Community Chat

[Jordan2]

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.

[GCR18]

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.

[MyGirlsMom]

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

[Mary Bailey]

Is Platinum a HMO plan?

[maryebrown]

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.

[Jordan2]

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@Mary Bailey wrote:

Is Platinum a HMO plan?

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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.

[ShowMe]

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@MyGirlsMom wrote:

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

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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.

[labs]

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.

[MENTL]

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.

[MyGirlsMom]

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@ShowMe wrote:

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@MyGirlsMom wrote:

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

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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.

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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).