Health Insurance options and feedback on my choice

[cathy63]

Quote:

Originally Posted by utrecht Try to find one testimonial online by someone who CHM screwed over.

That's not hard at all! A single Google search turns up plenty. These are just a few of the negative ones from Yelp.

"If you ever heaven forbid change to another health coverage (insurance another cost sharing) then you won't be covered for anything that occurred during the last 4 months you were with CHM because they take 4 months to process your bills and won't pay anything if you cancel during that time. "

"This so called Ministry is a joke. My wife had surgery in 2018 and was denied all coverage and sharing because she had a Pre-existing condition from over 30 yrs ago."

"If you get sick and need a surgery, no good hospital or surgeon will accept you because "you don't have health insurance"."

"Paid as gold member for $150 plus $50 for the so called "brothers keeper" but after getting a first time infection they declined to pay the bills even after I already negotiated very very hard to reduce my bill in half from the hospital. Talked to CHM at 1-800-791-6225 to reconsider, as $15,000 of ER bills is no way I can pay, but they just keep saying Sorry it was denied. CHM personnel/agent did not even offer anything, like helping me further to negotiate with the hospital to see if they can further reduce the bills, or even offer me a what they call "PRAYER". In my opinion I was scammed by CHM. The so called brothers KEEPER is really meant they are keeping your money as a brother."

"Here's what really happens: You have a health issue requiring surgery that's necessary for you to live. You're listed as self-insured by all providers (surgeons, hospital, labs, anesthesiologist, office visits), all of which have their own bills, and often the hospital doesn't send an itemized bill unless you request it directly and then it may take a month. Now you're a month in, and get the claims up to CHM as soon as you can. You request a discount from all providers, which they may or may not offer. Then you wait. And wait. And wait. You're making small payments to each provider to keep collections at bay, but they now call and say you're late and they'll send you to collections if you don't pay more or all of the balance due. You send more or all that's due, because you're now six months and maybe 9 months post-surgery. Then someone at CHM - and you have no idea who, because CHM works behind a curtain - moseys over to the phone and (supposedly) arranges for a deep discount with the provider who's been yelling at you to pay up. In my case, I'm a year out from two major surgeries and waiting on thousands in reimbursement - and I'm the highest level member of CHM. But the checks that actually finally trickle in, although they declare my claims "eligible", remit only a fraction of what I've paid out bc they say the provider offered a substantial discount. I'm sure they did - they've already been paid at this point, so it means nothing to them to tell CHM, Yeah, sure write down the bill so you can tell your member it was really only 20% of what they've paid for, and then CHM can retain 80% of what they've declared is eligible. Want the rest? It's up to you to try to get a refund back from the provider based on what CHM claims they wrote down, except no one provides you with any paperwork substantiating this."

https://www.yelp.com/biz/christian-h...ries-barbertonhttps://www.yelp.com/not_recommended...mended_start=0

[Rianne]

Quote:

Originally Posted by utrecht CHM doesn't use networks. You go to literally any doctor you want to go to. Any Hospital, any doctor, any specialist in any state. If the doctor says you need a procedure, there is no approval needed or no second guessing from CHM. They are a non profit which is another reason things are cheaper on top of a couple reasons someone listed.

I have no criticism of CHM. I considered joining but was on the fence with my Catholicism, I could not be honest describing myself as a Christian.

Our HC system is also a nonprofit. The doctors, hospitals, procedures, meds are profit. For example, I go to Mayo Clinic, see a specialist. The same specialty is available at my local hospital, but I want the best. I want the tests, procedures and anything that can accurately diagnose my condition with full confidence. The difference in cost of these 2 options is quite extensive. The way you describe the benefits are quite amazing.

[ER Eddie]

OP here. I reviewed the inclusions and exclusions of the short-term policy I was looking at, and I don't have any problems with it. The big stuff is covered. None of the exclusions raised any concerns for me. The vast majority of exclusions aren't things I'm interested in having protection against. I don't mind paying OOP for the others. I'm just looking for protection from financial catastrophe.

I also was pleased to discover the definition of a pre-existing condition avoids the horror story mentioned earlier in the thread (someone was diagnosed with cancer shortly after the policy began, and the company denied coverage because the cancer was presumed to have been a "pre-existing condition"). I also live in a state where that language has been tightened up even more.


I woke up early today with some agita about all the unanswered questions, so I'm spending the day researching insurance. Whee...

[GTFan]

Quote:

Originally Posted by ER Eddie Question for anyone, then: Does all that buying and selling incur capital gains that I wouldn't have incurred otherwise? That is, do you get more capital gains if you do all the buying, selling, and trading I alluded to above, rather than just letting money sit in an index fund? I don't know enough about how cap gains are calculated to say. If that's the case, then I can hope that cap gains may decrease in the future, once I stop all my fiddling.

Uh, yeah.

Quote:

Thanks for the input, folks. I see I have a lot of thinking and research to do.

Without a doubt.

[ER Eddie]

No need to be condescending. I'm just asking questions.


It looks like I qualify for the affordability exemption for catastrophic coverage mentioned earlier. Bronze will be nearly 20% of my income in 2020. (This is part of why I'm having trouble with the ACA rates. Another part is that an ACA plan would represent nearly a third of my total expenses, which, for a frugal guy like me, is a hard pill to swallow.)

So, the affordability exemption opens up another option, and that's good. I'm not clear how much of a cost difference it will make, though, given that those policies cover the same areas as normal ACA plans do, and the deductible is similar. They quote $7900 as the deductible for catastrophic (although I can't actually view any specific catastrophic plans in my area), and the bronze plan had a $6500 deductible. Anyone have any specific data from their own experience, re. cost savings with catastrophic vs. bronze?

Another MAGI question, if anyone's still following along: If I put income into a 403b, that is not counted in MAGI, correct? So I could reduce MAGI by putting whatever income I get into my 403b?

Thanks, folks. Appreciate the input. It has made me aware of some alternatives I didn't know existed and prompted me to double-check for pitfalls, which has made me feel more knowledgeable and secure.

[MichaelB]

Quote:

Originally Posted by ER Eddie Another general tax/MAGI question, if anyone's still following along: If I put income into a 403b, that is not counted in MAGI, correct? So I could reduce MAGI by putting whatever income I get into my 403b?

This is correct.

[Bir48die]

Quote:

Originally Posted by GTFan Uh, yeah. Without a doubt.

This reflects my main issue with this forum

[MichaelB]

Quote:

Originally Posted by ER Eddie So, that opens up another option, which is good. I'm not clear how much of a cost difference it will make, though, given that those policies cover the same areas as normal ACA plans do, and the deductible is similar. They quote $7900 as the deductible for catastrophic (although I can't actually view any specific catastrophic plans in my area), and the bronze plan had a $6500 deductible. Anyone have any specific data from their own experience, re. cost savings with catastrophic vs. bronze?

A I recall. pb4uski has the most experience here. Looking over some of his posts from the early ACA days might help understand the comparison between Bronze anbd Catastrophoc coverage. As for savings, though, you really need to look at pricing in your area. You may have to call the major insurers to see if they have catastrophic policies available. Also try an insurance agent.

[ExFlyBoy5]

Quote:

Originally Posted by utrecht I use Christian Healthcare Ministries and will never go back to traditional insurance. At least not until Im eligible for Medicare.

Not wanting to derail this, but since others may see this thread and think that CHM might be a good deal, I came across this...

Quote:

You can receive assistance up to $125,000 per illness

That, my friend, is not much money in the health care world. When my DW had spinal surgery a few years ago, the bill far exceeded that limit in the period of about 7 hours. That doesn't count for all the additional expenses after surgery and the every 6 month MRI scans that are over $15,000 a pop.

[REWahoo]

Quote:

Originally Posted by cathy63 That's not hard at all! A single Google search turns up plenty.

Interesting distribution on the Yelp! ratings which average three stars (out of five). It appears people either love CHM or hate them.

[zinger1457]

Quote:

Originally Posted by ExFlyBoy5 Not wanting to derail this, but since others may see this thread and think that CHM might be a good deal, I came across this... Quote: You can receive assistance up to $125,000 per illness That, my friend, is not much money in the health care world. When my DW had spinal surgery a few years ago, the bill far exceeded that limit in the period of about 7 hours. That doesn't count for all the additional expenses after surgery and the every 6 month MRI scans that are over $15,000 a pop.

I'm no expert on CHM but know there are different price options and and-ons. As mentioned above Brothers Keeper would increase the $125K/illness limit to unlimited with their gold plan for an extra $40/mo, would seem to be a no brainer add-on if one was to go with that type of plan. Another forum member has talked about his experience using Liberty Healthshare, I believe he stated their limit is $1M/incident.

[ER Eddie]

Quote:

Originally Posted by MichaelB This is correct.

Great, thanks. I was afraid of being put in a position where I'd have to choose between a subsidy and continuing to work (which I value). If I can sequester my income from Mr. AGI by squirreling it away in a 403b, then I can get out of that trap.

Quote:

Originally Posted by MichaelB A I recall. pb4uski has the most experience here. Looking over some of his posts from the early ACA days might help understand the comparison between Bronze anbd Catastrophoc coverage. As for savings, though, you really need to look at pricing in your area. You may have to call the major insurers to see if they have catastrophic policies available. Also try an insurance agent.

Gotcha. Thanks for the input. You're right about pricing being different from area to area.

I'll make a call to the ACA insurer in my area. There is only one. Their website did not fill me with confidence. I searched for Primary Care Physicians in my area, and the first one it listed was an elementary school...

[jkrm]

My daughter is 31. Two years ago she was the picture of health - never got sick, ran marathons, saw a doctor once a year for annual exam. Then her hands started hurting after a fall. Many months later she got the diagnosis - rheumatoid arthritis. Chronic disease. Biweekly injections of a biologic drug that costs over $1,000 per injection, as well as regular visits to a rheumatologist, frequent blood tests, and regular physical therapy.

So I would go with 1 or 2. You just don't know what might happen. I guess you might get away with a short term plan and switch to an ACA plan at the next open enrollment, so long as the provision still exists that pre-existing conditions can't cause you to be rejected. But I am not sure I would risk that.

[MichaelB]

Quote:

Originally Posted by ER Eddie I'll make a call to the ACA insurer in my area. There is only one. Their website did not fill me with confidence. I searched for Primary Care Physicians in my area, and the first one it listed was an elementary school...

Oh boy, That is not a good sign.

[ER Eddie]

I just found out COBRA is cheaper than I thought it would be. I expected it would be $1000/mo., but it's actually $600/mo.. That's reasonable. It's good insurance. So, that might be a good option. It's a few thousand a year more than the short-term plans plan or subsidized ACA plans, but it may be worth that to avoid the hassles and downsides of those other options. At least for a while.

[MichaelB]

Quote:

Originally Posted by ER Eddie I just found out COBRA is cheaper than I thought it would be. I expected it would be $1000/mo., but it's actually $600/mo.. That's reasonable. It's good insurance. So, that might be a good option. It's a few thousand a year more than the short-term plans plan or subsidized ACA plans, but it may be worth that to avoid the hassles and downsides of those other options. At least for a while.

It's a good option, lasts 18 months, and if you choose an ACA plan, you have guaranteed enrollment outside of the normal November enrollment period.

[utrecht]

Quote:

Originally Posted by zinger1457 I'm no expert on CHM but know there are different price options and and-ons. As mentioned above Brothers Keeper would increase the $125K/illness limit to unlimited with their gold plan for an extra $40/mo, would seem to be a no brainer add-on if one was to go with that type of plan. Another forum member has talked about his experience using Liberty Healthshare, I believe he stated their limit is $1M/incident.

Actually the "Brothers Keeper" add on which gives you unlimited lifetime coverage doesnt cost $40/month extra. It costs $25/ quarter extra.

[BeachOrCity]

For your long term HC / ACA sanity get your ducks in a row on the rules around catastrophic plans even if you go Cobra. Bottom line is it is alot of paper work, but worth it if you are somewhat healthy and bronze premiums are over 8% of your projected income.
For me the cost was 1/2 that of a bronze plan for what is not that different coverage.

In most states getting the actual catastrophic premium without getting the exemption first is cumbersome and difficult. they do not make it easy which is why few do it....and is also why it is so much cheaper.

Even if going cobra you can apply for the exemption just to understand the process and premiums.

[ER Eddie]

Quote:

Originally Posted by BeachOrCity For your long term HC / ACA sanity get your ducks in a row on the rules around catastrophic plans even if you go Cobra. Bottom line is it is alot of paper work, but worth it if you are somewhat healthy and bronze premiums are over 8% of your projected income. For me the cost was 1/2 that of a bronze plan for what is not that different coverage. In most states getting the actual catastrophic premium without getting the exemption first is cumbersome and difficult. they do not make it easy which is why few do it....and is also why it is so much cheaper. Even if going cobra you can apply for the exemption just to understand the process and premiums.

Will do. Thanks for mentioning the option. I wasn't aware of it.

[utrecht]

Quote:

Originally Posted by cathy63 That's not hard at all! A single Google search turns up plenty. These are just a few of the negative ones from Yelp. "If you ever heaven forbid change to another health coverage (insurance another cost sharing) then you won't be covered for anything that occurred during the last 4 months you were with CHM because they take 4 months to process your bills and won't pay anything if you cancel during that time. " This makes no sense at all. Yes, CHM takes about 4 months to pay. That is clearly stated. Its not a secret. How does that have anything to do with not being covered during your last 4 months under CHM? If I quit CHM and join an ACA plan tomorrow, I was still covered by CHM the past 4 months. "This so called Ministry is a joke. My wife had surgery in 2018 and was denied all coverage and sharing because she had a Pre-existing condition from over 30 yrs ago." Again, pre-existing condition rules are clearly stated. This person most likely either didn't disclose the condition when signing up and/or the surgery was performed fairly soon after signing up so it wasnt fully covered. "If you get sick and need a surgery, no good hospital or surgeon will accept you because "you don't have health insurance"." This is 100% total nonsense. CHM members pay cash up front. EVERY doctor loves this. You know how long it takes them to get paid by insurance companies? If its an expensive procedure you can go on a payment plan and pay the doctor in full when CHM pays you. I pick any doctor I want, unlike the ACA plan I was on where most of the doctors in the plan got their degree in places like Granada. "Paid as gold member for $150 plus $50 for the so called "brothers keeper" but after getting a first time infection they declined to pay the bills even after I already negotiated very very hard to reduce my bill in half from the hospital. Talked to CHM at 1-800-791-6225 to reconsider, as $15,000 of ER bills is no way I can pay, but they just keep saying Sorry it was denied. CHM personnel/agent did not even offer anything, like helping me further to negotiate with the hospital to see if they can further reduce the bills, or even offer me a what they call "PRAYER". In my opinion I was scammed by CHM. The so called brothers KEEPER is really meant they are keeping your money as a brother." Cant answer this one but my guess is there's more to the story than this person is letting on. Maybe CHM had a problem with a person going to the emergency room and racking up $15000 in medical costs, for a "first time infection"? Not too mention that anything over $1000 CHM has their own dept to contact the doctor/hospital to negotiate the price lower for cash patients. "Here's what really happens: You have a health issue requiring surgery that's necessary for you to live. You're listed as self-insured by all providers (surgeons, hospital, labs, anesthesiologist, office visits), all of which have their own bills, and often the hospital doesn't send an itemized bill unless you request it directly and then it may take a month. Now you're a month in, and get the claims up to CHM as soon as you can. You request a discount from all providers, which they may or may not offer. Then you wait. And wait. And wait. You're making small payments to each provider to keep collections at bay, but they now call and say you're late and they'll send you to collections if you don't pay more or all of the balance due. You send more or all that's due, because you're now six months and maybe 9 months post-surgery. Then someone at CHM - and you have no idea who, because CHM works behind a curtain - moseys over to the phone and (supposedly) arranges for a deep discount with the provider who's been yelling at you to pay up. In my case, I'm a year out from two major surgeries and waiting on thousands in reimbursement - and I'm the highest level member of CHM. But the checks that actually finally trickle in, although they declare my claims "eligible", remit only a fraction of what I've paid out bc they say the provider offered a substantial discount. I'm sure they did - they've already been paid at this point, so it means nothing to them to tell CHM, Yeah, sure write down the bill so you can tell your member it was really only 20% of what they've paid for, and then CHM can retain 80% of what they've declared is eligible. Want the rest? It's up to you to try to get a refund back from the provider based on what CHM claims they wrote down, except no one provides you with any paperwork substantiating this." This entire rant is just more complaints from someone who didnt know what they signed up for. https://www.yelp.com/biz/christian-h...ries-barbertonhttps://www.yelp.com/not_recommended...mended_start=0

I dont trust Yelp reviews at all. Ive read so many reviews saying a restaurant or hotel was terrible but I saw none of the things they talked about. Ive seen people complain about tiny rooms that I thought were pretty big...ect.