Tips on Shopping for Health Insurance?

audrewuh

I've got to get information in to my SPR today on what health insurance plan I want to enroll in. I have a max budget of $200/mo I need to stay at or under.

Do you have any advice or tips? I've never done this before, I just switched my old policy into my name when my dad passed earlier this year. I'm not even sure where to start, besides with my current insurer (where my payments are not current).

[Deleted User]

Are you shopping for your insurance on the open market or choosing from plans your work (or your H's work) offer?

I've only ever had insurance through the military (my dad was Navy) or through my employer (who offers multiple plans that I can choose from annually). I've never shopped for health insurance on the open market...but H has and it's quite expensive. I would guess you wouldn't be able to get under $200/mo premiums unless it was just disaster coverage.

audrewuh

I'm shopping in the open market and right now, my current coverage is all right and just a little over $200. I know it's possible, I'm just not sure where to start. I guess I go to individual insurance sites and see. 

buddysmom80

@audrewuh have you checked your state's Affordable Healthcare Act website? Last I heard, those policies don't roll out until 1/1/14, but something to look into.

audrewuh

Yes, our state doesn't have an individual one, @buddysmom80. The healthcare.gov website says I'm elligible for deductions, as does Blue Cross Blue Sheild, but I'm unable to view my eligibility results due to the shittastic problems the website is having. 

So yay. 

Can anyone explain to me what co-insurance is?

buddysmom80

audrewuh said:

Yes, our state doesn't have an individual one, @buddysmom80. The healthcare.gov website says I'm elligible for deductions, as does Blue Cross Blue Sheild, but I'm unable to view my eligibility results due to the shittastic problems the website is having. 

So yay. 

Can anyone explain to me what co-insurance is?

I would try to call them too, like if you have a whole day of nothing to do because you'll probably be on hold all day.

A co-insurance is money you would be responsible for after you go to the doctor, hospital, etc. Some plans are like this:

X deductable. once X deductable is reached, pt is responsible for X% coinsurance to an X amount out of pocket.

OR

You could have a co-insurance with no out of pocket (which sucks if you're going to get major surgery, but if you're healthy it's a decent option) your contract might state: "pt has X% coinsurance NO out of pocket max"

OR

You could have just a co-insurance with an out of pocket max so your contract might state: "patient has X% coinsurance to an X amount out of pocket max"

audrewuh

@buddysmom80, I called back in October when I finally got through and got my application submitted, but they said they weren't able to discuss my eligibility over the phone. 

So, the plans I'm seeing say:

$3,000 deductible

$6,350 out of pocket maximum

80% coinsurance

$35 office visit copay

That would mean that once my $3000 deductible is met, I'll be responsible for 80% of the costs?

Why does this all sound like an awful plan?

[Deleted User]

@audrewuh - the plan you show above means you pay $35 every time you go to a doctor's office/ER/Hospital. Once you reach your $3000 deductable, coinsurance pays 80% of future claims and you're out of pocket expense is the remaining 20%.

buddysmom80

audrewuh said:

@buddysmom80, I called back in October when I finally got through and got my application submitted, but they said they weren't able to discuss my eligibility over the phone. 

So, the plans I'm seeing say:

$3,000 deductible

$6,350 out of pocket maximum

80% coinsurance

$35 office visit copay

That would mean that once my $3000 deductible is met, I'll be responsible for 80% of the costs?

Why does this all sound like an awful plan?

You would be responsible of 20% of the costs to $6350. I mean, fwiw, if you're healthy and young, it's not a horrible plan, but someone like my parents age, I'd be like "yeah, no" even I wouldn't get this plan because I always get sick every few years and it costs thousands of dollars for them to figure out wtf is wrong.

audrewuh

buddysmom80 said:

audrewuh said:

@buddysmom80, I called back in October when I finally got through and got my application submitted, but they said they weren't able to discuss my eligibility over the phone. 

So, the plans I'm seeing say:

$3,000 deductible

$6,350 out of pocket maximum

80% coinsurance

$35 office visit copay

That would mean that once my $3000 deductible is met, I'll be responsible for 80% of the costs?

Why does this all sound like an awful plan?

You would be responsible of 20% of the costs to $6350. I mean, fwiw, if you're healthy and young, it's not a horrible plan, but someone like my parents age, I'd be like "yeah, no" even I wouldn't get this plan because I always get sick every few years and it costs thousands of dollars for them to figure out wtf is wrong.

Samesies. 

My current plan is carried over from my dad, but it's a little more than what my church is willing to pay, and they aren't budging on it. I can totally swallow the extra cost, but it might make it a massive headache to figure out who pays what when and how. And then what happens if I'm eligible for something on the marketplace?

My current plan, from what I understand, gives me $25 co pay, $1000 deductible, and 80% coinsurance. Even that $1000 screws me over each year bc my allergy stuff costs about that much in one visit. 

Bah. I hate all of this and I'm being whiney. Thanks @allusive007 and @buddysmom80 for helping me understand all of it. 

buddysmom80

Insurance companies suck the big one.

That is all.

They also make it sometimes very difficult for the consumer to understand the contract. I always tell people READ YOUR CONTRACT.

@audrewuh does your H's employer offer any medical insurance?

Also, if you do choose a plan with a higher deductable/coins/oop you may be able to write those expenses off on your income taxes.

audrewuh

@buddysmom80 - HA. No. Working as an intern gets you no benefits. Thank God the ACA allows him to be on his mom's insurance for another two years. 

I'm eligible to be on my mom's but it would be crazy expensive. 

So I'm playing around on healthcare.gov and I can't see my eligibility results, but I can see my enrollment options. What information is contained in the eligibility results? 

audrewuh

How do we feel about HMOs vs PPOs?

buddysmom80

audrewuh said:

@buddysmom80 - HA. No. Working as an intern gets you no benefits. Thank God the ACA allows him to be on his mom's insurance for another two years. 

I'm eligible to be on my mom's but it would be crazy expensive. 

So I'm playing around on healthcare.gov and I can't see my eligibility results, but I can see my enrollment options. What information is contained in the eligibility results? 

Good question. I'm thinking if ACA is like state-funded healthcare programs, it would be based on your income/assets? And then from there it would tell you your monthly premium.

audrewuh

buddysmom80 said:

audrewuh said:

@buddysmom80 - HA. No. Working as an intern gets you no benefits. Thank God the ACA allows him to be on his mom's insurance for another two years. 

I'm eligible to be on my mom's but it would be crazy expensive. 

So I'm playing around on healthcare.gov and I can't see my eligibility results, but I can see my enrollment options. What information is contained in the eligibility results? 

Good question. I'm thinking if ACA is like state-funded healthcare programs, it would be based on your income/assets? And then from there it would tell you your monthly premium.

It is, which is great, but the plans in the marketplace are not shown using any kind of deductible. It says I'm eligible for one, I just can't see what the deduction is! Arhg. I'm chatting with someone now. 

Hummingbird125

@Audrewuh - Let us know how chatting with a rep goes. I tried that a few weeks ago, and didn't get anywhere. I'm going to have to figure out the application soon if I don't get a job.

audrewuh

@hummingbird125 - chatting with the rep was a total bust, as usual. I called the number and the girl told me my social wasn't connected to my application, so she couldn't pull it up. She thinks that my application is incomplete, which is why it's not showing my eligibility. When I research it further on the website, they want documented proof of my incarceration record (WTF?!?) as well as documented proof of my citizenship. 

Girl on the phone said to start a new application. So I did, and now I'm getting an error message that I have to call in about. Woohoo. 

I'm pretty sure this whole healthcare thing is a disguise to get people to kill themselves. Less humans = less medical costs. Holy fucking cow. 

phira

I've had two HMOs (one was my dad's insurance, the other was the insurance at my old job). I had somewhat low premiums (work paid for almost all of it), and I basically had $20 copays for almost everything, and $10-45 copays for prescriptions. I remember my $25k surgery was about $250 for me. The thing I hated was that I had to get referrals to see anyone who wasn't my primary care doctor, and I had an asshole doctor who wouldn't let me see the specialists I wanted to see.

I have a PPO now, but it's a student health plan. I pay extra to have the better plan that my school offers. Originally, I was paying $25 copays for appointments and $10-30 for prescriptions, but then 20% of everything else (blood tests are expensive!!). I also didn't know there was a cap for prescriptions, and I hit it really quickly because of how expensive my medications are. The better plan costs about $1000 more a year, but after copays, everything is 100% covered. I do have to get referrals still (from student health services), but 1 referral is good for the whole policy year. Normal PPOs, you don't need referrals.

I hate insurance companies.

audrewuh

@phira, I kinda want to be a student again just so I can reap the benefits of the health plans. 

That's what turns me off so much about the HMO's. I don't want to end up paying $75 in co-pays just because I need to see one dr that would have cost me $25. And medications are crazy expensive. I've learned how to live off samples from offices. 

I'd rather have a PPO, but the insane deductible is not enticing. Then again, in my budget, all the deductibles are insanely high. 

phira

@audrewuh My friend has a non-student PPO from the same company I have my student insurance from, and her plan is TERRIBLE. I'd recommend an HMO over her PPO, honestly. The deductible is killing her.