As I am about to begin my eighth year assisting consumers under the Affordable Care Act, I must say that it mystifies me that so many people are still choosing to live without health insurance.
Since all three states in the Tri-State signed on for “expanded Medicaid,” anyone making less than about $1,500 per month (or $3,000 for a family of four) is eligible for totally free coverage. And for those making less than $50,000 a year ($100,000 for a family of four), anyone without employer-sponsored coverage can get a very good deal, thanks to income-based credits to their monthly premiums.
How good? Consumers can go to KyHealthPlanFinder.com, OhHealthPlanFinder.com or WvHealthPlanFinder.com and get quotes on all available plans in less than five minutes, anonymously and with no obligation.
Any plan you choose will include free checkups and preventive care procedures like mammograms, colonoscopies and pelvic exams. Also, even if you don’t meet your deductible, you will get deep discounts on all your services just for having the insurance card in your pocket as long as you use doctors and other providers in the network of the plan you’ve chosen.
One concept that people miss too often is that even if you never meet your plan’s deductible, you are protected from the volume of medical bills that can make you go broke. By law, the highest maximum out-of-pocket expense (or “MOOP”), even on the cheapest plans offered, will be $8,550 for 2021, or twice that for any size family. That would certainly be a blow to a budget, but keep in mind that the average hospital stay amounts to $10,700, according to BusinessInsider.com. And, after your MOOP is met, the rest of the year will be free of additional charges for covered health care. The insurance company must pay them 100%.
As I work to advise my neighbors during the Nov. 1 through Dec. 15 open enrollment for 2021, I will be urging them to pay close attention that the doctors and hospitals they want to use are in the provider network of the chosen health insurance plan. This won’t be easy for some, such as consumers in eastern Lawrence County, Ohio, because none of the three carriers (as of this writing) have contracted with either of the hospitals in Huntington. Two of them do include the medical center in Ashland.
One Ohio carrier, the one most competitively priced for 2020, has made it more confusing by contracting with most Huntington physicians, while not covering their associated hospitals. For example, if a doctor at Marshall Health gives a patient orders for lab work, they can’t be taken across the hallway to Cabell Huntington and still be paid for by that insurance plan.
Consumers would be also well-advised to use primary care doctors with facilities like labs and X-rays on site. This is because most plans incorporate charges for such procedures in the doctor’s visit co-pays, as long as all of the services are on the same date and billed together. In other words you don’t have to meet the deductible for the bill to be covered.