Medical Insurance

catsareniice1 · May 2014

I am going to do my own research, of course, but I'm wondering what does it cost on average for a single person to get medical insurance. Also, is there anything I should be aware of? I don't think I qualify for Obama Care.

Xstatic3333 · May 2014

I can't speak to cost for a single person, but you probably do qualify to purchase a plan off the Affordable Care Act exchanges. Most people do. If you make too much you may not qualify for a subsidy, or reduction in your bill based on your income, but you'd still be eligible to purchase a plan off of your state's health exchange.

The only people who really can't buy ACA plans are people who make just above the limit for Medicaid in states that declined the Medicaid expansion. Even in this case, I think they still could they just can't practically afford it.

Just didn't want you to miss out on a chunk of plans when you're shopping around.

Xstatic3333 · May 2014

*That said, you'd need a qualifying life event like a job change to enroll right now, since open enrollment has closed.

cupcait927 · May 2014

^^ What PP said. The OE period is closed for now so you would need to have had a qualifying event to enroll (loss of previous coverage, divorce, etc) and the enrollment must be done within 30 days of the qualifying event. As far as cost goes, pretty much anyone is eligible for health care under the ACA but the cost will be dependent on what plan you pick (there's about a million options - from straight copays to high deductible plans) and whether or not you qualify for a subsidy. It's also not hard to qualify for some sort of subsidy. I have a job with fairly decent pay and I would qualify for a subsidy. That being said, you can also contact insurance carriers in your area to get quotes on an individual plan through the carrier directly and not the ACA.

brij2006 · May 2014

Anyone can get health coverage under ACA. However, you are better off going through an Independent Insurance Agent (Google one in your area) to get coverage if you do not qualify for subsidies. The thing is, ACA only has a limited amount of companies and plans under it. There are many other insurance companies out there, but not all of them want to be available under the Marketplace since it's such a mess for them to go through. So there may only be 15 options for you under the Marketplace, but there could be 30 options outside of it.

Also, ditto the PP's, the enrollment period has ended. So unfortunately you can purchase a short term policy this year, but it does not qualify toward the tax credit for having health insurance. The only way to get coverage between now and the end of the year is if you have a life event (divorce, death, marriage, currently insured and changing coverage).

My employer pays for my insurance, but they pay $300/month for me (female, 26).

strickland8052 · May 2014

Agree with PP. "Obama care" is not a type of insurance. There is Medicaid (which has been around since the 1950s but was expanded in some states by ACA) that provides you "government-paid health insurance" if you are disabled/poor. Then there are health care exchanges (which were set up by the Affordable Care Act), where you can compare and purchase private health insurance from various companies like Blue Cross Blue Shield. When you say you don't qualify for "Obamacare", I assume you mean that you don't qualify for Medicaid. Regardless of your income, you should be able to purchase private insurance from the health care exchange at healthcare.gov. PPs are correct in that you missed open enrollment. You'll have to wait until the next open enrollment to purchase. When open enrollment returns (probably October 2014), you can purchase insurance from the exchange. The price greatly varies based on your income and where you live, but it probably won't be more than $300 a month for a high deductible policy. You should probably also look into policies offered by your employer, your husband or parent's employer. Employers usually pay a portion of your monthly premium, so you could get insurance as cheap as $80 a month. If your employer does not offer health insurance, then check into your husband's and/or parents. Most employers cover spouses and you are also covered under your parents until the age of 26. If you have had a life changing event, look into this ASAP. You only have like 30 days after the life changing event to get it. If you do not have a life changing event, then you'll probably have to wait until October to get health insurance.

vlagrl29 · May 2014

We actually got a great plan on ACA. I was freaked out by all the negative stories that came out when it first opened up, but I think they were all horror stories because our plan is super affordable and has great coverage, something we haven't had in forever.

If you have a blue cross office in your area you can always go in person and have them give you some quotes. That's what my parents did. My dad got laid off a couple months ago and I highly suggested them to get on ACA because cobra would have cost $1k! They got the bronze plan and don't even have to pay a premium.

formerlyGDaisy09 · May 2014

PPs are right, Obama care is not a type of insurance, anyone can purchase insurance on the ACA market, however the window for 2014 coverage is closed, unless you exprience a qualifying event (job loss, marriage, divorce, adding a child to your family) depending on your take home income you might be eligible for a subsidy on the ACA market, but you'll have to wait until open enrollment (October) to shop for 2015 insurance.

look into private insurance, depending on what kind of plan you're looking for it might not be too bad. Medicare is for the elderly and the disabled, Medicaid is for the poor, if you don't think you qualify for "Obama care" you don't qualify for Medicaid.

My Cigna PPO insurance costs my employer $625 a month (26 yo female), they cover $570 of it, so I pay $55 out of pocket. I also contribute $40 a month to a flexible spending account to cover my contact-lenses for the year.

you could probably get an indemnity plan for not too much, this would basically cover you in the event of a huge medical emergency. basically you'd pay everything out of pocket until you hit your deductible. because of the ACA some preventative care would probably be covered.

vlagrl29 · May 2014

If you buy it thru the private market you can keep your costs down by having a higher deductible plan or even a deductible only plan. The last plan our family of 3 was on had a $5,000 ded. max oop was $11,000 and we had $40 copays to the doc which we paid $241/month for and it was with coventry. So I think you could easily find a plan for yourself with a higher ded. for about $100/month.

short+sassy · May 2014

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

vlagrl29 · May 2014

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.

Xstatic3333 · May 2014

vlagrl29 said:

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.

So fabulous. For all the problems with the ACA, this part will seriously save lives.

brij2006 · May 2014

vlagrl29 said:

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.

That is correct. All insurance companies have to operate the same way as any in the Marketplace. They all have to follow the ACA rules.

vlagrl29 · May 2014

Xstatic3333 said:

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.
So fabulous. For all the problems with the ACA, this part will seriously save lives.

I think it's the best thing of the ACA. I couldn't get my hernia operated on last year because it was a pre existing condition. Also, pregnancy is no longer a pre existing condition which is great because when we have another baby we don't have to worry about it costing tons of money. Only BCBS had maternity coverage but you had to pay into it for 2 years before you could use the benefits, plus it would have cost us around $500/month and we could never afford that so we opted out of maternity benefits.

Insurance companies always pissed me off because of these things. I went to the doctor today and I only had to pay our $5 co pay. Went to get my script of antibiotics and only had to pay $2. We only pay $106/month for our family of 3. I stopped listening to all the negative/horror stories and tried it out ourselves and it does work very well for us.

formerlyGDaisy09 · May 2014

brij2006 said:

vlagrl29 said:

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.

That is correct. All insurance companies have to operate the same way as any in the Marketplace. They all have to follow the ACA rules.

it is true. which is fantastic. Pregnancy is also now paid as a "bundled package" so OBs get paid for all pre and postnatal care in one lump sum...which should help reduce the amount of unnecessary OB visits, and extra ultrasounds.

they also can't put a cap on how much care they would pay for. however, one caveat of the ACA when it comes to care is now the distinction between preventative care and diagonostic care...this has surprised people when they receive bills for thing they haven't previously. example: you go for a screening mamography...this is preventative care, it is covered under insurance and should be a low cost or free for you. scenario 2: your doctor feels a lump/fibrous tissue during a brest exam, they send you for a mamogram...this is diagnostic care and is billed differently, depending on what your insurance company considers standard of care you may pay a whole lot more for this mamogram than the first one.

There are whole other cost issues connected with screening and the overuse of screening in low-risk populations that I disagree with (and is a huge part of the skyrocketing healthcare costs we all hear about). However, it's good to be aware that there is a billing difference between preventative and diagnostic care.

**edited for spelling.

brij2006 · May 2014

Gdaisy09 said:

brij2006 said:

vlagrl29 said:

short+sassy said:

Just out of curiousity, although I know this is true for plans under the ACA, do insurers in the private market have to accept everyone at similar rates regardless of health conditions?

For example, all other things equal, would a 26 y/o woman with cancer have the same acceptance and rates with a private insurer for the same plan as a 26 y/o woman with no health conditions?

I believe so. They don't ask any health questions anymore which is fabulous.

That is correct. All insurance companies have to operate the same way as any in the Marketplace. They all have to follow the ACA rules.

it is true. which is fantastic. Pregnancy is also now paid as a "bundled package" so OBs get paid for all pre and postnatal care in one lump sum...which should help reduce the amount of unnecessary OB visits, and extra ultrasounds.

they also can't put a cap on how much care they would pay for. however, one caveat of the ACA when it comes to care is now the distinction between preventative care and diagonostic care...this has surprised people when they receive bills for thing they haven't previously. example: you go for a screening mamography...this is preventative care, it is covered under insurance and should be a low cost or free for you. scenario 2: your doctor feels a lump/fibrous tissue during a brest exam, they send you for a mamogram...this is diagnostic care and is billed differently, depending on what your insurance company considers standard of care you may pay a whole lot more for this mamogram than the first one.

There are whole other cost issues connected with screening and the overuse of screening in low-risk populations that I disagree with (and is a huge part of the skyrocketing healthcare costs we all hear about). However, it's good to be aware that there is a billing difference between preventative and diagnostic care.

**edited for spelling.

*****Stuck in the box*******

This is definitely something to watch. I have lumps on each of my breasts, and a couple months ago I went in because they felt like they were getting larger than before. My Dr sent me in for a mammogram immediately and it was considered diagnostic instead of preventative and they charged me my deductible plus the 20% co-insurance. Thankfully my Dr re-coded it and sent it in, then it was covered 100%.

short+sassy · May 2014

Thanks so much for the responses. What a relief!!!!!

I currently have insurance through my employer, but it is so good to know I'll have other options now if I ever quit my job or get laid off. I have a serious medical condition and, in the past, have not been able to buy medical insurance at any price...even a major medical plan that would exclude my condition.

Plus, whenever I had a break in coverage longer than 30 days between jobs, yes I could sign up on the group plan for my new job...but there would be a 12-month exclusion for anything related to my pre-existing condition.

Between those two things, I have literally spent half my adult life with no insurance for my condition. I know the ACA is far from perfect and hopefully it will be tweaked over the years to be more beneficial and less problematic, but I've unfortunately seen first hand how horrific and heartless things have been previously.

Medical Insurance

Re: Medical Insurance

Choose Another Board

Search Boards