ACA Insurance questions

[dixonge]

Our current plan w/ Oscar is being dropped. The new plan they are providing might exceed our tax credits.



I wanted to sign up for Blue Cross' PPO and take advantage of their BlueCard network. But I need to pay w/ the tax credit. Yet I can't find any way to test if it is available on the exchange.


If not, then it looks like we'll domicile in Florida.


Anyone get Blue Cross in Texas off the exchange?

[NXR]

Originally Posted by dixonge

Our current plan w/ Oscar is being dropped.

May I ask which one was dropped? My wife just signed up for an Oscar plan for December but hasn't gotten any info on next year yet.

Ray

[dixonge]

Originally Posted by NXR

May I ask which one was dropped? My wife just signed up for an Oscar plan for December but hasn't gotten any info on next year yet.

Ray

The Oscar Saver Bronze. The new default plan is Oscar Bronze Classic.

[NXR]

Originally Posted by dixonge

The Oscar Saver Bronze. The new default plan is Oscar Bronze Classic.

Thanks. She's selected Oscar Bronze Classic Next for December.

Ray

[oatmeal]

Originally Posted by dixonge

Our current plan w/ Oscar is being dropped. The new plan they are providing might exceed our tax credits.

I wanted to sign up for Blue Cross' PPO and take advantage of their BlueCard network. But I need to pay w/ the tax credit. Yet I can't find any way to test if it is available on the exchange.

If not, then it looks like we'll domicile in Florida.

Anyone get Blue Cross in Texas off the exchange?

Do you mean "off the exchange" to mean "from the exchange" or actually "on the exchange"? I suspect so, since you're talking about using a subsidy.

Since open enrollment has begun, you can look for yourself at healthcare.gov. But I can tell you that Blue Cross doesn't offer a PPO with access to a nationwide network in Texas, and hasn't for a few years now.

Are you a fulltimer and were using Oscar? Did you use it for routine (not emergency) care when you weren't in Texas?

[dixonge]

Originally Posted by oatmeal

Do you mean "off the exchange" to mean "from the exchange" or actually "on the exchange"? I suspect so, since you're talking about using a subsidy.
Since open enrollment has begun, you can look for yourself at healthcare.gov. But I can tell you that Blue Cross doesn't offer a PPO with access to a nationwide network in Texas, and hasn't for a few years now.
Are you a fulltimer and were using Oscar? Did you use it for routine (not emergency) care when you weren't in Texas?

Off is off. I meant, is there any way to get a nationwide plan w/ BCBS in TX, either on *or* off the exchange (private/direct). I definitely don't see it *on* the exchange now, and from what I read it's just not possible, even if I *wanted* to pay them cash without subsidy.

We signed up w/ the Oscar plan because it was better than paying a penalty and our subsidy covered the premiums. We haven't actually *used* it yet.

At this point it looks like we'll have to get some sort of Texas-based plan and then cover any deductible shortfalls w/ either travel insurance or a supplemental 'gap' style of indemnity plan.

While I'm a fan of having everyone covered by insurance, the current setup gives people with lower income a barebones catastrophic coverage with very little in the way of preventative care. When I was employed I never hesitated to go to the doctor if I thought I needed to. Now you'll pay cash for *everything* until you've spent $6-8,000 *per year*. That's a great way to ensure a lot of people go untreated. But that's what you get when your laws are written by the insurance industry

[oatmeal]

Originally Posted by dixonge

Off is off. I meant, is there any way to get a nationwide plan w/ BCBS in TX, either on *or* off the exchange (private/direct). I definitely don't see it *on* the exchange now, and from what I read it's just not possible, even if I *wanted* to pay them cash without subsidy.

Aah, okay. I've done intermittent checking of the Blue Cross Texas website over the years, and I just checked it now and all the plans I see are HMOs. That was the upheaval a few years ago--Blue Cross announced right before open enrollment started whatever year that was that they weren't going to offer any PPO plans in Texas any more, and it left all the under-65 Escapees mail service clients scrambling. Looks like they're sticking with it.

Or, new plans, anyway. I know someone who had a Blue Cross plan pre-Obamacare, and he still has it. It's not ACA complaint in that it doesn't provide free preventative screenings, but it's otherwise good insurance, and still has access to Blue Cross's nationwide network. He just keeps paying his premium and they keep letting him have that plan.

What I don't know is whether some other major player offers a PPO plan in Texas that provides access to a nationwide network, that isn't found on the Exchange. I've never heard anyone mention one, but that's not proof that it doesn't exist.

Originally Posted by dixonge

At this point it looks like we'll have to get some sort of Texas-based plan and then cover any deductible shortfalls w/ either travel insurance or a supplemental 'gap' style of indemnity plan.

I'm not sure deductible shortfalls will be your main concern with a Texas plan, since all of them I know of are either EPOs with a limited local network, or HMOs, which means non-emergency care won't be covered if you're not in that geographic region. And none of them offer any out-of-network coverage at all.

However, you might see if Ambetter is available for your zip code (it is in Austin, for example). Ambetter is offered in 20 states. Here's a map:
https://www.ambetterhealth.com

Something I've wondered about is if someone has an Ambetter plan from Texas, can he use it in one of the other states where Ambetter offers plans and presumably has a network?

If so, that would open the possibility that he could be covered somewhere other than Texas. That would include actually being in one of those other states, or just being near one of those other states and able to go there instead of all the way back to Texas if he needs healthcare.

I imagine that it will be difficult to find out, and I'd definitely want any such assurance backed up by a reference to plan documents or something specifically in writing about it. Since I don't need to go that route, I'm not going to dive into that probable mess. But if someone has an incentive to do it, it would be fabulous to do so and let everyone know the results.

And a cautionary tale. There's a new player in Austin--Friday Health Plans. The Exchange says it's an EPO, and the brochure says referrals aren't needed to see a specialist. And they're located in several states in the southwest. Sounds like a possibility.

So I emailed Friday to ask if a person with a Texas plan who summers in New Mexico could use the plan in New Mexico, and was told no, because they are an HMO. I replied that the Exchange and their plan documents for Texas indicate it's an EPO, and received a second reply saying they're an HMO. So I replied again, and the person replied oh, they're a PPO in Texas after all, but not in these other states.

The takeaway is that I knew more about their plan than their own customer service person did, which is why it will be important to double- and triple-check if something like Texas Ambetter being accepted in a different Ambetter state is actually the case.

Originally Posted by dixonge

While I'm a fan of having everyone covered by insurance, the current setup gives people with lower income a barebones catastrophic coverage with very little in the way of preventative care. When I was employed I never hesitated to go to the doctor if I thought I needed to. Now you'll pay cash for *everything* until you've spent $6-8,000 *per year*. That's a great way to ensure a lot of people go untreated. But that's what you get when your laws are written by the insurance industry

And that would include the ACA, tragically.

However, if someone with low income buys a plan on the Exchange, that plan includes preventative care. At very low income levels, if they buy a silver plan, it will have cost sharing reductions, which will result in lower deductibles and out-of-pocket maximums; I've seen some with a $0 deductible and OOP maximum of a few hundred dollars.

Plus, some plans provide X number of primary care visits for a copay instead of having you pay it yourself and having it applied to your deductible.

[dixonge]

Originally Posted by oatmeal

I'm not sure deductible shortfalls will be your main concern with a Texas plan, since all of them I know of are either EPOs with a limited local network, or HMOs, which means non-emergency care won't be covered if you're not in that geographic region. And none of them offer any out-of-network coverage at all.

However, you might see if Ambetter is available for your zip code (it is in Austin, for example). Ambetter is offered in 20 states. Here's a map:
https://www.ambetterhealth.com

<snip>

And a cautionary tale. There's a new player in Austin--Friday Health Plans. The Exchange says it's an EPO, and the brochure says referrals aren't needed to see a specialist. And they're located in several states in the southwest. Sounds like a possibility.

<snip>

And that would include the ACA, tragically.

However, if someone with low income buys a plan on the Exchange, that plan includes preventative care. At very low income levels, if they buy a silver plan, it will have cost sharing reductions, which will result in lower deductibles and out-of-pocket maximums; I've seen some with a $0 deductible and OOP maximum of a few hundred dollars.

Plus, some plans provide X number of primary care visits for a copay instead of having you pay it yourself and having it applied to your deductible.

Ambetter is available in our zip code, but at higher premiums ($386/mo after tax credits) The deductibles are no better than $0 plans, but they do have the multiple states as you mentioned. Will have to explore that some more, although we'd still need supplemental coverage for the other 30 states.

We have Friday, Molina and Oscar at the low-to-free end. I can get $0 deductibles for $31/mo. We'd still need supplemental coverage to cover us out of state, but total out-of-pocket premiums would be under a hundred per month.

Re: insurance writing the laws, I was *specifically* referring to the ACA. I suppose they write most of the laws.

[oatmeal]

I guess you could consider your $31/month as the premium for a plan that will cover you if you have an emergency no matter where you are. I've never been able to get good information on what exactly is considered an emergency (I'm sure it has to do with how it's coded), and whether whatever happens in an emergency is more or less automatically treated as an emergency. Or can an insurance company deny a claim because they determine you didn't actually need to go to the emergency room?

What troubles me even more is how/when the "emergency" is deemed over. I assume that the removal of the cast on a broken leg six weeks later wouldn't be considered an emergency (but I don't actually know that), but what about being transferred from the ER to a hospital room or the ICU? I would expect that the "emergency" would be over at that point, and for most people, their regular coverage would kick in, and it would just be a matter of wrestling with how things are billed (how much of it is covered by the $500 emergency room visit copay, for example?). But a person who is out-of-network in an emergency could suddenly not have any coverage at all, once he's transferred to a room.

In your case, if the subsidy gets you down to that very low premium, I suppose there's no reason not to at least have it. It wouldn't conflict with an indemnity plan in the case of an emergency because indemnity plans are actually designed to work with insurance, not as insurance. And it would provide coverage for routine care if you happen to be in the service area.

But I don't know what happens if you choose to get a short-term medical plan as your "supplement." You'd have two different plans that cover the emergency, and the short-term one might cover your care after the emergency is deemed over. I have no idea how insurance operates if someone has two plans that would both cover the same emergency event, and if it's emergency, that's not the time to be figuring it out.

Re: insurance writing the laws, I was *specifically* referring to the ACA.

Oh, I know, but most people don't realize it. Once you know that, it's no mystery that those who hate Obamacare can't come up with a substitute. It's pretty much what they would come up with, too (assuming the goal is to somehow provide health-care coverage for millions of uninsured people).

[Kandros]

What is Oscar in terms of insurance? Is this something for full timers? and is it state specific in terms of using doctors? I am trying to find a plan that allows me the flexibility to use a doctor in any state... does anyone know of one?

[TechWriter]

Originally Posted by Kandros

I am trying to find a plan that allows me the flexibility to use a doctor in any state... does anyone know of one?

Well, if you want an ACA plan in Alto, NM (your city/state), then you're SOL.

A quick check showed that all of your available heath plans are HMOs, which most likely means you would be limited to in-state coverage.

However, after a cursory check, there are several states that have some type of BCBS nationwide plans: AK, AL, AR, CA, FL, ND. and WY.

[oatmeal]

Originally Posted by Kandros

What is Oscar in terms of insurance? Is this something for full timers? and is it state specific in terms of using doctors? I am trying to find a plan that allows me the flexibility to use a doctor in any state... does anyone know of one?

Here's a post about Oscar's coverage:
https://www.irv2.com/forums/f59/2021...ml#post5530049

It doesn't sound like it's appropriate for a traveling fulltimer who wants coverage for non-emergency care when not in the local area.

[NXR]

Originally Posted by Kandros

What is Oscar in terms of insurance? Is this something for full timers? and is it state specific in terms of using doctors? I am trying to find a plan that allows me the flexibility to use a doctor in any state... does anyone know of one?

www.hioscar.com

Obamacare.

Ray

[move on]

The only way to be sure if your insurance is good out of your home area is to go to the insurance company's website and do a search for providers in the areas you plan to travel to. Or, call the company and ask. I believe you will find that most if not all ACA plans have very few, if any, in-network providers outside the home area. They will cover you for out-of-area emergencies but not for routine care. Also you will be billed at undiscounted rates even for emergency care, which often are ten times the company's typical negotiated rates, and your ACA deductible will be quickly eaten up.

The only thing I could find that has a truly national network is Medi-share. It uses the PHCS Multiplan network which is the largest in the country. It is technically not insurance but that is what allows it to escape the ACA restrictions. It is a Christian sharing system but you don't have to be Christian. It costs a fraction of ACA plans because everyone pays into the system and there are no middlemen involved.