Any advice on health insurers?

[progree]

Yes, I'm searching for health insurance at this late date. DERP.

It might be too late to avoid the penalty already, but that's another post (my penalty would be a lot more than $95; the 1% of income part applies).

The 5 insurers for my zip code ( 1st suburb west of Minneapolis ) are (with some of the plan names to help with identifying purposes):

PreferredOne (plans named with "Select", "Choice", "Afford" )...

Group Health (most plans have "HealthPartners" in their name)

Blue Cross Blue Shield

Medica (some of their plans have "North Memorial" or "HealthEast" in their name)

UCare - its an HMO, so I'm not interested. https://www.healthsherpa.com/learn/types-of-insurance

Even after selecting some screening criteria (e.g. maximum acceptable deductible level), I'm still looking at 37 plans, so I'm hoping to eliminate some insurers.

Thanks for any advice.

I'm having a miserable time of it so far, understanding even the basics so I can at at least do some intelligent screening, rather than having to read a lot of the plan details to even know if a plan is of further interest or not -- http://www.democraticunderground.com/114211792

I know that it's a lot better than before (sigh) -- http://www.democraticunderground.com/?com=view_post&forum=1014&pid=758167

[BlueStreak]

1. Think of it as a 1-year deal, not a long-term relationship

You have to go through this deal every year. Of course, if you are happy with your company, they will try to get you to renew directly with them.

The most important thing it to determine who is in network. In my market there are only two insurers, Anthem BCBS and a no-name. Anthem has a HORRIBLE network -- basically nobody is in it, and you probably wouldn't want to use the ones who ARE in it. The no-name company has a very comprehensive network, basically anybody I'd want to use.

I would have gone with the no-name, but my other half had a preference for staying one more year on the Anthem non-ACA policy, which also has a good network. So we didn't go with the no-name. My expectation is that for 2015 there will be another company or two in the mix and the networks will be better, so I plan to get an ACA policy for 2015.

[progree]

2. Oh well. I already started looking at BCBS first. Thx for heads up. n/t

[BlueStreak]

7. BCBS may be fine in your area. You have to check out the networks.

That takes time to research. When I was on healthcare.gov, the links to the networks did not work. I had to go to the websites of the individual companies to get that info.

And the same company can have different networks for differently policies. In my area, the BCBS ACA policies were complete garbage (and that is 95% of what is on the exchange in my area.) But I had a BCBS policy from pre-ACA which had a good network, so I kept that policy for 2014.

[Travis_0004]

3. If you enroll by March 31st, you avoid the penalty for not having insurance

Even if you don't enroll, you can still avoid the penalty. The law was recently changed to say you can avoid the penalty if "You experienced another hardship in obtaining health insurance." That is so wide, that anything could allow you to be exempt. If the only way you could afford health insurance is to sell your second Ferrari, you could argue that's a hardship, and be exempt from the fine. (I would argue your priorities are backwards, but that's another conversation. I'm also being a bit sarcastic with that example, but I'm sure everybody could find at least one hardship if they don't want to pay the penalty).

I don't know anything about those insurers, but if you have a doctor, or know who you want to be your doctor, find out who they accept first.

[progree]

5. They also require I pay the first month's premium by March 31, and can't pay online

[font color = blue] >> If you enroll by March 31st, you avoid the penalty for not having insurance. Even if you don't enroll, you can still avoid the penalty. The law was recently changed to say you can avoid the penalty if "You experienced another hardship in obtaining health insurance." That is so wide, that anything could allow you to be exempt. I'm sure everybody could find at least one hardship if they don't want to pay the penalty) ... << [/font]

As for paying online, MNSure, Minnesota's health exchange says,

To pay online, consumers using MNsure.org must complete all application, plan selection and payment steps in one sitting. This eliminates the need to return to the website to complete enrollment. MNsure strongly recommends this method in order to ensure coverage begins when intended by the consumer.

Well, too late. No way I can do all that in one sitting, and anyway have already done the application without selecting a plan and doing the payment thing, so that option is foreclosed.

So my other option is to be invoiced by the insurance company... I have to sign up on the MNSure exchange to qualify for the subsidy, then I have to trust that they get that information to the insurance co. in time, and that the insurance co. acts in time to "invoice me" (snail mail?) ... anyway it might be a tight fit since I have a lot of work to do before selecting a plan (it is the biggest expenditure of my life other than my house and car).

As for hardship in enrolling for insurance, I'm not sure the IRS will accept just any explanation, and I don't want to lie and face penalties for perjury. I've dealt with them, and usually procrastination and I stubbed my toe are usually not the things they accept for getting something done late.


[font color = blue] >> I don't know anything about those insurers, but if you have a doctor, or know who you want to be your doctor, find out who they accept first. << [/font]

I don't like my doctor, and don't have another one in mind, so that specifically isn't a factor. But yes, I do want the primary clinic I go to to be reasonably nearby, as well as a network hospital being nearby. So what is in the network is a priority. Thanks.

[kickysnana]

4. What I know.

Medica and Group Health are also HMOs. Group Health and Medica originated in the eastern Twin cities, Ucare in the western part.

If you have preexisting conditions or there are doctors you trust ask each plan if they specifically are in the network. If you take prescription look in their formulary to see if they are easily available. There are good doctors in almost all insurance plans/clinics/hmos.

I know some about UCARE, my doctors are not in their network so I have not been with them since about 2005 but my Aunt is she is in the Fairview Clnic network. so I deal with them. The rest I have no direct experience. ( I have straight Medicare/MA right now. )

[progree]

6. Hmm, HealthSherpa and MNSure list Medica as a PPO

As for Group Health, HealthSherpa lists all its plans as PPO. MNSure doesn't show "Group Health" but shows a number of HealthPartners plans (which I believe is Group Health) -- all of them they list as PPO.

[pnwmom]

8. If you have a primary care doctor, call the office and find out what plans they accept. Then

go to those sites and, if you have any opinions about which hospitals are good in your area, check to see that they're listed as providers, too.

[dflprincess]

9. When my brother had cancer he was covered by HealthPartners

there was never a problem with any claim and they paid claims promptly. This is not something I had experienced with any insurer They even agreed to pay for a last ditch chemo that had the potential only to buy him some more time - at that point we knew there would be no cure. This was a drug that a lot of insurers wouldn't cover at the time.

HealthPartners has partnered with Park Nicollet which opens up all of PN's clinics & Methodist Hospital to "tier 1" coverage with them. With most HP plans you can pretty much go anywhere you like - you're not limited to HP or PN clinics, though should you go to Fairview or Allina your co-pay may be higher (i.e. $25 vs $15) - though check the network before you pick a plan (this would be true of whoever you go with).

I believe the Medica "Healtheast" or "North Memorial" plans may limit you to one of those networks.

The terms "Select", "Choice" or "Afford" may refer either to network options or deductibles and copays (look at the price of each one - it may help give a hint as to the network choices as well as the deductibles/copays).

My past experience with Medica and Blue Cross have been okay though I am still suspicious of the relationship Media has had with United Health Group - though they supposedly cleaned that up.

All these plans are non-profit so at least they won't be worrying about shareholders.

If you're not eligible for a subsidy you can also go directly to the insurers' websites (or call them) and see what kind of coverage you can get that way. It would probably be easier to get the payment in on time that way.

[progree]

10. Thanks!

Thanks for the comprehensive and very helpful to me response! There's a Park Nicollet clinic about 2 miles from me, so that would be great too. And Methodist Hospital is a very reasonable distance, as is Park Nicolett Medical Center on Excelsior Blvd in St Louis Park.

I'm not thrilled with my experience with a North Memorial clinic, so choosing a plan where they are not in the network is not a problem, maybe even a bonus (as an incentive to try something different).

I had started out looking at Blue Cross -- there is a plan on MNSure that I can't find on the BCBS website (blueCrossMN.com), oh well, will try harder, haven't called them about it yet, just getting started drilling down on some plans to look at details, to get the "lay of the land". For that particular plan, MNSure has a link to the Summary of Benefits and Coverage, which is quite comprehensive, although it doesn't say anything about who and what are in the network.

I will follow your suggestion to concentrate on HealthEast after looking at a BCBS plan or two (since I've already invested time figuring out their website to some extent).

[font color = blue] >> My past experience with Medica and Blue Cross have been okay though I am still suspicious of the relationship Media has had with United Health Group - though they supposedly cleaned that up. << [/font]

Yeah, the name Medica has stuck in my mind in a negative way from something I read, but don't remember anything and can't find anything in my "news notes" -- which isn't unusual for me.

[font color = blue] >> All these plans are non-profit so at least they won't be worrying about shareholders. << [/font]

That's good to know. Particularly when coupled with the ACA requirement that at least 85% of all spending is on actual health services, leaving only at most 15% for administration, marketing, and profits (for for-profits).

[font color = blue] >> If you're not eligible for a subsidy you can also go directly to the insurers' websites (or call them) and see what kind of coverage you can get that way. It would probably be easier to get the payment in on time that way. << [/font]

No doubt that would be smoother and easier. Unfortunately, I do anticipate a subsidy of about $91/mo subsidy so I don't want to leave that on the table. Thus I'll have to enroll through MNSure to get the subsidy. However, I'm encouraged to read the following:

U.S. to allow some people to enroll in Obamacare after deadline, Reuters, 3/21/14
http://news.yahoo.com/u-allow-people-enroll-obamacare-deadline-000535875--sector.html

The Obama administration will soon issue new Obamacare guidelines allowing people to enroll in health coverage after a March 31 deadline, but only under certain circumstances, according to sources close to the administration.

The sources said the new federal guidelines for consumers in the 36 states served by the federal health insurance marketplace and its website, HealthCare.gov, would allow people to enroll after March 31 if they had tried earlier and were prevented by system problems including technical glitches.

On Friday, the administration published in the Federal Register new regulations that would allow state-run marketplaces new flexibility in setting insurance coverage effective dates for people who sign up during special enrollment periods.

"Open enrollment ends March 31. We are preparing for a surge in enrollment, and if consumers are in line on the 31st and can't finish, we won't shut the door on them. To be clear, if you don't have health insurance and do not start to sign up by the deadline, you can't get coverage again until next year," HHS spokeswoman Joanne Peters said in a statement.

So if the only problem is not getting "the invoice" in time (see #5), I'll probably be OK as far as being excused from the penalty. Unless its 2-3 weeks late, it won't affect my anticipated coverage start date of May 1.

[dflprincess]

11. Esme Murphy had the head of MNSure on WCCO this morning

from what he said, I got the impression that as long as your application is in process on or before the 31st you won't be liable for the penalty.

You could probably find the interview at WCCO's website just to make sure I'm interpreting what I heard correctly.

[progree]

12. Thanks - I found an article about MNSURE enrollments not fully completed by March 31

http://minnesota.cbslocal.com/2014/03/24/mnsure-grants-reprieve-for-late-enrollment-snags/

It talks about enrollment snags, though that's not my issue (though could be a factor on the last day or two if web traffic is heavy). Still if I have my plan selected and all that by the end of March 31 (Monday), and the only thing not done is that I haven't paid because I'm waiting for the invoice, I think I'll be OK. I'm aiming to be done Friday.

[progree]

13. At about 300% of poverty, they signed me up for Medicaid!

I applied at MNSure on the 19th for the Obamacare subsidy and gave them the details of my projected income, nearly 300% of the poverty guideline. It told me right away that I was qualified for $91/month of premium tax credit subsidy, as I expected based on the Kaiser Family Health subsidy calculator.

Well, today, the 29th, I got a snail mail letter saying I'm enrolled (effective May 1) in Prepaid Medical Assistance Program (PMAP) -- Minnesota's version of Medicaid! Not what I expected, I thought that was for people 138% of the poverty guideline and below.

So I called the number on the letter, and she said, no, at my income, I'm not qualified for PMAP. She talked to her supervisor and then said she would put in a work order to have someone review it.

I asked if I would have any problem enrolling in regular Obamacare through MNSURE, and she said she wasn't sure if MNSure would block me or not from enrolling given that (for now) I'm being enrolled in PMAP. But to wait to hear from us.

Well, I plan to go ahead and see if I can't enroll in a regular MNSure private insurance choice tomorrow given that the (nominal) deadline is Monday.

I wonder though if this is a common problem.

MNsure on the verge of enrollment milestone, Star Tribune, 3/22/14
http://www.startribune.com/local/251729731.html

Minnesota’s health insurance exchange is on the verge of reaching its goal to sign up 135,000 people by March 31. More than 1,000 Minnesotans are enrolling daily as MNsure enters the final days.

Enrollment in government programs for those with low incomes has been particularly strong, offsetting figures for commercial health plans that are much lower than expected.

... In Minnesota, the mix of plans sold through the exchange has been much different from expected. About half as many Minnesotans as first projected in October have bought private coverage through MNsure, and interest from small businesses has been nominal. Eventually, it will be important to sell more commercial plans, because a key funding source for MNsure is a fee insurers pay based on premiums for private insurance.

More than five times more Minnesotans than projected have gained health coverage under Medical Assistance, the state’s version of Medicaid for the poor. Public health leaders see this as an encouraging sign, as 60 percent of the uninsured are eligible for one of the state’s public programs but haven’t signed up.

Do they have a glitch that is enrolling too many people in Medicaid or other low income programs? Hard to believe at this late date.

[progree]

14. Done. I am enrolled in a MNSure exchange health insurance program

I called this morning about 930 AM to make sure that the Medical Assistance determination snafu discussed in #13 above wouldn't cause a problem or issue when enrolling in a regular MNSure exchange program. After looking at it, and after I described what I'm seeing on the screen, he said go ahead and enroll, there shouldn't be a problem, and in the meantime they will look at the Medical Assistance thing and probably notify me that that's been cancelled.

Wait time on the phone was only 15 minutes, not bad at all on "Penalty Eve" day. MNSure.org was a little glitchy here and there in spots but pretty smooth overall and enrolled and paid the first month's premium online.

HealthPartners silver with a $2750 deductible, $373/mo before subsidy, coinsurance 10% generally speaking, $6,350 maximum out of pocket (I'm a "bit" over 60 so that's why the high premium)