Intro: Hello everyone. I am purchasing health insurance for the first time in my life and am losing my mind comparing plans. I don’t know what I’m doing wrong with my calculations and would greatly appreciate a third-party opinion.
Insurance situation: On Jan. 1st I was taken off my parents’ Medicaid because including me and my income in their household would put them over the Medicaid threshold. Mom has breast cancer, so they really need Medicaid.
In late December, in preparation for the ski season and knowing I would lose coverage, I purchased a catastrophic health plan from Oscar (details on that in the table below). That plan kicks in Feb. 1st. Thus, I am currently uninsured.
Important Context: Male, 22, live in NYC (zip code 11377) with parents, close to 0 living expenses, gross income ~$5.5k/month, have an emergency fund of 15k, and lead a very active lifestyle. I started working in the past year as a contractor (freelance translator).
Injury: Yesterday I took a fall on my left shoulder while skiing. All signs point to it being a rotator cuff tear, but this isn’t 100% confirmed yet. Today I got an x-ray that showed no abnormalities. I need to see an orthopedist and get an MRI to confirm this tentative diagnosis (sister is an MD). It’s kinda urgent so I will likely pay for the MRI without insurance (any tips about how to avoid paying a lot for that also appreciated).
Top priority: Regain full function of my shoulder to continue leading an active lifestyle. Spend less time thinking about insurance, more time working and enjoying life.
Prognosis: To regain full function of shoulder for active purposes, I likely need rotator cuff surgery followed by physical therapy.
Important considerations: I ski hard, so I might get injured again. Also, I need major dental work done (I need an implant), which puts one point in favor of the platinum plan, which covers dental work, whereas the Oscar plan doesn’t.
Main Question: I can’t decide if I should stick with the catastrophic plan that I already purchased or change it to a platinum plan. Here is a quick comparison of the two. Please let me know if you need any more info.
Company Plan Name Premium (after $158 APTC) Deductible Maximum Out of Pocket Yearly Cost (Premium*12+Deductible) Inpatient Physician and Surgical Services Outpatient Rehabilitation Services Imaging (in-network cost share) Oscar Secure Catastrophic, ST3PCP, INN, Circle, Dep25, Pediatric Dental, Step Tracking Rewards 187.08 (APTC ineligible) 8700 8700 10944.96 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible MetroPlus Health PlatinumPlus-P2, NS, INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards, Metro-MP 782.71 0 2000 9392.52 $100 (nothing said about deductible) $25 (nothing said about deductible) $30 (nothing said about deductible)
One thing I don’t understand is how it’s possible that the catastrophic (“crappy”) plan covers everything after my deductible, but the platinum (“amazing”) plan makes me pay a fee for all the services I might need. Can someone explain that as well?
Thank you guys. I really appreciate it.
submitted by /u/bwryan
[link] [comments]Intro: Hello everyone. I am purchasing health insurance for the first time in my life and am losing my mind comparing plans. I don’t know what I’m doing wrong with my calculations and would greatly appreciate a third-party opinion. Insurance situation: On Jan. 1st I was taken off my parents’ Medicaid because including me and my income in their household would put them over the Medicaid threshold. Mom has breast cancer, so they really need Medicaid. In late December, in preparation for the ski season and knowing I would lose coverage, I purchased a catastrophic health plan from Oscar (details on that in the table below). That plan kicks in Feb. 1st. Thus, I am currently uninsured. Important Context: Male, 22, live in NYC (zip code 11377) with parents, close to 0 living expenses, gross income ~$5.5k/month, have an emergency fund of 15k, and lead a very active lifestyle. I started working in the past year as a contractor (freelance translator). Injury: Yesterday I took a fall on my left shoulder while skiing. All signs point to it being a rotator cuff tear, but this isn’t 100% confirmed yet. Today I got an x-ray that showed no abnormalities. I need to see an orthopedist and get an MRI to confirm this tentative diagnosis (sister is an MD). It’s kinda urgent so I will likely pay for the MRI without insurance (any tips about how to avoid paying a lot for that also appreciated). Top priority: Regain full function of my shoulder to continue leading an active lifestyle. Spend less time thinking about insurance, more time working and enjoying life. Prognosis: To regain full function of shoulder for active purposes, I likely need rotator cuff surgery followed by physical therapy. Important considerations: I ski hard, so I might get injured again. Also, I need major dental work done (I need an implant), which puts one point in favor of the platinum plan, which covers dental work, whereas the Oscar plan doesn’t. Main Question: I can’t decide if I should stick with the catastrophic plan that I already purchased or change it to a platinum plan. Here is a quick comparison of the two. Please let me know if you need any more info. Company Plan Name Premium (after $158 APTC) Deductible Maximum Out of Pocket Yearly Cost (Premium*12+Deductible) Inpatient Physician and Surgical Services Outpatient Rehabilitation Services Imaging (in-network cost share) Oscar Secure Catastrophic, ST3PCP, INN, Circle, Dep25, Pediatric Dental, Step Tracking Rewards 187.08 (APTC ineligible) 8700 8700 10944.96 0% coinsurance after deductible 0% coinsurance after deductible 0% coinsurance after deductible MetroPlus Health PlatinumPlus-P2, NS, INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards, Metro-MP 782.71 0 2000 9392.52 $100 (nothing said about deductible) $25 (nothing said about deductible) $30 (nothing said about deductible) One thing I don’t understand is how it’s possible that the catastrophic (“crappy”) plan covers everything after my deductible, but the platinum (“amazing”) plan makes me pay a fee for all the services I might need. Can someone explain that as well? Thank you guys. I really appreciate it. submitted by /u/bwryan [link] [comments]Read Morer/HealthInsurance