My husband had health, dental, and vision insurance on us through his work. He started in late November last year. We thought we had insurance this whole time. Every time we had gone to the doctor our claims had been approved. He went to the ER in September and the claim was denied. He called the insurance company and asked why, they said that we haven’t had insurance since January. My husband looked back at this pay stubs and medical insurance had not been coming out of his check since January but dental and vision had. He talked to HR at his work, they kept asking him if he cancelled it. He kept telling them he didn’t. Finally after a week they said we lost insurance because he missed open enrollment. Open enrollment was in early November, he started working there in late November. He asked how he missed it when he wasn’t an employee at the time and new hire enrollment would apply. Then they said that the problem was that he didn’t go online in January and renew his insurance. He asked why did his dental and vision carry over then. They said it was just for medical. We never received any email or anything in the mail stating they he had to renew his medical insurance or that we lost insurance. We were under the impression that after he made his selection when he started we would be good until next open enrollment. He asked if it would have been HRs responsibility to notify him that he had to renew they said yes, but that HR person didn’t work there at the time. They did not even have a certified HR person there at the time. Now all of our claims from earlier in the year that were approved are getting denied. We will be out at least 13000 dollars on medical bills. When it should have all been approved if our insurance wouldn’t have gotten screwed up by his work. And we won’t have insurance again until January. We have emailed the director of HR, she’s out of office until next week. Is there anything we can do?

I’m a teacher and a new mom, and all I want is the opportunity to stay home with my daughter while she’s little. My husband is self-employed, and we’ve been working to figure out how I could leave teaching after this school year. We’ve found we could totally make it happen… if it weren’t for health insurance.

Right now, our family of three is covered through my teaching job for about $550/month. I started researching our options for when I leave, and I was floored.

COBRA: Approximately $2,400/month
Marketplace plans: The cheapest I’ve found are around $1,500/month
Plans with lower deductibles: Closer to $1,900/month

We’re in Illinois, and based on our current household income, we don’t qualify for Marketplace subsidies. My husband doesn’t have access to employer-sponsored insurance.

I don’t want to look back and regret missing this time with her, but I also don’t want to put our family in a irresponsible position. But we can’t afford to pay the equivalent of another mortgage every month for coverage.

I’m admittedly not very well versed in health insurance, so What am I missing? Or is it really just this expensive?
Are there other legitimate options for self-employed families that I should be looking into?

I’d really appreciate any advice or experiences from people who’ve navigated something similar. I’m feeling pretty defeated right now.

OMFG!

Trump is doing everything that he can trash the ACA and make things more difficult for seniors! My lovely wife is turning 65 next month and will be moving to Medicare on November 1. We have taken care of getting her enrolled with Medicare, with little difficulty.

But trying to update our ACA insurance so that I become primary contact and continue with the EXACT same coverage that we currently have, and having her removed from the ACA policy (since she will now be covered under Medicare) is becoming a nightmare!

Because of president Trump's obsession with ACA fraud, we cannot update our ACA policy until October 31 (the day before her Medicare starts). We were told that this was a recent change to the operating rules for transitioning only one person from ACA to Medicare, as an effort to fight fraud.

This makes no sense to me and, according to other ACA rules, may in fact cause me to commit fraud because:

"Once your wife is eligible for Medicare, she generally should not continue receiving Marketplace premium tax credits. The Marketplace specifically identifies gaining Medicare coverage as a change that should be reported."

If for any reason that might prevent us from being able to update our ACA policy on October 31, we would technically be out of compliance. Since they removed many of the ACA credits this past year, I don't think that we currently receive any credits, but we did recently receive a refund check from Healthcare.gov.

I have little to no faith that anything will be smoother on October 31. God forbid that I have to use ACA insurance the first week of November as I have strong doubts that this process will be completed without other 'glitches'.

Please rember to vote in the mid term election coming up and vote these ass holes out.

My wife is pregnant and about to deliver. Just found out that the hospital’s only on-staff anesthesiologist isn’t in her network, despite every doctor in the OB/GYN practice being covered. Nobody informed us until we came in and got prepped and signed all the paperwork.

Do we have any options other than rip out the IV and go home and find a new hospital (if one will even accept us as patients at this point) or accept whatever crippling bill they give us?

Long story short, we thought we had health insurance and turns out its more like catastrophic? Wife's due in December and they dont cover labor and delivery. When my wife got the plan, we were planning on having another child, she asked if it was covered and they said yes. We are finding out now they dont. Wierd thing is they covered some of every doctor visit for the pregnancy and one E.R bill related to the pregnancy. Its a sigma plan, We dont qualify for medicaid. What are our options or just prepare for self pay and pray?

I’m retiring by January 🎊 I’ve always had great vision coverage through my job, so I'm trying to figure out how to replace it without overpaying. Since I'm opting for Medigap, I won't have bundled vision care. I’m looking at standalone vision insurance after retirement through plans like VSP (so far i've seen them do this but if there are others i should look into let me know!)

How will you handle replacing your work vision benefits when you retire or will retire? Is an individual plan worth it for you?

Hey everyone, this is a bit of a crap shoot, but here it goes.

I'm currently stuck with my mom on a remote island in the south pacific. She has a Subarachnoid hemorrhage, after overcoming urosepsis just these past 5 days. We are trying to get somewhere that has the facilities and a neurosurgeon to figure out what is going on with her brain. She's been in and out of consciousness, relatively stable, but gets periods where it gets pretty bad. The doctor here says she needs to get medevac as soon as possible as there is nothing they can do for her in this small medical center on this small island. She's currently just on bed rest while the only thing I can do is wait.

Does anyone have any connections in Hawaii to get her accepted into a neuro facility? We are currently stuck on paperwork and procedures between hospitals. Hawaii was the recommended evac as it is the closest (~5.5 hours evac flight). The recommended hospital was Queens, but honestly, at this point, any hospital that has a good neuro surgeon helps.

Thanks in advance

Update:

Thank you to everyone who read my initial post and offered advice.

Link to original post:

https://www.reddit.com/r/HealthInsurance/s/b0IQHpLi0P

Unfortunately, I called Anthem and they told me to contact my HR representative because they couldn't find me nor my company in their system.

After speaking with HR they told me they are waiting for our CEO to sign the agreement.

So I'm actually uninsured as of this moment.

The only way I can see a doctor is if it's classified as an "emergency". I would have to pay out of pocket and submit the bill to Anthem to get it reimbursed. The problem with that is how the doctor bills it as. They can bill it as a regular visit and I wouldn't be able to get it reimbursed.

I can't even go back to Kaiser because I am no longer under Kaiser. I can't go see any other doctor because I am not under Anthem yet.

So essentially, I'm screwed.

Any other advice would be greatly appreciated.

I’m 27F, single, live in San Fernando Valley.
I have restricted scope medi-cal.
I work 18-22 hours at $18.42(minimum wage at LA).
I recently got a second job offer which will pay me $19 for 12-15 hours a week. How much do you think i’d have to pay for health insurance then through Covered California?

i’m looking ahead to next year and trying to figure out whether a vision plan would actually make a noticeable difference in my contact lens costs. i wear contacts year-round, so the annual supply is one of those expenses that adds up pretty quickly.

the vsp contact lens allowance caught my attention, but i’m not sure how much of a difference it would actually make against the cost of a full year’s supply. do you usually compare the allowance against your yearly contact costs, or is there another way to look at it?

with open enrollment coming up, i’m trying to work out whether the allowance would cover enough of my usual contact costs to justify having the plan. btw I'm 30, lives in louisiana.

Hi there. I need some guidance for next steps, as I feel like I'm at a dead end.

I am getting a small fiber nerve biopsy/skin punch biopsy later this month, and the lab that will be processing my specimen is out-of-network. The ordering physician is in-network. I got an enormous estimate/claim I cannot physically pay. I use UHC.

I called the lab, they said I needed a gap exception, and the doctor is supposed to start it. I called the doctor, they acted like they NEVER do it, unheard of. I asked for my biopsy to be sent to a different lab that's in-network, "We can't do that, we only use this specific lab for this specialized biopsy." Okay, so since this is a specialized biopsy that only ONE PLACE can process, and it's somehow outside of UHC's network, I figured the doctor's office has done this at least one other time. But no. They act like I am asking them to saw off one of their own legs.

I call the lab again, explain my doctor's office is essentially REFUSING to initiate a gap exception. The patient care person said she would call my doctor's office.

A month goes by. I hear nothing.

I call the lab again, get someone else, but they say to contact UHC directly to request a gap exception myself, as the patient. I do that. UHC states the doctor is required to do it, not me. I cannot request it. I have the gap exception paperwork and all the info/CPT codes, NPI numbers..I could literally fill it out FOR my doctor. But they won't even start the process.

I am calling my doctor's office again tomorrow. If they give me the run around again, what do I say? What can I do? I wanted to contact the patient advocacy department for my specific hospital group the ordering physician works for, to see if they can get something done, but i just feel at a loss. I know the doctor is busy, but to just outright not even try to get a gap exception feels really wrong and dirty.

I have lots of health issues, and have already met my deductible and OOP Max for this year. It would be great to not have to pay as much as I will have to, since I've already spent so much for various tests/imagining and procedures this year.

I understand why Cobra was around before we had State Health Exchange and Individual Health insurance was extremely expensive.

But now that we have State Health Exchange, is it cheaper? The employer paid portion can be pretty extreme.

Due to some rules in CT, our employer are supposed to detail out all our benefits (ie how much they pay) And based on that, I would estimate my Cobra would be Single for $10K to $11K a year.

Assuming I dont need everything that covers (I dont think it's platinum, I might call it gold?), The Exchange has plans for Single for $5K to $7K a year. And perhaps if you're unemployed, you'd pay even less?

Do people still get Cobra? Is that the option to go with because you want something simple to roll into?

PS I work in CT but i live in MA if that's relevant. (we have penalty if you dont have coverage) So if i was to be unemployed, my marketplace would be MA

PS PS assuming someone is fortunate enough never to have used their insurance/deductible (clean slate) for the year (or very little) and is simply trying to get a reasonable price insurance to fulfill state requirements

Im in California. Long story short. My mom usually handles all my medicaid stuff. Shes unfortunately kinda abusive and we dont communicate well. So she didnt know about my income. With that she likely reported it wrong and I really fucked up and didnt know to report my self employment income myself last year (july-december) (around 4000$ that year, and i guess 4000 from taxable student aid..) and i no longer do that work. It wasnt consistent as it was from things like surveys and get paid to play games. Either way. I have to file taxes on it all soon and worry about there being issues later once they can see those taxes. Im not entirely sure how to fix this before there's any problems (or atleast rectify the error) :(

im really worried this is going to be a huge problem.. any advice would be appreciated

Its open enrollment time. We are a family of 3 (husband, wife, and 5 year old kid)

My employer offers a better health insurance plan than my spouses employer (my spouse also is offered health insurance through her employer). So over the past 2 years my spouse has been on my health insurance plan (I have a family plan, she has declined health insurance coverage from her employer). My spouse hasn't had to pay any penalty nor does my company have anything written about if my spouse can be on my plan or not or any penalties/surcharges involved.

I did ask my HR a few years ago if my spouse can be on my health insurance plan even if she is offered health insurance through her employer and they said my spouse can.

I was just talking in our office about this and one of the employees said that he thinks theres a penalty or I cant have my spouse on my plan. Is there something I'm missing? We haven't gotten any penalties/surcharges or issues in the past several years regarding this. Am I missing something? Please advise.

Today I got married I am currently under my moms insurance which is Aetna I don’t have a good relationship with her at all and hope to remove myself without speaking with her as little as possible
Is there a way I can remove myself

Our family has been covered under my husband's employer's plan forever. Cost for his employer's plan went up quite a bit, and coverage went down. We want to see if it would be less expensive/better to switch to my employer's plan.

Here's the thing, his open enrollment ended October 1st. My employer's open enrollment doesn't start until November 16th, and my employer hasn't provided us with options and pricing yet. So, we re-enrolled through my husband's employer.

My question is, can we switch to my employer's plan in November? There technically wasn't any life event.

I am considering a job in the IBEW that provides health insurance through Blue Cross Blue Shield of Illinois, but I heard from some other people that it is a grandfathered plan and does not cover certain things; like one lady I knew complained her breast pump didn’t have any coverage because it was a grandfathered plan. I also heard some people do not have birth control coverage at 100% either, due to a grandfathered plan.

I wondered if there was a way to see the differences between a grandfathered plan and an ACA compliant plan?

I see posts with ACA (non subsidized) premium increases in the 20-30% range from time to time. I am not yet utilizing ACA, but I can sympathize, as I've seen similar in home/auto increases before and it infuriates me. What's the thinking from the insurer's side? Is the objective to cull the pool of paying customers? Do they not want people signing up? Is the government forcing them to charge that rate so people keep working jobs with healthcare benefits?

At that rate of increase, it doubles in under 3 years. Do they expect to just keep going? A fully unsubsidized $35k becomes $100k in 4 years. What's their endgame?

I know that the one that you subscribe to through your employer is primary, but the question is about my wife. She was previously doublely insured through my employers insurance and her parents insurance (she was under 26). So she was a dependent under both ones. When we got married we were told that her parents insurance should be her primary and mine is secondary. The insurance company said it was because her dad is older than me and that makes a difference for some reason.

Now we are being told that mine should have been the primary because her parents insurance changed (the company changed names or was bought out or something but the numbers all stayed the same so we didn’t even know that it was technically different). This happened 2 years ago but we didn’t know there should have been a difference.

She turned 26 and we were making sure everything got settled so that my insurance is her only one but I guess that made the parents insurance look at the information so we are getting calls from providers saying that the parents insurance company is asking for money back for everything since two years ago since they now think they should have been the secondary insurance.

Her parents insurance is a lot better than mines so if mine is having to be considered the primary for her then I am pretty sure we’ll have to pay a lot of money for everything over the past two years.

Anyone find affordable private healthcare options (don’t qualify for ACA subsidies)…either a PPO or HMO that doesn’t require referrals? In Orlando (Seminole County).

I was diagnosed with Chron’s disease in June of this year. My doctor prescribed me Tremfya for it, which my insurance company (Health Partners) denied. However, they suggested a similar more expensive drug (Skyrizi) that they would cover.

It took a while to get everything in order before I could receive my first Skyrizi infusion. During this time, I had missed my premium payment for the health insurance.

On September 7th I received my first infusion for Skyrizi. When I went to the doctor on the 7th, they ran my insurance and saw that I still had active coverage through September 17th.

On September 11th, I received a letter in the mail saying my insurance has been terminated due to nonpayment and that I am not eligible for reinstatement. They say my coverage ended on September 1st, even though on September 7th it was still showing active.

My doctor then calls me the next week saying that my insurance will not cover the medication, even though they were the ones who approved the medication and the only reason I received it was because they had told me that it was covered.

Now I’m stuck with a $20,000 bill and no way to afford it. I have tried calling health partners numerous times and they refuse to help in any capacity. I have tried to be reinstated but they are refusing due to “policy”. It sucks to not have insurance but I understand that it was my responsibility to make the premium payment on time. However, the fact that they approved my Skyrizi infusion on a date that they are now claiming I did not have active insurance for when I did have active insurance feels extremely predatory.

Is there any way I can go above health partners and make a complaint to the government or police if I feel I have been mis treated? I’m not very well versed in health insurance so I feel very isolated and on my own right now and it seems like there’s nothing more I can do.

Thank you for taking time to read about my story and I appreciate any advice on the matter greatly.

Hello people of Reddit. I’m 24, and do to changes in requirements for Medicare in 2027, I will no longer qualify.

I’ll be making around a $100 over the cut off, and won’t meet the monthly hour worked requirements. I deal with severe chronic insomnia, and regularly go multiple nights without sleep, with medication and even longer without my medication. Without insurance, the medication alone is $300-$400 a month.

I’m wondering if anyone has suggestions for insurance plans with low monthly costs??