Health Insurance-outside of Marketplace

Discussion in 'Health Insurance and Ancillary Benefits' started by groverson, Aug 31, 2017.

  1. groverson
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    groverson New Member

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    I'm currently covered with an Obamacare plan here in Tennessee for 2017. It's a Humana PPOx plan that doesn't cover much. I'm thinking about coverage for the 2018 coming year. Im trying to find the answer on the internet but still terribly confused about being denied coverage on an individual plan outside of the marketplace. Here's my question: I currently have type 2 diabetes and hypertension and would like to enroll in a healthcare plane outside of the ACA marketplace. Say on the Aetna or BCBSTN website, whichever is available at the time. Can they deny me coverage? I thought I read somewhere that you cannot be denied coverage wether your applying inside or outside the marketplace. I get yes and no answers. Is there a difinitive answer?

    Thanks for your help!
     
  2. YouGotMyMoney
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    YouGotMyMoney Guru

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    You can not be denied for health reasons if a carrier is offering coverage.

    I suggest you get a job with benefits.
     
  3. groverson
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    groverson New Member

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    Thanks for your response.
    So when Farm Bureau Health of Tennessee denied me coverage last year due to diabetes they broke the law.?
    Also, I don't have to work. I just want to buy good healthcare coverage where I'm not denied.
     
  4. FLM2
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    FLM2 Guru

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    I am not licensed in TN but if they denied you coverage then their plan is not compliant with the Affordable Care Act.

    From what I've read on these forums there aren't any good options for individual coverage in your state as almost all carriers have pulled out. If Blue Cross and/or Aetna offer plans through their website then they will be guaranteed issue and compliant with the ACA.

    If a plan is offered on the Marketplace it will also be offered off the Marketplace plus there could be others but again, it depends on how many companies are offering plans.
     
  5. groverson
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    groverson New Member

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    Thanks FLM2. I think that clears it up for me. But anyone offering non ACA compliant plans can deny coverage....right?
     
  6. FLM2
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    FLM2 Guru

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    They can but, given your personal health situation, why would you ever consider a non-compliant plan that might approve you but then deny claims by underwriting at the time of the claim? That's a really bad idea and no professional agent would ever recommend it.
     
  7. TN_agent
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    TN_agent Guru

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    You applied for a non-compliant plan with TRH, that is why you were denied. Non-compliant plans (only available off-exchange) can deny coverage and exclude pre-existing conditions.

    AFAIK, Aetna did not file to offer plans in TN in 2018. BCBSTN did. Cigna filed in some counties for next year, I have also heard Oscar filed in the Nashville area. BCBSTN may be your only option in a lot of the state. If you don't qualify for premium assistance, expect it to be pretty pricey.
     
  8. groverson
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    groverson New Member

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    Knowing whats coming for the 2018 calendar year with the ACA plans here in Williamson County Tennessee, I started to look for alternative coverage. I'm pretty sure that Cigna and Oscar will not offer any health plans that my doctor accepts. This is #1 priority for me. So I checked with USHEALTH and told them that I wanted a plan with no underwriting due to my medical conditions. Cancer, Diabetes and High Blood Pressure. He agreed that no underwriter would approve you. He did have a PHCS PPO plan that had no underwriting process. Sure its not the greatest plan but at least I can get to see my doctor. With my current ACA Humana PPOx plan I cant see my doctor.
    I got the PHCS PPO plan brochure and read through it- No surprises, it is what it is. The USHEALTH agent did a good job explaining it. For someone who is not at that medicare age yet, this is my only and best option.
     
  9. STIBROKER
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    STIBROKER Super Moderator Moderator

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    Its not seeing the doctors that you want that is the problem......getting a $600,000 hosp. stay is the problem......and it sounds like your new plan will leave you high and dry......
     
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  10. kgmom219
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    kgmom219 Guru

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    Sorry, but you are looking at this wrong.

    1. Based on your posts, you are between 60 and 64.11 months, retired and cash flow isn't your problem
    2. You don't need insurance for your doctor visits. You have the cash flow to maintain that relationship.
    3. You don't need insurance for your prescriptions. You have the cash flow to pay at the pharmacy. (Use goodrx to get the best deal)
    4. US Health has pre-ex questions, so I am not even sure how you would get it, but if you are Type 2 on Metformin, I would assume you can afford the $20/month
    5. Do the math. Figure out the the cost of the cheapest HSA plan, add the doc and prescription costs. Compare THAT number.

    You need insurance so that you are not financially wiped out with a catastrophic event or diagnosis. Get the least expensive HSA eligible plan, on the exchange, so you aren't wiped out if the doc says "its cancer". You may not like the doc list, but so what? Pay cash. What's important is the hospital list.
     
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