I am considering switching from my former employer's retiree health plan through United Healthcare to an ACA plan through Health Republic Insurance of New Jersey. It appears that my doctors and facilities (both oncology and non-oncology) and my wife's doctors are all in-network for Health Republic, and we should save a lot on premiums if we switch.
But I've never heard of Health Republic, so I am wondering if anyone has direct experience with them, good or bad, to share?
Thanks,
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Experience with Health Republic Insurance of New Jersey?
Hi Mike, all I can say is: Buyer Beware!
About a year ago I was in the same boat – do I stay on a group plan (former employers COBRA / United Healthcare) or switch to an individual plan offered by Health Republic Insurance of NEW YORK (NOT New Jersey).
For $500 a month (single), they offered - $0 deductible, $0 co-insurance and a great New York network. All of my docs, my wife's docs, and most importantly Memorial Sloan Kettering and other top hospitals in New York City, were in the network. My COBRA plan was $650 per month with a $2000 deductible plus 80% co-insurance up to approx. $6,500. So it seemed like a no brainier. I checked with brokers, the billing offices of my providers, and even got the financial rating, and all was good. So I made the change to Health Republic of NY.
All was great. Best insurance I ever had. All claims paid. All my drugs – Xarelto, Revlimid, Zometa, etc. – all paid. I even had a prescription that I had to pay out of pocket, Xarelto, and I submitted a form along with a receipt and they sent me a check. The customer service folks were even outstanding.
Then with about 30 days notice they announced they were going out of business. They will stop processing claims with dates of service on or before November 30, 2015. 100,000+ people now have 30 days to find insurance for December 2015 then 2016.
What a freeking mess! Although I am not surprised, as a I paid $6,000 in premiums and rang up over $125,000 in claims.
If I were you, I would find a good broker and think twice about leaving your group plan. My understanding is employer sponsored / group plans offer you a national network (ACA and other individual plans only offer a local network) and you can have both Medicare and group insurance. (My broker tells me it's illegal to have both Medicare and an individual health insurance plan. A second transplant is an issue with Medicare, I believe, and our oral chemo drugs will cost about $10,000 per drug under Part D and after the cost supplemental Medicare plan.)
If you go the SSDI route (I had to because my former employer sponsored private disability plan made me file for SSDI and I was approved for SSDI in about 4 weeks), you will have to take Medicare in 2 years from your date of disability. If you don't, you have to repay the SSDI payments to Uncle Sam.
To sum up, I think, find a good broker in New Jersey and review all of this with him or her. In the long run I think you will be better off with that employer sponsored group plan. You will have a national network and if you ever go on SSDI / Medicare, you will have cheaper coverage assuming that you will need catastrophic Part D drugs. If Health Republic of New Jersey goes the route of Health Republic New York, I doubt you will have the ability to go back to your group plan. Half of the ACA co-ops are already gone. More will follow.
I hope this helps. Managing multiple myeloma is the easy part. Figuring out how to pay for it in the good old USA – well that's another matter!
About a year ago I was in the same boat – do I stay on a group plan (former employers COBRA / United Healthcare) or switch to an individual plan offered by Health Republic Insurance of NEW YORK (NOT New Jersey).
For $500 a month (single), they offered - $0 deductible, $0 co-insurance and a great New York network. All of my docs, my wife's docs, and most importantly Memorial Sloan Kettering and other top hospitals in New York City, were in the network. My COBRA plan was $650 per month with a $2000 deductible plus 80% co-insurance up to approx. $6,500. So it seemed like a no brainier. I checked with brokers, the billing offices of my providers, and even got the financial rating, and all was good. So I made the change to Health Republic of NY.
All was great. Best insurance I ever had. All claims paid. All my drugs – Xarelto, Revlimid, Zometa, etc. – all paid. I even had a prescription that I had to pay out of pocket, Xarelto, and I submitted a form along with a receipt and they sent me a check. The customer service folks were even outstanding.
Then with about 30 days notice they announced they were going out of business. They will stop processing claims with dates of service on or before November 30, 2015. 100,000+ people now have 30 days to find insurance for December 2015 then 2016.
What a freeking mess! Although I am not surprised, as a I paid $6,000 in premiums and rang up over $125,000 in claims.
If I were you, I would find a good broker and think twice about leaving your group plan. My understanding is employer sponsored / group plans offer you a national network (ACA and other individual plans only offer a local network) and you can have both Medicare and group insurance. (My broker tells me it's illegal to have both Medicare and an individual health insurance plan. A second transplant is an issue with Medicare, I believe, and our oral chemo drugs will cost about $10,000 per drug under Part D and after the cost supplemental Medicare plan.)
If you go the SSDI route (I had to because my former employer sponsored private disability plan made me file for SSDI and I was approved for SSDI in about 4 weeks), you will have to take Medicare in 2 years from your date of disability. If you don't, you have to repay the SSDI payments to Uncle Sam.
To sum up, I think, find a good broker in New Jersey and review all of this with him or her. In the long run I think you will be better off with that employer sponsored group plan. You will have a national network and if you ever go on SSDI / Medicare, you will have cheaper coverage assuming that you will need catastrophic Part D drugs. If Health Republic of New Jersey goes the route of Health Republic New York, I doubt you will have the ability to go back to your group plan. Half of the ACA co-ops are already gone. More will follow.
I hope this helps. Managing multiple myeloma is the easy part. Figuring out how to pay for it in the good old USA – well that's another matter!
Re: Experience with Health Republic Insurance of New Jersey?
Hi borntorun,
Wow! Thanks a lot for sharing your Health Republic experience with me. I'm sorry you went through that. What a cruddy thing to do, cancelling everyone with one month left in the year!
Now you've got me thinking extra hard about this, even harder than I was before. I'll look into finding a broker here in New Jersey.
By the way, I am treated at Memorial Sloan-Kettering also. I hope things are going well for you.
Mike
Wow! Thanks a lot for sharing your Health Republic experience with me. I'm sorry you went through that. What a cruddy thing to do, cancelling everyone with one month left in the year!
Now you've got me thinking extra hard about this, even harder than I was before. I'll look into finding a broker here in New Jersey.
By the way, I am treated at Memorial Sloan-Kettering also. I hope things are going well for you.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
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