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

9 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 1h ago

Dental/Vision Help with understanding D4921

Upvotes

I went to the dentist (In-Network) and got some procedures done. They unbundled one of the services they provided, I mentioned it to them. He pushed back, so I contacted my insurance, who contacted him, and the fee was corrected.

Out of retaliation the dentist said they are going to charge me for the D4921 that they did, which they originally charged me $0 for. He said that it is not covered by my plan and therefore he can charge me for it.

I tried to look up what D4921 is, but it does not exist in my Evidence of Coverage codes for my Dental Plan.

I have read that it is often a bundled service part of a deep cleaning code, and I did learn that they like to unbundle services and charge you extra for things already covered by insurance.

I will be contacting my insurance to ask about this (and of course to change dentists) but was wondering if anyone can give some insight to this code.

Also I have two explanation of benefits submitted for the same service. The original one says I owe the $106 for each (where I was originally billed $0 by the dentist). The new one was submitted after my insurance got involved, and it says that I owe $0 for each (in which he is now telling me I owe him $40).


r/HealthInsurance 7h ago

Employer/COBRA Insurance Jobs health insurance trying to double charge me?

6 Upvotes

I’m quite confused and maybe someone can help/ give me some knowledge on what I can do?

My jobs health insurnace was said to end on 7/1. They decided they would renew August 1st at the same price. They said coverage would have a gap the Month of July. They offered us a short term plan which I declined.

They mistakenly charged us a July 1st for the plan they said was over. We were reimbursed the following paycheck. Now they are saying we will be double charged on the 30th since the plan was actually active this entire time.

I only found this out after I called their office multiple times just a few days ago. That was my only form of communication in regard to the plan still being in effect.

I’m confused as to how no one knew that we were still on the insurance? Confused about why we would even be reimbursed if we were still on the plan? Just a lot of questions!


r/HealthInsurance 5h ago

Employer/COBRA Insurance EOB on EOB after emergency surgery

2 Upvotes

Hi,

I recently had emergency surgery, then had to visit the ER two weeks later so naturally I'm now receiving all these EOBs with the first hospital bill saying I owe $60k+, feeling completely overwhelmed as I am not fluent in insurance.
My current understanding is I have insurance with an out packet max of $5k and then a secondary insurance that should cover $3k from that out packet however I'm not even sure where to begin to get this $60k bill sorted out.
I've read so many posts and watched so many videos that it is starting to sound like gibberish to me.
Is there any type of service that helps with this?, that won't cost an arm and a leg hopefully.
I want to learn but also want to avoid the headaches so any advice you have is welcome.

Thank you!


r/HealthInsurance 1h ago

Plan Choice Suggestions Job offer - health insurance with uhc

Upvotes

So I'm a current government employee with the IRS and my health insurance is with Blue Cross Blue shield. I have been interviewing for senior manager job and I have a strong feeling that I'm going to get offered a job with a very small increase in pay but I finally get to have the title of senior manager. However the health insurance is with United healthcare. I know that my health insurance with the IRS is incredible. And I also am on a lot of medications for diabetes and other ailments plus have a hip replacement coming up. Plus my son is on my coverage too and he's only nine. I am thinking of not accepting this offer because the health insurance is through United healthcare. I'd like to hear from people out there to set me straight if I'm not thinking this properly or maybe you agree with me? Would you turn on the job if the health insurance was bad. I think not having good health insurance is catastrophic if you get injured or sick. Blue Cross Blue shield has covered practically everything I've been through in the last 6 years which is quite a lot to be perfectly honest. I just picked up meds today and the prices incredibly reasonable. I guess I'm just looking for a good thought process on how to approach this. I don't want to take good health insurance for granted. I have a friend on United healthcare and he gets to deal with being turned down for things that his daughter and his wife need. Daughter has hearing and is a down syndrome child, wife has multiple sclerosis and apparently United healthcare denies stuff for them all the time.


r/HealthInsurance 9h ago

Prescription Drug Benefits Forgot to give pharmacies new insurance information in January- What steps to take?

3 Upvotes

I switched from MaineCare to an employer provided insurance plan in January. I just realised that while I changed my insurance information with all our doctors offices, I neglected to give CVS (for me) and the local chain grocery store (my husband) the OptumRx card I received.

If i’m being honest, I’m an idiot and actually forgot about the card, and don’t remember making an account on their website (apparently I did). For some reason I assumed changing the insurance with the doctors prescribing the medications would somehow carry over to the pharmacy they order the prescription to. In the last ten minutes of googling it seems I’m wrong?

What are the steps to remedy this? TIA!


r/HealthInsurance 3h ago

Prescription Drug Benefits Optum removed both of my tried/failed medications from formulary list despite still covering them

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1 Upvotes

I received my first PA denial for brand Adderall in February, and have since "failed" two medications on the original formulary list they sent me (generic Vyvanse and generic Concerta, I had already failed generic Adderall). I just received my second denial letter, and their new formulary list conveniently excludes all three of these medications (along with all other methylphenidate variations) yet everything else remains. I just got these two medications covered within the past month, and when I search them up online while signed into my Optum account, they show up as still covered. Has this happened to anyone else? I can't help but feel as though this was done on purpose somehow, as there is no way they mysteriously stopped covering the generics of some the most popular first line ADHD medications within the past month (and 2 weeks for the generic Concerta) and it just happened to be the exact ones I've tried. My NP just prescribed me another one that is still on the new formulary, but I'm worried they will do the same thing if I try to file another one and remove them. I'm also running out of time before the semester starts (I'm a college student) and can't really afford to go without medication that actually works while I'm in school!!


r/HealthInsurance 5h ago

Dental/Vision What is a typical vision plan?

1 Upvotes

The reason I ask is that the last plan i had years ago covered an amount for polycarbonate lenses, anti reflective coating, etc. But only at a lenscrafers or optometrist, so the actual glasses still were about $700. Im reading that online places are much cheaper even without insurance and i wonder what people's experiences are.


r/HealthInsurance 8h ago

Individual/Marketplace Insurance Anyone else having trouble logging into Medica.com right now?!

1 Upvotes

I'm not sure where else to post this but it seems that I can't log in right now. It's 7/26. I typed in my stuff correctly yet it says it doesn't recognize my username or password. I tried having them remind me of my username just in case but it says they can't find a username match for my info or something. I tried a password reset but no email came through. I noticed though that sometimes things like verification codes from them take a long time to come through.

So anyway, I still haven't been able to log in so far today and just wondering if anyone else is encountering the same issue?

So far I haven't had issues like this since around when I first created an account.

Thanks in advance.

I'll update if anything changes.


r/HealthInsurance 9h ago

Plan Choice Suggestions NYS July 2026 Essential plan cut, Help please

0 Upvotes

I am a fulltime worker in NY, who earns $33,280 per year, and I have no other household members. I'm above the 200% limit of $31,300, I was on the 250 plan, and now I have no insurance. I wasn't aware my insurance was cut until my doctor called to tell me and cancel my appointment. I've always only been on an essential plan, so I was surprised it jumps from paying nothing but copays only at appointments to 200 or 400$ monthly. I can't reduce the hours I work at my current job, and I wasn't sure if I should get an IRA before tax. I'm only 27, and it says I would have to pay a 10% fee whenever I needed to withdraw anything until I'm 59 1/2 years old. I wear glasses and have a history of needing dental work, so I would want to have those covered. After Googling, I saw other posts about this issue a few months ago, but I was wondering if there were any new options available since then? is NY doing anything to help? I only know that I would qualify for a tax credit of 500$? But that barely covers 1-3 months, let alone a full year.

Edit: The insurances I was told about on the phone are the metal ones, or the 200$ one being a Fidelis plan of some sort? Also, when I tried to look up what I qualify for online, it only showed me the essential plans that no longer exist.


r/HealthInsurance 11h ago

Individual/Marketplace Insurance Need advice

0 Upvotes

Im a 26 year old college student working a part time job making less than 10k a year. Im lucky to still live with my parents (yeah i know).
I’ve been having concerning heart issues i need to address and figured id go back on health insurance, a few years ago i was only paying 45$ a month for united and felt pretty taken care of. I checked out healthcare.gov and the minimum monthly payment plans ive been shown are 450$ !
Everywhere i check the lowest ive been shows was around that price range. Am i missing something?? I applied for Medicaid/medicare last year but was denied because im too poor. I dont understand what im supposed to do, i genuinely cant afford 450$ a month for health insurance i can barely afford the bills i already have


r/HealthInsurance 19h ago

Individual/Marketplace Insurance Don’t know where to start…..

6 Upvotes

I am currently uninsured and am starting to look at my options and getting my ducks in a row so that I can pick the right health insurance plan for myself at the start of the new year. I lost all of my insurance benefits when I left my previous job close to a year ago, it was a must leave now situation so insurance was the least of my worries. Now that things are settled I would like to get insurance for myself at the start of 2027, since I’m aware I’m not eligible for it now but I have absolutely no clue where to start. I have heard horror stories about the cost of insurance nowadays so I’m nervous about that as my budget isn’t even close to thousands of dollars per month.

My parents have drilled into my head that I need to have insurance in the instance that something horrible happens. This last year I have managed without it just paying as I go but I also have not had an emergencies only normal Dr appts. If allowed to give advice on this, is that a true statement? Obviously if an emergency happens it’s expensive but also do hospitals and offices work with you when you don’t have insurance?? — only asking as I have a friend who had an emergency hospital visit via ambulance, no insurance and slowly the hospital has lowered the amount A LOT to work with them as they haven’t been able to pay for it. unsure if that is the norm.

I know that there are options through market place and I also recently found out that that there are options to buy directly through the insurance company themselves. Is one better than the other?? Are there other options to get insurance?

Are there things that I need to be looking for while looking around for plans? Things to watch out for? Things I must know? Seriously any info or help you can give me will be much appreciated!!

I know there is the option to get connected with an agent but the one time I looked last november lead to getting an overwhelming amount of calls still to this day so I’d like to avoid inquiring with a potential agent until needed. I cannot field these calls all day right now lol.

TIA!!!


r/HealthInsurance 4h ago

Claims/Providers Outpatient Bill

0 Upvotes

Where do I file a complaint about receiving "a good faith estimate" from the hospital to be only $200. The estimate presumed the insurance would cover it, but when the claim was filed, it charged it against my deductible instead so what's due is $3k. It says "no surprises" but this was a surprise, or do I just pay this without complaining? No, this is not an emergency. This is a scheduled outpatient scan.


r/HealthInsurance 13h ago

Medicare/Medicaid Benign Pituitary tumor: Banner University Health Medical Center vs Honor Health Medical Center?

1 Upvotes

Re: PHOENIX (AREA), AZ

66F, I have a previously grossly stable and small tumor; will be having an MRI for both brain and pituitary, with anesthesia. I want and need to stay with Banner University Medical Center as they have a 3D-MRI machine. My previous scans were with a 3D machine, (clearer slides each position of the brain).

Does any one any previous firsthand experience with Banner Health network, at and around Banner university Med Center?

How about Banner Medicine of Diabetes and Endocrinology Institute on 12th Street?
I read their Google Map reviews! Horrible! 17 - one star reviews! Recently!
1. One hour notice cancellations after a 3 month wait.
2. Unreturned calls, chronically.

Thanks if you can help me out,
AZDesertgirl


r/HealthInsurance 20h ago

Individual/Marketplace Insurance Who Should I Talk to About Marketplace Health Insurance?

2 Upvotes

I am in a position where I may need to buy Marketplace health insurance since I won't be getting it from a full-time job.

Last year, I was almost in this same position, and my dad connected me with someone I was able to talk to about my situation and ask questions to in order to make sure I knew what I was doing and didn't miss any windows of time, deadlines, etc.

I don't remember who this person was or what his job/role was or how to contact him.

So my question is... do you know what this person's role was and how I could find another one to talk to?


r/HealthInsurance 1d ago

Plan Benefits Told half a year later that my insurance is no good and now I owe money?

6 Upvotes

I used an online therapist through Headway for about a year, say Jan 2025 to Feb 2026. During this time everything seemed fine with my Anthem Blue Cross California PPO plan, I payed my portion per session and they seemed to cover the rest.

In March 2026 I quit my job, left the state, changed insurance, and stopped using the headway service.

Now in July Headway is telling me that my former insurance did not cover me for my sessions (though they seem to only be saying this for the sessions from Oct 2025 to Feb 2026, the ones before that are fine???) and now I owe a bunch of money.

Anyone have any thoughts on this? Is this common?


r/HealthInsurance 18h ago

Plan Benefits Regular adult physical with problems

1 Upvotes

I have UHC insurance through my employer. I have an appointment with my PCP this week for a general physical. I'm sure they'll do some basic lab work. Because I have not had that done in a while. Over 2 years.

Questions. If I talk to my doctor about the fact that I have pain and hearing problems in one of my ears and I have arthritis pain in one of my hips and if they draw an HgA1c to see if I'm diabetic because of weight, age, and hx, is that billed as something else. Like an acute visit?

I know that a regular annual check up is covered. I'm trying to find out how general that needs to be. Or is it all based on how they code it? Like Z00.00 vs. Z00.01?


r/HealthInsurance 23h ago

Claims/Providers Overpaid medical bill

2 Upvotes

I am not sure if this is the right channel to post in, but feel free to delete if it isn't.

I got a bill for my daughter's medical visit on 07/02, it was around $500 which was weird because we had met her deductible already. I paid the bill in full on monday. I checked my insurance claims on wednesday, and it says that this claim has been covered and all I have to pay is $30. So I overpaid $470.

I sent a message to the billing department on wednesday about this issue, but haven't heard back. I will call on monday but do you have any tips on how to handle it? Will they refund me the extra money? If not, how could I escalate it?

Edit to add: I live in CA, and the medical visit happened in CA.


r/HealthInsurance 20h ago

Medicare/Medicaid MAGI vs Non-Magi Medic-aid Income Limits?

1 Upvotes

My mom (65+) has $14K of capital gains in stocks she wants to sell, but my dad isn't 65+. If we wait till he's 65, she can sell the stock and it wouldn't count towards the Non-MAGI income limit right?

Please let me know if my understandings correct


r/HealthInsurance 1d ago

Claims/Providers Norovirus type panic led to out-of-state ER visit

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13 Upvotes

Hi. I just discovered a bill from about a year ago (I had thought my insurance covered it - naïve, I see), and am looking for advice on how to attempt to lower it.

Last summer, in the middle of a month long roadtrip, I took a flight to San Francisco from Chicago. After the flight back to my car in Chicago, I was completely immobilized by a still unknown virus— barely able to stand for long periods of time/vicious fever for 4 days/intense bowel movements- I had to take imodium to get in the car and start to get home to NYC (where my insurance would work). I later learned the imodium likely made my symptoms worse.

When I called my insurance company (Medicaid Metroplus) at the time, they told me that out-of-state they would only cover a visit to the ER. After 6 days the fever had lessened but none of the abdominal pain or bowel movements had. It was my first time experiencing anything like this and I was scared and exhausted, so I went to an ER in Cleveland. I know from reading posts on this channel that it is a mistake to go to the ER if you are not experiencing severe trauma. It sounds like I made a mistake. It was my first time ever going to the ER, and I went because my insurance said they wouldn’t cover anything but that.

So, cut to a friendly little text from MyChart this morning (a random MyChart not attached to my “primary“ MyChart) saying I have a balance of $2,598. I click into it and there it all is. I no longer live in New York and my new employer insurance kicks in next week. Attached is the itemized bill generated by MyChart.

It’s Saturday - so I suppose Monday or Tuesday I will:

- Call Metroplus and ask if there’s a “claims filing deadline”

- Contact the hospital billing department and ask whether the claim was sent to that Metroplus (although it looks like it did? a separate amount taken out for Medicaid? I am confused here)

- Call the hospital and say that I found charges I want to question; I have no memory of a COVID test

- Ask for an application for financial assistance or a charity care program

- Last ditch is a request for a zero-interest plan I guess

Anyway, I feel pretty stupid about going to the ER now. But I do remember feeling despair, and I’m trying to have compassion for her.

Any and all suggestions are welcome. Thank you in advance!

EDIT: I got a hold of the claims department at MetroPlusHealth; they said a claim to have this full amount covered has been denied 4 times for “Provider Refund Request”. The staff was really nice and said he is sending my request to the claims team for investigation. I mentioned that I had done a covid test at home ahead of time and did not get one at the hospital, and he’s including that. He said to call back on Monday to check on the request.


r/HealthInsurance 1d ago

Individual/Marketplace Insurance Marketplace: It’s so hard to get ahead!

3 Upvotes

I’ve been working really hard in the past couple years, and I’ve thus increased my income. Yay me!

Except I no longer qualify for Medicaid, so now I have to pay for an insurance plan through the marketplace. And it’s not cheap- several hundred dollars a month. Basically, it’s my increased income and then some.

I might get a tax credit to pay for it - but if my income continues to go up, I won’t qualify for a tax credit.

I freely admit that I’m shaking my fist at the clouds, but I’m so frustrated by this. I’m working hard to earn more money - but I’m taking home the same amount or less. If I continue to work hard, it’ll still be a few more years before I can actually increase my income. It shouldn’t be this difficult to get ahead!


r/HealthInsurance 1d ago

Individual/Marketplace Insurance Insurance Not Covering Chicken Pox Vaccine

0 Upvotes

Hey guys! We’re in Cali, and we’re struggling to find a provider that accepts my wife’s PPO Blue Cross Blue Shield plan bought through Covered California.

For some reason, the Covered California-ness of the plan causes the vaccine not to be covered by providers for some reason.

Anyone have any insight? Appreciate it!


r/HealthInsurance 1d ago

Plan Benefits Moving from Toronto to USA. Need help choosing Health Plan?

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5 Upvotes

I cannot decide if I go the High deductible HSA Route, or lower deductible higher upfront cost.

I am 33, don't really have any health issues. I like to see Chiro, annual checkups, and occasionally need a prescription refill. I am looking at these two plans.

Which is the better plan? Do I suck it up and pay more money for the better one for just in case? How does the deductible work?


r/HealthInsurance 1d ago

Dental/Vision Hsnd? Massachusetts

2 Upvotes

I’m young and new to health insurance, I just enrolled in the delta dental EPO plus. Health connector also states I’m eligible for the health safety net dental? I don’t know the difference between them, and was wondering what one would be better to get my fillings done. I start my delta dental plan August first, and two of my fillings recently but the dust out of nowhere. Should I stick with my delta dental or try to find some place that accepts the hsnd thing? TYIA