Partner got laid off in the spring, took till late summer to get another job. We’re in the US (SC) but the new job is not, so on our own for insurance. Tried contacting an insurance broker, was told to wait for open enrollment. Insurance broker gave me the feeling they didn’t care about details. Talked to my PCP in early fall about it and they recommended another broker, this broker also said contact me when open enrollment starts. I do that, this broker says we’re working on getting a form out, should be to you the 6th, and then no further contact. Tried multiple times to contact them, silence. Emailed a third broker on the 17th, so far no response.
We are in the awkward situation where the marketplace does not give us any subsidies, yet the plans I’m looking at are…odd. I have not been able to find a single plan that covers all of my doctors, despite those doctors all being covered under previous insurance and all being referrals from one another/in the same hospital system. We are in our mid thirties and are relatively healthy, except I have a neurological condition. I have dealt with many health insurance companies over the years but it was always employer based, What’s new to me is the ability to choose. So I have some questions and I’m hoping you all may be able to help.
1 When I load in my list of doctors I’m seeing various discrepancies. Looking at the same insurance plan, sometime it will claim to cover the doctor individually by name and not cover the practice, sometimes it will cover the practice and not the doctor, or both or neither. Are these lists actually correct or is this “information” as useless as it seems?
2. There are plans that list they are health + dental+ vision, and then there are plans that don’t list anything that I assume are just health. I have notice the health only plans sometimes cover specialists like optometrists. Is this something like, if you have an eye injury that doctor is covered and not routine vision care? What am I looking at here?
3. There seems to be no way to search for a vision plan on its own on the ACA site. Am I missing something or am I supposed to find it off marketplace?
4 I am under the impression that there are potentially more health plans available to an agent/broker than are listed on the ACA site. Is this correct? Is it worth trying to track someone down or should I be looking at settling for something that doesn’t really fit our situation?
5, I am interested in family planning, but more in family prevention than OB/pediatrics. Is there some terminology for this? How do I go about finding a plan more catered to that?
6. What am I doing wrong with these brokers? Is there a way to get a response? I’ve tried to plan ahead here to only get ghosted, we haven’t had insurance now in almost a year and I really, really want to have something starting on Jan 1. I don’t want to be rude or desperate, I appreciate this is probably their busiest time of the year, but my situation is not that complicated and I have all my ducks in a row. What can I do?
7. Is there a way to find more detailed versions of these plans? Looking on both the insurance company site, and the aca I have seen things like this: Gold plan 1 Deductible 2000 monthly premium 1100 max oop 10000. Gold plan 5 deductible 1000 monthly premium 1000 max oop 5000. Everything else seems to be the same. Why would anyone ever choose gold plan 1? is there some detail that this plan covers more? I’ve also seen bronze plans that seem to cover more than the gold plan did, at least according to the stats but since it’s bronze I assume it covers less but I have no way to functionally know what that entails. Where do I go to get this information? Is this really an “everything is made up and the points don’t matter” situation like it seems?
Thank you for reading this. I’m happy to try and clarify anything, I hope this is coherent.