Need Advice on NY Essential Vs. Silver

upstateny

New Member
1
Hi, my business partner and I just lost coverage due to the Jan 1 law requiring at least one common law employee covered on a group plan, so I've spent the last few days navigating the mess known as ACA.

I just need to cover myself, so I initially got approved for the Essentials Plan, with a choice of Fidelis and MVP in my county. I did some very brief research and became somewhat concerned that I wouldn't get the quality I want. Luckily, my income this year will be dependent on whether I contribute to my IRA or not... if I do, I have to take Essential. If I don't, I can go to Silver.

Currently I'm leaning toward a CDPHP Silver plan, with a premium of $467, which I can afford (plus get a $200 subsidy, which I'll gladly take).

Unlike most, I'm not focused solely on premiums, co pays or deductibles. I'd like to make the IRA contribution, but it won't kill me if I don't. Of course, I don't want to waste money, and I'm relatively frugal...but I can afford the crazy-high deductibles the silver plans offer if I have to (don't get me started on the massive jumps in consumer costs and deductibles due to ACA). My health is good.

My main concerns are, if I have a life-threatening illness, I want to go out of network to the best specialist I can get. I also don't want to be bankrupted by that, or by Tier 4 meds.

So does anyone have any experience with the Essentials Plan, and/or MVP? Especially as it regards my concerns? Any other advice for me?

I'm a big fan of catastrophic plans, and would get one if I could. But I can't find any in my area...? I had one for many years, probably saved me a ton over the long run. But alas, thanks to ACA, it looks like they've done away with that, unless you're under 30. Isn't that age discrimination?
If they did offer it to everyone, and regulated/promoted it differently, wouldn't ALL of our costs would be lower? Oh well, when I run for office... :)

BTW, I spoke with the insurance person at my Dr.'s office, and she said the silver plans I was looking at are good companies, and in most cases my doc has been able to get out of network specialists and tier 4 drugs paid for. Of course that's just one person, and that's not going to be in the contract, but it gave me a little more peace of mind on that count.

Many thanks for the help!
 
Yes, a long time ago. There is no money to be made in the individual health market in NY and it's been that way for a long, long, long time.
 
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