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Questions tagged [health-insurance]

For questions about health insurance policies, including relevant terminology, types of policies, how to evaluate a health insurance policy, etc. Questions should be tagged with a country-specific tag in most cases, e.g. "united-states" or "canada".

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Health insurance overturns original denial

Health insurance overturns original denial of prescription. However, member already paid out of pocket to receive medication in a timely manner. The price for the member is higher than contracted cost ...
paulj's user avatar
  • 1,166
1 vote
1 answer
90 views

Dependent is insured through COBRA, when they turn 26 can they elect COBRA again?

I was on my dad's insurance. When he retired in 2020, he went on Medicare, and enrolled my siblings and I in COBRA. I am about to turn 26. I know that "dependents may enroll in COBRA for up to 36 ...
Missyinvisible's user avatar
2 votes
1 answer
562 views

Does retirement (pre-Full Retirement Age) qualify for a special enrollment period for the affordable care act?

If I retire before I am old enough to be eligible for Medicare, and it wasn't a forced retirement by my employer. Do I qualify for a special enrollment period for the Affordable Care Act (aka ...
JohnFx's user avatar
  • 53.1k
3 votes
3 answers
3k views

Deciphering my Payroll stub

My employer here in Florida doesn't offer health benefits. However, each pay period (every 2 weeks) they include $150 (untaxed) for me to spend toward health care. Am I required to spend that on ...
Brian's user avatar
  • 31
1 vote
4 answers
585 views

Buying health insurance though the Marketplace vs directly

I'm considering purchasing a Kaiser Permanente plan, either directly from Kaiser or through the state marketplace. The two plans appear identical, with slightly different names: "Silver HSA X&...
Panic's user avatar
  • 148
1 vote
1 answer
59 views

NJ Employer health insurance offerings

How do you find out what health insurance plans are offered by employers in NJ to their employees? Is there a website I can look at? Thankyou.
Lisa C Smith's user avatar
5 votes
2 answers
1k views

Why are Group health insurance premiums smaller?

I want to make certain I understand group or employer-based health insurance premium pricing. An employer has dozens of employees. The risk for all employees requiring high-usage of healthcare is ...
paulj's user avatar
  • 1,166
21 votes
3 answers
8k views

Doctor won't let me self-pay because I've "already presented" them my insurance card?

My doctor's cash price is lower than the insurance price. Since I likely won't hit my deductible this year I asked to switch to self-pay. They told me they are "not allowed" since I have &...
Derek Fulton's user avatar
1 vote
2 answers
231 views

My wife is 26 and I am 30. We want catastrophic health insurance. If she is the policyholder, can we do this?

Please do not reply with "you can't get catastrophic if you're not under 30". I know that. My question is can WE get it as a FAMILY PLAN if my 26-year-old wife is the policyholder.
Derek Fulton's user avatar
3 votes
1 answer
382 views

Can my spouse use her HSA funds to pay for insurance premiums if she lost her job?

My wife was recently laid off and will be joining my health insurance plan that I have through my employer. She's on a visa, so will not be claiming any unemployment benefits. Since my insurance will ...
mathemagician's user avatar
3 votes
1 answer
324 views

How can I know the price and make sure insurance is going to pay for a certain procedure beforehand?

This is a test for me. I'm used to using the software side of StackExchange, but I think this format could work for this. Let's see and please let me know if there's a better place to discuss these ...
A Campos's user avatar
  • 133
2 votes
2 answers
147 views

Can only the individual version of this health plan be a High-Deductible Health Plan?

I'm looking at a health insurance plan that has a deductible of $3000, for each person enrolled. If you enroll one person, it pays out when that person has $3000 or more of medical expenses. If you ...
interfect's user avatar
  • 159
1 vote
2 answers
264 views

What are the risks of buying health insurance directly and not through the federal or state exchanges?

I'm self-employed and it's open enrollment time. My current health insurance was bought on the state exchange but the premium is going up 22% so that certainly encourages you to shop around. I've ...
Craig W's user avatar
  • 16k
8 votes
3 answers
5k views

Switching health insurance due to birth of baby

Expecting a baby in a few months and also working through Open Enrollment season. If I chose a low deductible plan for the beginning of 2024, and then switch to a high deductible plan after baby is ...
kk7534's user avatar
  • 232
5 votes
6 answers
8k views

How can I find out what % of the health insurance premium my employer pays?

Let's say I pay $600/month (deducted from my paycheck) for the premiums in my PPO plan. Is there a public place to check how much of the premium my employer pay (without needing to ask them of course)?...
Henley Wing Chiu's user avatar
1 vote
0 answers
229 views

EOB says $4k total charges, $4k ineligible charges, PR $0, still got bill from the provider for $1431

The EOB for the service (epidural) says that: charge: $4000 allowed charge: $0 ineligible: $4000 patient responsibility: $0 ineligibility code: 1 - The Provider is not eligible to receive ...
Vadim K.'s user avatar
  • 111
1 vote
1 answer
104 views

Qualifying for an HSA contribution

There are two basic criteria to check if your health insurance qualifies for HSA contributions. (There are details on the IRS website.) Minimum annual deductible (single person): $1,500 Maximum ...
Fuzzy's user avatar
  • 59
3 votes
1 answer
3k views

Insurance taken out when payed 3 times in a month

I worked at a company where I got payed every 2 weeks. Insurance would be taken out out of each check. On the months we got 3 checks they would still deduct insurance out of the 3rd check. Is that ...
Mike Mata's user avatar
4 votes
1 answer
269 views

What protection is there against profiteering by health insurance providers when renewing cover in future years (UK)?

I am assisting a family member who wishes to have health insurance in the UK. We have obtained quotes from a number of providers. However, these generally relate to the first year only. We ...
Adam Bailey's user avatar
7 votes
4 answers
3k views

Is it worth submitting an out of network claim if it won't meet my deductible?

My wife gave birth to our child at home, under the care of both a midwife and doula. Our insurance does cover all of this, but as out-of-network. Total charges for both providers would be $4,600. This ...
Nosjack's user avatar
  • 8,827
7 votes
2 answers
4k views

Short term health insurance between jobs

My wife is changing jobs- her and the kids are currently on her employer's group health plan. She is changing employers unexpectedly- she has only been at this employer for about four months. She has ...
David's user avatar
  • 405
2 votes
1 answer
199 views

Break even point for HDHP plan vs being uninsured?

I just learnt about nearby hospital's "uninsured patient discount" policy document that states: The Uninsured Patient Discount will not apply to any item or service provided to a patient ...
user4910112's user avatar
3 votes
1 answer
495 views

What Schedule C Health care Expenses can I deduct?

I am helping my daughter do her taxes, and have a question about what deductions are appropriate. She is on her own, not a dependent anymore but still on my insurance as she's under 26. Her income is ...
JTP - Apologise to Monica's user avatar
1 vote
2 answers
236 views

Should I claim medical expense before insurance made final determination?

A family member has had a surgery at the end of last year. So far the insurance claim has been rejected because the doctor did not report it properly. I have no idea when that will be resolved and ...
taxpayer2022's user avatar
0 votes
0 answers
167 views

Dr. office moved my payments around and now double billing me?

I had to pre-pay for treatment until insurance kicked in; insurance totally messed up all the claims and paid where they should not have which made doctors billing dept. move my payment to other ...
Sick of Billing's user avatar
2 votes
2 answers
273 views

Can I receive APTC if I am on F1?

Last year I used the marketplace (healthcare.gov) to get health insurance for myself (F1) and my dependents (F2). Based on the information and documents I provided, they found me eligible and gave my ...
Mohammad Hassany's user avatar
-3 votes
1 answer
340 views

Is it legal or ethical for the insurance company to increase the cost of the service from the service provider to the patient?

I visited the emergency room, out of state, for lower back pain. My bill was $1,013.08. The providers bill showed Florida Blue Cross/Blue Shield paid $129.91 but also INCREASED my bill in the amount ...
Bill's user avatar
  • 1
2 votes
0 answers
92 views

Who pays for costs of organ donations?

If person X's advance directive for healthcare has them listed as an organ donor, who pays for life sustaining treatment to ensure that the organs remain viable before harvesting? Is it person X's ...
heretoinfinity's user avatar
1 vote
1 answer
325 views

Lab repeatedly submitted bill to wrong insurance. How do I resolve the issue?

I am handling the estate of my late step-father. In November 2021 he was in the hospital and had lab work done. The lab company sent the claim to the wrong insurance. My mother & insurance company ...
Minerva1us's user avatar
0 votes
1 answer
205 views

Does my spouse's income count the income calculation for the Affordable Care Act? (See details)

Scenario: I plan to retire before I am eligible for Medicare My wife is eligible for and plans to sign up for Medicare when I retire My wife has income from social security We file our taxes as ...
JohnFx's user avatar
  • 53.1k
2 votes
1 answer
191 views

Health insurance company went out of business; what am I on the hook for?

In June 2020, I had a biopsy (negative). At the time, I was “covered” by ACA-compliant insurance that was paid in full, in good standing, etc. I paid the required co-pay on the day of the procedure. ...
AndreaDoria's user avatar
1 vote
2 answers
212 views

Paying too much for health insurance - is there a crisis-only policy avaialble?

Say there's a family of four living on one income. The income level is moderate, say in the $80-100k per year range, they live simply and budget carefully, and have a relatively comfortable, debt-...
nuggethead's user avatar
  • 2,099
1 vote
2 answers
669 views

Are there any tax/general implications to adding my fiance on employer sponsored insurance?

I recently started a new position and am working on declaring/electing benefits with my employer. To my surprise this employer allows "domestic partners" to be insured for various forms of ...
KDecker's user avatar
  • 1,108
0 votes
2 answers
335 views

Pre-existing conditions on short-term health insurance

Despite the many answers on this site saying pre-existing conditions are a thing of the past, there are non-marketplace US insurance plans that exclude pre-existing conditions on a 12 month or 24 ...
Dragonel's user avatar
  • 797
11 votes
3 answers
6k views

Can you just cancel a health insurance plan and buy a new one at any time?

So I need to buy insurance for myself. I picked one of those plans where you pay a huge premium monthly and also get to pay for all the healthcare too. My question is, can I just cancel my plan and ...
DotNetRussell's user avatar
1 vote
1 answer
992 views

What does a negative plan discount mean on a medical insurance claim in the United States?

I saw the following medical insurance (Aetna) claim in the United States: What does the negative plan discount mean?
Franck Dernoncourt's user avatar
24 votes
8 answers
8k views

Dental insurance isn't really a type of insurance?

The central tenet of insurance is to pay slightly more on average while getting protected from paying very large amounts of money should disaster strike. In essence it's paying a premium to lower risk....
Kevin Kostlan's user avatar
3 votes
1 answer
184 views

Is the hospital illegally using "balance billing" of primary and secondary health insurance to charge us too much?

My wife and I live in New York City and recently we had a baby and my wife stayed in the hospital for two nights. She has insurance through her employer, which is her primary insurance, and she is ...
Clem Marshall's user avatar
3 votes
1 answer
241 views

Private health insurance in Germany

I moved to Germany as a university professor two months ago. This month, I discovered that I am partially issured through the so called 'Beihilfe,' and that I have the option of choosing between ...
RobUn's user avatar
  • 33
2 votes
0 answers
52 views

Dual citizenship. Live 1m in Florida, 1m in Buenos Aires, 1 month in Florida, and so on. I'm covered in Argentina. What should I do while in the US?

Dual citizenship: American and Argentinian. I'm covered in Argentina, but does not have health insurance in the US. I would like a catastrophic plan, but they aren't offered to 46 years old. Do I have ...
Roger Kasinsky's user avatar
6 votes
1 answer
1k views

From a customer standpoint, does it make any financial difference to go to a non-profit hospital or a for-profit hospital? [closed]

From a customer standpoint in the US, does it make any financial difference to go to a non-profit hospital or a for-profit hospital?
Franck Dernoncourt's user avatar
2 votes
1 answer
60 views

Are COBRA plans subject to the same special enrollment rules as non-COBRA group plans?

I recently elected COBRA coverage, and a few weeks later my wife left her job. She has access to her own COBRA coverage from her job, but we'd prefer her to be on my plan rather than hers. My COBRA ...
TAGraves's user avatar
  • 123
-4 votes
3 answers
841 views

Why do some medical insurances only allow their insurees to buy 30 days worth of some pharmaceutical drugs (not a narcotic) at once?

I have a 90-day prescription for a pharmaceutical drug (which isn't a narcotic) in the US. By default, my medical insurance only allows me to buy for 30 days, i.e. I'll have to go 3 times to the ...
Franck Dernoncourt's user avatar
0 votes
1 answer
226 views

Can an Orthodontist charge you more later on due to over calculating?

I went to the dentist for a cleaning March 2020. I had said while there that my mouth hurt as well as my jaw. The dentist recommended I see the orthodontist and asked if I had time that day for a ...
Samatama1's user avatar
2 votes
1 answer
148 views

Did the Hospital Mis-Bill My Insurance Plans?

Some months ago, I received treatment at a hospital in New York City. While I was there, I provided them with the insurance information for two plans under which I was covered. Company A sent me an ...
szkoda's user avatar
  • 51
1 vote
1 answer
438 views

Do you qualify for Medi-Cal if you are wealthy and just don't work?

If I'm reading the descriptions of Medi-Cal correctly, low income alone is enough to qualify you for free medical coverage. So, if you are taking a sabbatical, working on your own startup (that isn't ...
MWB's user avatar
  • 541
1 vote
1 answer
2k views

If I meet my Out-Of-Pocket Maximum, but not my deductible then what happens to my medical bills?

Out-Of-Pocket Maximum is the amount you pay including any cost sharing payments such as coinsurance, copayments and deductible amounts. Usually copayments don't get counted toward deductibles and ...
LeanMan's user avatar
  • 271
0 votes
1 answer
49 views

What are the minimum financial benefits a long-term care insurance must have to allow a Washington tax resident to opt out from the long-term care tax

Revised Code of Washington (RCW) 48.83.020 (mirror) states: "Long-term care insurance" means an insurance policy, contract, or rider that is advertised, marketed, offered, or designed to ...
Franck Dernoncourt's user avatar
4 votes
2 answers
2k views

Which insurance is primary when you have coverage through two employers?

If someone has health insurance coverage in the U.S. through two separate employers, which is considered primary for the coordination of benefits? How is this determined?
Daniel's user avatar
  • 5,330
-2 votes
1 answer
176 views

Is it allowed to change one's qualifying long-term-care insurance after opting out from the long-term care payroll tax in Washington?

After opting out from the long-term care payroll tax in Washington by purchasing a qualifying long-term-care insurance, one has to keep a qualifying long-term-care insurance, other one may get in ...
Franck Dernoncourt's user avatar

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