Got an email from the HealthCare government Team today, with a headline of "USING YOUR NEW HEALTHCARE INSURANCE COVERAGE". It says:
"Learn how to use your new insurance coverage to fill a prescription, get care when and where you need it, improve your health, and appeal a decision by your insurance company.
Get prescription medication under your new plan. Health plans will help pay the cost of certain prescription medications. We can show you how to find out if your prescription is covered.
Get medical care and find a doctor. Most health plans give you the best deal on services when you see an “in-network” doctor who has a contract with your health plan. We can show you how to find doctors and other health care providers covered through your new plan.
Get emergency care. In an emergency, you should get care from the closest hospital that can help you. Your insurance company can't charge you more for getting emergency room services at an “out-of-network” hospital.
Improve your health. Now that you have health coverage, learn what you can do to stay healthy and get the care you need. Read health tips and information.
Appeal a health plan decision. If your health insurance company doesn’t pay for a specific health care provider or service, you have the right to appeal the decision and have it reviewed by an independent third party. We can show you what to expect from the appeals process.
Some comments about MY coverage:
Prescription drugs fall under the $12,000 deductible; with my meds costing under $50 per month it is unlikely the coverage will pay much.
Doctors may or may not be cheaper; I've been using the same one for a decade now and she always gives a hefty cut because we had no insurance. We do now, but I doubt her fee will go down below what she already cut it to, and before the insurance pays anything I face that $12,000 deductible again.
Emergency care may not go up outside the network, but it doesn't mean much when the deductible includes emergency rooms and is $12,000. In network or out, I will owe the first $12,000.
Doesn't matter if I appeal or not as I must pay the first $12,000 and that will bankrupt me. Any charges after that are just icing on the cake as they won't be paid anyway, but included in the bankruptcy filing.
GREAT insurance, right?
Why did you choose one with such a high deductible? Did you have someone help you choose the best plan you could afford?
Because it was the only "affordable" one.
But on top of that, a good study of the silver plan next in line revealed that there was almost no circumstance where out of pocket expenses (including premiums) would fall. Only a very narrow range of care costs (something like 6,000-8,000 per year), evenly split over two people and then the savings was minimal - a few hundred per year. This plan was actually affordable, but after paying premiums there was nothing left to pay doctors, drugs, etc. and it STILL had a deductible of several thousand.
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