Ranking insurance providers

[gwendally]

Phoebe, I just checked this link.  The two health insurance companies I have as choices are both ranked with a score of 90 and highest customer satisfaction across the board.

http://www.consumerreports.org/health/insurance/NCQA-rankings.htm?state=MA&planCategory=privateHMOBut when I went and looked at what you have available in Oklahoma, drastic

Comments

[bart_calendar]

Gwenn can you answer a question that pretty much every expat out here has but we have yet to be able to find a reasonable answer to?

We know we have to fill out our forms to get the Expat Tax write off and know how to do that. What we can't figure out is if we have to get health insurance or else be fined by the IRS.

Does us not living in America exempt us from that? If not, could we buy health insurance here (where it costs about $30 a month) and have that fulfill the requirement? Does being part of a general socialized medical system exempt us?

There's nothing online at all anywhere to answer these questions - and we are all used to just filling out a fairly simple form saying we have not made more than 90k this year.

[gwendally]

Join the crowd. The ACA is simply filled with policies that are, in practice, difficult to impossible to administer and have unintended consequences out the wazoo

[aelf]

Could it also have something to do with the amount of money MA folks have available vs OK folks?

11 nations

[gwendally]

I think so, but it's also a cultural thing. People in northern climates are culturally really aware of the need to save: "winter is coming" is ingrained in us. Yankee thrift, yankee frugality, the ability to come together to plan for really foreseeable calamaties. It's just part of how we process the world.

The culture in places without winter is really different.

If you haven't seen this thing about the "11 nations" inside North America, it's a useful concept:

http://www.washingtonpost.com/blogs/govbeat/wp/2013/11/08/which-of-the-11-american-nations-do-you-live-in/

[daphnep]

That's exactly the article I thought of, reading your original comment re: OK! Glad you linked it. It's also economic, though...I think, if OK is at all comparable to AZ. It's your hypothetical test family, needing to decide in this case between insurance and gas for the car to get to work.

[mybonnykate]

http://www.gallup.com/poll/156851/uninsured-rate-stable-across-states-far-2012.aspx#2... )

[allyphoe]

Chicken and egg, though. Why buy health insurance from a company that's going to cheat you at every opportunity? Also, I suspect net worth and availability of bankruptcy play a role. I cared a lot more about health insurance (and lots of liability coverage for auto) when I had assets.

[allyphoe]

Having now looked at the link - that's a weird selection of plans. No one I know here has HMO coverage (because HMO is code for "we don't cover that"), and none of the major PPO plans are represented on the PPO list. They aren't "plan not reporting." They just aren't there at all.

[allyphoe]

Right - what disincentivizes free riders? It ain't paying for insurance that's going to decline to pay for anything at all on the grounds that you forgot to report your visit to the doc for a headache 20 years ago, and that headache was a migraine that unmasked your risk for cardiac disease so no, your heart attack isn't covered...

[gwendally]

In Massachusetts we have an insurance commission that hears appeals.

Is it a matter of corruption? Your state insurance regulators turn a blind eye because of bribes?

[ford_prefect42]

Premiums in ok are half what they are in mass. How does that happen, when per procedure costs are the same, and the plans are the same? The cheaper option gives worse customer service of course! People that can afford to will oay more for better customer service, but a poor state has more people that can't afford to. And in a given economic climate, outliers get crushed. The company giving mass service at mass prices in ok would get very few subscribers, and those would be *expensive*.

I do take some exception to the use of the term "market forces" here, since every individual aspect of this situation is regulated and diatorted to a shocking degree.

Rent is a market force too.

[jorrocks_j]

Health care must be administered somewhere, and that somewhere has a cost per square foot. Pricing one-bedroom apartments in Bahstahn vs Tulsa should give one an idea of what clinics, hospitals and private practices have to pay, and pass along to their customer as overhead.

This being overhead I'm not sure if it's factored in with the cost-per-procedure. Is it?

Re: Rent is a market force too.

[ford_prefect42]

I'm pretty sure that real estate values are not that significant a factor.

Re: Rent is a market force too.

[gwendally]

Oh, I think it could be, in the sense that the entire cost of living is different. Our real estate taxes here are astonishing, and it's not just the medical center paying them, it's all the staff who works there.

We also have higher employee costs of all sorts, ranging from a higher unemployment tax rate and a higher minimum wage all the way up to the compensation levels our top physicians and executives think are appropriate.

I lived in Tulsa for four years and got excellent health care.

[jorrocks_j]

It covered some fairly serious elective sinus surgery and a bout of mild pneumonia with no problem, as well as my usual checkups