Recommend an insurance plan from New York Healthcare Exchange?
August 28, 2015 4:08 PM Subscribe
I'm looking for any wisdom or caution about navigating individual plans in NYC.
I'm looking at going on an ACA insurance via the New York Healthcare marketplace. I'm looking at Gold and Platinum options from insurers that my primary care physician accepts.
I'm leaning towards Health Republic but I'd never heard of them before starting this process. Their coverage seems on par with/better than companies I've heard of (United etc.) but the premiums are quite a bit less.
I know everyone's situation is different, but I'm hoping there are some New Yorkers out there who have gotten insurance via the exchange and can offer any recommendation at all. I don't have any major health concerns (knock wood)—basically I'm hoping for the sort of insurance I've had when insured through jobs at big companies--no referrals necessary, $10 or less for generic drugs, $35ish for specialists, and if I need some kind of emergency care I can be fairly certain I'm covered.
(And if anyone can speak for/against Oscar I'm very curious about them.)
I'm looking at going on an ACA insurance via the New York Healthcare marketplace. I'm looking at Gold and Platinum options from insurers that my primary care physician accepts.
I'm leaning towards Health Republic but I'd never heard of them before starting this process. Their coverage seems on par with/better than companies I've heard of (United etc.) but the premiums are quite a bit less.
I know everyone's situation is different, but I'm hoping there are some New Yorkers out there who have gotten insurance via the exchange and can offer any recommendation at all. I don't have any major health concerns (knock wood)—basically I'm hoping for the sort of insurance I've had when insured through jobs at big companies--no referrals necessary, $10 or less for generic drugs, $35ish for specialists, and if I need some kind of emergency care I can be fairly certain I'm covered.
(And if anyone can speak for/against Oscar I'm very curious about them.)
I looked over all of them in great and terrible detail, and though I decided to stay with my obscenely priced COBRA coverage, the one closest to something I could deal with was, in fact, Health Republic. There are various levels of it and iirc on some of the lower ones you end up paying $70 each time you see a specialist. Don't get that one if you can avoid it.
the one thing that scares me about it is that it's an EPO which i assume means terrible financial things can potentially happen to you if you are transported unconscious to a hospital outside their network and need further critical care there. i worry that the obamacare laws regarding forcing insurers to cover you out of network for unconscious transport do not extend to further critical care to which you can't consent because you're on some kind of lifesaving machine or whatnot but i honestly haven't a fucking clue how it works.
posted by poffin boffin at 9:09 PM on August 28, 2015
the one thing that scares me about it is that it's an EPO which i assume means terrible financial things can potentially happen to you if you are transported unconscious to a hospital outside their network and need further critical care there. i worry that the obamacare laws regarding forcing insurers to cover you out of network for unconscious transport do not extend to further critical care to which you can't consent because you're on some kind of lifesaving machine or whatnot but i honestly haven't a fucking clue how it works.
posted by poffin boffin at 9:09 PM on August 28, 2015
Response by poster: cushie: I've seen those terrible reviews of Oscar...I figured *all* insurance companies get terrible Yelp reviews and maybe someone on MeFi has had another experience?
poffin: I haven't seen any out-of-network coverage at all for ACA insurance. My current insurance is an EPO and it's been fine—I could go on COBRA for it, but it too is a (small business) Gold ACA plan and it costs more than Health Republic Platinum. Thanks for the heads up on the $75 specialists—I saw that. Ugh.
posted by annabellee at 9:55 PM on August 28, 2015
poffin: I haven't seen any out-of-network coverage at all for ACA insurance. My current insurance is an EPO and it's been fine—I could go on COBRA for it, but it too is a (small business) Gold ACA plan and it costs more than Health Republic Platinum. Thanks for the heads up on the $75 specialists—I saw that. Ugh.
posted by annabellee at 9:55 PM on August 28, 2015
I am kind of an NYS health exchange nerd, if you can see from my earlier posting trail here.
I ended up choosing Health Republic when I first went on the Exchange when it opened and I did not change it last year. I am finally getting work health insurance this coming year, but if I were not, I think I would stick with HR.
All the companies have awful reviews. They are all pretty awful, including HR. (They have good coverage for therapy but despite the apparently robust list of psychiatrists, they were able to find two in-network doctors in all of Brooklyn). United seems to have a much larger network in general but I've mostly been able to find good doctors who take HR.
At least until now, I think HR has been the best value and in some ways less icky (at least by my subjective standards). Their prices have been going up (a fair amount) year to year, so it's worthwhile to re-research every year, I think.
None of the exchange plans have out of network coverage. HR's hospital network is pretty good, and NYS just passed a new balance billing law that should give some relief to people who, unwillingly and inadvertently, get treated by out of network doctors in network settings.
(I will note that Pomco, the processing company upstate that HR seems to use for a lot of things, is a hot mess and can be a nightmare to deal with. Sometimes I'll call "HR" and they'll be great, other times, incompetent to the point of reading to me from their website and not understanding it. 9 times out of 10 when they're horrible it's because I'm actually talking to someone at Pomco who has a Health Republic hat on).
posted by Salamandrous at 4:56 AM on August 30, 2015 [1 favorite]
I ended up choosing Health Republic when I first went on the Exchange when it opened and I did not change it last year. I am finally getting work health insurance this coming year, but if I were not, I think I would stick with HR.
All the companies have awful reviews. They are all pretty awful, including HR. (They have good coverage for therapy but despite the apparently robust list of psychiatrists, they were able to find two in-network doctors in all of Brooklyn). United seems to have a much larger network in general but I've mostly been able to find good doctors who take HR.
At least until now, I think HR has been the best value and in some ways less icky (at least by my subjective standards). Their prices have been going up (a fair amount) year to year, so it's worthwhile to re-research every year, I think.
None of the exchange plans have out of network coverage. HR's hospital network is pretty good, and NYS just passed a new balance billing law that should give some relief to people who, unwillingly and inadvertently, get treated by out of network doctors in network settings.
(I will note that Pomco, the processing company upstate that HR seems to use for a lot of things, is a hot mess and can be a nightmare to deal with. Sometimes I'll call "HR" and they'll be great, other times, incompetent to the point of reading to me from their website and not understanding it. 9 times out of 10 when they're horrible it's because I'm actually talking to someone at Pomco who has a Health Republic hat on).
posted by Salamandrous at 4:56 AM on August 30, 2015 [1 favorite]
Also I worked with a lot of people on the exchange and everyone seemed pretty happy with whichever plan they ended up on, which mainly depended on their budget flexibility, which plan already had their favorite doctors in network, and their general risk tolerance. If you're in outer Queens or Long Island (I'm not) I think the LI North Shore plan may be worth a second look. I knew people on HR, Oscar, Emblem, and Empire BCBS.
Also, depending on your actual use, a lower metal plan (unsubsidized bronze more so than unsubsidized silver, from my research) may be a better value than it seems. The negotiated rates are actually pretty low so you could get a long way through your deductible before hitting the basic premium costs of a platinum plan. That said, if you're the kind of personality for whom the higher in the moment costs would be a psychological deterrent from seeing care, or you have a reasonable expectation of using a LOT of health care, the gold or platinum is a better bet.
The way that HR primary select plans are structured worked out that I would need at least one or two huge unexpected expenses to make the platinum work out better for the year, so it's worth it to do some math for that. Memail me your email if you want the spreadsheet I used last year to calculate various scenarios.
posted by Salamandrous at 5:14 AM on August 30, 2015 [1 favorite]
Also, depending on your actual use, a lower metal plan (unsubsidized bronze more so than unsubsidized silver, from my research) may be a better value than it seems. The negotiated rates are actually pretty low so you could get a long way through your deductible before hitting the basic premium costs of a platinum plan. That said, if you're the kind of personality for whom the higher in the moment costs would be a psychological deterrent from seeing care, or you have a reasonable expectation of using a LOT of health care, the gold or platinum is a better bet.
The way that HR primary select plans are structured worked out that I would need at least one or two huge unexpected expenses to make the platinum work out better for the year, so it's worth it to do some math for that. Memail me your email if you want the spreadsheet I used last year to calculate various scenarios.
posted by Salamandrous at 5:14 AM on August 30, 2015 [1 favorite]
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posted by cushie at 7:22 PM on August 28, 2015