Have to change from Aetna to Kaiser or United Health.......any input from medical people?

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Originally Posted by fitz19d

Bump for knowledgeable people. Wife finally let me make some choices with her healthcare stuff as she doesn't do well figuring it out. Already got her from highest to medium plan last year. Now working on dumping premium dental plan when she doesnt even go but somehow thinks 360/yr for that is trivial to pay.

Anywho, wondering about out of pocket maximum. Seems too good to be true. On her cheap plan under ACA it was added. To boot it is also the lowest out of pocket of the 3 plans. If we are going to have a kid c-sect. We know cost would be over any plans out of pocket, why would you not do the cheap plan? No way carrier can force us into family plan since we are married if I'm doing my own companies ins. right?

Cheap plan 73/month, 1700 deductible, 5,100 out of pocket.
Mid grade plan, 170/m, 1250 deductible, 6,250 out of pocket.

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I don't believe anyone can "force" you into a family plan as long as everyone has coverage meeting ACA minimum requirements.

I figured it was some kinda I provided the baby batter therefore I'm involved kinda thing. Actually at the borderline of needing to bug my company about info since I should be getting close to the 6 month mark.

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Originally Posted by Dave_L

Same here. I had a deviated septum and had surgery last year on it. Zero complaints. Was very easy and no issues. I actually really like my doctor too. They go out of their way to check EVERYTHING if something is wrong. Maybe that's because my wife works there? I dunno. But their "one stop shop" model is great for men. Lol. Simplicity is beautiful.

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No shit. Prescriptions cost us $5, so far no matter what it is. Thank God neither of us need anything really exotic yet.

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Originally Posted by tmckay2

kaiser is having some pretty major financial problems right now and have been doing large hiring freezes. so its possible they may be even more understaffed than normal. a prescription can sometimes have a VERY long wait time, like 4-5 hours. we have people come to our pharmacy and pay out of pocket that are kaiser members because they don't want to wait and sometimes our cash prices are lower than kaisers covered prices. thats not ALWAYS the case though.

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Yeah, spot on. I left KP as an employee this past summer after years, my wife still is employed there, and I kept my own insurance through them. They priced their product wrong and are trying to make operations make up the difference, which is difficult. The ACA has been negative margin for them, and by diluting out the membership without hiring, they've really pushed out access which I see in so many posts here. It is sad. I do think KP is the correct model, but while everyone is trying to look like KP, KP is busy trying to look like one of the big 5, and failing.

But, they cured my cancer - so nothing but love. I would go back and work there if the circumstances were right.

The question is, with UHC pulling out of ACA. What happens next ?

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Originally Posted by Great-Kazoo

The question is, with UHC pulling out of ACA. What happens next ?

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The differential pooling of risks by insurance companies was there for a reason. The ACA threw that baby out with the bath water. The ACA is unsustainable and has led to overall higher healthcare costs. The government doesn't comprehend "efficiency".

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Originally Posted by Gman

The differential pooling of risks by insurance companies was there for a reason. The ACA threw that baby out with the bath water. The ACA is unsustainable and has led to overall higher healthcare costs. The government doesn't comprehend "efficiency".

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I / we're well aware of that. The question should have been how bad do you think everyone's gonna take a hit. I know the spouse has been trying to get any info on line. According to the "help desk" the number of people who lost their carrier, have been overwhelming the system. Again...............

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Originally Posted by Great-Kazoo

I / we're well aware of that. The question should have been how bad do you think everyone's gonna take a hit. I know th espouse has been trying to get any info on line. According to the "help desk" the number of people who lost their carrier, have been overwhelming the system. Again...............

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There are at least two companies locally in town going out of that business not counting UHC. Maybe more.
Anthem and Aetna are claiming stability, but I'm as skeptical as you both.

I'll go out on a limb and state that I think there will be more uninsured under the ACA than there were prior to it. I have doctors that are bailing on their practices, so I know my access to medical care was better before the ACA. I also know that I'm spending more than ever for the same level of care...or worse.

My doctor bailed, closed his practice and went to work for a bigger group. The practice he was partnered with is still limping along, but I'm not sure how long they are going to survive either.