[quote=bearishgurl][quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).
It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.
I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.
As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.
If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.
But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.[/quote]
Both of the bolded plans suggested by nsr are EPO’s and thus do not have out-of-network coverage.
All EPOs and the Kaiser HMOs are inferior to citydweller’s current Anthem/Blue Cross PPO.
I agree that a Kaiser HMO can contract out a patient within their service areas to a specialist provider which they do not have locally available. I’ve seen this happen a few times with co-workers on their plans. I also agree with UCGal in that Kaiser HMOs cover emergencies while the planholder is traveling within the US (not sure out of country). As far as Kaiser’s 60% HSA plan mentioned here by citydweller which will be featured as a “Bronze Plan” on CA’s exchange, it is anyone’s guess if this particular plan will cover out-of-network providers. This particular plan seems as if it may have been “watered down” specifically for CoveredCA and not one of Kaiser’s typical HMO plan offerings.
In spite of citydweller’s $700+ mo current premium, I really think he (or she) should think twice before leaving his current plan to purchase one on CoveredCA, especially since he states that his existing policy has been “grandfathered” and that he won’t be eligible to receive tax credits in 2014.
There are no longer any more PPO plans available which have quite the level of coverage and features of a “grandfathered” plan. Break out your magnifying glass, folks, as the devil is in the details :=0 They have ALL been “dumbed down” in various (insidious) ways to be marketed on the state’s exchanges, since the carriers can no longer discriminate as to who gets covered. That’s the major reason why Aetna, Cigna and United Healthcare have decided to dump their indiv policyholders located in CA on the state’s exchange, IMO.
citydweller was obviously medically underwritten at one time (upon application).
