So…with some guidance from @“Cardinal Fang” it looks like kid 2 will be getting a plan, no subsidy, that is $376 a month…so that is over $4000 a year in premiums…and it’s a $6500 deductible for the big things…but that deductible doesn’t apply to doctors visits and RX coverage.
It is what it is.
The crack up was when the kid started her healthcare.gov account today,and put in her (lack of) income…they sent her an email saying that her income would qualify her for free or very low cost insirance IF her state had opted to be an expansion state. BUT it didn’t. Now really…what was the point in that email??
I’m on a Facebook group about health care. Someone there had a similar problem to NJres-- they had a credit freeze, and their information couldn’t be verified by the exchange. They believe that the credit freeze was the issue, which makes sense. The federal exchanges use Experian, I believe.
S is looking at a plan similar to thumper’s D. $352 a month with a $6200 deductible for anything more than visits and prescriptions. Our only concern is the limited EPO network, but we’ll deal with it. I just hate that you can do your research and go to an IN doctor and hospital, and still wind up with OON charges from radiologists, labs and anesthesiologists that are beyond your control. Without OON benefits, this is scary.
Even with out of network benefits covered, these out of network “surprise bills” can be costly. States should crack down on them. My proposal is that if I go to an in-network facility, all the care I get there must be in network, and whatever out of network bills I get from that facility or its providers are the responsibility of the hospital or clinic, not me.
ACA did address this, for ED care. But if the emergency visit is deemed not truly an emergency, I don’t know. This OON issue is something to address with the insurer.
Different states may have different rules for what’s allowed. In my case, yes, all procedures at one of the covered hospitals was in network.
Which of the large multispecialty practices actually do this (i.e. the whole practice is in-network, so anything done in their facility is in-network)? Seems like Kaiser would do that… but what about other large multispecialty practices that are not tightly tied to the insurance plans like Sutter Health (yes, I know Sutter Health is expensive and is part of the reason for high insurance plan costs in the area)?
Re: OON costs. My kid was seen in an ER while in college (pre ACA with a VERY rich BCBS plan PPO that also had Blue Care). The hospital took her wonderful insurance, and so did the first doc who saw her in the ER. BUT a second doc was called in…and THAT doc did not particulate in BCBS. We got a HUGE bill…and I mean several thousand dollars.
We successfully got that bill deleted…because i was the policy holder…and had permission to speak also…and I politely told BCBS “this was the ER. Once you arein the little cubicle, are you supposed to ask every doctor who sees you if they take your insurance.”
But I don’t think that would be successful now.
As an aside, this same kid had two ver expensive surgical procedures…after that ER visit…and every doctor and all the expenses were fully covered…we didn’t pay a dime. It was just that ONE ER doc who was OON.
@my-3-sons my kid is looking at an HMO…it has a very limited network…but we are happy there is any plan for her.
@thumper1 -Agreed. At the end of the day, we are just glad that with a pre-existing condition, S can get insurance. I just wish SC had options. Who knows, he may still have chosen the same plan but at least it would be his choice. There is only one carrier and network on or off exchange here. Doesn’t feel like much if a choice but better than nothing.
There is at least one state who made this practice illegal (for an ER doc not to take your insurance when the hospital does) if my memory is correct.
ETA: Google tells me that several states have passed some form of protection but even New York, who has the most comprehensive coverage, has some pretty large loopholes.
If you want to see if your state has anything, I recommend googling “(state) surprise medical bill law”
HealthSherpa.com is a good way to look at your options for health insurance.
I ran the numbers for myself on their site. If I predict low health costs, Bronze. Medium health costs, Bronze. High health costs, Bronze. Bronze is so much cheaper than Silver or Gold that I should just buy Bronze.
“they sent her an email saying that her income would qualify her for free or very low cost insirance IF her state had opted to be an expansion state. BUT it didn’t. Now really…what was the point in that email??”
I think it is a valid and important email. Folks need to know why they face insurance limitations and the costs they do. Not to blame it all on ACA or Obamacare. In this case, the blame should go to state officials in GA for not opting for Medicaid expansion.
@Cardinal Fang (or any other knowledgeable, helpful person) - This question concerns potentially combining an ACA subsidy with a Health Savings Account. DW and I, a two person household, intend to keep our 2018 Adjusted Gross Income just below the ACA subsidy cutoff level, say $64,900. All our income comes from “pass through” sources over which we have significant control. This gives us flexibility in setting our income, but also limits our ability to take “above the line” deductions which would reduce our AGI. For example, we aren’t eligible to make IRA or SEP contributions and have no self employment deductions, but we are eligible for HSA contributions.
It seems the only ways to lower our AGI are 1) minimize our top line income, 2) open HSA accounts and maximize our contributions, or 3) get divorced and pay each other alimony (too complicated and would make me sad).
So I’ve started reading the HSA rules and my head is spinning. In order to contribute to an HSA you need to be enrolled in a high deductible health plan (HDHP), which is defined as a plan with a deductible of at least $2700 for a family of two, as well as a maximum out of pocket requirement that I don’t yet fully understand.
My fundamental question is: Is it practical to combine a HSA with an ACA subsidy and use the HSA contribution to lower one’s AGI?
@Sherpa, yes, it’s definitely a smart tactic. Not sure I can recommend other forums but you can find lots of details about people managing their AGI on that head bogling group.
@sherpa The ACA plan I have selected for next year specifically states “HSA eligible”, in fact here is the plan name:
so I think the answer to your question is “yes”, but I wonder if the “HSA eligible” part needs to be explicitly stated in your plan name. Nice thing about an HSA is the contributions don’t have to be from earned income (unlike an IRA). I will only be on this plan for 4 months next year (then Medicare) but I will make an HSA contribution.