Re: Questions About Health Insurance

terrier3 · ‎03-10-2010

@physicsnut wrote:
O care is a joke for the majority of people and the deductibles are ridiculous. Just pray you don't get sick!!!!!

O care includes 4 levels of insurance - including a level with NO deductibles and low co-pays.

The platinum level, with no deductible, was the level chosen in Post #1.

It also is usually half the cost of COBRA - a godsend for people who have been laid off and need continued health care.

60sgirl · ‎11-24-2014

@Jordan2 wrote:
Thank you to everyone for their advice. I do plan to call my insurance provider, I just haven't had the chance yet. The reason I'm thinking of switching to a gold plan is because my current plan has increased by about $50 a month. I was wondering if it is more than I need. Thanks again.

since you are asking aobut deductibles and co-pays would it be fair to say you have not had any medical bills at all while on your current plan? If that is the case, then you must not go to the doctors much so perhaps you only nheed a plan that has catastrophic coverage.

I'm done with P.C. Just say what you mean and mean what you say. It's easier.

60sgirl · ‎11-24-2014

@reiki604 wrote:
@maryebrown wrote:
My DH brought home the new Health Insurance info from work today. For the 2 of us a Cigna EPO Middle Plan would cost $797 per pay period (biweekly). The .OOP is $8000 per year, deductibles $3000. That's a Huge chunk of change and I don't call that "affordable"...
Mary..........clearly his company did not negotiate for the benefit of its employees. Perhaps you should go to the exchange and see what's available. I've been pricing plans and for about the same that you are paying I could get a platinum plan with 0 deductible and low copays. I'm on COBRA right now and will be paying just about the same for a 300 deductible. Complaining may fit an agenda but until you investigate alternatives it all just ether.

you cannot buy on the exchange if you have employer sponsored coverage. My son just tried that since his employer's coverage is so high.

I'm done with P.C. Just say what you mean and mean what you say. It's easier.

reiki604 · ‎03-09-2010

@60sgirl wrote:
@reiki604 wrote:
@maryebrown wrote:
My DH brought home the new Health Insurance info from work today. For the 2 of us a Cigna EPO Middle Plan would cost $797 per pay period (biweekly). The .OOP is $8000 per year, deductibles $3000. That's a Huge chunk of change and I don't call that "affordable"...
Mary..........clearly his company did not negotiate for the benefit of its employees. Perhaps you should go to the exchange and see what's available. I've been pricing plans and for about the same that you are paying I could get a platinum plan with 0 deductible and low copays. I'm on COBRA right now and will be paying just about the same for a 300 deductible. Complaining may fit an agenda but until you investigate alternatives it all just ether.

you cannot buy on the exchange if you have employer sponsored coverage. My son just tried that since his employer's coverage is so high.

I understand what you're saying. What I don't understand is how an employer sponsored plan is more expensive than a privately purchased one that has lower deductibles and lower out of pocket costs. There is something wrong if an employer offers a gold plan for more money that an unsubsidized platinum plan costs.

'I refuse to engage in a battle of wits with an unarmed man'.......Unknown

60sgirl · ‎11-24-2014

@reiki604 wrote:
@60sgirl wrote:
@reiki604 wrote:
@maryebrown wrote:
My DH brought home the new Health Insurance info from work today. For the 2 of us a Cigna EPO Middle Plan would cost $797 per pay period (biweekly). The .OOP is $8000 per year, deductibles $3000. That's a Huge chunk of change and I don't call that "affordable"...
Mary..........clearly his company did not negotiate for the benefit of its employees. Perhaps you should go to the exchange and see what's available. I've been pricing plans and for about the same that you are paying I could get a platinum plan with 0 deductible and low copays. I'm on COBRA right now and will be paying just about the same for a 300 deductible. Complaining may fit an agenda but until you investigate alternatives it all just ether.

you cannot buy on the exchange if you have employer sponsored coverage. My son just tried that since his employer's coverage is so high.
I understand what you're saying. What I don't understand is how an employer sponsored plan is more expensive than a privately purchased one that has lower deductibles and lower out of pocket costs. There is something wrong if an employer offers a gold plan for more money that an unsubsidized platinum plan costs.

well, I guess if and when you are poor enough to not be able to afford $300 out of every paycheck just to avoid penalty tax, (and don't even see a doctor because you are young enough and healthy enough) and still make enough money for your basic needs, you will understand it. When you go to the exchange and think maybe you can find a subsidized plan while you are working, think again. The website tells you that you are not eligible since you can get it at work.

Therein lies the dilemma. What one person thinks is affordable, another cannot make ends meet. And that's one reason that a)young adults who are paying back enormous school loans have to move back in with parents, and b)many people would rather pay the penalty tax at filing time because it costs less than $7500 A YEAR.

I'm done with P.C. Just say what you mean and mean what you say. It's easier.

Group 5 minus 1 · ‎03-11-2010

Ask the insurance company. Better yet have them snail mail or e-mail what you want to know.

reiki604 · ‎03-09-2010

@60sgirl wrote:
@reiki604 wrote:
@60sgirl wrote:
@reiki604 wrote:
@maryebrown wrote:
My DH brought home the new Health Insurance info from work today. For the 2 of us a Cigna EPO Middle Plan would cost $797 per pay period (biweekly). The .OOP is $8000 per year, deductibles $3000. That's a Huge chunk of change and I don't call that "affordable"...
Mary..........clearly his company did not negotiate for the benefit of its employees. Perhaps you should go to the exchange and see what's available. I've been pricing plans and for about the same that you are paying I could get a platinum plan with 0 deductible and low copays. I'm on COBRA right now and will be paying just about the same for a 300 deductible. Complaining may fit an agenda but until you investigate alternatives it all just ether.

you cannot buy on the exchange if you have employer sponsored coverage. My son just tried that since his employer's coverage is so high.
I understand what you're saying. What I don't understand is how an employer sponsored plan is more expensive than a privately purchased one that has lower deductibles and lower out of pocket costs. There is something wrong if an employer offers a gold plan for more money that an unsubsidized platinum plan costs.
well, I guess if and when you are poor enough to not be able to afford $300 out of every paycheck just to avoid penalty tax, (and don't even see a doctor because you are young enough and healthy enough) and still make enough money for your basic needs, you will understand it. When you go to the exchange and think maybe you can find a subsidized plan while you are working, think again. The website tells you that you are not eligible since you can get it at work.

Therein lies the dilemma. What one person thinks is affordable, another cannot make ends meet. And that's one reason that a)young adults who are paying back enormous school loans have to move back in with parents, and b)many people would rather pay the penalty tax at filing time because it costs less than $7500 A YEAR.

60's girl...........clearly you are talking about an entirely different set of circumstances than the one I am questioning. Again, I am saying that I don't understand how an employer subsidized gold plan can be more expensive than an unsubsidized privately paid platinum plan. Please let me know if you have an answer or idea about that without deflecting and changing the focus of my question.

'I refuse to engage in a battle of wits with an unarmed man'.......Unknown

bebe777 · ‎12-10-2012

@labs wrote:
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.

and later in post #20 of this thread, labs added:

Jordan,I'm a navigator with the NYS marketplace. You can compare the two plans on the link below.

Go to view plans now.

Enter zip code and letters/numbers listed.

Once on the plans find your current and then the gold plan, click the box next to each and compare.

https://nystateofhealth.ny.gov/individual

______

@labs, that's so thoughtful of you to share your expertise with @Jordan2.

-- bebe

______

bebe777 · ‎12-10-2012

@terrier3 wrote:
@Jordan2 wrote:
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.
I sell ACA insurance in NY State, so I'm happy to help.

Well visits and shots (flu, tetanus, anti-shingles, etc.)are not subject to deductibles.

Everything else is - doctor visits, hospital stays, prescriptions.

If you have a $600 deductible, you pay the first $600 of payments out of your own money. Ex.: You have a sore throat and go to the doctor. He charges $50 (insurance company rate) for the visit. You have to get a lab test, another $50 and a prescription for an antibiotic, $10. You have to pay 100% of it (in this case $50 plus $75 plus 10 = $135). You pay until your $600 deductible is met.

AFTER that, you switch to co-pay (or co-insurance if you pay a percentage of services/charges).

If your policy has a $1,000 out of pocket for the year...you add the $600 deductible and your co-pays - once you reach the out of pocket MAXIMUM for the year $1,000 - you pay nothing else for the rest of the year (just monthly premiums).

If you are healthy and rarely see the doctor, the policies with deductibles can work.

If yu are on a lot of meds (chronic condition like diabetes), sticking with a platinum plan might work.

If you use a lot of medical services - figure out if the lower monthly premium and the $50/month average of your deductible) is LESS than the difference between the monthly premium for the platinum and the gold plan. If the platinum has a $600 monthly premium, and the gold has a $450 monthly premium, the gold would be better for you.

The deadline to have new insurance for January 1st is December 15th.

Let me know if you have any other questions!

@terrier3, thank you for sharing your professional expertise with @Jordan2 and the rest of us.

-- bebe

physicsnut · ‎08-26-2013

@CelticCrafter wrote:
@MyGirlsMom wrote:
@physicsnut wrote:
O care is a joke for the majority of people and the deductibles are ridiculous. Just pray you don't get sick!!!!!
@physicsnut

It's the best thing that happened to people without health care as well as college aged children able to stay under their parents plans.
No, it's the best thing that happened to people without health care that are eligible or entitled to subsidies.....$5300 annual premium with a $5000 deductible is not the best thing that happened to a healthy 27 year old.....