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Respected Contributor
Posts: 2,218
Registered: ‎10-07-2013

Re: Choosing A New Health Plan

Here's a thought.  In EVERY state there are people who are trained to help you out.  They are called SHIP Counselors.  They have no axe to grind other than helping you get the plan that best suits you.  There is no charge for their service.  You can probably find a Counselor who is in your area by calling your local government office (city, town, county, etc.)>

Honored Contributor
Posts: 14,682
Registered: ‎03-16-2010

Re: Choosing A New Health Plan

I called the insurance company that I was thinking of purchasing insurance from to understand the differences in the plans. I have always bought my plans from the NY exchange. The woman I was speaking to said it was better to purchase directly from the company because if you need to make changes, such as a new phone number or new address the company can't make the changes, you have to go through the exchange which can be challenging. I'm not sure if I want to not buy through the exchange, I never considered there being a problem. I'm not sure what I should do.

Honored Contributor
Posts: 19,307
Registered: ‎04-28-2010

Re: Choosing A New Health Plan

[ Edited ]

Seems all so confusing (to me).  So far, I haven't had to make any decisions re: my present personal health plan (not employer-company related).  'Same old, same old', so far, knock on wood.   .................  p.s. 'It just 'dawned on me':  I have a good feeling that many problems re: rising health insurance rates will be improved, so try to hang in there.  Wishing us all well, healthwise.

'More or less', 'Right or wrong', 'In general', and 'Just thinking out loud ' (as usual).
Honored Contributor
Posts: 36,429
Registered: ‎03-09-2010

Re: Choosing A New Health Plan

@Jordan2

After I signed up through the marketplace (is this the same as your exchange?)

I had the website and contact info for Cigna, the company who offered the plan I chose. 

I preferred not needing to go thru an agent. However, my dental was Cigna, thru the marketplace (?) and his name was "jazzman" -- he was helpful and very nice. The rate was the same and they allowed electronic CC payments, which the marketplace did not. HTH

~Have a Kind Heart, Fierce Mind, Brave Spirit~
Honored Contributor
Posts: 14,682
Registered: ‎03-16-2010

Re: Choosing A New Health Plan


@LTT1 wrote:

@Jordan2

After I signed up through the marketplace (is this the same as your exchange?)

I had the website and contact info for Cigna, the company who offered the plan I chose. 

I preferred not needing to go thru an agent. However, my dental was Cigna, thru the marketplace (?) and his name was "jazzman" -- he was helpful and very nice. The rate was the same and they allowed electronic CC payments, which the marketplace did not. HTH


Yes I can sign up through the marketplace as I have done for about three years. I never thought I needed to go through the insurance company itself. I live in New York state and there are not too many options. I am looking at 2 maybe 3 plans, none of which my PCP is participating in so I will have to change. I have to decide which doctors I'm willing to change and which I really don't want to. It's like getting insurance for "just in case" and not really using it to it's fullest.

Super Contributor
Posts: 431
Registered: ‎03-10-2010

Re: Choosing A New Health Plan

Good luck, Jordan.  I too am losing doctors right now, for the second time in a little over a year. It's tough as a doctor, whether seen once a year or more, is someone you build a relationship with and come to trust to some extent. I'm disabled and can't afford ACA this year and will have to change doctors after just finding new ones a year ago from September, which was stressful enough! I'm losing 2 doctors and will work out an arrangement with the third, as I only see her a few times a year.  I'm also in the middle of physical therapy and that won't be covered either.  My current insurance is going up 25%.

 

As far as doctors to change and not change, usually, unless it's an HMO (where the PCP needs to refer you to a specialist), you may be able to see your doctors who are not covered as out-of-network.  If there's certain ones you really don't want to change, I would look into this first.  There's two things to check into here, first being the cost to see an out-of-network doctor for each insurance (a specialist is more expensive than a PCP), and if the doctor will take someone who doesn't have that insurance.  I had kept my previous PCP once I switched insurance and paid out-of-pocket to see her, and at some point, she no longer accepted patients who didn't have insurance she took.  Frustrating since I chose an ACA plan that had her name listed incorrectly! You may want to double-check if you DO see your doctor listed under one as well, as that was a blow to me! Like I did, you can also decide if it's worth it to pay out-of-pocket to see a doctor as well.  They may arrange a price for this that is less than if you had full insurance.  Getting out-of-network coverage would be better if you had this option depending on how much is covered.  Also, you would want to make sure any type of tests or labs done by that doctor are covered as usually, they would all be associated with a certain medical group, and that may not be under your coverage.  I had that happen with blood tests I had to take. 

 

It's tough to say what is the best thing to do as far as going throug a company or the insurance group as it sounds like you don't know which one you're going to go with at this point.  I had gone through someone for the ACA, but that's different than what you are talking about.  I don't know if this is something you pay for or if the insurance company you choose does, but if it's the latter and/or they can get all your questions answered and find the best fit for the best price, I see where the marketplace is helpful.  I think insurance can be extremely confusing and it helps to go through someone who knows what he/she is doing unless you have the time to research and wade through it all.  As far as people at one saying the other is't the way to go, I'm sure having salespeople at each end influences that too, and both can help you.  If you had narrowed it down to one insurance company, they could help you pick the right choice for you at that point.  Good luck!

 

Honored Contributor
Posts: 14,682
Registered: ‎03-16-2010

Re: Choosing A New Health Plan


@Katmary wrote:

Good luck, Jordan.  I too am losing doctors right now, for the second time in a little over a year. It's tough as a doctor, whether seen once a year or more, is someone you build a relationship with and come to trust to some extent. I'm disabled and can't afford ACA this year and will have to change doctors after just finding new ones a year ago from September, which was stressful enough! I'm losing 2 doctors and will work out an arrangement with the third, as I only see her a few times a year.  I'm also in the middle of physical therapy and that won't be covered either.  My current insurance is going up 25%.

 

As far as doctors to change and not change, usually, unless it's an HMO (where the PCP needs to refer you to a specialist), you may be able to see your doctors who are not covered as out-of-network.  If there's certain ones you really don't want to change, I would look into this first.  There's two things to check into here, first being the cost to see an out-of-network doctor for each insurance (a specialist is more expensive than a PCP), and if the doctor will take someone who doesn't have that insurance.  I had kept my previous PCP once I switched insurance and paid out-of-pocket to see her, and at some point, she no longer accepted patients who didn't have insurance she took.  Frustrating since I chose an ACA plan that had her name listed incorrectly! You may want to double-check if you DO see your doctor listed under one as well, as that was a blow to me! Like I did, you can also decide if it's worth it to pay out-of-pocket to see a doctor as well.  They may arrange a price for this that is less than if you had full insurance.  Getting out-of-network coverage would be better if you had this option depending on how much is covered.  Also, you would want to make sure any type of tests or labs done by that doctor are covered as usually, they would all be associated with a certain medical group, and that may not be under your coverage.  I had that happen with blood tests I had to take. 

 

It's tough to say what is the best thing to do as far as going throug a company or the insurance group as it sounds like you don't know which one you're going to go with at this point.  I had gone through someone for the ACA, but that's different than what you are talking about.  I don't know if this is something you pay for or if the insurance company you choose does, but if it's the latter and/or they can get all your questions answered and find the best fit for the best price, I see where the marketplace is helpful.  I think insurance can be extremely confusing and it helps to go through someone who knows what he/she is doing unless you have the time to research and wade through it all.  As far as people at one saying the other is't the way to go, I'm sure having salespeople at each end influences that too, and both can help you.  If you had narrowed it down to one insurance company, they could help you pick the right choice for you at that point.  Good luck!

 


@Katmary, I think I will buy through the exchange and will decide by this weekend. I called the doctor's offices to make sure they take the insurances I'm interested in. The place I go for my mammo and sonogram isn't on one of the plans. I asked how much it would cost for both tests, I was told $900-$1,000! I guess I'll have to find some place else to go. I guess you have to weigh the pros and cons of each plan. I wish you the best of luck with your health care. 

Esteemed Contributor
Posts: 6,287
Registered: ‎01-24-2013

Re: Choosing A New Health Plan

Good luck. You'll have at least a year until it all blows up.
Respected Contributor
Posts: 2,522
Registered: ‎11-20-2013

Re: Choosing A New Health Plan

I'm looking too, since they're discontinuing my particular plan. I have called three different insurers available in my state. None of them were able to answer any very specific questions about the coverage on their different plans, and they are the big three. My question ... who pays about $12-15,000 for something vague. Who accepts waiting to find out exactly what you paid for while going along and crossing bridges when you get to them in any other high cost business contracts? This whole system is way too confusing when their own reps can't answer specific questions on coverage.

 

The health insurance industry is switching over to a universal catastrophic  plan if you ask me, except for those who can afford over 1000/month/individual. They are asking you to pay for all your health care out of pocket with their very high deductibles and for relatively risk free healthy individual with only limited health care needs.

 

I feel that laws must be changed to demand that the insurers provide much more transparency, and to demand that qualified individuals from their own companies are made easily available to prospective buyers to provide help with and simple explanation of benefits.

Valued Contributor
Posts: 805
Registered: ‎06-25-2015

Re: Choosing A New Health Plan

Last year my husband turned 65, and I had no idea how to go about learning about Medicare and selecting an advantage plan, etc.  I looked up health care specialists in my area and chose one. He helped me enormously, and I didn't have to pay him a thing.