Questions About Health Insurance - Page 3

maryebrown · ‎04-07-2015

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"...

reiki604 · ‎03-09-2010

@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.

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

Jordan2 · ‎03-16-2010

I'm the OP and I called my insurance company today. I spoke to a very helpful agent today. I decided although the cost is higher than last year (every plan went up) I'll stay with what I have. The lower premiums of the other plans didn't come with the "freebies" the higher plan came with.

maryebrown · ‎04-07-2015

His company representative said that the new premiums for the old insurance would more than double, so they went with a different provider. I have an appointment with Our Insurance Agent tomorrow, perhaps he can offer us a more affordable Plan.

terrier3 · ‎03-10-2010

@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 · ‎03-10-2010

@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.

Please keep in mind - if your husband's company provides HI, you cannot automatically get an alternate policy through the Marketplace.

You will have to get documentation from your DHs employer and fill out forms that show that the premiums at work are more than 9% of his gross pay.

I suggest that you work with a professional to determine eligibility. You can use an insurance broker, someone at a HI company that sells Marketplace plans or a navigator - there is no fee to you for any of them.

terrier3 · ‎03-10-2010

@labs wrote:
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 - Sorry I missed your post! I'm a licensed broker and work for a health insurannce company.

Good luck this year...lots of changes, like usual!

physicsnut · ‎08-26-2013

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

MyGirlsMom · ‎03-09-2010

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

@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.

Keep Your Face To The Sunshine and You Will Not See The Shadow

CelticCrafter · ‎03-09-2010

@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.....