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Health insurance confusion

Health insurance confusion

Old Jul 15th 2020, 6:55 pm
  #16  
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Default Re: Health insurance confusion

Originally Posted by user77575775 View Post
Great thread thanks.

Could you ellaborate on Health Insuracne Broker?
Above someone stated this service is free. Does the broker get paid by insurance company? Is the broker likely incentivised by certain companies/policies? Would the broker inform on ACA?

thx
This is like any other insurance broker, except they specialize in the health field. They take your personal particulars, and then advise you of the options available and what they cost. There is no cost to the client, but I'm sure they do get something from the program the client opts for. However, they will have a relationship with all the companies, so they aren't going to try to skew your thinking. A broker wouldn't stay in business long if they didn't find the best options for the client. I have worked with my broker for over thirty years and have introduced him to many people. The options he recommends to me, a self-employed individual, are totally different from the options he offers a small business, a corporation, or a nonprofit. At renewal time last year he advised me of a new plan that he thought would work well for me, I switched, and it has indeed been an improvement. And yes, a broker can help with your state's ACA option.
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Old Jul 15th 2020, 7:05 pm
  #17  
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Default Re: Health insurance confusion

I've never used one myself.

Like all insurance brokers, they are usually paid by commission. I am sure that would advise on all options.
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Old Jul 15th 2020, 8:53 pm
  #18  
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Default Re: Health insurance confusion

It maybe that Medicaid and the Healthcare Marketplace (healthcare.gov) cannot be combined. I am not sure where you would start? I don't believe either option allows for double coverage.
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Old Jul 15th 2020, 10:17 pm
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Default Re: Health insurance confusion

Originally Posted by user77575775 View Post
Great thread thanks.

Could you ellaborate on Health Insuracne Broker?
Above someone stated this service is free. Does the broker get paid by insurance company? Is the broker likely incentivised by certain companies/policies? Would the broker inform on ACA?

thx
Yes, the broker gets incentivised by the insurance company, so you need to make sure you are getting good advice regarding health plans. Yes the broker would have all info on ACA,
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Old Jul 16th 2020, 3:25 pm
  #20  
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Default Re: Health insurance confusion

After speaking to someone that knows more about medicaid than me, Family Care is the premium medicaid, if there is sure a thing. The advice is to call New Jersey Family Care and ask them to explain how this works. Medicaid is not normal health insurance. If you can afford health insurance, you are probably committing medicaid fraud, which is serious. If you cant get through to Family Care, ask at your PCP if they have a number for the insurance you could call. I hope this helps.
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Old Jul 26th 2020, 8:18 pm
  #21  
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Default Re: Health insurance confusion

Hello everyone, thanks very much for all this helpful information. I feel like I'm walking through a minefield, but this all helps. I've read through all of your responses, but need to read through again. I might have some follow up questions. Thanks again.

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Old Jul 26th 2020, 8:54 pm
  #22  
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Default Re: Health insurance confusion

Originally Posted by mrken30 View Post
After speaking to someone that knows more about medicaid than me, Family Care is the premium medicaid, if there is sure a thing. The advice is to call New Jersey Family Care and ask them to explain how this works. Medicaid is not normal health insurance. If you can afford health insurance, you are probably committing medicaid fraud, which is serious. If you cant get through to Family Care, ask at your PCP if they have a number for the insurance you could call. I hope this helps.
Thanks, mrken30, but I’m not sure exactly what you are suggesting by calling New Jersey Family Care and asking them to explain how “this” works? What is the question exactly? “If you can afford health insurance” seems much more complex in reality than it might seem at first. I’ve heard of many people just scraping by once they paid for their health insurance. In other words, eligibility for Medicaid and being able to afford health insurance is not a neat line, where one thing ends and another begins. We last completed New Jersey Family Care paperwork one year ago. We haven’t accessed any healthcare since late last year, partly because of the covid-19 lockdown (and fortunately not getting covid-19) and partly because the health care service provided was so s*** that we gave up! And obviously everything is so messed up right now, New Jersey Family Care has not contacted us for an update on our financial situation, and when I tried to call them recently, I couldn’t get through to anyone anyway. As I said, fortunately, “our financial circumstances are improving, except the uncertainty of covid-19 and the economy etc. I’m going to be eligible for health insurance through work in a couple of months, but unfortunately while for one individual the rates are very good, the “family” (+spouse) coverage costs are about one quarter of my monthly income”. But if New Jersey Family Care don’t contact us with more of their paperwork, how am I meant to report to them, all the while when I’m still on a low income, which changes every couple of months, currently unemployed through the summer, more work on the horizon + health insurance? Everything is in flux. As far as I can tell, New Jersey Family Care are only ever interested in last year’s tax return and "current" income. My income in June and July were totally different. In July, it is $0. For two weeks in May it was $0. For half of May and all of June I had a low income. For July it is $0. Am I meant to update New Jersey Family Care every time if fluctuates, knowing that they take so long to process the paperwork (even before covid-19) that we’ll be left without health insurance for most of the time (e.g. when actually eligible) if we contact them every time we might “possibly” (and temporarily) be ineligible? Do they have time to process four applications from us per year? Because that would certainly have been necessary over the past year or two. Even now, half of the work I have lined up for the fall and winter might fall through. It remains to be seen. And I have no idea whether or not this work (0% or 50% or 100%) will continue in January–May. The system isn’t designed for people who are in flux, and yet so many people are!

Anyway, I appreciate your advice. Thanks.
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Old Jul 26th 2020, 8:59 pm
  #23  
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Default Re: Health insurance confusion

Originally Posted by Nutmegger View Post
I would suggest googling for an insurance broker local to you who specializes in health insurance. As you say, the options are indeed complicated and working with a professional (at no cost to you) is the best way to find the right plan and to have the workings of the system explained.
Thanks Nutmegger and others who suggested a health insurance broker. Please can any of you advise how to find a good one and avoid the sharks?
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Old Jul 26th 2020, 9:10 pm
  #24  
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Default Re: Health insurance confusion

Going by your name 'Expat2000' have you only just arrived in the US?
Does your wife not work and have health insurance through her job?
Just trying to figure out your situation, as you say that YOU will be covered in a couple of months through a new job......
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Old Jul 26th 2020, 10:01 pm
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Default Re: Health insurance confusion

Originally Posted by SanDiegogirl View Post
Going by your name 'Expat2000' have you only just arrived in the US?
Does your wife not work and have health insurance through her job?
Just trying to figure out your situation, as you say that YOU will be covered in a couple of months through a new job......
I don't think you can be covered by Medicaid if you are a new immigrant. Part of the immigration rules are who ever sponsors you is responsible for you . At least that is how it used to work.
Maybe the OP has been here awhile?
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Old Jul 26th 2020, 10:24 pm
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Default Re: Health insurance confusion

Originally Posted by Sugarmooma View Post
I don't think you can be covered by Medicaid if you are a new immigrant. Part of the immigration rules are who ever sponsors you is responsible for you . At least that is how it used to work.
Maybe the OP has been here awhile?

That's what I would like to know...... the OP does not seem to know very much as to how the US health system works; just asking....
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Old Jul 26th 2020, 10:46 pm
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Default Re: Health insurance confusion

Originally Posted by SanDiegogirl View Post
That's what I would like to know...... the OP does not seem to know very much as to how the US health system works; just asking....
Well, admittedly it is not easy for any of us to understand but if he or his wife were covered by Medicaid then it may be there were only a limited number of doctors in the area that accepted Medicaid coverage hence the long wait!
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Old Jul 26th 2020, 10:54 pm
  #28  
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Default Re: Health insurance confusion

Originally Posted by expat2000 View Post
Thanks Nutmegger and others who suggested a health insurance broker. Please can any of you advise how to find a good one and avoid the sharks?

You could ask for recommendations from people you know in the community. Google for comments/reviews online. But I'm not sure why you are worried about "sharks." You tell the agent what you are looking for and what your budget is; they give you recommendations, explain the options to you, and you choose. They will receive a commission from any of the companies, so aren't going to try to steer you for personal gain. They wouldn't stay in business very long that way. And that business is matching client to provider -- that is the whole object of using an agent, they aren't beholden to any one company..
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Old Jul 26th 2020, 11:05 pm
  #29  
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Default Re: Health insurance confusion

Originally Posted by Pulaski View Post
In my experience, the mistake that a lot of people arriving from the UK make, is to try to replicate the "all you can eat buffet" model of health care that the NHS provides. This is expensive, and for most people, wholly unnecessary. I compare "traditional" US health insurance to being like paying for car insurance that covered new wipers, oil changes, tyres, etc. .... it would be hellishly expensive!
Thanks, Pulaski, for all the suggestions. I suppose it goes to show how effective the NHS is, compared to a system designed for profit over healthcare. The alternative to the "all you can eat buffet" approach seems to be a "menu", with each option leading to another "menu"...all of which is written in another language, and referring to our hunger way into the future. Seems to be asking the customer to rely on a crystal ball. We don't know which disease is going to come after us. We don't know what's going to happen. It's like buying a lottery ticket. What good is an insurance policy, such as one I just looked at, that covers a whole range of things but which doesn't pay for an ambulance or "facility fee" (hospital room)?

The whole health insurance system in the US just seems sick to me.

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Old Jul 26th 2020, 11:12 pm
  #30  
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Default Re: Health insurance confusion

Originally Posted by Nutmegger View Post
You could ask for recommendations from people you know in the community. Google for comments/reviews online. But I'm not sure why you are worried about "sharks." You tell the agent what you are looking for and what your budget is; they give you recommendations, explain the options to you, and you choose. They will receive a commission from any of the companies, so aren't going to try to steer you for personal gain. They wouldn't stay in business very long that way. And that business is matching client to provider -- that is the whole object of using an agent, they aren't beholden to any one company..
Thanks Nutmegger. The whole system is a business. "Customers" are promoted particular drugs on TV (not legal in the UK) and then request those drugs from their PCP and specialists. The customer's "knowledge" based on a TV ad carries more weight than the PCP's knowledge and experience. And there have been cases in the US of drug companies "buying" doctors to get them to prescribe their drugs. Seems like we need to be careful of sharks. And who is to say that one insurance company doesn't pay a higher commission than another? Who is regulating that? Of course it's possible for a broker to steer you for their own personal gain. If it's regulated and the fees were the same, regardless of the company, then they are still steering you for personal gain – that's their job. But considering it's all a business based on competition, of course brokers stand to gain more from one insurance company than another?? To know that the broker is making the right suggestions and that they weren't benefitting more form one insurance company over another would surely take a lot of research – which we don't have time and patience to do, which is why we're going to a broker. And as long as we don't have time and we're too stressed to do that, they can stay in business...
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