2019 ACA plans now available for preview. Don’t forget to look at the network & out of network coverage!

by jason_for_prez

The 2019 plans are now available to be previewed. If you might be using them, check it out! www.healthcare.gov/see-plans/

Deductibles, coinsurance rates, and out of pocket maximums are very different in-network and out-of-network, so be sure to take those into account when choosing a plan! A personal example:

I’m happy covering most of my health expenses, but I want health insurance to cover me if something major and unexpected happens. I live within a mile of 3 counties, and due to a recent dispute between providers and insurers, I have a challenge. Insurer “Nearby” has a network that only covers providers in the county next to me, where I spend a lot of time, but they cover nothing in my county. Insurer “Home” covers many providers in the county where I currently live, and where my PCP is, but nobody in the neighboring county, and it is $2.5k/yr more (regardless of subsidies).

If I have a non-emergency, I can plan to get my healthcare wherever I have coverage. My concern is what happens if I have an emergency where I am rushed to the hospital. There is roughly a 40% chance I would end up at a hospital in the Nearby network, and a 50% chance it would happen in the Home network, and a 10% chance it would happen when travelling elsewhere. So whichever plan I choose, there is unfortunately a really good chance I’ll end up at an out-of-network hospital if I have an emergency. For the plans from both insurers, deductibles increase to $35,000 for anything out of network. That’s a huge increase! And, there is no out-of-pocket max for either insurer for anything out of network! Not only that, but for the Home insurer, they offer no coverage at all for a hospital stay not in their network, while the Nearby insurer at least covers 70% after the deductible. For that reason alone, I will likely be choosing the Nearby insurer.

Also, Nearby insurer has 6 different plans available. The best coverage for out-of-pocket post-deductible was actually on one of their bronze plans (better than their silver and gold). The silver and gold paid much better in-network and for more minor healthcare needs, but for major issues, bronze actually paid out better!

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