My wife is looking at Philadelphia American insurance group, for BASIC coverage. She is past child bearing age LOL and just needs over 50 style coverage, I am going to speak to her nephew ,who sells the above insurance,
any questions I need to ask him, she asked me to "look it over" before she buys it. It is 350 or so month, she is 51, superb health (owns a gym and wellness center) and non smoker..

Any advice as to what to ask salesman is SUPER appreciated !

Deductible and maximum out of pocket are the parameters that I am most concerned with.

I am interested in this subject, as I'm soon going to need 6 months of healthcare coverage to bridge the gap between the end of my COBRA health plan and the start of Medicare.

Is her doctor and hospital in their network? Any exclusions for pre existing conditions. Any coverage exclusions? Since it is family ask about need of prior authorizations for procedures.

quote:

I am interested in this subject, as I'm soon going to need 6 months of healthcare coverage to bridge the gap between the end of my COBRA health plan and the start of Medicare

^^^^^^^^^^
First ask your Cobra plan about bridge coverage.

exec info so far

Basic coverage is well visit? Emergency room? Labs? Radiology? Hospital stay? Copay?
Deductible is $8,000 or $10,000?
At $4,000/year, there must be a significant deductible with a lot of exclusions.

get a quote from the ACA website

tax subsidies are well worth looking into as well as plans based on your specific zip code

https://www.healthcare.gov/

you can get 'generic' quotes and detailed quotes depending o how much information you provide

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thanks fellas

Since me and the wife have both been self-employed for a few decades, we've faced this and it isn't getting better with time.
My advice is to find a good independent agent that handles just this type of insurance and give them the particulars.
I'm lucky to now be on Medicare after years of this stuff. Unfortunately getting older does not result in lower premiums, male or female. In fact it will get worse, a lot worse as you move up the magic age of 65. I was never so happy to be getting older until I got to Medicare age.
For us, the ACA policies made no sense at all. You have to have a low or no income situation to actually benefit, otherwise you pay a huge premium for things you don't want or need.
Once again, get an agent to interpret as reading all the fine print will just wear you out and make you mad.

I wish you the best of luck with finding insurance. When my pension plan bailed on health care coverage I had to find individual insurance. I could only find a plan that was $350+ a month. No Dental or Optical coverage. $7500 deductible per year and 80% coverage after the deductible. Cost possible for a year before the 80% coverage:
$350 X 12 = $4200. $4200 + 7500 = $11700.
And there was lots of things they declined to pay for, regardless of deductible payment. Including something every Doctor on the planet immediately requires for any treatment: Lab Tests.
I bought the policy since I felt I lousy coverage was better than nothing.
And I never used it and went several years with no health care visits at all. I just lucked out. I guess.

Also worth looking at HMO vs EPO vs PPO, out of network coverage, and who is in the network.

In an HMO in general, you have to see your primary care doc first for anything and get a referral for any specialty care. In all the Obamacare HMOs I have seen, there is literally ZERO out of network coverage - out of network care is not even subject to the out of pocket maximum. Further, where I was looking at the plans, the networks for the HMOs were terrible. Literally not a single provider at any of the good hospitals in the area.

In a PPO you can go straight to a specialty care doc without a referral and out-of-network care is generally covered, although often you have to pay coinsurance until you get to the out of pocket maximum. The networks are also generally better.

Of course, PPOs are a lot more expensive and in many places they are not offered at all on the Obamacare exchange.

quote:

Originally posted by ZSMICHAEL:

quote:

I am interested in this subject, as I'm soon going to need 6 months of healthcare coverage to bridge the gap between the end of my COBRA health plan and the start of Medicare

^^^^^^^^^^
First ask your Cobra plan about bridge coverage.

No habla, so still on the hunt.