pinkmint Posted March 10, 2016 Share Posted March 10, 2016 (edited) Edited: never mind! I am just confused and frustrated trying to figure out marketplace insurance, and it looks like I might've got a bad plan. Edited March 10, 2016 by pinkmint 1 Quote Link to comment Share on other sites More sharing options...
cjzimmer1 Posted March 10, 2016 Share Posted March 10, 2016 We had it for a few months when DH was switching jobs and there was a waiting period for insurance with the new job. Picking a plan was the most difficult part because there was so many options at so many price points and trying to understand the coverage of each. But the coverage of doctors was not an issue. For me the choices were among all the well known medical groups in my area so before even picking a plan I knew what set of doctors was covered and who I wanted to see (DH has switched jobs and insurances many times during our marriage so I have a favorite set of doctors within each group that I use). I'm not sure anyone else can help you find a doctor since the insurance plans are location specific. Can they really REQUIRE you to see a doctor? I'd be checking on that. They might send letters suggesting that but I don't see how they can require you to visit a doctor. 1 Quote Link to comment Share on other sites More sharing options...
Goldilocks Posted March 10, 2016 Share Posted March 10, 2016 Our family has insurance through the marketplace. We chose a well known insurance provider and are having no problems. I am so sorry that you are not having a good experience! 1 Quote Link to comment Share on other sites More sharing options...
Lanny Posted March 10, 2016 Share Posted March 10, 2016 OP Call the office of an Independent Insurance Agent or Broker. They may be able to find you something better, for the same price or a lower price. GL 2 Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 (edited) Yeah, maybe it's because it's the cheapest, lowest income plan. I am always in a hurry when choosing things bc a I have 3 little kids in my presence at all times, plus it is quite confusing, but maybe I didn't pick the best plan. I will look into changing the plan if there's one I can afford. It might be the area I'm in too. And as far as getting in trouble for not seeing the Dr by a certain date I'll look into that too. Maybe I am understanding it wrong. The notice I got said "contact your provider to make an appointment within ____ days from now" Edited March 10, 2016 by pinkmint 1 Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 (edited) *double post Edited March 10, 2016 by pinkmint Quote Link to comment Share on other sites More sharing options...
Scarlett Posted March 10, 2016 Share Posted March 10, 2016 So I recently had to sign up for a marketplace (government) health coverage plan because they were starting to take more and more out of our tax return because of me being uninsured. I have been eligible for medicaid while pregnant but not at other times, so for the most part I've been uninsured until now. But at this point I'm so annoyed I wish it were legal to be uninsured. Before anyone comes out with the judgmental comments, I do not like being on government assisted anything. If we could afford to get me health insurance through DH's work and pay our rent at the same time we definitely would. So my frustration is in trying to find a provider. I have gone through roughly 20 of the suggested providers on my plan's website, googling them briefly. The vast majority of them either get bad reviews online and/ or are located in dangerous neighborhoods. One's name came up in several medical fraud news articles and the last one I looked up is dead. I know some people (yes, I know for a fact, someone actually did say this to me) think that I shouldn't be allowed to complain or have any preferences since I am leeching off tax payers (like my husband, who works more than full time). I should take what I can get and shut up. But at this point, I wish it were legal to be uninsured because at least then I could qualify for some charity programs offered by good reputable doctors ( I know a doctor who does this). Anyone else have this insurance? Which by the way appears to be nothing more than medicaid that you pay for. Anyone have experience with this or can offer helpful thoughts? I am apparently going to get in trouble if I don't find a doctor and get a check up by a certain date so the clock is ticking. I have experience with using the market place.....which I don't consider government assistance, but wouldn't judge you for using it even if I did.....anyway what insurance company did you pick? I chose BCBS and had no trouble with my normal providers being on the list. What do you mean you are going to get in trouble if you don't get a check up soon? In trouble with whom? The law is to have insurance....I don't recall anything in the law about forcing anyone to go to the doctor. 2 Quote Link to comment Share on other sites More sharing options...
Scarlett Posted March 10, 2016 Share Posted March 10, 2016 Yeah, maybe it's because it's the cheapest, lowest income plan. I am always in a hurry when choosing things bc a I have 3 little kids in my presence at all times, plus it is quite confusing, but maybe I didn't pick the best plan. I will look into changing the plan if there's one I can afford. It might be the area I'm in too. And as far as getting in trouble for not seeing the Dr by a certain date I'll look into that too. Maybe I am understanding it wrong. How much are you paying for the one you chose? I chose the highest deductible plan, but every plan pays for certain things without having to meet the deductible. Like mammograms, pap, some blood work. 1 Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted March 10, 2016 Share Posted March 10, 2016 I second the suggestion of calling an insurance broker. Or call a couple of the bigger health insurance companies. I've found them to be very patient and helpful in explaining the plans and most, if not all, have selections that are part of the Marketplace plans. I find it cheaper to find insurance for the children and myself apart from dh's work benefits. 1 Quote Link to comment Share on other sites More sharing options...
Corraleno Posted March 10, 2016 Share Posted March 10, 2016 Would one of the Christian "health sharing" plans work better for you? Many people seem to find them cheaper overall and you can see your own doctor (no "in network" vs "out of network" issues). 2 Quote Link to comment Share on other sites More sharing options...
zoobie Posted March 10, 2016 Share Posted March 10, 2016 There is no government insurance available through the marketplace. They're private plans the private insurance companies put up that 1) they feel would appeal to a wide range of people and 2) qualify for the government subsidies. You can choose *any* private plan you like, but the private company may not choose to accept a subsidy for payment. The government does not force you to accept a subsidy even if you qualify for one. We have gotten private health insurance through the marketplace even though we were paying full price with no subsidies. One they offered was better than our previous private plan through the same company. I agree with Lanny's advice to seek out an independent health insurance broker if you aren't satisfied with the selection of plans listed on the Marketplace. The broker's commission is paid by the insurance company and doesn't cost you extra. 4 Quote Link to comment Share on other sites More sharing options...
zoobie Posted March 10, 2016 Share Posted March 10, 2016 Yeah, maybe it's because it's the cheapest, lowest income plan. I am always in a hurry when choosing things bc a I have 3 little kids in my presence at all times, plus it is quite confusing, but maybe I didn't pick the best plan. I will look into changing the plan if there's one I can afford. It might be the area I'm in too. And as far as getting in trouble for not seeing the Dr by a certain date I'll look into that too. Maybe I am understanding it wrong. The notice I got said "contact your provider to make an appointment within ____ days from now" The private insurance company could make that a contractual agreement. By enrolling, you agree to abide by their terms. It's the same as any other contract. The government is not involved in this. If you violate the contractual agreement, the insurance company could cancel your plan, same as if you failed to pay or fraudulently completed the application or any other violation of their terms. 1 Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 I don't know what an insurance broker is :blushing: Sounds like I need to make some phone calls though... not an easy thing since I'm always alone on weekdays with the kids inevitably having crisis in the background while I'm trying to talk and listen but I will try. 1 Quote Link to comment Share on other sites More sharing options...
kewb Posted March 10, 2016 Share Posted March 10, 2016 Our family has had no issues purchasing through the marketplace for the last 3 years. Last year we ran into a problem finding specialists who took the insurance and were accepting new patients. I chose a different bcbs plan this year and so far no issues. The marketplace is not medicaid. I am sorry you are having difficulty. Quote Link to comment Share on other sites More sharing options...
zoobie Posted March 10, 2016 Share Posted March 10, 2016 I don't know what an insurance broker is :blushing: Sounds like I need to make some phone calls though... not an easy thing since I'm always alone on weekdays with the kids inevitably having crisis in the background while I'm trying to talk and listen but I will try. It's someone who sells insurance. An independent broker will search through many different companies and present you with options. If you call a broker who works for a specific company, he will only present you with those plans. They're awesome for home and life insurance too! Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted March 10, 2016 Share Posted March 10, 2016 Google "health insurance brokers" - it should show ones in your area. If not, add your locale to the search terms. A health insurance broker is a person(s) who help match people with the right insurance policy. Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 Well I'm kind of sorry for my original post now. I probably look like an idiot. Thanks for the advice everyone. How do I find an insurance broker? Quote Link to comment Share on other sites More sharing options...
Crimson Wife Posted March 10, 2016 Share Posted March 10, 2016 We got stuck having to briefly use Covered California a couple years ago when my DH was between permanent positions. I deliberately chose Kaiser HMO even though it did not have the lowest premiums because it automatically included every Kaiser doctor and facility in the state. The premium difference wasn't that much, <$100/mo. compared to the cheapest plan. The nightmare we experienced was trying to get signed up in the first place and then cancelling it when DH got a new position with family coverage. Plus it made our taxes that year difficult because the state put the wrong amount of the subsidy on the 1095-A form. We'd canceled as of March 31st since we had new coverage beginning April 1st. But stupid Covered CA claimed that we had gotten a subsidy for the month of April even though we didn't have coverage in April. :glare: 1 Quote Link to comment Share on other sites More sharing options...
QueenCat Posted March 10, 2016 Share Posted March 10, 2016 Well I'm kind of sorry for my original post now. I probably look like an idiot. Thanks for the advice everyone. How do I find an insurance broker? You don't look like an idiot. You just appear frustrated........ there are a lot of misconceptions about the marketplace. The biggest is that people get it confused with govt insurance. It's not, all of the plans on it are private. The govt part is that some people qualify for subsidies to help purchase the private plans. And many people don't realize that there are brokers available to help them navigate the system. Don't beat yourself up about it. 4 Quote Link to comment Share on other sites More sharing options...
Crimson Wife Posted March 10, 2016 Share Posted March 10, 2016 Well I'm kind of sorry for my original post now. I probably look like an idiot. Thanks for the advice everyone. How do I find an insurance broker? If you're getting a subsidy, you have to buy through either your state marketplace or the Federal one. You can buy a plan outside of the marketplace but it will cost a lot more (unless you're already paying full price). 1 Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 Now I'm back to being confused. Lol. I signed up through healthcare.gov. I'm pretty sure I have a subsidy. Can I still use a broker? There's no way we can afford a plan without a subsidy. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted March 10, 2016 Share Posted March 10, 2016 https://www.healthcare.gov/get-coverage/ click the "find local help" button on the right side of the screen. You should be able to talk to someone locally to walk you through it. Otherwise, the website will walk you through it, if that is more convenient for you. Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 The person I talked to on the phone from healthcare.gov helped me pick a plan. 2 Quote Link to comment Share on other sites More sharing options...
Corraleno Posted March 10, 2016 Share Posted March 10, 2016 (edited) Yes you can use a broker and still get a subsidy. Also, since you mentioned not liking to use government programs/subsidies, I would really encourage you to look at some of the Christian health sharing plans. The monthly costs are pretty low and you can see any doctor you want. There are several people here on the boards who use one and are very happy with it. I know people IRL who use it and are very happy with it, and it saves them a ton of money even without the govt subsidies. ETA: And these plans count as "insurance," so there are no fines for being uninsured. Edited March 10, 2016 by Corraleno Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 Yes you can use a broker and still get a subsidy. Also, since you mentioned not liking to use government programs/subsidies, I would really encourage you to look at some of the Christian health sharing plans. The monthly costs are pretty low and you can see any doctor you want. There are several people here on the boards who use one and are very happy with it. I know people IRL who use it and are very happy with it, and it saves them a ton of money even without the govt subsidies. ETA: And these plans count as "insurance," so there are no fines for being uninsured. That's what I was wondering about these Christian health sharing programs. I'm confused about those too but I'll look into it. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted March 10, 2016 Share Posted March 10, 2016 The person I talked to on the phone from healthcare.gov helped me pick a plan. So the problem is finding a doctor on that plan? Do you already have a doctor? If you do, call their office and ask them to tell you which insurance plans they accept. They might be able to tell you if any of them are Marketplace plans. Then call those providers or call the person at healthcare.gov and ask about those specific plans. Hopefully that might give you a plan that will meet your healthcare and financial needs. 1 Quote Link to comment Share on other sites More sharing options...
Scarlett Posted March 10, 2016 Share Posted March 10, 2016 We got stuck having to briefly use Covered California a couple years ago when my DH was between permanent positions. I deliberately chose Kaiser HMO even though it did not have the lowest premiums because it automatically included every Kaiser doctor and facility in the state. The premium difference wasn't that much, <$100/mo. compared to the cheapest plan. The nightmare we experienced was trying to get signed up in the first place and then cancelling it when DH got a new position with family coverage. Plus it made our taxes that year difficult because the state put the wrong amount of the subsidy on the 1095-A form. We'd canceled as of March 31st since we had new coverage beginning April 1st. But stupid Covered CA claimed that we had gotten a subsidy for the month of April even though we didn't have coverage in April. :glare: Yes that was the kind of problems I had too. I was glad to get free of them, but would take the help if I needed it again. Quote Link to comment Share on other sites More sharing options...
Scarlett Posted March 10, 2016 Share Posted March 10, 2016 Now I'm back to being confused. Lol. I signed up through healthcare.gov. I'm pretty sure I have a subsidy. Can I still use a broker? There's no way we can afford a plan without a subsidy. First of all....you are NOT an idiot for asking questions. Don't be so harsh with yourself. You do need to figure out if you are getting a subsidy or not. If you aren't getting a subsidy there is no reason to go through the marketplace. You can buy your insurance direct which is what I am doing. And if you are getting a subsidy it will be reported to the IRS for calculating how much tax you owe next year....if say your husband got a big raise be sure to have the marketplace recalculate things otherwise you could end up paying all the subsidy back come tax time. When you look for plans on the marketplace you can sort by lowest to highest premium or by deductible. Quote Link to comment Share on other sites More sharing options...
Carrie12345 Posted March 10, 2016 Share Posted March 10, 2016 I don't think you sound like an idiot. It is a complicated process. This is our 3rd year through the marketplace, and sometimes I feel like it's a part time job. Filling out an application for seven people takes FOOOORRREVVVER!!! And then there are the glitches on top of that. @@ All that aside, we've been with BCBS the entire time, on three different plans. One year we qualified for a small subsidy and didn't take it. One year we didn't qualify for a subsidy. This year we qualified and took it. We've done platinum and we've done silver. High deductible and low. Every state's options are going to be different, but ours have always been many and varied. We are BCBS customers and treated like any other BCBS customer. Quote Link to comment Share on other sites More sharing options...
pinkmint Posted March 10, 2016 Author Share Posted March 10, 2016 Thank you so much, everyone. It does feel like a part time job sometimes. "Your estimated wait time is... ten. minutes." So I just got off the phone with a healthcare.gov representative and I am stuck with my current plan because it started March 1st and the next open enrollment period is estimated to start in November (the guy didn't know for sure). The only thing I can do to get out of it is terminate the plan and get the penalties, or terminate it and get some sort of non-marketplace insurance. That's what I think the deal is anyway. The whole thing is confusing. Quote Link to comment Share on other sites More sharing options...
Corraleno Posted March 10, 2016 Share Posted March 10, 2016 Thank you so much, everyone. It does feel like a part time job sometimes. "Your estimated wait time is... ten. minutes." So I just got off the phone with a healthcare.gov representative and I am stuck with my current plan because it started March 1st and the next open enrollment period is estimated to start in November (the guy didn't know for sure). The only thing I can do to get out of it is terminate the plan and get the penalties, or terminate it and get some sort of non-marketplace insurance. That's what I think the deal is anyway. The whole thing is confusing. Yes, and even though the open enrollment period will reopen in November, any new plan you select in November wouldn't go into effect until January 2017 anyway. Here's a very informative site that compares three of the more prominent Christian health share programs and explains how they work. The two families I know of that use this sort of program have Samaritan, which is one of the programs listed here. I think people can enroll at any time, but I'm not positive since I don't use one. But it's definitely worth checking out, as it tends to be cheaper than regular insurance and it does qualify as "health insurance" for purposes of the ACA. Quote Link to comment Share on other sites More sharing options...
zoobie Posted March 10, 2016 Share Posted March 10, 2016 Thank you so much, everyone. It does feel like a part time job sometimes. "Your estimated wait time is... ten. minutes." So I just got off the phone with a healthcare.gov representative and I am stuck with my current plan because it started March 1st and the next open enrollment period is estimated to start in November (the guy didn't know for sure). The only thing I can do to get out of it is terminate the plan and get the penalties, or terminate it and get some sort of non-marketplace insurance. That's what I think the deal is anyway. The whole thing is confusing. I was wondering about getting a plan when it wasn't open enrollment, but I didn't want to confuse anything more. I didn't realize you had already purchased a plan. Registering on the Marketplace website isn't the same thing as choosing and buying a plan. You can register, browse plans, and ultimately purchase from another source. Open enrollment typically begins November 1, and the end date typically is December 15 for most companies, meaning you have to be registered and paid by that date for coverage to begin January 1. Quote Link to comment Share on other sites More sharing options...
Corraleno Posted March 10, 2016 Share Posted March 10, 2016 (edited) I was wondering about getting a plan when it wasn't open enrollment, but I didn't want to confuse anything more. I didn't realize you had already purchased a plan. Registering on the Marketplace website isn't the same thing as choosing and buying a plan. You can register, browse plans, and ultimately purchase from another source. Open enrollment typically begins November 1, and the end date typically is December 15 for most companies, meaning you have to be registered and paid by that date for coverage to begin January 1. For marketplace plans, I think the open enrollment period finally closes on January 31st, but in that case coverage wouldn't start until March 1st. The deadline for coverage starting January 1 is December 15th. Edited March 10, 2016 by Corraleno Quote Link to comment Share on other sites More sharing options...
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