Ny/nj health insurance?

amother

OP ↓

Tue, Jul 30 2024, 9:13 pm

Hi
We’ve always had health insurance through my husbands job but he is starting something new and will be receiving a stipend towards benefits instead of a benefits package. We are trying to match what he had before…is there such a thing as insurance that you can use in two states? Our regular (soon to be old) insurance has coverage anywhere in and out of network. But when I speak to agents for marketplace insurance seems it’s in state only. We are able to do cobra for now but trying to see what our options will be. Anyone knows? Tia!

amother

Glitter

Tue, Jul 30 2024, 9:44 pm

amother OP wrote:

I never heard of such a thing though my company does offer one option for locals. Did you try calling major names like bcbs and UH and asking for help?

amother

NeonYellow

Tue, Jul 30 2024, 9:57 pm

amother OP wrote:

I called bcbs they seemed confused by my question and said they don’t know who I should speak to. That most people are fine to just use the in state doctors and hospitals. Problem is we use some doctors in the city.

We have horizon bcbs and I'm pretty sure we were recently told that if we get the highest tier coverage (gold), it would cover across state lines.

Otherwise AFAIK the only insurances that cover across states are those you get through an employer.

Amarante ↓

Tue, Jul 30 2024, 10:07 pm

Theoretically it is available. However when you purchase insurance not through the marketplace, you are entering the Wild West because all kinds of scam insurance is peddled that isn't ACA compliant.

If he has lost health insurance he only has a limited period of time to purchase insurance which is ACA compliant.

This is important because unless you purchase during Open Enrollment, you can't purchase insurance which covers pre-existing conditions. There are reasons for this which are irrelevant but that is the reality. Insurance not purchased during Open Enrollment is what is called "medically underwritten" which means that you fill out an extensive application in which you list your medical history - if it is inaccurate or incomplete, they will not cover you if you put in an expensive claim - and they have whole departments looking for a way not to pay.

The other issue is that the premiums for this kind of insurance are very high - if you can even find it. This is because people who want coverage in multiple states tend to be heavy users of more expensive medical care. That is just statistically of course.

You should consult your tax person because you might do well (depending on your tax situation) with a high deductible plan with some form of HSA. This is a good way to shelter income as well as you don't pay taxes on the amount it increases like you do with most investments.

amother

↑ OP ↓

Tue, Jul 30 2024, 10:12 pm

Amarante wrote:

Would a high deductible plan be sensible for a large family with a high income? Even with an hsa

amother

↑ OP ↓

Tue, Jul 30 2024, 10:13 pm

amother NeonYellow wrote:

Can I ask: What is your premium and family size?

↑ Amarante ↓

Tue, Jul 30 2024, 10:15 pm

amother OP wrote:

Would a high deductible plan be sensible for a large family with a high income? Even with an hsa

You really need to speak to a professional rather than someone on the internet who has no knowledge of your circumstances.

You need to estimate your anticipated annual costs based on how you use medical expenses - factor in everything - premiums, co-insurance, co-payments, deductible, annual out of pocket expenses to see what makes sense.

Speak to your tax person in terms of whether the tax savings for a high deductible plan make sense for you.

The lower the deductible/co-payments the higher the premium will be - also of course HMO will be less expensive than a PPO.

↑ Amarante ↓

Tue, Jul 30 2024, 10:22 pm

amother NeonYellow wrote:

Your post is a bit confusing - do you get insurance through an employer?

Also Platinum is the highest tier and cross state coverage would depend on the specific plan as Blue Cross/Blue Shield have multiple plans.

To give you a rough sense, I just ran a mythical 45 year old couple (husband and wife) through the Caiifornia official website. A Blue Shield Platinum PPO $2336 per month for premiums. There would be no coverage outside of California but costs for medical care would be good - e.g. no deductible and $15.00 co-payment/

↑ Amarante ↓

Tue, Jul 30 2024, 10:26 pm

amother OP wrote:

Can you clarify-who should I speak to about the insurance. We have been spoiled by having benefits for years and I have no idea how to proceed. Obviously will discuss tax issues with our accountant.

I assume you are in New Jersey as no one who lives in New York is worried about not having access to care in New Jersey - no shade to New Jersey. Very Happy

You can go to the official NJ marketplace and you will get an idea of what an ACA Plan costs as you might be eligible for a premium subsidy depending on income and size of family.

Theoretically you could speak to an ethical knowledgable broker but I hesitate to suggest that because there are a lot of scam agents who will sell you worthless policies that aren't ACA compliant.

You might ask your lawyer or accountant.

I do urge you to act quickly because you have a limited amount of time to enroll in insurance after you have lost your insurance. I think it could be 30 days.

↑ Amarante ↓

Tue, Jul 30 2024, 10:29 pm

amother OP wrote:

I think we can use cobra for at least 18 months so will do that for now. It’s also not cheap but I don’t think anything good is. at some point need to figure out next steps.

COBRA makes sense - have you gotten the amount it will cost because people are often shell shocked when they find out what the premium is because of how much their employer subsidized it

Also keep in mind that once you take COBRA, dropping it doesn't create a Qualifying Event so you would only be able to sign up for ACA compliant insurance during Open Enrollment or if you had a Qualifying Event

↑ Amarante ↓

Tue, Jul 30 2024, 10:42 pm

amother Rose wrote:

Am I naive or clueless?
Aetna and United Healthcare are nationwide no?
I've have both and can go to any dr. Any state

That is extremely unusual because almost all health insurance has networks and there is either no coverage or more expensive coverage if you go out of the network.

All insurance will cover you out of state for an emergency but once you are medically stable, you need to get further medical care in your area.

Some networks in large states don’t cover outside of certain geographic areas. If you are in Mew York your network wouldn’t have providers in Buffalo for example.

hello12341

Wed, Jul 31 2024, 1:30 am

Based on your question, I'm assuming you are in New Jersey.

This year there is no longer any personal insurance plans on or off the marketplace that offer out of state coverage. The only way to get nationwide coverage is through an employer plan. (Someone mentioned Horizon Omnia Gold. That used to have nationwide coverage but as of 2024 no longer does.)

This is a problem for many. Some people have found ways to create their own business and get health insurance that way.

One thing you can look into is going onto a Horizon BCBS plan. You won't get NY coverage, but they do cover HUP (adults) and CHOP (kids) in Pennsylvania, which is a great hospital network with good options for doctors.

For all of your NJ coverage options, you can call an insurance broker that deals with personal plans. Diamant and Associates in Lakewood does this, and I believe Cosmo Insurance as well.