I don’t think my PPO covered OON care at any preferential rates. Rather, that it allowed a virtually nationwide web of in network doctors and facilities. BCBS.
No one in our family has a steady relationship with a doctor or specialist. Too many changes over the years with in-network & out-of-network.
I really like my new therapist, but I’m bracing myself for bad news once the 2018 plans are revealed.
The practitioner we’ve had the longest? Our dentist. We don’t have dental insurance.
If she has no income, she would not be eligible for a subsidy. She could buy coverage Direct,y from one of the insurance companies. That is what my kid 2 has to do. In your case…it is likely this won’t be for a lot of months.
Does she have coverage through her college? If not…maybe that’s an option that would be less costly than keeping her on your plan…depending on when that coverage ends. Just a thought.
It sounds like your kiddo would be on your plan, then she could get her own unsubsidized plan until her employer covered insurance kicks in.
The difference between a PPO and an EPO is precisely that a PPO pays some amount of out of network care and an EPO pays none. If you have a “PPO” that doesn’t cover out of network care, it’s not a PPO.
Why does noname’s daughter need separate coverage, if she’s in college 5 months and has virtually no income? And what do we suppose she does in August, when her college plan ends (or whichever date it is?)
And at the point where she graduates and gets a well paying job, she’s either covered by the employer or gets her own plan.
After grad, I kept mine in the “household.” That 7k D2 earned didn’t hose my premiums that much. When she got the FT job, she came off my household, my MAGI totals, everything.
My kid two has had an Anthem POS plan. It was nice because it covered docs in states other than where she lives…so she was able for the last three years to continue seeing her PCP here where we live.
That ends January 1…she will either have some Kaiser plan or some Ambetter plan…I think there are likely Kaiser docs here who she could see (or will GA Kaiser be limited to GA?). But her current PCP isn not Kaiser affiliated.
Oh wel.
It’s so strange for me to see that in other states, there are doctors that are affiliated with Kaiser and also with other plans. In my area, Kaiser doctors are employed by Kaiser hospitals and Kaiser clinics. Unlike the situation with other insurance companies, you don’t have any doubt whether your primary care doctor is a Kaiser doctor. Did it say KAISER on the building you walked into to see him/her? Yes: Kaiser doctor. No: not Kaiser doctor.
@“Cardinal Fang” - Our kids are covered through their jobs, so it’s just DW and me. We’re semi-retired/self-employed and don’t qualify for subsidies. Up until now we’ve been buying outside the exchanges and opting for very high deductibles.
2018 will be our first year in our new state, Washington. Any insight how things will work here?
Also, we have the ability to control our income and could easily limit it to 399% of the poverty level. How would that change things?
@sherpa, You should absolutely make your income less than 400% of the percent of the federal poverty level. If you are the age of most parents on this site, you will save thousands of dollars by getting federal subsidies.
Buy on the Washington exchange. It’s here, but prices for 2018 are not yet up. https://www.wahealthplanfinder.org
Washington apparently has loaded all the CSR surcharges on the Silver exchange plans. Probably a Silver plan will not be right for you. Very likely Bronze plans will be cheap for you, really cheap. If you want more coverage, very likely Gold will be a better bargain than Silver.
@“Cardinal Fang”, Thanks. I went to the Washington exchange, registered, and was able to see what my 2017 options would have been. Definitely more affordable than unsubsidized policies. If I’m understanding things correctly, our premiums will be subsidized by over $700/month in the form of tax credits. This is where it starts getting confusing for me. Would pay the lower premium level and then pay our regular federal tax liability? What if our tax liability was less than the subsidy we’d received? Would we then owe the difference?
So confused.
We have a high deductible plan with a HSA. Different coverage for in network and out of network. We always reach our 100% coverage within the first 6 months (H on a very expensive medicine and we reach our deductible fast).
H has one doctor who is out of network. No matter how many medical expenses we have, his out of network Doctor is never covered so we pay out of pocket for him even though we’ve already paid $6000 in in-network expenses.
But we can use our HSA to pay this doctor.
Good questions, sherpa.
You’ll enter your predicted 2018 income into your account on the exchange. You’ll pick a plan and enroll. Then each month you’ll pay your subsidized price. In April of 2019, when you file your taxes, you’ll reconcile what your premium subsidy should have been based on your income with what it actually was, and you’ll pay extra or get a refund. If you made a good guess about your income, the adjustment will be small.
The tax credit is refundable. That means you get the credit even if you don’t owe any taxes. In practice, what happens is you pay less for insurance than people with higher incomes pay.
Expect that your subsidies will be much more in 2018 than they would have been in 2017. Your price for a Bronze plan will probably be less than it would have been this year. Your price for a Gold plan might be less, or maybe not. In my area, if I had a $47K income and was filing alone, in 2018 I would get a $700 subsidy every month In other words, the savings are enormous.
If you say that your income is going to be less than 400% of the federal poverty line, and then when you file your taxes, it isn’t, you’ll have to pay back your subsidies. Don’t let this happen!
I have an employer paid PPO and I have no deductible if I stay in network. Just a co-pay. OON has a $1k per person deductible and pays 80/20 after that until OOP max. I have no idea what our OOP is as I’ve never, in 29 years, needed to use a doctor OON. But, it was very important we have that option in case we needed to go to Sloan Kettering/Mayo Clinic etc for a very serious illness. There are virtually no OON providers in my area as my Insurance is through NYS government and with 50k employees and their families in my area, doctors can’t afford to not take our insurance.
Just told Child one to make sure his income is below the subsidy amount…if not, he should contribute to a retirement account. Can it be a Roth? Or does it need to be tax deferred?
He can do this for 2017…and again for 2018 if needed.
I also told him to check the costs of gold plans.
Contributing to a Roth won’t lower his AGI. He’d need to contribute to a traditional IRA to get the adjustment to his income.
I have a Bronze plan from Blue Shield. If I renew, the family out-of-pocket max for out of network will be $40,000. I’m sure some families have more than $40,000 of out of network charges. Not many, though.
Ok…so,he would need to start a traditional IRA. That shouldn’t be hard!!
Thanks for the explanation, @“Cardinal Fang”. The fact that they’re refundable credits is incredible and, in some cases might lead to strange consequences.
For example, if a hypothetical married couple were to report long term capital gain income of $64,000, which is just under 400% of the poverty level, and report no other taxable income, they would be in the 15% marginal bracket (which has a long term capital gain rate of 0%) and would therefore pay zero federal income tax (and of course no SS or self employment tax), but would still be entitled to health insurance subsidies of about $9000.
Is that correct?
@“Cardinal Fang” - here’s an article from an insurance site from 2015 explaining the thing about out-of-network maximums – it’s old, but in this case I think you want to know the history:
https://insuremekevin.com/out-of-network-costs-vary-greatly-among-california-ppo-health-plans/
I remember when ACA first came in that the OON max was one of the main distinguishing factors between Blue Shield and Anthem – so one aspect that wasn’t strictly regulated by Covered California - but now that Anthem has pulled out, I guess Blue Shield doesn’t see a competitive advantage in offering better OON coverage. Or maybe it’s just an actuarial thing that allowed them to shave a few dollars off premiums.
My Blue Shield HSA had improved benefits for 2017 only - it went to copays for doctors, labs and prescriptions rather than requiring me to run up my full deductible – but for 2018 it’s back to -0- benefits pre-deductible, other than preventive care – and then kicking in at 40% copay until the max limits have been hit.
But, as someone else has noted, the nice thing about an HSA is that you can use the HSA money to pay for out-of-network. So the math works out well for low-end users – lower premiums, and the savings on premiums can used to fund the HSA instead.
I’m in Ca. Until the ACA I always bought Anthem Blue Cross on the individual market. Pretty much every Dr in my area took my insurance. I buy my insurance off the exchange through a broker. Each year the deductible has gone up and the network of providers has narrowed. Almost all my Providers are now out of network. My last in network dermatologist just went to a no insurance practice. For the most part we have low expenses. We have been buying the Anthem bronze PPO. In January we will only have one option Blue Shield with the three metal options or Vlue Shield with a HSA. The provider network is terrible worse than what we had with Anthem. For many specialists they don’t have any providers in our city. That is ridiculous because it’s not like I live in a rural area. I’m not familiar with an HSA. Can anyone have one? Is there income limits? Is there any benefit to having one if we have few medical expenses.
I’m also confused about the discussion of buying on or off the exchange. At least in the past the plans in my area have cost the same and had the same limited network no matter where I purchase.
My oldest D will also have to switch to Blue Shield PPO. I think she will buy the bronze. She doesn’t qualify for a subsidy or any tax rebates. Her main expense is an asthma inhaler about 8 times a year. Would the HSA option make sense for her.
D3 I’m considering keeping her on my plan and her having the Blue Shield PPO in Northern Ca. Blue Shield up in her area seems to have a good amount of Providers. For the same cost I can buy her her own Kaiser policy. I don’t think the out of pocket costs will be much different.
Am I missing something?