CPAPtalk.com

Anyone with an individual health insurance policy happy with their insurer in terms of cost and what they cover relating to sleep apnea equipment, studies, etc. ? I have BCBS HSA Silver and pay $503 a month w/$3,000 deductible for in network. It's going up so I'm shopping around.

The problem is that you can't really find out what type of DME coverage it is until AFTER you sign up, and then only if you request the Evidence of Coverage document which spells it out in detail. If you try to get the EOC before you sign up they may not provide it and may tell you that it's "proprietary".

You can try asking an insurance agent to get you the details on DME coverage--in some cases they can. But all I got is "yes, there is DME coverage". Turns out to be rotten DME coverage--I MIGHT get a pair of crutches if I break a leg, but CPAP is NOT covered.

The ACA plans vary wildly state to state, even coverage level to coverage level, so just because someone else has a BCBS HCA silver does not mean that they have the same coverage you do. Even within your state, it depends on which coverage levels you're eligible for--based on income there are multiple BCBS HCA silver plans.

So much for consumer choice.

And before anyone starts trying to say the ACA is bad, I will state that it's ONLY because of the ACA I have any insurance at all and I'm grateful to have coverage. When my husband lost his job there were three of us with pre-existing conditions and no way in the world we could afford coverage without the ACA. It's not perfect, but way better than no coverage.

Janknitz wrote:The problem is that you can't really find out what type of DME coverage it is until AFTER you sign up, and then only if you request the Evidence of Coverage document which spells it out in detail. If you try to get the EOC before you sign up they may not provide it and may tell you that it's "proprietary".

You can try asking an insurance agent to get you the details on DME coverage--in some cases they can. But all I got is "yes, there is DME coverage". Turns out to be rotten DME coverage--I MIGHT get a pair of crutches if I break a leg, but CPAP is NOT covered.

The ACA plans vary wildly state to state, even coverage level to coverage level, so just because someone else has a BCBS HCA silver does not mean that they have the same coverage you do. Even within your state, it depends on which coverage levels you're eligible for--based on income there are multiple BCBS HCA silver plans.

So much for consumer choice.

And before anyone starts trying to say the ACA is bad, I will state that it's ONLY because of the ACA I have any insurance at all and I'm grateful to have coverage. When my husband lost his job there were three of us with pre-existing conditions and no way in the world we could afford coverage without the ACA. It's not perfect, but way better than no coverage.

Just to be clear preexisting condition clauses before the ACA kicked in after like 60 or 90 days uninsured. That being said the subsidies do help people with low income afford insurance.

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Could be cheaper in the long run to buy out of pocket on the net. Cpap.com is where I got my unit. It's nicer to work we honest providers. Any cheaper! Jim

I agree about buying it on your own. A lot of inusrance plans are useless now. I can only use mine if I meet my deductible, which keeps going up. I met it this year since I had an ER trip for e-coli. Then I had a 2 week migraine, and later, mysterious chest pain that had to be checked out. I have insurance, yet I am still paying off those bills from the summer.

I buy my cpap supplies online. Sometimes ebay. I also check craigslist on a regular basis. I got my backup machine that way. I am past 5 years now, so, I supposed I could have asked for a new machine this year. But I still would have had my 20% to pay plus deal with a DME. I have a good working machine and a backup/travel machine. I will wait.

I am not looking forward to this coming year. I am praying no big problems (certainly not 3 ER visits in 3 months). My HRA account will be smaller this year, and my deductible will go up again. I am also very concerned about my contract which is up in May. I have been looking online, and so far, it looks like the Cadillac tax is still set to start in 2018, which means my plan will cost my employer a LOT more, over $4,000 more per person. We almost lost our insurance 3 years ago because this tax was coming. So, I may be without once the contract goes through. Or I could be on strike in May. Either way will be bad.

Fortunately, I have backups of everything I need cpap - wise, so it will just be prescriptions and doctor visits that I need to worry about for awhile.

Janknitz wrote:The problem is that you can't really find out what type of DME coverage it is until AFTER you sign up, and then only if you request the Evidence of Coverage document which spells it out in detail. If you try to get the EOC before you sign up they may not provide it and may tell you that it's "proprietary".

You can try asking an insurance agent to get you the details on DME coverage--in some cases they can. But all I got is "yes, there is DME coverage". Turns out to be rotten DME coverage--I MIGHT get a pair of crutches if I break a leg, but CPAP is NOT covered.

The ACA plans vary wildly state to state, even coverage level to coverage level, so just because someone else has a BCBS HCA silver does not mean that they have the same coverage you do. Even within your state, it depends on which coverage levels you're eligible for--based on income there are multiple BCBS HCA silver plans.

So much for consumer choice.

And before anyone starts trying to say the ACA is bad, I will state that it's ONLY because of the ACA I have any insurance at all and I'm grateful to have coverage. When my husband lost his job there were three of us with pre-existing conditions and no way in the world we could afford coverage without the ACA. It's not perfect, but way better than no coverage.

Exactly Janknitz. Without the ACA, I would have been in big trouble without the ACA since I was treated for Lymphoma.

As far as answering lwieland11's question, I agree that it is impossible to tell what type DME coverage each plan provides. And in my current plan, they changed the rules on me. One time, they paid for a mask without the doctor having to file for preauthorization. Another time, they decided it was necessary so I simply purchased the mask out of pocket to avoid the hassle.

49er

Just to be clear preexisting condition clauses before the ACA kicked in after like 60 or 90 days uninsured. That being said the subsidies do help people with low income afford insurance.

NOT true! If you managed to get insurance, the pre-existing clause would "kick in" after 60 0r 90 days or even 6 months. But first you had to get the insurance. if you got insurance through an employer, there might be a pre-existing clause so you wouldn't be covered for certain things for 60 or 90 days.

But private insurers practiced UNDERWRITING. They did not have to accept anyone. And I know because I "failed" underwriting more than once because of my pre-existing congenital heart condition. They refused coverage for standard policies. I was directed to high risk pools I could NOT afford. This was when my husband was employed but we had to pay out of pocket for family, and I didn't want the insurance he had. I had no other choice.

Now I'm self-employed and husband is no longer employed. We would NOT have insurance if not for the ACA.

Janknitz wrote:

Just to be clear preexisting condition clauses before the ACA kicked in after like 60 or 90 days uninsured. That being said the subsidies do help people with low income afford insurance.

NOT true! If you managed to get insurance, the pre-existing clause would "kick in" after 60 0r 90 days or even 6 months. But first you had to get the insurance. if you got insurance through an employer, there might be a pre-existing clause so you wouldn't be covered for certain things for 60 or 90 days.

But private insurers practiced UNDERWRITING. They did not have to accept anyone. And I know because I "failed" underwriting more than once because of my pre-existing congenital heart condition. They refused coverage for standard policies. I was directed to high risk pools I could NOT afford. This was when my husband was employed but we had to pay out of pocket for family, and I didn't want the insurance he had. I had no other choice.

Now I'm self-employed and husband is no longer employed. We would NOT have insurance if not for the ACA.

Same here. My husband and I are both self-employed and don't make a lot, so without the ACA, we would not have health insurance. We have to get a low-premium/high-deductible policy, but at least we have it. (And it definitely was needed big time a few years ago.) And it's nice not to have pre-existing conditions be an issue. The individual policies I had before ACA, I had to wait a year before being covered for a pre-existing condition and the premiums were much higher. I think they had levels or tiers for policy premiums depending on what risk category they put you in. And it didn't take much to bump you to the worst one.

Janknitz wrote: NOT true! If you managed to get insurance, the pre-existing clause would "kick in" after 60 0r 90 days or even 6 months. But first you had to get the insurance. if you got insurance through an employer, there might be a pre-existing clause so you wouldn't be covered for certain things for 60 or 90 days.

But private insurers practiced UNDERWRITING. They did not have to accept anyone. And I know because I "failed" underwriting more than once because of my pre-existing congenital heart condition. They refused coverage for standard policies. I was directed to high risk pools I could NOT afford. This was when my husband was employed but we had to pay out of pocket for family, and I didn't want the insurance he had. I had no other choice.

Now I'm self-employed and husband is no longer employed. We would NOT have insurance if not for the ACA.

Glad you chimed in because I was going to.
You are correct. The only time pre existing conditions might be covered after a short period of time is with a group policy.
Private policies typically would permanently not cover a condition or sometimes maybe offer a period of time like 1 or 2 years and then only for a condition that was relatively minor. Insurance companies didn't want to maybe have to pay for something if they could figure out a way to get out of it. So they would either simply exclude coverage for that pre existing condition or rate it up so high that the person wouldn't/couldn't pay the premium. Most of the time it was exclusion. I sold insurance for 6 years (pre ACA days) and saw it happen all the time.

Jerseyguy wrote:That being said the subsidies do help people with low income afford insurance.

Not only low income people! Two cases, friends of mine:

Case 1: Retired at age 60. Lives in a nice neighborhood in a well-kept 4,000 sq.ft. house. Bought a $75,000 pickup last year (top-of-the-line F450 with all options). Took a six weeks vacation to Canada and Alaska. Spent two weeks in an expensive VRBO in Georgetown, seeing expensive concerts and dining at expensive restaurants. All of this in 2016. Brags about how large his ACA subsidy is. Big Democrat/liberal.

Case 2: Net worth about $4.0 million. Owns two tree farms and one soybean/corn/cotton farm plus some nice commercial rental properties. Retired, 69 years old. Second marriage - a young wife. Defers income so the wife can get maximum subsidy under ACA. Doesn't brag, but told me this confidentially. Supports all Democrats.

Both cases really piss me off. The first guy I dumped as a friend when he bragged about this. The second guy, we go out and raise a lot of hell - I'll probably keep him.

I don't mind tax money helping low-income people struggling with finances. But, these fat cats sucking on the government teat piss me off. Vote against all incumbents!

Pugsy wrote: Insurance companies didn't want to maybe have to pay for something if they could figure out a way to get out of it.

People and companies that buy policies don't want to pay high premiums, so the insurance companies are forced to cut out something to stay in business. I see these people that say they can't pay high premiums spending money on liquor, concerts and tattoos. Pisses me off.

Chevie wrote:I see these people that say they can't pay high premiums spending money on liquor, concerts and tattoos.

... plus NFL and NBA tickets. Lower section.

Chevie wrote: I don't mind tax money helping low-income people struggling with finances. But, these fat cats sucking on the government teat piss me off. Vote against all incumbents!

Pugsy wrote: Insurance companies didn't want to maybe have to pay for something if they could figure out a way to get out of it.

People and companies that buy policies don't want to pay high premiums, so the insurance companies are forced to cut out something to stay in business. I see these people that say they can't pay high premiums spending money on liquor, concerts and tattoos. Pisses me off.

Dang! When I looked at it 3 years ago, it said I qualified for subsidies, but even with them, my premiums would have gone up 5x and my deductible would have 8x higher. I was able to get my employer insurance, and it is better and cheaper than the ACA plan, but I am still paying down $1500 in bills from this summer. I'm praying I don't have any emergencies this year. My deductible is going up again.