Falling off the Essential Plan - what's next affordable?

amother

Sun, Oct 06 2019, 7:49 am

Hi all. Really hope to get helpful answers.
We will most probably not be able to get the Essential plan health insurance program after recertification. The insurance through my work is too expensive for us. Husband's job doesn't offer insurance.
I thought we'd be doing a healthshare, but firstly it also expensive and then I'm reading other threads where people warn against it.
We're in our 40s, with no known health conditions bli Ain hara. What can we do for health insurance - affordable and acceptable by doctors in BP/ Flatbush? Thank you!!

Amarante

Sun, Oct 06 2019, 11:10 am

Find a broker who is knowledgable and buy something on the Exchange.

Since you are on the threshold of income, I will assume that you will be eligible for a nice subsidy for your health insurance purchased through the Exchange. Each of the states will have a website so you can feed in your income and it will give you a general idea of what your actual premium will be - e.g. after the subsidy.

However, I urge you to find an experience broker who can advise based on your exact needs. My understanding is that there are additional subsidies available for people with certain income levels for the SILVER PLANS. I apologize for being cryptic but I don't know how it works in real life in terms of income levels. But basically if your income is low enough to qualify for this additional subsidy, the actual costs of care are even lower - e.g. there is a subsidy for MEDICAL EXPENSES in addition to the subsidy for the premium cost. This only applies for the Silver Tier level.

This is why finding a good broker is critical. They are often more knowledgable about which providers - especially hospitals - are within specific networks and can also help run costs to let you know what each scenario would cost you each year - e.g. both premiums and actual expenses based on various scenarios.

monkeys

Sun, Oct 06 2019, 11:35 am

Amarante wrote:

I think it depends on the state. This is correct for covered CA. A good broker is critical.

Last edited by monkeys on Mon, Oct 07 2019, 12:07 am; edited 1 time in total

Amarante

Sun, Oct 06 2019, 11:48 am

monkeys wrote:

I think it defers by state. This is correct for covered CA. A good broker is critical.

Not sure what you mean by defers by state - assuming it was autocorrect and you mean depends.

However, still not sure what aspect you are referring to.

The additional subsidy for Silver Plans is - at least from my research - a national subsidy so it should be available in every state.

However it is only something I read about when researching which is why I advised using a knowledgable broker. It is something that isn't obvious if one is just signing up through the website.

I can only surmise that OP's income is low enough so that she might be able to take advantage of this.

amother

Emerald

Sun, Oct 06 2019, 11:52 am

I did it through the NYStateofhealth website, without a broker. There's a lower tier than Silver. I think it's called Bronze. I'm on it with dh and dd above 18, and for the three of us it was in $800-range, but some kind of tax credit gets automatically deducted bc of income level (this deduction was calculated by website right away and didn't require additional calls or anything), and we pay in the $500 range per month. This was the lowest plan and is through Fidelis. Our monthly invoice shows the full amount, the deduction, and then how much we actually owe. Don't remember the exact deductibles, but no dental of course, and annual visits are with minimal copay and bc/IUD is covered.

Amarante

Sun, Oct 06 2019, 11:57 am

Bronze is the lowest tier and least expensive premium per month. The deductible and annual out of pocket maximum are highest and generally co-payments are also higher.

The subsidy for premiums is automatically calculated at the website when one purchases through the website.

However, depending on income level the Silver Plan can actually be less expensive than the Bronze Plan. This isn't apparent from the website because it is not a subsidy for the premium but it subsidizes the medical expenses.

There is always going to be an element of uncertainty in terms of predicting the future as to what your total medical expenses will be based on different scenarios. A good broker can show you the analysis and advise as to what makes the most sense for each individual person or family.

amother

Sun, Oct 06 2019, 2:09 pm

amother [ Blonde ] wrote:

My husband's on a cheap catastrophic plan from Oscar. Very few Drs take it though. Would that be an option for you?

Thank you for all the replies and everyone. The catastrophic plan won't work because it's only offered for people under 30 and the deductible is at least 6,000 per person.
I used to be very familiar with the " Obamacare/ exchange" plans and I believe doctors are not thrilled with accepting patients who have this coverage. I will go through the application and see what's available, with a navigator if necessary, but would love to find out if there choices costing less than $450-500 a month. Thanks again!

amother

Blonde

Sun, Oct 06 2019, 2:28 pm

amother [ OP ] wrote:

Sorry about the age limit. I do want to point out that the $6000 deductible isn't crazy if you factor in the $400 we save a month- comes out to almost $5000 a year so we pay an extra thousand only if we use the plan. Otherwise we save many thousands.

Whatever plan you choose, do the math- if the difference in premium is more than the difference on deductible, the "better" plan might not be worth it

amother

Emerald

Sun, Oct 06 2019, 2:59 pm

amother [ Blonde ] wrote:

Yes, this was exactly our cheshbon. Rather pay less for Bronze plan and CERTAINLY save money, than pay more for a Silver plan, and maybe save money, if c"v we have more medical expenses. And even then difference might not be significant after calculating the monthly savings.
Op, our plan is within $500 range for 3 adults, including my 18yr dd. That Bronze plan would be less for you for two adults. Idk where you are, but I have many good choices with Fidelis/Bronze in my area.

amother

Sun, Oct 06 2019, 3:38 pm

amother [ Emerald ] wrote:

I do understand the above. I also have a child turning 19 who will lose child health plus, and a few more kids on child health plus. So I might be looking at $500 + $90-180. The state might think it's affordable, but just like most here I'm paying yeshiva tuition, bh. ,🤪
I'm glad Fidelis is accepted. Do they cover BC? Thanks

amother

Emerald

Sun, Oct 06 2019, 9:30 pm

amother [ OP ] wrote:

Yes, bc is fully covered even with Fidelis (which had used another company for bc coverage in the past...), since it's required of every marketplace plan by law. I got my IUD inserted by my regular ob (who accepts Fidelis) for free, after switching to the Bronze plan.

amother

Sun, Oct 06 2019, 10:33 pm

amother [ Emerald ] wrote:

Thank you so much for the reply!

monkeys

Mon, Oct 07 2019, 12:06 am

Amarante wrote:

Sorry about the typo. Yes, I meant to write that it depends on the state. From what I understood the silver plans were CA specific but I could be totally wrong. OP needs to speak to a knowledgeable broker.