Need to shop for health insurance.

[Rick Lee]

Mrs. Lee's previous job covered me for $200/mo. She started a new job last week and it's now $600/mo for me, $54 for her. I need to shop. Where to even begin?

[peppy]

For decent coverage if you are over 50, $600 may not be so bad.

[LWJ]

$600 is probably about right.

You need to find an agency that deals with individual health plans. I have zero experience here.

[red-beard]

Mine is $1,250/mth for me and Mrs. Beard.

Start at the ACA website...

[mattdavis11]

If you like your PCP, I'd start there and work your way towards a health insurance provider.

[Tobra]

^Mr Davis is spot on^

I don't know how it is in TX or AZ, but here in California, at least half the doctors don't accept ACA plans

[KFC911]

Originally Posted by Tobra

^Mr Davis is spot on^

I don't know how it is in TX or AZ, but here in California, at least half the doctors don't accept ACA plans

I've had BCBS forever (but now through the ACA), and there is nothing on my insurance card to indicate such. If a doc doesn't want to accept BCBS here.... they might not have ANY patients .

[mattdavis11]

Originally Posted by KC911

I've had BCBS forever (but now through the ACA), and there is nothing on my insurance card to indicate such. If a doc doesn't want to accept BCBS here.... they might not have ANY patients .

He's shopping, you start with a Dr. and what he accepts. I started with my cardiologist because he's just a bit more important than a PCP. BCBS coverage might not be within budget.

[KFC911]

Originally Posted by mattdavis11

He's shopping, you start with a Dr. and what he accepts. I started with my cardiologist because he's just a bit more important than a PCP. BCBS coverage might not be within budget.

I doubt there is a single Dr. in NC that doesn't accept a BCBS card (even specialists)... and that's what ACA coverage is here. There is no way for a doc to know an ACA BCBS plan verses a corporate funded group BCBS plan or an individual BCBS plan.... and I've had them all. But every state is different...

[mattdavis11]

There's more out there than BCBS. He's looking at $600/mo and wants to know where to start.

[Tobra]

Originally Posted by KC911

I've had BCBS forever (but now through the ACA), and there is nothing on my insurance card to indicate such. If a doc doesn't want to accept BCBS here.... they might not have ANY patients .

It is different in every state.

In California, you had to take a big ding, 30% if I recall correctly, on all your BC/BS contracts if you accepted ACA plans. Basically, if you were willing to take the pay cut on the ACA patients, you were agreeing to taking it on all your BC/BS patients. When they set it up, they neglected to read the law. They were required to have a panel of physicians to care for the patients. They planned to use their existing panel, but you can't change a contract without both parties agreeing. They tried to slip it through with a letter saying the default is you agree to the pay cut on all their plans, unless you opt out of the ACA plan. That seemed pretty sketchy to me

It used to say on the card if it was an ACA plan. You can't tell from looking at the insurance cards any more, you have to look it up on the website, also pretty sketchy.

[rfuerst911sc]

I am 64 years old and pay $820.00 per month for myself. I have Care Source through the ACA . If you can find an insurance rep near you that knows what they are doing I suggest you start there .
Warning: be VERY careful about your stated income . If you under estimate you will end up paying back when you do your taxes. You want a plan you can afford with the least amount of government subsidy . Good luck

[Rick Lee]

Ok, gonna look for a broker around here who knows the marketplace and rules. I'm having bloodwork done tomorrow, so I'll ask the office staff which plans to look at to keep that doctor too.

[mattdavis11]

The pathology lab work might be cheaper without insurance. I had mine drawn/analyzed a year ago and it was near $80. My insurance company has yet to pay out on this years draw. I can read my own.

Be sure to look at ER visits and hospitals accepting your chosen carrier. I traveled 55 miles today for in-network.

[Jeff Hail]

Shop, shop, shop!

Doctors in California have gotten very keen to the insurance industry. A few remain stagnant when it comes to what carriers they accept and how they bill. At the end of the day they will get paid no matter what the insurance provider pays, customer will get billed for the difference. At the same time you dont want your insurance provider dictating what level of health care you deserve but they feel they should pay.

I think its more like 80% percent dont accept ACA plans. Number seems to be growing.

Also something in the past few years is happening Doctors no longer classify themselves as GP's and go to Specialty Practice for billing purposes which allows them to bill at higher specialist rates. I personally have no issues with this as in network allowances for GP rates as so low it makes no sense to accept that insurance carrier any longer.

I have family and friends that are practioners. I have two Doctors that are great. None accept insurance any longer because #1 it takes too long to get paid and #2 costs too much to employ people to get paid. By the time they do see payment its 90 days down the road. These Doctors are super busy and will spend 2-3 hours with a patient versus 40 minutes trying to cure the world.

It is also not uncommon for a practice to have $750,000 to $1 million in receivables on the books while still paying off medical loans , tuition, rent, lease, practice, employee's, billing sub-contractors, malpratice insurance etc.

Doctors are not doing anything for a $150 or $200 visit anymore. If anyone thinks they are wise up.

Get good insurance with a good carrier if you can. The best you can afford. If you can get into a group plan to dilute the cost pool try to. Evaluate premium cost, deductibles, current age and health considerations. Look at health insurance for the big cost items, open heart surgery, bypass, valve replacement, joint replacement, cancers, pre-existing concerns. Have kids and /or spouse versus being single all need to be factored. Drink or smoke all matter on what you will pay. Small stuff like office visits or cheap meds consider paying cash for them. Most medical practices will discount a self -pay bill and not have to go about collecting for it.

If you have lab work let them bill your carrier so you can get the agreed contractual rates and discounts are applied to when the out of pocket comes to you.

Most importantly if you are not healthy and have sins to pay and atone for get healthy, get on a program or talk to someone to get you in the right direction. Lots of free stuff for nutrional guidance, physical activity and lifestyle adjustments is available.

Friend of mine griped at having to pay $7k a year in premiums with a $1000 deductible and no co-pays. Until he had a full chest crack quintuple bypass, aortic valve replacement, pace maker, 4 stents, saphenous vein harvested for coronary bypass surgery all in the same day. Bill was $450k for a weeks work. $1,500 ambulance ride he paid for which was credited towards his deductible.

Looking at the cost versus the scope of repair and replacement he received a bargain.
A lot of people think it or nothing will ever happen to them. With age it will, its inevitable.

Also think about long term care insurance. Cost is about $3000-4000 a year. If you are disabled or unable to care for yourself its a bargain. Post surgical care recovery outside the hospital setting needed that is not covered under out patient services or home medical coverage. Most long term care has limits of around $2500- $2800 a week for a good policy. The term is usually unlimited. Current caregiver rates are about $15 an hour for semi-skilled persons live in 24 hours per day, cost is around $360 a day. Premiums are also deductible as medical expenses on taxes. Do the math, if you are getting older really consider long term insurance is a steal.

[Rick Lee]

Just poking around, it looks like BCBSAZ runs just over $400/mo with an $8700 deductible. That might be the best one I've seen so far. This is a pain in the ass. Every website wants all my info and, the second I click "enter," my phone rings. I just want to shop around online before I start with the phone calls.