January 28, 2019 2:22 am at 2:22 am #1669109bestcoverParticipant
For a frum Jew in Brooklyn, what insurance carrier and plan would be the best choice to select from those available in the New York State of Health marketplace?
Some of the available choices are United HealthCare, Oxford, Blue Cross Blue Shield, and a bunch of others. Each carrier might have various sub-carriers and plans you must select from. (I haven’t gotten that far, so I’m uncertain.)
What choices must be made other than selecting a specific insurance company? Do prescription, dental, vision and other services have to be selected separately from your main insurance selection?
Are there Gold, Silver, Bronze plans you must select from? What is the “Essential Plan”? What are the differences in coverage and cost between them, generally speaking. This would be for an individual, not a family.
TIAJanuary 31, 2019 10:32 am at 10:32 am #1671522
The Essential Plan is for low income families that make too much for Medicaid. Depending on income it may or may not have a monthly premium and/or co-pays/co-insurance. On the lower income side the Essential Plan is completely free with no monthly cost and no cost to see doctors or get prescriptions. On the higher income scale that still qualifies for the Essential Plan it cost $20/month and has copays that are generally either $15 or $25 a visit. Dental and Vision is either free (including no copays), if income eligible, or between $10 and $25/month in monthly premiums with low copays, depending which plan you choose.
The Qualified Health Plans (otherwise known as ACA or Obamacare plans), for those earning too much to qualify for Medicaid or the Essential Plan, come with a federal tax subsidy to pay for a portion of the monthly premium, if income eligible. You can choose levels called Catastrophic, Bronze, Silver, Gold and Platinum. (Catastrophic doesn’t qualify for a tax subsidy. The Silver may, if income eligible, receive a further reduction in copays/coinsurance/deductibles). You can choose from different insurance carriers, each offering different metal levels, with different premium amounts. The benefits, for the most part, are the same across them all. The differences is the cost, both monthly and for every medical visit/usage.
As far as the insurance carriers are concerned, the major differences are their network of physicians and medical facilities. That’s where you have to do your homework to see which insurance networks your doctors are part of. If you choose a PPO plan instead of an HMO plan (the PPOs cost more per month), you also can use out of network doctors by paying the coinsurance instead of the lower copays of in-network doctors.
Either way you’ll first need to meet your annual deductible, paying out of pocket, before any insurance coverage kicks in for that year, other than well checkups with your primary physician, which is included for free several times a year.January 31, 2019 10:34 am at 10:34 am #1671566yungerman1Participant
Check pricing. Then check with all the doctors that you, your wife, and children use or may use to see if they accept the insurance and the particular plan you are looking at.
You should estimate what your healthcare expenses may be for the year and do the math. high premium with low deductible, low premium +high deductible, lower coinsurance/copay or high coinsurance/copay
Premium+ deductible +maximum out of pocket (which may include the deductible)….
There is no one right answer for everyone.January 31, 2019 10:57 am at 10:57 am #16715741Participant
Getting a job at mid-sized company.January 31, 2019 9:25 pm at 9:25 pm #1672222
United Healthcare appears to be the provider of choice for the heimishe crowd.February 3, 2019 11:09 pm at 11:09 pm #1673205
HealthFirst is also a better plan from the available choices.February 4, 2019 9:04 am at 9:04 am #1673354anonymous JewParticipant
Joseph, exactly how do you know this about United Healthcare ?February 4, 2019 9:21 am at 9:21 am #1673378
Almost any NYC doctor with a large frum clientele can authenticate that the largest public healthcare plan patients carry is UHC.
- You must be logged in to reply to this topic.