Healthcare Plan advice

[Iusta]

Hi All, Been living out of the country for years. Wife and I are 44 with two children 6 and 8. We are semi retired and self employed status. Moving to California. We are healthy and do not use healthcare system except for yearly checkups. Looking for a low cost plan with high deductible. Please let me know what company/ plan you found to be best.

[bingybear]

really depends on income. Assuming you are looking for an individual plan (not group/employer), you really need to look at the ones available in California. I'm not familiar with them. You can get them thru California's exchange or directly thru the companies offering individual plans in California.

[Iusta]

Yes, it would be individual with income above threshold allowing government discounts. Seems there are only two companies offering insurance and it's unbelievable price even with high deductibles. Are their any private insurance alternatives?

[MBSC]

Quote:

Originally Posted by Iusta Yes, it would be individual with income above threshold allowing government discounts. Seems there are only two companies offering insurance and it's unbelievable price even with high deductibles. Are their any private insurance alternatives?

Since you do not qualify for subsidies, you can use the following link to see if there are any off-exchange only ACA-compliant plans in the area. https://finder.healthcare.gov/

If you are healthy, you may want to consider non-compliant Short-Term Medical (STM) plans. E-healthinsurance.com is a good starting point. The STMs from large insurers such as United HealthCare (UHC) and National General use broad PPO provider networks. Technically, there is still a penalty for having non-compliant coverage if you do not qualify for one of the many exemptions.

If the children are into sports, you could have them on an ACA-compliant plan and yourself on an STM. One new caveat about STMs is that policies issued after 4/1/17 have a 90 day limit so you have to switch back and forth between two carriers each quarter. The new HHS secretary is expected to rescind this limitation for 2018 allowing STMs to return to 11 or 12 month policies.

[cathy63]

What part of California are you looking in? I'm pretty sure all the urban areas have more than 2 insurance cos. At the least, there should be Kaiser, Aetna, Blue Cross and Blue Shield. Are you in a very remote area?

[AllDone]

The price of health care comes as a shock when you have been living outside of the US.

[travelover]

Quote:

Originally Posted by AllDone The price of health care comes as a shock when you have been living outside of the US.

....or getting it "free" from an employer for years.

[Iusta]

We will be in LA. After further research, there are 3 providers; Anthem, Blue Cross and Kaiser. Seems Blue Cross is the most expensive and covers less for the money. I assume this is because they have better or more doctors in the HMO/PPO? Anyone know which companies have the best service? Blue Cross has brand recognition.

[PERSonalTime]

Kaiser is an HMO with fairly good service. They even have their own hospitals.

[MichaelB]

Quote:

Originally Posted by Iusta We will be in LA. After further research, there are 3 providers; Anthem, Blue Cross and Kaiser. Seems Blue Cross is the most expensive and covers less for the money. I assume this is because they have better or more doctors in the HMO/PPO? Anyone know which companies have the best service? Blue Cross has brand recognition.

If the policies are ACA compliant, coverage will be exactly the same for all. The policies will differ in two ways. One is cost sharing - deductible, copay and total out of pocket. The other is the scope and reach of the provider network, including out of network coverage.

There is no way to determine if providers in one plan are better than another. The insurers will have tools on their website to compare how big their networks are. Look for the "find a doctor" tool and use that to get an idea of number and reach.

[bingybear]

Quote:

Originally Posted by MichaelB If the policies are ACA compliant, coverage will be exactly the same for all. .

Is this true? Just a question. ACA requires these insurances to have many characteristics like covering pre-existing conditions, unlimited benefit, etc.

But does the ACA compliance say that a given insurance can't cover something that is not in the must have list?

I have not read the rules that closely.

[MichaelB]

Quote:

Originally Posted by bingybear Is this true? Just a question. ACA requires these insurances to have many characteristics like covering pre-existing conditions, unlimited benefit, etc. But does the ACA compliance say that a given insurance can't cover something that is not in the must have list? I have not read the rules that closely.

Sure, insurers can provide additional coverage, but they don't for individual policies. For all practical purposes, ACA compliant individual policies all have the same coverage.

There are some differences. Probably the biggest is the formulary list. Insurers have latitude with regard to which drugs they cover, as long as they meet a minimum standard. Also, media reports some insurers treat some procedures, like colonoscopies < 10 years, as billable to patients, while others include them as covered screenings. Unfortunately, there is no way to identify these differences until the bill arrives.

[bingybear]

Quote:

Originally Posted by MichaelB Sure, insurers can provide additional coverage, but they don't for individual policies. For all practical purposes, ACA compliant individual policies all have the same coverage. There are some differences. Probably the biggest is the formulary list. Insurers have latitude with regard to which drugs they cover, as long as they meet a minimum standard. Also, media reports some insurers treat some procedures, like colonoscopies < 10 years, as billable to patients, while others include them as covered screenings. Unfortunately, there is no way to identify these differences until the bill arrives.

Even before ACA many insurers would treat a colonoscopy as diagnostic if they found anything... even if it was your first one and at 50 years old. From my experience all the ones after finding something in a previous were considered diagnostic (means they are not well care and are charged to the patient). That may change at medicare time. I don't think this is new to the ACA.

I agree with the formulary and would add the "agreed upon rates" as I'm seeing a great difference this year personally.