Quick question/needing advice

roser13, ASN, RN · Jul 7, 2015

I don't know much about the ACA insurance coverage (Healthcare.gov) but my impression was that anyone could purchase it. How did you "not qualify"?

Also, I hope you know to ask for a huge discount when paying cash for medical services? In the 30-40% range?

Kaitybar7 · Jul 7, 2015

I am married and we both have income and she told me to try ahcccs, which I found weird because if you make to much on healthcare.gov then obviously you make to much for ahcccs lol. And yes I have been told about asking for a discount. I guess I am just stressed. I am going to tour this birthing center next week, do you think asking them for a self pay discount is inappropriate since its not a hospital?

roser13, ASN, RN · Jul 7, 2015

I am married and we both have income and she told me to try ahcccs, which I found weird because if you make to much on healthcare.gov then obviously you make to much for ahcccs lol. And yes I have been told about asking for a discount. I guess I am just stressed. I am going to tour this birthing center next week, do you think asking them for a self pay discount is inappropriate since its not a hospital?

Ansolutely not. Tell them you're self-pay. Ask very confidently what their discount will be. Trust me, they will still make money on you. And if you saw how little the insurance companies pay for the same services with their managed care contracts, you would not hesitate to ask. Do not settle for anything less than 25% discount for cash, but as I said, 40% would come closer to appropriate.

beekee · Jul 8, 2015

Under the ACA, you are eligible for health insurance no matter what your income is. In fact, if you do not obtain health insurance, you are subject to a penalty, which is the greater of:

â€¢ 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan; or

â€¢ $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

See https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/

DowntheRiver · Jul 8, 2015

Did you mean that you don't qualify for the subsidy, and therefore cannot afford insurance without a subsidy?

jdub6 · Jul 9, 2015

One thing to consider before ruling out these insurance plans as too expensive: after the ACA passed my employer very quickly changed to expensive high deductible insurance comparable to the healthcare.gov plans (btw I think what the OP means by "not qualifying" for healthcare.gov is that she doesn't qualify for subsidies due to income...could be wrong though). I was blown away but took it because I have wound up in the hospital several times and needed coverage in case it happened again (and it has to the tune of 16 grand total bill of which I payed about 2800 including the ED visit, but I had already made a dent in my deductible as an outpatient).

What I didn't know, and was pleasantly surprised to learn, is that my out of pocket costs (at least with in network providers) when paying my deductible and coinsurance are reduced to what the insurance company would pay. I get the same rate that United Healthcare gets with that provider (and they get a HUGE discount, in my experience 30-75 percent off outpatient bills and about 75 percent off of the one hospital bill I've seen with them). (It has also opened my eyes to how little private insurers actually pay and how much private pay patients can get ripped off, but that's another story...) That combined with the tax incentives of my health savings account has made it much, much easier to swallow and I have several chronic conditions so regularly spend at least a few grand a year plus premiums.

I confess, I am an RN and not a waitress and I don't have kids and I'm sure it's that much harder for you, and I'm not sure that all plans work the way mine does in terms of the patient paying the insurer's contracted rate but it may be worth looking into because like I said it is a huge cost savings. If you don't go that route, like others have said, definitely ask for discounts. I now know for sure exactly what the insurance company pays and it is disgustingly less than the total bill (and this is private insurance, not Medicare/Medicaid), so you have every right to have your bill reduced as well.