2019 ACA - Ambetter ? (Washington, Rex: health insurance, deductible, cost)

[don6170]

In addition to BSBCNC and Cigna, Ambetter is shown as a choice for 2019 ObamaCare policies. I have never heard of them - has anyone used them before? With BCBSNC dropping Duke, they may need to be a consideration.

[E. Milton]

Originally Posted by don6170

With BCBSNC dropping Duke, they may need to be a consideration.

To be clear, it's only BCBSNC Local patients who will no longer be in-network with Duke Health (and WakeMed). Ambetter is the only option for patients who were covered by the Local plan who want to maintain care within the Duke Health system. Ambetter is owned by Centene, which has a long track record of managing BCBS products across the country. Centene has negotiated to offer both commercial products, and Medicaid plans (under the new waiver proposal), in North Carolina.

[Jkgourmet]

I had never heard of Ambetter either, until I saw them on this year's ACA plan choices. While I'm going to stick with my grandfathered BCBS plan, I did do a little research.

I pay very little attention to online reviews for this kind of thing. After all, one of the major sites is called Pissed Off Consumer. That tells us something, right? But this site did have some factual info about them and an interesting write-up https://bestcompany.com/health-insur...mpany/ambetter

Ambetter is new to the NC market. They are offered in only 15 other states, all listed in the above linked site. You would have more replies to your OP by posting on the boards for those states.

BTW, BCBS did not "drop" Duke. They changed many of their plans to UNC as the preferred provider (which, interestingly, significantly reduced the premiums on lower tier plans). Duke is still available as an out of network provider, albeit with higher out of pockets/deductibles. And IIRC there are still plans that include Duke in network with higher premiums.

This is the very first year that the premiums on my grandfathered plan are MORE expensive than the similar offerings on the ACA. My 2019 premium of nearly $1,000 per month would have dropped about $200 a month with that UNC bronze plan. However, the $5k deductible would have increased to $7k (higher for out of network). As a healthy person with minimal health care needs, I probably would have switched. BUT there's a high likelihood that I'm getting cataract surgery in 2019, so any premium savings are going to be eliminated by the higher deductible. While I have ZERO problems with UNC and would have had no problem changing my doctors, I do prefer to use Duke for that specific procedure (special circumstances).

Plus once I give up that grandfathered policy, I can't get it back. With 3 years to go until Medicare and the question of what Washington will do with health insurance, I'm extremely hesitant to give up my current plan.

[rabbitsong]

I haven't heard of it either, but since my husband and I both have our specialists at Duke, this appears to be our only option. We'll have to pay out-of-network for our PCP. He's been our doc for almost 20 years, plus I have to go every 3 months for a med check/prescription refill. The Marketplace literally saved Mr. Rabbitsong's life this past year, and to think we got it because of all of MY issues!

[scubadvr]

Some July news about Ambetter
https://www.newsobserver.com/news/bu...215665910.html

For someone that has no ties to Duke and WakeMed Doctors/Hospitals and can find what they need in the UNC/Rex system, why would they choose Ambetter? BCBSNC seems to be much more cost friendly in this case.

[hackwriter]

Originally Posted by Jkgourmet

I had never heard of Ambetter either, until I saw them on this year's ACA plan choices. While I'm going to stick with my grandfathered BCBS plan, I did do a little research.

I pay very little attention to online reviews for this kind of thing. After all, one of the major sites is called Pissed Off Consumer. That tells us something, right? But this site did have some factual info about them and an interesting write-up https://bestcompany.com/health-insur...mpany/ambetter

Ambetter is new to the NC market. They are offered in only 15 other states, all listed in the above linked site. You would have more replies to your OP by posting on the boards for those states.

BTW, BCBS did not "drop" Duke. They changed many of their plans to UNC as the preferred provider (which, interestingly, significantly reduced the premiums on lower tier plans). Duke is still available as an out of network provider, albeit with higher out of pockets/deductibles. And IIRC there are still plans that include Duke in network with higher premiums.

This is the very first year that the premiums on my grandfathered plan are MORE expensive than the similar offerings on the ACA. My 2019 premium of nearly $1,000 per month would have dropped about $200 a month with that UNC bronze plan. However, the $5k deductible would have increased to $7k (higher for out of network). As a healthy person with minimal health care needs, I probably would have switched. BUT there's a high likelihood that I'm getting cataract surgery in 2019, so any premium savings are going to be eliminated by the higher deductible. While I have ZERO problems with UNC and would have had no problem changing my doctors, I do prefer to use Duke for that specific procedure (special circumstances).

Plus once I give up that grandfathered policy, I can't get it back. With 3 years to go until Medicare and the question of what Washington will do with health insurance, I'm extremely hesitant to give up my current plan.

Those of us who are new to ACA (or in my case, will be new after July 2019 when COBRA runs out), and who are over 60, only have access to BC/BS plans with UNC, or Ambetter with Duke -- and the Ambetter plans are HMOs. And as for Duke still being covered but "out of network", be aware that there is NO out-of-pocket maximum for out-of-network. So if you go to Duke, you could be in for serious sticker shock. I have only one doctor with Duke and I may have to drop her until I am Medicare-eligible in 2020.