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.
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| 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 |
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| 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 |
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| Provider Directory | Provider Directory |
| National provider network | Yes |
| Multi-state plan | Yes |
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| 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 |
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| Total cost for a healthy pregnancy and normal delivery | Data Not Available |
| Total cost of managing type 2 diabetes | Data Not Available |
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| Routine dental care | Not Covered |
| Basic dental care | Not Covered |
| Major dental care | Not Covered |
| Orthodontia | Not Covered |
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| 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 |
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| 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
|
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| 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 |
Miss Attorney Ma'am 