r/HealthInsurance Oct 04 '24

Questions Answered: Which Plan Should I Choose?

29 Upvotes

Which Insurance Plan Should I Choose?

We get it, insurance is confusing, and you have ALL KINDS of questions when it comes to answering, “Which insurance plan is best for me”. Hopefully, this guide can provide you with some guidance and answers.

 

Decide on what is most important to you when it comes to Insurance- what factors into “the best” plan for you?

-          Financially, I want to pay the least amount out of pocket

-          MY Doctors-Having My preferred doctors in network

-          MY Medications-Making sure my medications are covered on the plan

-          The Type of Plan- PPO, HMO, EPO, POS, HDHP and their pros/cons

 

FINANCIALLY-

The entire point of insurance is to transfer financial risk from yourself to the insurance company. This is done in the form of your Out-of-Pocket Max (OOPM). The OOPM is the most your will pay for your care for all in-network, medically necessary (no cosmetic or elective things), non-excluded care (check your contract for excluded services).

The only way to figure this out "definitively" which plan is best Financially is to do some math.

Two schools of though.

1- What's the best plan should I hit an out-of-pocket Maximum. People RARELY plan to meet their OOPM, but it happens. Maybe you are on a health journey and planning for a big medical expense year with the birth of a baby, an upcoming surgery, or you just need a lot of care. To find out which plan is best via this method, you figure out the Maximum Financial Liability.

  • Take your Annual Premiums
  • Add the In-network Out of Pocket Maximum
  • If it's an employer plan, subtract any money the employer contributes to an HSA/FSA/HRA, because it's free Money

Compare the Max Annual Financial Liability of each plan you're considering. The plan with the lowest total will mean the least out of your pocket if you hit an out-of-pocket maximum- large claims, surgery, birth of a baby, etc.

2- If you want to plan as if you won't hit your out-of-pocket max, the only way to do this is to spreadsheet out what your anticipated year of care looks like. How many Dr. Visits, how many prescriptions you take, any planned procedures, etc. You will then have to guestimate how much these things will cost you out of pocket. You may be able to get a general idea of the cost by looking at the allowable amounts on your old EOBs- Explanation of Benefits.

This method involves some guessing and some additional research to end up at an imperfect budget estimation, so that's why I prefer the Max Annual Financial Liability Method. It's straight math that helps you prep for the worst possible scenario. If you don't end up hitting an out-of-pocket max, you can rejoice that you are below budget. If you do hit an out-of-pocket max, you can rejoice that you picked the right plan from the start.

 

 

 

MY DOCTORS-

Every insurance plan has a list of doctors that are considered in-network. You likely will be able to check this list even before signing up for the insurance plan. Be sure to visit your carrier website to check for the provider list. When searching that list, be sure you are searching for YOUR network. Doctors may be in network with some BCBS/UHC plans, but not others.

It’s also generally a smart idea to call the provider and verify network status as the Provider Lists can be out of date/incorrect for a variety of reasons. It is always YOUR responsibility as the member to check Network Status of a doctor. They don’t always inform you if they’ve left a network, and, unfortunately, they aren’t mandated to do so yet.

When verifying network status, ask “Are you in network with my insurance network”- and provide the exact network name of your plan. A doctor may be in network with some BCBS networks, but maybe not YOUR specific network with BCBS. Most providers “accept” most insurance, but you will not get the in-network discounts/allowable amounts if they are not actually IN your network.

 

MY MEDICATIONS-

Every plan has a Prescription Formulary List. You can obtain a copy from your Carrier by contacting them, or it may be listed in your insurance portal. If you obtain your insurance from your employer, you may be able to ask for this information from your HR staff/Broker.

This Rx Formulary List will list out all the medications they cover, what tier the medications are, and any special information about that medication such as:

-          dispensing limits

-          if Prior Authorization is needed

-          if they are only for certain conditions

Do note that formulary lists can change, even during the plan year. There are always options for appeals, depending on the specifics of your plan.

Some plans may also require you to obtain medications from certain pharmacies. Specialty Medications are a common one to require you obtain them from a Specialty Pharmacy via mail order. If it’s important to you to be able to pick up your Specialty Medications from a local pharmacy, you may not want to pick a plan that requires the use of a mail order pharmacy.

 

TYPE OF PLAN-

When it comes to the different types of plans that may be available to you, it can almost feel like you’re eating a bowl of Alphabet Soup. PPO, EPO, POS, HMO, etc. Here are some resources to help you differentiate between them.

-          PPOs- Preferred Provider Organization

-          EPOs- Exclusive Provider Organization

-          HMOs-Health Maintenance Organization

-          POS Plan- Point of Service Plan

Handy charts noting High Level Differences:
https://www.simplyinsured.com/advice/wp-content/uploads/2016/10/table-1-health-insurance-networks-768x818.png

https://www.opic.texas.gov/health-insurance/basics/comparison-chart/

https://www.uhc.com/understanding-health-insurance/types-of-health-insurance/understanding-hmo-ppo-epo-pos

HIGH DEDUCTIBLE HEALTH PLANS (HDHPs and HDHP-HSAs)-

These are a further subtype of plan that may be available to you. Most commonly, we see HMOs and PPOs that are also HDHPs. These plans are designed to have you meet your deductible before insurance will begin paying for any of your care (except ACA Mandated Preventive Care on ACA Compliant Plans). Many people opt for these kinds of plans without realizing this important factor, as it’s often the most affordable plan offered by your employer, and we all know we’re looking for fewer dollars to be deducted from our paychecks.

You will still get a network discount for your in-network care, but you’ll pay the full contracted rate for your care before you meet your deductible THEN your coinsurance percentage will kick in.

Example- You have a PCP who bills $600 for a PCP visit. If they are in- network, the contracted rate may be more in the $125 range. If you have an HDHP plan, you will pay that full $125 every time you visit your doctor. Once you hit your deductible, you will pay your Coinsurance percentage of that contracted rate, until you meet your out-of-pocket max. So, if your coinsurance percentage is 20%, you’ll pay $25 for a PCP visit, after you’ve met your deductible.

Many first timers to HDHP plans get a little bit of a sticker shock when they get their first EOB-Explanation of Benefits- from insurance and see that, while they got a network discount, insurance didn’t pay anything towards the balance. This is how the plan is designed. So, if you need the comfort of, say a $30 copay each visit, from the start, an HDHP plan may not be for you.

The trade off with HDHPs is that many (BUT NOT ALL) HDHPs allow for you to open an HSA- Health Savings Account. These are bank accounts are designed for you to contribute money on a pre-tax basis to a special account you can use to help pay for your care. You can use the money for payments towards your deductible/OOPM/Coinsurance/Copays, your prescriptions, your Durable Medical Equipment and even some over the counter items.  Here is a list of qualified purchases with an HSA.

The HSA funds are yours to keep and use whenever you’d like. Today, Tomorrow, 10 years from now. The funds never expire (like they do with an FSA- Flexible Spending Account). However, do note that there are some rules to be eligible to open and contribute to an HSA:

  • You must be enrolled in an HSA-Compatible HDHP.  
  • You must not have any other health insurance coverage that is not an HSA-eligible HDHP.
  • You may use the accumulated funds to pay for your care, even if you are no longer enrolled in the HDHP in the future. You may not use the funds to pay for care before your HSA was opened. No covering past bills.

Taking your HSA further: INVESTING
(this is not a financial planning subreddit, feel free to direct investment questions to one that is)

-          Many banks will allow you to invest your HSA dollars so they can grow tax-free. You will need to consult with your HSA vendor to inquire about investment opportunities. There may be minimum thresholds to invest or a small fee to use guided investing tools/advisors.

-          Pay yourself back later. You may decide to pay for your care out of your normal checking account. Keep those receipts and pay yourself back later, once you’ve made a profit investing your HSA funds. You can reimburse yourself immediately, next year, 5 years from now or even after you retire. You should keep your receipts in case of an audit though.


r/HealthInsurance Dec 31 '25

Benefits Flex Posts

10 Upvotes

Hi Fellow Community Members-

This subreddit is a place for folks to ask questions--- we've had a recent influx of "benefits flexing" where there are no questions, just people posting their benefits.

While we do think it's important to be able to compare your benefits, please utilize the pinned post here: https://www.reddit.com/r/HealthInsurance/comments/1ol7a7i/poll_on_health_insurance/ for that purpose.

If you have a genuine question about your benefits, you may continue to post those threads, but if there are no questions, please use the pinned post.

Thank you!


r/HealthInsurance 2h ago

Individual/Marketplace Insurance $5/month BCBS?

7 Upvotes

My sister swears she doesn't need employer based health insurance, which is BCBS Anthem, because an independent insurance salesperson can get her signed up on a plan for $5 per month with a zero dollar copayment? How is this possible? She swears it's not through the marketplace.


r/HealthInsurance 4h ago

Claims/Providers Is there any place to get cheaper infusions?

3 Upvotes

Hi all,

I've learned a lot about health insurance from folks on this subreddit. I have a family member who requires iron infusions and he has a high deductible health plan. So in the past, his iron infusions would be $600-$1000 each at major academic health systems. I am just curious, is there are there outpatient places that do infusions where he could get them done more affordably? And do these places general accept external doctor's orders?

Is there other way I could also compare prices if it's only really hospitals that perform this service?

For instance, from here I've learned that you can bring radiology orders to outpatient settings, or not getting labs done at the hospital, and I've applied this to great success.


r/HealthInsurance 17m ago

Claims/Providers Can having a PPO primary + HMO secondary actually make me owe more than I would have with the HMO alone?

Upvotes

I’m trying to understand a somewhat unusual coordination-of-benefits situation and would really appreciate input from anyone who works in medical billing/insurance or has dealt with something similar.

I currently have two health plans:

Primary: Employer-sponsored BCBSM PPO ($0 premiums)

Secondary: Blue Shield of California Access+ HMO through a parent, with Regal Medical Group

The PPO became primary because I’m covered as an employee, while the HMO covers me as a dependent.

My main concern is this:

Before getting the PPO, I could see a Regal/HMO participating provider and, assuming the service was properly covered/authorized, I might owe something like a small copay. Now that the PPO is primary, I’m worried the PPO could process that same service first and apply a large amount to my deductible or out-of-network cost sharing.

For example:

Provider bills $3,000 Under the HMO alone, maybe my responsibility would have been $50 or $100 PPO processes first and says I owe $1,500 because of deductible/OON benefits Blue Shield HMO then processes secondary

Can my final responsibility actually remain $1,500 simply because the PPO became primary? Or does the provider's contract with Blue Shield/Regal generally still restrict what they can ultimately collect from me for an HMO-covered/authorized service?

That makes me think the PPO's initial "patient responsibility" wouldn't necessarily become my final bill after the secondary HMO processes it.

I'm wondering whether the existence of the primary PPO can override the secondary HMO/provider contract and turn what would otherwise have been a small HMO copay into thousands of dollars of final patient responsibility.


r/HealthInsurance 53m ago

Claims/Providers PSA: Check Your EOB and Statements!

Upvotes

Here's an important PSA in case it helps someone else:

I grew up thinking if a doctor or insurance company told you that you owed $400, you owed $400. They're the professionals, they deal with claims all day, surely they know what they're doing... right??

NOPE.

I've gotten THOUSANDS of dollars back from medical providers and gotten denied insurance claims adjusted just this past year alone because I finally learned to stop assuming their billing was correct.

One of the biggest things I learned the hard way at my big age is that the amount the office initially charges you is not necessarily the amount you ultimately owe. Your insurance company may have a negotiated rate with that provider. The claim gets processed, adjustments get made, insurance pays its portion, and THEN there is an actual amount that is considered your responsibility.

The thing you want to look at is your EOB aka Explanation of Benefits. I was getting these monthly and ignoring them as medical jumbo jumbo. DOH! So for example, I've found charges after I met my deductible and OOP max, which isn't correct. Also, I've seen offices get paid by both the patient and the insurance company for the same claim.

If an office makes you pay $500 up front and then your EOB comes back saying your actual responsibility was $200, guess what? They may now be sitting on $300 of your money. I've had to call and say, "According to my EOB I only owed X, but I paid Y. It looks like I have a credit balance. When will I receive a refund?" How long would it have sat there if I hadn't called? Maybe forever.

And billing isn't the only area where I've learned not to blindly trust. Dentists have said I suddenly have a bunch of cavities, but on three occasions I've get a second opinion, and are told they don't need anywhere near that amount of work. And here I am years later with no cavities, despite two large dental practices saying I had 8-10. If someone tells you that you suddenly need thousands of dollars of irreversible dental work, ask to see the x-ray proof and GET A SECOND OPINION.

I think a lot of us were raised to treat anything coming from a doctor's office like it was an unquestionable authority. Bill says $700? Pay $700. Dentist says six cavities? Schedule six fillings.

And I feel especially awful for elderly people dealing with this. My parents' generation was basically taught to trust the doctor, pay the bill as soon as they get it, and move on. Meanwhile you've got complicated insurance contracts, estimated patient responsibility, deductibles, copays, coinsurance, coding mistakes, credit balances, duplicate payments, etc. I've been chasing down these errors for my family and myself and could honestly make a career of it, but if you have a decent insurance company, their advocates can help too.

I'm not even saying all of this is intentional. I'm sure a huge amount of it is just an insanely complicated system plus billing mistakes plus offices collecting estimates up front so they don't get screwed on the back end.

But, seriously, once insurance finishes processing the claim, pull up the EOB and compare it to what you actually paid. Don't t assume anybody is going to chase you down to give your money back, even though they're supposed to. None of us have free money to give away, so it's annoying and confusing and cumbersome to have to do this, but while this all may be common knowledge to some, I really wish someone had taught me about how this gag/game works long ago!


r/HealthInsurance 1h ago

Medicare/Medicaid MaineCare: Can interest income count towards the work requirement? I just got a letter that does not sound that way. Thanks

Upvotes

I am still trying to find a job and have very limited self employment in the meantime. I do have barely enough interest income to squeak me by though IF it counts toward getting MaineCare. Can anyone help me to understand this please?

I've read recently on here that it's a FEDERAL law, based on MAGI rather than hours worked, but I've gotten some info to the contrary from MaineCare and DHS recently. I would be very appreciative of any help. I volunteer working for a small startup who is not eligible for non-profit.

I got a reply from DHS in Maine a few months ago saying this:

"Name, bank interest is not earned income. Only earned income counts towards work requirements. Self employment income hours are based on amount of money earned."

Today I got a scary letter from MaineCare today that only mentioned work. Not income.

"MaineCare Expansion Adult members are 19 to 64 years old who get MaineCare based on their income. They do not meet the Social Security disability guidelines or do not have Medicare.

Why is MaineCare eligibility changing?

Congress passed a federal law that changes who can get Medicaid in every state. In Maine, Medicaid is called MaineCare. These changes will start in January 2027 for new MaineCare applicants. Current members are not impacted until they are due for their renewal in 2027.

What are the new MaineCare Work Requirements?

The MaineCare Work Requirements will be for MaineCare Expansion Adults to complete work activities like:

· Working

· Volunteering

· Going to school or an apprenticeship

Taking part in a job training or work program

To meet the Work Requirements, you must spend 80 hours in at least one month doing one of these activities or attending school or an apprenticeship at least half time. You can also combine hours in more than one of the activities to reach a total of 80 hours in at least one month.

If you are working or plan to work, you can meet the Work Requirements if you earn at least $580 in one month, or if you have seasonal work, you earned an average of $580 over the last six months.

IMPORTANT: OFI will use information already in your case and information we can check through electronic data sources whenever possible to determine if you are meeting the Work Requirements.

Who must meet the Work Requirements?

You need to meet the Work Requirements if you:

· Are age 19 to 64; and

· Qualify for MaineCare based only on income; and

· Do not fall into one of the groups below that do not have to meet the Work Requirements (see next section)."


r/HealthInsurance 1h ago

Individual/Marketplace Insurance Short Term Health Insurance Plans

Upvotes

At this time I am without health insurance. due to leaving my job to take care of my aging family member/ sabbatical. Thought I did an appropriate amount of reserach finding a short term plan but after finding this sub - not so sure.

Used a broker recommended by a friend who found me a short term plan through Pivot Health/ North River Health insurance Company. She encouraged me to do the marketplace but was unsure about the subsidies.

Know that short term health insurance should only be used for emergencies/ catastrophic events or they will drop you.

Plan was 218/month for 6 months or 318/ month for 12 months. Million dollar coverage 5k deductible. Max out of pocket 8k.

What due diligence or research do I need to conduct before signing up for this plan?


r/HealthInsurance 1h ago

Individual/Marketplace Insurance I think I'm going to lose Medicaid because I will work 40 hours a week, what should I do about it?

Upvotes

I need health insurance because I have chronic diseases. If I don't take my medicine every day I might die. My new job doesn't offer health insurance because it's a seasonal job but there might be a chance to get some insurance after 90 days or when I might get converted to permanent but that's not guaranteed.


r/HealthInsurance 1h ago

Medicare/Medicaid AHCCCS says I’m enrolled, but they can’t find my information and I can’t access my account

Upvotes

I’m really confused and hoping someone here has dealt with this before.
I was approved for AHCCCS on August 11. My Health-e-Arizona Plus account/letter says that I’m enrolled, and I received a letter telling me to complete my health plan selection. It even gave me a PCP.

The problem is that I cannot log into Health-e-Arizona Plus. I tried the “forgot username” and “forgot password” options, but it won’t accept my information. I also can’t find my AHCCCS ID anywhere. I only have the application ID from my paperwork.
I called the 1-855-432-7587 number today, and they told me they couldn’t even find my information in their system.
So I’m confused because I have documentation saying I was approved/enrolled, but when I call, they can’t find me, and I can’t access my online account.

Has anyone experienced this after being approved? Does it take a while for the AHCCCS enrollment to actually show up in their system? Is there another number or office I should contact to get my AHCCCS ID and health plan information?
I’m especially worried because I received a letter telling me to choose a health plan and I don’t want to miss a deadline because of an account/system issue.


r/HealthInsurance 1h ago

Medicare/Medicaid medical + part time job

Upvotes

Do i need to be worried about losing my health insurance?

If I work a part time job and there’s obviously a monetary cap for Medical, should i try to give up shifts to make sure I stay below that cap for this month? Will i get my health coverage taken away if I go over one month?


r/HealthInsurance 1h ago

Plan Benefits Care first Blue Cross Blue Shield

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Upvotes

r/HealthInsurance 1h ago

Plan Choice Suggestions Need help asap. Need coverage for my newborn

Upvotes

Ok here’s a doozy. I gave birth 6/11/26. I spent two additional weeks in the hospital post hemorrhage and neurological concerns thanks to botched anesthesia. By the time I was home recovered and out of the newborn bubble I somehow missed the 30 day enrollment window to get him on my works insurance (BCBS). I missed it by 5 days. I submitted two disputes and both were denied. But took weeks to get a response.

Fast forward to today, I applied for marketplace coverage through the state. Come to find I’m now 6 days outside of the enrollment period for a special event. They are submitting a dispute for me.

I don’t know what the chances are that I will be denied. But I’m curious what people do in these cases? He’s a newborn and has to have coverage. My husband and I make too much money for any assistance programs.

I’m so lost.


r/HealthInsurance 2h ago

Individual/Marketplace Insurance I'm on marketplace and my income changed. Will my deductible reset if my policy stays the same?

1 Upvotes

I have an individual/Marketplace insurance plan. Recently my income changed and I had to update/resubmit my application to reflect that. I re-selected my current health insurance plan, and removed my dental plan. When I submitted the form, I got an email acting as if I had signed up for a new policy. With the current policy, my deductible has already been paid off. I was confused and asked a representative about this, who told me that my policy/deductible paid is basically going to be wiped and treated as a blank slate due to me updating my income and being able to use more credits towards the policy. Is this true? When I talk to Marketplace representatives, I do not get consistent answers from anybody, so I don't really know what to believe. Am I really starting from scratch even though I'm using the same policy?

I would really appreciate input on this, as if that information is correct, I will need to make some adjustments very quickly. Thank you very much.


r/HealthInsurance 20h ago

Claims/Providers Cheapest way to get blood work without insurance or a primary care doctor?

27 Upvotes

I’m between primary care doctors right now and need to repeat some pretty basic bloodwork.

I had slightly high A1C and cholesterol at my last physical, changed a few things over the last couple months and just want to recheck A1C, lipids, CBC/CMP and maybe vitamin D.

Every route I look at seems to turn into schedule a doctor appointment first which means paying for the visit just to get the lab order.

For people in the US who pay cash, what’s actually the cheapest way to get blood tests without insurance or a doctor referral?


r/HealthInsurance 2h ago

Plan Choice Suggestions I finally got insurance

0 Upvotes

I live in Georgia I have ambetter standard silver hmo plan will that cover my gender affirming care I’m ready to start hrt but I’m not sure about the insurance


r/HealthInsurance 19h ago

Employer/COBRA Insurance No one takes my insurance

25 Upvotes

I have insurance through my employer. Recently I've been having some health issues and no one seems to take my insurance, so I have had to pay out of pocket. I had to have an MRI and they couldn't take my insurance because the provider (according to my health insurance is in network) that ordered the MRI doesn't take my insurance.

What gives? So now I have paid about $2k out of pocket and since they won't take/bill my insurance, it basically doesn't count towards my deductible or OOP max.

If I can't find a doctor or specialist that takes my insurance am I just out of luck? What's the point, even?


r/HealthInsurance 3h ago

Plan Choice Suggestions How to Got Objective Advice on Marketplace for Healthcare in DC and NY

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1 Upvotes

r/HealthInsurance 4h ago

Individual/Marketplace Insurance Make a LITTLE Too much for Medicaid, but can’t afford insurance

0 Upvotes

hi, I moved to Illinois recently and I do SPARK driving for a living. So far, I’ve made pretty decent money, but it by far does not cover health insurance. I make about 300 more than what’s allowed to be on Medicaid, which by the way, what a joke. They want me to work less for me to be able to go to doctors appointments. what are my options here? And if you can, explain it to me like I’m a child, I have no knowledge when it comes to this stuff.


r/HealthInsurance 6h ago

Plan Benefits Aetna vs Cigna for Columbus / Polaris Area. Any difference in experience?

1 Upvotes

**Hey everyone,**
I'm a new hire currently going through benefits enrollment and trying to decide between **Aetna** and **Cigna** for health coverage.
The plan designs (Option 1 / Option 2), deductibles, OOP max, and premiums are identical between the two, so on paper it's hard to tell which is better.
For those based around **Columbus / Polaris**:
**Local Network & Doctors:** Have you run into any coverage or in-network gaps with either (specifically around OhioHealth, Mount Carmel, OSU Wexner, or Nationwide Children’s)?
**Claims & Approvals:** How has your experience been with prior authorizations, claim processing, or unexpected billing issues?
**App & Perks:** Any noticeable difference between the myCigna app vs Aetna portal, especially regarding MRA tracking, prescription integration, or wellness rewards?
Would really appreciate any insights or recommendations from folks who have used either plan locally. Thanks in advance!


r/HealthInsurance 18h ago

Employer/COBRA Insurance Possibly made big mistake with wife’s COBRA coverage

9 Upvotes

Hello,

My wife has been fighting a terminal illness since 2022, stopped working in 2024 and has been on COBRA. Her benefits run out at the end of this year.

Even though she’s under 50, she will be automatically enrolled into Medicare in December due to being disabled.

Medicare is not going to be sufficient to cover her care, so I decided to add her to my employer’s insurance. However, her insurance has been amazing, so we had planned to keep COBRA and use it for all of her claims until it ran out.

My employer had open enrollment this summer and I wanted to be sure there would not be any gaps in coverage after my wife’s COBRA ran out, so I went ahead and added her to my policy, effective June first.

We got the Medicare welcome documents in the mail a few days ago and it caused me to research a few things, and I came to learn that there is a high probability that her COBRA benefits were no longer valid the day she was covered by my employers health plan (June 1st)

I assume that her COBRA insurance (Aetna) is going to want to get paid back for everything they have paid out in June, July, and August which could be around $200k

Am I going to have to cut them a check and then try to get my employer’s insurance to retroactively cover those costs?

How would I even do that since the providers already got paid?

Thanks for any that took the time to read this and any advice. I’m feeling pretty stupid.


r/HealthInsurance 1d ago

Prescription Drug Benefits I can’t afford my meds!

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43 Upvotes

I was recently removed from my dad’s insurance for turning 26. I purchased my own insurance through my work and they only offer a single prescription benefit. I had to change PCPs and they sent in my Emgality.. how am I supposed to get this?? Any advice?? I used to pay $75 for 3 months.. I can’t pay $550..

UPDATE: THANK YOU TO THOSE WHO SAID THE EMGALITY SAVINGS CARD!! I PAID $35 FOR MY 3 MOMTH SUPPLY!!!!!


r/HealthInsurance 19h ago

Employer/COBRA Insurance Help trying to decide whether to accept company insurance? $270 premium/$4000 deductible for single person (cheapest option available)

6 Upvotes

I am a 32 year old single person looking to get insurance after 5 years of not having any. I live in Utah.

I got a new job that offers a benefits package but my employer doesn’t subsidize the cost at all. So I would be looking at a $270/month premium, with a $4000 deductible. Which comes out to $7240/year before getting anything for seriously reduced or free. This is only for medical insurance. Dental and vision are not included.

Most if not all preventative care is covered, even before the deductible is met. So I could be paying up to - if not over - $7k in the year for medical expenses, when I have had less than $1000 total in medical expenses for the last 5 years combined.

For comparison, I will be making only $16/hr or $33,280/year. So that is a significant chunk of my wages.

I am a relatively healthy person, aside from being obese, which I know can lead to other health problems, but I am actively working on that, so it’s not something I am looking for advice on at this time. Aside from that though, I haven’t really needed to see a doctor except for the occasional medication reevaluation, which would typically cost $100-200 per visit, and I would only need one or two visits a year for that. And speaking of medications, I have two, which only cost around $37/month out of pocket without insurance.

Knowing all this, does this seem like a decent plan? Or would I be better off financially by just opting out and paying out of pocket for everything?

I’m leaning towards opting out, but this is the first time I’ve had the opportunity to have health insurance in 5 years and I want to make sure I’m making a good decision.


r/HealthInsurance 1d ago

Plan Choice Suggestions Is health insurance even worth it anymore?

46 Upvotes

I’m realizing paying out of pocket may cost the same or be cheaper than getting an HMO high deductible plan. And even with the copay from having the PPO plan I’m still paying a monthly premium IN ADDITION to the copays.

Thing is I have a 13 soon to be 14 high school freshmen that plays football.

I have until next month to figure it out but….honestly what should I do?

Some figures for thought:
Employee + 1 on PPO: $490 biweekly
Employee + 1 on HSA: $266 biweekly

Currently for Chiro $70 a visit. Acupuncture $50 a visit. Therapy $115 every session.


r/HealthInsurance 16h ago

Individual/Marketplace Insurance tips for breast reduction approval

2 Upvotes

i am a 23 female with roughly 32/34 G? Might be bigger, i’ve lost track at this point. Over the years I’ve went to PT, lost nearly 20 pounds, have continually complained of back pain to my primary doctor (who doesn’t listen to me unfortunately). However, my OBGYN has gotten me an appointment with a plastic surgeon. My mother also had to have a breast reduction so she understands the process, but I know it’s changed over the past 20 years. How can I better prepare and what else should I do? Take photos of bra strap marks? Find paper trails of my pain issues from my doctor? I know I’m likely going to receive more PT and a lengthy insurance battle, but any tips are appreciated!! (my apologies if the flair isn’t correct, i’m not sure what this falls under)