Healthinsurance.gov questions (aka we spent 1 billion on this shit???)

[Meresgi]

So question regarding the wording of some of these plans and shit. I left my job this month and my coverage ends on the 31st. I can do COBRA which, looks like it's around $2500 annually. I believe it's annually but it doesn't so so anywhere on my documents, I would doubt it was $2500 a month.

So went to Healthcare.gov and had to call because it's not open enrollment and why have a website when you can do phone service instead?! After doing the application they pointed me at www.healthsherpa.com. Looking over these plans I can't seem to understand what all is going on here. Case in point this random one:

Deductible
You are responsible for all costs up to this amount per year. You pay part of your costs above this amount, until you spend your out of pocket max. See cost sharing below.


MedicalDrug
$4,000 / person-
$8,000 / family-
Out of Pocket Maximum
This is the most you will spend per year for your healthcare costs.

MedicalDrug
$6,350 / person-
$12,700 / family-

So what is that $4000 per person deductible? Is that how much I have to pay before the insurance covers ANYTHING? aka if my ER visit is $3500 i'm paying it all out of pocket?

Site is annoying as fuck and since my new job pays so much, I don't qualify for anything below $260+ a month due to lack of tax breaks. I don't get coverage from new job till January though.

[archibaldcrane]

I think it's more likely that your COBRA is 2500/mo than 2500/year, actually. Is it just for you or do you have a family on your plan?

So what is that $4000 per person deductible? Is that how much I have to pay before the insurance covers ANYTHING? aka if my ER visit is $3500 i'm paying it all out of pocket?

Yes, that is what that plan offers. Some services, like a yearly physical exam, woman's yearly gyno exam, and a few other things are not subject to deductible - those are "free" to you - but for an ER visit, yes in that plan you'd pay up to the first $4000 out of pocket. Remember, even though it's "out of pocket up to deductible limits" - you still wouldn't be paying "cash" prices, you'd be paying the negotiated rates your insurance company set up with your network providers. If you want no deductible, you need to look at Gold and Platinum plans.

[archibaldcrane]

Keep the questions coming btw, I'm kind of the master of this shit by now.

[archibaldcrane]

Also I'm really surprised that, since you are obviously eligible for special enrollment, that you can't shop directly on Healthinsurance.gov.

Weird.

[Meresgi]

Yeah not sure why I can't just go to healthinsurance.gov.

It's me and my wife on the plan and that's it. No history of anything, or smoking/habits and shit. Honestly i'm thinking if it's fucking $4000 then I might just be better of not having insurance for the next 4-5 months when I get enrolled into my new company. Other then wife getting sick this past week and going to urgent care to get some antibiotics/fluids I havn't even used my health insurance for a year. Since they are basing it off my salary at my new job which is over $60k i'm getting fucked lol. Even based off my old income I would still not qualify for any reductions it seems when combined with wife's income.

[Quixon]

You can use Cobra as a safety net. Decline it at first. If anything happens before the COBRA expiration date, you can call them up and they will just backdate the billing.

[Meresgi]

You can use Cobra as a safety net. Decline it at first. If anything happens before the COBRA expiration date, you can call them up and they will just backdate the billing.

Oh really? I didn't know that. I'll probably just do that then incase something major happens (like massive ER bill) and pay out of pocket for simple shit.

[archibaldcrane]

You can use Cobra as a safety net. Decline it at first. If anything happens before the COBRA expiration date, you can call them up and they will just backdate the billing.

Oh really? I didn't know that. I'll probably just do that then incase something major happens (like massive ER bill) and pay out of pocket for simple shit.

This is a shady but not-terrible idea. Note that you have 60 days from when you're offered COBRA to accept it - so once you get your COBRA package (it should have dates on it) you are "potentially" covered if you need major medical as long as you file before the end of that 60 days and pay for those two months. After that 60 day window I think you are SOL though.

However, how much is the cheapest gold plan you're offered, since you're so worried about high deductibles?

[archibaldcrane]

So when you go here: https://www.healthcare.gov/screener/ Choose your state and select "Find out if you qualify for a Special Enrollment Period." and then click YES on "Did you or anyone in your household lose health coverage in the last 60 days OR do you expect to lose it in the next 60 days?" on the next screen - it doesn't take you to a place to create an account and apply for insurance?

[Meresgi]

So when you go here: https://www.healthcare.gov/screener/ Choose your state and select "Find out if you qualify for a Special Enrollment Period." and then click YES on "Did you or anyone in your household lose health coverage in the last 60 days OR do you expect to lose it in the next 60 days?" on the next screen - it doesn't take you to a place to create an account and apply for insurance?

It sends me to Maryland's site, which then has a phone # you have to call

[archibaldcrane]

It sends me to Maryland's site, which then has a phone # you have to call

oh

yeah don't go to healthcare.gov if your state has it's own exchange. It looks like Maryland's site is currently being upgraded, hence the phone-only option. That has nothing to do with healthcare.gov or "the billion dollars" spent on it. Maryland chose to run their own exchange - your issue is with them. Healthcare.gov is only for people in states who decided not to run their own exchanges.

[Ksandra]

You can use Cobra as a safety net. Decline it at first. If anything happens before the COBRA expiration date, you can call them up and they will just backdate the billing.

Bit of warning on doing this: when I was preggo with my daughter, and hubby was laid off, doctors wouldn't see me until they saw the cobra paperwork. It was a nightmare.

[Roranora]

Is this where I can mention non-ACA options? (*'-'); At the very least, they'll prevent a better temporary option than short-term plans, if some coverage is needed/desired before open enrollment returns this fall.

Maryland is one of the initial 14 states that set up their own state exchanges, but that'll fluctuate, and I don't know its future. Oregon shut its down state exchange down. Conversely, New Mexico and Idaho went with healthcare.gov initially, but will run hope to run their own exchanges in the future.

Even with the exceptions that conceivably allow for people to enter ACA plans outside of open enrollment, I've yet to actually see someone get that coverage in place since April - even with a qualifying divorce, birth, etc. Maybe some states are better at getting those policies in-force.

You outta consider yourself lucky in Maryland, at least assuming a state-ran exchange is preferable to healthcare.gov.

Nearly 48 million Americans, 15.4% of the total population, lacked health insurance last year, according to a new Census Bureau report. And most of them — 59.4%, to be exact — live in states that have chosen not to set up their own insurance exchanges under the Affordable Care Act, commonly called Obamacare.

http://www.pewresearch.org/fact-tank...are-exchanges/

[Grey Jorildyn]

Sadly I am a CAC in NY now and insurance is still confusing. Most anyone I enroll only qualifies for medicaid anyway. Makes it simple!

[archibaldcrane]

Compared to applying for insurance before the ACA, it's incredibly simple now. You don't have to delve into your medical history, listing every ailment you've had in the past 20 years, names of doctors you've long since forgotten, etc. etc.

Now you just have to say whether you smoke, how much money you make and how old you are lol.

[Meresgi]

Archi,

any idea if they will give me a discount as I work full time but am not offered healthcare at this time? Wife when she was fulltime was going to put me on her policy but she decided to go back to college and lost those benefits.

[archibaldcrane]

Discounts (tax subsidies) are solely based on household income and size for the calendar year. I assume you are looking for a plan for both yourself and your wife? If your household income this year will be more than 62k, you will not qualify for a subsidy.

The good news about that is you don't have to go through the Maryland site to buy your insurance - you can just buy directly from individual insurers in your state, who likely have much more functional website shopping tools. Find out who they are and check them out.

[Skyylya]

I left my last job in april and found a short term plan with united for 159/mo with 1k deductable over 6 mo ths. Better than healthcare.gov and and just took some looking. Just me a 31 male with no smoking or anything

[Quixon]

I look at some peoples health care prices and I almost want to scream. My health insurance costs a fucking fortune through my employer.

[Meresgi]

I look at some peoples health care prices and I almost want to scream. My health insurance costs a fucking fortune through my employer.

Yeah and they only cost that much because of the way the system is set up. Same way how fucking bandages cost $150 at a ER. Price gets jacked up super high for people with insurance, fucking over others who don't have it.

@Sky

It's just called United? http://www.uhc.com/ This one?

Also question on the copay stuff, since i'm new to all this.

Say I go to the doctor for the flu, and get some antibiotics or w/e. Do I need to pay all of this out of pocket up to my deductible? or is that there for serious things like I get rushed to the ER and lose a leg type stuff?

Since it's usually just a visit to Patient First to get checked out right now and get some prescription, I want to make sure i'm not paying out of pocket for the entire visit.