I have been calling around to try to locate insurance for our D when she ages out at 26 and is no longer covered as a dependent under our family medical insurance plan. Since we live in HI & she lives in CA, they told us we need to buy her a CA plan. I have called around and checked online and only found HSA, HMO and EPO (exclusive physician organizations). None of these appeal to us.
I have also spoken with BCBS of southern CA 1-800-660-3007, & they told us they can’t give us quotes until 45 days prior to when she would be signing up for coverage or the qualifying event. They did give a ballpark of $246-333/month for coverage, with varying co-pays and deductibles, but refused to give any details because they said things are fluid and could well change between now and then.
Anthem 1-866-791-5538, said they have absolutely NOTHING in CA individual or alumi plans other than HSA, HMO and EPO plans, absolutely NO PPO plans. Does anyone have any suggestions? It’s VERY frustrating and I am really not planning to have D go on Medicaid (tho she has no income and few assets). Covered California (the ACA website for CA) only has the HSA, HMO and EPO plans, none of which appeal to us. She probably won’t qualify for any subsidy since she currently has NO income.
Did you go to healthcare.gov to look at plans. You can’t get a quote until 45 days prior (crazy rule, but it’s true) but you can get a good idea of what will be available within that 45 day window.
I’m not surprised at the lack of options you are finding. This ‘new world order’ isn’t what people hoped it would be.
I would recommend you find a insurance agent. It won’t cost you anything.
I have a Anthem individual plan that is a PPO in Ca. I think in Ca it depends on where you live. My friend lives part time in my community and part time in LA. She keeps her billing for Anthem in my area since in LA she would have to switch to a EPO.
My oldest just went off her work plan and bought a Anthem PPO. Her premium is about 220 a month with a 6500 deductible.
Another thing to be aware of is that Anthem only covers emergency care outside Ca. If she had a Ca Anthem plan she would not be able to see a dr out of state.
My DD is the same age. I’m paying $326.09 with Blue Shield for the “platinum” PPO coverage in suburban Los Angeles. I used an agent since there was no subsidy available, and it’s nice to have someone else handle the details and make a living. The coverage she has should be available on the Covered California site, though I found it difficult to navigate, at least last year. As best I could tell, only Blue Shield offers a PPO; the rest are HMOs or EPOs. Before you make a final decision, she should check with her physicians, as some only contract with Blue Cross, and others only with Blue Shield, and that’s been a problem now and again.
I think the California exchange is called Covered California so you might want her to google that website. i just went through this with my oldest last year in a different state before insurance was added to his benefit plan. It took him months to get everything in place and many phone calls and trips here and there to get paperwork he needed, but at least in Colorado and I’m sure in California on the exchange the insurance is retroactive to the date of application. My son filed for insurance in mid-November and all the paperwork etc. was fianlly completed in April literally 2 months before his work medical insurance kicked in LOL. Just make sure she knows to make the effective date the date she needs so there is no gap. Good luck…in our case there were many phone calls back and forth with questions, but to me it simply another apron string getting snipped and a good lesson for my son on the ins and outs of medical insurance. She absolutely could work with an insurance agent, but if California has discounts based on income she might be better going it alone on the exchange. I know for my son there was a nice discount off the list price for the six months he had to pay for himself on the exchange and if she has no income she should qualify for Medicaid which is worth looking at if she’s healthy. In Colorado one of the hurdles he had to jump over was actually getting rejected by Medicaid…in order to buy on the exchange and get the discount.
I don’t know about applying directly with private insurers, but my understanding is that if your D has no income and applies through Covered California ( the obamacare exchange), she has no choice but to go on Medi-Cal (what CA calls Medicaid).
Our D has absolutely no income, but she does have a few assets–used car, IRA, (3digits), stock (4 digits), EE bonds she inherited. Have not filed for disability and not sure she’d qualify, as she “looks” great!
I really want her to have a PPO, so she can keep her HI and CA docs. Finding docs tobwork with is a challenge! She does have some chronic health issues and it took us along time to build her current medical team. We are OK with no subsidy.
Those who recommend insurance agents–how did you find a good one? Can anyone PM meme a good one in LA area? Thanks!
I don’t know what the income threshold was for my son but I know his salary isn’t very high…he probably earns around 30K and his discount was around half the exchange list price for a “silver” plan. Right after Obama care hit I ran the numbers on his income which was significantly lower at 24K and he would have only paid around $50 a month for the same plan.
None of her current docs are Kaiser docs, tho they are big in HI too. It was literally 15 years finding and putting together her med team. I am unwilling to spend another 15 years.
HImom,
I called Blue Shield directly about private coverage for our fam and my D individually when she turned 26, and was told that the Covered California plans are the same as the individual ones they offer. I don’t know about other carriers, but I think there are only a few in CA.
Great thread. DD1 will still be in school in NY when she turns 26 in half a year. Has anyone researched and compared the lazy approach - going with the school’s insurance - with one of the other options in terms of cost and coverage?
The Covered CA plans I saw had no PPO option. I want to know D would be covered whenever and wherever she is, even if the premium is higher. I want a good PPO plan.
I recommend using an insurance agent. It’s free. I recommend an insurance agent who is local to the area she’s living in, rather than a national agent, so that the person knows the area.
Does anyone here have a non-grandfathered plan that covers out of state doctors? I believe such plans are unusual.
Bay is partially correct and partially wrong. A person who has no income can’t get subsidized insurance on the exchange. But they can get unsubsidized insurance no matter what their income is, just by writing the check.
We have a non-grandfathered PPO plan that covers any participaing and preferred doc in the US, as well as up to the US usual & customary rates anywhere in the world. It’s an excellent plan and we would like to get her a similar one if we can afford to. Does anyone have a good referral of an insurance agent in Los Angeles? Please PM me, as I’m assuming not all agents are equally excellent.
Dad of 3,
My D ended up going with her grad school’s plan, because it was the easiest thing to do once she turned 26, and I left it up to her to figure out.
The insurance agent I used for this I selected randomly - I knew what I wanted, but wanted someone else to “push the buttons” as the Covered California website was hard to follow - so I’m not sure it’s the referral you want. I did look at the state website again, and found it still difficult to navigate, but here’s what I found: Go to http://www.coveredca.com/individuals-and-families/, then, under “Resources,” which is in the gray border at the bottom 1/3 of the page, select “shop and compare tool.” From there, input the data (I used a high income to avoid being sent to Medi-Cal since I was paying forgoing the subsidy), which should lead you to the options. For at least the platinum level, Blue Shield PPO doesn’t show up on the initial results; there’s an arrow to the right of the first four insurance plans/companies first show up which you need to hit in order to show the additional options, Blue Shield PPO being one of them. At least when I checked, the Covered California options were the only options available on the market for individuals, and Blue Shield offered the only PPO.
Now, if someone has the answer to the post about NY above, I’d love that information as well, as DD is about to start her second grad program there, and I don’t want to reinvent the wheel!