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Forum -> Household Management -> Finances

View latest: 24h 48h 72h

amother

Orange

Mon, Feb 06 2023, 6:57 pm

amother Glitter wrote:

We can, because the qualifying event didn't happen yet. Dd will be turning 26 very shortly, and will be getting kicked off our insurance.

I have no idea where to start, who to call or what to do Can't Believe It

Ok. That is different.

Your best option is to contact a good insurance broker. You don’t pay anything and they generally have both software and knowledge of different plans.

A good way to get a general sense is to go to your state’s marketplace and you will get a sense of what the cost is. The premium for a 26 year old is relatively reasonable because most states factor age although New York might not but I am not familiar with each state.

Depending on your daughter’s income,e she could be eligible for premium subsidies which lower the cost

amother

Glitter

Mon, Feb 06 2023, 7:00 pm

amother Orange wrote:

Thank you, but how do I get a good sense of what plans are awful, that no doctors take, and that we should stay away from?!

amother

Orange

Mon, Feb 06 2023, 7:06 pm

amother Glitter wrote:

Thank you, but how do I get a good sense of what plans are awful, that no doctors take, and that we should stay away from?!

A good broker would know this.

In general Blue Cross and Blue Shield plans are the best but you also have to consider whether a plan is an HMO, PPO or EPO. HMO is the least expensive but generally has the smallest network and most restrictions on accessing specialists.

But health insurance has tiers with Bronze being the least expensive and Platinum being the most expensive. The level also will impact deductibles, co payment, and annual pit of pocket expenses.

You can ask your doctor which insurance they take and also find out which hospitals are in the network.

But really a good broker is yiur best guide because you are balancing cost based on how you use medical care. Someone who is healthy might have different needs than someone who has a chronic condition.

esuss

Mon, Feb 06 2023, 7:19 pm

Refuah does cover maternity but only I believe if you were signed up for a full year before conception. So unless the newly married couple are willing to use birth control for the first year don’t do it. They also don’t cover diabetic supplies so if she was diagnosed with diabetes during the pregnancy you will pay a lot for that.

Getting married should be a qualifying event to be able to sign up for the marketplace after open enrollment is over.

amother

Orange

Mon, Feb 06 2023, 7:35 pm

Refuah does not cover prescription drugs. They cover drugs administered in a hospital and certain high cost drugs over $10,000. I would assume this would be chemotherapy or the equivalent.

HIGH-DOLLAR DRUGS: Expensive medication or treatment protocols are eligible for sharing. The definition of a high-dollar drug is one that the cost of a full course of treatment is over $10,000.

BRAND NAME DRUGS: Prescriptions for brand name medication are ineligible for sharing. However, we can assist our members in obtaining these medications, usually at very significant discounts or even at no cost, through the Patient Assistance Programs of the drug manufacturers for self-pay patients.

STANDARD PRESCRIPTIONS: Standard Prescriptions are not eligible for sharing. All members should have received our TeleRefuah discount card for discounted medications nationwide. This card should help you get a 30%-50% discount on medications at the pharmacy of your choice. If you don’t have the card, please call us, and we will mail you a new one. Many other online resources can also help you find great prices on medications, such as GoodRX.com and NeedyMeds.org.

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