I NEED HELP !

[trekbyfaith]

Hello, everyone. I (25M) currently reside in Washington State (King County) and am on the dire hunt for health insurance. I am completely uninsured and suspect that I *may* request an MRI down the road. Here's the bad news: I'm an independent contractor that makes $600-$800/week before taxes. I don't have much money saved up and have credit card bills ($13K), which are not due for 10ish months (0% interest).

I've put any relevant information into HealthPlanFinder but don't know if A) I should pick any of them (maybe there's a better option for me + I've read online that many of the plans are terrible), B) If I should pick one, which one is best for my needs (primary care visit + possible MRI scan), and C) How to proceed after buying insurance?

In relation to C), where the heck do I go for treatment? Do I shop around? Do I just blindly pick a provider in the network that's nearby? Does the insurance go immediately in effect or do I have to wait a period. I know. Kind of dumb questions, but I have never done this before. Here's a list of the current options I've been shown:

OPTION 1: Ambetter - Cascade Select Gold

1) Premium with savings: $19.09/month

2) Annual deductible: $600 Medical Individual, $0 Prescription drug, $0 Family

3) Estimated total yearly cost: $658

4) Out of pocket max: $5,900 Individual

OPTION 2: Ambetter - Cascade Gold

1) Premium with savings: $43.30/month

2) Annual deductible: $600 Medical Individual, $0 Prescription drug, $0 Family

3) Estimated total yearly cost: $851

4) Out of pocket max: $5,900 Individual

OPTION 3: Ambetter - Cascade Select Silver

1) Premium with savings: $0/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $797

4) Out of pocket max: $7,250 Individual

OPTION 4: Ambetter - Cascade Silver

1) Premium with savings: $22.66/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $979

4) Out of pocket max: $7,250 Individual

OPTION 5: Community Health Plan of Washington Cascade Select Silver

1) Premium with savings: $32.40/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,057

4) Out of pocket max: $7,250 Individual

OPTION 6: Kaiser Permanente Cascade Silver

1) Premium with savings: $49.73/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,195

4) Out of pocket max: $7,250 Individual

OPTION 7: Molina Cascade Silver

1) Premium with savings: $59.86/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,276

4) Out of pocket max: $7,250 Individual

OPTION 8: Regence Cascade Silver Eastside Health Network

1) Premium with savings: $96.62/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,570

4) Out of pocket max: $7,250 Individual

OPTION 9: United Healthcare of Oregon, Inc. Cascade Silver

1) Premium with savings: $109.14/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,671

4) Out of pocket max: $7,250 Individual

OPTION 10: Regence Cascade Silver Individual and Family Network

1) Premium with savings: $110.03/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,678

4) Out of pocket max: $7,250 Individual

OPTION 11: BridgeSpan Cascade Silver

1) Premium with savings: $110.47/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,681

4) Out of pocket max: $7,250 Individual

OPTION 12: LifeWise Cascade Silver

1) Premium with savings: $111.24/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $1,687

4) Out of pocket max: $7,250 Individual

OPTION 13: Premera Blue Cross Cascade Silver

1) Premium with savings: $203.59/month

2) Annual deductible: $2,500 Medical Individual

3) Estimated total yearly cost: $2,426

4) Out of pocket max: $7,250 Individual

OPTION 14: Community Health Plan of Washington Cascade Select

1) Premium with savings: $61.37/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $996

4) Out of pocket max: $5,900 Individual

OPTION 15: Molina Cascade Gold

1) Premium with savings: $70.92/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $1,072

4) Out of pocket max: $5,900 Individual

OPTION 16: Kaiser Permanete Cascade Gold

1) Premium with savings: $82.89/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $1,168

4) Out of pocket max: $5,900 Individual

OPTION 17: Regence Cascade Gold Eastside Health Network

1) Premium with savings: $186.97/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $2,001

4) Out of pocket max: $5,900 Individual

OPTION 18: LifeWise Cascade Gold

1) Premium with savings: $190.28/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $2,037

4) Out of pocket max: $5,900 Individual

OPTION 19: United Healthcare of Oregon, Inc Cascade Gold

1) Premium with savings: $193.96/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $2,057

4) Out of pocket max: $5,900 Individual

OPTION 20: Regence Cascade Gold Individual and Family Network

1) Premium with savings: $203.59/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $2,134

4) Out of pocket max: $5,900 Individual

OPTION 21: BridgeSpan Cascade Gold

1) Premium with savings: $204.14/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $2,138

4) Out of pocket max: $5,900 Individual

OPTION 22: Pemera Blue Cross Cascade Gold

1) Premium with savings: $326.96/month

2) Annual deductible: $600 Medical Individual

3) Estimated total yearly cost: $3,121

4) Out of pocket max: $5,900 Individual

OPTION 23: Kaiser Basics Plus Catestrophic Plan

1) Premium with savings: $199.94/month

2) Annual deductible: $9,1000 Medical Individual

3) Estimated total yearly cost: $2,838

4) Out of pocket max: $9,100 Individual



COST OF PRIMARY CARE VISIT/GENERIC DRUGS RANGE FROM $10-$30.

 

[ngocvncom]

@trekbyfaith You can't just purchase a plan outside open enrollment without a qualifying event. Do you have a qualifying event?

There is definitely no better option. The plans from https://www.wahealthplanfinder.org/ are the only ACA compliant plans that are going to provide you comprehensive coverage and truly limit your financial liability. Anything you buy anywhere else will have all kinds of hidden conditions and gotchas and not provide adequate protection.

If you have a qualifying event, the type would dictate when your coverage would start...at this point you're probably waiting until June 1st for the coverage to actually start.

You get treatment from in-network providers. That's the most important part of picking a plan. You need to figure out what doctors and hospitals and prescription drugs you need and pick a plan that covers them. If you don't have any existing providers, then your selection of the plan is going to dictate who you can see and have insurance pay.

Note that you can't just request an MRI. A doctor would order an MRI if they found it necessary to diagnose a condition...you can't just go ask for one to be done.

 

[trekbyfaith]

@ngocvncom Ok, thank you for the quick reply. Yes, I had no idea about the enrollment period. I looked at the list of qualifying events for SEPs on insurance.wa.gov and don't see one that I qualify for. So, does that mean that I can't get covered until November 1st of this year and that I have to pay out of pocket for everything if I need to visit a physician now?

If that's the case, what's the suggested route I take? I can try to get a full-time W2 job, but I still won't get coverage for 60-90 days usually. I don't know how much I can pay out of pocket because I don't know how much things cost. Do I just shop around for a visit to a primary care doctor and go from there? Thank you again!

 

[ngocvncom]

@trekbyfaith Without a qualifying event it means you won't be able to purchase coverage that starts any early than Jan 1, 2024 (open enrollment for 2024 starts on Nov 1st, but coverage won't begin until 1/1).

The majority of Americans get their insurance through their employer and if you need insurance sooner than next year, your best best is to stop being an independent contractor and start being an employee with benefits.

But barring that, yes, the only option for uninsured people to get medical care is to pay cash.

 

[trekbyfaith]

@ngocvncom Wow, I had no idea. I wish that I had spent the time to research this earlier. Thank you.

 

[trekbyfaith]

@ngocvncom Hey! I know rely is a bit late, but I just found out that my AGI is 133% is above the FPL. Wouldn't that qualify me for Apple Health Care or even a covered visit at a non profit hospital?

 

[goozlo]

@ngocvncom This is kind of an old thread, but for the sake of accuracy, yes, you can buy plans outside of Healthplanfinder that are just as good as plans inside of Healthplanfinder. Regence and Premera both offer plans outside of the Exchange and actually if you know you won't be subsidy eligible, the plans outside of the Exchange tend to be better (if you're using Regence or Premera). The one major catch of purchasing a plan outside of the Exchange is that you won't be subsidy eligible.

I wouldn't touch a plan by Ambetter, Molina or Community Health Plan of WA, inside or outside of the Exchange. They make big promises about networks, but if you call providers, the providers don't accept them.

 

[megano]

@trekbyfaith Primary care and MRI are both relatively affordable- chances are low that paying your monthly premium and any co pays and deductible, would be cheaper than paying for a couple things out of pocket. Look for a free standing independent radiology clinic, and ask about their cash pay prices.

But... its kinda hard to imagine needing advanced imaging, for no reason- I'm assuming this might lead to something serious and expensive. So, you should also look at the financial assistance programs at all the major hospital systems in the area, knowing that you might need to apply. Also, remember that medicaid (aka apple health) is open enrollment year round, so if something major happens, you might need to let your business temporarily fail, so you can qualify.

Some stuff to look at, even if its just a jumping off point

https://centerspotlight.seattle.gov...-free-dental-vision-medical-care-april-27-30/

https://www.freeclinics.com/co/wa-king

https://www.hca.wa.gov/free-or-low-...al-dental-or-vision-care/eligibility-overview

 

[jasonsmith]

@trekbyfaith There are plans that you can enroll in without it being open enrollment. If you haven’t found something that works for you yet, I’d be happy to help you find what works for you. Some plans don’t even factor in deductible unless you’re hospitalized. Again, you do not have to wait for open enrollment. Send me a direct message if you’re still actively searching

 

[marcyann81]

@jasonsmith Hi could you assist me? My husband’s work based insurance seems very high and we’re considering purchasing and individual plan. Hope to hear from you soon.

 

[clestial]

@trekbyfaith Insurance open enrollment