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Old 05-31-2018, 10:10 PM
 
14 posts, read 17,565 times
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My husband is starting a new job at a practice in a different state and we are moving there in June. The practice will contribute 100% for my husband's (employee only) cost for the Anthem HMO plan. These are the monthly premium rates if our entire family elects to get health insurance: Anthem HMO Plan ($1,071.74), Anthem PPO Plan ($1,994.89), Dental Plan ($187.29).

When I was looking at what the cost would be for myself and 2 kids to get a gold HMO plan through Kaiser, the rates were similar but a bit lower (especially if you are looking at the silver deductible plans).

I believe my husband will be making too much $ (over 400k) for us to qualify for subsidies in the marketplace so I think we are stuck shopping directly with insurance companies. But I could be mistaken.

Does anyone know how to compare the two HMOs? Any other insurance plans (I do like the HMO or EPO structure) we should consider (We will be in the San Diego area)?

Also if we enroll with Kaiser, is there a waiting period for when your insurance kicks in? I am assuming our move into a new state will allow us to enroll even though it is not open enrollment? Or am I missing something?
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Old 05-31-2018, 11:56 PM
 
Location: TOVCCA
8,452 posts, read 14,957,050 times
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Quote:
Originally Posted by BBooger View Post
I believe my husband will be making too much $ (over 400k) for us to qualify for subsidies in the marketplace
Ya think?
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Old 06-01-2018, 12:53 AM
 
14 posts, read 17,565 times
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Thanks for the confirmation. Currently we have an income that falls in the range for tax credit and he won't be starting his work right away so we are looking at several months of no coverage and honestly we have no idea how it all works since we've always had great and affordable healthcare provided by employers in the past. We feel very fortunate we will be able to afford to buy most insurance plans. Just trying to figure out how our best options and that includes asking stupid questions to get us on a path to figuring it out. Thanks!
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Old 06-01-2018, 07:08 AM
 
Location: Texas
5,840 posts, read 6,114,265 times
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From the way you describe your circumstances, I am going to assume that your husband is a physician and he is currently in training, but about to complete that and join a practice, which of course, describes the overnight income bump. Correct me if I'm wrong. I can't really advise on how to choose between Kaiser and Anthem, but you might want to post this in the San Diego forum where there are many people covered by both these insurers. In regards to the time lag when you won't be covered, you'll probably need to get COBRA, though you can stretch that timeline out to about 2-3 months by dragging your feet with both signing up and paying the first premium.

Having gone through this same thing myself, I would advise you to consider talking to an independent insurance agent that has a lot of experience with health plans. The ultimate answer may be some hybrid of splitting the family where he is covered by the group plan and you and the children are covered by a private plan (at least, that's what we did). The days of you having your hands held for expenses such as these are over and depending on the size of his practice and their staff, they may or may not have much expertise in these things at all. It's an entirely different kettle of fish when you are in practice and become self employed, but you'll figure it out. Good luck.

Last edited by Texas Ag 93; 06-01-2018 at 08:12 AM..
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Old 06-01-2018, 09:29 AM
 
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Thank you so much. Yes that is our situation exactly and after I posted here I realized that I should also post in a San Diego specific forum to get recommendations. But your idea of getting an independent insurance agent that has experience with health plans in the area sounds like an excellent idea. How did you go about finding that type of agent? Are they through insurance companies or just completely independent?
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Old 06-01-2018, 09:36 AM
 
Location: Texas
5,840 posts, read 6,114,265 times
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Quote:
Originally Posted by BBooger View Post
Thank you so much. Yes that is our situation exactly and after I posted here I realized that I should also post in a San Diego specific forum to get recommendations. But your idea of getting an independent insurance agent that has experience with health plans in the area sounds like an excellent idea. How did you go about finding that type of agent? Are they through insurance companies or just completely independent?


They were an independent agent that worked through a small, private firm. Our practice gave us her name. My husband was one of 3 partners and everyone there just did their own thing. They also gave us a few names for disability agents, and the local IPA helped us with malpractice. Even so, at the end of the day, we were on our own and had to figure it out for ourselves. It worked out fine.

Last edited by Texas Ag 93; 06-01-2018 at 10:50 AM..
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Old 06-01-2018, 11:34 AM
 
14 posts, read 17,565 times
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Thanks so much! I will start looking and asking for names and I'm usually pretty good a figuring all of this out but with planning the cross country move its hard to wrap my brain around some of these things that, as you said, our hands were held before (more than we ever realized!).
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Old 06-01-2018, 12:23 PM
 
Location: Texas
5,840 posts, read 6,114,265 times
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Talk to the Office Manager for the practice or have him ask some of his new partners. That's the best place to start.
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Old 06-02-2018, 01:47 AM
 
Location: Wisconsin
25,593 posts, read 56,262,852 times
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Since money isn't an issue, don't confine yourself to an HMO and its limited network of providers. A PPO will allow for out-of-network coverage and far more provider flexibility should that become necessary. Of course, there is more cost-sharing when one uses out-of-network providers but, in your case, it would appear you can handle it.

If your circumstances were different, Kaiser in CA is a decent HMO choice in many areas of that state.
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Old 06-03-2018, 12:33 PM
 
3,886 posts, read 3,463,364 times
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Quote:
Originally Posted by Ariadne22 View Post
Since money isn't an issue, don't confine yourself to an HMO and its limited network of providers. A PPO will allow for out-of-network coverage and far more provider flexibility should that become necessary. Of course, there is more cost-sharing when one uses out-of-network providers but, in your case, it would appear you can handle it.
Be aware of the true nature of out of network coverage, which is prohibitively expensive in most cases. Let me explain. A non-network provider does not have an insurance contract with the insurer. Therefore, the provider can charge anything they want. The insurance will pay a fraction, often 60%, of "reasonable and customary" which is the negotiated charge of the insurer. The patient can be (and will be...) balanced billed for any remaining unpaid charges. Example: $10,000 billed. R&C 3000. 60% of 3000= 1800, paid by the insurer. The patient is then responsible for the remaining $8200, or 82% of the total cost. Some choice, eh?
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