clifffaith
TUG Member
- Joined
- Feb 24, 2016
- Messages
- 5,559
- Reaction score
- 6,805
- Points
- 498
- Location
- San Juan Capistrano, CA
- Resorts Owned
- Worldmark
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.
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
Plan Details
View Similar Plans
Find Doctors
Add to Cart +
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
Plan Details
View Similar Plans
Find Doctors
Add to Cart +
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
Plan Details
View Similar Plans
Find Doctors
Add to Cart +
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.