Re: Purchasing Health Insurance Is Confusing

donniesmom · ‎12-31-2011

Hi Jordan2--it's funny you posted something that I am going through now too! Marketplace is very confusing and most of the time reps are not very helpful. The way I'm looking at how to choose is this: I have 3 prescriptions (thyroid & mild HBP) that I'm on but basically I'm pretty healthy (so far thank God) so normally it's just routine checkups. I'm looking for something in the "middle". I don't need a premier plan but I don't want to scrimp on a plan that won't pay for what I need. I want decent prescription coverage and I feel a deductable of 1600 is ok. I noticed some deductable were 3,000 and payment was very reasonable but I don't want a high deductable. I feel middle ground is around 1600. I also saw a plan Oscar which you mentioned. I never heard of this one before! I asked the Markeplace rep & she didn't know anything about it! Their prices were pretty good but since I'm not familar with it I'm skeptical. Can you tell me your experience with it please? I currently have Horizon but I am considering Amerihealth. Horizon's premium went up quite a bit & I will only need this insurance until July 2019 at which time I will be on Medicare. Any help you can give me about Oscar is appreciated. I hope we can navigate this insurance maze soon.

RainCityWoman · ‎06-16-2015

Does your state have a website where you can compare plans based on your own special needs? The U.S. government has one for Medicare which makes it all so much easier, even giving an estimated yearly total cost, computing yearly cost for Part D prescriptions by plan, etc.

Jordan2 · ‎03-16-2010

@donniesmom wrote:
Hi Jordan2--it's funny you posted something that I am going through now too! Marketplace is very confusing and most of the time reps are not very helpful. The way I'm looking at how to choose is this: I have 3 prescriptions (thyroid & mild HBP) that I'm on but basically I'm pretty healthy (so far thank God) so normally it's just routine checkups. I'm looking for something in the "middle". I don't need a premier plan but I don't want to scrimp on a plan that won't pay for what I need. I want decent prescription coverage and I feel a deductable of 1600 is ok. I noticed some deductable were 3,000 and payment was very reasonable but I don't want a high deductable. I feel middle ground is around 1600. I also saw a plan Oscar which you mentioned. I never heard of this one before! I asked the Markeplace rep & she didn't know anything about it! Their prices were pretty good but since I'm not familar with it I'm skeptical. Can you tell me your experience with it please? I currently have Horizon but I am considering Amerihealth. Horizon's premium went up quite a bit & I will only need this insurance until July 2019 at which time I will be on Medicare. Any help you can give me about Oscar is appreciated. I hope we can navigate this insurance maze soon.

@donniesmom, Oscar hasn't been around that long, I currently have them and had them 2 or 3 years ago( in between I had Care Connect because my OB/GYN wasn't with them, but is now back again). A lot of people haven't heard of them, they aren't in that many states yet, but are expanding ( I live in New York, I think they are available in New Jersey and California, and more). I like them, they have good customer service. Oscar has an agreement with Quest Diagnostic Labs, so that's where I go for lab work. They cover a woman's wellness visit OB/GYN, an annual physical with a primary care physician, and a mammogram ( I get a breast sonogram too, but was told they don't cover it, but I haven't been billed for it yet). I was covered for a flu shot and I was covered for the two part shingles vaccine ( not every plan pays for this, it's $175 for each shot). You don't need referrals to see specialists. I don't know how they put together their roster of providers, my ophthalmologist was dropped by them so I have to find a new one. I think they are as good as any other plan, you have to do your homework and find the best plan for you. If you have doctors you see that are deal breakers, make sure they are in Oscar's provider network. Good luck to us both for selecting our health plans.

donniesmom · ‎12-31-2011

Hi Jordan2--thank you so much for all the info you provided. I am in N.J. so Oscar is available to me. I am going to check to see if my doctors are listed with Oscar. I'm still researching my options. I have spent a few hours the past 3 days looking over my options. My eyes are blurry! LOL! I hope to make a decision soon. Thank you again for filling me in on your experience. Best of luck to you too!

Jordan2 · ‎03-16-2010

@Icegoddess wrote:
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?

@Icegoddess, $800 for a bronze plan seems rather pricey. I'm looking at the most expensive silver plan for Oscar and that is about $640. I guess each state sets their own prices.

pigletsmom · ‎11-21-2011

I don't know much about Oscar since it's not in my area of NY. It doesn't sound like you use healthcare very often. So there are two ways to look at it.

Higher deductible means if you do run to the doctor once or twice you'll probably save money by just paying co-pays.

Lower deductible means if you go to the doctor a couple of times you could pay more (which it seems like you might be used to) but if you break your leg it's easy to pay your deductible.

So if your biggest concern is getting hit with a sudden big bill just go with the lower deductible.

Helen852 · ‎03-11-2010

@Icegoddess

This past October my husband feel and needed to have an emergency splenectomy. He is covered with BCBSMichigan (he's 63). Anyways, he had to be transported to a trauma center after the initial diagnosis at the first hospital. From there he had emergency surgery and spent a day in TICU, then another 9 days in the hospital, followed by 10 days in rehab. So the bills started to come in.

2 ambulance rides $1800 each, one we owe $300, the other they want the full amount but that is being disputed/appealed. The other bills fall in line with everything in our plan. Without any insurance, the total bill for the hospital for ER, Surgery, ICU and hospital stay and PT/OT (which was useless) was $97,000. Of that so far we owe $900. Have not received anything yet from the rehab.

What happened to him was a fluke, thank goodness we have the coverage. He's recovering slow and steady, not as young as he used to be.

Helen852

Icegoddess · ‎03-19-2010

@Jordan2 wrote:
@Icegoddess wrote:
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?
@Icegoddess, $800 for a bronze plan seems rather pricey. I'm looking at the most expensive silver plan for Oscar and that is about $640. I guess each state sets their own prices.

@Jordan2, we only have one choice in AL, Blue Cross Blue Shield, but even when whe did have a choice between two carriers the plans were exactly the same. I don't think it is the state that sets the price, although they may have to approve it. I'm not sure how they are set, but I do know that's what it costs for the cheapest plan available if you don't qualify for a subsidy.

Edited to say: Oh, and my deductible is going up to $7150.

Icegoddess · ‎03-19-2010

@Helen852 wrote:
@Icegoddess

This past October my husband feel and needed to have an emergency splenectomy. He is covered with BCBSMichigan (he's 63). Anyways, he had to be transported to a trauma center after the initial diagnosis at the first hospital. From there he had emergency surgery and spent a day in TICU, then another 9 days in the hospital, followed by 10 days in rehab. So the bills started to come in.

2 ambulance rides $1800 each, one we owe $300, the other they want the full amount but that is being disputed/appealed. The other bills fall in line with everything in our plan. Without any insurance, the total bill for the hospital for ER, Surgery, ICU and hospital stay and PT/OT (which was useless) was $97,000. Of that so far we owe $900. Have not received anything yet from the rehab.

What happened to him was a fluke, thank goodness we have the coverage. He's recovering slow and steady, not as young as he used to be.

@Helen852, I'm sorry that happend to your husband. However, I'm not sure how that applies to which plan I choose. Once the deductible kicks in all the plans in AL are the same. So, the question becomes do you want to pay a higher premium to get a lower deductible. For me that's a no brainer.