This year is the first year that I enrolled in my own health insurance. I pay $53/month. I received a form saying that I can change my plan, or stay with this plan but the monthly premium could change.

For 2026 the total is 271.41 minus tax credit and state premium = $53 which checks out.

For 2027 its 308.04 minus tax credit and state premium = $20

This seems extremely low, like unheard of.

its the same plan, so its not possible my benefits could change right?

I am not very experienced with how it works.

But it being $20 per month just feels like somehow I am going to get screwed

Thanks for any insight

what is regarded as the most fair and comprehensive health insurance in california

I got approved for surgery in November under my job’s current insurance provider but we just got notified the company is transitioning to a different insurance provider 12/1. My surgery will still be covered but I don’t know what happens with my required weekly follow up appointments through the end of December.

I’m panicking because I’ve waited years for this surgery and I can’t afford to pay out of pocket for 4 appointments. I don’t even know how I’d start the process to get my surgeon’s office covered through my new insurance until I have an account with them but I don’t switch over until 3 days before a very important post-op appointment. I don’t know what to do and would appreciate any advice.

He's Claiming North Texas Cities Are Getting Ripped Off for Millions by PBMs, I looked more into it and he owns a company called BetterBuy R & the prescription prices on there look pretty cheap. Any one heard of it?

I checked out the rest of this guys social his name is Don daud, hhes been going around to city councils in, I think just around Texas talking about how their self funded health plans are getting screwed by the PBM contracts. He specifically called out Frisco saying they're losing around $5 million a year because of the way their PBM deal works. He said the cost are going up yearly not because employees got sicker or anything, just because of a middleman markup that charges the city whatever they want.
Don't know if it's true or not but interesting stuff to dig in a rabbit hole of lots of info. Didnt know what PBM's are before this but I just found out we are the ONLY country in the world using them!!

Anyways someone of those prices on that website are lower than my health insurance deductible. By a lot. What the hell am I paying for. I wish out of pocket cash expenses could go towards my deductible if I used these coupons… what do you think about these big three PBM influence in health insurance, they seem to use them to process prescription drugs for all of us?

Im in Florida and work as a waitress. I am going to earn about $42,000 this year. I make to much to qualify for Medicaid for my daughter(it’s just her and I) I also make over the cut off for help from Florida Kid care. They want me to pay $246 a month for her insurance.
I’ve filled out the application for insurance through the marketplace and for some reason am only seeing plans for 250-350 dollars, and they aren’t great ones.

I’m new to all this and after rent, food, all the other bills I just don’t have an extra $250 a month for insurance for her. Am I missing something or is that just what insurance rates are for a child?

We have some patients that have insurance that requires an authorization for x amount of visits. We are not able to “backdate” appointments anymore if they don’t use all their appointments in the given time frame. This week that’s caused a lot of problems. They had me create a visit for a patient even though she wasn’t in because we didn’t get paid for a visit last month because it didn’t fit into the given date range for the auth. So the visit she didn’t actually have is supposed to make up for that one somehow. I don’t really understand how this works, I’ve worked in a medical office before but only for a year with minimal training. I’m nervous because they had me schedule it so my name is attached to that visit and then had me request another authorization for her last visit and for another date we didn’t get paid for. Is this still fraud?
I’m trying to find another job but I’ve been struggling to find something with similar pay.
Should I report them? I’m scared I’ll be the one that gets in legal trouble if that could happen.

Also, for those who work as medical receptionists, have you had proper training by the company you work for or did you do an online course to train yourself??

I have lived in the US only for a few years, so some of the nuances of the various plans is lost on me, so I'm hoping for some direction. A few facts to know

• I live in Chicago and my wife is newly pregnant (due in the Spring), so ensuring the best coverage is #1 for me right now.
• I have had a HDHP for the last couple of years, and have therefore been maxing out my HSA.
• For 2027, my Employer has opened up different benefit options, including 1 PPO option, and another HDHP option. I am less familiar with the PPO, but recognize that it means no HSA contributions.
• In a year when there will be pregnancy and all associated costs, I assume that I will max out of pocket costs. When AI runs the comparison, it looks at the Premiums + Out-of-Pocket max as the number to compare.
• Using this method, the PPO appears as the best value. This is fine, just trying to assess the "unknown".

1. Is there anything I should know about the PPO before getting into it?
2. On the HSA, I assume I can keep what I have in there, and just not contribute? Are expenses only for 2025/26 (when I had the HDHP) the only ones that can be paid back by the HSA?

I have BCBSM insurance. I went to Corewell hospital for a routine screening mammo. Then I got stuck with the full bill because apparently Corewell isn't part of this thing called LOCAST and mammos are only covered at Henry Ford and Trinity hospitals. Literally everything else at Corewell is covered by BCBSM and there was no warning at all. Seems like a bit of a blindside.

HI everyone, I need help with insurance thing

My dad did a heel surgery back in july 20, until the beginning of this month I receive a notification from Anthem insurance said they denied to cover the claim because the authorization was not approved. They said they will let the healthcare provider know and I dont need to do anything for now

But the EOB show that I have to pay the huge bill which is 30K and it even show on my Allina bill that's the amount I have to pay

Although Anthem told me to just wait to Allina do the preauthorization or post-authoriztion but I'm worry about that

Have anyone go through this situation before and what should I prepare to fight for that?

Thank you so much!

Update: it’s been a month and the bill is still there

I wasn't sure what flair to use as none of them really fit...I got kicked off my parents insurance plan and my secondary insurance, Anthem, needs to become my primary insurance. I have been trying to reach out to them to get this updated for two months but they are refusing to be my primary and are now refusing to cover anything. Has anyone dealt with this? What do I do? I'm pregnant and it's high risk so I need extensive medical intervention. I don't think I qualify for most of the other insurance options for pregnant women because I am technically insured...they just keep taking my money and won't cover anything...any advice or insight is really appreciated...I have no idea what to do.

I have been searching this sub, but don't see anything relating to best sites to research and compare a variety of Insurance Plans for 2027. Appreciate any tips or sites that have been useful for you. This online searching site by site is a killer. TIA!

I had a double mastectomy with reconstruction in August using my husbands insurance thru his employer. He is scheduled to be terminated effective the 20th of this month. My next surgery is going to be December or January. If his insurance approves the surgery but then he is terminated, will the insurance cover it still?

Yesterday I got a letter in the mail saying my Medi-Cal coverage would end on 11/01/26 because I essentially "make too much money". But I'm currently unemployed & the only income I have is from unemployment. & that monthly total doesn't even cover a fraction of my bills. How am I supposed to be able to afford healthcare if I can't afford food. I have several chronic conditions that need consistent management and without health insurance I am completely fucked. I'm really stressed and I don't know what to do

Hello,

 I am in the union for 25 years. When I retire in about 6 years my family and I get lifetime medical insurance until Medicare kicks in at 65 then it becomes secondary.

This I assume is a big deal as if I was with “private” company I would not get this. I make around $200k a year but had some offers from private firms for almost double the salary.

What are my health insurance options in retirement(until 65) if I did not have my union insurance to cover my family(wife and child) ? Just pay out of pocket correct? Which I assume is about $2k month. Thanks for any input.

Pension is another story but have that under control. Just looking for health insurance advice.

I have a self-funded employer plan. I was prescribed a speciality/biologic for the first time, and couldn’t order through the specialty pharmacy until SaveOn completed their process. I already have the copay card and have opted out of SaveOn for now. I don’t understand how I would benefit from it:

According to my PBM’s app, my meds are $1250 a month (although Save On said it was over $2000 a month).

The copay card covers $16,000 a year (or $1,333 a month)

Save On says they guarantee a $0 copay, but doesn’t the copay card do the exact same thing? I just don’t like having an extra middleman involved with my healthcare.

After being told by Anthem Blue Shield Blue Cross that my abdomen MRI to check for cancer spread was deemed NOT a medical necessity, I put them on blast out of desperation and pure rage: the audacity of a massive company charging me inflated self-pay premiums only to DENY vital life saving imagery. As the post went viral, I was suddenly contacted by Anthem, who apologized and immediately approved the scan. They don't like it when their nefarious ways are boosted in the public sphere. The philosophy of "let's deny critical care until we get caught" is an ugly one.

In August, I severely injured my left foot, and have been in acute pain and confined to a huge walking boot. The boot does offer some temporary relief, but try walking your 11 year-old to school through downtown Brooklyn in the boot featured in the images, and you'll understand that it's not a longterm solution.

After a two week battle to get an in-network podiatrist authorization (yes, it takes that along), I was able to see a surgeon who immediately ordered an Xray. Based on the images, which showed a hairline fracture as well as damaged areas of the achilles tendon or muscles that wraps around the heal, she ordered an MRI so she can determine the exact nature of my injury, and devise a treatment plan based on this critical information. In the meantime, I'll have to make do with the boot, pain meds and crutches as needed.

I was told I needed to schedule the MRI myself once it was called into the imaging center, and that they would get any pre-authorizations required by Anthem. Given my past troubles, I was sure this would not be a problem. My podiatrist assured me as well as SHE IS THE DOCTOR HERE, NOT ANTHEM. And the MRI was needed ASAP.

Well... SURPRISE... with a straight face, Anthem informed me yesterday that my MRI has been DENIED, deemed to be NOT a "medical necessity" by some imaginary Anthem "doctor" who somehow, without even reviewing the X-rays, determined what care is in my best interest.

I am livid. My scan is scheduled for Tuesday October 20th at 5PM. I'm working now to get through to both the provider, the imaging center and Anthem's appeal department (they only offer an "appeal portal" with no timeframe on when the Anthem Supreme Care Court might rule on my case).

In the meantime, the message I'm getting is this:

"Thank you for paying our massive premiums and meeting your huge deductible. We really appreciate your money. Since you met your massive deductible, we don't feel like paying for anything else until January, when your deductible resets and YOU will be responsible for scans of this nature, not us. This is how we become rich. Enjoy your pain, and good luck getting your daughter to school safely. Best, Anthem."

Attached is an image of my boot. How have others handled these situations where insurance "doctors" -- who have NOT examined injuries -- decide if the care requested by a specialist is a medical necessity?

I'd love to hear other stories, and how they were resolved, or not resolved. I'm going to fight this battle, even if I have to go out of pocket for the scan, and then invoice Anthem for reimbursement so I can share that story, too. Today, I can afford the scan, but millions of Americans being treated similarly or worse cannot afford a scan, are are left to suffer or die by ruthless, greedy insurance companies that could give AF about the care of their policy-holders.

I contacted a local insurance agent and he strongly suggested I considered something called a Med Performance Value Plan. It is a Non ACA compliant plan and does not cover pre existing conditions. He said they only accept about 70% of the applicants. My wife and I are currently on a ACA catastrophic plan with an 10+k deductible. We are both healthy. No pre existing conditions and rarely see a doctor other than our annual physical.

This plan has a lower deductible. It uses the Cigna network - not a Cigna plan.

Anyone familiar with these types of plans? Should I avoid them and not even consider?

It cost considerably less than even a catastrophic plan.

I need some advice,I'm due to have surgery Nov 2.Im having the above procedure done and a hysterectomy.Which for that I have to put 1000 down.

I cant get charity assistance since the hospital said until after surgery. I have Anthem bluecross blueshield and im extremely depressed because im not able to come up with this. It is hard as it is coming up with the 1000 to put down to get my hysterectomy. I'm in pain and just sad because im not able to afford this. Any advice?