Lets pretend that Obamacare is not going away
November 12, 2016 8:46 AM   Subscribe

I know, I know, it’s a hypothetical now. But I’m in NY state and I’m looking for a plan for a married couple that doesn't see the doctor that much - knock wood - but has lots of prescriptions. Healthcare spending would be a plus but not a necessity and I’d like to pay around a grand for the two of us. Suggestions?
posted by captainscared to Law & Government (6 answers total)
You're looking for a plan via the healthcare marketplace? Go to healthcare.gov. The plans are different in each state and the plans you can choose from/ tax credits offered also depend on your income and family size, so people here will not really be able to give you specific suggestions. You can also schedule an appointment with an in-person assister or call the marketplace, information which is located on the website.

If you make under 400% of the federal poverty line (but above 138% in NY which has expanded medicaid) as a household you should be eligible for tax credits for your premiums; if between 138% and 250%,then you'd be eligible for tax credits and cost-sharing reductions. Cost-sharing reductions are applied to silver plans only and reduces the cost of co-pays and prescriptions as well, so it is usually recommended for people under 250% (but above 100%) of the poverty line to choose a silver plan.

If you make under 138% of the poverty line as a household you should directly apply for Medicaid, in NY.
posted by bearette at 9:09 AM on November 12, 2016

I look at healthcare.gov but am overwhelmed by choices. I wonder if someone has experience with a particular plan thats working. Thanks for the other info.
posted by captainscared at 9:31 AM on November 12, 2016

Even if you don't see doctors that much, do you have a doctor(s) that you want to keep? The way I found a plan was to first check with my doctors to see which ACA plans they accepted. Then I chose the plan that was common to them all.

Also, if this is your first time looking at the exchanges, you should absolutely find a healthcare navigator to help you. It's a totally free service... most are hooked up with social service agencies or other non-profits. They will help you with the application and figuring about what amount of subsidy you will qualify for, as well as what type of plan will work best for your needs.
posted by kimdog at 1:24 PM on November 12, 2016

you'll usually get the best deal with a silver plan if you are within 250% of the poverty line. you can narrow down the search for silver plans once you get your eligibility determination. I'd meet with a navigator in person since every state has different insurance companies on the marketplace so even if someone suggested one they like on here, it might not be on your exchange. Also, they might be paying very different amounts for it depending on their situation.
posted by bearette at 5:32 PM on November 12, 2016

Are your prescriptions generic? I've had Oscar via the health exchange and I've been happy with them and will probably renew with them. You get a few free visits to your primary care doc each year and a visit to your gyn, and your generic prescriptions are very cheap, like 5 or 10 bucks, I think. But if they're not generic, then you have to pay out for them of pocket, and the deductibles are pretty high. It's basically like having a catastrophic plan.
posted by swheatie at 4:35 PM on November 13, 2016

Healthcare.gov is the federal platform for selecting a plan, and is only used for states that did not set up their own exchange/marketplace.

New York State of Health (NYSOH) is the portal for enrolling in a ACA plan in New York. https://nystateofhealth.ny.gov/

Strongly nthing using a navigator. You can call NYSOH to find a navigator near you. 1-855-355-5777

Community Service Society is a navigator network with 39 community-based organizations serving 61 of New York’s 62 counties.

(888) 614-5400 or email enroll@cssny.org.

It is deeply unlikely that any plan enrolled in for 2017 will not last the whole year. 2018? who knows.
posted by gnar_gnar at 11:31 AM on November 16, 2016

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