Individual PPO policy for 58 year old BC survivor?

DO NOT DROP OUT OF YOUR EMPLOYER GROUP PLAN.    I cannot emphasize this enough.   The main difference between group coverage and individual is that the individual plan will drop you the minute you get sick.  Your group plan won't.   HMO, PPO, whichever.   Just so long as it's part of GROUP COVERAGE.

An individual policy will be much, much more expensive.  There are at least three reasons for that:

1.  As a member of the group, you get the benefit of a group rate (based on the underwriting for the entire group).  A non-profit law firm may be getting its insurance through a collective of similarly placed employers, which would spread the risk (for the insurer) even more, making the rates even lower.  As an individual, they're going to underwrite the risk they have on you, as an individual.  They may not be willing to underwrite an individual policy for you at all.  

2.  Many employers subsidize the underwritten rate for their employees as an employee benefit.  If you're paying anything less than $300 a month or so for an indivdual policy, they're probably subsidizing your insurance.  If you decline the insurance, they are unlikely to pay you the difference between the unsubsidized and the subsidized rate, you will simply be forgoing the difference.  If you have a so-called "cafeteria plan" where you get to choose which benefits you want to use your pre-tax dollars to pay for, you're still not paying "market" price for your coverage.

3.  Employer-sponsored group policies are paid for with employer dollars, instead of your "after-tax" income dollars.  So you will need to gross the price of the individual policy up by your tax rate to make a fair comparison with the unsubsidized group rate.

Finally, you may not be able to get an individually underwritten policy at all (I couldn't) so you would then have to look to either your state's high-risk pool, or (if your state has one) it's mandated cover group.  Qualification for the mandated cover group (at least in my state) usually is based on exhaustion of COBRA benefits, no group coverage & no lapse in coverage.

And by the way, my unsubsidized, employer sponsored policy (for me only) was $280/month.  My policy wasn't subsidized, but our clerical staff's was subsidized, so that they paid something between $25 and $50 for the same policy.  It's the loss of the employer subsidy that makes people think COBRA coverage (which is the same price as the unsubsidized policy + a 1% or 2% administative fee) is expensive.    

My mandated group cover policy (which is only oftered in a high-deductible policy) is $648/month.  That means my costs (for premium & deductible) are $13,000/year for insurance before the insurer pays anything.  

All that is another way of saying, please reconsider keeping your group policy! 

LisaAlissa 

Agree with Fearlessone...stay with your employer group plan. One of the reasons they are more reasonable is more participants in the plan. We have BCBS which is pretty good. Our deductible is high - $5000 but we have already met that..no surprise with the medical bills - and now they are covering everything 100% which is a blessing. I have read posts from some ladies who have been taken to court because they cant pay the medical bills. You can negotiate the balance with a provider. Some ladies have done that and ended up paying half of the total charge. You need to pay on the bill for a few months but after that make them an offer. All they can do is say no. I have never really been sick until now so the medical charges have been a real eye opener. At least with BCBS if you use one of their providers they have a set amount they can charge and in my case it has been as much as 50% less than the original charge. Is it no surprise why a lot of people who need to go to the doctor, dont? Now with the price of food and gas rising almost daily, you arent left with any options...do you eat, drive to your job or go to the doctor? It really galls me when you schedule a surgical procedure and they are all over you the day before telling you what you have to pay to be admitted? One of my friends got such a call and they told her she had to pay $500 and she said sorry dont have it...they said okay $100...go figure...Keep us posted. diane

Sheesh Soccermom, how can they get away with this? They take your money when you are well, then as soon as you get sick and need to claim, they drop you, that is just so evil. Makes my blood boil for you.

I am unemployed and my Cobra ran out.  I tried to get a policy but because of my pre-existing condition, I was denied.  I was able to get on the Federal high-risk plan, called PCIP.  It is kind of a bridge plan until the provision in the new health care law that prevents private insurance companies from rejecting people with pre-existing conditions begins in 2014.  My premium is $624 (Northern California) for PPO.  However, you have to be without insurance for 6 months before you can apply.

Dear Soccermom,

Think about setting aside $$ in a cafeteria plan for at least one visit a year with your treatment team.  (I assume that a nonprofit would be responsible enough to have one for its employees).  Ask for a reduced rate in light of your circumstances.  Ask what tests are needed for their "second opinion" and ask Kaiser to administer them for you.  Don't be shy about saying you are getting a second opinion - a standard thing and here particularly appropriate from the team that got you to where you are now.   In other cases I have seen that an outside opinion and recommendation from cancer specialists will be followed by the HMO.  Ask your existing team to write up what is needed from kaiser to monitor for any recurrence - i.e., cancer markers, MRIs, etc.  Kaiser has an internal ombudsman who can help you get what you need from Kaiser.

Breast Cancer soultions is good option as is the Cancer Legal Resource Center at Loyola Law School:  http://www.lls.edu/academics/candp/clrc.html.

 But my hope is that there will be no recurrence.