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And by that, I mean shopping for 2025 health insurance.
For my 2024 coverage (57-year-old male, zip code 64108) I’ve used HealthCare.gov to get coverage via Ambetter Standard Expanded Bronze for $803/month ($7,500.00 deductible/$9,400.00 max out of pocket/$50 copay).
For 2025 Ambetter actually reduced my premium to $731/month.
Since I’m quite healthy I wanted to get a plan with a lower premium and tried ehealthinsurance.com but the best they could offer was $827/month for an Ambetter Health Solutions Bronze HSA ($6,400 deductible/$8,050 max out of pocket/20% Coinsurance after deductible copay).
I also tried some other websites and then deluged with very “spammy” phone calls, texts, and emails (as well as a few offers from potential girlfriends). None of which seems legit and all of which required me to keep re-entering my age, sex, tobacco use, and zip code.
I spoke with one broker who quoted an Aetna plan ($680/month) that had a lower copay and max out of pocket than my current Ambetter, but then could not share any documents without me enrolling by providing a credit card number.
Has anyone ever done this before? Is there an organization, website, or broker that can provide legitimate non-marketplace health insurance plans?
Epilogue: I went with the Ambetter from Home State Health
Standard Expanded Bronze for $730.58/month (Deductible:
$7,500, Out-of-pocket max $9,200, Doctor visits $50, Generic drugs $25).
Getting Health Insurance is NO easy task. Check out a broker with highly legit companies like Mutual of Omaha, Prudential, United Health Care etc. I did this about 5 years ago and it all worked out. You are picking the right time to do this, as when you are healthy is the only time to change. I got cancer and if I change the rates goes through the roof. Best of luck hunting and I would stay with a highly recognized successful company that has been around for many years.
Here is the list of the best from Copilot AI:
Kaiser Permanente: Known for its integrated care and high customer satisfaction, Kaiser Permanente offers comprehensive health plans with a focus on preventive care.
UnitedHealthcare: Offers a wide range of plans and is known for its extensive network of healthcare providers.
Humana: A popular choice for Medicare Advantage plans, Humana provides affordable options with good coverage.
Blue Cross Blue Shield: Offers a variety of plans with extensive provider networks, making it easy to find a doctor near you.
AARP/UnitedHealthcare: Their Medicare Supplement Plan G is highly rated for its flexibility and coverage.
Wellcare: Known for its prescription drug plans, Wellcare is a good option if you need comprehensive medication coverage.
William Dorner, When you have a moment, please reply with the name of that broker.
You really need to be careful if you sign up for a plan that is not on the ACA marketplace. These plans may not cover what you think they will cover and you could be stuck paying thousands of dollars in medical bills. You think you’re saving money and you’re covered but you can’t possibly read all of the fine print in the contract. My friend got stuck with a $10,000 hospital bill that she thought was covered. All the plans in the ACA marketplace. (healthcare.gov) are regulated by the federal government and cover the same things. Here is a good article https://www.commonwealthfund.org/blog/2019/seeing-fraud-and-misleading-marketing-states-warn-consumers-about-alternative-health
We had an Obamacare plan that was HSA eligable and now it has dissapeared… Apparently BCBS of North Carolina no longer offers HSA eligible plans. Crazy.
How long have you been with Ambetter? I am considering it for the first time (for next year) but see a lot of negative reviews. How has been your experience? Our usage should be on the low side with no existing conditions.
sksharma123, I have been with Ambetter for the last year. It was a good experience though I did have an issue getting a CT scan approved, though it may have been my doctor’s fault for not following up and pushing the issue. I’ve blogged about it all here.
Unless something happens over the next few days, the plan is to re-up with them for 2025 (using the above $731/month Bronze plan).
I’ve had Ambetter for the past two years and had no problems, despite huge bills in 2024 for my cancer treatment. On the other hand, within weeks if not days, I hit my out-of-pocket maximum, so there wasn’t much to quibble over, at least when it came to my share of the cost,
I want to point out that Ambetter offers plans on the ACA marketplace (where they are regulated by the government) and also offer plans that are not on the ACA marketplace. I would be careful about selecting their plans that are cheaper and not on the ACA marketplace (Healthcare.gov). These plans may or may not cover your bills. They can also ask about pre existing conditions which they cannot on the ACA marketplace. Here is an article about non compliant ACA insurance https://www.commonwealthfund.org/blog/2019/health-plans-that-dont-comply-with-aca-put-consumers-at-risk#:~:text=Relatively%20cheap%20health%20plans%20that,hidden%20costs%20and%20limited%20coverage
Mike, were you eligible to keep your previous company’s health care benefits when you retired? If so, what caused you not to? That seems like it would be the simplest approach, though obviously not necessarily the “best” for everyone.
Michael1, I was not.
Try Stride, not sure if it will offer different results, I haven’t tried it but I heard a pharmacy chain was partnering with them. Let us know if they’re any good. Many people are looking for plans right now.
Margaret Fallon, I tried Stride, it appears it is just a mirror of HealthCare.gov, as it displayed the exact same plans including the $731/month Ambetter policy I mentioned above.
Since I’m on Medicare I have different problems. However, I went to healthcare.gov, as Dick suggested, and knocked 15 years off my age. I was offered a choice of 63 plans. My only experience with a broker was not happy, and I would not recommend using one. The government website seems fine.
The cheapest plans in my zip code are from Blue Cross, and if I were in good health I would probably just choose the cheapest. I was a little surprised that claiming an annual income of $125,000 got me a $192/month “tax credit”.
This post is confusing Kathy as you say you are on Medicare but: 1) Healthcare.gov is for affordable care act (ACA) policies NOT for Medicare, the site for Medicare is Medicare.gov, and 2) there are no tax credits for Medicare policies that I am aware of, but are for ACA plans, t3) trying to obtain a lees expensive policy claiming you are 15 years younger than your actual age is insurance fraud, and considering both insurances are subsidized by the Federal government I assume would mean it is a Federal offense.
Of course, Rick’s reply below is correct. I did what anyone can do: experiment with the site. As I wrote, I was offered 63 plans. I did not say that I signed up for one.
If you are considering a move it’s a good idea to do this either with the ACA site or the Medicare site. Prices vary a lot between locations, which is why I noted that the plans I was offered were for my specific zip code.
Sorry Kathy but when you wrote, “I was a little surprised that claiming an annual income of $125,000 got ME (my capitalization) a $192/month “tax credit”, it sounded like you had obtained a policy.
If you had written something like, “I was curious so I tried a scenario”, and then “one would be able to obtain” then it would have been clearer. Again my apologies
I see you have added a paragraph to your post. Please note that I wrote: “If I were in good health I would probably just choose the cheapest.” Emphasis added. I’m sorry, but I have a hard time understanding how you could think that someone on Medicare would randomly sign up for an ACA plan because someone started a thread about them.
Not at all. I didn’t even sign in on the site. Sorry if the wording was confusing, but your interpretation never crossed my mind. Why would I do such a thing? In any case, the ACA policies were all more expensive than my Medicare plus Medigap. BTW, neither the age nor the income were accurate.
David, I’ll let Kathy answer, but I read her post as she performed an experiment by exploring the ACA site. Any of us could do this using the age and gender mentioned in the original post. You can also do this on the Medicare site to get data on available plans and costs in your area. I very much doubt Kathy tried to sign up for a plan that she was ineligible for.
Thank you, Rick.
I would recommend that people who haven’t used the ACA and Medicare sites take a look at them.
Here in Pennsylvania, I have a high-deductible silver-level Ambetter policy, which means I can fund a health savings account. I’ve had the policy for two years, and found it through eHealthInsurance. The policy’s 2024 deductible and out-of-maximum are both $5,800. My monthly premium is $564. I’ve had no complaints about Ambetter. The folks there, on the other hand, might not feel so warmly toward me, given the exorbitant cost of my cancer treatment.
You’re lucky the ACA stopped insurance companies taking preexisting conditions into account. Very unfortunately, it didn’t do the same for people on Medicare.
Not sure what you mean… You cannot be denied Medicare because of a pre-existing condition.
You can be denied a supplemental Medigap plan if you fail medical underwriting, other than during your initial sign up period and in another couple of very specific circumstances. I believe there are four states where this is not the case, but I don’t live in one of them. You may still be able to sign up with some plans, but at a higher price. I know because I fail underwriting. If you signed up for Medigap when you first signed up for Medicare you can keep that plan, but good luck changing.
Since there are thousands of articles dealing with how to obtain Medicare and only this one dealing with how to obtain off-Marketplace health insurance, can we keep the comments focused on the latter?
I was asked a question. I replied. Feel free to ignore the exchange.
Your health status is unlikely to get you a lower premium as an individual. What’s wrong with healthcare.gov? Unless you vary deductible and co-pays/co-insurance, wide premium differences are unlikely and if you found a really low cost, I’d be concerned they are low balling for 2025. Keep in mind in most states the premiums are reviewed and approved.
R Quinn, I’ve used HealthCare.gov for the last few years. What I don’t like is that it is my only viable option for obtaining health insurance and it does not give me the exact options you specifically mention (varying the deductible, and co-pays) as well as varying max out-of-pocket.
I don’t necessarily want low cost, I just want options.