Does anyone have experience with converting from a group plan to an individual policy?
I've had good coverage with our group plan with Anthem Blue Cross / Blue Shield, but due to others in our small firm going on Medicare, we will lose our group plan and I need to find a good individual policy that will cover me both in state and out of state. I go out of state for treatment and consultations.
I've been told by my broker that there are currently no good options for an individual plan that will "travel."
Any suggestions will be helpful. I'm a few years away from being eligible for Medicare.
Forums
Re: Converting to an individual health insurance plan
Hi Robert,
We currently are on COBRA thru my employer until Dec 31 and need an individual policy starting in 2016. We wanted to continue with a Blue Cross Blue Shield policy because it has been excellent covering my husband's treatments since 2011.
I recently spent a lot of time looking at the different policies on Healthcare.gov. We live in Michigan, and when looking at the different plans offered on Healthcare.gov for our state, Blue Cross Blue Shield had some plans they identified as "Multi-State". I assume those types of plans might allow one to get treatment in another state outside your residence, but I did not check on that to be sure. The Multi-State premiums were more than the BCBS plan we eventually signed up for, since my husband's multiple myeloma specialist is also located in Michigan making the more expensive Multi State plan unnecessary. I found that all his Rx would also be covered, and even a few of the new ones that his oncologist says he might need to take in the future.
I don't know if the broker you're working with already checked Healthcare.gov but if they didn't, you might want to check it out.
Good luck,
Chris M.
We currently are on COBRA thru my employer until Dec 31 and need an individual policy starting in 2016. We wanted to continue with a Blue Cross Blue Shield policy because it has been excellent covering my husband's treatments since 2011.
I recently spent a lot of time looking at the different policies on Healthcare.gov. We live in Michigan, and when looking at the different plans offered on Healthcare.gov for our state, Blue Cross Blue Shield had some plans they identified as "Multi-State". I assume those types of plans might allow one to get treatment in another state outside your residence, but I did not check on that to be sure. The Multi-State premiums were more than the BCBS plan we eventually signed up for, since my husband's multiple myeloma specialist is also located in Michigan making the more expensive Multi State plan unnecessary. I found that all his Rx would also be covered, and even a few of the new ones that his oncologist says he might need to take in the future.
I don't know if the broker you're working with already checked Healthcare.gov but if they didn't, you might want to check it out.
Good luck,
Chris M.
-
Chris M
Re: Converting to an individual health insurance plan
Be careful with regard to multi-state plans. The name is incredibly misleading.
A multi-state Obamacare plan means that there is one common overall plan that has been contracted with the government and is offered in several states under Obamacare. However, it does NOT necessarily mean that you can go out-of-state and be covered under that plan. Some multi-state Obamacare plans do allow you to go out of state and be covered, but it varies from plan to plan in any given state. So, you have to read the fine print in the detailed certificate of coverage and call the insurance company itself to verify whether the plan truly offers multi-state coverage.
Since I want to use specialists that are outside of my state, I used to be really excited about Obamacare multi-state plans until I discovered this major gotcha.
A multi-state Obamacare plan means that there is one common overall plan that has been contracted with the government and is offered in several states under Obamacare. However, it does NOT necessarily mean that you can go out-of-state and be covered under that plan. Some multi-state Obamacare plans do allow you to go out of state and be covered, but it varies from plan to plan in any given state. So, you have to read the fine print in the detailed certificate of coverage and call the insurance company itself to verify whether the plan truly offers multi-state coverage.
Since I want to use specialists that are outside of my state, I used to be really excited about Obamacare multi-state plans until I discovered this major gotcha.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Converting to an individual health insurance plan
Multibilly makes a good point. We have to research those policies thoroughly to make sure of the benefits and restrictions.
The Michigan Blue Cross Blue Shield policy we selected, which is not listed as multi state, has a drop down where I searched and found our providers and hospitals. Out of curiosity, I just searched for oncologists / hematologists in Ohio, just to test it out. Many Ohio providers showed up in the search results, so if you find a plan you think might meet your needs, use its links to search for your providers and hospitals.
As a final verification, you could also call your provider and hospital to confirm that they accept the plan you're considering.
Best wishes,
Chris M.
The Michigan Blue Cross Blue Shield policy we selected, which is not listed as multi state, has a drop down where I searched and found our providers and hospitals. Out of curiosity, I just searched for oncologists / hematologists in Ohio, just to test it out. Many Ohio providers showed up in the search results, so if you find a plan you think might meet your needs, use its links to search for your providers and hospitals.
As a final verification, you could also call your provider and hospital to confirm that they accept the plan you're considering.
Best wishes,
Chris M.
-
Chris M
Re: Converting to an individual health insurance plan
Just because an out-of-state doctor is listed as in network on the carrier's insurance site, that does not necessarily mean that one can go out of state and be covered. It just means that they are in the overall network. Also note that these in-network doctor lists are notoriously out of date and full of errors. If you have a specific doctor or institution you want to see, you should also call them up to verify that they are still in-network (after you have first verified with your carrier that you can in fact go out of state).
As an example in California:
"California health exchange pulls error-ridden physician list -- again", Los Angeles Times, Feb 7, 2014 (full text of article)
As an example in California:
"California health exchange pulls error-ridden physician list -- again", Los Angeles Times, Feb 7, 2014 (full text of article)
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Converting to an individual health insurance plan
A group plan only requires two people and you need to stick with that most likely. When I was diagnosed, my group plan didn't cover any of the leading transplant centers, so my employer got a group plan for him and me under one of the sub companies so that I could get the doctors and facilities I needed access to.
I have Blue Cross of California and it has been excellent. Blue Cross uses centers of excellence for transplant so I was able to go to Fred Hutchinson in Seattle, which is what I needed.
Talk to other brokers if necessary but you need to be POSITIVE you can see your doctors. I ran a medical practice management and billing company for 14 years so my insurance knowledge is pretty strong. Happy to answer more questions or help review policies for you if you would like.
Cindy
I have Blue Cross of California and it has been excellent. Blue Cross uses centers of excellence for transplant so I was able to go to Fred Hutchinson in Seattle, which is what I needed.
Talk to other brokers if necessary but you need to be POSITIVE you can see your doctors. I ran a medical practice management and billing company for 14 years so my insurance knowledge is pretty strong. Happy to answer more questions or help review policies for you if you would like.
Cindy
-
CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
Re: Converting to an individual health insurance plan
In addition to all of the other good information that you've been given, you need to make sure that any hospital and any doctor that you might see in addition to your oncologist is in network. That includes doctors in emergency rooms that you might use at some point.
There was an article in the Philadelphia Inquirer a week ago about a man who went to the ER that was listed as in network for his insurance. He was shocked when he received a bill for using an out of network doctor when he was in the ER. The ER doctor that night was a contractor and not in network for the man's insurance. So, even though he made sure he was going to an in network hospital, not all of the people who treated him were in network.
Good luck finding what will work the best for you. I would ask the billing department, or finance person, at your oncologist's office what insurances they accept in addition to talking with the insurance company about the specifics of the policy that you are interested in.
Nancy in Phila
There was an article in the Philadelphia Inquirer a week ago about a man who went to the ER that was listed as in network for his insurance. He was shocked when he received a bill for using an out of network doctor when he was in the ER. The ER doctor that night was a contractor and not in network for the man's insurance. So, even though he made sure he was going to an in network hospital, not all of the people who treated him were in network.
Good luck finding what will work the best for you. I would ask the billing department, or finance person, at your oncologist's office what insurances they accept in addition to talking with the insurance company about the specifics of the policy that you are interested in.
Nancy in Phila
-
NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Converting to an individual health insurance plan
Thank you everyone for your replies and suggestions. Unfortunately, I have no choice about converting to an individual policy, and the options that I've seen so far don't look very promising. I'll see about talking with my oncologist's business office to ask if they have any suggestions. It just seems strange that there are no individual policies that are comparable to the group policy I had. Thanks again to everyone who took the time to reply. Any other suggestions would, of course, be welcome!
Re: Converting to an individual health insurance plan
There was a headline in the business section of the Dallas Morning News this morning: "Heath care choice: Your doctor or your money".
Apparently, at least in Texas, the networks that are offered on Healthcare.gov are dramatically shrinking. The insurance companies have dropped some of the leading cancer and research hospitals. For example, UT Southwest Medical Center in Dallas and M.D. Anderson Cancer Center in Houston are being locked out. THESE INSTITUTIONS ARE NOT INCLUDED ON ANY PLAN OFFERED BY THE EXCHANGES.
That means they are out of network and that forces the patient into a tough choice. Either they patient will have to find a myeloma specialist who is in network, which may not even exist, or pay out of network pricing, which they likely cannot afford. This is similar to the return of the HMO environment of the 1990s whith very limited networks that exclude most of the large research, teaching and specialty hospitals.
This is a horrible situation. Apparently the insurance companies took a financial beating last year and have reacted by dropping or paring back some of their broader networks. According to the article, 2/3rds of the PPOs on the exchange nationwide have been eliminated or reduced for calendar year 2016.
http://www.dallasnews.com/business/columnists/mitchell-schnurman/20151116-health-care-choice-your-doctor-or-your-money.ece
Apparently, at least in Texas, the networks that are offered on Healthcare.gov are dramatically shrinking. The insurance companies have dropped some of the leading cancer and research hospitals. For example, UT Southwest Medical Center in Dallas and M.D. Anderson Cancer Center in Houston are being locked out. THESE INSTITUTIONS ARE NOT INCLUDED ON ANY PLAN OFFERED BY THE EXCHANGES.
That means they are out of network and that forces the patient into a tough choice. Either they patient will have to find a myeloma specialist who is in network, which may not even exist, or pay out of network pricing, which they likely cannot afford. This is similar to the return of the HMO environment of the 1990s whith very limited networks that exclude most of the large research, teaching and specialty hospitals.
This is a horrible situation. Apparently the insurance companies took a financial beating last year and have reacted by dropping or paring back some of their broader networks. According to the article, 2/3rds of the PPOs on the exchange nationwide have been eliminated or reduced for calendar year 2016.
http://www.dallasnews.com/business/columnists/mitchell-schnurman/20151116-health-care-choice-your-doctor-or-your-money.ece
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Converting to an individual health insurance plan
Hi - I too am finding it very difficult to find affordable medical insurance. This year my husband will start Medicare but I have about 5 years before I'm eligible for Medicare. We had been on my husband's retirement health plan that stops when the employee is 65. Learned today our PCP we've seen for years will not accept any of the health exhange plans and only takes PPOs and Medicare. Also, Mayo was in net on the plan we are losing and can't find them on the exchange plans.
Spoke with a health insurance broker and she said the best plan for me would be a limited plan with a premium of about $650/month with a deductible of $6,500. I will have to find all new doctors too. Because our health insurance costs have more than doubled over the past 3 years, we have severely cut back to 1-2 doctor visits/year. Was starting to consider the penalty option, but with MGUS you never know. Don't know what to do. Diane
Spoke with a health insurance broker and she said the best plan for me would be a limited plan with a premium of about $650/month with a deductible of $6,500. I will have to find all new doctors too. Because our health insurance costs have more than doubled over the past 3 years, we have severely cut back to 1-2 doctor visits/year. Was starting to consider the penalty option, but with MGUS you never know. Don't know what to do. Diane
-
Dianem
14 posts
• Page 1 of 2 • 1, 2
Return to Insurance & Patient Assistance Programs