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Cost of Care: For couple, insurance policies only go so far to cover expenses
02:04 PM CDT on Saturday, September 19, 2009
Gwen and Alan Lummus of Dallas may feel they have health insurance in name only. "We have insurance protection against a catastrophic illness or injury, but that's pretty much it," Alan said.
The Lummuses, who are self-employed entrepreneurs in their early 60s, have $7,500 annual deductibles on the individual health insurance policies they bought through the Texas Health Insurance Pool, a program for people who have struck out on finding private insurance.
"We never reach our deductible each year, so we end up paying out of pocket for almost all of our care," Alan said. "A few doctor visits are covered each year, but we even have to pay for the tests and other lab services connected with those appointments."
When the couple first purchased the policies through the state pool in 2003, their annual deductible was just $1,000. But they've been forced to raise it over the years to hold down their monthly premiums. Even so, Gwen pays $694 a month, while Alan pays $736. The Lummuses figure their premiums would have more than doubled if they had kept their deductible at $1,000.
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Alan said the high premiums have prevented him and his wife from expanding their business, which sells book holders and related accessories. "We could probably hire an employee if it weren't for our medical costs," he said.
The two turned to the state's high-risk insurance pool, because both had been denied coverage when they applied for insurance on their own. Alan has diabetes and a history of heart problems, while Gwen has a heart murmur. "No company would insure us, so our only option was the high-risk pool, where the premiums are twice what we'd otherwise pay for individual coverage," Gwen said. "We can't wait until the day we're 65 and qualify for Medicare."
Because they already pay for most of their health care bills, the Lummuses sometimes wonder whether they'd be better off simply dropping their coverage and avoiding the more than $1,400 in premiums each month. "But we never follow through, because then we'd be just one major illness away from bankruptcy," Gwen said.
