Re: grad school plan
My D’s only current medical expense is bcps. With her grad school’s coverage, she discovered that bcps were $50+ at her regular drug store, but free of charge if she filled them through the campus health center. Something to check out.
Good to mention & think about. At this point, neither of my kids are students and neither have need of any BC, that I’m aware of, as neither are seriously seeing anyone or as far as I know even dating!
Putting a 26 year old living in a Los Angeles ZIP code into https://v.calheers.ca.gov/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage&_ga=1.82890518.1607507530.1431061153# , the following PPOs come up:
Blue Shield Bronze 60 PPO
Blue Shield Bronze 60 HSA PPO
Blue Shield Silver 70 PPO
Blue Shield Gold 80 PPO
Blue Shield Platinum 90 PPO
Note: for $0 income, it gives MediCal / Medicaid, so put in a higher income to see the other possibilities.
Subsidies are only available for those earning over 100%/140% of the poverty level (depends if you are in one of the 26 medicaid expansion states or not; California, Colorado, NY all are). You can buy a private plan, but no subsidies until you reach that level of income, usually somewhere in the $15-20k range for a single. Zero income is zero, and you get medicaid, which in some states covers a lot.
The Medicaid threshold is $16.1k for a single person. If she makes less than that, she must go on Medicaid or you will pay the entire premium OOP.
Good luck. My PPO plan only covers in-state doctors except in the case of an emergency. I don’t think any plans that go across state lines are common.
It looks like the HSA Bronze PPO is better for some kids. They can save the money. I wish I had this option when I was younger. For my daughter her company will pay for it.
I can’t help the OP as I have no experience with CA policies, but I thought I’d add our experience w healthcare.gov for others benefit.
D graduated from uni in 2014. As we (the parents) live overseas, she had been covered on her U’s health care policy. After grad, she used the District of Columbia marketplace to get a Silver BCBS PPO. At an annual income of $25,000, she paid only $48/month and had the deductible waived. She was able to use all of her previous doctors and has had no issues at all with coverage.
Now, she is moving to South Carolina for grad school. She gets a small discount on the university policy which brings the monthly cost to about $120. We thought that was high, so we investigated the South Carolina marketplace. Well, the equivalent Silver policy (still with $25,000 annual income) will be $144/month with a $5000 deductible. I had no idea that there were such big differences in premiums from state to state. So, it looks like she will go ahead with the university’s policy.
I have another question, what kind of income are we referring to? Is this the one after all deduction and retirement contribution? Thanks for all the information.
I think its MAGI, but in D’s case, she has NO income. I have found two insurance agents online that have glowing 5* reviews who live in LA. I will try contacting them and see how that goes. I still have 5 months before D’s birthday.
Great thread HIMom! Does anyone have any tips for NY? We have an HMO which still covers our D while she is in CA. She was out of the country for a year but was covered by her employer’s insurance during that time. She is back now but will be moving to NYC in a month looking for work and our HMO won’t work for her there. Anyone have an agent in NYC that I might be able to use to figure everything out? We have told her we will pay for her insurance for now as I don’t want to chance a catastrophic health event that would require us to dip into our savings to cover.
Yes, we will be paying for D"s insurance as we are not willing to have gaps in health coverage and she has no income anyway and few assets. We’re hoping she is healthy enough soon that she can start interning or get some sort of a job, but we’ve been hoping that for quite a long time. None of us have good answers on her health. We may go with her to her next infectious disease doc’s visit, but last time we went with her, he was cautiously optimistic, which is what he remains, I suspect.
But isn’t that a fed employee (retiree?) plan?
Yes, it is a federal retired employee health plan, but it IS a non-grandfathered plan. That was the question some posed upthread. BCBS insurer did follow ACA and allow coverage for our under 26 year old kids (wherever they resided), after ACA became effective.
Does anyone have a PPO plan that pays out of state and that is available for all to buy?
Yes, I’d like to buy a plan like that for my D, CF. I’ll ask the agents when I call them about whether such plans exist in the marketplace. I have go get mentally geared up to speak with them.
There is a difference between an employee plan which often allow coverage nationwide (mine does) and an individual policy that you buy from a state exchange. Most individual policies are a lot more limited. They have been approved by that state’s insurance commissioner, the doctors part of the plan in that state, and really no up-side to the insurer to do any more than that. Emergency care out of state is covered, but little else. Prescription pick up, maybe an urgent care visit, but no well health check ups.
Yes, my employer PPO is transportable and it was for the kids while they were in college. One of mine even had surgery in his college state and it was treated financially as if he was at “home” so I don’t think transportability is all that rare. For my ‘adults’ there is not any extensive travel out of state so the transportability was not as important in choosing their own care and wellness care can be handled in their home base. Each person probably needs to base their insurance choice on their particular situation and needs. HImom, my guess is you can find what you want it’s just going to be impacted by cost, so if cost is not an issue and you plan on continuing funding of insurance then I’m guessing you’ll find a plan that works for her and your financial parameters. For me, i was more interested in cutting the last 'strings" with the kids once they turned 26. It was helpful to keep them on my insurance as they weren’t making all that much money and the cost to me was not a factor as it was a family plan plus I still have one in college so will be paying “family plan” premiums for a few more years and the money the post-college kids didn’t need to spend as they were getting “launched” into their career could be put to other necessities.
Himom- I don’t think what you want exists any longer. Prior to ACA we had such a policy through Anthem. We now have what Anthem considers a comparable plan but we no longer can go out of state for health care nor are most of our previous md’s in network. The frustrating thing is that all of them are in network for Anthem if you have a group plan. We do have the option of seeing a out of network Dr in Ca at a higher deductible.
In my part of Ca we could have went with Blue Shield and had out of state coverage but the network in our town is very small.
Another frustration is finding a Dr taking new patients. My D in Northern Ca called over 20 in network providers before she found 1 taking new patients. She wanted a female and has ended up with a male.
Himom- if she has a Dr you are happy with you might call the office and see what individual plans they are in network.
Yes, I am in northern California, have a Blue Shield PPO plan that includes Blue Card coverage, via Covered Cal.
But apparently the same plan is not offered in So Cal.
The provider network is still limited – PPO means I can choose any doctor, but it doesn’t mean that all doctors are in-network.
I’d note that I’ve never used the out-of-state coverage, as I have never needed any medical care while traveling since I’ve been on this plan. .
OK, I’m trying to work with our insurer and the Office of Personnel Management to see if they can declare D medically disabled so that she can remain on H’s federal retired annuitant policy past her age of 26. The employee at the insurance company was encouraging and says that OPM has a great deal of discretion about allowing this, especially if I speak with someone “nice.” I said that I’m sure her MDs will write her letters supporting her condition and treatment, and opining that she cannot hold a job because her stamina is so unreliable and fluctuates so much.
The two independent insurance agents I called in LA did NOT return my phone messages from this morning. 
Oh well, I’m hoping that working with OPM will be more constructive and provide what we really need–D to have continuing care from her current medical providers in HI & CA. At this time, I am not particlarly interested in applying for SSI or having D declared disabled under SS.