Update: I enrolled through the Marketplace and Purchased Health Insurance

This is the conclusion of my hunt for the least expensive individual health insurance policy

Update February 21, 2014:

I have purchased insurance through the Marketplace! After my research of coverage options and assessment of my needs.  I came to the conclusion: since my current spending is zero on health care all I need is health insurance.  I need the lowest monthly premium, regardless of out of pocket maximum.  If and when my needs change, I can increase my coverage; there is no longer a bar for preexisting conditions.

I first attempted to select a plan on February 13, but encountered system errors.  I waited a few hours, and tried again, again errors.  I called the customer service, had a 10 minute wait time, only to be told that beyond waiting a few hours and trying again, I would need to delete my application and start all over again.  February 14, I deleted my application and tried again.  This time I received a notice that the system would be down till February 18 [after President’s Day Holiday].  On February 18 I was able to enroll and pay my first month’s premium, took about 30 minutes. As of today, I haven’t got my materials in mail and my payment hasn’t processed.

I selected a Blue Cross Blue Shield Bronze B02E [Personal Blue Network E] plan with a monthly un-subsidized premium of $131.91 and annual out of pocket max of $6300. Details after jump.

Costs for medical care

Collapse –

Primary care doctor visit 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Specialist visit 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
X-rays and diagnostic imaging 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Laboratory and outpatient professional services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Hearing aids 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network; 1 Item(s) per 3 Years ;Limits and Exclusions Apply
Routine eye exam for adults Not Covered
Routine eye exam for children No Charge In-Network; 40% Out-of-Network; 1 Visit(s) per Year
Eyeglasses for children No Charge In-Network; 40% Out-of-Network; 1 Item(s) per Year
Health Savings Account eligible plan Yes
Prescription drug coverage

Collapse –

Generic drugs 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Preferred brand drugs 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Non-preferred brand drugs 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Specialty drugs 50% Coinsurance after deductible In-Network; Not Covered Out-of-Network
List of covered drugs  View Covered Drugs
Three month in-network mail order pharmacy benefit Yes
Prescription drug deductible Included in Combined Medical & Drug Deductible
Prescription drug out-of-pocket maximum Included in Combined Medical & Drug Maximum Out-of-Pocket
Access to doctors and hospitals

Collapse –

Provider Directory  Provider Directory
National provider network Yes
Multi-state plan Yes
Hospital services

Collapse –

Emergency room care 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Inpatient doctor and surgical services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Inpatient hospital services (like a hospital stay) 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Cost and coverage examples

Collapse –

Total cost for a healthy pregnancy and normal delivery Data Not Available
Total cost of managing type 2 diabetes Data Not Available
Adult dental coverage

Collapse –

Routine dental care Not Covered
Basic dental care Not Covered
Major dental care Not Covered
Orthodontia Not Covered
Child dental coverage

Collapse –

Check-up No Charge In-Network; No Charge After Deductible Out-of-Network; 1 Visit(s) per 6 Months
Basic dental care 20% In-Network; 20% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Major dental care 50% In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Medically necessary orthodontia Orthodontic treatment may require pre-approval and must meet the plan’s ‘medical necessity’ criteria. 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Medical management programs

Collapse –

Asthma
Asthma program available
Heart disease
Heart disease program available
Depression
Depression program not available
Diabetes
Diabetes program available
High blood pressure & high cholesterol
High blood pressure & cholesterol program not available
Low back pain
Low back pain program not available
Pain management
Pain management program not available
Pregnancy
Pregnancy program not available
Weight loss programs
Weight management program not available
Other benefits

Collapse –

Acupuncture Not Covered
Chiropractic care 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network; 20 Visit(s) per Year ;Limits and Exclusions Apply
Infertility treatment 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Mental/behavioral health outpatient services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Mental/behavioral health inpatient services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network;Limits and Exclusions Apply
Habillitative services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network; 20 Visit(s) per Year ;Limits and Exclusions Apply
Bariatric services Not Covered
Outpatient rehabilitative services 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network; 20 Visit(s) per Year ;Limits and Exclusions Apply
Skilled Nursing Facility care 50% Coinsurance after deductible In-Network; 50% Coinsurance after deductible Out-of-Network; 60 Visit(s) per Year ;Limits and Exclusions Apply
Private-duty nursing Not Covered
Advertisements

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s