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I just had to purchase health insurance two week ago in the state of MI(Just turned 26). I had 3 options: 1. Obama Care - I qualified for a $16 subsidy... 2.

by Beached 11y ago

I just had to purchase health insurance two week ago in the state of MI(Just turned 26). I had 3 options: 1. Obama Care - I qualified for a $16 subsidy... 2. Individual plan from a health care provider in state 3. Health Share plan (think Credit union for health care) Obama care cost 2x as much as an individual plan, and almost 3x as much as a health share plan, so even after the subsidy, this was not an option. Health share plan was very affordable, however it only worked with the health care providers on the east side of the state(I live on the west), it had a low yearly deductible, much lower then the individual High deductible HMO, however it had a 20% copay for all health services, including routine physicals and checkups. Individual Plan from an instate health care plan costs slightly more each month, but all routine check ups, generic brand pharmaceuticals proscribe from my doctor, and any specialist (Chiropractor, Knee Doctor, etc) visits are 100% covered IF I am referred by my primary care physician. I went with an individual plan for about $140/m and $28/m for dental coverage. A political side note: this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play. (edit: Health Care cost, not Heath + Dental)

artlogic 11y ago
I'm also in Michigan and curious about the specifics of options 2 and 3. Would you be willing to share the details?
- Beached 11y ago
  Certainly, 2. The individual plan is from Priority health, it is their individual High deductible HMO HSA plan with a annual deductible of $6300. The entire spectrum health network is covered in the plan, (Spectrum health pretty much owns all of west MI and the Grand Rapids area). 3. http://www.healthshareplan.org/ http://www.healthshareplan.org/ When I contacted them, they only paid out to UoM and Mercy Health networks, not spectrum health. Since I live in Spectrum health land, this wouldnt work well for me. however if you live in East MI, you may consider this.
  - artlogic 11y ago
    The HSP looks really interesting, and I'm currently living in Ann Arbor so UofM is practically within walking distance. Thanks for the information!
    - Beached 11y ago
      no problem, i will also say that PH insurance has some of the BEST customer service. Both public facing and internal. They actually have an internal department that the public is unaware that does some amazing things that help reduce cost for both them and you as a customer. This department also help make sure the care you receive is the best available for you, as well as thoroughly completed to avoid complications and repeat visits, which also help reduce costs but improve quality of life. I cant say much more then that because im pretty sure its what they would call a trade secret... I am only aware of it because I worked for them and was involved in supporting this from an IT perspective. On a side note for all of you people looking for a change of pace. Health care is IMO the most fascinating place to be as far as IT is concerned, I would have never left the health care industry except that I wanted the benefit of working from home full time. When I left, I told my boss and a few other managers to let me know if a full time work from home position became available.
gwbas1c 11y ago
The cost went up because of the pre-existing condition situation. Pre Obama Care, if you had any kind of pre-existing condition, you wouldn't be able to buy the $84 coverage. (I got stuck having to get a normal job because of a pre-existing condition.)
- Beached 11y ago
  Yes, Since I do not have any pre-existing condition, and have never smoked, that $84 would have been mine. Because no insurer can decline someone, my cost went up to make insurance for people with per-existing conditions more affordable.
  - dimino 11y ago
    I'm quite sure they appreciate it, thanks. :D
  - Aqueous 11y ago
    The fact that you didn't have to buy insurance until 26 is a result of Obamacare too. Think of all the money you saved being on that insurance for several extra years. You're welcome! And maybe in part because you're spending that $84 now someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious. You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it.
    - Beached 11y ago
      >The fact that you didn't have to buy insurance until 26 is a result of Obamacare too. Think of all the money you saved being on that insurance for several extra years. You're welcome! yes i am aware that the 26 rule is an obama care result. However, if I am nice, and I am, I pay my parents the extra cost per month to go from a spousal plan to a family plan, which is $85/m, shocker.... However if my parents had other kids younger then me that required a family plan it would have saved me money, yes. in my response to another post, i noted that this was really the only positive to Obama care that I experienced. >And maybe in part because you're spending that $84 someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious. I dont think it is fair that I have to pay for someone elses health care expenses. ESPECIALLY since that someone else doesnt take the time of day to shop around for the best coverage for the cost, care to look at success rates to avoid re-works, or heaven for bid, self diagnose themselves and go directly to a specialist that can result in more expensive care. If people actually had to pay for the coverage they used, they would take the time to shop around and make informed decisions, and do things like exercise and eat well, avoid smoking and recreational drugs, then people with pre-existing conditions, and low incomes wouldnt have to pay so much for their care. Its called capitalism, and the health insurance industry would look VERY different. Obama care only gets us farther from where we need to be, and makes the entire situation worse. I know I sound like a jack ass right now because some people would suffer in the short term, but if you eliminated obama care, and the health insurance industry, we would be better off in 10 years. keep medicare for the poor, old, and disabled if you want, keeping it will have very little affect as its an income tax and not a premium subsidy. >You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it. If the government allowed care providers to go after uninsured individuals assets and not eat the costs. AND if the government allowed back charging for care given to qualified medicare/medicaid individuals, there would be no need to increase the burden on me to help pay for everyone else who goes in for care un covered. over 75% of the uncovered costs pre-ACA are people treating the ER like their PCP anyways. If we allowed capitalism to work, those individuals who go to the ER for a cold would eventually go to a PCP and only pay $25 for the visit and $15 for the generic meds.
hackuser 11y ago
> Obama care cost 2x as much as an individual plan What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know. > this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc. EDIT: Remove something that I think was overly provacative, (even if not meant that way).
- Beached 11y ago
  > What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know. Ironically a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. This is for a couple reasons: On the market place, a qualifying plan must meet ALL ACA requirements. This includes a capped deductible, bundled Dental, vision coverage, prenatal coverage/birth control coverage. Also, ACA plans are held to a higher standard then individual plans purchased on the open market. I have fewer options to choose from, and those fewer options all come with lower deductibles and more coverage then I need/want. This means higher monthly premiums. >Were you pricing insurance 2 years before you need it? Many years ago (before Obama was elected), when I was pricing individual insurance the price was several times more. Insurance companies seemed uninterested in individual consumers. I had the wonderful experience of working at Priority Health from 2011-mid 2014. I got to see ALL sorts of chaos unfold as they tried to meet all the requirements and deadlines (They did just fine, but there certainly wasn't much cushion on time). This increase in coverage was literally over night, as in 12/31/2013 Individual Plan A (The actual name...) was $84/m, on 1/1/2015 Individual Plan A was $136/m (Priority Health did grandfather in the pre-ACA prices for anyone already on the plan for 1 year, however any new members paid the new price) >How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc Overall ACA has negatively affected my coverage and most people I know. However to be fair, I was in the Goldilocks zone for health care coverage. Young, white, healthy athletic male, no pre-existing conditions, never smoked, and located in a relatively low health care area when compared to LA, NY, Chicago, etc. Pre-ACA my health care costs would have been as low as low could be. I do think that coverage until age 26 is a good additional, however I wish it was through the entire year they turn 26 in, and not just until the month they turned 26, (For me June and I had to find coverage within 30 days of my birthday). I do like the fact that it give subsidies to the individuals who cannot afford even a $84-$150 monthly premium pre ACA, however I wish that they just expanded the medicare program to give these subsidies as these people only represent about 1/3 of 1% of Americans, and in many cases a large portion of this small percentage would have been covered under medicare anyways I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.) I think it is stupid that my obama care plan purchased through the open market also includes Dental, Vision, Prenatal care, and Birth Control coverage. I think its a smart marketing move to bundle these together into one plan for certain females, however it is not possible to unbundle this. And yes that means all you males out there, and all you women after menopause have prenatal and birth control coverage... I think its stupid that as a male i am REQUIRED to purchase prenatal care and birth control coverage for myself even though i will NEVER use this. why do i have to purchase this? All US Citizens are required to purchase a plan that meets the affordable care acts requirements, it does not mean i must purchase a plan on the open exchange, but yes that mean individual buyers must purchase coverage they will not use in an attempt to make health care for everyone good. If I dont purchase prenatal care, I will qualify for the penalty at tax season.
deleted 11y ago
[deleted]

by Beached 11y ago

artlogic 11y ago

I'm also in Michigan and curious about the specifics of options 2 and 3. Would you be willing to share the details?

Beached 11y ago
Certainly, 2. The individual plan is from Priority health, it is their individual High deductible HMO HSA plan with a annual deductible of $6300. The entire spectrum health network is covered in the plan, (Spectrum health pretty much owns all of west MI and the Grand Rapids area). 3. http://www.healthshareplan.org/ http://www.healthshareplan.org/ When I contacted them, they only paid out to UoM and Mercy Health networks, not spectrum health. Since I live in Spectrum health land, this wouldnt work well for me. however if you live in East MI, you may consider this.
- artlogic 11y ago
  The HSP looks really interesting, and I'm currently living in Ann Arbor so UofM is practically within walking distance. Thanks for the information!
  - Beached 11y ago
    no problem, i will also say that PH insurance has some of the BEST customer service. Both public facing and internal. They actually have an internal department that the public is unaware that does some amazing things that help reduce cost for both them and you as a customer. This department also help make sure the care you receive is the best available for you, as well as thoroughly completed to avoid complications and repeat visits, which also help reduce costs but improve quality of life. I cant say much more then that because im pretty sure its what they would call a trade secret... I am only aware of it because I worked for them and was involved in supporting this from an IT perspective. On a side note for all of you people looking for a change of pace. Health care is IMO the most fascinating place to be as far as IT is concerned, I would have never left the health care industry except that I wanted the benefit of working from home full time. When I left, I told my boss and a few other managers to let me know if a full time work from home position became available.

gwbas1c 11y ago

The cost went up because of the pre-existing condition situation. Pre Obama Care, if you had any kind of pre-existing condition, you wouldn't be able to buy the $84 coverage. (I got stuck having to get a normal job because of a pre-existing condition.)

Beached 11y ago
Yes, Since I do not have any pre-existing condition, and have never smoked, that $84 would have been mine. Because no insurer can decline someone, my cost went up to make insurance for people with per-existing conditions more affordable.
- dimino 11y ago
  I'm quite sure they appreciate it, thanks. :D
- Aqueous 11y ago
  The fact that you didn't have to buy insurance until 26 is a result of Obamacare too. Think of all the money you saved being on that insurance for several extra years. You're welcome! And maybe in part because you're spending that $84 now someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious. You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it.
  - Beached 11y ago
    >The fact that you didn't have to buy insurance until 26 is a result of Obamacare too. Think of all the money you saved being on that insurance for several extra years. You're welcome! yes i am aware that the 26 rule is an obama care result. However, if I am nice, and I am, I pay my parents the extra cost per month to go from a spousal plan to a family plan, which is $85/m, shocker.... However if my parents had other kids younger then me that required a family plan it would have saved me money, yes. in my response to another post, i noted that this was really the only positive to Obama care that I experienced. >And maybe in part because you're spending that $84 someone else who has a pre-existing condition and no health insurance will be able to not die or go bankrupt if they get something serious. I dont think it is fair that I have to pay for someone elses health care expenses. ESPECIALLY since that someone else doesnt take the time of day to shop around for the best coverage for the cost, care to look at success rates to avoid re-works, or heaven for bid, self diagnose themselves and go directly to a specialist that can result in more expensive care. If people actually had to pay for the coverage they used, they would take the time to shop around and make informed decisions, and do things like exercise and eat well, avoid smoking and recreational drugs, then people with pre-existing conditions, and low incomes wouldnt have to pay so much for their care. Its called capitalism, and the health insurance industry would look VERY different. Obama care only gets us farther from where we need to be, and makes the entire situation worse. I know I sound like a jack ass right now because some people would suffer in the short term, but if you eliminated obama care, and the health insurance industry, we would be better off in 10 years. keep medicare for the poor, old, and disabled if you want, keeping it will have very little affect as its an income tax and not a premium subsidy. >You have to buy insurance because our system now factors in the strain on the system you would cause if something happened to you and you didn't have insurance. Just think of it like a tax (or the tax penalty like a tax, and the subsidy like a reward for responsible behavior.) That's how the Supreme Court thought of it. If the government allowed care providers to go after uninsured individuals assets and not eat the costs. AND if the government allowed back charging for care given to qualified medicare/medicaid individuals, there would be no need to increase the burden on me to help pay for everyone else who goes in for care un covered. over 75% of the uncovered costs pre-ACA are people treating the ER like their PCP anyways. If we allowed capitalism to work, those individuals who go to the ER for a cold would eventually go to a PCP and only pay $25 for the visit and $15 for the generic meds.

hackuser 11y ago

> Obama care cost 2x as much as an individual plan What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know. > this same exact coverage would have only cost me $84/m before 2014 when Obama care went into play How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc. EDIT: Remove something that I think was overly provacative, (even if not meant that way).

Beached 11y ago
> What is an Obamacare plan? I thought the ACA created a marketplace that listed plans from insurers, and set minimums for coverage (that would apply to options #2 and #3). I haven't had to deal with it so I don't know. Ironically a plan through Priority health on the market place cost 2x as much as the same plan purchase through the same insurer individually. This is for a couple reasons: On the market place, a qualifying plan must meet ALL ACA requirements. This includes a capped deductible, bundled Dental, vision coverage, prenatal coverage/birth control coverage. Also, ACA plans are held to a higher standard then individual plans purchased on the open market. I have fewer options to choose from, and those fewer options all come with lower deductibles and more coverage then I need/want. This means higher monthly premiums. >Were you pricing insurance 2 years before you need it? Many years ago (before Obama was elected), when I was pricing individual insurance the price was several times more. Insurance companies seemed uninterested in individual consumers. I had the wonderful experience of working at Priority Health from 2011-mid 2014. I got to see ALL sorts of chaos unfold as they tried to meet all the requirements and deadlines (They did just fine, but there certainly wasn't much cushion on time). This increase in coverage was literally over night, as in 12/31/2013 Individual Plan A (The actual name...) was $84/m, on 1/1/2015 Individual Plan A was $136/m (Priority Health did grandfather in the pre-ACA prices for anyone already on the plan for 1 year, however any new members paid the new price) >How else has the ACA affected your insurance? For example, I think it allows you to stay on your parents plan until now (i.e., through age 25), guarantees you won't be turned down, eliminates caps on coverage, etc Overall ACA has negatively affected my coverage and most people I know. However to be fair, I was in the Goldilocks zone for health care coverage. Young, white, healthy athletic male, no pre-existing conditions, never smoked, and located in a relatively low health care area when compared to LA, NY, Chicago, etc. Pre-ACA my health care costs would have been as low as low could be. I do think that coverage until age 26 is a good additional, however I wish it was through the entire year they turn 26 in, and not just until the month they turned 26, (For me June and I had to find coverage within 30 days of my birthday). I do like the fact that it give subsidies to the individuals who cannot afford even a $84-$150 monthly premium pre ACA, however I wish that they just expanded the medicare program to give these subsidies as these people only represent about 1/3 of 1% of Americans, and in many cases a large portion of this small percentage would have been covered under medicare anyways I agree that per-existing conditions should not be denied for coverage, however I do not agree that those without conditions should be required to pay higher premiums to subsidize their premiums. (sounds harsh I know, but thats my opinion.) I think it is stupid that my obama care plan purchased through the open market also includes Dental, Vision, Prenatal care, and Birth Control coverage. I think its a smart marketing move to bundle these together into one plan for certain females, however it is not possible to unbundle this. And yes that means all you males out there, and all you women after menopause have prenatal and birth control coverage... I think its stupid that as a male i am REQUIRED to purchase prenatal care and birth control coverage for myself even though i will NEVER use this. why do i have to purchase this? All US Citizens are required to purchase a plan that meets the affordable care acts requirements, it does not mean i must purchase a plan on the open exchange, but yes that mean individual buyers must purchase coverage they will not use in an attempt to make health care for everyone good. If I dont purchase prenatal care, I will qualify for the penalty at tax season.

deleted 11y ago

[deleted]