So I work per diem as a nurse which means I don’t get health insurance through my employer. I’m in my late 30s without any major health issues and just got my renewal notice from MNSure -

For just me: $467/month with a $4100 deductible - $100 increase from last year.

I don’t go to the doc enough to meet the $4100 deductible so it just feels like setting money on fire and I’m struggling to afford it. I keep it for peace of mind/ just in case because I know a prolonged hospitalization or randomly needing surgery could financially ruin me without insurance. I just don’t know what to do though because I’m right at the cusp of not being able to afford it anymore…cash/self pay is also cheaper without insurance before deductible is met.

If you have any thoughts/advice/anything then please chime in :) I’m at a loss.

So I’m in a bit of a weird situation and wanted to get some input from more experienced people on what to do next.

I was hired full time starting in August. My employer uses a 3rd party to run payroll and manage HR things like health insurance (which from my understanding, the 3rd party is the broker for the employer’s health insurance). I was able to sign up for health/vision/dental through the 3rd party’s portal, but the health insurance was stuck in “processing” while everything else went through and is now active. In the portal it said my coverage would be backdated to Sep 1, which the 3rd party confirmed in follow up emails when I asked about this.

So now the fun part is that I originally had a plan through the ACA (Georgia Access). After calling them about now having employer insurance, they advised I cancel my ACA plan, which they did for me on the call (Aug 31).

After now waiting a month for the application to process, I reached out to the HR company to see what was going on. After a bunch of back and forth that didn’t provide any answers, my employer was able to get ahold of United Health (which is who their group policy is through), and UH informed them that the group policy had been terminated due to nonpayment. Apparently the 3rd party had the wrong address on file (an unrelated address that my employer has never used) and United Health sent notices of the policy termination there, which obviously my employer never saw. The 3rd party also never relayed this information to the employer.

After calling Georgia Access, they confirmed I don’t qualify for a SEP since I never “lost” health coverage because I was technically never enrolled in the group policy, since it was terminated before I applied, even though I was able to complete the application and even received confirmation my application was received by UH.

I guess my question is… what do I do now? It sounds like my only option is temporary coverage, which I’m going to sign up for this week, unless there’s a better option in this situation. Thankfully I didn’t have any claims that would need to be covered during the lapse.

Is it just me or did premiums sky rocket this year, specifically to cover yourself + a partner? If i pay for myself it's $71 but if I add my husband, how on earth does it go to $400 per paycheck.

Located in Bay Area, CA -- in healthcare

would love to hear what yours is?

I looked over some past posts, spoke to people, did research and feel like I’m still getting various or conflicting information about this situation.

I am an adult and would like to start taking medication. I went to a local urgent care, used my health insurance, paid a copay and now have a prescription ready for pick up. The prescription has a claim that’s been processed, and will be super cheap once I pay upon pick up.

I have my own health insurance “account portal” I made after my visit, and when I signed up for a pharmacy account using my phone number, my prescription popped right up.

Problem is, I am over 20, but still on my parent’s health insurance, issued through their state employer.

If they review their EOB, receive some sort of text notification, emails, or review statements, will they see only a claim/code for what was billed, or will they see my specific medication and price reduction?

— — —

I plan on calling my insurance tomorrow to clarify communication. I recieved my info directly to my phone number when called by the office, but one of my parent’s numbers is still listed as the “primary number” for benefit related things.

I am worried.

TL;DR - will my parent, primary policy holder on employer provided insurance, see my specific prescription?

Thank you for any help.

I'm 50 years old and had stage 4 uterine cancer at age 39 i live in Texas. I had aggressive treatment and was approved for cancer disability this provided me Medicaid insurance coverage. In March my coverage was terminated. I didnt think I would get sick, so I got a cheap 300.00 policy, but this policy doesnt cover much and im having to pay 2400 for a simple catscan using my insurance when paying cash cost 600. . The catscan found a tumor on one of my adrenal grands most likely cancer since I have lynch syndrome. I dont know what to do I have an appt with SSI to apply for cancer disability again and that is scheduled for mid Nov. However my Dr requested I take an MRI and see and endocrinologist and a urologist and a gastro. Apparently im not in good shape. I dont drink I dont smoke and im not overweight, but lynch syndrome makes me prone to cancers. In order to be approved to cancer disability I need to be diagnosed first, but i cant afford it. I did purchase a cancer policy so if I get a diagnosis of cancer I get a lump sum, however I cant afford to pay for the imaging or even the specialist. I am not provided Healthcare via my employer and Medicaid has denied me. Im single never married and no kids and looking for help in the form of finding an insurance that will cover me without having to pay thousands or even marriage just to be able to get a diagnosis. I am insured by Golden Rule a division of United Healthcare.

Hello,
I am not sure where to start. I am covered by Medi-cal due to job loss. My 18 year old daughter is covered also. She is attending college out of state Today I received a telephone call from my case worker advising that as of November 1st my daughter will not covered by for Medi-cal because she is out of state. It is too late to get her insurance via school insurance coverage. Is there some way to purchase a policy privately. Covered CA policy will not cover her out of state.

Hi everyone. So I had to get a pre-auth for a procedure at a clinic I've been going to for 2 years. The pre-auth was very quickly approved (as they all have been) and shows "covered", but when I click to view more details, it says "out of network". I've been going to the same in-network clinic with the same doctor the whole time. Nothing has changed.

I contacted my insurance (UHC), and they said the clinic and the doctor are both showing that they're in-network and to treat it as a glitch. But that makes me uneasy, considering this "glitch" could cost me thousands of dollars if they end up denying it. Has anyone ever dealt with something like this before? Thanks in advance.

hi, i’ve had medicaid for as long as i can remember. i recently got switched to trillium about 2yrs ago. so far, it’s been good.

i went to the doctor today just for a checkup and apparently, my visit wasn’t covered. they said everything got switched to “family planning” instead of covering everything (including the doctor visits, etc). they mentioned how it was due to income?? i recently got a job at an hospital making 1k vs. $800 at walmart.

i really really need my medicaid. im not sure if theres something i can do?? i dont know if i should head to social security and speak to someone in person?? or call someone??is there something i can say to fix it??

I have no clue what I'm doing, I moved from Maryland to Arizona for my partner, I was still on my parents plan before the move, I'm waiting on the start date of my job, but I developed a really painful ganglion cyst (rather, always had jt, it was just benign until now) and need insurance ASAP, I'm also (ironically) a Trans person, which in hindsight should have made me think more abt health insurance. Any ideas or advice would be loved, ty in advance

I have an HMO from my employer. I am paying $225/week and i hate the inconvenience of getting referrals for specialsts, etc. The employer PPO is expensive and was going to look at the Marketplace. Any pro/coms of switching to a PPO? Marketplace?

PS..... my idea of Marketplace would be that i could leave my employer anytime and still have coverage for the fam because if Marketplace insurance....

Looking through my insurance claims for the year to get a good idea on if it would financially ruin me if I moved to a HDHP.

With my PPO I currently would pay $25 for this claim. What would I pay if I switched to HDHP? Would i pay the $168 and the $106 until i meet my deductible?

In this example this is for therapy, weekly. So would i be looking at spending $300 out of pocket weekly until i meet deductible?

Thanks so much.

To add me to his insurance it’s $600/month. I have income right now but when I go back to school it’s going to be slashed and be about a quarter of what I’m earning. Am I just going to have to go without insurance or is there a possibility that I will qualify for marketplace even though I’m married?

Edit
I am 27f my husband is 26m
Right now we make around $84,000/year gross and when I go to school he will make around $42,000/year and I’m not sure how much I will make. I’ll be working a part time job at a food place so maybe $11/hr max 20 hours a week.
We live in Texas

Does anyone have a good recommendation for a supplemental insurance to go with Medicare? Would greatly appreciate any recommendations
Also are there any ones that cover prosthetic supplies?

Is this plan similar to PPO? There’s also an OAP plan offered but that’s over $300 semi-monthly for non-smokers, and I think it’s pricier b/c it offers access to out-of-network providers. OAPIN is $90 semi-monthly, so will there be an extra charge in addition to the base copay? Would that be billed later? I don’t go to the dr often

Okay so could someone tell me how this is right. I have a prescription that costs$14000 and it's name brand and that's what was billed to my health insurance, but when I picked it up from the specialty pharmacy and got home it says it's the generic brand of my medication so is there fraud going on where they charge the extra ~ $5k and somehow giving me the generic but charging my insurance for the brand name. Because how would anyone know the difference really they wouldn't care as long as there's no copay you wouldn't care what they bill your insurance but someone is making money in there somewhere other than the drug company wouldn't you agree ? Or not agree? Please any info would be great. The med in question is called epclusa .

Hello! I am 21 years old, a part time college student, and I’m moving out very soon. My insurance plan with my family has run out- and I have no idea where to start. I used to be on Tricare Prime.

I live in San Diego California. Anytime I try to look into health insurance companies, where to apply, getting quotes, etc. I always find dead ends. I just don’t have the vocabulary to navigate any of the websites. (i also foolishly put my phone number in a ‘free quote’ fake website, and im being bombarded with spam calls…)

Does anyone have any health insurance recommendations? I am not married, I have no dependents, and I am not under my families plan anymore. I make about ~14k a year.

Thank you all so much!

I’ve been on Fidelis Medicaid for four years and have never had to file about my disability. I got a notice and it said I could call Fidelis and they were such morons it made me want to scream.

Apparently it says on the website that I am fine till Nov 15 (last month it said March…)

Can some nice person tell me what I am supposed to do here? The Fidelis guy kept telling me I had to file for SSDI and I’m pretty certain that’s not true. Then he told me to call HRA. I actually asked him if he had ever helped a disabled person on the phone before.

My physician is ready to write a letter but needs to know what it needs to say and where it goes and where we send it. I am 60, btw. Really I just want to make a plan: I am not working and haven’t been all year. I need to know what to do. I’m certain someone here is smarter than the guy on the phone.

Hey yall, I am currently on a student insurance plan and have my early checkup coming up. My plan gives full coverage for various preventive care services, and at least for the time being I plan to do these tests at my upcoming doctor's visit.

1. Physical checkup/examination
2. Bloodwork
3. Urine Test

My goal overall is to be able to get as much information as I can about my overall health, and am wondering what other preventive labwork / tests I could add to this visit, if any, to assess other important health markers. For example, ideally I was thinking of asking my doctor about these tests:

1. Kidney / Liver Assessment: LFT (liver function test); EUC (Electrolytes, Urea & Creatinin); eGFR (estimated Glomerular Filtration Rate - cane be measured from creatinine levels in blood / urine)... Can these be lumped into the normal bloodwork testing?
2. Lipid Profile Testing
3. Blood Glucose Test (I think this and/or A1C will be tested in the bloodwork)
4. Lifestyle/diet assessment

Are there any other preventive care tests/services I should ask for or mention that would be covered by my insurance plan? For example, I'm curious about my health as it pertains to my gut/digestion, spleen, gallbladder, lymphatic system, and sinuses/throat. I'm not sure how much I can know about the health of these other organs / systems simply through the general bloodwork testing... I don't have any symptoms that would make me think anything is necessarily critical any of these other organs / systems, which is why I would think this should fall under the category of preventive health care/services/testing and should be covered by my insurance.

Not sure if anyone could offer any thoughts or ideas, thanks! (I know AI could probably give me some good answers on this, but honestly I'm trying to boycott / limit my AI use as much as possible these days)

Hi! I’m currently searching for health insurance in Nevada (Vegas specifically), & I spoke with a broker through the nv marketplace site who really recommended Ambetter insurance. Cost-wise, this is looking like the best option as both HPN & BCBS have insane deductibles with high monthly premiums. The only issue is, I’ve seen a ton of terrible reviews for Ambetter. I looked through Reddit, and one person said that they think the service you receive depends on your location. Does anyone have any advice on this?

Any opinions on Ambetter? For context I’m a chronically ill woman in my 30s. I’ve been uninsured for over a year bc of cost, and I really need good health coverage.

I have anthem which recently switched to carelon (which I believe is in house) for pharmacy. It is one thing after another with them. Hoop after pointless hoop. My doctor called twice to try to do a prior authorization on the phone because the website they use was glitching. He was told on the phone it was received and pending. Carelon says they never got any phone call and one rep actually called my doctor a liar and said "we don't lose requests."

So I ask for them to fax over everything to my doctor. They say they did, my doctor doesn't receive it. This happens twice, the third time they say "by the way here is the code." Turns out they hadn't been sending an actual fax but an electronic fax to the website that isn't working. So I ask them to send a real fax. They say they did. Doctor hasn't received it.

How tf am I supposed to get this prior authorization (for the med I've been on for two years) under review? And of course they will probably deny it on a technicality when it finally is under review.

I tried logging in to my member portal online and the issues have been endless. First it says to do double authentication with my email then when i submit the email to send the authentication to, it says there is a technical error and to call the service hotline.

Then i call the service hotline and they want me to enter in my username. My username has always been my email to my knowledge…

I try and reset my username and then i enter in all my info and it takes me to a security question page.

It asks me for the answer to security question #1 without even showing me what the question is? Never had that happen before, how am i supposed to answer a question without knowing what the question is?

Once i try putting in random answers to questions that i think the security question might be, it gives me another technical difficulties notification and to call the service hotline.

The service hotline brings me to some call center with someone from asia that barely speaks english (no offense) and says they will send a username and password reset to my email.

I have them send the email apparently a dozen times and it never comes through. Yes i checked my spam and junk. Wtf do i do now? I told them ill just look out to see if i ever get the email and ill follow up tomorrow

Funnily enough i am getting other emails from BCBS about open enrollment coming up etc, but nothing about the actual email that i am waiting for.

Has anyone else had issues with this? It feels like im running into issues left and right. Its the end of the year and im getting alot of healthcare since my deductible and OOP max is met. I feel like it isnt a coincidence that all these issues are happening toward the end of the year when i want to check claims, find doctors etc…

Such a joke

My husband and I are moving back to California in early November, and I will be 31 weeks pregnant when we land. We are completely stuck on health insurance:

• My husband starts a new job with an ICHRA on December 1st, but our current income is of course $0.
• If we try to get Medi-Cal, processing takes time.
• If we buy a private plan for December, we'll hit our out-of-pocket max for December careonly for it to reset to $0 on January 1st, right when I'm due

With my due date so close, how can we handle immediate care and avoid this financial trap? If you've navigated a late-stage pregnancy move to CA, what would you do?

My wife (28) and I (30) are planning a pregnancy for next year. We each have employer coverage, and we're planning to split plans instead of putting both of us on one family plan. I've run the numbers, so I'm mostly looking for a gut check on whether it makes sense to split and if anyone else has done this.

Planned setup:

• Wife: Her employer's Aetna or UHC PPO: $70/mo premium, $400 deductible, 10% coinsurance, $3K OOP Max (+$1500 in prescriptions). Prenatal visits are covered, and infertility treatment is covered up to $25K max.
• Me: My employer's Aetna HDHP: $0/mo premium, $1,700 deductible, 10% coinsurance, $5,500 out-of-pocket max. I'd max my HSA, invest it, and pay medical bills out of pocket.
• Baby: Added to wife's PPO after birth (own $400 deductible and caps).
• Wife will skip her employer's general-purpose health FSA so it doesn't disqualify my HSA.

Our logic for the split is that my wife’s medical costs will be high and predictable (hence the PPO), while mine will likely be low. Adding me to her plan would cost ~$1,540/yr more in premiums and end my HSA contributions, while my HDHP is free and lets the HSA grow invested for decades.

What we've accounted for:

• Deductibles and OOP maxes reset every January, so if trying plus pregnancy spans two calendar years, we could hit the caps twice.
• medical coverage costs will likely be low as most medical expenses (prenatal care, delivery, baby's care) are billed to the mother/baby. My costs would range from nothing to carrier screenings, fertility evaluation, and male infertility treatments.
• My plan covers basic male infertility care but NOT IVF-related procedures like surgical sperm retrieval or sperm freezing. The odds of male infertility are relatively low, so I'm willing to take the risk. Worst case, if we discover male infertility, I can join her plan at the next open enrollment.

Open questions:

1. Is there a structural reason couples avoid splitting like this during a pregnancy or fertility treatment?
2. My wife's company offers Aetna and UHC while I am on Aetna. Is there any advantage to both of us being on Aetna, even if the plans are different? IF not, her UHC plan has better benefits.
3. Are there unforseen expenses that can be billed to the father that I'm not accounting for?
4. Any problems with coordinating care, billing or preauthorization when partners are on different plans?
5. Anything about the HDHP side I'm overlooking that would make this a bad idea?

Thanks in advance!

Please keep in mind as you read this I'm a type 1 diabetic who depends on insurance for insulin, and I depend on insulin to live. It's important context.

Amerihealth Caritas Next kicked me off their plan. Why? They wouldn't let me pay my premium. Seriously. That's the reason. They literally made it impossible. Here's what happened: I got a letter saying my account was past due. Particularly it said I paid only half of my copay for September. That was curious, because I was enrolled in autopay. I checked the website, and it said I owed nothing. Okay, so wait and see I guess? When I rechecked my account later, it said I owed two premiums and wasn't enrolled in autopay anymore. I tried to pay, but after entering all of my information and pressing "pay," it gave me an error. I was, however, able to re-enroll in autopay, which I did. Then I went back a few days later and tried to pay again, and it said "payment is not available for this account." I called them. The rep said it was because they changed their billing system and that I needed a new account to pay. Okay, first time I heard about it. She gave me the new account number and guided me through how to pay, but I got the same message: "payment not available." Then after some inquiry she told me I had been kicked off the plan because my account was overdue. She said there was a 15 day grace period and that I missed it. She encouraged me to see about coverage from the marketplace because open enrollment is coming up. I then asked her if I got the chain of events correctly: They changed the way I had to pay my premium, didn't tell me, blocked me from paying the only way I knew how, and were now kicking me off the plan because I didn't pay. She said that was right.

So here I am getting ready to fill some prescriptions for insulin and other diabetes-related medications/devices in the next week and I suddenly have no insurance. I'm not kidding when I say these prescriptions are out-of-pocket like $3000 dollars.

My theory is they did this little billing switcharoo to kick a number of people off their plans by administrative error because this time of year people are meeting their deductibles and the math stops making sense for the insurance company. I don't see any other reason. Otherwise, why don't they want me to keep paying them monthly for the rest of the year? Is my legal tender somehow not so legal or tender enough for them? If that's the case, and they don't like my filthy lucre, maybe they can they just cover me and not get their hands dirty with my coin. I'd be fine with that. We just need a solution that provides continuity of life-saving medical care. That would be optimal.

I have an active case open with them contesting this. We'll see what happens. I wanted to post here for public record. May their evil deeds shine brightly in the open light of reddit!

Long story short I’ve got some issues going on with my health that require some expenses that I can not cover out of pocket. I haven’t had insurance since I was 18 from Medicare(?) I think I’m not too sure, can’t remember. I never bothered to look in to other options because I didn’t really make enough money to afford the monthly payments on it.

I don’t think I make enough now either but I am at a point where I have put off what I need health wise to where it is now affecting my ability to work. I make on a good year roughly 10k~. Is it feasible to even find insurance that I could afford? And if so, how do I go about finding or applying for it?

Edit: I currently live in Georgia sorry forgot to add