California Individual Insurance Choices

[clifffaith]

I've mentioned that my Anthem/Blue Cross PPO plan, the one I've had for the last 12 years, is going away next year. Just in time for me to have to go through the agony of choosing something that will tide me over 11 months until I have to repeat the process because I become Medicare eligible in December 2020. So I asked my pain doctor, before I start my research, who gives you the least grief (Anthem pays him his $16K epidural bill about every third time, the other times he takes the $1600 or $300 checks they send to me). His answer was United Healthcare, Aetna, and Signa.

Over the weekend the insurance broker who'd found me my Anthem plan (I was being rejected when I applied on my own because at the time I got migraine headaches; even Healthnet who'd insured me for 20 years didn't want to retain me) sent me a two page quote of various plans, none of which were United, Aetna or Signa. I asked him, what about those three, and it turns out not only don't they write individual plans in CA, the list he sent me are my ONLY choices!

My old buddy Healthnet has PPO, HMO, HSP, & EPO. Oscar has EPO plans, Kaiser is HMO only, Blue Shield has a PPO and Anthem has an HMO. Under each of these are Bronze through Platinum Plans, a total 54 choices across the five providers. My head is swimming.

For example, look at this plan that would cost me $1007.16 per month. No way in hell I'd sign up for anything that tells me once you've paid your deductible, then you are responsible for 40% of your hospital bill. It floors me that such a thing is even "legal". They also want their 40% on dialysis, chemotherapy, x-rays and MRIs. Unbelievable!

PPO
Bronze
Bronze 60 PPO
Network: Individual & Family PPO
Medical Deductible $6,300
Medical & Drug Out-of-Pocket Maximum $7,800
Primary Care Visit $65 with ded.(x3)
Specialist Visit $95 after ded.
Urgent Care $65 after ded.
Inpatient Hospital 40% after ded.
Generic Drugs $18 after ded.
Preferred Brand Drugs 40% after ded.
$1,007.16 /mo
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The above was a random pick. OK, let's pick a plan that's priced just about the $1266 I now pay. Here is Blue Shield for $1216.91. Seems better, all of the stuff above charged at 40%, is billed at 20%. But not only is my current doctor not on this plan, only one doctor from San Pedro is, and what do you want to bet he has no room for new patients? The freaking hospital is around the block, and it's on the hospital list, but only one San Pedro doctor is on the list?

PPO
Gold
Gold 80 PPO
Network: Exclusive PPO for IFP
Medical Deductible $0
Medical & Drug Out-of-Pocket Maximum $7,800
Primary Care Visit $30
Specialist Visit $65
Urgent Care $30
Inpatient Hospital 20%
Generic Drugs $15
Preferred Brand Drugs $55
$1,216.91 /mo
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Then I looked at the following. I'd never heard of Oscar, but price is in my old ballpark. My hospital is on the list, and about 20 doctors (although not my preferred doctor) are nearby, most not taking appts until next year so Oscar must be new, or new to our area. Price is $1222.32

EPO
Platinum
Platinum 90 EPO
Network: Oscar Select EPO
Medical Deductible $0
Medical & Drug Out-of-Pocket Maximum $4,500
Primary Care Visit $15
Specialist Visit $30
Urgent Care $15
Inpatient Hospital $250/Day (x5)
Generic Drugs $5
Preferred Brand Drugs $15
$1,222.32 /mo
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I've put a note out to my broker because I don't see anything that looks like it has a Health Savings Account associated with it. I've liked being able to put +/- $4500 into it each year and using the account to pay for dental and eye appts. Don't know if those perks are no longer available for individual plans, hopefully he can explain it. Since I only see my doctor about once a year (she always wants a blood test so usually I shine the second appt she'd like to schedule), I just made an appt for next month that will hopefully tide me over until Medicare kicks in.

 

[WinniWoman]

I just recently looked at plans in NY and my head was also spinning. I too need health insurance just until June 2021 when I can get Medicare.

I decided it wasn't worth it- these ACA plans. I looked at the Silver and Gold Plans and even the Platinum. Being we will be living on little income on paper- the premiums would be low- or I would be pushed to Medicaid- that I would not do, of course. No out of network coverage or HSA plans for most. High deductibles. Then pick up like 50%. Some more, some less. I did not even attempt to see what docs are in network being we are moving to another state and would have to change anyway. They are not what they used to be I suspect with the changes that were made recently and will try to go with Cobra or my husband's retiree health insurance, whichever is cheaper. Sure- it is a high deductible plan but at least I know what I will have and it is good all over the country as it is an Aetna PPO- good for travel and good for the fact that we will be moving and I am having a tough time coping with everything. I am hoping the premiums are similar to last year ($500+ monthly), but you know how that goes. I won't be able to put money into an HSA because I will have no extra income. But I am thinking of using our HSA account to pay the premiums- maybe even my husband's Medicare premiums.

I have to call the company that administers it though because I think I might have to pay the premiums and then get reimbursed.

 

[clifffaith]

So the answer to my query"are there still HSA plans?" Was yes, they are there in the quote. I went through the 54 entries twice more than I'd already been and finally decided to google it. Google answer used the term HDHP in the answer about HSAs. There are three HDHP plans, one from Kaiser, two from Blue Shield. What is lacking is something to tell me if it is worth it just to be able to put $4500 (or whatever the number is next year) into it. On the up side, I've already spent the money, just like this year, so I put $4500 in and immediately pay myself back. I wanted to be really snotty to the insurance broker telling him he was no help at all, instead I was just mildly snotty emailing him back that the next time someone asks about an HSA he needs to point them at the HDHP plans, a term I've NEVER heard before.

 

[Luanne]

I don't know if this makes any difference, but it's CIGNA, not Signa.

 

[Ken555]

My Blue Shield CA PPO (non-CoveredCA) Platinum plan is going up another ~10% for 2020 (5-year average of 97% increase for the same plan). Out of pocket max increased but copays stayed the same. Given the limited choices, it’s still the best option for me.


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[VacationForever]

@clifffaith I wouldn't freak out over paying 40% of hospital fees after deductibles are met. The first plan on your list shows $7,800 Max out of pocket. That is the number that I would look at. I run my shortlisted plans on a spreadsheet and do what-if analysis to come up with the plan that is best value and still giving me access to the doctors whom I want to see. Another way to look at worst case scenario would be adding up annual premiums and maximum out of pocket. If I think I am using maximum services for the year, then the lowest sum of annual premiums and maximum out of pocket is all that I am going to be responsible for.

 

[bogey21]

@clifffaith I wouldn't freak out over paying 40% of hospital fees after deductibles are met. The first plan on your list shows $7,800 Max out of pocket. That is the number that I would look at.

On the surface focusing on Max out of Pocket makes sense to me if one anticipates large medical bills...

George

 

[presley]

I really feel for you with trying to buy insurance. It's even more convoluted now than it was before Obamacare. I was fortunate in that I found our regular doctors on a HealthNet HMO plan. I was on Blue Shield PPO for many years. When I switched to Healthnet HMO, not only did my monthly go down almost $300, but what they consider not part of the deductible is a billion times more generous than BlueShield. We weren't expecting to save thousands each year because so many things were covered as medically necessary and not subject to the annual deductible.

Aren't you moving to Carlsbad? If so, I'd look at the plans and hospitals in that area because I found that plans were drastically different depending on zip code.

 

[clifffaith]

Aren't you moving to Carlsbad? If so, I'd look at the plans and hospitals in that area because I found that plans were drastically different depending on zip code.

I don't see us moving before I have to repeat this process in nine months to choose a Medicare plan. At that time I'll find out which plan/company would transfer south.

 

[SmithOp]

On a related note, I just found out about this at an FTB tax law update.


https://www.ftb.ca.gov/about-ftb/newsroom/news-articles/health-care-mandate.html


October 18, 2019

The State of California is working to reduce the number of uninsured families with the adoption of a new state individual health care mandate.

Here are three things California residents need to know:

1. Make sure you have health coverage
The mandate, which takes effect on Jan. 1, 2020, requires Californians to have qualifying health insurance coverage throughout the year.

Many people already have qualifying health insurance coverage, including employer-sponsored plans, coverage purchased through Covered California or directly from insurers, Medicare, and most Medicaid plans.

Under the new mandate, those who fail to maintain qualifying health insurance coverage could face a financial penalty unless they qualify for an exemption.

Generally speaking, a taxpayer who fails to secure coverage will be subject to a penalty of $695 when they file their 2020 state income tax return in 2021. The penalty for a dependent child is half of what it would be for an adult.

The penalty is based on your income and the number of people in your household.


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[bogey21]

Is the primary purpose of this to reduce the number of uninsured or to raise money for the State...

George

 

[VacationForever]

Is the primary purpose of this to reduce the number of uninsured or to raise money for the State...

George

When this was introduced, it stated that revenue will help fund health insurance for the illegal immigrants.

https://thehill.com/homenews/state-...state-to-offer-health-insurance-to-some-adult

 

[isisdave]

Welcome to Individual Health Care from 60 to 65, a terror film brought to you by our health care system. It's the reason DW and I had to wait until 65 to retire. Before I got my last job, in about 2012, our monthly insurance was $1800, and that was more than the mortgage.

Regarding the 40% and $7800 max out of pocket for a $1200 monthly cost -- yes, this is probably bearable for 5 years or so, and will protect you from calamity. But the idea of paying $14000 a year for insurance you're pretty sure will not pay a dime is just so wrong.

 

[Cornell]

I'd like to add that you can use the funds you've saved up in your HSA for any upcoming medical bills, even if you are no longer enrolled in an HSA insurance plan. You can use that money to pay for co-pays, medical bills that have yet to be met by the deductible, etc.

 

[bogey21]

When this was introduced, it stated that revenue will help fund health insurance for the illegal immigrants.

Interesting...

George

 

[Luanne]

Interesting...

George

And if you read the article it says for "some" undocumented immigrants. It's not a blanket thing.

 

[clifffaith]

I'd like to add that you can use the funds you've saved up in your HSA for any upcoming medical bills, even if you are no longer enrolled in an HSA insurance plan. You can use that money to pay for co-pays, medical bills that have yet to be met by the deductible, etc.

And it works on your spouse's bills, too.

 

[turkel]

I am sorry about all your healthcare issues. If it was me Kaiser would be out since none of your doctors are currently Kaiser doctors.

Since you only need 9 months of coverage I would focus on overall costs.

As a Fellow Californian I wonder how much more this state can take of the ridiculous laws and if the pendulum will swing back or if us average folks throw in the towel and beat feet.

 

[VacationForever]

I am sorry about all your healthcare issues. If it was me Kaiser would be out since none of your doctors are currently Kaiser doctors.

Since you only need 9 months of coverage I would focus on overall costs.

As a Fellow Californian I wonder how much more this state can take of the ridiculous laws and if the pendulum will swing back or if us average folks throw in the towel and beat feet.

Towards the end of my Kaiser patient days, my experience was becoming like OP's in a separate post about her husband's skin cancer experience. Once upon a time I could not imagine wanting to be outside of Kaiser's system. I loved my PCP and ObGyn doctors in Kaiser. Everything else was almost criminal medical negligence.

 

[SteelerGal]

When this was introduced, it stated that revenue will help fund health insurance for the illegal immigrants.

https://thehill.com/homenews/state-...state-to-offer-health-insurance-to-some-adult

Dreamers.

 

[DeniseM]

Folks: Please focus on the OP's questions - let's not stray down the "immigrants" path - thank you.