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From what I can tell, the main difference between the two is that the Molina plan requires 20 percent copay on several things, while the Community Health Plan has a set rate.
I have a chronic stomach condition that I'll need to see a specialist several times during the year for. I'll also need to probably have multiple tests done (an example of one such test I know I'll need is a pulmonary functions test).
Which of these plans would be best for something who will require multiple specialists tests, have a recurring monthly prescription, and probably require multiple tests throughout the year?
Due to my household income, I don't qualify for any relief on the marketplace and I declined my wife's workplace insurance because it was more expensive and treatment was more expensive than what these plans offer.
And if any further information is needed to help: This is in Houston, TX (77072), 28 year old male, non smoker.
Thank you if anyone is able to provide any assistance!
Also, if there's anything else I should be looking at - please advise. I am from Canada, and this is my first year that I'll be dealing with the US health insurance system.
Look at the networks and providers to be sure that the required specialists are in network in your area. Also compare the out-of-network coverage to know what will happen if some highly-recommended specialist is NOT in your plan but you decide to see him/her anyway and compare the out-of-network max with the in-network max.
Before choosing any carrier (company) AND plan, be sure that the doctors and hospitals that you want are in network. You get the best rates in network. Out of network can create coverage issues or be more expensive. When checking, talk to the insurance agency and talk to the doctors’ offices for back-up. Sometimes, provider lists on the carrier websites are not always up to date or have to be searched under specific plans.
I would also suggest checking to see if leaving the state totally puts you out of network. There are some carriers and plans that have you as out of network should you have something happen out of state. Some don’t. You may want to be aware of this as you choose a carrier. (Should you end up with a carrier that handles out of state as out of network, you can look into travel insurance like TravelEx that has a health coverage component to it. I don’t know how well it pays, but it is there for travelers. This isn’t for treatment and visits for your routine treatment for known illnesses, but for things like an accident or a heart attack on a vacation.)
When choosing a plan, you have to weigh what is important to you and how you think you are best handling your money for the best bang for your buck. Is it easier for you to pay a larger monthly premium than be saddled with a large deductible, should you have to meet part of it/whole thing from illness or an emergency?) The typical scenario is the more your monthly premium, the lower your deductible. The lower your premium, the higher your deductible. You have to weigh what fits your needs and what you can live with, financially.
If you can afford it, without hardship, I suggest investigating a plan that offers, at least, co-pays for primary care physicians and specialists. If you are anticipating a lot of doctor visits in 2018, this would be good to have. I also suggest taking a good look at silver plans. In many cases, they will fit your needs, if paying out a gold plan premium affects your financial lifestyle. Gold plans have bells and whistles, but silver is often workable for a lot of people.
In the end, what someone needs can only be weighed by the person shopping for themselves. There is no cookbook recipe for choosing plans.
In saying all this, I did not look at your plan links. Good luck!
When unsubsidized and not self employed, believe it or not, bronze usually does best. Really all you are insuring for is max OOP + premiums: that will be your total possible cost.
No matter what tier, it all adds up to be almost the same. With bronze you have cheaper monthly premiums (which you can not deduct) and higher out of pocket costs which depending on your income, you may be able to deduct on Schedule A.
I've never dealt with a doctor here in the US, so I don't currently have a preference for any specific doctor. I don't plan to use out of network or out of state coverage.
And in regards to handling the money - that's the hard part I've been trying to tackle.
I've been looking at the silver plans and comparing them to the gold plans. For the silver plans, I see things such as "Outpatient facility" and "Outpatient professional services" costing 300 on the silver vs 150 on the gold for the plans with a set rate or 20 percent on the gold vs 40 percent on the silver for plans with percentage rates.
This is the spot that I get hung up on as I'm not sure where the tests that I'll need fall under and how to determine their costs. I'll be talking with a broker tomorrow, but I'm not sure how familiar brokers are here with the actual medical testing side of things and their costs and where they fall under.
I'm still in the diagnostic stage of a chronic stomach condition that I was undergoing testing for in Canada before moving here to the US with my wife. The 0 deductible gold plans are more expensive monthly, but I was approaching this upcoming here as realizing that I may have to pay more for medical treatment to get everything figured out and then hopefully go with a lower plan the following year when not as much medical treatment will be needed (hopefully).
But, I am still heavily conflicted on how to approach it from determining the best cost scenario with knowing that I'll need multiple tests and doctor visits throughout the year. When I see a fix cost of 150 for something like "outpatient facility" vs a 20 percent fee with another plan, I'm not sure how to approach this to determine which one is more cost effective because I don't know how much that 20 percent would ultimately be and I also don't know what categories my tests fall under.
It gets very overwhelming deciding what to do, but honestly as my link shows it all winds up costing the same. It is which road you want to take: more money paid out up front or pay less and pay as you go. All the plans have the same maximum out of pocket spending.
As Classic gal said, the most important thing is to make sure the doctors and hospitals you use are in network with your plan. That way you will have to only pay the negotiated rate per visit/procedure no matter how much the doctor wants to bill.
I have purchased my own insurance for 20 years. I prefer to pay the smaller premium, bank the difference and save it to pay the deductible. So far, with 2 kids and ER visits, lab work etc I still came no where near the deductible even when I went to the lower deductible silver plan for one year.
This year I went back to a Bronze plan because it was almost $300 a month cheaper so I will bank that money. If you get an HSA compatible plan, the money you place in it to pay the deductible can be deducted from your income when doing your taxes (page 1 of 1040 Form). Even if you don't have extra money to build up your HSA, open one anyway. Say you owe a doctor $100, deposit $100 into your HSA and write a check from the HSA to the doctor, and you have a $100 HSA contribution to put on your 1040 Form when doing your taxes.
Note if you were getting a subsidy, the advice given might be different depending upon your income.
Last edited by NSHL10; 12-14-2017 at 06:38 PM..
Reason: Added
Your comment about the HSA had me thinking. I'm going to see what I can find out about this tomorrow, but thought I'd get your take on it as well, if you don't mind.
I declined general health insurance through my wife's workplace insurance to opt to buy my own. However, I have dental and eye insurance on her plan.
Her plan offers a HSA. If we contribute money to it, am I able to use that toward my plan that is outside of her plan? I'm not entirely sure how that works.
Think many times before choosing Molina. I had no problems with them because they were my secondary insurance when I had Medi-Cal, but I definitely wouldn't have them as my primary. They have major problems.
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