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Marketplace Insurance



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mushkale




 
 
    
 

Post Fri, Apr 30 2021, 5:07 pm
Is a regular (not Medicaid or subsidized) plan through the Marketplace the same as a private plan? For example- if I get a higher tier United Healthcare plan, does everyone who takes UHC take it? Or is it considered something else?
I can't figure it out and the doctors office that I need to know this most for, doesn't answer the phone....
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amother
Linen


 

Post Fri, Apr 30 2021, 5:37 pm
No they are not the same and they have very different networks. The private plans have better networks than the marketplace plans. If it is important to you to stick with certain doctors, then you need to call those doctors and ask which marketplace plans they accept

To go with your example, there are definitely doctors who take United healthcare that you have from an employer, and not united healthcare from the marketplace (I think the one from the marketplace is called united healthcare compass).

That is the reason that I keep my employer plan and do not switch to a marketplace plan, even though it would be cheaper for me. I need to be able to get to certain doctors who do not take marketplace plans
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amother
Sapphire


 

Post Fri, Apr 30 2021, 5:42 pm
mushkale wrote:
Is a regular (not Medicaid or subsidized) plan through the Marketplace the same as a private plan? For example- if I get a higher tier United Healthcare plan, does everyone who takes UHC take it? Or is it considered something else?
I can't figure it out and the doctors office that I need to know this most for, doesn't answer the phone....


I had the same question. I called my primary and he doesn't take any of them (marketplace).
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amother
Linen


 

Post Fri, Apr 30 2021, 5:57 pm
And it's not just doctors, its hospitals also. Many marketplace plans have only a few hospitals in network.

I had united healthcare compass a few years ago (before I switched to employer insurance). I was seeing a dr who accepted it. Then I needed a medical procedure. And only then did I found out that the hospital this dr was affiliated with does not take united healthcare compass. It was a huge mess.

Since I switched to employer insurance I have never had any issues with any dr or hospital. Its just alot of $$$$. But worth it in my opinion
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mushkale




 
 
    
 

Post Fri, Apr 30 2021, 6:02 pm
I don't have an employer option. It would be through my husband's job and it would be over a thousand more than the Marketplace. That's not just more expensive, that's astronomical. And I'm paying out of pocket for my midwives whichever plan so is it really worth it?
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amother
Aquamarine


 

Post Fri, Apr 30 2021, 6:05 pm
Linen is right, it's not the same thing and many don't take it. I've used it when I didn't have a choice before and it was ok.
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Amarante




 
 
    
 

Post Fri, Apr 30 2021, 7:08 pm
not all market places plans even with the same company have the same network. A platinum pan might have a different network and an HMO will have a different network than the PP OR EP plans. You really have to check out each plan which is why a good broker is helpful because they often know about networks at different tiers.
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amother
Linen


 

Post Sun, May 02 2021, 11:00 am
mushkale wrote:
I don't have an employer option. It would be through my husband's job and it would be over a thousand more than the Marketplace. That's not just more expensive, that's astronomical. And I'm paying out of pocket for my midwives whichever plan so is it really worth it?


ok It doesnt sound like you really need the employer option then. It sounds like you need to find out from one specific doctor if they take any marketplace plans, and if so, which ones
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Amarante




 
 
    
 

Post Sun, May 02 2021, 11:17 am
mushkale wrote:
I don't have an employer option. It would be through my husband's job and it would be over a thousand more than the Marketplace. That's not just more expensive, that's astronomical. And I'm paying out of pocket for my midwives whichever plan so is it really worth it?


Unless the laws have changed, you are not eligible for a subsidy through the marketplace if you can get insurance through your spouse's employment. It is one of the things which should have been corrected but unfortunately it wasn't until this year that any amendment making Obamacare BETTER was even possible. Very Happy

You can purchase insurance through the marketplace but you aren't eligible for the premium subsidies. Your best bet is to contact a good broker and find out what your options are. The marketplace is just one way to buy private insurance but it is the ONLY way to buy insurance and get the premium subsidy. If premium subsidy isn't a factor, then you might do better in terms of networks getting a plan that isn't offered on the marketplace.

One of the reasons insurance for family and dependents is so expensive is that many companies only subsidize for the actual employee. People don't realize how expensive the premiums are because the company is paying a significant percentage. And often corporate plans are very generous so again the actual premiums are high but company covers as a benefit. Sticker shock also occurs when people find out what COBRA costs.

Health insurance is very complicated. Best bet is to find a broker to determine what your best options are.
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amother
Linen


 

Post Sun, May 02 2021, 11:22 am
Amarante wrote:
Unless the laws have changed, you are not eligible for a subsidy through the marketplace if you can get insurance through your spouse's employment. It is one of the things which should have been corrected but unfortunately it wasn't until this year that any amendment making Obamacare BETTER was even possible. Very Happy

You can purchase insurance through the marketplace but you aren't eligible for the premium subsidies. Your best bet is to contact a good broker and find out what your options are. The marketplace is just one way to buy private insurance but it is the ONLY way to buy insurance and get the premium subsidy. If premium subsidy isn't a factor, then you might do better in terms of networks getting a plan that isn't offered on the marketplace.

One of the reasons insurance for family and dependents is so expensive is that many companies only subsidize for the actual employee. People don't realize how expensive the premiums are because the company is paying a significant percentage. And often corporate plans are very generous so again the actual premiums are high but company covers as a benefit. Sticker shock also occurs when people find out what COBRA costs.

Health insurance is very complicated. Best bet is to find a broker to determine what your best options are.


I think if the employer plan costs more than a certain percentage of your income (10%) then you can still get a subsidy on the marketplace

And not all employers subsidize the employee....my employer does not pay into my premium at all, I pay the full premium myself which is more than 10% of my salary. I have an individual plan from my employer and my husband has a marketplace plan
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mushkale




 
 
    
 

Post Sun, May 02 2021, 11:24 am
My OP said without subsidies- I know I'm not eligible. Even so it's still cheaper than being added to my husband's plan. I wish I could just call any of these companies and pay private to them without the middle man of the Marketplace but it seems like they isn't an option. At the end of the day- the deductibles are so high on every plan that having a baby is going to cost me a ton no matter what and the question is if I also have to shell out a crazy premium monthly. What are those benefits.
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Amarante




 
 
    
 

Post Sun, May 02 2021, 11:29 am
amother [ Linen ] wrote:
I think if the employer plan costs more than a certain percentage of your income (10%) then you can still get a subsidy on the marketplace

And not all employers subsidize the employee....my employer does not pay into my premium at all, I pay the full premium myself which is more than 10% of my salary. I have an individual plan from my employer and my husband has a marketplace plan


Yes you are correct - the plan must be affordable which is 9.56% of income.

Not all corporate plans are subsidized as many small companies simply can't afford it. Before Obamacare, the real benefit to those kinds of plans was that employees could obtain insurance because prior to Obamacare people with any kind of pre-existing condition often couldn't get insurance - let alone somewhat affordable insurance.

I was dealing with insurance for the employees for a small company prior to Obamacare and when it was implemented. We could get a "group" plan for our employees which we did but every individual employee was rated so that we were paying a very high amount for the older employees and a lower amount for the younger employees.
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amother
Mint


 

Post Sun, May 02 2021, 11:51 am
It's a little unconventional, but you might be better off with Refuah Health Share.

Sample cost breakdown:

Couple + 0 kids:
$350 per month
First $1000 of medical costs out of pocket
After this, 80% of costs up to $20,000 of expenses (I.e. $4,000 out of pocket)
+$900 pregnancy
= Minimum total per year (I.e. zero medical expenses) is $4,200 per year
= Maximum total per year is $10,100

Couple + 4 kids
$500 per month (additional kids are $50 each per month)
First $1,500 of medical costs out of pocket
After this, 80% of costs up to $40,000 of expenses (I.e. $8,000 out of pocket)
+$0 for a birth on a family plan
= Minimum total per year (I.e. zero medical expenses) is $6,000 per year
= Maximum total per year is $16,400

Caveats:
You must be a member prior to the beginning of your pregnancy for it to be covered
Significant limits on pre-existing conditions
Standard medications are not covered, although they provide a discount card
Some providers will require you to lay out money for services (and Refuah HS will pay you back)
There is a maximum of $1 million per medical event (I don't know how common this is)

If you join, it would be responsible to put the maximum total for the year in a savings account in case it was needed.
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mushkale




 
 
    
 

Post Sun, May 02 2021, 12:14 pm
Thanks! I actually spoke to them awhile ago and I know people who use them but it doesn't work for out family (mostly because of my children's preexisting conditios)
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amother
Linen


 

Post Sun, May 02 2021, 12:17 pm
mushkale wrote:
My OP said without subsidies- I know I'm not eligible. Even so it's still cheaper than being added to my husband's plan. I wish I could just call any of these companies and pay private to them without the middle man of the Marketplace but it seems like they isn't an option. At the end of the day- the deductibles are so high on every plan that having a baby is going to cost me a ton no matter what and the question is if I also have to shell out a crazy premium monthly. What are those benefits.


I could be totally wrong on this, as I was not pregnant when I had a marketplace plan, but I think I heard that prenatal/childbirth costs are covered by the insurance company even if you didn't meet your deductible?
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Amarante




 
 
    
 

Post Sun, May 02 2021, 2:12 pm
mushkale wrote:
My OP said without subsidies- I know I'm not eligible. Even so it's still cheaper than being added to my husband's plan. I wish I could just call any of these companies and pay private to them without the middle man of the Marketplace but it seems like they isn't an option. At the end of the day- the deductibles are so high on every plan that having a baby is going to cost me a ton no matter what and the question is if I also have to shell out a crazy premium monthly. What are those benefits.


You don’t have to go through the marketplace. You can get health insurance directly. It may or may not be better but network will be different. For example, in Los Angeles, Cedars Sinai was not in a network for ANY marketplace plan but was if you got a plan not through the marketplace. This was in one year and then networks changed.

Of you don’t have a subsidy there is no reason to purchase through the marketplace. A broker can sell you a marketplace plan or one directly with the insurance company. They get their commission either way.
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