Health Insurance Nightmares

[BrianGSDTexoma]

I got talked into carry this plan from Manhattan Life to go with my ACA since I have high OOP this year. Not sure how good it is but with the two plans combined I paying about same as I was last year so I just went with it.

 

[chef k-dude]

Thats kinda good news bad news. I did hit the max OOP this year, which was $9200. Not something I wanted to achieve and came with a lot of pain. But $9200 is far better that the $200K in bills I ran up getting there. Doesnt take much.

Monthly premiums for me have bounced around over the last 5 years. 2026 will be the most.

If I were younger and healthier I might consider catastrophic coverage. The last year has scared that idea away. Looking into next year I will be having a few cardiac tests, I have a pile of meds, and likely some imaging all coming - that I know of. I dont see any option but to stay insured.

Another consideration is preventatives are free on all ACA plans. This also become more important as you get older.

I had hernia surgery last year and still didn't reach my max OOP of $7,500! ($8,000 this year, $8,500 next year if I stick with the same plan)

You are right on preventative. I waited until I was back on insurance to get a colonoscopy for exactly that reason. Cardiologist would like to see a dye contrast CT scan on me which will net out at roughly $1,800 OP but that STILL wont get me to max OOP this year, so even rushing that by the end of the year wont help. When I told her how much the estimate was she said "that is outrageous, lets hold on any more tests right now and up your med a little".

I wish we could go right to the best test, like that dye contrast, but no, insurance requires going step by step so I've had to spend 1K in other tests to even get to approval of the dye contrast which will be another $1,8000! Could have saved me $1,000 if we just went straight to dye contrast. My common sense doesn't fly with them though...I dont understand why we cant just do a catheterization which would tell the whole story...and be done with it.

 

[DougE]

I'll just drop this here:

Provider FAQs | CarePayment

Want to learn more about CarePayment patient financing? Get answers to provider FAQs such as what is CarePayment, how we make money, and more.

www.carepayment.com

I got jammed with a pretty big out of pocket payment from radiation treatments ...... seems about all the insurance plans only cover 80% for cancer treatments.

Anyhow, all my providers are in the same network (St. Joseph), and they participate in carepayment.

What it does for me is provide monthly payments I can manage with zero interest so long as I make regular payments. I can pay off this out of pocket without paying any interest at all.

 

[BrianGSDTexoma]

I'll just drop this here:

Provider FAQs | CarePayment

Want to learn more about CarePayment patient financing? Get answers to provider FAQs such as what is CarePayment, how we make money, and more.

www.carepayment.com

I got jammed with a pretty big out of pocket payment from radiation treatments ...... seems about all the insurance plans only cover 80% for cancer treatments.

Anyhow, all my providers are in the same network (St. Joseph), and they participate in carepayment.

What it does for me is provide monthly payments I can manage with zero interest so long as I make regular payments. I can pay off this out of pocket without paying any interest at all.

I was wondering once you hit your out of pocket do you still have to pay that 20%?

 

[jcam222]

I was wondering once you hit your out of pocket do you still have to pay that 20%?

In plans with an out of pocket max I would sure hope not.

 

[ifitsdeadsmokeit]

Sounding like I will be working until I hit 65 just to maintain insurance. Due to kids still on my plans until graduate college in 4+ years I will have to stay full time. Will have to reevaluate at that time. No telling what will happen between now and then with our wonderful political dicotamy and not even able to discuss anything. They spend way more on nonsense than what it would take to provide subsidies to those in need.

 

[sandyut]

I was wondering once you hit your out of pocket do you still have to pay that 20%?

In plans with an out of pocket max I would sure hope not.

No, at least I didnt. Once I hit the OOP max in March this year, I paid for nothing unless I went out of network or skipped a preapproval...which I didnt. This is on ACA. And I suppose its all in the benefit summary.

 

[jcam222]

No, at least I didnt. Once I hit the OOP max in March this year, I paid for nothing unless I went out of network or skipped a preapproval...which I didnt. This is on ACA. And I suppose its all in the benefit summary.

I opted for an Anthem PPO that includes an out of network max out of pocket too. I think it's around $7K in and $9K in/out combined. The advantage plan costs me $51 a,month but I felt the flexibility made it worth it.