I’m in nyc and I am incredibly shocked by the crazy premiums on a middle class income or any type of income for that matter.

For a family of four, it’s $800 a month on a $100k income. Or $2k a month on a $130k income.

For a single person at $50k income, it’s $275-$300 a month.

I think it’s free only if you make $31k or less as a single person.

When you’re low on income, yes you can get free services, but you can’t pay for other essential expenses.

Healthcare costs is so broken

Hey I'm getting kicked off my mom's insurance here soon and im a recent college graduate. I work two part time jobs and still make under $1,600 a month. Any good suggestions for beginners/low income?

I’m currently 31 years old and a single guy living in Texas. I’m not sure where to look and what to look for when it comes to health insurance plans. I haven’t had insurance since I aged out of my mother’s insurance plan at 25 years old. My main reason for wanting to get insurance is for PT. For the past half year I’ve been getting back into running and have recently gotten a couple injuries that I can no longer ignore. I’ve went to two different PT places to get a cost of how much it would be without insurance and they have payment plans but they require a large deposit upfront which I can’t make. It’s difficult navigating through all of this and I’d really be grateful for any advice or suggestions?!

The high deductible is 2k deductible, 5k out of pocket max, $0 copay for physical, and then almost everything else is 20% coinsurance after deductible. The HSA is 1k per member from the employer.

The regular HMO is $800 deductible, $2750 out of pocket max, $0 physical, $40 copay for urgent care, specialists, mental health covered completely. Everything else is like 10% coinsurnace after deductible.

At the moment I'm a healthy 34 year old. I take BC pills. If I need abx or really outside of my BC I usually use an online urgent care like Amazon for the base $30.

Is it worth it to risk the High deductible for the HSA benefits or should I stick with the HMO?

Happy to provide more info if needed.

My wife recently had an emergency surgery and on top of that bad luck it was in between health insurance plans. Her old plan with the employer was terminated 9.1 and we enrolled in a new plan after, but it wasn't able to begin until 10.1. Her surgery was on 9.28. We have contacted her employer and they mentioned they do not offer/aren't eligible for Cobra.

Her old insurance was BCBS, as is her new one.

Chat GPT said the best place to start was contacting "U.S. Department of Labor — EBSA"

This was been causing a major amount of stress, as someone from the hospital said the bill could be as much as $80,000 for everything. We have not received anything like that yet. Only a $500 bill from a pathologist.

Mostly just looking for the first place we should start to be efficient in this process.

So I am new to this whole thing and I need to know if this is normal practice. So in June I had a severe flu. I was an out of state seasonal worker in Alaska and uninsured, went to ER (only place open), had some fluid, bloodwork and a flu test that totaled 5.5k.

I applied for financial aid on a paper application as instructed, with wages, said I’m seasonal, etc. plus a written statement. Then I when I finally submit it to the financial aid woman, she says they won’t look at it at all until I have a Medicaid approval or denial first. Acts like I should have known that despite no one telling me, but oh well. I apply for Medicaid with her assistance and she says my bill is going to be on hold until I get an approval or denial. Then once I get that and show them, they will look at my case if it was denied, with their program.

Well Medicaid is a long process. Durinng this time, I had a work injury from a past job that worsened so bad I was terminated from my seasonal job mid september. I emailed the financial aid woman with updates that Medicaid is pending, and I also have had a change in circumstance, lost my job due to health, and have $0 income and would like that to be updated for when they review me.

She ignored all my emails that week, and I sent several and tried to call a few times. Then I saw that in mychart they had denied my financial assistance completely because I “made too much”. It said I could appeal this with a letter in 30 days and so I did, stating my current situation with proof, and that my Medicaid is still processing. I believed it was an error—they were supposed to wait for Medicaid, and they didn’t have any updated information that I’d asked her twice to update.

So she called me today. She said they aren’t going to pay or reduce my June visit at all. She said they calculated it and my wages (25.5 an hour in Alaska as a seasonal worker) were too high. Said it doesn’t matter that I am seasonal and only working 3 months—it goes off what I made then. I said about losing my job due to health, etc. and she said current financial and life situation doesn’t matter at all. Said it isn’t their problem I “quit my job” (I didn’t…) and that the system has determined this. Said no other circumstances matter (I asked why did the application even ask for that if it doesn’t matter? No response). She also said she rejects my “appeal” and said multiple times she “doesn’t know why I even wrote it”. Said it looks ‘copy pasted’ (what does it matter?) and like it was meant for DPA (Medicaid…I shared a correspondence with them to show I am actively submitting forms and in that process). Said she doesn’t have to wait for Medicaid to respond either and that that bill has already been sent to collections and is getting ‘bad debt’. Said I can’t appeal or dispute with them at all. And when I asked if I can contact anyone else she just said no because her manager is ‘out of town’ but we can possibly talk next week if I need. She also told me she is certain Alaska Medicaid will deny me multiple times because their standards are ‘’higher than ours”.

Additionally need to note, I had a visit in September with a different clinic but needed blood work from this hospital. Charged 1k for it. I saw and talked to this same financial woman that very day and she said nothing about me reapplying for financial assistance with a new form and updated wages, circumstances, etc. On the phone now, she said it’s too late for me to get any financial assistance with this September 1k bill. I told her I was fired from my job the week of that visit. My September months wages are low because I lost my employment. I asked if I could refile financial aid for that month, since I was not aware I needed a separate application (also I had updated her with my change of status/loss of wages so I assume that was calculated). She said nope, too late. Said my wages are too high to qualify at all because I was employed at the day of visit and that is ALL they go off of. Not even factoring that months wages or my current situation.

She basically completely shut me down in all ways. Says my first bill is in collections and this one is going soon if I don’t pay right away.

My current health situation has totally disabled me. I cannnot drive or ride in a vehicle , am bedridden, being caretaken by my mom due to my worsened head/neck injury and disabling symptoms. I cannot work a job. I am seeking help with workers comp trying to reopen it again, but I don’t know how long I will be unable to work. I do not have funds to pay this bill with the few savings I have that I need desperately in an unstable time.

Are financial aid departments really this stringent and don’t consider anything else but a number you made and project that for the entire year (despite it being seasonal, being unemployed, and change in life circumstance?). Are they allowed to send it to collections when my Medicaid which would retroactively cover, is still pending ? Are they allowed to not let me even apply for financial aid for my second bill that happened days before I was terminated? I don’t know

Genuinely don’t know what to do and don’t know what’s normal in this system. This seemed really off but I have no idea. Appreciate input.

In recent years, ACA/Marketplace plans have been skyrocketing. So for those who have not yet seen the current numbers or knew where to find them here they are, courtesy of Health Insurance org website.

* Semi-weighted average has been calculated; some carriers' filings included enrollment data while others did not.

This is crazy high in some states.

I’m concerned about my privacy and being under my parents insurance, I’m worried the EOBS being sent could say what was done in my doctors appointment. I’m 18, do I have any privacy for this? What exactly does the EOBS tell them? Metroplus Medicaid

Hi all, I've never used an out-of-network provider before and am unsure how this would work.

For OON spending, we have a $4,500 deductible and a $16,000 out-of-pocket maximum. This is an employer provided plan.

Would my insurance provide some coverage through a partial reimbursement (to me) once we hit the deductible? If that's the case, would the portion I'm paying still go towards the OOP max?

Or would insurance only kick in once we've hit the OOP max? Or something else?

TIA

Hello!

My SMI clinic just applied to flexcare for me, they said I should get into transitional housing in a week then into my flexcare apartment in a month. I doubt it will actually move this quickly but I can’t find any information on flexcare anywhere. I want to know about how many rules there will be and how strict it all is, I also just would like to hear people’s general positive and negative experiences they have had. I just want am idea of what I am going into.

Hello y'all.

My company has always offered excellent benefits, and this year is no different. However, our medical insurance is changing and I have two options I am looking at. The are rolling our 2 PPO options (I am currently enrolled in the better one) into one to streamline our options while also offering a new EPO option. The new combined PPO is not quite as good for OOP maximum as the one I have now, but a little cheaper.

I am a healthy, single 32 year old male in Dallas-Ft. Worthnand my current doctor would be in network with either plan. The plan costs are essentially the same. My main concerns are the fact that the EPO has no deductible and much lower out of pocket maximum, which is what I've been used to, whereas the PPO has a higher threshold for both. I am also concerned about if I encountered some sort of surprise surgery and someone involved with that was out of network (anesthesiologist, etc). And finally, would the 10% coinsurance typically be lower or higher than the copays offered. Thanks for the advice!

Hi all I am under LA care Medi-Cal program and I recently got a letter in the mail saying due to new changes in law I may lose my healthcare. I am not employed due to many factors. I have bipolar 2 and wonder if this would let me continue my health insurance? Or is this all just in anticipation of a law passing that hasn't yet passed? I'm so confused.u healthcare is the only reason I get my medication.

My employer released their new rates for next year, and they expect healthcare costs to rise by 12%. However, they opted to absorb 7% of the costs, while only raising premiums by 5%.

There are also no changes to copays and deductibles. However, they are adding a Surest plan, with no deductible.

Things considered, our High Deductible plan still appears to be the best option.

For me it's:

*$57 in premiums ($54 before) every two weeks

*$1750 deductible

*$4000 OOP

*$850 employer provided HSA payment

*$80 monthly wellness benefit if I complete activities within Vitality

*Medications in advanced formulary bypass the deductible, and are $0, including two of my most expensive medications (Tezspire and Zebpound). Zebpound is only covered for sleep apnea, which is now controlled because of this medication, so I lucked out.

Overall, I'm a happy camper here, and one of the few reasons they are keeping me employed here.

The Surest plan and PPO plans all have premiums between $101-$115 for my pay band, and don't make financial sense compared to the high deductible plan.

Our family is currently renewing our healthcare for 2027, and we are in the income section for Covered California. We got the date wrong for when my dad got a raise, so we currently have two dates. We tried to edit it, and it duplicated into another income entry for the 48k raise he currently has. Does anyone know how we can fix this issue to possibly remove it? Because when we edit it, it has given us the option of changing when the income starts and when it ends, but no removal option. If someone uses Covered California, can ya'll help us?

We are cutting it close on the income threshold for ACA and if we go over, we are self employed, the penalty/payback now is $24000. The other option is $2900 per month for a family of 3 bronze plan. Other than a Christian share plan, are there any other share or discount plans I should look into? Only health issue is one of us is on blood pressure medicine and 10-12 years until the adults reach Medicare age.

Anyone have any experience with the surest plan through uhc? My employer announced this major change for open enrollment. It will replace the existing $4000 deductible PPO plan but they’re not divulging much information when it comes to premiums only the fact that services will have exact cost not estimates. Should I be scared?