hoffage123

I just did a random quote for health insurance through Aetna and it came up with a $700/month premium with $25 co-pay (no deductible) based on a family of two adults in their early 30s (non-smokers) and one 4 year old. Is this reasonable do you think?

I am trying to get an idea of how much of our monthly income is likely to be needed to ensure relatively ok coverage. I was worried more for our little boy. For certain policies would it be possible to give greater coverage to one of the individuals under a family policy, or would this require a separate policy to be taken out? My plan would be to give him the most comprehensive coverage, and to give myself and the missus the minimum. Does that sound silly? Just trying to get my head around it all ...

Hoffage

Michael

Go to Health Care.gov to get quotes. You may possibly be eligible for a federal subsidy through the "Affordable Care Act".

Unfortunately an insurance quote on the internet may possibly not be the price or coverage that you will eventually get. Through healthcare.gov, insurance companies have to provide the stated coverage at the price quoted.

hoffage123

Thanks Michael for the link, appreciated

I just tried and it directed me to the NY website, which then said "No Connection". I wonder if I have to wait until I am actually in the US to be able to browse for quotes on it?

Hoffage

Michael

I just tried it and the NY site came up. Try again and if it still doesn't work, you'll probably have to connect through a US proxy server and hopefully that will work. Although you have to register to see the quotes, I believe you can use a fake name and other fake information to register. Then when you arrive, you can create a new account.

http://www.publicproxyservers.com/proxy/list1.html

You should also be able to call them if that doesn't work (1.855.355.5777).

Pulaski

The answer fundamentally depends on whether you get a job with medical insurance included.
And as Michael said, you may be eligible for a subsidy if your income is low. I think you'd need around $70k income for a family of three before the subsidy fell to zero.

For what you describe, the premiums sound as if they're in the right ball park. For employment based coverage the cost could drop to around $500.

As far as I know, all the people covered under one policy must have the same coverage, and in the case of employment linked policies, the employee MUST be covered.

Bomjeito

We are two adults in mid 40s and twin one year olds. We aren't eligible for any subsidy with healthcare.gov, so purchased directly from Blue Cross/Blue Shield here of Texas. We pay $727 a month for the bronze level. Silver level was $1020.

Deductible is $6k per person or $12,700 for family.

Our COBRA payments were $1600!

You can work with an agent or broker who normally gets the commission from the plan provider you choose, so they could advise about the particularities you ask.

hoffage123

Thanks for this Bomjeito.

Does the $6K deductible limit include things like doctor visits? Or is it for things like hospital care?

So if my son had a need to see a Paediatrician would that be chargeable for example?

Hoffage

RoadWarriorFromLP

If you have a US employer, then I would expect your employer to provide your insurance. The amount that you pay would be based upon the group deal that your employer has arranged, and the degree to which your employer chooses to subsidize your share of the cost.

The new Obamacare plans (which you won't need if you have insurance provided by your employer) are tiered into "bronze", "silver" and "gold" levels, and possibly "platinum."

The bronze plans are high deductible plans, and the deductible is applied to everything, although you get the (presumably) discounted rate for services that your insurer has negotiated. These are disaster care plans, and should be used in conjunction with an HSA account, which is basically a tax-sheltered account into which you deposit some of your earnings so that you can bank your deductible.

The silver plan has a lower deductible, and that applies only to procedures and hospitalization, not to individual doctors visits. The doctor visits don't involve deductibles, but "copays", which are fixed amounts that you would pay for an individual doctors visit -- the insurer pays the amount of the fee that exceeds the copay. The silver, gold and platinum plans do include one free physical per year.

The gold and platinum plans have no deductible at all and lower copays.

All of the plans have annual cost caps. If you need $100,000 worth of treatment, for example, you won't be liable for most of it.

One thing to note is the concept of the "network." Each insurer provides a limited pool of doctors and other providers who participate in their plan, and some of those networks are better than others. If you use a provider who doesn't belong to the network, then you'll be expected to pay the provider on your own, and your insurance will reimburse you for only a small amount or perhaps none of what you owe. In other words, you'll generally want to use providers who are in your network, and it makes sense to find out whether the better hospitals in your area are included in your network.

sir_eccles

The ACA makes a lot of things free such as preventative care. So a regular annual visit to the pediatrician may be free or at most just your regular revisit copay.

Bink

Just to add to this - Employment based coverage also typically has much lower deductibles and maximum OOP (Out of Pocket) expenses than individual plans too.

Bink

Just read this again - No deductible?! That sounds very cheap to me for a no deductible plan. What's the coverage and maximum out of pocket (OOP) on the plan you've been quoted.

For reference I'm on a corporate plan, $750/pp ($2,250 family) deductible which costs me $430/month and costs my company another $1200/month which has a max OOP of $2,250/pp ($3,750 family). This is for me, my wife and our 2 yr old.

Michael

When I originally read that, I also wondered and assumed it was probably a pre-ACA quote where that price was only for a family in perfect health and once someone got sick, they were either cancelled or put in a risk pool where premiums were so high they couldn't afford the premiums.

I suspect currently if someone purchased directly from the insurance company (not through ACA), the insurance company is under the same rules as ACA policies where they can't charge more than other families in the same age group, can't have more than $6,350 per person per annum out of pocket expense ($12,700 for a family), must cover the same procedures as ACA policies, and can't cancel a policy or put them in a risk pool. I that was not the case, then insurance companies individual plans would likely only have healthy families and undercut the prices of ACA policies and when someone got sick, they'd cancel them and ACA would only be for sick people with very high premiums.

hoffage123

When I received the quote, I went through their online calculator - I didn't save it unfortunately so I don't have the exact details to hand, and was a bit confused by the terminology. I did put we were all in good health, our ages and postcode/zipcode etc.


Hoffage

Bob

The bolt ons might be, such as dental and eyeballs.

On a slight tangent, the weird thing about the company plan where the missus works is what type of plans you can get. Employee has a plan, it's whatever it is depending on the tier. A spouse can get a spouse plan on the same tier, but only for married spouse which costs a bit extra, long term partners, kids etc have to come under a family plan and that's the same rate whether you have one person or ten kids, so very expensive for a unmarried partner or one kid but very cheap if you have a large family. The bolt ons work the same way.

sir_eccles

All new plans sold whether directly or via the healthcare.gov website must be ACA compliant. I think the only exception might be pre-ACA plans which are grandfathered in that you can keep for a limited time if you like.

Actually, it doesn't really make sense to shop directly anymore (unless you have a particular affinity to a certain insurance company), by not going through healthcare.gov you miss out on seeing competitor companies side by side.