topic Re: Choosing A New Health Plan in Community Chat

Choosing A New Health Plan

Jordan2 — Mon, 07 Nov 2016 19:46:55 GMT

I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

Re: Choosing A New Health Plan

MyGirlsMom — Mon, 07 Nov 2016 19:50:15 GMT

Q: Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)?

A: medical tests. i.e. CAT scans, x rays, etc.

Re: Choosing A New Health Plan

beckyb1012 — Mon, 07 Nov 2016 20:01:42 GMT

@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

Do a shout out for Terrier3. She is the expert. Good Luck, mine is going up by almost $100.00 for just me in my own private little world. I hate all this.

Re: Choosing A New Health Plan

Jordan2 — Mon, 07 Nov 2016 20:24:05 GMT

@beckyb1012 wrote:
@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!
Do a shout out for Terrier3. She is the expert. Good Luck, mine is going up by almost $100.00 for just me in my own private little world. I hate all this.

@beckyb1012, thanks that's who I meant! Hopefully maybe she'll see this. I have to change my health insurance plan and find a new PCP!

Re: Choosing A New Health Plan

LTT1 — Mon, 07 Nov 2016 21:39:09 GMT

@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

@Jordan2

I will try as I have just had to choose a new 2017 plan.

Deductible: amount you must pay ($1000) before the insurance kicks In EXCEPT:

1) usually yearly checkups are free

2) Out-of-pocket-- once you have spent $3000 (ie: car accident) they will then pick up the expense. So, let's say car accident hospital bill costs $5000, you will owe $1000 + $2000 = $3000 from you. The rest of this bill they will pay for you.

Let's say a person needs monthly RXs totaling $50 /month. Each plan may offer differing methods concerning the RX falling under the covered deductible amount.

I will put a graphic from the plan I chose here as a demo.

My concerns (this is for MY NEEDS and yours may be different)

1) Can I go to an Emergency Care place and will it be covered? (My answer: yes they will cover this IF I go to an "in-network" place.

2) How much would I have to pay for if I would go to a hospital ER?

3) Is MY hospital "in-network?" (No not)

4) Are my favorite doctors "in-network?" (No not)

5),Which Doctor or Hospital will I see that are "in-network?"

HTH BRB

Re: Choosing A New Health Plan

LTT1 — Mon, 07 Nov 2016 22:20:32 GMT

@Jordan2

The above is an example only. This plan is no longer available.

$2000 deductible.(individual) check to see how this is handled if more than one person is on your policy.

Notice the counsurance/copay. You owe these amounts for these services.

Notice also that In the middle column you must use "in-network" to get the rates shown. Likely, if you go to an "out-of-network" doctor pharmacy or facility, you won't get any help from your plan. (What you spend then may apply to the total out-of-pocket total for the year, but I don't know for sure.)

Re: Choosing A New Health Plan

Melania — Mon, 07 Nov 2016 22:17:26 GMT

@LTT1 wrote:
@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!
@Jordan2
I will try as I have just had to choose a new 2017 plan.
Deductible: amount you must pay ($1000) before the insurance kicks In EXCEPT:
1) usually yearly checkups are free
2) Out-of-pocket-- once you have spent $3000 (ie: car accident) they will then pick up the expense. So, let's say car accident hospital bill costs $5000, you will owe $1000 + $2000 = $3000 from you. The rest of this bill they will pay for you.

Let's say a person needs monthly RXs totaling $50 /month. Each plan may offer differing methods concerning the RX falling under the covered deductible amount.
I will put a graphic from the plan I chose here as a demo.

My concerns (this is for MY NEEDS and yours may be different)
1) Can I go to an Emergency Care place and will it be covered? (My answer: yes they will cover this IF I go to an "in-network" place.
2) How much would I have to pay for if I would go to a hospital ER?
3) Is MY hospital "in-network?" (No not)
4) Are my favorite doctors "in-network?" (No not)
5),Which Doctor or Hospital will I see that are "in-network?"

HTH BRB

Well said!! That breakdown is very important as it will leave out any surprises if an event should occur.

I just went through this too. We went onto the exchange and found a number of plans and then had our agent help us decipher the best plan for me. He is great.

But the crummy thing is that most of the carriers will no longer pay the insurance agency a fee so he can't help us anymore. It can be so frustrating and you think you are getting the right plan but not always.

Re: Choosing A New Health Plan

Mom2Dogs — Mon, 07 Nov 2016 23:34:53 GMT

My health insurance will go UP $80.00 a WEEK! We were shocked and will have to dip into retirement money to keep the plan.

Going on the exchange was not available for me since I am offered insurance thru my husbands plan....even if I went on the exchange the price was only 100.00 a month less expensive for terrible coverage!

Also, if you get a subsidsy to help pay your insurance thru the exchange you are taxed on what 'they' 'give you'! What is the point of the 'help' if you are taxed on it at the end of the year?

Trying to figure out insurance should not be so difficult...

Re: Choosing A New Health Plan

maestra — Mon, 07 Nov 2016 23:39:31 GMT

my premium for ACA went up by 300%, with only 1 provider in my state.

Re: Choosing A New Health Plan

Wayne-QVC — Mon, 07 Nov 2016 23:47:02 GMT

This post has been removed by QVC because it's political

Re: Choosing A New Health Plan

Jordan2 — Mon, 07 Nov 2016 23:59:05 GMT

@LTT1 wrote:
@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!
@Jordan2
I will try as I have just had to choose a new 2017 plan.
Deductible: amount you must pay ($1000) before the insurance kicks In EXCEPT:
1) usually yearly checkups are free
2) Out-of-pocket-- once you have spent $3000 (ie: car accident) they will then pick up the expense. So, let's say car accident hospital bill costs $5000, you will owe $1000 + $2000 = $3000 from you. The rest of this bill they will pay for you.

Let's say a person needs monthly RXs totaling $50 /month. Each plan may offer differing methods concerning the RX falling under the covered deductible amount.
I will put a graphic from the plan I chose here as a demo.

My concerns (this is for MY NEEDS and yours may be different)
1) Can I go to an Emergency Care place and will it be covered? (My answer: yes they will cover this IF I go to an "in-network" place.
2) How much would I have to pay for if I would go to a hospital ER?
3) Is MY hospital "in-network?" (No not)
4) Are my favorite doctors "in-network?" (No not)
5),Which Doctor or Hospital will I see that are "in-network?"

HTH BRB

@LTT1, thank you so much for your reply. I have pretty much decided on a health insurance company, but I'm not sure if I should get a gold or platinum plan. Also within the metal tiers there are about 3 different plans. I don't know why they make this so confusing! I know I have to pay the deductible, but barring something unforeseen as long as I stay in network, is the out of pocket costs something to be that concerned about? I will call the health insurance company and see if they can help me to choose the right plan for me. I don't want to buy something I don't need, but don't want to buy something that won't be enough either. No plan is going to be perfect for me, I have to pick a plan I can live with.

Re: Choosing A New Health Plan

LeoGrl — Tue, 08 Nov 2016 00:04:30 GMT

Momtodogs - Yes, they are hitting everyone with increases including employers. My employer just switched to a completely different health insurance company after having the same one for many years because they increased their rates too much. Both my mom and sister both were hit hard with higher monthly payments. My sister was so upset the other day when in the mail she received yet ANOTHER increase in her medical coverage. She went from $397 to now $522 a month. She is looking around as well. And get this, this is the THIRD time in two years they increased her insurance rates (and she is someone who rarely goes to the doctor and keeps herself healthy). It is very upsetting and scary what is going on with health insurance right now.

Re: Choosing A New Health Plan

conlt — Tue, 08 Nov 2016 00:51:23 GMT

Are you talking about private insurance, Medicare, or a Medicare replacement plan?

Re: Choosing A New Health Plan

Its Me LuLuBelle2 — Tue, 08 Nov 2016 01:53:04 GMT

@Jordan2, I'm in the same boat you are. My head is spinning. Prices for DH and I are obscene - they were terrible for 2016 but are sky high for 2017. And that's just the monthly premiums - forget the deductibles and out of pocket expenses. We're actually considering dropping it for 2017 and paying the tax penalty and keeping our fingers crossed that we stay healthy. Oh, and to add insult to injury we went to get our flu shots at the pharmacy we have our prescription plan through and were told, oh, it's not covered in NY. You'll have to go to NJ for that. Really?!? It's a shame that so many people who have worked and payed taxes all of their lives are finding themselve's in this position.

Re: Choosing A New Health Plan

Jordan2 — Tue, 08 Nov 2016 02:48:03 GMT

My mother use to have Medicare first and from her job (she's retired) her union picked up the 20%. About 4 or 5 years ago it was changed to a managed senior care and every year they change it and it's getting worse and worse. They don't care, you could opt out and shop for your own supplemental insurance, but who wants to do that? As for me I purchase it for myself and the pickins are slim!

Re: Choosing A New Health Plan

LTT1 — Tue, 08 Nov 2016 11:20:14 GMT

@Jordan2

We were thinking of a catastrophic type of plan for me DH is on Medicare). There are not any classified as such.

Gold, Silver and Platinum plans appear to be split as 3 metals.

A GOLD plan will have a split of 10-90... "they will pay 90%"

My SILVER plan last year, we chose and the split was 15-85... they would pay 85% (of a hospital bill, for instance.

Assess your everyday costs for medical... checkups (which doctors); yearly exams (which doctors/facilities); which RXs. Then find out which are allowed on the plans you are considering.

For instance, I take Nexium every day... NO INS covers this one!

I wanted a nearby hospital and there is one plan that includes the hospital.

The bronze choices have the least coverage... and seem to be HMOs.

When the dust settles, I have the feeling that there will be more and better choices available. Right now insurance companies and medical care are in flux.

Re: Choosing A New Health Plan

SilleeMee — Tue, 08 Nov 2016 13:20:35 GMT

I just renewed my Bronze Plan through my state's health insurance exchange and because my income is low enough I qualified to receive the subsidy which pays for my plan in its entirety. This is a blessing for me because there is no way I could afford to pay for health insurance. I do realize that these Bronze Plans have a ridiculous deductible...like around 9,000...but I am also a patient at our local health clinic that offers care for low-income people like myself. This clinic offers many services that cost me a price according to my income level. I'm am so thankful that this clinic is here in my city. I feel lucky to have it! I am a low-income individual who got this way because of disability. Wish I could still work and make more money so that I could afford a better health insurance plan but for now the exchange is where I go to buy my plan.

Re: Choosing A New Health Plan

nunya — Tue, 08 Nov 2016 15:46:06 GMT

@Mom2Dogs wrote:
My health insurance will go UP $80.00 a WEEK! We were shocked and will have to dip into retirement money to keep the plan.

Going on the exchange was not available for me since I am offered insurance thru my husbands plan....even if I went on the exchange the price was only 100.00 a month less expensive for terrible coverage!

Also, if you get a subsidsy to help pay your insurance thru the exchange you are taxed on what 'they' 'give you'! What is the point of the 'help' if you are taxed on it at the end of the year?

Trying to figure out insurance should not be so difficult...

They get you coming and going. IMO, there should be an opt in/ opt out option. Everyone who opts in, pays the same price. How any working, middle class person can afford this, is beyond me. Sure you can buy a cheaper plan, just don't plan on ever meeting your deductible for anything to be covered.

Re: Choosing A New Health Plan

SilleeMee — Tue, 08 Nov 2016 16:13:56 GMT

@Mom2Dogs wrote:
My health insurance will go UP $80.00 a WEEK! We were shocked and will have to dip into retirement money to keep the plan.

Going on the exchange was not available for me since I am offered insurance thru my husbands plan....even if I went on the exchange the price was only 100.00 a month less expensive for terrible coverage!

Also, if you get a subsidsy to help pay your insurance thru the exchange you are taxed on what 'they' 'give you'! What is the point of the 'help' if you are taxed on it at the end of the year?

Trying to figure out insurance should not be so difficult...

@Mom2Dogs,

I have never been taxed on the subsidy I get every year. Where did you get this information?

Re: Choosing A New Health Plan

nunya — Tue, 08 Nov 2016 17:16:33 GMT

I think it is because you use a projected income amount for the next year, if you go over the amount you thought you would make, you need to pay back what you got as a tax credit (subsidy)