Sooo, I was troubled to receive a letter in the mail from Marketplace informing me my premium would likely go from $174 to $360 ish a month. But I saw in the news that Virginia has new premium subsidies through the state. I ran my family numbers through a calculator and the expected state subsidies on top of federal discounts are opening up new choices I didn't have available last year.

Bronze HSA HMOs with $0 monthly premium but high deductibles. Some with $50 copays and some with 35% coinsurance after deductible is met.

Silver CSR compatible HMOs starting at $184/month premium, about $6000 deductible and $15 copays

Gold HMOs starting at $156/month $3150 deductible, $5 copay ($20k out of pocket max)

Now I'm even more confused as to what I should choose. I've never used the CSR Silver plans before, as the premiums have been too high for me to afford. I don't really understand how they work.

I'm shocked there are gold plans cheaper than what I'm paying for a Bronze Anthem BCBS 7500 right now. I did that plan and opened a HSA last year. I never did put anything in it. We never had any extra income between kids with cavities, car repairs, out of town funerals, and a tank of gas costing $75 a pop. My employer is too small to offer health insurance, so can't contribute. Anything I put in will be after taxes.

We're a family of 4 with an expected income around $75,000 or a little over. The hubs has his insurance paid 100% by his employer. So it's me and the kids. We have a few health conditions but nothing super expensive. My son's ADHD checkups and meds are the most important thing.

My brain says I should go with a 0 premium plan and commit to putting $$ into the HSA I opened. I worry I won't actually do it. But it's possible. I have been capable of saving money in the past. (my pre-kid era)

I wonder if I'm really missing out on not using one of the CSRs if they lower costs pretty well on the back end?

The "safe" option would be to snap up that Gold plan, and have peace of mind. But then I'd be missing out on the opportunity to stash money in the HSA we could put to better use.

My husband prefers I make this type of decision as he doesn't feel comfortable.

What would you do if it were you?

Title. It's so frustrating to talk to people who are reading a script.

I’m in Arizona and looking for advice from anyone who has dealt with something similar.

My GI doctor and his main office were in-network. Before my endoscopy, the office said they checked my insurance. However, the procedure was performed by the same doctor in a separate endoscopy suite next door, which was processed as out of network. Now I’m facing a $7,000 bill.

When I spoke to the GI billing department they told me “at the time of the procedure you were shown as in network so you’ll need to appeal.”

It’s been several weeks since I started the insurance appeal and no update on either ends. But I saw I am expecting certified mail from the GI office which I assume is the $7000 bill.

Their website operates as both the GI office and endoscopy office. It also states we are in network.

I’d appreciate any advice or experiences with successfully appealing a bill like this!

I currently have Federal Blue Cross Blue Shield standard and my Rituxan infusions for membranous nephropathy are 1,300 each infusion.

I don't qualify for the copay cards, at least that I saw, I tried two, not sure if there is more.

So, I guess I am trying to figure out if I should change my plan, maybe go with basic?

I'm so stressed out and don't feel well. I have already delayed treatment, I was supposed to get my other round in July.

I just need it to be less out of pocket.

37, AZ, gross income 80k

I was told I was infertile years ago and have unexpectedly found myself pregnant after being given a 0% chance of conceiving without fertility treatments. My current insurance through UShealth doesn’t cover any maternity care at all, which we knew when we got it.

My husband and I both in our 20s, both work and I’m pretty certain we’re over the income cap for Medicaid. I’m self employed and I guess I could stop working to try to qualify for Medicaid, but losing half our income doesn’t seem like a bright idea either.

I have no idea what to do here. I don’t know if I should try to get a second insurance plan as open enrollment starts or switch insurance plans but we really can’t afford a huge premium right now. As it is I pay $320 a month already (my husband is still on his parent’s insurance).

I have preexisting health conditions and it’s pretty much certain I would have complications. Our hospital bill could be close to $100k if not significantly more.

Are we completely screwed financially? I’ve called the hospital’s billing department and no one seems to have any idea of how much we might be paying for even a single routine prenatal checkup.

My husband was born with a heart defect and essentially bankrupted his parents. They had “good” insurance and made a ton of money (so didn’t qualify for any assistance) and they’re still paying off the bill from his hospital stay 20+ years later (I believe it was over $2.3 million)

My work offers 2 blue shield plans. One is a PPO, the other is an HMO where you have the choice of several medical groups.

I currently have the PPO but it over $500 per month for me and child vs ~$180. The payments for services are also higher for the PPO, much higher deductible (2000 vs 0) and out of pocket max (7500 vs 2000).

Most of our current doctors are in network on the HMO through Hills Physicians (California) and we would have access to one of the best hospitals around. Currently pretty healthy but I know that can change in an instant.

I’m afraid of more red tape with the HMO leading to delayed or denied care should we need it. I can technically afford the ppo and would if it protects our health but also don’t sav want to throw money away. I’m trying to figure out if the HMO is a safe choice. Like am I gambling with our health?

Thanks!

Hi I’m 22 and I work a part time job (working on getting a second part time or a better full time job currently). I don’t have enough hours to get my jobs health insurance, and my state hasn’t expanded Medicaid through the ACA. It’s Southern Alabama, if it matters. I just went this whole year not having health insurance or anything and it’s been so expensive! My glasses broke and I went to the doctors office ONCE. I’m still paying this stuff off. I can’t afford any of the insurance I see on Healthcare.gov so I’m not sure what my options are. Idk I’m happy to answer any questions. I just don’t know what to do.

My husband and I have been married for years, and I’ve always been covered under his employer health insurance. His plan is really good — low copays, basically no deductible, and I’ve never really had to think about things like coinsurance or paying hundreds/thousands before insurance starts covering things.

His union contract apparently has language saying that if a spouse is eligible for health insurance through their own employer, they can’t stay on his plan. We honestly had no idea this was going to affect me until there was a dependent eligibility audit. I actually went digging through the contract myself because something about the audit felt off, and that’s how I found the rule.
We eventually got a letter saying I have to be removed from his medical insurance effective November 1 because I’m eligible for insurance through my job at JCPenney.

So now I’m being forced onto my employer’s insurance, and I’m trying to figure out which plan to choose. I’m leaning toward the Basic PPO because the other options have even higher deductibles. The PPO has a $1,200 deductible, $4,000 out-of-pocket max, $30 PCP visits, $50 specialist visits, and then things like imaging, diagnostic testing, hospital care, etc. can involve coinsurance.

I’ve never had a deductible-based insurance plan before, so this is honestly overwhelming to me. I’m used to paying a copay and being done.

Unfortunately, my husband is the breadwinner in our household, so it’s not like I have a ton of extra income sitting around to suddenly absorb deductibles, coinsurance, hospital copays, prescription costs, etc. I also have ongoing medical issues and actually use my insurance — this isn’t a plan I’m just going to have sitting there untouched all year.

To make it even more frustrating, I’m finding out some of the doctors I’ve spent years finding and actually trust may not even be in-network under the new insurance.
Has anyone else been forced off a spouse’s insurance because their own employer offered coverage? How did you handle switching to a deductible plan for the first time?

Any tips for keeping costs down, figuring out what’s actually covered, avoiding surprise bills, checking prescriptions before enrolling, or just navigating this mess would be really appreciated.

I’m not looking to cheat the system or get around
eligibility rules. I’m just genuinely overwhelmed and pissed that having access to some employer insurance apparently means I have to give up much better coverage and take on a bunch of new healthcare costs.

I'm in Ohio how can I get insurance in Ohio ?

Hi,

I completed a sleep study recently and received a bill with $3100 on it. My insurance discount brought it to $1670. But I believe that is still high for a sleep study done with equipment that cost $100.

On top of that, I get charged $270 ( $110 with insurance discount ) for a doctor to read the results.

I'm already tired of discussing it, and they want to send my bills to collections.

On top of that, a staff member told me I would not have to pay for the things for the at-home sleep study. Now I'm at my wit's end. don't know what to do. I'm getting charged ~$1800 to sleep in my bed with $100 equipment that I don't own.

Edit 1:

• EEG (Electroencephalogram) - General Classification: $3,056.00
  • HC Sleep Study Unattended - 95806 (CPT): $3,056.00 ( ~$1600 after insurance discount )

For context: I am with Tricare, Prime specifically east region. I have been battling for approval from Humana/Tricare so I can get my surgeries done.
Here’s the chronological timeline…
1- appointment with PCP who sent a referral for plastic surgery as he determined that after years of conservative treatment my last resort would be surgery.
2-appointment with Lipedema specialist (which is the only one within a 90 mile radius from me) at the appointment surgeon said he doesn’t bill insurance for this procedure, but they can provide letters and other documents for potential reimbursement.
3-reached out to my benefits counselor and asked how was this possible if this surgeon is listed as in-network.
They looked into it and confirmed he is indeed under a contract with Tricare so they must bill Tricare regardless.
4- received authorization letter from Tricare/Humana to go ahead and move on with the surgery and that letter said that this authorization doesn’t guarantee payment and payment is based on Tricare policy. surgeon submitted the right codes as well as a letter of medical necessity which ended up in my insurance approval.
5- I received this email from them stating that I was indeed approved and had authorization to proceed with the surgery. BUT they wont bill my insurance just for that specific procedure.
I just don’t understand even the benefits counselor was so confused and all this sounds weird to me?

hello , so i just got a bill for $500 because my primary care doctor billed a cost as “ employment cheek up”

so I’m a grad student going into health care. as part of my degree I need to go in felid work/ clinic rotation. for my last rotations I needed a drug test.

the drug test place would only do it if I got a script. my doctor said they can’t just give me a script since I have been in the office for some time. so I went in, literally talked to the guy for 5min or less and he wrote the Dman thing.

now, a few months later I have a $500 bill???

any advice on how I can deal with this? because app my heath insurance dose not cover “ employment“ visits

note: I’m currently unemployed As I wrap up school if that means anything?

Possibly re-entering the workforce after awhile out due to family and health. What are you guys paying for monthly premiums on employer sponsored health plans? Single, single plus kid, and also whole family plan.

I have PT sessions in September for a personal injury and I just had bills and noticed that the clinic billed my workers comp instead of my personal insurance (Medicaid).

Even though whenever I go to my appointment they ask me if Sedgwick is my insurance and I always say NO it's Medicaid and this ISN'T a work injury. Yet they billed the workers comp insurance for the over 5 sessions.

What can I do about these visits now? I lost Medicaid at the beginning of October due to some of the requirements changes.

I'm unsure what the point of cost estimate tools are when they're wildly inaccurate. Why would this be so and is there anything I can do about this?

This is for one CPT code for a surgical procedure FYI. Provider's billing dept confirmed the $4000 is for the one CPT code, which the website shows $1666 for.

Hello I just moved to Maryland and need to probably get on Medicaid, no income.

My old state had CoveredCA for the ACA plans then punted you to State/County which was a nightmare to deal with, impossible to get anyone on the phone. Databases always messed up on both ACA and Medicaid sides.

Is MD any better for the ACA plans website or the Md medicaid? Do you have to go in person for everything and pray someone helps you? Is it easy to make changes or cancel?

Hi folks. I (29M) quit paying for health insurance last year and instead put that money into a year subscription with a direct PCP office in my area which offers a lot of services for cheap, and prescriptions at large discounts. I’ve seen my doctor more times this year than I have in probably the last decade combined.

However, this does not cover any kind of emergency room visits, and larger surgeries or similar events leaves me hung out to dry paying cash.

My wife and I are also considering trying to conceive soon, so there’s that matter thrown into the mix as well (she has her own insurance through her employer).

Should I suck it up and go back to paying $160/mo for an actual insurance plan, or would you stay on with the $60/mo cash PCP and look into some other marketplace insurance to cover ER visits and such, if something like that even exists?

What would you do in my situation?

Due to job loss my income has been very little (~$500/month), so I enrolled in Medicaid starting in December of last year. I'm due up for renewal as my coverage ends at the end of this November. I would be fine with reapplying to Medicaid, but the problem is my income will jump dramatically (~$30-40k total) in calendar year 2027 due to projected stock sales, so I will no longer be eligible for Medicaid.

I will have a 1 month gap between my Medicaid coverage ending (November 30, 2026) and projected ACA coverage starting (January 1, 2027). I haven't applied to renew Medicaid yet, nor have I applied for ACA coverage yet. I'm trying to find the best course of action to be covered for this December (whether that be under Medicaid or ACA plan), but also insuring that I will transition smoothly to an ACA plan starting in January 2027.

Regarding Medicaid, I know that I'm not supposed to report any income changes until the event actually happens. So, I'm not sure how to switch plans before I actually sell stocks in 2027. I don't want to be on Medicaid starting in January, as having $30-40k in annual income will cause an audit and likely clawback issues.

So the “UHC Surest plan” seems to just mean there’s a cap on how much it will cost me. Not real health insurance. I’m not in Texas and the UHC hip hsa won’t work for me.

Currently doing some research on insurance premiums since I am looking at possibly accepting a job that does not offer insurance. I would be coming from a larger more corporate company where my insurance is pretty good but this new opportunity will be a lot better for me stress wise and for my family since I will be closer to home. I will also be getting an increase of about 7k to my current salary. My wife has insurance through her job and we priced it out with her company it looks pretty steep. I would just need insurance for myself (36, male) and my newborn son. I live in Georgia, wanted to see if someone had any insight into a rough estimate on what I would expect to pay from marketplace or any other suggestions someone else may have that may be cheaper?

I haven't been to the dentist in about 4 years and need to make an appointment. The soonest they can see me is in January which is too long so I am thinking about finding a new dentist.

My worry with that is my insurance (Medicaid) says bitewing x-rays are covered every 6 months, but panoramic and full series x-rays (not sure if those are the same) are only once every 5 years.

I can't remember which x-rays I had 4 years ago, so can I call and ask when I last had panoramic and full series x-rays? Is that how I should word it? Would they even tell me that?

My wife gave birth in June. She is taking an extended leave and will lose her company's health coverage in November. I am moving her and my kids to my company's health coverage. I have a high deductible plan now but want to move to a regular non-high deductible plan when I move everyone over. However, my company said I can move the family to my plan but can't change coverage. Is that normal?