Thanks for all the discussions on medicare. I have a new question.
Both of my DDs are in college and are out of state, their father has medicare and I have purchased ACA. I will be eligible for medicare soon. Last year, I purchased the college plan for my older DD and am planning to purchase the college plan for my younger DD this year. After reading the discussions with medicare, I wonder whether there is any other option for them.
If they meet the income threshold, they might be able to purchase individual plans off the ACA exchange.
If not, they could buy an individual plan from the insurance company.
Our kids both have these individual plans…just under $400 a month each.
But our research showed that the college health insurance plans were less costly.
Anyone of any income who is lawfully in the US can purchase an individual plan off the ACA exchange. People at some income levels will get subsidies to do so.
@thumper1 if a student were to buy insurance under ACA, will they have to use my income? Yes, the college health insurance plans are cheaper, however, I am just concerned during the summer breaks. I knew the college plans will cover them during summer, but what if they have to withdraw during summer.
They will if you claim them as a dependent on your tax return.
Coverage usually goes for a full calendar year on the school plans. But you need to understand the coverage when they are home on breaks or away from school in the summer (the plan may be in effect, but what is covered when you are far from campus and how do claims work?).
You can buy through the ACA marketplace or directly from insurance companies themselves. Same questions apply about breaks and summers. Also, issues with state of residency can arise. Generally the ACA marketplace require less proof of residency. We got hassled a lot about purchasing for D2 in our home state when she was away at college for most of the year when purchasing directly from the insurance company (a rep there instructed us one year to go to the ACA marketplace site to avoid the hassle). But you need to consider whether you can/should buy in your home state or college state if they are different. We never tried a purchase in the college state, but I’d assume they would want proof of residency.
We ended up with BCBS plans in our home state purchased through the ACA marketplace most years with D2. BUT — some BCBSs are not offering their national network for some individual plans in the last couple of years! So… that may or may not be a good option in your case.
READ the insurance plans you are considering. The policy we bought when our S was aging out of our family plan covered him for fall and then the Spring coverage was from Jan thru mid-Aug. I bought a plan from our local BCBS to cover him from when the school policy ended until Dec 31, as due to ACA he’d thereafter be covered under our policy until he turned 26.
The policy the U offered was a pretty good policy but not as good as our family policy. The policy I bought from our local BCBS was the only one I could find for him. He was denied when I applied under e-surance because he had asthma since childhood, which they said was a pre-existing condition, never mind that it had never required much treatment, no urgent medical visits or much of anything else.
He never had any medical care nor got Rx while on the U policy nor the short-term BCBS policy.
It’s very concerning that they are trying to allow pre-existing conditions to be excluded again from insurance policies. This is really difficult for so many of us who have asthma or a myriad of other health issues. 
^^ @HImom isn’t the insurance company required to cover even with pre-existing condition?
When I checked the price during the previous enrollment period, I found the ACA and BCBS as a private plan priced the same, I decided to apply through ACA as BCBS web site gave me some problems in registering.
It was from reading previous threads that I realized college plan could be quite good, hence I purchased the college plan for her. The BCBS plan for myself is an HMO plan. However, my younger DD’s college isn’t as good, hence I am looking for other options. It seems that if she will have to use the college plan as I checked BCBS again and their plan is HMO.
OTHO, my older daughter is in the college plan, I just received a medical bill of $450 for blood work done during her regular check up. Her doctor is covered, however, the blood work on iron, vitamin D is now. I will have to figure out why.
Currently, WITH ACA, insurers are required to cover pre-existing conditions because of ACA. Without ACA, insurers were free to reject people because they had pre-existing conditions.
Plans are very different from one another and insurance is strictly bound by the contract, so read the contract carefully. When I am told x or y isn’t covered or only at a lesser rate, I ask insurer’s customer service folks to point out which part of the contract they’re relying on for their determination.
We are very fortunate that our insurer has most lab work covered under our plan and we have no out of pocket. I’d call the ordering doctor’s office about the bill for the labwork. I’d also call the lab and see whether you can get a cash discount or something.
Thanks. I need to figure out how to deal with the doctor’s billing. I read the summary of benefit, my DD should be covered for “preventive care and screening”. The doctor’s billing office told me they are in network and the insurance company denied them for routine lab work.
I think my insurance company thinks that the work does not fit the “preventive care guideline” (will have to call tomorrow to confirm), but how can a consumer know whether the care is necessary or whether a doctor uses a test as a gold mine.
Is a doctor required to tell me whether the tests are reasonable or necessary?
I initially thought the college plan is good, but now I have to deal with an unexpected bill.
Both of my kids have individually purchased health insurance policies. They have to deal with bills all the time…because of very high deductibles.
Sometimes the doctor’s office is in network, but the lab they use is not…
The college health plan might use the same definition of preventive care and screening as the ACA does. See here: https://www.healthcare.gov/coverage/preventive-care-benefits/
Iron and Vit. D are not generally considered routine screenings for a young person so wouldn’t normally be covered as part of a routine checkup. If the Dr. had specific concerns, those tests might be covered as diagnostic, but then likely subject to deductible.
@thumper1 unfortunately this is my first time deal with this. Now, I am not sure whether I should keep her in the school plan, but then I do not have other choices.
@intparent the lab is part of the same medical group as the doctor, the billing office told me they are in network.
@rosered55 thanks for the link. Unfortunately, none of the tests is listed under preventive care, I am not sure why the doctor sent a 19 years old to do an iron and vitamin test. It was an annual regular check up. There are two doctors in the office, my DD has been seeing since she was a baby, but this time the other doctor was busy, hence we got this “new” doctor to see her. I knew this doctor always sent the kids to do tests. I plan to ask her tomorrow why the tests are necessary.
Was she complaining of being tired? I had some issues several years ago (in my 40s at the time, not 20) when I just felt crappy. Turned out both my iron and vitamin D were low. So she may have said something that triggered them to test. Does the plan have a deductible? Because those probably would have been considered part of those, not part of a normal checkup office visit.
@alooknac exactly, we did not even raise any concern. I am not sure why she even considered vitamin D. The two tests combined is $150. I suspect the doctor looks at the teenager walking in as a cash cow and order as many tests as she could. The lab is part of the same medical group.
Obviously, in the worse case, I will pay, but does anyone know where I can file a complaint? for the past 18 years, they never ordered any vitamin D tests.
I will ask her, but I do not think she complained anything as I knew this doctor always sent kids for testing. We occasionally had her when their regular doctor was busy.The plan has deductible but for this group of tests, they just denied it. Now, I read it again, it said that we may have to pay for services that aren’t preventive.
The doctor may have said something to your kid that she did not understand about it not being preventative, but having some reason for ordering it. Kids have no idea about medical billing, and the jargon of things like deductibles, not preventative, in network, etc. goes right over their heads a lot of times. I really loathe our health care system…
Thank you for the discussions. I began checking “preventive care”, DD used to have BCBS and now UH, none of their preventive care included iron / vitamin tests (I don’t think either DD had those tests in the past). If it were not preventive, it would be diagnostic test, right? then they should be covered for 80%, but in this case, UH just denied the bill and the billing office told me that she was denied for routine lab test.
In my experience with other doctors, most of them knew what is covered and what is not. I suspected some doctors would perform unnecessary tests knowing they would be paid by insurance. (such as my eye doctor). I am going to ask them in the morning.