Insurance woes 2018

I just signed up. When Trump limited the funding for silver plans, and Congress didn't restore it, they reacted by either increasing prices (like mine did) or pulling back on the doctors/hospitals covered, or both. My silver plan increased 60% in price, but I found that the gold plans hadn't. I found a gold plan for just $20 more than my silver plan that covers more doctors, had much lower co-pays and no deductible. Check the gold plans.

Carolyn,
Although we have a premium Security Blue HMO in Western PA it typically does not cover out of network. It has been great insurance for my wife and I and covered all our needs until until my recent PCa diagnosis. When I could not find anyone locally using SBRT for PCa ‘in network’; we requested to go out of network and be evaluated at Cleveland Clinic. Although our initial request was denied and we filed a very simple appeal on line that was granted. In the end we ended up saving our BCBS a lot of money since the SBRT was cheaper than if we had elected IMRT locally.

One of the most challenging aspects of PCa is evaluating all the treatment options and deciding which one best suits your own situation. Although for most guys all of the treatments have pretty much the same ‘cure’ rate. Each treatment also has potentially very different side effects.

We found BCBS willing to work with us regarding going out of network since the treatment we selected was not available locally. We did have to learn how to work within the insurance system just as we had to learn about our treatment options. Possibly our situation is similar to yours?

What planet do you guys live on, that with a preexisting cancer diagnosis you can get individual health care coverage off the marketplace? Yes, I’ve tried, based on your suggestions - never had such short conversations with insurance people in my life.

Mr. TA: yes, I checked the gold plans.

It’s not that our local hospital is bad, so it’s not desperate. But sigh.

cspivak,

Please note:

https://www.healthcare.gov/coverage/pre-existing-conditions/ This is the US Government site for your clarity. It very clearly state that no one can be turned down or charged extra due to preexisting conditions. This is confirmation of coverage for all individual plans.

If you are having issues or not getting proper information, look at www.ehealthinsurance.com. This is a nationwide sales site that will show most all the plans in all areas. Most all companies use this site as a means of distribution and they link with professional agents in your area. I am not connected with the site or endorsing it over any other, just that it is my 'go to' site for information and research for health insurance and I have always found it to be reliable.

Thanks to the Affordable Care Act, health insurance plans can no longer deny anyone coverage for their pre-existing condition. It definitely sounds like you misunderstood what they said...

They cannot limit benefits for a pre-existing condition and they can't refuse to cover treatment for a pre-existing condition.

The ONLY exception is:
The pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family on or before March 23, 2010 that has not been changed in certain specific ways that reduce benefits or increase costs to consumers...but this does not seem to be the situation you described.

LINK

I suggest you use your new knowledge and try again. You said you had short conversations before...try saying this: "I know that pre-existing conditions are not a barrier to coverage or benefits because of the ACA laws; does my past experience with prostate cancer affect my potential coverage with you an ANY way at all?"

Post Edited (NKinney) : 11/13/2017 12:18:55 PM (GMT-7)

Stay clear of the third rail, please.

As to 2018 changes, I just got my COBRA plan changes, which are identical to the plan offered to the 25,000+ employees at my past workplace.

YES, they are changing the Out-of-Network for everyone. The co-pay goes up by 50%, and the OON out of pocket will no longer count toward deductibles or out of pocket annual max. That effectively means that out-of-network is out of reach. Period.

They are dropping CVS as an authorized provider. Not a big deal for me, as I don't like the employees at the one near me.

Out of pocket for non-mail order prescriptions goes up.

They are forbidding use of prescription assistance plans for meds provided through the mail-order.

Monthly cost is up only slightly, but that is clearly to do with the loss of OON and locally-filled prescriptions.

But it is still a much better coverage in my area, so I'll stay with it until Medicare comes around.

Exactly right on the non-conforming plans. That is nothing new and not a problem. They can be very valuable for many people and it is good the marketplace has non-conforming plans available. All plans on the exchange are conforming hence no preexisting exclusions. All conforming plans that are not on the exchange have no preexisting restrictions.

Earlier I did a search on ehealth and in my zip code found 21 conforming plans from three insurers. Of course the exchange has far fewer. I always suggest that people stay off the exchange because of the severe limitations unless they absolutely have to have the current offsetting subsidy. If the subsidy is small or non-existent, or you can wait for tax time to recover the subsidy, then the exchange is the last place to go. I just did a search for zip code 17036 (Hershey, PA area) and it showed 12 plans. I did not go in to look at the plans as to what companies were offering them.

Remember you do not have to be on the exchange to get the subsidy. Most people simply do not know this. You do not have to go to the exchange to get a conforming plan with no preexisting restrictions. Both the subsidy and preexisting conditions are available without going on the exchange.

lovif,

Federal law provides for the credit to apply to qualifying plans purchased through licensed agents, but some states have required that lower income people have to purchase through the state exchange to get the credit. I just went into a sales site and used a hypothetical male age 60 in Georgia with a $25,000 income and every one of 20 plans showed a premium tax credit though most were not listed on the exchange. You might be in a state that forces you into the exchange for the credit.

When I report that you do not have to go to the exchange to get a subsidy, what I mean is that you can use a licensed agent to advise and assist you. If you go directly into the exchange, you will rely on a Navigator who by law can not provide professional advice. Typically the exchange will have significantly limited choices. By using an agent, you can get professional advice and assistance that can help find the best networks and benefits for your situation. By law, the plans must cost the same whether offered by the exchange or by licensed agents, so you do not pay more to get the advice and assistance of a qualified licensed agent.

Generally we advise people to avoid the limitations of the exchange and direct them to qualified licensed agents. We have found they will have a broader range of plans and networks available. Basically when you go to the exchange first, you will pay the same for the insurance but will have limited choices and not receive professional advice and assistance.

Jack