topic Re: Purchasing Health Insurance Is Confusing in Community Chat

Purchasing Health Insurance Is Confusing

Jordan2 — Wed, 28 Nov 2018 23:33:14 GMT

I live in New York state and purchase my health insurance on the marketplace exchange. Every year I wonder if I have made the right choice. I started out once upon a time with a platinum plan, then gold, now I'm down to silver. I have Oscar which I do like, I called today and spoke to an insurance broker that works for Oscar for advice which silver plan to get (there are three) she was no help whatsoever. I understand what a deductible and out of pocket expenses are, after that I kind of get lost. This year my deductible was $2000 I have paid about $500 of it. Two plans I'm looking at are only about $3 difference in the premiums. One plan has a $1,700 deductible and $7,500 out of pocket expenses, the other has a $7,350 and $7,350 out of pocket expenses. The one with the $1,700 deductible has copays after you reach the deductible. The plan with the $7,350 deductible has copays right away. I'm wondering which is a better option for me? I know I don't want a bronze plan as I feel that is for someone in their 20's or 30's who doesn't visit a doctor often. I also feel you never know what life throws at you, maybe you'll use the insurance more or less than you think, I would appreciate any advice anyone can offer me.

Re: Purchasing Health Insurance Is Confusing

I am still oxox — Wed, 28 Nov 2018 23:37:43 GMT

Sounds like you need a broker and you should be able to explore other plans out, are you also on Medicare ?

Re: Purchasing Health Insurance Is Confusing

ShowMe — Wed, 28 Nov 2018 23:53:03 GMT

@I am still oxox wrote:
Sounds like you need a broker and you should be able to explore other plans out, are you also on Medicare ?

@I am still oxox.....I was just going to ask her the same thing.

Yes, health coverage is very confusing....and tough decisions to make.

Re: Purchasing Health Insurance Is Confusing

BalletBabe — Wed, 28 Nov 2018 23:53:35 GMT

@Jordan2 wrote:
I live in New York state and purchase my health insurance on the marketplace exchange. Every year I wonder if I have made the right choice. I started out once upon a time with a platinum plan, then gold, now I'm down to silver. I have Oscar which I do like, I called today and spoke to an insurance broker that works for Oscar for advice which silver plan to get (there are three) she was no help whatsoever. I understand what a deductible and out of pocket expenses are, after that I kind of get lost. This year my deductible was $2000 I have paid about $500 of it. Two plans I'm looking at are only about $3 difference in the premiums. One plan has a $1,700 deductible and $7,500 out of pocket expenses, the other has a $7,350 and $7,350 out of pocket expenses. The one with the $1,700 deductible has copays after you reach the deductible. The plan with the $7,350 deductible has copays right away. I'm wondering which is a better option for me? I know I don't want a bronze plan as I feel that is for someone in their 20's or 30's who doesn't visit a doctor often. I also feel you never know what life throws at you, maybe you'll use the insurance more or less than you think, I would appreciate any advice anyone can offer me.

Making an insurance decision is something you need to sit down and talk to someone. It can get really confusing. Make sure whatever you choose has good prescription coverage. You may not take a lot of prescription meds but one heart attack can send you into poverty. It is a shame that they make it so confusing. I got shoved into the marketplace when it first came out. It was a nightmare. I agree with @I am still oxox, you definitly need to talk to someone. I think picking a plan really has to be based on your income, and also your medical needs.

Re: Purchasing Health Insurance Is Confusing

Jordan2 — Thu, 29 Nov 2018 00:38:05 GMT

@I am still oxox wrote:
Sounds like you need a broker and you should be able to explore other plans out, are you also on Medicare ?

@I am still oxox, no I’m not on Medicare. I’m thinking of calling Oscar again, maybe I’ll luck out and get someone else who is a little more helpful. I can also call the market place, they advise on all plans.

Re: Purchasing Health Insurance Is Confusing

software — Thu, 29 Nov 2018 00:42:46 GMT

You are not alone.

It's a gamble.You make a decision you have to live with for at least a year

Anything can happen.

I always tell people buy all the insurance you can comfortably afford and hope for the best.

@Jordan2

Re: Purchasing Health Insurance Is Confusing

SilleeMee — Thu, 29 Nov 2018 00:58:39 GMT

I'm not on Medicare yet. So I buy my insurance from our state exchange. When this ACA all started a few years ago, it was required to obtain a broker in order to buy a plan through that marketplace. My appointments with my broker made it clear to me what kind of plan I needed for my particular health care situation. I've pretty much stayed with the same kind of plan since and there's been no problems so far. What happened, however, is that when I went to renew my plan for the upcoming year I found my plan no longer existed or the company bailed from the marketplace. I was forced to look for another plan. That happened three years in a row.

Re: Purchasing Health Insurance Is Confusing

Pearlee — Thu, 29 Nov 2018 01:04:46 GMT

@Jordan2 wrote:
I live in New York state and purchase my health insurance on the marketplace exchange. Every year I wonder if I have made the right choice. I started out once upon a time with a platinum plan, then gold, now I'm down to silver. I have Oscar which I do like, I called today and spoke to an insurance broker that works for Oscar for advice which silver plan to get (there are three) she was no help whatsoever. I understand what a deductible and out of pocket expenses are, after that I kind of get lost. This year my deductible was $2000 I have paid about $500 of it. Two plans I'm looking at are only about $3 difference in the premiums. One plan has a $1,700 deductible and $7,500 out of pocket expenses, the other has a $7,350 and $7,350 out of pocket expenses. The one with the $1,700 deductible has copays after you reach the deductible. The plan with the $7,350 deductible has copays right away. I'm wondering which is a better option for me? I know I don't want a bronze plan as I feel that is for someone in their 20's or 30's who doesn't visit a doctor often. I also feel you never know what life throws at you, maybe you'll use the insurance more or less than you think, I would appreciate any advice anyone can offer me.

@Jordan2 As to what I highlighted of your post in red, I'm pretty sure just about everyone who doesn't have 20/20 foresight wonders the same thing! If only we could know what our health issues will be in the upcoming year!

Re: Purchasing Health Insurance Is Confusing

Carmie — Thu, 29 Nov 2018 01:05:35 GMT

An insurance broker is not allowed to suggest a plan for you or steer you to a certain coverage. By law, they are only allowed to explain the benefits and then you must decide for yourself.

I am guessing by the coverage you used last year that you are pretty healthy, but do go to the doctor occasionally.

What I would suggest is that figure out which benefits you know for sure you will be using...maybe a routine gym exam and mammogram,a physical, a couple of office visits, and maybe an ER visit for an injury.

then figure out which plan would work best for the type of services you know you will use. I am sure all of the plans cover catastrophic illnesses, which can happen to anyone, but are probably unlikely, unless you have an underlying condition.

For instance, some plans always have a copayment for office visits, but there might not be a deductible for office visits. Services that might apply to the deductible would be diagnostic services, such as x-rays and blood work.

Only you can make a decision. You can ask a broker to explain how claims would be paid for the procedures you think you will use and compare them for you. No matter which plan you choose, it's always a gamble. Usually the same medical procedures are covered by all of the plans, but just paid at different levels with a different premium that you must pay monthly.

Re: Purchasing Health Insurance Is Confusing

ECBG — Thu, 29 Nov 2018 01:07:08 GMT

I can't think of a time when insurance wasn't a major headache!

Re: Purchasing Health Insurance Is Confusing

Jordan2 — Thu, 29 Nov 2018 01:23:21 GMT

@Carmie wrote:
An insurance broker is not allowed to suggest a plan for you or steer you to a certain coverage. By law, they are only allowed to explain the benefits and then you must decide for yourself.

I am guessing by the coverage you used last year that you are pretty healthy, but do go to the doctor occasionally.

What I would suggest is that figure out which benefits you know for sure you will be using...maybe a routine gym exam and mammogram,a physical, a couple of office visits, and maybe an ER visit for an injury.

then figure out which plan would work best for the type of services you know you will use. I am sure all of the plans cover catastrophic illnesses, which can happen to anyone, but are probably unlikely, unless you have an underlying condition.

For instance, some plans always have a copayment for office visits, but there might not be a deductible for office visits. Services that might apply to the deductible would be diagnostic services, such as x-rays and blood work.

Only you can make a decision. You can ask a broker to explain how claims would be paid for the procedures you think you will use and compare them for you. No matter which plan you choose, it's always a gamble. Usually the same medical procedures are covered by all of the plans, but just paid at different levels with a different premium that you must pay monthly.

@Carmie, thank you for your advice. I know no one can tell me which plan to go with, but the woman I spoke with could have explained the two plans to me better than she did. I would think by the information I gave her she could have guided me to the benefits of each plan, how each would be beneficial to me.

Re: Purchasing Health Insurance Is Confusing

manhattan1950 — Thu, 29 Nov 2018 02:28:23 GMT

Find a broker who will either come to your house or have you meet them at their office. It's much easier to understand your different options when speaking to someone in person, rather than talking to someone on the phone.That's what i did and I'm happy with the insurance I chose. My broker also calls me if she finds a better plan.

Re: Purchasing Health Insurance Is Confusing

software — Thu, 29 Nov 2018 02:31:12 GMT

Something else to think about, if you choose a high deductible policy, you may be eligible for a tax free health savings account. I am no expert about the details.

You could ask your tax preparer

@Jordan2

Re: Purchasing Health Insurance Is Confusing

lulu1 — Thu, 29 Nov 2018 03:23:32 GMT

For retired NJ school employees, medical insurance was one of our benefits. Unless you take the initiative, in January our insurance provider will automatically switch. The new provider will save the state a good deal of money. The provider is promising us everything we now have plus more. Somehow that just doesn't add up. No insurance company will give you more for far less money.

I've had Blue Cross/Blue Shield my entire life and have never had a problem. I am not going to switch.

Re: Purchasing Health Insurance Is Confusing

shoekitty — Thu, 29 Nov 2018 03:34:12 GMT

@manhattan1950 wrote:
Find a broker who will either come to your house or have you meet them at their office. It's much easier to understand your different options when speaking to someone in person, rather than talking to someone on the phone.That's what i did and I'm happy with the insurance I chose. My broker also calls me if she finds a better plan.

Shoekitty said,

they sure do help. The great part is they dont charge a fee. I am sure they get a kickback from the insurer, because they dont do for fun. Lol! They ask you many questions, take notes of your medical needs, doctors you want, medicine you need, and they have a comparative program that hooks you up with a health insurance that suits your needs. I had doctors I didn't want to part with, a pharmacy I preferred, a list of medicines I take. It is so confusing.

Re: Purchasing Health Insurance Is Confusing

sue311 — Thu, 29 Nov 2018 16:04:04 GMT

Just wanted to let you know that you can go to Legal Aid. I dont know if thats available in all states but I took someone there and the service is free.

Re: Purchasing Health Insurance Is Confusing

Icegoddess — Thu, 29 Nov 2018 16:28:46 GMT

Here in AL it's quite simple. Bronze, Silver, or Gold. Since I'm apparently "rich" I don't qualify for subsidies, so the Bronze plan will cost me over $800/month with a $6500 deductible. It pays for nothing until I reach the deductible. So, why would I want to pay more to get a slightly less deductible when I never get anywhere close to meeting it? I visit my doctor maybe two to three times a year and one of those is the physical. There's the gyno and BCBS won't even pay for the labs for that. And, then the mammogram which I'm not sure if they're paying for or not yet. It depends on whether the doctor that "reads" the mammogram is in-network or not.

I long for the days of a high deductible plans meaning low premiums. Mostly, I just need a catastrophic plan. Basically, this plan is a very expensive catastrophic plan.

BTW, I'm 60, nowhere near the 20's or 30's OP mentioned as the only people a Bronze plan would be appropriate for?

Re: Purchasing Health Insurance Is Confusing

CelticCrafter — Thu, 29 Nov 2018 17:17:05 GMT

I have a question, does the deductible count towards the out of pocket expenses or is it in addition to the out of pocket?

The OP mentioned $1700+7500=9200 or is it $7500-1700 leaving a balance of 5800 still due out of pocket?

Re: Purchasing Health Insurance Is Confusing

Laura14 — Thu, 29 Nov 2018 18:00:04 GMT

Anything that goes through the medical insurance that you pay for should go against your deductible.

@Jordan2 If I am understanding you correctly, the $1700 deductible is a no brainer. Most insurance is 80/20 when you reach the deductible (if you can reach it) and $1700 is fantastic! That's extremely easy to reach if you have an issue. I am covered through my employer and I have a $6750 deductible and then only 80/20 coverage.

The only way that the $7350 deductible plan makes sense is if it covers 100% after you meet it and then it's just a matter of math and risk assessment.

If you are putting out $7350 in medical expenses a year and will hit that easily so you get the 100% coverage afterwards, it's a viable option. If your medical expenses don't come anywhere near that a year, you want the $1700 plan all day long.

Even if something does happen and you are on the hook for 20%, hospitals work with patients all day long. My brother in law is a small business owner who can't get coverage for himself and his employees and he pays pennies on the dollar anytime he has a medical issue because he is a cash customer. Don't let the 20% bother you too much. Any medical facility will work with you on that.

Re: Purchasing Health Insurance Is Confusing

Still Raining — Thu, 29 Nov 2018 18:55:03 GMT

Somehow the math does not work. If the premiums and total out of pocket are much the same, there has to be a major difference in the way the copays or COINS (or both) apply in order to make up the difference in deductible. That is quite a gap.

You need to have a lot more questions answered. Might want to have covered services looked at too.