I almost have health insurance ... I think

[ashling]

We have had to start over so many times because we got locked out ...password change ... start over... repeat for several months

so I'm finally looking at plans but the deductables make it look like nothing is going to be able to help

are we going to have to pay these deductables . Looks like everything is out of pocket until after we are bankrupt anyway.

[lostincalifornia]

1. You do realize that a yearly physical with labs and other preventives are not subject to deductibles

What is the maximum deductible that you see. Without giving specifics, how can you expect a reasonable response

What state, what plan, etc.

[ashling]

6. Here - the most basic

Blue Cross Blue Shield of Texas Blue Advantage Bronze HMO 006

Plan ID: 33602TX0460006
HMO Bronze
Compare
Save
DETAILS
ENROLL
Monthly premium

$18.72/mo.
was $706.72

[which is great, but we need help paying for meds now]

Deductible

$12,700
group total

Out–of–pocket maximum

$12,700

Copayments / Coinsurance

No Charge After Deductible Primary doctor
No Charge After Deductible Specialist doctor
No Charge After Deductible Generic prescription

[Recursion]

22. This whole "deductible = out of pocket maximum" thing is weird to me

But apparently that's how most of the bronze plans work. It's not really a "deductible" in the normal sense of the word; they don't coinsure at all.

[Ex Lurker]

2. Which ones are you looking at?

There are silver plans in my state with deductibles as low as $100.

[lostincalifornia]

3. In my state the max bronze plan deductibles for 1 person is 5000 dollars. When I think of a

bankruptcy usually it involves a lot more than that

[sobenji]

4. Routine care and a drug copay card

Those are not part of the deductible

[Lex]

8. which is heads and shoulders above

what a lot of people had before (often nothing)

not perfect, but something

[Lex]

5. With ACA, you don't pay everything out of pocket until you meet your deductible.

That should be clear on the details of the plan on-line.

[Ms. Toad]

7. The other thing to remember is that if you buy a silver plan,

and are eligible for premium subsidies, you may also be eligible for cost sharing of the out of pocket expenses. There are two separate subisdies, and the one that shows most clearly on the plans is only the premium subsidy.

Try here for a more realistic estimate of your actual costs (both premium, and your share of the day to day expenses): http://kff.org/interactive/subsidy-calculator/

[Glitterati]

9. Ignore the BRONZE plans, look at SILVER

There's at least one where the deductible and out of pocket are lower than the bronze.

And, as said upthread, your doctor visits are going to be about $25 co-pay, prescriptions ~15.00 copay BEFORE deductible (despite your deductibles/out of pockets).

[ashling]

10. I can't afford the premium

for the silver

[Glitterati]

11. The silver plan for me is $28.55 per month

and for my 18 yr. old daughter, $38.75 per month.

That, of course, includes subsidies, but I'm assuming you qualify for a subsidy of some kind?

[ashling]

12. The lowest silver for me & my wife

is $314.23/mo. with the subsidy

[Ms. Toad]

13. Remember, though,

There are also subsidies for the coinsurance and out of pocket maximum - but only for the silver. Make sure you check that out - the nominal out of pocket on the silver plan may be quite different from what you actually pay.

[Glitterati]

15. Some questions?

Does it cover basic care (doctor appointments, prescriptions) despite the deductible/out of pocket? Because, frankly, that's where most of your medical costs are going to come from on an annual basis. Hospitalizations, hopefully, are rare. Even though I have a chronic condition, most of my medical bills come from doctor visits, routine blood work, and prescription meds. My silver plan keeps those out of pocket costs to a minimum.

Be sure to look at all the silver plans....the lowest priced one was not on the top at first and I, like you, was horribly discouraged when I looked at healthcare.gov until I spent a good bit of time really looking at the plans.

With that silver plan, what's the cost of a doctor visit? prescriptions? specialists?

What's the deductible/out of pocket on this silver plan?

I know that it's time consuming and frustrating to go through all this. I just about tore my hair out looking for a decent plan for myself and my daughter. But my perseverance paid off and I found a good plan for us at prices I could afford. Don't get discouraged and give up.

[ashling]

16. But if the premium is more than I can pay,

the rest doesn't matter.

My wife and I are talking about just getting the bronze that we can get into and change next time or if things change ... like one of us gets a full time job.

In the meantime it sounds like even the bronze will allow us to get checkups and scripts for our maintenance meds ... right?

I know I sound real dense about this, but I have just been around in circles so much . . .

[Glitterati]

17. I know, the circles are maddening. But, I'm afraid I have bad news for you

this in your post about the Bronze plan spells it out......

No Charge After Deductible Primary doctor
No Charge After Deductible Specialist doctor
No Charge After Deductible Generic prescription

The key words are AFTER DEDUCTIBLE. You have to pay that deductible before ANY medical expense is paid by the insurance company.

ONLY the Bronze plans are like this. That's why the Bronze plan is nothing more than "hospitalization plans." The only time you are going to use them is in a serious medical emergency requiring hospitalization.

[ashling]

19. That's what I thought originally,

I guess I misunderstood what somebody said about that ...

at this point I am just pretty confused -

and then that damned golf ball smashing into the windshield the other day . . .

[Glitterati]

18. According to your post on the bronze plan, your subsidy is

$688.00/month

That's more than my subsidy is, and should almost cover a Silver plan. Honestly, I have to believe there's a Silver plan that is more affordable for you somewhere on that website.

[ashling]

20. I'm fixin' to take another look

thanks for your help

[Glitterati]

21. You're welcome

I did a fast calculation on the Kaiser Foundation website, with 2 adults, age 30, in zipcode 75448, $20,000 income and came up with a Silver plan which would cost you approximately $33.00/month for both of you.

Of course, all of the above is assumptions, but I'm pretty certain that 318.00/mo for a silver plan you're seeing is incorrect.

I know it's frustrating, and it's been an absolute nightmare getting signed up, but don't give up. I'm certain there's a silver level plan for you that is affordable.

[ashling]

23. unfortunately

we are 2 adults, 53 & 61 yrs old in 76063

[Glitterati]

25. Believe it or not

your ages mean your subsidies go UP.

Plugging those numbers into the Kaiser Foundation site, means your monthly subsidy is $1000.00/month for a Silver plan!!!!!!!

Here's the number I got from Kaiser (again, making an assumption about your income - 20,000)


Household income in 2014: 129% of poverty level
Maximum % of income you have to pay for the premium, if eligible for a subsidy: 2%
Health Insurance premium in 2014 (for a silver plan, before tax credit): $12,402 per year
You could receive a government tax credit subsidy of up to: $12,002 per year (which covers 97% of the overall premium)
Amount you pay for the premium:
$400 per year (which equals 2% of your household income and covers 3% of the overall premium)

[Glitterati]

24. One more thing if you're still reading

When you get to healthcare.gov, if you put a checkmark in the Silver column, it will only display Silver plans for you. You'll manage to get rid of all the other confusing stuff and be able to concentrate only on Silver plans.

In fact, if I remember correctly, it was only after I did this that I saw the inexpensive Silver plan come up to the top of the selections..........if I remember correctly.

[ashling]

26. I tried that, but it got

hung up and I had to start over ... it's doing that now ... I hope it doesn't have me start all over agiain

[Glitterati]

27. OK, a couple more numbers for you from Kaiser

When I used your correct zip code and ages, but increased the income to $30,000 per year, this is what I got.

The bottom line is $1,799.00 per year is $149.00 per month.


Household income in 2014: 193% of poverty level
Maximum % of income you have to pay for the premium, if eligible for a subsidy: 6%
Health Insurance premium in 2014 (for a silver plan, before tax credit): $12,402 per year
You could receive a government tax credit subsidy of up to: $10,603 per year (which covers 85% of the overall premium)
Amount you pay for the premium: $1,799 per year (which equals 6% of your household income and covers 15% of the overall premium)

I hope this is encouraging for you.

[ashling]

28. Yes, Thanks

now I just have to get through and locate a plan

[ashling]

29. After about 15 times of

entering my account data and getting a white screen

I finally get a message that it is down for maintenance temporarily

[Glitterati]

30. Oh you poor thing

been there, done that.

I know time is getting short for sign up, but really do hang in there. Get a good night's sleep and try it again in the morning.

BTW, I put my numbers through the Kaiser Foundation script and they were about double what my premiums actually turned out being - they said $55/month and I pay 28.55/month.

So, your possibilities look really promising for a Silver plan. Just take a break and try again in the morning.

[ashling]

31. still down

[progree]

32. Try HealthSherpa.com for shopping for plans (but don't buy there because won't get subsidy)

Last edited Sun Mar 30, 2014, 12:52 PM - Edit history (1)

HealthSherpa.com is well-regarded from what I've read, has the same exchange plans as healthcare.gov from what I've read and seen, and they also have the subsidy calculation. Anyway, it will let you see what plans are available to you and get some details on the plans, without all the website glitches healthcare.gov seems to be having if i understand what i'm reading here correctly.

IMPORTANT: do not buy a plan at HealthSherpa.com or any website other than (in your case as a Texan) healthcare.gov because if you do, you won't get the subsidy. (HealthSherpa.com tells you that too at the appropriate time. So does the Medica website, and I've read it in innumerable places -- you must enroll / buy the plan at the appropriate exchange website -- healthcare.gov for those whose states don't have an exchange, and the official state exchange for states like mine, Minnesota, that have a state exchange -- MNsure.org in Minnesota -- yes, oddly .org not .gov).

My experience is a little different since I'm shopping on a state exchange, MNSure.org . But I'm also using HealthSherpa.com and I find the plans are one-to-one identical -- HealthSherpa.com has ONLY plans that are on the exchanges (based on my observations from a Minnesota perspective and what I read generally). MNSure.org and HealthSherpa.com both have their advantages and disadvantages relative to each other as far as shopping.

Again, as a Texan, just be sure *NOT* to buy the plan on HealthSherpa.com or anywhere but healthcare.gov if you want to get the subsidy.

I think under bronze plans, as well as silver and higher, there are certain preventitive screenings, an annual physical, vaccinations (flu shots too), and certain other services (like contraceptives) that are free -- I would look that up to get a complete list, but I have to get back to shopping myself. But I agree with Gliteratti's advice on getting silver, I'm just vague on the details, well, here's a few from my notes:

The law's subsidies to help with out-of-pocket costs are only available to people who get a silver plan. - ABC News 1/5/14

For those with especially low incomes, there's a modified Silver plan that slashes coppays and coinsurance. - by Jane Bryant Quinn

By the way, Pollitz offered this tip for those who have an income between one and 2.5 times the Federal Poverty Level: Choose a Silver plan that covers 70 percent of your medical bills. You'll automatically be upgraded to a Gold plan that pays 80 percent of the bills at no extra cost. - Good Morning America, 12/23/13