topic Re: Questions About Health Insurance in Community Chat

Questions About Health Insurance

Jordan2 — Sun, 15 Nov 2015 01:49:29 GMT

I'm hoping someone can help me. I live in New York state and must purchase a health insurance plan on the exchange. I currently have a platinum plan but was wondering if I should get a gold plan. Currently I don't have a deductible. The new plan has a $600 deductible. I was wondering what things get applied to the deductible? Are they your copays, cost of doctor's visits, etc? Also what is out of pocket expenses? Are these expenses you incur if you go out of network?Also does anyone know the deadline to buy insurance for it to start in January?Lastly are you automatically rolled into your current plan if you take no action?Thanks for any advice you can give.

Re: Questions About Health Insurance

GCR18 — Sun, 15 Nov 2015 02:06:56 GMT

Copays don't apply to a deductible. My deductible was filled with chiropractor visits and I had an outpatient procedure. So if you just have routine wellness apps, you will pay the copay and not worry about the deductible. It's when you need appt for things other than routine wellness that you'll pay toward the deductible.

Re: Questions About Health Insurance

MyGirlsMom — Sun, 15 Nov 2015 02:10:33 GMT

If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.

Re: Questions About Health Insurance

Mary Bailey — Sun, 15 Nov 2015 02:12:23 GMT

Is Platinum a HMO plan?

Re: Questions About Health Insurance

maryebrown — Sun, 15 Nov 2015 02:16:20 GMT

For the OP -- a poster here, Terrier3, is very knowledgeable about the insurance exchanges in NY. Last winter, she was very helpful in her explanations about O'Care. Perhaps she'll see this thread and respond to your questions.

Re: Questions About Health Insurance

Jordan2 — Sun, 15 Nov 2015 02:27:43 GMT

@Mary Bailey wrote:
Is Platinum a HMO plan?

No the plans are different tiers of metals. There is Bronze, Silver, Gold, and Platinum.There is also catastrophic plans for those that need it.

Re: Questions About Health Insurance

ShowMe — Sun, 15 Nov 2015 02:48:17 GMT

@MyGirlsMom wrote:
If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.

Since January I have had the need to have 3 PETscans, at a cost of about $4,000 each scan. They were done at the hospital. Medicare and my supplemental provider took care of the whole thing.

Sounds to me this OP should be communicating with her health care insurance carrier. They could answer all her questions......even give her a deadline date.

Re: Questions About Health Insurance

labs — Sun, 15 Nov 2015 02:38:45 GMT

Also does anyone know the deadline to buy insurance for it to start in January?

Dec 15, 2015

Lastly are you automatically rolled into your current plan if you take no action?

Only if you signed up for auto renew and they don't need proof of income.

I was wondering what things get applied to the deductible?

Health insurance deductible is the amount that you will have to pay annually for your healthcare (such as surgical procedures, blood tests, or hospitalizations — but not some routine care) before the health insurance pays anything.

Also what is out of pocket expenses

The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.

Re: Questions About Health Insurance

MENTL — Sun, 15 Nov 2015 02:42:05 GMT

Healthcare is changing big time in 2016, there are no more PPOs and the prices have skyrocketed! Healthnet has dropped my platinum PPO plan and my premium has almost doubled for much, much less coverage. There is no such thing as great healthcare anymore, if you're looking for individual coverage things are bad. Only employers are being offered PPO plans that are decent.

Re: Questions About Health Insurance

MyGirlsMom — Sun, 15 Nov 2015 02:42:37 GMT

@ShowMe wrote:
@MyGirlsMom wrote:
If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.
Since January I have had the need to have 3 PETscans, at a cost of about $4,000 each scan. They were done at the hospital. Medicare and my supplekental provider took care of the whole thing.

Sounds to me this OP should be communicating with her health care insurance carrier. They could answer all her questions......even give her a deadline date.

***

We don't have Medicare and I had a PET scan which cost $23,000.00, our private insurance covered $6,800.00 of it. Our deductible is $6,300.00 (per person) and 'out of pocket' is $1,500.00. (per person).

Re: Questions About Health Insurance

151949 — Sun, 15 Nov 2015 02:42:43 GMT

@ShowMe wrote:
@MyGirlsMom wrote:
If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.
Since January I have had the need to have 3 PETscans, at a cost of about $4,000 each scan. They were done at the hospital. Medicare and my supplekental provider took care of the whole thing.

Sounds to me this OP should be communicating with her health care insurance carrier. They could answer all her questions......even give her a deadline date.

The OP is asking about Obamacare exchanges not medicare.

Re: Questions About Health Insurance

ShowMe — Sun, 15 Nov 2015 02:52:48 GMT

@MENTL wrote:
Healthcare is changing big time in 2016, there are no more PPOs and the prices have skyrocketed! Healthnet has dropped my platinum PPO plan and my premium has almost doubled for much, much less coverage. There is no such thing as great healthcare anymore, if you're looking for individual coverage things are bad. Only employers are being offered PPO plans that are decent.

I don't know who you are covered with, but my coverage is being rolled over in 2016, and I have PPO. Just confirmed this with them Friday to be sure......

Re: Questions About Health Insurance

ShowMe — Sun, 15 Nov 2015 03:03:39 GMT

@MyGirlsMom wrote:
@ShowMe wrote:
@MyGirlsMom wrote:
If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.
Since January I have had the need to have 3 PETscans, at a cost of about $4,000 each scan. They were done at the hospital. Medicare and my supplekental provider took care of the whole thing.

Sounds to me this OP should be communicating with her health care insurance carrier. They could answer all her questions......even give her a deadline date.

***

We don't have Medicare and I had a PET scan which cost $23,000.00, our private insurance covered $6,800.00 of it. Our deductible is $6,300.00 (per person) and 'out of pocket' is $1,500.00. (per person).

I recently realized that liquid gold is being fed into my vein once every 2 weeks with the chemo I am on. Each treatment costs $24,000, and Medicare has agreed to paying $6,000 per treatment and my supplemetal is paying their 20% of that; I hava no idea how many treatments I have had. This has been going on since the first part of February.....and I just had a treatment this past Tuesday......

Re: Questions About Health Insurance

ShowMe — Sun, 15 Nov 2015 03:02:09 GMT

@151949 wrote:
@ShowMe wrote:
@MyGirlsMom wrote:
If you need an expensive test such as a CT scan or PET scan, that will be applied to your deductible.
Since January I have had the need to have 3 PETscans, at a cost of about $4,000 each scan. They were done at the hospital. Medicare and my supplekental provider took care of the whole thing.

Sounds to me this OP should be communicating with her health care insurance carrier. They could answer all her questions......even give her a deadline date.

The OP is asking about Obamacare exchanges not medicare.

Yes, I realize that...... But she would be better off calling the company that she is insured with. That is what they are there for.

Re: Questions About Health Insurance

Black Cat Back — Sun, 15 Nov 2015 03:42:26 GMT

In AZ, the plans are expensive and have high deductibles. My deductible is $6300!

I have tons of out of pocket. And now in AZ, 2016 will only allow HMO plans.

I am not on the exchange because I didn't have work in 2015. I'm hoping to get a job in 2016... can I go on the exchange or not?

Re: Questions About Health Insurance

151949 — Sun, 15 Nov 2015 03:48:15 GMT

@Hot Street wrote:
In AZ, the plans are expensive and have high deductibles. My deductible is $6300!

I have tons of out of pocket. And now in AZ, 2016 will only allow HMO plans.

I am not on the exchange because I didn't have work in 2015. I'm hoping to get a job in 2016... can I go on the exchange or not?

If you are not working then you would be on the exchange as you would not have insurance thru an employer and , by law, you are required to have insurance.Once you start working you probably will have insurance thru your employer, but if you don't for some reason, then you can go on ACA,Everyone except medicare patients can go on the ACA to get insured.

Re: Questions About Health Insurance

Black Cat Back — Sun, 15 Nov 2015 03:51:24 GMT

I am not working but had to buy insurance out of the exchange since I don't want Medicaid.

I had to buy through the insurance co directly which is very expensive with little coverage.

Re: Questions About Health Insurance

Mary Bailey — Sun, 15 Nov 2015 13:11:39 GMT

@Jordan2 wrote:
@Mary Bailey wrote:
Is Platinum a HMO plan?
No the plans are different tiers of metals. There is Bronze, Silver, Gold, and Platinum.There is also catastrophic plans for those that need it.

I work in dental insurance and Platinum is HMO, Bronze doesn't cover major, Gold has a higher max and pays higher % than Silver.

Re: Questions About Health Insurance

Jordan2 — Sun, 15 Nov 2015 15:29:02 GMT

Thank you to everyone for their advice. I do plan to call my insurance provider, I just haven't had the chance yet. The reason I'm thinking of switching to a gold plan is because my current plan has increased by about $50 a month. I was wondering if it is more than I need. Thanks again.

Re: Questions About Health Insurance

labs — Mon, 16 Nov 2015 00:21:52 GMT

Jordan,I'm a navigator with the NYS marketplace. You can compare the two plans on the link below.

Go to view plans now.

Enter zip code and letters/numbers listed.

Once on the plans find your current and then the gold plan, click the box next to each and compare.

https://nystateofhealth.ny.gov/individual