Author Topic: Health care: group health vs. preferred provider vs. Medicaid  (Read 983 times)

RedmondStash

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I'm having some sticker shock looking at current ACA premiums, even bare-bones bronze-level. I may be FIRE-ing in the next couple of months and am trying to figure out healthcare options.

Does anyone know if group health plans (which are much cheaper) give you the same out-of-network discounts that preferred provider plans do? I figure I'll be paying out of pocket for most healthcare costs anyway because of high deductibles, so I might as well pay the smallest possible premium for catastrophic coverage, and then just go see the doctors and specialists I want and pay the rates negotiated by the insurance companies, even if they don't actually cover any of the costs. I can't tell if there's a financial advantage to doing that with a group health plan vs. a preferred provider plan. Chances are good I won't actually use the group health plan's providers because I already have the doctors I want.

And Medicaid -- I might be eligible for it next year, but again, is it worth it? I keep hearing that many doctors don't take it; does that mean that I'd have to pay their full prices instead of a rate discounted by my health insurance?

Thanks.

jim555

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Re: Health care: group health vs. preferred provider vs. Medicaid
« Reply #1 on: April 29, 2017, 11:05:19 AM »
And Medicaid -- I might be eligible for it next year, but again, is it worth it? I keep hearing that many doctors don't take it; does that mean that I'd have to pay their full prices instead of a rate discounted by my health insurance?
Most states do managed care plans run by companies like UHC, Molina, etc..  Look up the plans in your state to see the doctor networks and compare it to the exchange plans to make an intelligent decision.  It is fantastic if your docs are in a Medicaid plan since everything is fully covered.

lhamo

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Re: Health care: group health vs. preferred provider vs. Medicaid
« Reply #2 on: April 29, 2017, 03:09:12 PM »
We are currently on Medicaid in WA.  I have been very happy with it.  I've gotten good treatment from/liked all the practitioners we have seen (primary care, dental, vision -- the latter including specialists at Harborview Eye Center, where I will be having my upcoming cataract surgery).   I did have to wait a long time to get a referral to the Eye Center, but I think that was more because I was seeking a second opinion.   I also had to call a few places to find a dental provider that would set up appointments with my kids in the late afternoon.   But I didn't feel any of the timeframes were longer than they would have been with a non-Medicaid provider.

I did end up going to a different mental health provider and paying out of pocket after seeing the one at my primary care clinic for a few months.   The Medicaid mental health providers (at least the one I went to) only do 30 minute sessions, and are focused more on immediate relief of acute issues rather than going more deeply into longer term issues.  It wasn't a good fit for what I needed, and I did better paying out of pocket for longer sessions with a different provider.

Have you looked at the Regence plans? They have ones that are Blue Cross/Blue SHield affiliated that will cover emergency treatment out of state or out of country at in-network rates at any BCBS affiliated hospital.   They are cheaper than the PRemera plans, too.   I'll eventually put us on a Regence UW Medicine silver plan when our income ramps back up.   I want the access to UW/Harborview specialists if anything major comes up.

RedmondStash

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Re: Health care: group health vs. preferred provider vs. Medicaid
« Reply #3 on: April 30, 2017, 08:45:31 PM »
We are currently on Medicaid in WA.  I have been very happy with it.  I've gotten good treatment from/liked all the practitioners we have seen (primary care, dental, vision -- the latter including specialists at Harborview Eye Center, where I will be having my upcoming cataract surgery).   I did have to wait a long time to get a referral to the Eye Center, but I think that was more because I was seeking a second opinion.   I also had to call a few places to find a dental provider that would set up appointments with my kids in the late afternoon.   But I didn't feel any of the timeframes were longer than they would have been with a non-Medicaid provider.

I did end up going to a different mental health provider and paying out of pocket after seeing the one at my primary care clinic for a few months.   The Medicaid mental health providers (at least the one I went to) only do 30 minute sessions, and are focused more on immediate relief of acute issues rather than going more deeply into longer term issues.  It wasn't a good fit for what I needed, and I did better paying out of pocket for longer sessions with a different provider.

Have you looked at the Regence plans? They have ones that are Blue Cross/Blue SHield affiliated that will cover emergency treatment out of state or out of country at in-network rates at any BCBS affiliated hospital.   They are cheaper than the PRemera plans, too.   I'll eventually put us on a Regence UW Medicine silver plan when our income ramps back up.   I want the access to UW/Harborview specialists if anything major comes up.

Good to know. Thanks. I haven't looked specifically at Regence plans. Right now, I have employer-sponsored insurance, and I'm just starting to look at my ACA exchange options.

Most states do managed care plans run by companies like UHC, Molina, etc..  Look up the plans in your state to see the doctor networks and compare it to the exchange plans to make an intelligent decision.  It is fantastic if your docs are in a Medicaid plan since everything is fully covered.

I didn't realize Medicaid covered costs that fully. I guess I'll check to see which of my docs are in Medicaid plans. Thanks.

cacaoheart

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Re: Health care: group health vs. preferred provider vs. Medicaid
« Reply #4 on: May 02, 2017, 07:03:00 AM »
Some docs like my daughter's pediatrician won't take new medicaid patients but if you go onto medicaid after becoming an established patient they may keep you.