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Old 09-20-2015, 07:43 PM   #61
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Unless I am very mistaken, the one I bought pre-ACA said nothing about being short-term. Regarding renewal, I could have continued and they could not kick me out. And the rate increase is regulated too. Yes, they do exclude preexisting conditions. I also could not be a motorcyclist. There could have been some other restrictions that I forget.
Yes, before ACA there were many other options....

I would be surprised that there was no ability to kick you out... that was one of the complaints people had with the individual market... if you got sick and cost them a bunch they did not want you going forward...


Just as an example... I had car insurance with a company probably 30 years ago... they told me they could not cancel and it would renew as long as I paid.... and their rates were regulated.... so everything was good until they lost money and decided to leave the state.... yep, they cancelled everybody's insurance because they could not cherry pick under the policy they created.... I think I got 30 days notice...
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Old 09-20-2015, 07:48 PM   #62
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It is true that they cannot cherry pick and have to leave the state. This makes sense though because you cannot force a business to stay open if it keeps on bleeding red ink.
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Old 09-20-2015, 11:22 PM   #63
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Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
$10K is too high for ACA deductible. Doesn't cover any visits or prescriptions until the $10K is met. Has a cap of either $1M or $2M. (Slight cost increase for the $2M plan) Pre-existing conditions not covered.

So it doesn't qualify as an ACA plan. You have to pay the penalty for being uninsured if this is your only plan. The penalty would be pro-rated for the number of months you were on this plan out of the year. You could then start an ACA qualified plan Jan. 1 of next year.
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Old 09-21-2015, 04:25 AM   #64
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DW and I are on ACA Bronze and pay almost $800/month. The deductible is $ 5K per person, so we're essentially self-insured for the first $ 5K per person per year.

You probably can find cheaper insurance, but you may be spoiled by low cost, the nice benefits and low deductible on your old plan, at least when it was largely subsidized by Megacorp or Big Gov'mint.

So yes, leaving Megacorp subsidized health insurance was a rude awakening, but we couldn't afford to go without HI. In my view, health insurance protects against catastrophic costs, not insure that health care is reasonably priced or even effective! It's an ugly business....

Although you are paying the deductible the first $5K you aren't entirely self insured because everything is billed at the rate negotiated by the insurance company. My husband's cholesterol labs cost less than half as much under our ACA plan than under my former employer's plan. And the premium is 60% less than COBRA would have been.


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Old 09-21-2015, 05:41 PM   #65
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Can't find any PPO Bronze plans in Indiana. .....HELP
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Old 09-21-2015, 05:56 PM   #66
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Assurant offers two Bronze PPO plans in Lake County, IN.
Link: https://www.healthsherpa.com/insuran...onze/pPPO/hhs2

Edit: So sorry, I forgot Assurant was the company leaving the industry. My apologies. UnitedHealthcare has EPO plans which are a hybrid HMO/PPO. These have a provider network for non-emergency care but you do not have to choose a PCM and do not need a referral to see an in-network specialist.
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Old 09-21-2015, 06:03 PM   #67
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Assurant offers two Bronze PPO plans in Lake County, IN.
Link: https://www.healthsherpa.com/insuran...onze/pPPO/hhs2
Assurant is getting out of the health insurance business effective 1/1/16 and no longer offers new policies Assurant describes health market exit plans | LifeHealthPro
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Old 09-21-2015, 06:19 PM   #68
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Cheapest Bronze HMO plan in Florida for our 3 person family is $566.
Cheapest Bronze PPO plan for us is $971.

Looks like we are going to an HMO
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Old 09-21-2015, 06:59 PM   #69
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Cheapest Bronze HMO plan in Florida for our 3 person family is $566.
Cheapest Bronze PPO plan for us is $971.

Looks like we are going to an HMO
LOL... yes, that happened to me last year... but even going to the HMO my premiums went up 40%+.... worried about next year....
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Old 09-21-2015, 08:56 PM   #70
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Can't find any PPO Bronze plans in Indiana. .....HELP
Anthem seems to have quite a few bronze plans for the Marion County zip code I entered. Do you live in a zip code that doesn't have many options?

https://www.anthem.com/health-insurance/
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Old 09-21-2015, 09:40 PM   #71
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$10K is too high for ACA deductible. Doesn't cover any visits or prescriptions until the $10K is met. Has a cap of either $1M or $2M. (Slight cost increase for the $2M plan) Pre-existing conditions not covered.

So it doesn't qualify as an ACA plan. You have to pay the penalty for being uninsured if this is your only plan. The penalty would be pro-rated for the number of months you were on this plan out of the year. You could then start an ACA qualified plan Jan. 1 of next year.
Here's another case of the gummint knowing what is best for you. Next, they will require everyone to have life insurance?

Anyway, does this mean that if one likes his pre-ACA insurance, he still cannot keep it? It sounds like you can keep it as long as you pay the gummint the penalty.

PS. I just read the ACA mandate again, and it appears to me grandfathered plans are acceptable. However, as these plans cannot sign on new patients, their pool will shrink due to attrition and eventually disappear when they are no longer economically feasible for the insurer.
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Old 09-22-2015, 08:52 AM   #72
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Next, they will require everyone to have life insurance?
There already is (sort of). It's called Social Security.
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Old 09-22-2015, 08:56 AM   #73
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The healthcare threads tend to be more helpful when they stick to the thread topic.
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Old 09-25-2015, 09:11 AM   #74
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I am not sure if anyone mentioned this but you can also get free quotes on ehealthinsurance.com to compare. We self insure and don't qualify for a subsidy. We pay about $750/month for a family of 3. I met the OOPM last year due to an unexpected surgery and was really happy with our coverage.

Also, if you have a small business, even freelance consulting, you can deduct your health insurance premiums on your taxes if you self-insure. That has been a great help for us.
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Old 09-25-2015, 04:27 PM   #75
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I am not sure if anyone mentioned this but you can also get free quotes on ehealthinsurance.com to compare. We self insure and don't qualify for a subsidy. We pay about $750/month for a family of 3. I met the OOPM last year due to an unexpected surgery and was really happy with our coverage.

Also, if you have a small business, even freelance consulting, you can deduct your health insurance premiums on your taxes if you self-insure. That has been a great help for us.
I think the original poster's definition for self insurance is no health insurance. They would pay for all medical expenses out of pocket.
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Old 09-25-2015, 04:29 PM   #76
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If he drops coverage and goes to a state exchange doesn't the employer have to pay a penalty?
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Old 09-26-2015, 08:38 PM   #77
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I only read half the thread.... but I would just buy the lowest cost bronze plan and call it a day....
That's the right choice for us too. I looked at Silver w/cost sharing, but even if doctor visits were free, that wouldn't save enough to make up the premium difference. Of course the math doesn't work that way if you have a lot of doctor visits, but we don't. The catastrophic policy would probably be better, since what I'm buying is the negotiated rates and the max out of pocket. The process to get the over 30 catastrophic put me off the last couple of open enrollments. Maybe I'll look into it again.
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Old 09-27-2015, 10:22 AM   #78
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Can insurers deny coverage if you have a hotelís address as your home address on your policy but arenít living in the hotel at the time of the claim?

Letís say youíre an RVíer or permanent traveler. You find the most inexpensive policy in a particular state. You enroll for coverage and list a hotel address in that zip code as your home address and your virtual mail service address (in the same state, but with a different zip code) as your mailing address (the ACA application has separate home address and mailing address sections). At the time of the application, you may or may not actually stay at the hotel.

Enrollment complete, your paper mail from ACA and your insurer should go to the virtual mailbox where you can have it scanned or forwarded to yourself, which you could do to get your insurance cards. You keep the hotel address as the home address on your policy.

Then you incur medical costs. Would the insurance company try to deny you coverage for gaming the system like this? I understand they have entire departments that seek out ways to deny claims.

Or say someone like the OP applies for a cheaper policy on the other side of his state using a hotel as his home address and his physical home as his mailing address. Would the insurance company try to deny coverage in that case? How would they even know about the scheme in either case?
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Old 09-27-2015, 10:33 AM   #79
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Can insurers deny coverage if you have a hotel’s address as your home address on your policy but aren’t living in the hotel at the time of the claim?

Let’s say you’re an RV’er or permanent traveler. You find the most inexpensive policy in a particular state. You enroll for coverage and list a hotel address in that zip code as your home address and your virtual mail service address (in the same state, but with a different zip code) as your mailing address (the ACA application has separate home address and mailing address sections). At the time of the application, you may or may not actually stay at the hotel.

Enrollment complete, your paper mail from ACA and your insurer should go to the virtual mailbox where you can have it scanned or forwarded to yourself, which you could do to get your insurance cards. You keep the hotel address as the home address on your policy.

Then you incur medical costs. Would the insurance company try to deny you coverage for gaming the system like this? I understand they have entire departments that seek out ways to deny claims.

Or say someone like the OP applies for a cheaper policy on the other side of his state using a hotel as his home address and his physical home as his mailing address. Would the insurance company try to deny coverage in that case? How would they even know about the scheme in either case?
I would think you would need to have a PPO plan if you are a perpetual traveler so imo the address you use on your tax return would be the valid address to use, but in any case if you have a PPO plan what does it matter where you have treatment as long as you are in network.

I don't know the answer, just speculating as I am someone who travels 6 months a year so need to have a PPO for decent coverage.
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Old 09-27-2015, 11:00 AM   #80
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Can insurers deny coverage if you have a hotel’s address as your home address on your policy but aren’t living in the hotel at the time of the claim?
They can deny coverage if they can show that any part of the application process was misrepresented. Residency is pretty easy to challenge if your driver's license, voting registration and banking records show a different domicile than the one used for health care.

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I would think you would need to have a PPO plan if you are a perpetual traveler so imo the address you use on your tax return would be the valid address to use, but in any case if you have a PPO plan what does it matter where you have treatment as long as you are in network.

I don't know the answer, just speculating as I am someone who travels 6 months a year so need to have a PPO for decent coverage.
+1

Insurers are even building PPO networks that are limited in scope. It is critical to familiarize ourselves with the specifics of network coverage, a mistake here will be very costly. Based on the past two years of policy offerings, this is where the insurers are focusing their efforts, and the broad national network policies are quite expensive, but basically mandatory for those of us that spend time in different locations throughout the year.
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