Can someone explain insurance plans to me like I’m 5???

I’m 25, and I’m currently dealing with a sickness that may be potentially serious.

Unlike most previous years, I did not get an insurance card from my father at the start of the year. When I asked him what’s going on, he had said:

“HR is working on it, I made a mistake on the open enrollment application, they’re fixing it.”

Fast forward to Wednesday, I get so sick that I miss work… I’m still out.

I messaged my PCP, he believes there is a small chance I may have been exposed to a rodent-borne illness with a mortality rate of 36%, and wants me to get blood work done to quickly rule it out.

That’s when I contacted my dad’s HR myself. I found out HR told my dad there is nothing they can do at this point within the legal confines of the IRS to try and get me back on his plan. I can’t even get put on Cobra right now.

Without any prior warning, I learned I do not have health insurance. I was lied to by my father, and that lie is why I did not pursue getting a plan any sooner than yesterday. I thought I had until the end of October to get this straightened out.

Now I have to find an insurance plan. I am considered a ‘contingent’ employee at my work, so I can not get insurance through my workplace. It has to be an individual plan for me.

My dad is a custodian at an elementary school, so he had terrific benefits. I had no deductible, ER visits were only $100, imaging services were 100% covered, mental health had a $0 copay… In terms of health insurance, I was spoiled. I never had to worry about coinsurance, difference between epo/ppo, finding out who is in my network and who isn’t, etc..

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What should I look for in an insurance plan? I live near Pittsburgh (16066), I’ve had UPMC my entire life. Highmark is big in my area, but I’ve had five concussions, as well as complex migraines… I only made about $20,000 last year because I missed about five months of time with various medical issues.

With UPMC having a good concussion/neurology program, I would like to stay with them, plus UPMC’s other doctors have a larger presence in my area.

I went on Pennie and found I am eligible for a tax credit that lowers my monthly premium, but I’m trying to figure out what plan will:

Allow me to keep my old doctors Has a low monthly payment Has lower payments for imaging services, hospital visits, etc.

How do I know what is a good plan and what isn’t?

submitted by /u/caniseeurid