Health Insurance Question

[mjj]

OP - Talk to an independent agent who specializes in individual health insurance.

There is so much incorrect information being shared in this thread it is comical if not dangerous.

[XutvJet]

$22/month sounds WAY TOO LOW for any sort of adequate health insurance. I would have expected at least $120/mo minimum.

At my company, Cigna HSA employee-only insurance with a high deductible ($2000 in network, $3000 out of network) is $97/mo. The Cigna PPO low deductible plan is $220/mo.

I would certainly get all the plan information in hand and have someone knowledge in insurance go over it and see what it exactly covers, what the deductibles are, and max out of pocket costs could be.

[Mosaud1998]

Originally Posted by XutvJet

$22/month sounds WAY TOO LOW for any sort of adequate health insurance. I would have expected at least $120/mo minimum.

At my company, Cigna HSA employee-only insurance with a high deductible ($2000 in network, $3000 out of network) is $97/mo. The Cigna PPO low deductible plan is $220/mo.

I would certainly get all the plan information in hand and have someone knowledge in insurance go over it and see what it exactly covers, what the deductibles are, and max out of pocket costs could be.

The thing is, I don't know anyone who is knowledgable about health insurance.

[XutvJet]

Originally Posted by thebmw

What you're describing is a personal experience. What I am describing is how the industry works. That said, you're describing a catastrophic event, which I described previously. Catastrophic events are typically covered. However maintenance and usual conditions have a lot of issues with coverage for procedures and medications.

I think the US medical insurance system and health care system are a disaster, but I can't say I agree with much of what you've said. My dad had all sorts of health problems the 4 years prior to his death at 70 in 2013. Tons of ER visits, ambulance rides, heart stints, multiple overnight stays, etc. My mom and him carried supplemental insurance in addition to Medicare. Their out of pocket costs only slightly exceeded their expected max out of pocket cost each year. In those 4 years, I believe it was something in the range of $200K. He then in the week prior to his death he had a heart valve replaced which his heart did not take. He was in the ICU for 12 days and then passed away. The surgery and ICU costs were in the range of $550K. My mother paid $7K of that and she met her deductible that year. She had a knee replacement and eye surgery that year. My mother's dealings with insurance in all of these cases has been surprisingly good.

For me and my family, we're very healthy, but we've had our accidents and sports related injuries over the past 5 years. I've had two 5th metatarsal foot surgeries which cost around $20k each and I paid out of pocket around $2500/ea. There were no surprises. I knew exactly what I was obligated to pay as my doctor's office disclosed everything I'd be billed for and when to expect the bills and from whom.

I don't enjoy spending the close to $500/mo for my family healthcare (high deductible HSA plan), vision, dental, etc., but I see the value in it, especially when your health hits the fan.

[XutvJet]

Originally Posted by Mosaud1998

The thing is, I don't know anyone who is knowledgable about health insurance.

Sounds like you'll need to educate yourself then. Google and YouTube are great sources. Get your information from multiple sources though. Trust, but verify.

[thebmw]

Originally Posted by XutvJet

I think the US medical insurance system and health care system are a disaster, but I can't say I agree with much of what you've said. My dad had all sorts of health problems the 4 years prior to his death at 70 in 2013. Tons of ER visits, ambulance rides, heart stints, multiple overnight stays, etc. My mom and him carried supplemental insurance in addition to Medicare. Their out of pocket costs only slightly exceeded their expected max out of pocket cost each year. In those 4 years, I believe it was something in the range of $200K. He then in the week prior to his death he had a heart valve replaced which his heart did not take. He was in the ICU for 12 days and then passed away. The surgery and ICU costs were in the range of $550K. My mother paid $7K of that and she met her deductible that year. She had a knee replacement and eye surgery that year. My mother's dealings with insurance in all of these cases has been surprisingly good.

For me and my family, we're very healthy, but we've had our accidents and sports related injuries over the past 5 years. I've had two 5th metatarsal foot surgeries which cost around $20k each and I paid out of pocket around $2500/ea. There were no surprises. I knew exactly what I was obligated to pay as my doctor's office disclosed everything I'd be billed for and when to expect the bills and from whom.

I don't enjoy spending the close to $500/mo for my family healthcare (high deductible HSA plan), vision, dental, etc., but I see the value in it, especially when your health hits the fan.

In regards to your parents, those were considered catastrophic and urgent and they had Medicare. We have rarely seen issues with catastrophic care with Medicare. We HAVE seen some issues with commercial, but still low for catastrophic.

In regards to your personal experiences, those are considered urgent and non-elective. Again, we see fewer issues there.

It seems that OP has some CHRONIC issues, which are not catastrophic or "urgent" (insurance company definitions...I think all suffering is urgent). It is in the chronic disease space that we see tremendous problems and issues. With cheaper quality policies and Obamacare or exchange policies, we see massive issues with coverage. By coverage, I mean what the insurance actually pays for vs. what is patient responsibility, as well as what insurance calls medically unnecessary and experimental, even though the service is "covered", necessary, and hardly experimental. THAT is what I am referring to and that is what OP needs to watch out for.

All that said, there may be no way to avoid issues no matter what policy OP has because of possible Chronic issues, but the Obamacare plans are absolute garbage. Only healthy people who have no chronic issues should be getting them simply to fulfill the requirement to have "coverage" (which is good to have for catastrophic).

[dreamingat30fps]

Originally Posted by thebmw

All that said, there may be no way to avoid issues no matter what policy OP has because of possible Chronic issues, but the Obamacare plans are absolute garbage.

You need to explain what an "Obamacare plan" is. Being self employed I get my insurance through the marketplace... some people consider that "Obamacare"... however I get no discount or subside as I do not qualify based on my income. I can go to the Florida Blue site and purchase the same exact plan directly through them for the same price. I can buy pretty much any plan I can buy directly through Florida Blue through the marketplace so I'm not sure how they are worse when they are the same plans and can be anything from total crap cheap 100% deductible plans to very expensive 0 deductible plans and everything in between.

Now if you mean individual plans suck compared to corporate plans you would get through an employer then maybe... I don't know as I don't have an employer and honestly can't remember the plan being any better or worse back when I did.

[RickFLM4]

As indicated earlier in the thread, your premium may reflect an income-based subsidy. It is odd to me that calling Blue Cross led you to another insurer, as Blue Cross would typically be happy to sell you a policy paid for in large part by the federal government. But perhaps the “agent” was independent and repping multiple insurers.

Ultimately, there is no way anyone here can explain how the premium is so low, other than through speculation. You’ll need to get the details of both plans (or even more options) and put them side by side to understand each variable. There are too many important variables to not analyze it closely. Coverages may be extremely limited because there are some plans out there that are intended as short-term bridges between policies. Additionally, deductibles, co-pays, out of pocket maximums, drug coverage and how amounts are applied to deductibles and OOP máximums may vary by plan and can seriously impact out of pocket costs aside from premiums. Additionally, and maybe most importantly, your access to preferred doctors, specialists and facilities will differ based on the type of plan (PPO vs. HMO) and the plan’s network. Needing to go out of network to see a doctor will cost a lot of money.

We look at our options from my wife’s employer every year to pick what fits us best. What fits us best may change year to year based on however the plans and our health/age change. So my advice is to try your best to take this opportunity to get educated on health insurance coverage and options and how to evaluate them to fit your needs. Given your previous transplant and meds, it is doubly important and highly unlikely to lessen in importance as you get older.

[RickFLM4]

Originally Posted by dreamingat30fps

You need to explain what an "Obamacare plan" is. Being self employed I get my insurance through the marketplace... some people consider that "Obamacare"... however I get no discount or subside as I do not qualify based on my income. I can go to the Florida Blue site and purchase the same exact plan directly through them for the same price. I can buy pretty much any plan I can buy directly through Florida Blue through the marketplace so I'm not sure how they are worse when they are the same plans and can be anything from total crap cheap 100% deductible plans to very expensive 0 deductible plans and everything in between.

Now if you mean individual plans suck compared to corporate plans you would get through an employer then maybe... I don't know as I don't have an employer and honestly can't remember the plan being any better or worse back when I did.

To me “Obamacare” means a subsidy is paid. Marketplace is just a place to buy an individual plan whether you get a subsidy or not. Individual plans have always existed. Obama did not invent them anymore than Al Gore invented the internet.

I have been self employed for a long time (20+ years) and have purchased our health insurance through small business plans (State of FL used to have a program that required insurers to open up small business plans to “groups of 1” in August of each year - killed off following ACA and replaced by individual marketplace), individual plans through the marketplace and off marketplace (no subsidies in either case) and my wife’s large employer. You can get equivalent individual plans to large employer plans but they are usually more expensive, especially if you are older. I believe ACA allows insurers to base rates on insured age whereas my wife’s employer bases employee contributions to premiums on a flat fee basis across the workforce without adjustment for age. I also saw a bump up in premiums when I had to switch to individual from small business. Less expensive individual plans typically have restricted networks, high deductibles and co-pays, etc.

I think ACA expanded access to healthcare for lower income individuals, but it impacted costs for others and, in some cases, access to previous plans (such as getting forced into individual plans from small business). The mechanism to get pre-existing conditions covered (no more exclusions just pay tax if not insured, which has since been repealed) was also flawed and this aspect of health insurance law should be reformed. But, like any legislation, it is what it is and you just need to put the work in to analyze choices to make the best decision you can.

[Mosaud1998]

Originally Posted by RickFLM4

As indicated earlier in the thread, your premium may reflect an income-based subsidy. It is odd to me that calling Blue Cross led you to another insurer, as Blue Cross would typically be happy to sell you a policy paid for in large part by the federal government. But perhaps the “agent” was independent and repping multiple insurers.

Ultimately, there is no way anyone here can explain how the premium is so low, other than through speculation. You’ll need to get the details of both plans (or even more options) and put them side by side to understand each variable. There are too many important variables to not analyze it closely. Coverages may be extremely limited because there are some plans out there that are intended as short-term bridges between policies. Additionally, deductibles, co-pays, out of pocket maximums, drug coverage and how amounts are applied to deductibles and OOP máximums may vary by plan and can seriously impact out of pocket costs aside from premiums. Additionally, and maybe most importantly, your access to preferred doctors, specialists and facilities will differ based on the type of plan (PPO vs. HMO) and the plan’s network. Needing to go out of network to see a doctor will cost a lot of money.

We look at our options from my wife’s employer every year to pick what fits us best. What fits us best may change year to year based on however the plans and our health/age change. So my advice is to try your best to take this opportunity to get educated on health insurance coverage and options and how to evaluate them to fit your needs. Given your previous transplant and meds, it is doubly important and highly unlikely to lessen in importance as you get older.

I think you're right about the premium reflecting on my income. I called Blue Cross Blue Shield and the phone representative forwarded my call to a licensed insurance agent that Blue Cross works with.

I posted a PDF file of all the plans the agent sent me if you'd like to take a look at it.

[Mosaud1998]

Alright, I got this figured out. So, the plans are based on my income. I just started a new job and can't enroll in the health insurance plan until I am employed for 3 months. So, I need insurance for 3 months. After the 3 months, I am going to cancel the insurance plan with Blue Cross Blue Shield and get onto the employer's health plan.

The agent asked me what I think I will make in 2024. I told him 20k (but I'll make around 20k in 3 months. I only need a plan for 3 months). So, I was able to get on a "Cost-sharing reduction" plan where the government gave me an estimated saving of $334. That's how the premium went from $335.45 to $21.45. The same goes for the deductible. The deductible went from $4,400 to $0.

I posted a screenshot with a $20,000/year income and $61k/year income. of the same plan.

I think I am going to say my income for 2024 is $20k. Take the $21.45/plan and make use of it for 3 months. After I enroll on my employer's plan, I'll cancel the Blue Cross Blue Shield plan.

[G35POPPEDMYCHERRY]

the healthcare system is beyond fucked, yall don't need to argue about it.

OP this is pretty simple

1. did you get booted off parents cuz your 26? if not and parents are okay then join back
2. do you qualify for medicaid in your state. EVERYTHING is covered on medicaid, they get some of the best healthcare in the country, its free and unlimited.
3. each time u start a new job its a life event meaning you can change plans...Its wild how to have to work for 3 months to qualify to healthcare.

at any rate the 21.45 is a steal and you should take that immediatly. is says you tacrolimus isn't covered but likely due to its BX rating
MMF should be covered as well and any others your are on

[dreamingat30fps]

Originally Posted by Mosaud1998

Alright, I got this figured out. So, the plans are based on my income. I just started a new job and can't enroll in the health insurance plan until I am employed for 3 months. So, I need insurance for 3 months. After the 3 months, I am going to cancel the insurance plan with Blue Cross Blue Shield and get onto the employer's health plan.

The agent asked me what I think I will make in 2024. I told him 20k (but I'll make around 20k in 3 months. I only need a plan for 3 months). So, I was able to get on a "Cost-sharing reduction" plan where the government gave me an estimated saving of $334. That's how the premium went from $335.45 to $21.45. The same goes for the deductible. The deductible went from $4,400 to $0.

I posted a screenshot with a $20,000/year income and $61k/year income. of the same plan.

I think I am going to say my income for 2024 is $20k. Take the $21.45/plan and make use of it for 3 months. After I enroll on my employer's plan, I'll cancel the Blue Cross Blue Shield plan.

Maybe I'm wrong but I think the income is based on yearly income... not on what you make while you have the insurance. So at the end of the year if you made more than the $20k you are claiming (for the whole year) I believe you would owe some of that subsidy money back.

[Mosaud1998]

Originally Posted by dreamingat30fps

Maybe I'm wrong but I think the income is based on yearly income... not on what you make while you have the insurance. So at the end of the year if you made more than the $20k you are claiming (for the whole year) I believe you would owe some of that subsidy money back.

Yeah, I'd owe some of the subsidie money back. I think I'd owe that money back if I was still insured with blue cross. If assume. If I cancel the plan in 3 months, I think I'd be okay

If I keep the insurance open for more than 3 months, I'd owe $1,005. I'll make more than 20k in a year. So, I pay the original plans premium times 3.

[ZL9M2]

Originally Posted by thebmw

This is not true. Providers are not the insurance company and they cannot tell you exctly what a patient's out of pocket will be. Obviously, provider offices try to be transparent but many times it backfires and patients blame the providers for lying. That is simply because when an insurance says a specific service is covered, that is not a guarantee of payment and that is listed on every approval. That is how the insurance companies are able to do a bait and switch and avoid lawsuits because it is in the fine print that approval or coverage has no connection with payments and patient responsibility.

Call the provider. The insurance provider. Tell them what procedure you are having done and they will tell you specifically if and what they will cover, including how your deductible and co-pays may come into play. This isn't that hard.

[RickFLM4]

Originally Posted by dreamingat30fps

Maybe I'm wrong but I think the income is based on yearly income... not on what you make while you have the insurance. So at the end of the year if you made more than the $20k you are claiming (for the whole year) I believe you would owe some of that subsidy money back.

Yeah, I'd think he'll need to pay the entire subsidy back, effectively getting him back to the pre-subsidy pricing. But that's just based on logic, as haven't dealt with subsidies or know how they work or any potential penalties.

[Mosaud1998]

Originally Posted by RickFLM4

Yeah, I'd think he'll need to pay the entire subsidy back, effectively getting him back to the pre-subsidy pricing. But that's just based on logic, as haven't dealt with subsidies or know how they work or any potential penalties.

Yeah, if I keep the insurance for 3 months and make over $20k in 2024 (which I know I will), I'll have to pay about $1,100 back(the full plan price is $355.45 x the 3 months I used the plan). I still think it's a better deal to take the $21/month for 3 months than take the employer health insurance when I can enroll and cancel the marketplace insurance.

If I take the marketplace insurance at the $355.45/month, the deductible goes up from $0 to $4,400, I'll have to pay for labs, etc. At the $21/month, I don't have to pay for Jack.

[UncleWede]

If you make it to 3 months with the employer, be sure to compare their offerings to what you are getting in the market. Full price with the market, if your employer gives you a "cafeteria" plan with optional cash back, may be better.
My wife's employer is way bigger than mine, but I get cash in lieu (cafeteria) so she pays for us, and I put cash in the bank.

Like Rick said, each year wife/I sit down and review her company offerings. We will typically have 5-7 tabs open in a browser, swapping from tab to tab to compare. The company is good about organizing each offering in a similar fashion, so we can scroll down and compare. It still takes a few hours/nights to get her selection updated. Like you, I'm a chronic user with the diabetes. Some plans don't include my specialist in their netowrk.

Again, welcome to adulting

[Mosaud1998]

Originally Posted by UncleWede

If you make it to 3 months with the employer, be sure to compare their offerings to what you are getting in the market. Full price with the market, if your employer gives you a "cafeteria" plan with optional cash back, may be better.
My wife's employer is way bigger than mine, but I get cash in lieu (cafeteria) so she pays for us, and I put cash in the bank.

Like Rick said, each year wife/I sit down and review her company offerings. We will typically have 5-7 tabs open in a browser, swapping from tab to tab to compare. The company is good about organizing each offering in a similar fashion, so we can scroll down and compare. It still takes a few hours/nights to get her selection updated. Like you, I'm a chronic user with the diabetes. Some plans don't include my specialist in their netowrk.

Again, welcome to adulting

Will do man. All I know right now is that with my employer's insurance, the monthly premium is $200~/month and the deductible is $1,000. Also, my doctors are in network with my employer's insurance (United HealtCare).

[RickFLM4]

Originally Posted by Mosaud1998

Yeah, if I keep the insurance for 3 months and make over $20k in 2024 (which I know I will), I'll have to pay about $1,100 back(the full plan price is $355.45 x the 3 months I used the plan). I still think it's a better deal to take the $21/month for 3 months than take the employer health insurance when I can enroll and cancel the marketplace insurance.

If I take the marketplace insurance at the $355.45/month, the deductible goes up from $0 to $4,400, I'll have to pay for labs, etc. At the $21/month, I don't have to pay for Jack.

Makes sense unless somehow the government claws back the subsidized deductible / OOP from Blue Cross who comes after you for it and / or there is a penalty. Hard to expect the government is that efficient so you’ll probably be fine with what you’re doing. Let us know how it turns out next year after tax time. Seems like a loophole.

[dreamingat30fps]

Originally Posted by Mosaud1998

Yeah, if I keep the insurance for 3 months and make over $20k in 2024 (which I know I will), I'll have to pay about $1,100 back(the full plan price is $355.45 x the 3 months I used the plan). I still think it's a better deal to take the $21/month for 3 months than take the employer health insurance when I can enroll and cancel the marketplace insurance.

If I take the marketplace insurance at the $355.45/month, the deductible goes up from $0 to $4,400, I'll have to pay for labs, etc. At the $21/month, I don't have to pay for Jack.

I still don't know how the $0 deductible works. My understanding is the plans don't change at all you just get a subsidy.

[G35POPPEDMYCHERRY]

this thread is the epitome of how broken the healthcare system is. with obamacare remanents and blood thirsty PBMS and lobbyists there is no hope.