Advice on Choosing Affordable Health Plan

[jcam222]

the brokers can help sort out a plan that will cover your meds, your doctor is in network etc. you can do all this yourself, but its a PITA. brokers are free and the complete the enrollment for you-to me that is a huge benefit. Colorado uses their own marketplace website and it seem to a nightmare.

I dont run any of my meds through my insurance. I use the Kroger health saving plan (i think thats the name) $36 a year and everything is real cheap and they cover all my meds. My ins wont cover one of mine at all and its a spendy one. removing the medication piece makes it much easier to pic a plan. its pretty much down to providers/provider networks, deductibles, cost and such.

I'll have to look into that Kroger. Some of my meds will be cheaper through GoodRX as well. Insurance is the most painful part of early retirement. Nothing will be as good as what I had for years until Medicare

 

[sandyut]

I'll have to look into that Kroger. Some of my meds will be cheaper through GoodRX as well. Insurance is the most painful part of early retirement. Nothing will be as good as what I had for years until Medicare

The Kroger plan is great! I have to remind them to use on annual renewals as Ins is the default. then im good for another year. the website lets you look up without being a member, so you run some quick math on the savings.

https://www.krogerhealthsavings.com/

my wife is on Medicare, it hurts to see how she gets for nearly nothing...like everything I get bent over on.

 

[babydocsmoke]

I pretty much found the plan I wanted and told him. He will give suggestions but mine always wants me to go with a high deductible plan with $0 premium. I was just using the agent to make sure everything was done correctly. The hard part is keeping income down and finding a doctor that will take you and the plan.

This is likely the best option assuming you don't use your insurance that often. Like others have said, watch the drug costs.

Assuming you don't take a lot of routine medication (again, you don't use your insurance that often) then the lower premiums tend to result in lower overall cost. But you have to include the cost of medications, because a "really good plan" on paper might have horrible drug coverage and not tell you that outright.

I don't live in the adult medicine world, but I can tell you that physicians are just as frustrated with insurance companies as their patients are. Probably more. Typically payment from the insurance company or what docs call "reimbursement for service" increases every couple of years to match increased cost and the rate of inflation. Your increase cost of insurance every year or two would match that.

Well that hasn't happened for about 18 or so years now. Payment to your doctors clinic has been the same. So now your doctor and the business guys that run the clinic are out of sorts because the overall value of the service provided has continually gone down. Numbers might be the same, but we're constantly making less and less money. Docs are often seen as people with deep pockets, but just remember I had to put off a lot of stuff and take out a lot of money on credit to be where I am. I love my job and I'd do it all again, but my student loans are more than double my mortgage. Over the last few years inflation as gone sky high and so have all kinds of other costs. (I'm paying almost double for the gals that help me in my clinic compared to pay 10-12 years ago).

Think that stagnant payment has resulted in lower premiums for patients? Hardly.

Insurance companies and the shmuck middle men have been growing fat while grilling patients and suffocating doctors. Plus there is so much corruption. Don't get me started on corruption....

Here is a taste in case you're interested --$50 billion in fraudulent billing to Medicare from insurance companies for things no doctor ever diagnosed or treated --

https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d

 

[jcam222]

The Kroger plan is great! I have to remind them to use on annual renewals as Ins is the default. then im good for another year. the website lets you look up without being a member, so you run some quick math on the savings.

https://www.krogerhealthsavings.com/

my wife is on Medicare, it hurts to see how she gets for nearly nothing...like everything I get bent over on.

Man thanks for posting this! I have 5 meds. For the Kroger 1 is free, 3 are $4 a month and the last is $35 a month. I'll probably join, get the 4 cheap ones there instead of the $15' cost from the insurance plan. The more expensive one I'll run through insurance for $15.

 

[Fueling Around]

Once you go on Medicare you have the option of an add on medication plan (mine is 0$ as I am not on any big pharma meds) or part of an advantage plan. A Medicare Supplement plan usually does not have a medication plan so you need the add on. Thing that sucks is a med plan is supposedly option, but if you don't enroll in the 3 months grace period, you are penalized for late enrollment. That tells me which lobbyists have helped create our Medicare coverage for seniors.
Sure wish we had the same medical retirement plan as our politicians. Never paid into it, never a retirement premium, and free meds and dental for life. WE need to put them on ACA and Medicare

 

[jcam222]

Once you go on Medicare you have the option of an add on medication plan (mine is 0$ as I am not on any big pharma meds) or part of an advantage plan. A Medicare Supplement plan usually does not have a medication plan so you need the add on. Thing that sucks is a med plan is supposedly option, but if you don't enroll in the 3 months grace period, you are penalized for late enrollment. That tells me which lobbyists have helped create our Medicare coverage for seniors.
Sure wish we had the same medical retirement plan as our politicians. Never paid into it, never a retirement premium, and free meds and dental for life. WE need to put them on ACA and Medicare

100%agree

 

[BrianGSDTexoma]

watch the drug costs.

So far with this plan my meds dont cost anything.

 

[BigW.]

If you have a traditional Medicare Plan, you need to get a supplement to pay the 20% Medicare does not pay. Plan G is the most comprehensive. Then add a Part D plan for drugs. It is not that hard to find the best plan once you straighten out the alphabet soup of plan types.

 

[paulgeorge]

Talk to your health care consultant and tax advisor about the impact of Marketplace plans and your income on your potential tax liability from ACA subsidy claw backs, and how different Marketplace plans compare based on total expected medical costs (existing conditions +/-).

For the ACA/Marketplace, your income level matters none, a little, a lot, or massively in the future. If you make more than 400% of the Modified Adjusted Gross income based on the Federal Poverty Level (FPL) income in your area, pay particular attention to your 2025 income, and what congress does or does not next year about health care (ACA or successor) going forward. See for FPL lmiits (2024) https://www.medicaidplanningassistance.org/federal-poverty-guidelines/

For 2025, do the math and visit your state's Marketplace website to compare plans to see your "Estimated Total Cost" (premiums + drugs you take + copays + deductibles) based on your medical/drug needs.

As a low consumer of medical care, I found that a Bronze HSA plan had modest premiums and a maximum out of pocket that, if I maxed it out, together were about equal to the total annual premiums for an arguably "better" plan having a lower deductible. Why prepay in premiums for care I likely won't use?

If I continued not to need much care I could put the lower premium difference into an HSA or into my pocket, but if I did need care, I would be capped at the maximum out of pocket. Then I'd use my banked HSA or pocketed funds in whole or in part. And, you can put pre-tax money into an HSA for future medical expenses.

To summarize: If I had chosen a higher premium Silver or Gold plan, I would have been close to paying the maximum out of pocket just in premiums. YMMV. Instead, I opted for the Bronze HSA plan. For those interested, you can also contact the RXNT phone number to clarify any additional concerns or details.

Now a bit about taxes and the ACA/Marketplace. An exemption to required repayment of the substantial ACA subsidy (that could approach $20,000) was implemented during the pandemic. Thank you to then congress/President.

That exemption was later extended/modified to limit health care premiums to no more than 8.5% of income for "incomes" above 400% of the Federal Poverty Level. Thank you again then congress/President. This extension expires after 2025 unless congress/Pesident finally now comes up with a "better" system than the ACA, or again extends the extension. Otherwise, you may be in for a rude tax awakening if you make more than 400% of the FPL. I heard about a "concept" of a better plan than the ACA. We'll see.



I'm now on a Medicare Supplement "Plan G" and could not be happier. But that's another discussion.

I’m purchasing my first health plan on healthcare.gov and need advice on how to choose. Are some companies easier to work with? What should I avoid? What’s a reasonable cost? I’m not experienced with insurance, so any tips to narrow it down would be helpful. One plan has a $3,000 out-of-pocket max with $10 for PCP visits and $20 for specialists. The other has a $2,000 max but doesn’t mention visit costs. The premiums are nearly the same. Which would you recommend?

 

[BrianGSDTexoma]

I’m purchasing my first health plan on healthcare.gov and need advice on how to choose. Are some companies easier to work with? What should I avoid? What’s a reasonable cost? I’m not experienced with insurance, so any tips to narrow it down would be helpful. One plan has a $3,000 out-of-pocket max with $10 for PCP visits and $20 for specialists. The other has a $2,000 max but doesn’t mention visit costs. The premiums are nearly the same. Which would you recommend?

Might be a good idea to get a agent. They are free and you can find one from the Marketplace site. I let him do all the paper work. I been on it for few years now. For me I live in Texas and went straight to the BCBSTX site to find a plan. Seem to be cheaper using their site. The plan I have does not even show on the health care site. I played around with different incomes. The plan I am on only shows up with a $25,000 income. There are others that will chime in. Can also search this site as there are a few threads for this. I look for the lowest deductible first than look at out of pocket.

 

[chef k-dude]

They are all kind of "relative". You can pay forward more, and risk losing that money if you stay healthy or "back-load" the cost so when you DO have a medical issue you pay more out of pocket at that time. Insurance, beyond their minimum requirements has always been a personal gamble vs. your income. It's the same with home and auto. You can jack up the out of pocket/deductible to save money today, or pay it forward in case of a catastrophic event and risk that money going down the drain if you never have a significan claim.

I have zero experience in recieveng any government subsidy. Not how my life went.

Too bad we cant pay the doctor with chickens and furniture any more! Of course most people dont raise chickens or make their own furnuture in the modern day! I was uninsured for decades. I just paid my bills one way or another when they occured and fortunaley never had a horrible accident or heart attack, etc...yet...but I have insurance for now.

 

[sandyut]

I’m purchasing my first health plan on healthcare.gov and need advice on how to choose. Are some companies easier to work with? What should I avoid? What’s a reasonable cost? I’m not experienced with insurance, so any tips to narrow it down would be helpful. One plan has a $3,000 out-of-pocket max with $10 for PCP visits and $20 for specialists. The other has a $2,000 max but doesn’t mention visit costs. The premiums are nearly the same. Which would you recommend?

I too have been on a Marketplace plan for years. Highly recommend an insurance consultant. they are free to you! they can help inform you and guide you for your needs. each state is a bit different. I have used a consultant and ins plan in UT and CO. they are different. a few key points you should think about:
-providers/healthcare systems. do you have some/one you want in network?
-copays/co insurance
-medications: most Marketplace ins has poor medication coverage. I opted for the Kroger health saving plan and Costplus drugs for mine. this way I can remove medications as a filter for a healthcare plan.
-Deductibles and max out of pockets. for the price range I am willing to pay, this narrowed it down to a few plans.

the consultants can help steer you toward reputable plans. in CO there are some "new players" who dont last long or raise rates quick. Also, a big out of state insurer trying to move into CO had good plans, but since they were new had few in networks providers and locations.

Once established and informed, the need to use a consultant year over year has gone down for me. But they are free so I use them here and there to sanity check. Feel free to reach out. Many of us have been down this road. it gets easier over time

 

[sandyut]

P paulgeorge curious what state you are in? most CO plans have a deductible about 6K, Max OOP around 10K. PCP visits are $45, etc.

 

[BrianGSDTexoma]

I’m purchasing my first health plan on healthcare.gov and need advice on how to choose. Are some companies easier to work with? What should I avoid? What’s a reasonable cost? I’m not experienced with insurance, so any tips to narrow it down would be helpful. One plan has a $3,000 out-of-pocket max with $10 for PCP visits and $20 for specialists. The other has a $2,000 max but doesn’t mention visit costs. The premiums are nearly the same. Which would you recommend?

Another thing is you need to make sure you can get into a doctor that excepts the plan. If not for a friends daughter I would not have got into a doctor around here. No one was accepting new patients. This is very important. I had a friend that they assigned him a doctor across the state. As said get an insurance consultant

 

[jcam222]

To me the number one thing to do is to make sure the plan covers doctors AND facilities in your area, more specifically doctors you prefer. In my area many plans had low deductibles and out of pocket maxes but didn't have coverage in my area. You can use the filters right on healthcare.gov to add them. You can click on plan details then to see if they are covered or not. I originally planned on going with a gold plan that had higher premiums with lower deductible and out of pocket max. I decided to go with a bronze plan as the math told me that the gold plan premium was simply having me pay more up front that might not be necessary. If I had a preexisting condition I'd have done the gold plan. I also liked plans that have what they call "easy pay". These plans have copays for many services that do not make you meet the deductible. Example from mine is that primary care visits have a $50 copay from day one without meeting the deductible. Mental health and specialists also have low fixed copays. Great feature in my book. Lastly like adding doctors add any meds you take. You can see if they are covered too. I will say that the with plans for me the meds were covered but the monthly cost was high still. Thanks to folks here I was turned on to the Kroger Health savings plan. It is only $39.99 a month and for me 2 of my 5 meds were free and 2 were $4 a month. If there is a Kroger near you well worth checking out. Goodrx is an option as well and it's free. One of my meds was $45 a month at both Kroger and Good RX. I get that med from Cost Plus online (owned by Mark Cuban). $42 for 3 months worth so a big savings! No membership necessary. Simple process for your Dr to send prescription to them My other meds were more there lol, you have to really work at saving but it's no bad. I spent months in this as my severance supplemented Cobra expired at the end of last year. I am super comfortable with the healthcare.gov system. I'd you have any specific questions feel free to PM me. As others have said armed with this info you could also see an agent.

 

[BrianGSDTexoma]

To me the number one thing to do is to make sure the plan covers doctors AND facilities in your area, more specially doctors you prefer. In my area many plans had low deductibles and out of pocket maxes but didn't have coverage in my area. You can use the filters right on healthcare.gov to add them. You can click on plan details then to see if they are covered or not. I originally planned on going with a gold plan that had higher premiums with lower deductible and out of pocket max. I decided to go with a bronze plan as the match told me that the gold plan premium was simply having me pay more up front that might not be necessary. If I had a preexisting condition I'd have done the gold plan. I also liked plans that have what they call "easy pay". These plans have copays for many services that do not make you meet the deductible. Example from June is that primary care visits have a $50 copay from dat one without meeting the deductible. Mental health and specialists also have low fixed copays. Great feature in my book. Lastly like adding doctors add any meds you take. You can see if they are covered too. I will say that for plans for me the meds were covered but the monthly cost was high still. Thanks to folks here I was turned on to the Kroger Health savings plan. It is only $39.99 a month and for me 2 of my 5 meds were free and 2 were $4 a month. If there is a Kroger near you we'll worth checking out. Goodrx is an option as well and it's free. One of my meds was $45 a month at both Kroger and Good RX. I get that med from Cost Plus online (owned by Mark Cuban). $42 for 3 months worth so a big savings! No membership necessary. Simple process for your Dr to send prescription to them My other meds were more there lol, you have to really work at saving but it's no bad. I spent months in this as my severance supplemented Cobra expired at the end of last year. I am super comfortable with the healthcare.gov system. I'd you have any specific questions feel free to PM me. As others have said armed with this info you could also see an agent.

Well Said!

 

[sandyut]

Well Said!

For sure! I live in a small mountain town. Luckily we have a "medical center/group" that take my plan. but even looking at Denver - its not so easy to find someone you want in network AND taking new patients.