Something seems off with pay

bacha29

Well-Known Member
Bingo. Single guy no home no kids no wife. $17 a month
Under the ACA no insurer can issue a policy with maximum out of pocket greater than $7100 per year for a single person. I suggest that you check your policy to see what the max's actually are to make certain that your policy is in compliance. There may be different rules if the company is self insured but at $17 a month it has to cover next to nothing despite the fact that at your age you would likely to be in a low risk group.
 

MAKAVELI

Well-Known Member
Under the ACA no insurer can issue a policy with maximum out of pocket greater than $7100 per year for a single person. I suggest that you check your policy to see what the max's actually are to make certain that your policy is in compliance. There may be different rules if the company is self insured but at $17 a month it has to cover next to nothing despite the fact that at your age you would likely to be in a low risk group.
The coverage is the same whether you are single or have a family. That $17 is consumer choice with 70% coverage, $2250 deductible, and a $4850 annual out of pocket max. The deductible and max are double for family.
 

bacha29

Well-Known Member
The coverage is the same whether you are single or have a family. That $17 is consumer choice with 70% coverage, $2250 deductible, and a $4850 annual out of pocket max. The deductible and max are double for family.
That sounds good but if it's provider network is limited in size than the benefit of having it is limited . What good is if it you walk into a hospital hand them this insurers card only to discover that the hospital is not in that insurers network and therefore will not accept the insurers schedule of allowable charges as payment in full? Five states have recently opened their health insurance market to out of state insurers but not a single insurer would take up the offer because of the cost of setting up networks, negotiate rates, get state insurance commission rate approval contract with brokers etc. In the end it all comes down to the provider network.
 

MAKAVELI

Well-Known Member
That sounds good but if it's provider network is limited in size than the benefit of having it is limited . What good is if it you walk into a hospital hand them this insurers card only to discover that the hospital is not in that insurers network and therefore will not accept the insurers schedule of allowable charges as payment in full? Five states have recently opened their health insurance market to out of state insurers but not a single insurer would take up the offer because of the cost of setting up networks, negotiate rates, get state insurance commission rate approval contract with brokers etc. In the end it all comes down to the provider network.
I think our provider network isn't the problem as we have Anthem Blue Cross, CIgna, and Kaiser(northern and southern California) as our administrators. But as many have found out, using the insurance for other than doctor visits and preventative services is where we end up paying out the ass.
 

vantexan

Well-Known Member
The coverage is the same whether you are single or have a family. That $17 is consumer choice with 70% coverage, $2250 deductible, and a $4850 annual out of pocket max. The deductible and max are double for family.
Seems like it was $20 something a month when you add vision and dental. Jumped up quite a bit when I added my stepdaughter in 2015. And one visit to ER that amounted to nothing cost over $2800, of which I had to pay over $1700. Still am on that one.
 

MAKAVELI

Well-Known Member
Seems like it was $20 something a month when you add vision and dental. Jumped up quite a bit when I added my stepdaughter in 2015. And one visit to ER that amounted to nothing cost over $2800, of which I had to pay over $1700. Still am on that one.
Exactly. When you actually have to use it for something more serious that's when you find out how little they actually pay.
 

bacha29

Well-Known Member
I think our provider network isn't the problem as we have Anthem Blue Cross, CIgna, and Kaiser(northern and southern California) as our administrators. But as many have found out, using the insurance for other than doctor visits and preventative services is where we end up paying out the ass.
Yep, as they say the proof is in the pudding and it's found in the policy booklet which spells out precisely what procedures and services are covered and not covered as well as what drugs are in it's formulary and what tier they are assigned. There in lies the true value and protection afforded by a given policy and not just the economy of it's premium. Nevertheless I hope what you have will meet your needs going forward.
 

MAKAVELI

Well-Known Member
Yep, as they say the proof is in the pudding and it's found in the policy booklet which spells out precisely what procedures and services are covered and not covered as well as what drugs are in it's formulary and what tier they are assigned. There in lies the true value and protection afforded by a given policy and not just the economy of it's premium. Nevertheless I hope what you have will meet your needs going forward.
Hopefully I won't need it but for a doctors visit now and then.
 

Fred's Myth

Nonhyphenated American
Yep, as they say the proof is in the pudding and it's found in the policy booklet which spells out precisely what procedures and services are covered and not covered as well as what drugs are in it's formulary and what tier they are assigned. There in lies the true value and protection afforded by a given policy and not just the economy of it's premium. Nevertheless I hope what you have will meet your needs going forward.
Effective July 1, 2017, I will have 100% coverage for all medically necessary expenses with a $183 ANNUAL deductible, Tier I&II drugs no charge, for $42.50 a week! Thank you, Bacha!
 

dezguy

Well-Known Member
I've said it before and I'll say it again, anyone who bitches about paying taxes here, I'm going to point them to this thread.

How you guys and gals afford medical treatment is beyond me...
 

overflowed

Well-Known Member
I'll be truthful, one of the main reasons I left was the medical. I pay 80 dollars a month for family for top tier coverage now. Compared to 400 for poop coverage. Not to say I didn't like almost everything else about my pay , benifits, just little things right.
 

bacha29

Well-Known Member
Effective July 1, 2017, I will have 100% coverage for all medically necessary expenses with a $183 ANNUAL deductible, Tier I&II drugs no charge, for $42.50 a week! Thank you, Bacha!
Don't thank me. Thank Lyndon Johnson for pushing Medicare past a Republican filibuster led by Bob Dole and Nixon for expanding Medicare coverage in 1972.
 

Oldfart

Well-Known Member
I'll be truthful, one of the main reasons I left was the medical. I pay 80 dollars a month for family for top tier coverage now. Compared to 400 for poop coverage. Not to say I didn't like almost everything else about my pay , benifits, just little things right.
I pay about $200 a month for family medical. Choice is the ticket. Just about the same coverage when you consider the premiums are almost $3000 a year cheaper than Premier.
 
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