Health insurance?!?!?

Amarante

Mon, Dec 21 2015, 3:25 pm

Yes you are missing that your total out of pocket medical expenses for a family are capped at 12,000 approximately which is a lot but which protects you from catastrophic medical expenses. Even a normal pregnancy is probably more than that.

Medical insurance in the IS is expensive for a variety of reasons. Most people don't realize how expensive it is because they receive through an employer and costs are subsidized.

You can shop around for a better plan because most plans pay more than 50% if you stay in network.

And you are risking a lot if you don't get medical insurance. You pay a penalty fr each uninsured person in your family. You have no coverage n the event that you need expensive care and you won't be able to get it until next year. You will als pay more for an care because most medical facilities charge higher rates if you don't go through negotiated insurance rates.

MagentaYenta

Mon, Dec 21 2015, 3:34 pm

hifromkgh wrote:

What do you do? Anything on the Obama care network is a fortune and barely covers anything. high deductible and once reach deductible only covers 50% thats after spending 20K on a family plan---are we missing something? does it even pay to have insurance?

Point of information: Obamacare is not insurance. The PPACA established criteria for health insurance on a national level. It did other things too, besides mandating that you can no longer be turned down for insurance if you have a pre existing condition.

The PPACA works a bit differently in states with medicaid expansion.

What you really should know is states regulate the health ins. business within each of their boundaries. 'Obamacare' doesn't determine what your premium will be. That is up to each state to hash it out with their own insurance commission and the insurance companies. If your rates are unaffordable then call the dept that regulates them in your state. They are the ones that approve policy premiums and rate hikes.

Talya

Mon, Dec 21 2015, 3:53 pm

MagentaYenta wrote:

Obamacare insured that I had to pay for lots of services I didn't need. Such as pediatric dental care when I didn't have any kids.

I put in that I get through my job but that is for next year. Until now I've had private insurance. Was a plan we were on before it came into effect and somehow managed to keep it until now. Our current plan will have double premiums next year. Completely unaffordable.

MagentaYenta

Mon, Dec 21 2015, 4:01 pm

Talya wrote:

I have empathy for anyone who has a plan that gives them services in addition to those they choose. I'm not someone who is carrying pediatric dental but I understand how bundles work and some policies bundle. I'm in an area with a lot of choices so I didn't have to consider bundled policies.

I've never had health ins. coverage that didn't rise annually. I know that ins prices (not the coverage which is regulated by the PPACA) are an individual states issue and not an issue of the PPACA.

Amarante

Mon, Dec 21 2015, 4:26 pm

Talya wrote:

That's extremely odd since my health insurance doesn't cover any dental care at all so if you have no children, why would your plan cover care for children. In purchasing insurance, it specifically has coverage for adults and then you add children if you are also covering children and your policy would also then be including dental coverage which mine doesn't.

Turn it around as many people complain that insurance covers child birth even though they can't give birth or don't intend to have children. But if they exclude it, the cost of getting insurance by "fertile" women would be very expensive so what the law does is spread the cost of what is thought to be basic medical coverage over everyone. That is what insurance does because some people pay more in premiums than they receive while others receive far more in medical coverage than they pay. Does a frum group of women want to exclude adequate health coverage for women?

There is an issue with how expensive medical care is in the US but what we have now represents the best that could be accomplished with a Republican minority that wanted to pass nothing.

Without the act, people could not get insurance if they had ANY type of pre-existing medical condition - and trust me that meant even the slightest issue like normal high blood pressure.
Children could not continue to be insured on parents' policy.

We should have had a public insurance policy similar to Medicare. No one I know is unhappy with Medicare Very Happy

But because of the private insurance lobby, we had to continue a system in which high administrative costs must be paid to ensure profits by the insurance companies who don't do anything.

And the Republicans refused to let the government negotiate with the drug companies which is why the US has the highest drug prices in the world.

And why does a hip or knee implant cost $5000 in Brussels and $30,000 or so for the same implant in the US. I chose Brussels because it has an excellent medical system.

I could go on.

wow

Mon, Dec 21 2015, 8:10 pm

I have health insurance through the ny health exchange aka obamacare. I didn't vote because it's "obamacare" and I also pay it "in full"... so not sure which to vote lol. We don't qualify for subsidies. As long as my husband and I are under 30, we choose a catastrophic plan, because it's the lowest premium, and even tho it also has the highest deductible, since it's capped at 6850.00 maximum out of pocket per person it still comes out the best bet. I figured out a good strategy. My husband and I use different doctors, who accept different insurances. Therefore, I requested to have two single individual plans from different insurance carriers, vs a couple / family plan. The reason being is that it's basically only I who use the doctor (in the even of pregnancy etc) while my husband goes much less often. With two individual plans , I only need to pay the 6850.00 deductible and reach my individual out of pocket max , as opposed to the 12k it would've been under a couple or family plan.
Regarding the kids , why haven't you chosen child health plus? It comes out cheaper than a family plan because it covers EVERYTHING! No deductibles and no copay. Most people are eligible for child health plus at a cheap subsidised rate capped at 180.00 per month for all kids. For example, a family of four, (two parents two kids) are allowed to make up to 96k per year and get child health plus for 60.00 a month per child.

MagentaYenta

Mon, Dec 21 2015, 8:23 pm

wow wrote:

... As long as my husband and I are under 30, we choose a catastrophic plan, because it's the lowest premium, and even tho it also has the highest deductible...

Snipped for brevity only. In the way back days (aka when I was young and childless) I bought catastrophic plans. I'd typically go for my physicals and routine care to a local Planned Parenthood. I was healthy and they provided adequate care for me.

Kudos, you seem quite savvy with regards to purchasing ins. Did you go through a broker?

wow

Mon, Dec 21 2015, 8:34 pm

MagentaYenta wrote:

No, I did it all myself. Two years ago, I was due in January, and my healthy ny got cut off in December. Obamacare and the ACA was so new then, and my doctor found himself being out of network for most exchange plans. I did a ton of research then on obamacare and insurance laws, as I was in a real jam. Ever since then, since my husband is self-employed and I need to find coverage myself, I'm always doing research and staying in the loop.
I calculated premiums plus deductibles a thousand times, and if I am to have a baby under these plans, the catastrophic plan comes out to be the cheapest!

MagentaYenta

Mon, Dec 21 2015, 8:41 pm

wow wrote:

You've done excellent work. You are insurance literate. I spent years on a state board that negotiated ins. for public employee union members so I wasn't really daunted by the PPACA and I also live in a medicaid expansion state. In my area our medical monopoly embraced the PPACA and is pretty much ahead of some future compliance areas. (My med records are all online, I can see test results as soon as they're entered, and I can skype my Dr. to see if a complaint is worthy of an office visit.)

Good luck and best wishes on your baby!

wow

Mon, Dec 21 2015, 8:42 pm

hifromkgh wrote:

Thanks wow for that info . I think we make just a little above the mark for CHP so we r paying for that in full. I believe that's almost 700$ a month for 4 kids. As for two ind plans I will look into the catastrophic choice . I know I can't be the only one with insurance issues so I figure id post here and hear everyone say on the matter

Yes 700 a month for four kids sounds just about right, however, I believe that if you go with the catastrophic plan, (and don't need to use your insurance often) it still comes out cheaper than a family plan.
Be aware though that you are eligible for catastrophic only if you are under 30 when you enroll.
Another point - as soon as anyone gets pregnant, the family size changes, so you can report it and your income level eligibility goes up.
Regarding two individual plans , wanna point out that you will need to call them to request this, as it's something they need to do for you on their end. You won't have the option to choose it yourself when you go online.
Another point - some silver plans are HSA compatible. If you are familiar with an HSA account , and think u can benefit, just pointing it out as another option. If u need more info on that , lemme know and I will explain.
Good luck! I know how hard this is! I sometimes feel it almost doesn't pay to make that extra money if I'm not eligible for any insurance help. It really sucks out so much money!

Mon, Dec 21 2015, 8:52 pm

wow wrote:

I understood that the per person max always stays the per person max. The only time the family max will come into play is if you have kids on your policy also.

busydev

Mon, Dec 21 2015, 9:12 pm

I would double check about the individual/family premium....

I thought the same (and it could be its different cause a. im in another state and b. in this case im talking about employer offered insurance) BUT DH was given papers to pick an insurance plan for next year and it specifically said very clearly that in a family plan any individual wont have to pay more then the individual amount of deductible and even if there is still more on the family deductible, coinsurance will kick in at that point. however if the family deductible is filled before the individual deductible then its onto coinsurance for everyone.

Amarante

Mon, Dec 21 2015, 9:17 pm

Yes it's definitely one figure for an individual to meet the deductible.

The family deductible kicks in when there are multiple family members so once Mother has reached the individual deductible, she is covered and then deductibles would only apply for father and any children until the family deductible is met.

FWIW, the Silver Plan is supposed to have a sweet spot if you are eligible for subsidies so that there is assistance for the deductibles which means for many people it's an extremely low cost plan with excellent coverage.

wow

Mon, Dec 21 2015, 9:20 pm

KB - I have double checked with the NY state of health, and they said that if there is more than one person on the plan, then you need to meet both individuals deductibles before the plan starts paying.
Busydev - I know that there are other plans who don't make you do that (I've been on an employer plan before that worked like yours) but unfortunately, I have made lots of calls regarding this, and this is what I was told.
If anyone can verify differently, then please let us know!