Can you help through my yearly NYC health insurance quagmire?
December 29, 2020 9:36 AM
I live in NYC, am self-employed, and buy my own health insurance each year. Every year I go round and round trying to figure out the best option over all. This year, the cheapest option seems to be HealthFirst, but I wonder if there's something I'm not seeing.
The main thing for me is being able to keep my primary care doc and having access to a decent sized network of good doctors should something go wrong and I need them. I choose plans with lower premiums and a higher deductible, hoping that I won't need much medical care in the coming year.
This year I had Oscar, but I'm not wowed by the selection of docs and hospitals. So I'm considering switching to either Emblem Health or Healthfirst. I had Emblem once before, and it was fine. The Healthfirst premiums, though, are MUCH cheaper. When I do a Doc search on the NYC.gov website, the various docs l search for all appear to take Healthfirst. So if lots of docs take it, why are the premiums $200 cheaper than Emblem each month? Deductibles are roughly the same.
Do you have first hand experience with any of these insurers? If not, do you have any other wisdom to share?
The main thing for me is being able to keep my primary care doc and having access to a decent sized network of good doctors should something go wrong and I need them. I choose plans with lower premiums and a higher deductible, hoping that I won't need much medical care in the coming year.
This year I had Oscar, but I'm not wowed by the selection of docs and hospitals. So I'm considering switching to either Emblem Health or Healthfirst. I had Emblem once before, and it was fine. The Healthfirst premiums, though, are MUCH cheaper. When I do a Doc search on the NYC.gov website, the various docs l search for all appear to take Healthfirst. So if lots of docs take it, why are the premiums $200 cheaper than Emblem each month? Deductibles are roughly the same.
Do you have first hand experience with any of these insurers? If not, do you have any other wisdom to share?
Call your doctor's office and speak to the billing department. Make sure that your doctor accepts the insurance you are considering for next year. Sometimes the online information is inaccurate or out of date.
posted by JackFlash at 11:23 AM on December 29, 2020
posted by JackFlash at 11:23 AM on December 29, 2020
I've been with Healthfirst for five or six years. I first chose them because I liked the looks of the Charles Wang Health Center, which had better written content than any other site (hospital, clinic, etc.) I was seeing, and that would be my go-to if I chose Healthfirst. I've had both for pay and, when unemployed, Medicaid coverage, and I've been very very happy. That may be partly because the Charles Wang is wonderful: Well-trained, professional, efficient and although almost entirely ethnic Chinese, which I am not, welcoming.
But my experiences with Healthfirst have also been good, even though on Yelp at some point I read lots of really bad things about them. For oddball prescriptions, requiring clearance from my doctor, my doctor at most has made a request twice, and then they **always** approved the prescription from thereonin. In both for pay and nonpay situations they covered pretty much everything I could have wanted without question or disincentive, and I've gone through phases where I needed or wanted to see a lot of doctors. Once a year, they call or write, urging you to get an annual physical. I approve of that, too. They are also, as you say, very cheap. My impression is that's partly because they have a huge number of Medicaid contracts, but I wouldn't swear by that assertion. I would, however, recommend them.
posted by Puppetry for Privacy at 11:33 AM on December 29, 2020
But my experiences with Healthfirst have also been good, even though on Yelp at some point I read lots of really bad things about them. For oddball prescriptions, requiring clearance from my doctor, my doctor at most has made a request twice, and then they **always** approved the prescription from thereonin. In both for pay and nonpay situations they covered pretty much everything I could have wanted without question or disincentive, and I've gone through phases where I needed or wanted to see a lot of doctors. Once a year, they call or write, urging you to get an annual physical. I approve of that, too. They are also, as you say, very cheap. My impression is that's partly because they have a huge number of Medicaid contracts, but I wouldn't swear by that assertion. I would, however, recommend them.
posted by Puppetry for Privacy at 11:33 AM on December 29, 2020
I buy health insurance through the marketplace in NYC and I just renewed with Healthfirst. So far I like them. I've had Emblem and a few others I can't remember the names of and Healthfirst is the only one that I've stuck with when it came time to renew (this will be my third year with them). NYU Medical takes them and I get regular injections in my knees that aren't always covered by insurance and so far I've had no issues with Healthfirst approving them, though that might also be more about my doctor knowing how to claim them to get them covered.
Everyone of course will have their own experiences, but at the very least I haven't found them to be any worse than the more expensive carriers offered on the marketplace.
Oh, and they're the only ones I found that include dental with the plan (though I haven't used it so can't comment on how good the coverage is).
posted by newpotato at 5:17 PM on December 29, 2020
Everyone of course will have their own experiences, but at the very least I haven't found them to be any worse than the more expensive carriers offered on the marketplace.
Oh, and they're the only ones I found that include dental with the plan (though I haven't used it so can't comment on how good the coverage is).
posted by newpotato at 5:17 PM on December 29, 2020
I only had two real hiccups with HealthFirst: the website was almost unusably terrible, and Duane Reade and Rite Aid wouldn't accept it for prescriptions. Both of these things may have changed in the last few years! But I do recommend checking on the prescription thing before you commit, unless you happen to be near a CVS (I successfully got a prescription filled at CVS).
I also felt it significantly limited what doctors I could see, but that's the story with all the cheapest exchange plans. It sounds like the ones you want are covered, which is all that really matters. Beyond that it's not all that different from Oscar or another low-premium, high-deductible option, so if it's the cheapest one this year I'd say go for it.
posted by babelfish at 11:18 PM on December 29, 2020
I also felt it significantly limited what doctors I could see, but that's the story with all the cheapest exchange plans. It sounds like the ones you want are covered, which is all that really matters. Beyond that it's not all that different from Oscar or another low-premium, high-deductible option, so if it's the cheapest one this year I'd say go for it.
posted by babelfish at 11:18 PM on December 29, 2020
Honestly, the best thing I did when I started buying my own insurance was to engage a health insurance agent.
She researches everything. Networks, my doctors networks, my pharmacy, my physical therapist, etc.She tells me which dentists in my town accept my dental plan. She compares the copays, deductibles, and maximums. She makes sure my plan is HSA eligible. Etc, etc, etc.
She consults with me when open enrollment comes around to tell me what’s changed. I have changed plans three times under her guidance and never had to change doctors. And she does the paper work and tells me where to sign. And she costs me nothing.
I tried to figure it out for myself the first year and will never do that again.
If such a person is available in your area I highly recommend trying them out.
posted by SLC Mom at 1:48 AM on December 30, 2020
She researches everything. Networks, my doctors networks, my pharmacy, my physical therapist, etc.She tells me which dentists in my town accept my dental plan. She compares the copays, deductibles, and maximums. She makes sure my plan is HSA eligible. Etc, etc, etc.
She consults with me when open enrollment comes around to tell me what’s changed. I have changed plans three times under her guidance and never had to change doctors. And she does the paper work and tells me where to sign. And she costs me nothing.
I tried to figure it out for myself the first year and will never do that again.
If such a person is available in your area I highly recommend trying them out.
posted by SLC Mom at 1:48 AM on December 30, 2020
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posted by reren at 10:40 AM on December 29, 2020