I moved to Japan immediately after graduating from college, so for the first ten or so years of my professional life my only exposure to health insurance was socialized Japanese health care.  When I began working on my own in Tokyo, I was initially shocked that I didn’t have a choice of vendors, and that my monthly payment was more like a tax than the purchase of a service.  I avoided paying for awhile.. at least until the government started sending me scary looking warnings in a gigantic red Japanese font (seriously, like a 200 point font).  I relented and paid.  In hindsight I’m glad that I did:  I started actually using the health care system.  It was inexpensive and straightforward.  I took better care of myself.

When my wife and I began the process of moving back to the US, my father nervously admonished me about getting health insurance as soon as possible.  I thought this a bit odd, but didn’t dwell on it.   I figured that the miracle of capitalism would provide us with a smorgasbord of inexpensive, high quality health care options.  Besides, if that didn’t pan out, I was sure that whatever the the national plan was, it would be fine.  I put it off.

On a return trip to the US I stopped by the hometown insurance agency ready to review the rich bounty of health care options due to me as an American.  The hometown agency listened, looked at me like I had two heads, and then gently sent me on my way.  As someone self-employed, they said, my only option in the state of Massachusetts was Blue Cross Blue Shield.  Blue Cross Blue Shield?  The geezer company with the dodgy Vitruvia Man/Staff of Asclepius double logo thing?   What the heck?   Where’s my laundry list of super affordable health insurance options from modern companies with cool logos??  I put it off again and went about my business.

Finally, a month or two before we were scheduled to move back  — about the time we finally learned how to sneak my wife past Homeland Security — I caught a 60 Minutes report on hospital pricing and the uninsured.  The obvious dawned on me:  In the US, unlike Japan, one is not automatically insured.  There’s no national safety net.  You don’t purchase a health care plan that you think is better than the national health care plan, you purchase a health care plan because there is no national health care plan. Holy crap!  I finally understood what my father was talking about.  If I didn’t get insured immediately, an injury could potentially bankrupt my wife and I.  Or even my parents.  No wonder my father was nervous.

I called Blue Cross Blue Shield the next day.

Back then, in 2006, Massachusetts did not require health care insurance.  The selection Blue Cross Blue Shield provided for the self employed was limited to four simple plans.  At the time I was just discovering the brilliance of Health Saving Accounts (HSAs), so I selected a high deductible plan that was HSA compatible.  Although I wound up paying for all of our own moderate medical expenses for the next year, care was not nearly as expensive as if I had not been on health insurance, and the HSA turned out to be a great way to save money while reducing taxes.  All good.

Earlier this year, however, two important things happened:  1. health care reform in Massachusetts, and 2. the upcoming birth of our first child.   Both require significant changes to how I have been managing our health care.  Hence, this blog entry.

I started this as an anecdotal note about what to consider when switching from pre-reform Blue Cross Blue Shield health insurance to post-reform insurance.   I figured I would post a few questions, do some research, and answer them.  Notes to self, plus maybe useful information for someone else.

The number of individual plans offered by Blue Cross Blue Shield of Massachusetts has gone from four to roughly fifty.  Wow.  Yet while there may now be a veritable bounty of health care options available to folks like me, no one seems to understand how they work.  A few questions has become dozens.

Hopefully this unorganized mini FAQ about choosing a plan with Blue Cross Blue Shield in Massachusetts will be useful to others.  If you have any additional questions, feel free to shout out a comment.  Better yet, call the Blue Cross Blue Shield 800 number and ask.  The sales agents are generally quite helpful.  (That said, knowledge about the plans and the system itself seems to vary rather drastically from agent to agent.  If you unsure about some of the answers you’re getting, call back to the main switchboard.  You’ll get a different agent; ask again.)