happen?

please help

dont know really which is better Kaiser or Blue Cross, somethings I really prefer Kaiser (maternity, unlimited maximum) but its an HMO, on the other hand Blue Cross is PPO (i really only want health insurance for serious health problems, i never get sick) has a wider coverage but doesnt cover maternity and the max is 5-7 million. Both cost around the same 80-100 dlls monthly, please help!!!!!

Answer 1

okay.. this is important to understand, but .. could be confusing..

people think that just because you have, say, a heart transplant.. and the bill is 100k, that the entire 100k counts towards your 5 million. that isnt the case. only the "contracted" amount will. now.. depending on the doctors/hospitals contract, they may only get paid 10k for that 100k procedure because that is what was prenegotiated with the insurance company. this is why you hear so much complaining from health care professionals, because they are mad that the reimbursement rates are low and the cost of health care is rising. i have worked in insurance claims for several years, and my company offers a max of 6 million per person. i have NEVER see anyone get remotely close to that, taking into consieration what i have previously said.

one major difference between an hmo and ppo generally is that with a ppo you have a larger selection to go where you want, however, you will incur higher out of pocket costs. with an hmo, you are more restricted on where you can go, but generally you pay just a flat copay for things and go about your business. keep in mind, that if you end up choosing a non-maternity health plan and get pregnant while on it, the health plan is not required to allow you to transfer without underwriting (generally, here in CA).

Answer 2

I will tell you that if you get a disease like Crohn's (autoimmune digestive problem) then it is expected that you will spend 2 million over your lifetime for medical care.

Something like a car accident or Cancer can really eat up money depending on how bad it is and what kind of treatment you get.

Also keep in mind that you want to be able to go to the Doctor for things like yearly physicials and such...so take into account yearly tests you should be having.

Answer 3

First the Blue Cross price must not have maternity included. With Blue Cross the Maternity is an extra rider and usually cost between $70 and $100 or more a month. Blue Cross also has a waiting period form 30 days (FL) to 6 months (VA) before conception can occur. In VA Kaiser will cover maternity as long as conception occurs after the policy effective date.

The lifetime max of 5 million will be enough for 99% of the population. For example a heart translplant could run 1.2 million.

Another benefit limitation you should consider is prescription drug coverage, In VA Anthem limits it to $3,000 per year. Cancer can wipe this out real quick leaving you with some very high medical cost.

Assurant has a 25 million lifetime max and no limit on prescription drugs. (may not be available in all states yet)

I keep mentioning the state becasue the plans vary depending on your state. I would seek out a broker in your area who can answer these questions and help you compare different companies.