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progree's Journal
progree's Journal
March 22, 2014

Any advice on health insurers?

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

March 20, 2014

Health insurance fundamentals - deductibles, copays - Help! this makes no sense

Confusing -- I thought the patient paid EVERYTHING up to the deductible, and the insurance co. paid NOTHING. But John Waski says this:

A Procrastinator’s Guide to Picking an Obamacare Plan, John Waski, FiscalTimes, 3/19/14

{Speaking of Bronze Plans} : For $662 a month, one Blue Cross/Blue Shield plan (in Illinois), offered a preferred provider organization. If providers were in the network — it was more expensive if they weren't — Blue Cross would fully cover all expenses after a yearly family deductible of $12,700 was met. Under that amount, 60 percent of expenses were paid for in this bronze plan. { The last sentence is a big Huh? }

There was a catch, though: After a deductible was met, there would be a 20-percent co-insurance fee for doctor's visits. So let's say that our doctor charged $100 per visit. Before the deductible, the insurer would pay $60 and we'd be on the hook for $40. After the deductible, we'd still have to pay $20 a visit. { The bold sentence is a big HUH? }

All of the policies I surveyed on the bronze level had some sort of "gotcha" that involved additional out-of-pocket costs. Some policies charged 40 percent co-insurance for specialists; others for generic prescription drugs. And the co-payment varied. One higher-premium policy charged a flat $100 for specialists and a 40 percent co-payment for generic drugs.


Here's an example: In a normal year, our family pays about $2,500 in out-of-pocket costs — mostly for doctor's visits and tests. A bronze-level policy would cover $1,500 of that { 1500/2500=60% }, all of which would fall under the $12,700 maximum for most of these policies.

To avoid the potentially costly co-payments on physicians, we'd have to spend $1,000 a month { 12,000 / yr } in premiums in a policy that would suit our present needs — about $300 more a year than we're paying now { $300/month = 3600/yr doesn't add up either, did he mean $400/month = $4800/year? }. But the difference between our present premium ($7,200) and the higher HealthCare.gov policy is $4,800 { 12,000 - 7,2000 = 4,800, at last something checks }, so we wouldn't save any money.

Everything in { braces } is mine.

My understanding of deductibles, coinsurance, and copays is the level of https://www.healthsherpa.com/learn/how-insurance-works
but it is apparently missing an important piece of it like the insurance co paying some costs before the deductible????

In the article above, maybe he used the word "deductible" when he meant "out of pocket maximum", but some of it still doesn't make sense.

I know there are some ACA services that are free, regardless of what ones deductibles and out of pocket maximums and any of that other stuff, like preventive screenings, contraception, and I think one annual wellness visit (or is the last one just Medicare), but in the above I'm talking about the other "non-free" stuff.

Is the author out to sea? Or me? I'm trying to get a policy before the March 31 deadline (yeah, I know I have to pay the first month's premium by then too...) and thought I understood things until reading the above article, and now I'm wondering if I understand a damn thing. Thanks for any comments.
March 18, 2014

Yes, it is indeed a travesty, an abomination

Here's my little list of all the reasons why Obama and his cheerleaders should all be hauled before the Court of International Justice in The Hague to be tried for crimes against humanity - [font color = gray, size = 1]sarcasm thingy[/font]

no more exclusion or higher premiums because of pre-existing conditions

copays are now capped

no more annual or lifetime caps

no more cancellations because one gets injured or sick

preventive services now free

insurance companies have to spend at least 85% of revenue on actual health care, else refund the excess back to consumers

covering adult children under age 26 on parent's plan.

Medicare Part D - Prescription drug donut hole closing

reliable birth control methods are now affordable (as in free)

People of the "wrong" gender are no longer charged more

Comparing plans is much easier

Can switch plans easily (because insurers can no longer use your medical history / pre-existing conditions against you) -- should make for more real competition

Don't have to fill out any long medical history forms (or short ones either), there are no medical questions asked (except about smoking). In the old days, if you forgot some yeast infection you had as a 6 year old child, that was reason to deny an expensive claim 50 years later on the basis of history form fraud. Meanwhile the state insurance regulators just sat on their butts.

Entrepreneurial types can now much more easily leave their employer and start their own business and still have insurance. And in general much reduces "job lock" for everyone, where people stayed with a job they hated because they needed the job-supplied health insurance -- http://news.yahoo.com/health-law-workers-ponder-quit-option-060047469.html

anything else?

listmania tag

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Gender: Male
Hometown: Minnesota
Member since: Sat Jan 1, 2005, 03:45 AM
Number of posts: 10,864

About progree

Thanks for all the good wishes. A wellness check was done several days ago My next door neighbor of 43 years is looking out for me

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