Purchasing Health Insurance Is Confusing

Jordan2 · ‎03-16-2010

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.

I am still oxox · ‎03-09-2010

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

Stop being afraid of what could go wrong and start being positive what could go right.

ShowMe · ‎09-06-2010

@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.

BalletBabe · ‎03-05-2011

@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.

Jordan2 · ‎03-16-2010

@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.

software · ‎06-08-2016

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

SilleeMee · ‎05-22-2016

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.

Pearlee · ‎06-11-2011

@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!

Carmie · ‎10-25-2010

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.