I'm getting different insurance starting early January so I don't need my marketplace insurance plan to reenroll in a new plan. How do I keep it from reenrolling and have my insurance end on, say December 31?

Question- I am losing coverage at the end of the year due to returning to school full time for the entirety of 2025 and take an antidepressant. Although my coverage isn’t great now (high deductible, copays up the wazoo etc) I still get my script for 3 months at a time. I plan on seeing my PCP next week to sort out my health and ensure I get my appointments needed done but since I won’t have coverage is it possible to get an antidepressant filled for a year in advance? Im a little stressed tbh.

PS working in healthcare is a sham. I have terrible coverage for taking care of others. Sad America and only to get worse I fear.

I was laid off from work roughly a month ago. I was told I only have the option to take cobra insurance.

But I am 28, single, and NYC resident. My mother has healthfirst, and my sister (21) is in healthfirst with my mother. My father has employer insurance.

Any chance I can join my mom under healthfirst?

I am also happy to pay around $200/month, just not the crazy $500-$700 for cobra.

What options do I have? Thanks

If a insurance plan provides 70% coverage if you go out of network, does the insurance negotiated price still apply like when you stay in the network?

In another word, let's say the out of network doctor charges $1000, and insurance negotiated price is $300. Is it 70% of negotiated $300 the insurance should cover? Or it it 70% of $1000?

I have family health insurance through my employer with an FSA. My wife and I are considering having her take out an individual health insurance on top through her employer.

Is this worth it? It would be about $50 per pay period for her, but I’m not sure how double coverage works. Also, she can open an HSA that would roll over year to year, and her employer will match her $800 a year (on single).

However, to further confuse me, her paperwork says that if you have an FSA, you can’t have an HSA as well, unless it’s the limited one. Does this apply when I’m the one who has the FSA and she would be the one with the HSA? Me file taxes jointly for the record.

This shit is so confusing. It would be awesome to get some real, knowledgeable advice without having to read and read and read endless stuff on the internet.

My parents currently have Aetna through the marketplace with no complaints, but see that the premiums for Molina and Baylor Scott & White are lower and want to switch. I’ve never used either Molina or BSW and was wondering if anyone here had experience with either of these companies? The reviews I’ve seen for Molina have all been pretty negative while BSW has been a mixed bag similar to Aetna. All of these are HMO plans and based in Texas. My parents are in their low 60s (not old enough for Medicare yet) and I’m not sure about income (to answer the mod). Would appreciate any advice!

Hello!

I don't have any family that I can ask regarding insurance as none of them have insurance, so I am hoping someone here can help me. I don't understand at all which amount per month I will have to pay when getting my own insurance. I have been on state insurance my entire life, but recently got denied it because I make literally $100 too much to qualify for it now and enrollment for my works health insurance closed so now I am trying to figure this out haha. below are the amounts and I just don't understand which premium per month I'd actually end up paying.

https://i.imgur.com/tGpM4cu.png

https://i.imgur.com/YZeeVGE.png

If it's anything but the green one, I think I'll just go to the free clinic if I'm feeling sick haha.

Thank you!

My husband works part time employment but isn’t offered health insurance through his job. He and I both also work part time self-employed. So we both qualify for health insurance through the Washington State Marketplace.

Is it possible to have 2 different health plans through the Marketplace? I would like to change my plan to one that includes a certain clinic in-network, but want to keep my husband with the lower-premium plan we have now.

Is there a way to do this on the application during open enrollment? I can’t see a way to do this.

ETA: we’re 35/36 years old in WA State and make ~$46k gross per year.

I had a very serious chronic medical condition 5 years ago but have completely healed, is there a way to get a doctors official clear status as to not have it on my medical record as an existing condition?

I currently pay for an individual plan on medical and dental. I work freelance and have an LLC, if by any chance Republicans do away with the ACA what does this mean for me?

Are individual plans automatically apart of the ACA? I do not recall reading anything about that care act when I signed up for insurance. I know my medical is from of my state's health exchange (marketplace) but my dental is just general (dentist office is technically out of state).

I am GenZ and only have pre-existing condition for dental, as I have periodontal disease. So I go to the dentist every 3-6 for routine maintenance.

NC
27 old
Working class

I underwent a small skin surgery a few months ago that thankfully found that the problem was benign (woohoo!). In the months since, a number of different bills have trickled in from that procedure, but each bill amount matched with a corresponding document I received from my insurer, until now...

I received a bill from the surgery center listing the following charges

• Surgery: $387.00
• New Patient OV: $324.00
• Anthem Payment: $0.00
• Anthem Adjustment: -$51.52
• Anthem Payment: $0.00
• Anthem Adjustment: -$71.94

...yielding a total balance due of $587.54

And a document from Anthem listing the following

• Surgery: $387.00 (Doctor charges), $51.52 (your discounts), $335.48 (due to your doctor (max allowed)), $0.00 (Anthem paid)
• Office Visit: $324.00 (Doctor charges), $324.00 (your discounts), $0.00 (due to your doctor (max allowed)), $0.00 (Anthem paid)

...yielding a total balance due of $335.48

Furthermore, the document from Anthem lists a code next to the office visit saying "164: we denied this care Office Visit because we covered it as part of other care you received Surgery. You are not responsible for this amount unless you chose to receive care from a doctor or facility not in your plan's network".

My question: Needing to pay the $335.48 for the surgery line item makes sense to me because my insurance only picked up $51.52 of the original $387 – that also seems to be reflected on the bill from the surgery center. However I am confused by the discrepancy on the office visit line item – the surgery center seems to think that insurance only picked up $71.94 of the $324 but the doc from Anthem seems to imply that they picked up the entirety of the $324 and that I owe nothing for that portion of the bill, if I am interpreting it correctly? Am I correct in interpreting that I don't owe anything for the office visit or does the "164" code change that?

Hey yall. For a bit of context, im a 20 year old university student who was raised by dirt poor parents. I was never taught anything about insurance or even taxes. When i comes to finance i simply save every penny i make and thanks to my frugality, i am doing slightly better than my peers financially speaking…. However i currently have medicaid. My plan is no longer accepted by most pharmacies and doctors and i pay for most of my medical expenses out of pocket because of this… naturally this wouldnt be much of a problem because i am typically in outstanding physical health. However i happen to be transgender, i have been paying for my hrt(hormone replacement therapy) out of pocket for 6 years, and recently paid for my top surgery entirely out of pocket, which cost me $11k. Seeing as how my current medicaid plan doesnt cover any of my medical expenses, i am eager to switch to a private insurance provider like Blue Cross Blue Shield or Aetna, both companies that provide coverage for most expenses even gender transition related expenses…. However google says that these will charge $400+ per month, which i simply cannot afford. Do you know of any way i can get a better price? Or what kind of employer might provide a better coverage? I also keep hearing about a “marketplace” and im not sure what that is referring to. 🤷🏼‍♂️

I’m trying to apply for insurance starting in January for my husband and I. On the application I put him as the head of household because he is, as well as the only one with an income since we had our first child in October. When it comes to selecting insurance it’s showing at the top plans to choose from for only his name, but it never gives an option to choose a plan for my name. If we enroll in a policy under his name, will I be an additional insured for this policy? It’s only important because we don’t want to pay the first premium and enroll starting 1/1/2025 if it’s a policy that won’t cover my specific doctor needs for OB care in case we decide to have another child as well as for basic OBGYN care. Any help would be appreciated!

When the EOB from BCBS says the provider has billed in excess of what is allowed and should not bill the patient for any amount over that, is that enforceable? I got a bill for what the EOB says is in excess, and that the provider should not bill the patient. The outfit that sent the bill has no phone number to call, just a payment website. I can't find the website for the actual entity sending the bill. What should I do?

This is in New Mexico.

I’m looking for a health insurance plan for my daughter because it’s too much through my job. The primary care visit copay states “$40/ visit for the first 3 visits; deductible does not apply, the 0% coinsurance”.

So are the first 3 under a specific copay and then I pay the full amount towards my deductible? Or is it no cost after the first 3? I’m assuming it’s the first but I’d like to understand better.

So, as the title says, I don't think I qualify anymore for my insurance plan. I went through the application thing, and I don't really know why I don't qualify anymore, because I qualified last year, and nothing has really changed. The enrollment period for my work's insurance isn't until about April of next year? And I can't go that long without insurance, I have mental health conditions that require regular access to my therapist and psychiatrist. I'm going to call a rep on Monday, but I don't have a good feeling about it, so I'm trying to prepare alternatives. I've also volunteered to get a few more extra hours at work to show proof that hopefully my income will be increasing in the coming months, if that's anything. But what are some next steps? Is there somewhere else I can get healthcare? Is there something else I can do?

EDIT: My age is 30, my income is roughly $15,000, and I live in SC

Hoping you guys can help me. I have a job offer at a small company that doesn’t offer health insurance, but offers a reasonable stipend.

I’m 36 years old and have always either been on my parents’ insurance or been insured through my employer and I’m a bit lost. Where do I even start? Are there sites where I can compare a few plans against each other?

Thanks in advance for any insight!

Hi all, I couldn’t find many posts about this so if you have any insight, please let me know. Back in February, I went to the hospital for troubled breathing. All is well and my insurance footed the entire $5,144.60 bill. Fast forward to now, I get a letter in the mail stating that the hospital is trying to gain my authorization for something (doesn’t specify) and wants me to sign this Designation of Authorized Representative form. Any ideas why I’d get this in the mail? And what it could be for? The claim was paid less than a month after the services. I am going to call the claim & member services on Monday but figured I’d ask here anyways. Thanks in advance :)

I’m fortunate to have great PPO Health Insurance through my employer, and have a child with a chronic health condition. I’m trying to understand how a potential repeal of ACA and/or insurance companies being able to deny coverage for pre-existing conditions may apply in the instance of employer sponsored health insurance plans.

Should I plan to stay at my current job where we are already covered by insurance? If I switch jobs (I am actively being recruited all the time), is there a risk that another employer sponsored program could refuse to cover my child’s medication?

Just trying to get an understanding about what possible issues are in the horizon.

I'm going through IVF treatments. I was recently laid off and therefore offered COBRA. My former employer's policy has great fertility coverage and has covered pretty much everything IVF-wise (amazing, I know).

I got a new job (yay!) but the new company's policy does not cover fertility treatments at all. However, their plan is amazing for people in more typical situations, aka successfully pregnant or already have kids.

My question is: If I pay for COBRA in order to retain my IVF coverage, at what point could I opt in to my new employers plan?

1. Whenever I drop COBRA: If I successfully become pregnant in say, June, could I decide to leave COBRA and join my new employer's plan then?
2. After I give birth: If the IVF works, and I have a baby this year, does the birth count as a qualifying event for me to drop COBRA and switch to the new employer's plan?
3. Only during my employer's open enrollment period: Meaning if I choose COBRA now, I'm stuck with it all the way until my employer's open enrollment period for 2026?

Hello all,

Me and wife are based in MA and are family planning next year. If I choose Anthem BCBS PPO 250 for both of us, it’s 370$ per paycheck whereas if my spouse goes for individual she has to pay $49 for CIGNA 500 and I can choose a lower cost PPO as well. While we save ~150$ per paycheck, I’m also worried about CIGNA’s reputation of rejecting claims. Can anyone share their experiences with Cigna or suggest which one would be the better option in this situation.

Thanks!

Hi everyone.

I have a question about Medicare coverage for my mother. Currently, my parents are covered by Ambetter with a $0 monthly premium based on their estimated income. Since my mother just turned 65, Ambetter recently sent a letter titled "Ambetter and Medicare Dual Coverage," indicating that she may not qualify for an Ambetter plan with a tax credit now that he's Medicare-eligible.

I don't think she is enrolled in Medicare—she confirmed this with Medicare, and they didn’t find any enrollment records, directing us to the Social Security Office more verification. If, since she’s eligible starting this February (2024), I’m concerned that sticking with the Marketplace could lead to significant tax credit repayments. My main question is: Can we continue with the Marketplace plan, or must she enroll in Medicare due to her eligibility?

According to https://www.healthcare.gov/medicare/medicare-and-the-marketplace/, generally, people eligible for Medicare cannot keep a Marketplace plan, but there are exceptions. These include cases like paying a premium for Part A, having End-Stage Renal Disease, or not yet collecting Social Security benefits. Based on my understanding from https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicare/index.html, my father likely wouldn’t qualify for Part A without a premium.

Thank you for any guidance you folks can offer on this situation.

I was denied my first level appeal for an FDA approved device for degenerative facet disease in my lumbar spine. I provided pages and pages of peer reviewed documentation on its efficacy. They are claiming that I didn’t provide enough evidence. The ‘committee’ that determined this decision is an internal medicine DO. Any advice on recourse that would help me in this next level of review?

Hi All - we have met our OOP max for the year but the EOB's still show co-insurance due. Why is that?

hi so I went to the ER for the first time the other night, for what ended up being "supraventricular tachycardia." they basically had to reset my heart rate, then they did multiple examinations (I think ekg, x-ray, and cat scan) along with blood tests to make sure I didn't have a blood clot. (thankfully did not!) I also had to stay in a hospital room for a few hours on a saline IV.

I got a $500 co-pay after meeting my deductible already. they said they'd send the bill later, but I'm confused since my insurance benefits say I only have to pay a co-pay. it seems like all these tests were necessary so would it be included? or would coinsurance be applied to the extra tests/treatment? what does ER coverage generally apply to when it comes to insurance?

just want to make sure I'm mentally prepared for the bill to potentially be much larger.

As title suggests,

I lost my job for an extended period of time this year, and I'm only just now getting back having an income within this last month. I forgot to report this to healthcare-gov, and now I'm curious how this will affect my premium, if at all, come tax season here in a few months and if I will owe money. The job I work now, is more or less the same amount of hours and pay as I was getting before. So nothing has changed much in that sense. Hopefully someone has a little insight on this.

For ACA, would I count the total income from an SCorp, or the amount I pay myself?

I (28F) in CA, recently got a test for Lyme disease done and the results came back unequivocal (meaning antibodies were detected but not enough to diagnose). I want to get a Western Blot Test ordered but my dr is hesitant because "insurance probably won't cover it". Is this true? If others have had Medi-Cal cover this test, I will push for her to order it, but if it's a lost cause, then my question is, what now?

Last year at this time, we changed our insurance during open enrollment to Aetna because I have systemic Sarcoidosis, ( in my Cardiac Sarcoid , pulmonary, cutaneous & presumptive Neurosarcoidosis. ) & the plan we had, BCBS of Illinois who would NOT cover the treatment. I went through all the other treatments, (prednisone, mycophenolate mofetil, methotrexate, hydroxychloroquine, ad nauseum), which gave me POOR control. I began infusion , (Remicade), in January and though it's cumulative, I am seeing a wonderful change. However, this enrollment period Aetna is no longer available. We could only choose from BCBS of Illnois OR Kaiser, (HELL NO!). I am SO afraid that BCBS Illinois will play the same game...Does anyone have a solution to this issue?

I just finished cisplatin/cyclophaosphamide/vinchristine chemotherapy and proton beam radiation and I really need some rest. I was thinking I about quitting instead of going back to work. My body and brain just cant tolerate the stress. However now that trump won I suspect I wont be able to get an ACA plan if I quit and he repeals the ACA like he tried to do last time he was in office.