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Health Insurance Dilemma

Active Member
Stephanie H Member Since: Jun 14, 2018
1 of 11

I am so happy with the switch to freelancing. In part it's allowed me to move back to where I'm from (Southwest Virginia) and be close to familiy without having to try to get a job in the limited local market. And I love my clients and the work I do! The problem is that the options on the health insurance exchange here are abysmal.

I was living in Utah before moving here and had an individual plan there that was great. Where I live in Virginia, the only insurer offering plans on the exchange is Anthem. None of the plans offer *any* out-of-network coverage. That means they cover 0% of any care you get from an out-of-network provider. And both the local hospital and my personal doctor are listed as out-of-network. There is no difference in this aspect of the bronze, silver, or gold plans. This basically means that if I went to the only hospital in the immediate area, I would be receiving any hospital-based services from an out-of-network provider and my plan would not pay any percentage of the bill.

Has anyone else run into this? Due to my income level, I can get a Bronze plan with no deductible, which I guess is at least supposed to cover care received in an emergency. But I know that many people have received emergency care that has been denied as out-of-network. I know if I walk into any of my local providers these plans would say, "We cover $0 as that is an out-of-network provider." I'm not sure what would happen if I was taken to the ER of the local out-of-network hospital.

I've been looking for alternatives. I can't find any local insurance agencies that offer plans outside of the exchange though I was willing to pay more from an honest local insurer. I did run into indemnity health insurance plans in my search today (such as Golden Rule and National General), which I'd never heard of before. They're short-term plans that will pay a fixed amount for any care you receive, regardless of where you get care. Such as $1000/day for hospital care, etc. The fine print makes it seem like a better plan than an Obamacare plan with no coverage for the local hospital, but then reading the reviews, it seems a lot of people have had to go through an onerous process to get any benefits paid and end up seeing these plans as scams after not getting any of the listed benefits from them.

I feel stuck in between a rock and a hard place. Every article I read encourages readers to do the responsible thing and get a "real plan" on the exchange, without acknowledging that people might live in an area where the plans available won't cover any local medical care. I am willing to pay a decent amount each month for decent coverage, but I can't seem to find that option. ANY advice would be much appreciated.

Moderator
Valeria K Moderator Member Since: Mar 6, 2014
2 of 11

Hi Stephanie,

 

I'm glad to hear that you've benefited from the switch to freelancing so far. I understand that finding available and affordable health insurance can be tricky. Other freelancers who visit these boards may chime in and share their experience, but I just wanted to share this resource page with you. You may find some information there that's useful in your situation. 

~ Valeria
Untitled
Community Guru
Mary W Member Since: Nov 10, 2014
3 of 11

I believe that there are options available through Freelancers Union. 

Good luck!

Community Guru
Jennifer M Member Since: May 17, 2015
4 of 11

yeah, obamacare options have gone to total crap. I haven't even looked at what they want from me next year but I'll probably just not buy any healthcare. I hear that you can get better options/rates by just shopping for your own, but I haven't tried this. The nice thing about the marketplace is that you see everyone in one place, but the choices have dwindled so much it's usually like one insurance company.

 

The only reason to have it now is if something crazy happens, and even then it's usually $10k out of pocket first. I decided just to quit having health insurance.

Community Guru
Phyllis G Member Since: Sep 8, 2016
5 of 11

I have been buying my own insurance for 20 years. In the years before the ACA took effect, my monthly premium increased by more than 600% over less than 10 years until it was nearly equal to my mortgage (and 2x the monthly payment for a mid-range car). That was for a healthy adult with no chronic conditions and no dependents, with an annual deductible that ranged as high as $5-6k (so I paid out of pocket for everything, anyway). Believe it or not, we are better off now than we were then.  ACA plans include certain things with no co-pay: a very basic wellness exam, flu shot, mammogram, pelvic & PAP, colonoscopy.

 

If your ACA plan cannot give you an in-network provider within a certain distance of your home, then they will pay in-network benefits for you to use an out-of network provider. I have not had to do this for primary/routine care, but I have done it for chiropractor and am in the process of getting the waiver to see an orthopedist. I have Anthem. I also live in a rural area and starting in 2018, they are the only carrier offering marketplace plans in my county. I've heard more carriers may be entering the market in poorly covered areas this year, so crossing fingers we'll see more competition.

 

The less expensive plans you can purchase outside the marketplace are cheap because they offer poor coverage. ACA plans are required to provide certain benefits which those others are not.

 

Another option is health sharing plans, which work kind of like co-ops. Most (maybe all) are faith-based. They can be more affordable but the ones I looked at a couple of years ago excluded pre-existing conditions entirely. I am a middle-aged person with very fair skin and had had a basal cell carcinoma years earlier, so I would not be covered for any dermatology care at all, even check-ups.

 

I look carefully at all of my options every year, and have never found a bronze plan that I thought was worth it. The silver ones are the best IMO. Obviously, it depends on the individual and many factors including your age, your general state of health, and your tolerance for risk. In 2003 I suffered a spontaneous detached retina which, had I been uninsured, would likely have caused me to lose my house. A cancer diagnosis can result in $250-500k worth of bills in a year, easily. People go bankrupt.

 

Active Member
Stephanie H Member Since: Jun 14, 2018
6 of 11

Thank you all for such a rich array of helpful replies! It looks like Freelancers Union plans aren't available to browse until Open Enrollment starts in a few days, so when it does I'll see if they have any options that aren't just the same as what I see when I log in to healthcare.gov. I'll also check out some of those other links from the Resources page Valeria posted. ehealthinsurance.com was where I found the indemnity plans.

I get what you're saying about Silver plans, Phyllis—I had a Silver plan in Utah—but the difference here is that it seems like a gamble whether any plan on any tier would cover any local providers and not pull a "gotcha!" by asking why I didn't get my emergency care at another hospital 30 minutes + away, as I'm not sure what the nearest hospital is that's in-network (I worked at a company that appealed insurance denials a couple years ago, so I'm familiar with the tactics insurance companies pull not to cover anything).

At this point I don't think I can do better than catastrophic coverage, and with the subsidy, I'll have a $0 premium on the Bronze plans but pay $100+ a month for the Silver plan that won't cover any of my regular doctor visits and may or may not pay for any emergency or hospital care. I will make sure to compare all of the plan documents if I can't find something through one of these other linked resources.

The reason I went without this past year is I didn't want to literally be paying for nothing. So I'm thinking if I can't find a better option (I'm leaning away from the indemnity plans because I can't find trustworthy reviews from anyone who's had a good experience with them), I'll just go with a Bronze plan just in case it might actually cover anything in case of an emergency and hope the options are better next year. I suspect the options are better across the state line in Tennessee, but moving isn't feasible right now—maybe it will be in a year or two.

Community Guru
Cheryl K Member Since: Jul 16, 2015
7 of 11

So, I don't understand your area....is it rural? I am in a rural area one county north of Columbus Ohio. My plan doesn't cover any hospital or specialist in my immediate area (Delaware County). However, I can drive 15 or 20 minutes into Columbus (Franklin County) and I have access with my insurance to an entire healthcare network through OSU. High quality stuff too. Some specialties are as far as a 25 to 30 minute drive if they are on the far south of Columbus, but some are on the very northern fringes of Franklin County and that's an easy drive.

I'll admit that I grumble about driving into Franklin County or Columbus, but heck when I lived in South Florida I could spend 20 minutes just trying to get to I75 from my neighborhood so I could start trying to drive somewhere!

My point is, look and see if your network is better in any adjacent county. Since moving to Ohio, I've had to learn to look at all facets of life much differently than highly urban South Florida and healthcare and health insurance are just a couple of those things.

Community Guru
Wendy C Member Since: Aug 24, 2015
8 of 11

Phyllis wrote "If your ACA plan cannot give you an in-network provider within a certain distance of your home, then they will pay in-network benefits for you to use an out-of network provider."  Before you spend a ton of time and frustation checking every plan option around, check what the parameters are for the above ACA scenario.  It has been beneficial for friends across the country.

Community Guru
Amanda L Member Since: Jan 23, 2018
9 of 11

The only nice thing about having been on SSDI is qualifying for Medicare before being 65. However, I'm hoping to pay out of pocket this year to get a better plan.  

Community Guru
Kelly B Member Since: Jan 1, 2016
10 of 11

I have a silver plan in AZ and I just love it. It's Ambetter. Best insurance I've ever had. In CO I had the same problem you have... EVERY doctor or hospital was out of network.

 

We had Golden Rule at one point and it seems their business plan is to deny every claim they get, knowing that the majority of people don't have the stamina or resources to fight. They didn't want to cover my husband's appendectomy and he was in a hospital union at the time. I would avoid them at all costs personally.

 

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