Health Care Switch

Yes I know but ACA doesn't work for me unless I want to quit making money and use doctors nobody goes too.

I had over 40 cardiologist in my group. Only two would take it and as you can guess they were poorly rated doctors. I lived this for years and at $16k a year for horrible coverage it is time to move on.

Here in Utah-the hospitals/insurance that are basically the "unofficial" defacto medical providers of the state is Select Health Insurance/Intermountain Hospitals. One MUST be prudent when signing up for plans that these providers are covered. It sounds like you are running in to those issues with your plan, the plan isn't great with the medical providers in your state. I paid well over $6,000.00 a year prior to Medicare for insurance for myself only under the ACA coverage. But made sure the hospital group/Doctors were covered. I received ZERO SUBSIDIES due to income level.

BTW-on edit my insurance agent called one of my doctors to be sure the office accepted the coverage I was getting.
 
Last edited:
Exactly...!

No this is not one of those.
Real health insurance excludes most things most of the time in my experience if you are not part of a group and self employed.
I don't know anything about Maryland health plans. I do know that a lot of states in pre-ACA days had just one or two providers statewide. Unfortunately, the scenario that some out-of-state provider is going to come sailing in and fix all the injustices is a pipe dream. Their infrastructure just isn't there. I don't know why some areas boiled down to just one or two providers, but I'm pretty sure it was driven by the profit motive of the health care industry.

IMO, health insurance is catastrophic insurance. The nickels and dimes are irrelevant. When the bills start racking up into the hundreds of thousands, that's when you need coverage.
 
  • Like
Reactions: CKN
If you use ACA for a PEC instead of the other in that year you'd have to report it to the new company or not?


About to go down that road and it's not as worse as you may think. The thing to do is go to a seminar that explains how it all works then you understand it.
I am past being there. I signed up for a Medicare Advantage Plan. The actual plan is an HMO and seems pretty decent. But if I got really sick and wanted to got to Mayo Clinic for example it would probably not be covered. Local hospital in Delaware would be covered.

The employer I retired from uses Via Benefits to help navigate the choices with Medicare. That was a big help for me.

I pay just under $500/month for Medicare Part B because I still work. Not the basic $180/month.

As more people over 65 continue working what I see missing is a plan from your employer that pays for Medicare Part B or a plan that works with Medicare. My current employer would provide normal health insurance for me where they pay a portion and I pay a portion as if Medicare was not in the picture. But the cost per month was not that much different than what I pay for Medicare Part B. Hassle to switch and switch back when I retire for good.
 
I don't know anything about Maryland health plans. I do know that a lot of states in pre-ACA days had just one or two providers statewide. Unfortunately, the scenario that some out-of-state provider is going to come sailing in and fix all the injustices is a pipe dream. Their infrastructure just isn't there. I don't know why some areas boiled down to just one or two providers, but I'm pretty sure it was driven by the profit motive of the health care industry.

IMO, health insurance is catastrophic insurance. The nickels and dimes are irrelevant. When the bills start racking up into the hundreds of thousands, that's when you need coverage.
Just an FYI- 20% up to your deductible is substantial to some. That's why I cautioned against the 80% plans-depending on one's situation.
 
Just an FYI- 20% up to your deductible is substantial to some. That's why I cautioned against the 80% plans-depending on one's situation.
Yep, it can hurt. But compare that 20% of deductible to $1 million. $2 million. A onetime coworker suffered a brain aneurysm and was in ICU for over a month before he died. Blew right through the lifetime cap our company health insurance had and left his widow hanging for the balance. It's one thing to feel financial pain, it's another to go broke. And as we know, medical bills are the No. 1 driver of bankruptcies in the US.

When I was in the ACA, I used the high-deductible Bronze health plan with HSA option. I was lucky, never had to tap into the HSA much. But I had $15K stowed away for easy access to cover our deductible.

BTW, the OP apparently makes enough money that he doesn't qualify for a tax credit. The last couple years wife and I were in the ACA. the tax credit covered our premium and then some because our modified adjusted gross income was under the $66k "cliff" (thank you, Donald Trump).

BTW, we used IRA and HSA contributions (tax deductible) to ensure we were under the cliff. In retrospect I don't think we needed to play that game, but the big boys use tax laws to their advantage all the time. Why not us?
 
Yep, it can hurt. But compare that 20% of deductible to $1 million. $2 million. A onetime coworker suffered a brain aneurysm and was in ICU for over a month before he died. Blew right through the lifetime cap our company health insurance had and left his widow hanging for the balance. It's one thing to feel financial pain, it's another to go broke. And as we know, medical bills are the No. 1 driver of bankruptcies in the US.

When I was in the ACA, I used the high-deductible Bronze health plan with HSA option. I was lucky, never had to tap into the HSA much. But I had $15K stowed away for easy access to cover our deductible.

BTW, the OP apparently makes enough money that he doesn't qualify for a tax credit. The last couple years wife and I were in the ACA. the tax credit covered our premium and then some because our modified adjusted gross income was under the $66k "cliff" (thank you, Donald Trump).

BTW, we used IRA and HSA contributions (tax deductible) to ensure we were under the cliff. In retrospect I don't think we needed to play that game, but the big boys use tax laws to their advantage all the time. Why not us?
If you don't qualify for a tax credit-but you want pre-existing conditions covered, you have no choice but the marketplace. So you either pay up or risk financial well being. It is what it is......
 
Yep, it can hurt. But compare that 20% of deductible to $1 million. $2 million. A onetime coworker suffered a brain aneurysm and was in ICU for over a month before he died. Blew right through the lifetime cap our company health insurance had and left his widow hanging for the balance. It's one thing to feel financial pain, it's another to go broke. And as we know, medical bills are the No. 1 driver of bankruptcies in the US.

When I was in the ACA, I used the high-deductible Bronze health plan with HSA option. I was lucky, never had to tap into the HSA much. But I had $15K stowed away for easy access to cover our deductible.

BTW, the OP apparently makes enough money that he doesn't qualify for a tax credit. The last couple years wife and I were in the ACA. the tax credit covered our premium and then some because our modified adjusted gross income was under the $66k "cliff" (thank you, Donald Trump).

BTW, we used IRA and HSA contributions (tax deductible) to ensure we were under the cliff. In retrospect I don't think we needed to play that game, but the big boys use tax laws to their advantage all the time. Why not us?
And I believe ACA plans don't have lifetime caps either. Some people here like to throw out that saying, you get what you pay for. I don't always believe it and you can save money here and there by shopping around and putting things out for bid. But OP sounds like he's getting a cheaper plan and of course a cheaper plan has less coverage. And he doesn't like his current ACA plan which really sounds like he needs to spend even more and get a better ACA plan. I tried that once, would have saved $200 going to the cheaper ACA plan, but the list of doctors they had for that plan was screwed up, said it was initially covered, but when I got the coverage, the doctors I used wasn't on the plan and I'd have to switch to their doctors, but because I was a new patient, it'd be 2 months before they'd see me so I had to do the emergency room. Luckily I was still within the open enrollment period and I was able to switch right back and went back to my old doctors.

I'd basically be warry of any non ACA plan and do a search for that plan and included screwed and scam as part of the keywords to get real reviews about it before switching.
 
An insurance story:

I was self employed in 2019-2021. Had short term plans that were basically catastrophic coverage as we were all healthy. I didn’t mind paying out of pocket for checkups and anything else minor.

I enrolled in an ACA plan for 2021 as I’d had nagging lower back pain and wanted to see a physical therapist or get an MRI and get it figured out. I had a primary care visit scheduled for the 2nd week of January 2021 for when I got back from vacation.

I did something to my back on January 10th and couldn’t walk or stand. Went to the ER, had an MRI followed by emergency back surgery. On the MRI they also found a tumor on my left adrenal gland that likely would’ve caused a stroke or heart attack and been discovered at my autopsy had it not been for it being partially imaged.

Had another surgery to remove the adrenal gland and tumor and then a bunch of follow up visits, PT visits and diagnostic testing for the rest of 2021. I was so glad I had paid for the ACA plan as my bills were in the hundreds of thousands of dollars before I paid 2 months premiums. Plus, now I have pre-existing conditions that any non-ACA plan isn’t going to cover. All at the age of 39. Insurance sucks to pay for but can keep you from going broke!
 
And I believe ACA plans don't have lifetime caps either. Some people here like to throw out that saying, you get what you pay for. I don't always believe it and you can save money here and there by shopping around and putting things out for bid. But OP sounds like he's getting a cheaper plan and of course a cheaper plan has less coverage. And he doesn't like his current ACA plan which really sounds like he needs to spend even more and get a better ACA plan. I tried that once, would have saved $200 going to the cheaper ACA plan, but the list of doctors they had for that plan was screwed up, said it was initially covered, but when I got the coverage, the doctors I used wasn't on the plan and I'd have to switch to their doctors, but because I was a new patient, it'd be 2 months before they'd see me so I had to do the emergency room. Luckily I was still within the open enrollment period and I was able to switch right back and went back to my old doctors.

I'd basically be warry of any non ACA plan and do a search for that plan and included screwed and scam as part of the keywords to get real reviews about it before switching.
I believe the OP made two mistakes-
1) Not using an agent
2) Not checking his providers or local network (Doctors and Hospitals-that everyone else uses-that are competent) took the insurance he signed up for.

Good lesson for everybody else.
 
I believe the OP made two mistakes-
1) Not using an agent
2) Not checking his providers or local network (Doctors and Hospitals-that everyone else uses-that are competent) took the insurance he signed up for.

Good lesson for everybody else.
I agree. Good thing the OP sorted it out.
 
Last edited:
And I believe ACA plans don't have lifetime caps either. Some people here like to throw out that saying, you get what you pay for. I don't always believe it and you can save money here and there by shopping around and putting things out for bid. But OP sounds like he's getting a cheaper plan and of course a cheaper plan has less coverage. And he doesn't like his current ACA plan which really sounds like he needs to spend even more and get a better ACA plan. I tried that once, would have saved $200 going to the cheaper ACA plan, but the list of doctors they had for that plan was screwed up, said it was initially covered, but when I got the coverage, the doctors I used wasn't on the plan and I'd have to switch to their doctors, but because I was a new patient, it'd be 2 months before they'd see me so I had to do the emergency room. Luckily I was still within the open enrollment period and I was able to switch right back and went back to my old doctors.

I'd basically be warry of any non ACA plan and do a search for that plan and included screwed and scam as part of the keywords to get real reviews about it before switching.

I am sorry you made a healthcare mistake. Glad you remedied it in time.
 
I don't know anything about Maryland health plans. I do know that a lot of states in pre-ACA days had just one or two providers statewide. Unfortunately, the scenario that some out-of-state provider is going to come sailing in and fix all the injustices is a pipe dream. Their infrastructure just isn't there. I don't know why some areas boiled down to just one or two providers, but I'm pretty sure it was driven by the profit motive of the health care industry.

IMO, health insurance is catastrophic insurance. The nickels and dimes are irrelevant. When the bills start racking up into the hundreds of thousands, that's when you need coverage.
Here before ACA we had it made.
Unlimited choices and great rates as I was always my own provider of insurance.
ACA here is a joke.
Because the doctors won't take it unless they are new or have a below average rating and most are in the bad areas of town. They tell me it takes forever to get paid.

That said if you have pre-existing condition's it may be your only option.

Their website shows all of the doctors in your area and when you start calling them most say they are no longer accepting it. Those list are so outdated they are worthless.

Seriously many times I went without care because I couldn't find a doctor. You suck it up, get better or die...

And if you are lucky enough to get a subsidy at the end of the year you will find out that free ride wasn't one
 
@CKN

BTW-on edit my insurance agent called one of my doctors to be sure the office accepted the coverage I was getting.


Yeah if you like your doctor the above is a must. I always do that and sometimes you get screwed.
I had a great primary care doc and he took my new insurance. A year later he didn't....had to switch to one he took. Eventually I moved on as he played musical chairs with insurance...lol
 
Somehow this thread evolved into a medicare thread which it is not but I have to throw my 2 cents in one last time because of what I am seeing posted here regarding medicare.

1. Medicare comes in 2 parts, part A and Part B. Part A hospitalization cost you nothing, Part B you will automatically be enrolled in at the age of 65 and coverers everything outside of the hospital , so you will have Part A at no cost and Part B at current cost of $170 a month will be taken from your social security check. Of course prudence on your part is required to make sure you get the proper notice that you are automatically being enrolled in Part B unless you "Opt Out"
So Part A and B pays 80% of all your medical bills except prescription drugs not given in a hospital setting (minus an irrelevant deductible) You are responsible for 20% of out of hospital costs (doctors ect) Does not include coverage outside of USA.

2. If you want you can buy additional insurance called Medigap from private Insurance companies. Medigap covers oil most all cases the other 20% that Medicare A and B doesnt pay. Chose plan G or N and you are all set.

3. You will then need drug coverage which would be Medicare part D at additional cost.
So you can keep your government Medicare A and B at a cost of $170 a month then select a Medigap private policy typically Plan N or Plan G and I private Drug policy Plan D.
So you will have Medicare A,B,G,D or A,B,N,D this will cover your medical expenses very well and almost never have a bill at a cost of in round numbers up to $400 a month but most likely closer to $350 or so.
All the plans above DO NOT include, dental, vision, hearing, over the counter products.
You can go to ANY doctor or hospital in the USA that accepts Medicare you also have limited coverage in an emergency outside of the country.
If one takes time to study it, it is pretty simple stuff.

Ok, one other Medicare option =
An all in one plan, so you can forget ALL THE ABOVE and sign up for a Medicare Advantage C private Insurance plan.
Advantage C plans cover all the above plus most also cover dental, vision, hearing, over the counter products and prescription drugs and out of country emergency but you must be careful and know what they cover and dont, the plans vary widely.
Total cost of my plan is the government $170 plus $25 = $195 a month.
Call me crazy but never has health ins cost me so little.
I would strongly in every sense of the word, if anyone is at the point of their life for Medicare or even in medicare consider checking United Health Care Medicare plans, largest in the country mainly because they team up with the AARP. With UHC (united health care) being so popular you will most likely find out, like I did in my state every single hospital network and doctors where I live take the plan.
But its easy to check on all the websites.

If your not one for details, it maybe best to contact a knowledgeable person. Keep one thing in mind EVERY MEDICARE PLAN MUST BE APPROVED by government. IN the case of the Advantage C the premium is paid by the government instead of you taking part a and b.

I have to stress, if you are not one to read all details of all the plans, spend hours and days on it, they talk to a local person who specializes in it.
What I like about United Health Care many of their plans are group priced and not age based so the rates doesnt increase with age only as a group. SO it might be a little higher at the start but it will stay that way and not go as high as the others.
DO not make decisions based on my little post here, there is a good amount of reading of plans and they are specific to your area.
GO to the government medicare.gov website and read for days on end.

My brother loved his A,B,G,D medicare, never gets a medical bill, but as he got closer to age 70 the rate kept going up so he just went into a Medicare C plan (partly because of me) and now pays almost $200 less a month.
 
Last edited:
Here before ACA we had it made.
Unlimited choices and great rates as I was always my own provider of insurance.
ACA here is a joke.
Because the doctors won't take it unless they are new or have a below average rating and most are in the bad areas of town. They tell me it takes forever to get paid.

That said if you have pre-existing condition's it may be your only option.

Their website shows all of the doctors in your area and when you start calling them most say they are no longer accepting it. Those list are so outdated they are worthless.

Seriously many times I went without care because I couldn't find a doctor. You suck it up, get better or die...

And if you are lucky enough to get a subsidy at the end of the year you will find out that free ride wasn't one
We have many more choices here, but the prices go up accordingly. Best is probably Blue Cross, for the equivalent type of plan I have now it's an extra $400-$500 a month. ACA plan prices here are cheaper than going to private insurers directly. As a 1099, I pretty much don't have any other choices.
 
We have many more choices here, but the prices go up accordingly. Best is probably Blue Cross, for the equivalent type of plan I have now it's an extra $400-$500 a month. ACA plan prices here are cheaper than going to private insurers directly. As a 1099, I pretty much don't have any other choices.
I did get a rider plan for heart issues.
7 years ago after I had my surgery I had to get back to work 10 days later as it was one of these out of the blue ordeals. Had no one to shut down my website and had a mutiny when I got home.

If i survive another incident I will sit in Florida and forget all of the nonsense and spend that $200k I get...😳
 
I did get a rider plan for heart issues.
7 years ago after I had my surgery I had to get back to work 10 days later as it was one of these out of the blue ordeals. Had no one to shut down my website and had a mutiny when I got home.

If i survive another incident I will sit in Florida and forget all of the nonsense and spend that $200k I get...😳
So if the plan you're looking at has pre-existing exclusions, what's the lifetime cap on the plan? Some of those used to be a million. A friend of mine did end up with a heart transplant, the insurance negotiated a 1 million cap on the transplant. Now he takes drugs every day too, who knows what his total costs of having the transplant is.
 
Somehow this thread evolved into a medicare thread which it is not but I have to throw my 2 cents in one last time because of what I am seeing posted here regarding medicare.

1. Medicare comes in 2 parts, part A and Part B. Part A hospitalization cost you nothing, Part B you will automatically be enrolled in at the age of 65 and coverers everything outside of the hospital , so you will have Part A at no cost and Part B at current cost of $170 a month will be taken from your social security check. Of course prudence on your part is required to make sure you get the proper notice that you are automatically being enrolled in Part B unless you "Opt Out"
So Part A and B pays 80% of all your medical bills except prescription drugs not given in a hospital setting (minus an irrelevant deductible) You are responsible for 20% of out of hospital costs (doctors ect) Does not include coverage outside of USA.

2. If you want you can buy additional insurance called Medigap from private Insurance companies. Medigap covers oil most all cases the other 20% that Medicare A and B doesnt pay. Chose plan G or N and you are all set.

3. You will then need drug coverage which would be Medicare part D at additional cost.
So you can keep your government Medicare A and B at a cost of $170 a month then select a Medigap private policy typically Plan N or Plan G and I private Drug policy Plan D.
So you will have Medicare A,B,G,D or A,B,N,D this will cover your medical expenses very well and almost never have a bill at a cost of in round numbers up to $400 a month but most likely closer to $350 or so.
All the plans above DO NOT include, dental, vision, hearing, over the counter products.
You can go to ANY doctor or hospital in the USA that accepts Medicare you also have limited coverage in an emergency outside of the country.
If one takes time to study it, it is pretty simple stuff.

Ok, one other Medicare option =
An all in one plan, so you can forget ALL THE ABOVE and sign up for a Medicare Advantage C private Insurance plan.
Advantage C plans cover all the above plus most also cover dental, vision, hearing, over the counter products and prescription drugs and out of country emergency but you must be careful and know what they cover and dont, the plans vary widely.
Total cost of my plan is the government $170 plus $25 = $195 a month.
Call me crazy but never has health ins cost me so little.
I would strongly in every sense of the word, if anyone is at the point of their life for Medicare or even in medicare consider checking United Health Care Medicare plans, largest in the country mainly because they team up with the AARP. With UHC (united health care) being so popular you will most likely find out, like I did in my state every single hospital network and doctors where I live take the plan.
But its easy to check on all the websites.

If your not one for details, it maybe best to contact a knowledgeable person. Keep one thing in mind EVERY MEDICARE PLAN MUST BE APPROVED by government. IN the case of the Advantage C the premium is paid by the government instead of you taking part a and b.

I have to stress, if you are not one to read all details of all the plans, spend hours and days on it, they talk to a local person who specializes in it.
What I like about United Health Care many of their plans are group priced and not age based so the rates doesnt increase with age only as a group. SO it might be a little higher at the start but it will stay that way and not go as high as the others.
DO not make decisions based on my little post here, there is a good amount of reading of plans and they are specific to your area.
GO to the government medicare.gov website and read for days on end.

My brother loved his A,B,G,D medicare, never gets a medical bill, but as he got closer to age 70 the rate kept going up so he just went into a Medicare C plan (partly because of me) and now pays almost $200 less a month.
One correction. The base cost of Medicare Part B is $170. If you work and depending upon your salary it can be a lot more. I am paying $450 (about).
 
One correction. The base cost of Medicare Part B is $170. If you work and depending upon your salary it can be a lot more. I am paying $450 (about).
Good point! Then again in your case if your paying $450 for Medicare B, the health care cost most likely doesnt concern you. :eek:)
 
I am 73, Medicare Advantge with a $16 extra a month to bring down copays…Despite not having the risk factors, 2-1/2 years ago I was diagnosed with a very lethal cancer. since then I have has several nasty surgeries, chemo and radiation..and for the last 1-1/2 years it‘s a stage 4 requiring chemo treatments every three weeks plus daily oral chemo…I mention this due to the co pays, we have actually paid about $16,000 out of pocket…The total cost of treatment would buy a nice Italian sports car with the horse logo… Always try to have some cash on hand because you never know about tomorrow …Oh,I can still work on and ride my motorcycles and hug my wife, it could be worse ,LOL
 
Back
Top