Do you really know how your health insurance works?

[kevo880]

I don't know of any fee. I get my insurance through my work and they have a plan that was grandfathered in so it isn't an ACA plan and I don't pay any extra fees.

 

Yeah he told me by not going with an ACA plan then I will get penalized just like anyone that doesn't have health insurance. What he presented was only like $204/month though. I attached the power point presentation that he emailed us.

US_Health_Advisors.pdf

[shipps]

Yeah he told me by not going with an ACA plan then I will get penalized just like anyone that doesn't have health insurance. What he presented was only like $204/month though. I attached the power point presentation that he emailed us.

 

Wow, how the hell is anyone supposed to evaluate a plan that is presented like that?

[kevo880]

Wow, how the hell is anyone supposed to evaluate a plan that is presented like that?

 

That's why I am lost. I wasn't involved in the conference call, only my wife. She is easily sold on things so she is ready to sign up. I'm skeptical of everything so I'm trying to get more information.

[shipps]

That's why I am lost. I wasn't involved in the conference call, only my wife. She is easily sold on things so she is ready to sign up. I'm skeptical of everything so I'm trying to get more information.

 

IMO that is purposely presented as complete f***ing jibberish because they have a lot to hide of what the benefits of that plan actually are. Do not sign up for that plan until you can see some stuff as we have talked about written in plain English.

[kevo880]

IMO that is purposely presented as complete f***ing jibberish because they have a lot to hide of what the benefits of that plan actually are. Do not sign up for that plan until you can see some stuff as we have talked about written in plain English.

 

What questions should I specifically ask him?

[kevo880]

Just like these main points?

 

1. What is the exact name of my policy and where can I go that is considered In-Network with my plan?

 

2. What is my deductible?

 

3. What is my Out of pocket Max?

[shipps]

What questions should I specifically ask him?

 

You need to know the Maternity benefits

What is the deductible?

What is the Co-insurance?

What is the Out of pocket max?

Office visit co-pays?

Is the hospital you are interested in having services In Network with the plan?

Are there any riders written in the plan? (These are services that are excluding coverage for a certain type of care)

[kevo880]

You need to know the Maternity benefits

What is the deductible?

What is the Co-insurance?

What is the Out of pocket max?

Office visit co-pays?

Is the hospital you are interested in having services In Network with the plan?

Are there any riders written in the plan? (These are services that are excluding coverage for a certain type of care)

 

You're the man shipps. Thanks for the help. I am going to email him those questions right now.

[Brian]

Like Rock, I had to learn while having to use it. It was later for me because I used to work at a hospital and I never had a bill so I'd go to Dr for anything cuz it was free outside of paycheck deductions.

Once I got new job, I had to learn about deductibles and out of pocket and stuff.

[Iwritecode]

Yeah he told me by not going with an ACA plan then I will get penalized just like anyone that doesn't have health insurance. What he presented was only like $204/month though. I attached the power point presentation that he emailed us.

 

I get it now. It's because it doesn't meet the minimum requirements. So you'd be one of the few that actually has insurance, but still have to pay the yearly fee (that will continue to go up every year) on top of it.

[kevo880]

I get it now. It's because it doesn't meet the minimum requirements. So you'd be one of the few that actually has insurance, but still have to pay the yearly fee (that will continue to go up every year) on top of it.

 

Correct. I have heard that the fee is 1% of your income. Does anyone know if that is true? Also, if I have my own insurance plan through work, would the 1% fee be our combined household income or only her income since she is the only one on it?

[Iwritecode]

Correct. I have heard that the fee is 1% of your income. Does anyone know if that is true? Also, if I have my own insurance plan through work, would the 1% fee be our combined household income or only her income since she is the only one on it?

 

https://www.healthcare.gov/fees/fee-for-not-being-covered/

 

2.5% of household income in 2016 or $695 per adult. Whatever is higher.

[kevo880]

https://www.healthcare.gov/fees/fee-for-not-being-covered/

 

2.5% of household income in 2016 or $695 per adult. Whatever is higher.

 

That is ridiculous that it is the household income and not the individual income if only one person in the family isn't covered in an ACA plan. That makes a massive difference as I make most of the money between the two of us, but she makes more than the minimum requirements.

[Chisoxfn]

I'll do my best to explain this.

 

1) The 800 number on the back of your card can be used to verify and/or answer any questions you may have.

 

2) The yearly deductible is what you will pay BEFORE insurance kicks in unless otherwise superseded by a listed co-pay. For example, if you have a 500$ deductible, but a 30$ co-pay for a office visit, for regular office visits you will pay the 30$, NOT the deductible.

 

3) The maximum out of pocket is what kicks in AFTER you've paid your yearly deductible, after this is reached, you are 100% covered for the remainder of the year.

 

4) This is where hospital charges or in/outpatient charges start kicking in. For example, if you were to break your arm, and the bill is $3500, you are responsible for 1) the deductible, which is $500. This leaves 3000$ remaining. Your insurance will then list a % you are responsible for, for example, 20%. So of that remaining 3000$, you are responsible for an additional 20% UP TO THE YEARLY MAXIMUM.

 

Charges are often separated by a in-network/out-of-network cost. You may see something similar to this: in-network/out-of-network office visit: 25$/40$. In this example, an office visit in-network is 25$, and that same visit to an out-of-network doctor would be 40$. The same goes for non-specialist/specialist: 50$/100$. In that example, a non-specialist would cost you 50$, whereas a specialist is 100$. What is a specialist? A dermatologist is a specialist for skin conditions, where as a general practitioner is just a regular doctor.

 

*** Keep in mind that ONLY FDA approved procedures and tests are covered. If there is an experimental test your doctor recommends, they SHOULD be telling you that insurance MAY NOT cover these charges, as they are not obligated to do so. That doesn't mean they won't, but they don't have to do so.

 

If you have an HMO, ANYTHING your PCP (Primary Care Physician) requests will be covered. Period.

If you have a PPO, you will be on the hook for anything uncovered (such as non FDA approved procedures).

 

If you disagree with a charge AFTER fighting it, and still do not agree with the insurance companies assessment, you can ALWAYS request the case go to arbitration.

 

Last but not least, keep in mind that if/when you cannot pay a bill, you CAN negotiate...and if they refuse to do so (they can), you can agree to make monthly payments and these "loans" CAN NEVER BE CHARGED INTEREST. If you owe 2000$, tell the hospital all you can afford to pay is $50 a month...they WILL let you interest free.

 

If you have any questions let me know.

One thing to make clear, your deductible payments count towards your maximum out of pocket cost. Your post is a little confusing and could lead some to believe they are seperate.

[Chisoxfn]

Kev...get an ACA quote and then call a variety of insurance brokers and get a variety of information. Also depending on your income situation, you may be in line for subsidies. I would be very skeptical of something that was non ACA. I'm also very skeptical of sales people in general though. I haven assumed biased that they will tell me whatever I want to get a sale and I test most sales people by asking select questions that I know the answer to and I want to see if they push me in the ethical way or not.

[Southwest Sider]

Thanks for this thread. It comes at a time when I am making an enormous life-decision, and part of my decision is made because I will have the ability to get an ACA plan with a low-income tax credit.

 

Basically, I'm going back to school in January and do not wish to continue working 4-5 days a week to maintain my companies health plan. In order to keep company benefits. I'd need to work at least 4 days a week. Not so bad, but there is literally zero wiggle room for a 1 week vacation or if I were to miss 1-2 weeks to sickness. If that happens at all, I then need to work 5 days a week while doing full-time school. Admittedly, I'm ignorant to how feasible this is because I haven't gone to school in such a long time, but the way I'm thinking is the less work the better, so I have the time I need to study, do homework, and at the same time have my hobbies and have my general life.

 

Now, I'm good on my companies insurance plan for the next 6 months or so, but after that I need to sign up for an ACA plan. I definitely noticed that all the BCBS plans are "in-network", which does worry me if that network is rather small. I'm not sure of that, though. What I did find out is if I qualify for a tax credit, I can acquire a plan similar to my current one. A Blue Cross "Silver" plan for approximately $51/month (after credit) with a $500 deductible. I noticed all the other plans are $5,000 or more deductibles, which is a bit scarier. I don't make doctors visits often, or hospital visits ever, but in the event that a freak accident happens, I'd rather not have to pay $6,000 before my insurance kicks in, so the $500 deductible is enticing.

 

If anyone knows better then I regarding any of this, I am all ears (or eyes, in this case). For the past 5 years (my early-mid 20s) I've been rolling with my companies insurance plan, rarely using it, and never bothering to read the fine print. I've read every post in this thread, but if I'm missing something in regards to my plan, please let me know. On the surface, that Silver plan seems very comparable to my companies aside from being an in-network plan. BUt is there something I could be missing?

 

Thanks!

[shipps]

One thing to make clear, your deductible payments count towards your maximum out of pocket cost. Your post is a little confusing and could lead some to believe they are seperate.

 

Sometimes it does not count towards the OOP max. So that's another thing to verify as well.

[Chisoxfn]

Sometimes it does not count towards the OOP max. So that's another thing to verify as well.

I believe it is a requirement of all plans compliant with the actual ACA requirements.

[shipps]

I believe it is a requirement of all plans compliant with the actual ACA requirements.

 

That may be true in terms of the ACA plans. I am not sure.

[kevo880]

Kev...get an ACA quote and then call a variety of insurance brokers and get a variety of information. Also depending on your income situation, you may be in line for subsidies. I would be very skeptical of something that was non ACA. I'm also very skeptical of sales people in general though. I haven assumed biased that they will tell me whatever I want to get a sale and I test most sales people by asking select questions that I know the answer to and I want to see if they push me in the ethical way or not.

 

I am waiting to see the insurance plan that the company I work for is providing for 2016. For some reason they never give it to us until around mid-December. I talked to a coworker who had a baby using our company's insurance this year and she said it was actually better than all of the ACA plans that they researched. Obviously I will still do my own research, but that was nice to hear. If it stays around the same as 2015 then it will cost about $405/month to have my wife and child covered. She made it sound like they didn't pay more than $6k in hospital bills when they had their child.

 

After talking to the insurance broker I'm even more skeptical than I was. I sent him an email with 6-7 questions and of course he called me to answer them instead of just answering my specific questions that I had in the email. Instead of answering them directly he was sidestepping them and would start talking about a different benefit that I didn't ask about. When I asked him about the fee for not having an ACA plan he said it is indeed 2.5% of household income, which would be a ridiculous amount. He then tried telling me if we can show that my wife is an independent contractor or something then there wouldn't be a fee...I was like yeah but she's not and he said it's easy to show that she is. I then started asking about deductibles because he said something about zero deductible and he assured me it's zero deductible. Then I brought up how he had already told me the deductible is $5k if we have a baby and he was like well yeah because that's something major...

 

Needless to say, I have pretty much already decided to go with an ACA plan.

[kevo880]

Kev...get an ACA quote and then call a variety of insurance brokers and get a variety of information. Also depending on your income situation, you may be in line for subsidies. I would be very skeptical of something that was non ACA. I'm also very skeptical of sales people in general though. I haven assumed biased that they will tell me whatever I want to get a sale and I test most sales people by asking select questions that I know the answer to and I want to see if they push me in the ethical way or not.

 

Also, since I am in sales I do the same thing as you. I am selling a product that has fixed pricing and benefits though. Since there's no negotiations it makes it a lot simpler and easier to get someone's trust, especially when it's all listed on the website. But when I am dealing with a sales rep I ask them a few questions I already know the answer to as well to feel them out.

[Iwritecode]

Sounds like your insurance broker may have been a car salesman at one time.

[LittleHurt05]

Is it normal for our doctors to suddenly not be covered by Blue Cross starting January 1? We received the notice to update our plan, but I never got around to confirming our doctors were still in the network. I assumed they would stay, but suddenly our pediatrician and my wife's doctor are no longer in network with Blue Cross. The only one they both are on is Land of Lincoln, whatever that is. Is that normal to just change like that? Luckily, the marketplace deadline was extended two days so I can still pick a new one today.

[Y2HH]

Is it normal for our doctors to suddenly not be covered by Blue Cross starting January 1? We received the notice to update our plan, but I never got around to confirming our doctors were still in the network. I assumed they would stay, but suddenly our pediatrician and my wife's doctor are no longer in network with Blue Cross. The only one they both are on is Land of Lincoln, whatever that is. Is that normal to just change like that? Luckily, the marketplace deadline was extended two days so I can still pick a new one today.

 

I preface this by saying this my personal observation/opinion...

 

A lot of insurance providers are contracting their networks in order to keep their premiums down, in addition to other things such as raising deductibles and out of pocket expenses, a smaller provider network will also decrease the premium.

 

What happened was some of the assumptions made with the ACA didn't pan out, for a number of reasons. It was predicted that prices would be kept down (or the same) by the young generation picking up health insurance as to avoid the "fine" (tax)...but what actually happened was only older people signed up...causing payouts from insurance companies to skyrocket. Since the younger healthier people never bothered (hopefully this will change), there was nothing to cover the new expensive portion of the population (older/sicker people that actually use insurance a lot).

 

The fine was too slow to implement, and frankly, too small to matter. If I were 21, I'd basically pay the fine it's so small, because insurance prices are too high for what amounts to near useless insurance. If you are young and have a massive deductible combined with massive out of pocket maximums, you essentially have what amounts to a VERY EXPENSIVE catastrophic plan. Since the ACA doesn't allow "catastrophic plans" anymore...all the insurance companies did was jack the expenses to the point that that's essentially what most bronze plans are...only they cost about 20X what an older catastrophic plan cost.

Edited December 17, 2015 by Y2HH

[LittleHurt05]

Be careful about going with a health care sales associates. In my opinion they have a biased and will push certain plans upon you instead of finding exactly whats in your best interest. So you are going to have to really ask a lot of questions and make sure there are giving you all options. As long as you keep with the basic fundamentals that have been posted in this thread you will be able to make an informed decision. Obviously make sure you find out the maternity benefits of the plan as well.

It MIGHT be a good idea to go outside of the ACA from what I am seeing now actually. Blue cross specifically changed all their ACA plans to Choice products. These products are Out of network with almost all of what people consider "good hospitals". If you have a Choice plan you will not have many options at all.

 

It appears that most of the plans that were offered in the ACA marketplace this year is changing next year to where contracting with In Network facilities are going to be extremely limited. The insurance companies are realizing it isnt financially beneficial for them at all to offer plans to this population so in order to stay in line they will still offer the ACA plans but no one is going to want them. Its ridiculous, but that is for the buster I suppose.

 

I just saw this post, and it's right along with what I posted this morning. Blue Cross was losing so much money on the individual/family plans that they removed most of the doctors and hospitals from the network. If we want to keep saying the same doctors, we are gonna have to switch to an insurance company I've never heard of, or stick to BCBS's limited list. Getting screwed over as a small business owner not being on a large group plan, thanks Obama!