For this activity, I decided to compare Fallon Community Health and my insurance which is MassHealth temporary coverage. My family and I decided to apply for MassHealth last January after my mother lost her job. My mother, at fist, felt very awful about the whole situation. She had never in her whole life asked for any help, and now here she was applying for MassHealth. My siblings and I tried to comfort her because any insurance was better than having no insurance. After we applied, we did not get a letter until March saying that we had temporary health insurance until December of 2014 because of continual delays within the new system. After reading about both insurances, MassHealth and Fallon Community Health are alike and different in many ways. MassHealth really strives to provide high quality health care to individuals and families who cannot afford it. Fallon Community Health, on the other hand, has many different plans that cover a wide range of needs depending on the individual. It usually covers up to eighty percent of a patient's costs and he or she often has to pay about twenty percent of the initial cost. One big difference between the two is that Fallon Community Health covers fitness reimbursements that can be used for gym memberships and home fitness equipment. I think this is a very nice incentive because it promotes staying active which can benefit the individual's health as well. One other difference is that MassHealth covers a wide range of family planning options and dental care. If I had to rank each of these insurances it would be difficult because both of them benefit different individuals. MassHealth has been a blessing to my family because we needed the help after my mother lost her job, so I am truly thankful. But if the circumstances were different, I believe that Fallon Community Health would also be a great fit for my family because of the range of coverage it provides.
Hi Angela: Laurencia did a good job, of what I was going to comment on. Just to reiterate: Masshealth, SNAP, Fuel Assistance, R2 ratings on electric bills, are all there to assist those in need. It is particularly, and respectfully used as assistance in times that are tough, such as loosing your job. I understand your mother's hesitancy, I have been there myself, but I had a very good caseworker that explained these programs were put in place for times like this: - out of work, or unexpected illnesses. I hope your mother finds employment soon.
Thank you Christine for your reply. I also agree that these programs are put in place to help families who are experiencing rough times. I think my mother just has a hard time asking for help, but I think now she understands that getting help is not always a bad thing. Thank you
Angela, There is no shame in asking for help when needed. I have many of our classmates blogs and it seems that each insurance option offers the basics like doctor visits and other preventative services, but the differences are the little nuances. For example, one of the insurances you talked about offers gym memberships while one of mine does not offer prescriptions. I think that shopping for insurance is like shopping for anything else. We have to look for the options we want for the price we can afford. Great job. Nena T.
I am so glad that you and your siblings were able to talk your mom into applying for Masshealth. I understand it is a delicate situation and it is hard for some people to ask for help. I have worked in a retail pharmacy for years before working at Umass today and I have come across many people on MassHealth. It is really nice for people to be able to pick up medications they need without such a hassle. Im glad that she has you and your siblings there to support her.
Mass Health is a great program and is there for people who need coverage no matter what. There is nothing wrong with getting help especially since your mother was hard working and unfortunately lost her job. No one should be ashamed to get help when they are going through hard times. The point of Mass Health is to assist when times are tough. It’s bad enough that people lose their jobs, it’s the least the state can do by assisting people because the price of medical care is outrageous and will never be cheap.
There is absolutely no shame in getting Masshealth , or any kind of help .No one thinks there will get to a point were they would need the help .People work for many years ,situations arise and the need for help comes about.Asking for help to maintain yourself in a difficult situation happens.Granted there are those that absolutely refuse to help themselves and rely solely on assistance.assistance. Masshealth,medicaid is a very resourceful program that I feel strongly about.There are individuals in our societies that absolutely need the help.Mass health for instance is great program that not only helps families in need,it helps students ,single parents ,the elderly ,people struggling to make ends meet and so on .By no means should your mother feel disappointed because of it..My I was a bit surprised to hear that people feel like this because of situations like this. Mass health from what I have heard allows families to have access to health programs and resources that with no insurance they would other wise not have .I have had fallon health since I could have insurance,My family has always had fallon insurance. I.I have had the same provider since I started going fallon ,so as member in my family.In my transition to part time work ,my coverage from fallon became different .I had to get referrals for outside providers ,my co pay went up and so on so forth.I was told I can supplement some parts of my insurance with medicaid ,but that is also not easy to do .I don't think I qualify for that supplementation.Which is OK for now ,I just have to make sure I do not get really sick or need some major medical procedure.I haven't had much of an experience with any other insurances other than fallon.I must say its a very family oriented services.When I looked at the coverage for fallon and Masshealth ,they were similar .Actually you can have Mass health and choose fallon as you provider ,which gives you access to more of the same things fallon provides to its customers.
Thank you for your comment, I agree with you Laurencia that there is absolutely no shame in getting Masshealth. Masshealth has been such a blessing in my family's time of need, and I am so grateful that programs like this are put in place. I also thought it was interesting that you can have Masshealth and choose other insurance companies as your provider.
I agree, there is no bad thing in having MassHealth. Both my daughter and I have MassHealth and I am very grateful that we have it! When I did my comparison I looked at a Blue Cross Blue Shields program and learned that you have to pay a deductible every year of $12,900 for a family. This plan was also aimed at people between 18-29, people my age. It really opened my eyes as to how expensive health insurance is and that I am so grateful we have MassHealth and I don't have to worry about affording insurance.
To add to the MassHealth conversation when working in healthcare many line staff (the hands on providers of care) workers do not know what insurances their patients have . Nurses are trained that all patients are to receive the same standard of care regardless of payer source , treatment otherwise would be unethical . Lastly I worked in Medicaid reimbursement in a local SNF/Nursing Home unless a person had unlimited wealth ( which is almost no one ) virtually everyone who lives in a nursing home ($300-$400 /day) ends up on Medicaid/ MassHealth and there is definitely no shame in it .
I agree with you, there should be no shame with MassHealth. I think that it is great that every one is receiving the care that they need and deserve to keep themselves, their families, and the people around them healthy.
The two health insurances I decided to compare this week were a Blue Cross Blue Shield insurance plan and my health insurance MassHealth. In order to qualify for the Blue Cross Blue Shield plan you had to be between the ages of 18-29 and make more than $45,960, which I don't think is really an accurate yearly income for an individual between these ages. You also had to pay a yearly deductible of $6,450 for an individual and $12,900 for a family. I could not get over how expensive this health insurance plan was. Having MassHealth I do not have to pay any deductibles or any cost for health care. In all the years I have had it I have not had to pay one medical bill. Completing this exercise has made me even more grateful that my daughter and I have MassHealth. We are able to receive great services like check ups and immunizations and not having to worry about how to pay for them.
Hi Breanna: I am curious, how did you find out that information on Blue Cross Blue Shield. I never heard of having to be between a certain age to get that insurance.Typically there are so many options you can get for an insurance as well. I am very concerned that you found something that said you have to be between the ages of 18 and 29....what does that mean, and why? Is that Obama Care? Of which I know nothing about. This to me is scary, any way you can clarify this demand for an age bracket?
To being with I do not have much experience when it comes to health insurance so to find an insurance plan to compare mines with I went to a insurance company I did know which is the Blue Cross Blue Shield. On their website they have different plans for different things like dental insurance, medicare, disability insurance, vision insurance etc.. They plan I looked at was you had to be between the ages of 18-29, if you were not you had to get a different plan. To see if you are eligible for this insurance you had to answer a couple of questions and one was the age. It said if you are not between the ages you have to choose a different plan. Here is the link for it: http://www.liveyourlifenow.com/. Also here is the link for all the other insurances they have as well: http://www.bluecrossma.com/visitor/plans-products/index.html. What I couldn't get over was how expensive it was for that age group who is not making that kind of money yet.
BCBS is one of the pricey ones out there ,my other job offered it ..but i declined .Its like come on ..I have to live too .Fallon does reimburse for fitness and nutrition programs but its usually when its through your provider.
Breanna, thank you for replying. A lot of changes have happened, from the mandatory Massachusetts health insurance, and now ObamaCare, whatever that means. However I received my insurance through the years through employment. I guess now if you don't have health care through employment, you have to buy your own. I had gotten laid off and had no insurance in 2012, so I called the Mass Health Connector - it was fairly new and they sent me information and I could not make heads or tails out of it. The end result was even though my income was very low, I could not get MassHealth because I was a student, it didn't matter how old or young I was, but I was a student and therefore I had to choose from a University Plan.
A lot of this information is overwhelming, some great points are made by all about access and cost. Tufts Navigator is our insurer and the coverage is comprehensive. I feel fortunate when reading these blog entries .Compared to what I have read here we pay a pittance ( not even $400 per month for employee and family coverage) and yet just a few short years ago we paid about $150 month for the same coverage. It covers less and co pays and other associated costs have risen dramatically over the years. Now my two older children are in the workforce and they honestly cannot afford good healthcare . The Affordable Care Act has protected their coverage over the last few years. My son aged out this month and his coverage expires on October 31st , He will need to navigate through this mess known as healthcare on his own now .Working two part time jobs , neither of his employers offer insurance and he will have to pursue other options. Hopefully he can afford it .
To all: Forgive me for getting sucked into the media version of The Affordable Health Care Act, which was pegged ObamaCare. Sorry to have used that terminology in some of my posts - Christine
Hmmm I know what you mean ..I think its a good program and I obviously didn't read the entire thing but some aspects that I seen made sense to me .The program used the same policies Masshealth does ...It was tailored similarly to masshealth but on a larger scale..And since I find Masshealth as such a beneficial porgram ,i m yet to critcize it .Its Obamacare ...but it works ..like most programs there are bound to be some aspects that need to be revisited ..but until then ,I ll still be an advocate for anything that helps our vets ,elderly ,student and those that need the help.
The two insurance companies I compared this week was NHP Prime HMO and Blue Choice New England Plan 2 PCP. The biggest differences between these two companies are how you acquire them, prescription plans, and the out of pocket expenses. NHP Prime is an application process based on income and this Blue Cross option was from an employer. There is not a prescription plan offered with this Blue Cross plan, but NHP Prime did have one with a copay and deductible. I was a little shocked that this Blue Cross plan did not offer prescription coverage because that is such an important aspect for most people. A lot of people take many medications and they depend upon coverage in order to help pay for them. Not very many people could pay for even one medication out of pocket because of budget constraints. Also the Blue Cross plan’s out of pocket expenses were almost double the NHP Prime plan.
As far as which option to choose, that’s a tough choice. I know over the years I have had many different insurance plans. I was not really happy with any of them. They each had their pros and cons and some were more frustrating than others. When I moved back home last year, I did not have any insurance so I had to scramble to get some. There were not many options to choose from. With a limited income and no time, my only option was NHP Prime. Thankfully I have not needed to use it for being ill, but the one time I did call to make an appointment I got the runaround. “No, the doctor you’ve been assigned no longer works here and no one else is accepting your insurance.” So I call the helpline to get another provider, they were happy to help and assigned me another. The other day, I got a letter in the mail saying that my provider was changed once again and the address they gave me for my new provider is the address where they were not accepting any new patients. A little frustrated is not the word to describe how I felt after getting that letter. Now the fun begins. Nena T.
Hi Nena: One observation: While many people need prescriptions, others do not. Prescription plans are expensive. I do not need a prescription plan, so therefore I do not want to pay for it in my deductible. These scenarios have been dealt with by groups of people going to Human Resources and expressing their disinterest in forcing us to pay for something we don't need. So having it is a rider is best...for me and for many. Certainly it should be offered at a reasonable rate, as they don't typically cover very expensive prescriptions anyway. I have had the scenario of having an insurance and going to a doctor that was not "my doctor" because she didn't accept that insurance. So I had to travel to this doctor further, and explain who I was and my expectations of care. He was young, and impressed with my "stats", but shortly thereafter, he was not longer there, and shortly thereafter that, my company in midstream changed insurance...two more times of this "game" and in the end: back to where we were in the beginning, back to my own doctor. I think I would be more frustrated shopping on my own though, so I do not envy you. I wish you the best, Nena, in your insurance endeavors!
After comparing both insurances (mass health and BCBS of illinois) I have learned about what each has to offer. I have had experience in pharmacy as well as working in a dental office and I understand how complicated and frustrating it can get. I am pleased that we have something to be able to allow everyone to have health insurance. I don't think that anyone should be ashamed to apply to MassHealth everyone has different situations and sometimes people need help during certain times, and nowadays that isn't uncommon. Fortunately, I have never had MassHealth, but I have family members who have had it and it was a great help.
For this week's assignment, I compared my insurance, which is Harvard Pilgrim HealthCare with MassHealth. I am fortunate enough to still be covered under my parent's health insurance which is sponsored by my mother's work! I deal with health insurance issues and struggles with patients every day... I work at CVS pharmacy as a pharmacy technician. I know how hard it is for some people to afford the healthcare that they need. I love MassHealth. I think it is an awesome way to help people who are in need! I also don't think that anyone should be ashamed because of the insurance that they have-- insurance is a messy and hard process to work with! Being a public health major, I think that I think that it’s so important that every person receives the health care that they need to keep themselves, their families, and the others around them as healthy as possible. Overall, I really enjoyed this assignment and I think that it is great that MassHealth can offer so many people a hand.
My own insurance currently is through the University Plan through Worcester State. I had no other means to purchase insurance, and I was in a gray area as a student. So I have Student Blue - The Blue Care Elect Preferred 80 Co-pay Student Blue Plan through University Health Plans, Inc. I have Financial Aid and Financial Aid lends me the money to pay for this insurance...therefore I guess I'll have to pay it back. I had no other choices except for more expensive plans. This is my third year having this plan, and each year the price has gone up, but this year, co-pays went down...amazing. It is basic medical insurance, any additions for dental, vision, prescription, etc.; I would have to pay more. The price is comparable to what I was last paying at my place of employment in 2011, maybe a little more money with a little less coverage. However, I can choose my own doctor and my own specialists without asking. There are benefits of staying in-network however.
I didn't search for a plan online that was comparable, but I asked a few people about their insurance. Most said I have this or that, and you don't know what you are covered for until you use it. One of my friends came through for me, and told me about her turning 65 and taking social security, therefore having Medicare for insurance. Medicare is the oldest health plan in America, and is part of the federal government. Medicare has to be supplemented by insurance, and is called Medigap. The insurances offered by Medigap are private, the companies that under 65 would look to for health insurance, such as Tufts, Fallon, BlueCross, etc. However, they must abide by certain rules which fall under the Medicare plan. She further had to buy a prescription plan. I estimated that her plan without the prescription plan of $27.95 per month, was still $50 more than my Student Blue plan, but was very comparable to the coverage with a few more benefits. Since getting the Medigap, she has noticed that she doesn’t have to pay copayments and has not received any billing for laboratory work. I also took notice that there were some safety nets laid out in purchasing Medigap insurance, such as having an extra 365 allowable days to be in a hospital, and the first 3 pints of blood in a year. With my varieties of insurance in the past, and in looking at these two different needs insurance – The Student – The 65 or older groups – I find many similarities, and feel that they are both “grouped” unwittingly. I am not convinced that it is completely in one’s favor to be advised into The Student plan or the Medicare Plan.
I find it amazing that very few people know what their health insurance covers. Health insurance is not cheap - if your buy from an employer, the money comes out of your paycheck every week, you receive a small tax benefit from it (the deduction for health insurance decreases your taxable income), but it's still a lot of money. By law, your employer must provide paperwork that succinctly explains the plan, how much is costs, what is covered, etc. Most employer have benefit specialist that can explain the plans to you if you do not understand the paperwork. Understanding your health insurance will not only save you money, but it will increase the quality of your healthcare - whether you have basic student insurance, a government subsidized insurance, or a employer program. Knowledge is power.
My employer offers several different health insurance options. Blue Cross Blue Shield Healthmate Coast-to-Coast, United Healthcare Choice-Plus, and United Health Care Consumer Directed Health Plan (CDHP). I am enrolled in two-person coverage under the Blue Cross Blue Shield Plan. There are no deductibles, I can see my primary care physician for free once per year, free OBGYN visit once per years, and copays for specialist are only $10. The total cost of the plan is 1212.64/month, but the university subsidizes the cost based salary - on a tiered scale. Because I work in human resources and have to explain the health plans to employees all day long, I am very aware at how fortunate I am. The plan I am enrolled in is what the federal government considers a "Cadillac Plan." Virtually every service is covered by the plan - and it is coast-to-coast, so I am covered at any doctor in the US and territories that will bill to Blue Cross. I compared this to a Blue Cross High-Deductible plan that I had with a former employer. With high deductible plans, you have to pay out of pocket up to a certain amount (under this employers plans my deductible under employee-only coverage, was $3000 - the lowest amount offered on the plan.) The coverage was in a small network of doctors in RI and I was very limited in the hospitals that the plan permitted. The deductible was particularly problematic for me because I have a neurological disorder that requires me to see a neurologist 4 times per year. Each visit was over $300, so I basically worked to cover my medical expenses. Previous to that I had no insurance for several years, so I was thankful to have any coverage at all.
High Deductible Plans and Consumer Directed Health Plans are difficult, specifically for lower income families. It is hard to predict what health care costs are going to be - you never know when you might be in an accident or contract an illness, or need surgery. Planning how much money to put in a FSA (flexible spending account or HSA (health savings account) is hard, especially considering money put into an FSA will be lost if you don't spend it all. And many families would have to decide between putting that money away for health expenditures or use it for current bills. A deductible of $3000 for a single person or $6000 for a family is a budget crusher. Some of the healthcare reform items are addressing the disparity between plans, but overall, the system is broken. Billing practices and regulations are confusing and difficult to interpret. I spoke to a woman this week who was crying because of an EoB (Explanation of Benefits - that is the sheet of paper that the insurance company sends to you in the mail after consuming some sort of medical service.) She had received and MRI and got the EoB in the mail and thought that she was being billed for $3000. It wasn't actually a bill, the service was completely covered by her insurance, but the paperwork is not friendly for the average consumer.
Hi Brittany, I can completely agree, learning what your health insurance covers exactly can be tricky, and many people dont take the time to find these things out until it is too late. You are lucky to be working in Human Resources because this helps you understand the plans and what you are paying for. I think another problem is that so many people are trying to save money that they go for the cheapest plan, and then if somethign unforeseen happens they are in over their heads in medical bills. Another thing I hear so many young people (especially guys) say is "I dont know whay its manditory to have health insurance, I never go see my doctor". If we are paying all this money then why wouldnt we at least take advantage of getting a check up once a year?!
Brittany , Our family has used an FSA for quite a few years . It has been a great bridge between my health insurance and out of pocket expenditures. You are correct in warning that it can be difficult to determine exactly how much to contribute . We started off small and increased it each year. If I have money left at the end of the year I go on a CVS shopping spree , they have end of the year sales specifically for that purpose. You can definitely find something to spend it on contact solution , heating pads , automatic blood pressure cuffs are among some of things I have purchased with mine. Additionally if you have to travel a considerable distance for an appointment you can submit a claim for mileage reimbursement.
I appreciate my FSA too... I wouldn't have previously been able to visit my neurologist or afford my medications without it! I think that because many people don't understand their health plans or what they cover, it can be hard to understand how the FSA or HSA works, when the funds expire and how it can supplement the health plan.
Health insurance has been pricey but it depends on what you have I guess. I have Tufts Navigator health plan through the State of MA. This get deducted from my paycheck and It is very expensive. I got the chance to talk to one of my coworkers who has Mass Health and she was explaining to me that I can call Mass Health and they can help me with my Premium. When it comes to Health insurance I do not know much. However,I decided to call Mass Health and they working on it to help me out. I am glad I did this comparison of health insurances because I would not have known that Mass Health can help families out when they pay a lot for their health insurance.
Barbara, I have the same health plan and it is very inexpensive for us comparatively speaking . We pay under $400 per month for a plan that covers employee and family , my husbands employer subsidizes the coverage and he works for the Commonwealth. We have low deductibles and comprehensive coverage . It is interesting to say the least that the same plan is offered a widely varying costs . That seems innately unfair.
The two health plans that I looked into were Blue Cross Blue Shield, PPO deductible plan (which is one of the options that my job offers) and Tufts Medicare Preferred HMO Basic RX Plan (which I found online). The two plans did not seem very different from each other in too many ways. BCBS offered an individual plan with a deductible of $3,500 max, for $71.00 and Tufts offered an individual plan with a deductible of $3,400 for $65.50 a month. Both plans offered $150.00 eyewear benefit and a $150.00 gym membership benefit. There was a difference in emergency room visits, where BCBS charged $150 and Tufts only $65.00. Both plans had tiered drug prescription costs that were about the same. Both plans also offered routine doctor visits with no co-pay but BCBS cost $20 per visit for other office visits and $20 for specialists visits and Tufts was $15 per visit for PCP and $30 for specialist visits. Overall, both plans seemed to be similar, or not far off from each other. Aside from the plans themselves, I know that sometimes depending on your employer can make a difference. I know that my company will reimburse the employee after the employee pays the first $500 in their deductible for the $3,500 plan. Meaning hte employee pays the first $500 of their deductible and the company will reimburse for anything after that, up to $3,500. Also, aside from these two plans, I have had Masshealth when I was younger for my daughter and I. The good thing about that was that we never had a co-pay for any doctor visits or prescriptions, we did not have to pay a monthly amount and I did not have to pay anything when I was in the hospital for giving birth to my daughter. Now, having a different health insurance, I get hit with a sizable bill after giving birth! I know that being able to get Masshealth depends on many things, and that it has helped a lot of people. The part that I struggle with is, even if you begin to make just a little bit more money, you can become "no longer eligible" to recieve these benefits.
I completely understand where you are coming from about Masshealth. I've applied for healthcare before through Masshealth and have been told I am ineligible for coverage because I make too much, or that I will still be required to pay monthly under certain plans. It's so frustrating to me because at the time I was a part time employee attending community college part time, and yet I felt like I was being punished for making just above the qualifying amount of money. Also you are very lucky to work for a company which provides that kind of cost coverage for you.
I compared the health insurance I receive through my parents who work for the state which is Tufts Navigator to Mass Health. The insurance my parents have covers 80% with them paying 300 a month plus co-pays when visiting a doctor. I never really understood how expensive it was to receive healthcare because my parents have been working for the state for over 25 years. At an early age I assumed everyone was getting the same amount of treatment and medication whenever they needed it at a reasonable cost. It wasn’t until I had multiple surgeries when I realized how expensive the procedures would have been without insurance. I think Mass Health is great in order to help people who are in need. Not everyone is fortunate enough to have a decent paying job with benefits to support a family. There is nothing wrong with Mass Health and people who don’t like it probably don’t understand what it’s like not to get exactly what you want when visiting a doctor or filling a prescription. The out of pocket cost for these simple things without insurance is ridiculous. Everyone should have healthcare in order to stay as healthy as possible. It’s not fair for some to get the treatment they need while others suffer.
Andrew, My health care costs about the same each month...just about $330 and has us paying co-pays as well. Like you, I never was truly aware at the costs of health insurance until I was in an accident. Its outrageous what we would be paying without it. I can add to your prescription comment that is insane how costly they can get without coverage. My father has cancer and is taking multiple, and I mean multiple oral chemotherapy pills and just one of them would be in the thousands without coverage. I cant even imagine the total on them all without coverage, its nauseating.
I agree. Health insurance is great because it allows that sense of peace. There is nothing wrong with MassHealth either because the patient is getting the treatment deserved and the doctor is able to provide it. Tufts is a great plan to have too. You and your family are also covered with what you pay!
For this assignment I chose to compare Neighborhood Health Plan (my current insurance) to Fallon Community Health Plan (provided by my previous employer). Up until I was 26, I like many took advantage of being able to obtain healthcare coverage through my parents insurance, so up until recently I never really had to deal with the headache that is health insurance. After I turned 26 I was without health insurance for a year because I worked for a state employer which didn't offer coverage to part time employees, however Mass Health claimed that I made too much money to qualify for insurance coverage which was affordable to me. I was so frustrated for that year because I am required to have health insurance, yet at the time I had no way of paying for it along with my other financial responsibilities, such as school and rent. I realized through this assignment that the two healthcare providers I researched turned out to be not necessarily one better than the other in terms of benefits and services, but rather which one was more cost efficient for me for whatever life situation I was in at the time. I guess I should just consider myself lucky that I work for an employer who offers health insurance, and thus far I have been able to get the services I need when I need them.
For this activity I decided to compare my current health insurance, which is Fallon Select, to my prior insurance, which was Tricare Prime. Tricare prime is only available to Military personnel, and their dependents. I loved the coverage - as I paid little to nothing out of pocket. Fallon Select has expensive premiums, deductibles, and copays. Fallon select has maternity deductibles and copays, where as Tricare prime did not. In March of 2013, I was in a terrible car accident (due to another running a stop sign), where my jeep flipped a few times. I broke four vertebrae, and has a serious TBI. I was in and out of the hospital for care, along with physical therapy. Fallon select sent me a bill for $250 total, where as my initial care cost over $16,000. I am truly thankful for the health insurance, and care I have received from them. However, both insurances has suited my needs at the time, and have so much to offer.
Jennifer, Fallon is the coverage I chose to compare to mine (Blue Cross) and I noticed that it is very expensive but I am so happy that you did have it. $250 is a beautiful price compared to $16,000. I was in an accident in 06 and needed multiple dental surgeries which were not covered by my insurance or many others, my bills are ridiculous. So glad you are okay, it sounded like a very terrifying accident...always one of my biggest fears.
Hi Jennifer: I hope your recovery for your TBI went smoothly. I have a lot of information and empathy for TBI's - feel free to reach out to me if you need. Breaking 4 vertebrae is no easy recovery either. Your advantage is your youth and your Insurance! It is nice to hear that you were able to benefit from the insurance coverage you had. It balances out the "bad talk"....here's to continuous healing and continuous health insurance coverage!
For this activity I compared my insurance, HMO Blue Cross, with Fallon Community Direct Platinum Plan A that I found while searching online for other insurances. This activity really opened my eyes to just how expensive health insurance really is. I never needed to really know before this assignment because I have always been under my mothers and I was something I didn’t worry about. While investigating I found that our insurance is $83 a week. If I was paying this right now I would be broke; I could not afford this along with rent, utilities, food, and my coming student loans. This makes me extremely grateful that I am covered until I am 26 years old. Under this insurance I get free yearly visits to my primary care doctor, for eye exams, and visit to the OB/GYN. After the yearly’s I have to pay a co-pay of $20 per visit and $25 for a visit to a specialist which I need a referral too. Two things I wish my insurance did cover is more dental and reimbursements for wellness. I had a bad accident in 06 and needed dental implants, multiple bone grafts, and multiple skin grafts and none were covered. I will paying for those bills my whole life. Secondly, I spend a good chunk of money a year on gym memberships and wellness programs and only get a very small amount of money back. This is what I like more about Fallon. This Fallon plan covers wellness programs completely. Other than that it had yearly deductibles that could not be exceeded, higher copay, and less visits allowed to doctors. Health care is something that I think is completely a mess in this world. It would work so much smoother if everyone just got the same insurance and was covered for the same things, sadly I know it would never be that way, not with our economy.
For this assignment, I compared my student Blue Cross Blue Shield with my parent's Network Health plan. Network Health is a plan through MassHealth and commonweath. However, one thing that should be noted is some of these plans still require a monthly fee as well as co pays. This was the first time my parents have had health insurance and it was bought through Obama's marketplace. Their plan is very similar to mine minus the fact they also have a vision plan as well as they have higher co pays however they pay less per month than I have. Honestly, it's nice to have health insurance and be covered by doctor's rather than my parent's who paid for everything out of pocket being business owner.
I chose to research Medicaid and Blue Cross HMO Blue Essential. I have Medicaid. I obtained it when I learned I was pregnant, and was transitioning off of my very expensive Blue Cross Student plan. I got Mass Health almost right away, I must have applied at the right time. I never have to pay for my medications, which would add up to about $500 a month. I never have to pay for lab work/fees, copayments, anything. The one downfall is there isn’t dental coverage. Luckily, my mother is a manager at a dental office and I get free care including cleanings and fillings. They are, however, coming up with a dental plan that covers the basics, which will come in handy. I still qualify for Mass Health because I am a young mother who is below the income limit. Sometimes I’m very, very thankful for my little surprise over here because even though he costs a whole lot to take care of, I don’t have to worry about paying thousands of dollars every year for health insurance.he Blue Essential plan is one of the plans I probably would have had to be on if I didn’t have Mass Health. Blue Essentials Out of pocket minimum is $12,900/year per family. Its sad to say that I don’t even make that much in a year, so how would I even afford that? Mass Health isn’t free care, its paid for by the state and you still pay very little taxes for it. Everyone deserves health insurance, but not everyone can afford it. Some people may be embarrassed by it but I’ve never had a problem with it, I’m just grateful to say I know I’m in great hands and that I’m safe because I have a reliable health insurance.
For this activity, I decided to compare Fallon Community Health and my insurance which is MassHealth temporary coverage. My family and I decided to apply for MassHealth last January after my mother lost her job. My mother, at fist, felt very awful about the whole situation. She had never in her whole life asked for any help, and now here she was applying for MassHealth. My siblings and I tried to comfort her because any insurance was better than having no insurance. After we applied, we did not get a letter until March saying that we had temporary health insurance until December of 2014 because of continual delays within the new system.
ReplyDeleteAfter reading about both insurances, MassHealth and Fallon Community Health are alike and different in many ways. MassHealth really strives to provide high quality health care to individuals and families who cannot afford it. Fallon Community Health, on the other hand, has many different plans that cover a wide range of needs depending on the individual. It usually covers up to eighty percent of a patient's costs and he or she often has to pay about twenty percent of the initial cost. One big difference between the two is that Fallon Community Health covers fitness reimbursements that can be used for gym memberships and home fitness equipment. I think this is a very nice incentive because it promotes staying active which can benefit the individual's health as well. One other difference is that MassHealth covers a wide range of family planning options and dental care. If I had to rank each of these insurances it would be difficult because both of them benefit different individuals. MassHealth has been a blessing to my family because we needed the help after my mother lost her job, so I am truly thankful. But if the circumstances were different, I believe that Fallon Community Health would also be a great fit for my family because of the range of coverage it provides.
Hi Angela: Laurencia did a good job, of what I was going to comment on. Just to reiterate: Masshealth, SNAP, Fuel Assistance, R2 ratings on electric bills, are all there to assist those in need. It is particularly, and respectfully used as assistance in times that are tough, such as loosing your job. I understand your mother's hesitancy, I have been there myself, but I had a very good caseworker that explained these programs were put in place for times like this: - out of work, or unexpected illnesses. I hope your mother finds employment soon.
DeleteThank you Christine for your reply. I also agree that these programs are put in place to help families who are experiencing rough times. I think my mother just has a hard time asking for help, but I think now she understands that getting help is not always a bad thing. Thank you
DeleteAngela,
DeleteThere is no shame in asking for help when needed. I have many of our classmates blogs and it seems that each insurance option offers the basics like doctor visits and other preventative services, but the differences are the little nuances. For example, one of the insurances you talked about offers gym memberships while one of mine does not offer prescriptions. I think that shopping for insurance is like shopping for anything else. We have to look for the options we want for the price we can afford. Great job.
Nena T.
Hi Angela!
DeleteI am so glad that you and your siblings were able to talk your mom into applying for Masshealth. I understand it is a delicate situation and it is hard for some people to ask for help. I have worked in a retail pharmacy for years before working at Umass today and I have come across many people on MassHealth. It is really nice for people to be able to pick up medications they need without such a hassle. Im glad that she has you and your siblings there to support her.
Vi
Mass Health is a great program and is there for people who need coverage no matter what. There is nothing wrong with getting help especially since your mother was hard working and unfortunately lost her job. No one should be ashamed to get help when they are going through hard times. The point of Mass Health is to assist when times are tough. It’s bad enough that people lose their jobs, it’s the least the state can do by assisting people because the price of medical care is outrageous and will never be cheap.
DeleteThere is absolutely no shame in getting Masshealth , or any kind of help .No one thinks there will get to a point were they would need the help .People work for many years ,situations arise and the need for help comes about.Asking for help to maintain yourself in a difficult situation happens.Granted there are those that absolutely refuse to help themselves and rely solely on assistance.assistance. Masshealth,medicaid is a very resourceful program that I feel strongly about.There are individuals in our societies that absolutely need the help.Mass health for instance is great program that not only helps families in need,it helps students ,single parents ,the elderly ,people struggling to make ends meet and so on .By no means should your mother feel disappointed because of it..My I was a bit surprised to hear that people feel like this because of situations like this. Mass health from what I have heard allows families to have access to health programs and resources that with no insurance they would other wise not have .I have had fallon health since I could have insurance,My family has always had fallon insurance. I.I have had the same provider since I started going fallon ,so as member in my family.In my transition to part time work ,my coverage from fallon became different .I had to get referrals for outside providers ,my co pay went up and so on so forth.I was told I can supplement some parts of my insurance with medicaid ,but that is also not easy to do .I don't think I qualify for that supplementation.Which is OK for now ,I just have to make sure I do not get really sick or need some major medical procedure.I haven't had much of an experience with any other insurances other than fallon.I must say its a very family oriented services.When I looked at the coverage for fallon and Masshealth ,they were similar .Actually you can have Mass health and choose fallon as you provider ,which gives you access to more of the same things fallon provides to its customers.
ReplyDeleteThank you for your comment, I agree with you Laurencia that there is absolutely no shame in getting Masshealth. Masshealth has been such a blessing in my family's time of need, and I am so grateful that programs like this are put in place. I also thought it was interesting that you can have Masshealth and choose other insurance companies as your provider.
DeleteI agree, there is no bad thing in having MassHealth. Both my daughter and I have MassHealth and I am very grateful that we have it! When I did my comparison I looked at a Blue Cross Blue Shields program and learned that you have to pay a deductible every year of $12,900 for a family. This plan was also aimed at people between 18-29, people my age. It really opened my eyes as to how expensive health insurance is and that I am so grateful we have MassHealth and I don't have to worry about affording insurance.
DeleteTo add to the MassHealth conversation when working in healthcare many line staff (the hands on providers of care) workers do not know what insurances their patients have . Nurses are trained that all patients are to receive the same standard of care regardless of payer source , treatment otherwise would be unethical .
DeleteLastly I worked in Medicaid reimbursement in a local SNF/Nursing Home unless a person had unlimited wealth ( which is almost no one )
virtually everyone who lives in a nursing home ($300-$400 /day) ends up on Medicaid/ MassHealth and there is definitely no shame in it .
I agree with you, there should be no shame with MassHealth. I think that it is great that every one is receiving the care that they need and deserve to keep themselves, their families, and the people around them healthy.
DeleteThe two health insurances I decided to compare this week were a Blue Cross Blue Shield insurance plan and my health insurance MassHealth. In order to qualify for the Blue Cross Blue Shield plan you had to be between the ages of 18-29 and make more than $45,960, which I don't think is really an accurate yearly income for an individual between these ages. You also had to pay a yearly deductible of $6,450 for an individual and $12,900 for a family. I could not get over how expensive this health insurance plan was. Having MassHealth I do not have to pay any deductibles or any cost for health care. In all the years I have had it I have not had to pay one medical bill. Completing this exercise has made me even more grateful that my daughter and I have MassHealth. We are able to receive great services like check ups and immunizations and not having to worry about how to pay for them.
ReplyDeleteHi Breanna: I am curious, how did you find out that information on Blue Cross Blue Shield. I never heard of having to be between a certain age to get that insurance.Typically there are so many options you can get for an insurance as well. I am very concerned that you found something that said you have to be between the ages of 18 and 29....what does that mean, and why? Is that Obama Care? Of which I know nothing about. This to me is scary, any way you can clarify this demand for an age bracket?
DeleteHi Christine,
DeleteTo being with I do not have much experience when it comes to health insurance so to find an insurance plan to compare mines with I went to a insurance company I did know which is the Blue Cross Blue Shield. On their website they have different plans for different things like dental insurance, medicare, disability insurance, vision insurance etc.. They plan I looked at was you had to be between the ages of 18-29, if you were not you had to get a different plan. To see if you are eligible for this insurance you had to answer a couple of questions and one was the age. It said if you are not between the ages you have to choose a different plan. Here is the link for it: http://www.liveyourlifenow.com/. Also here is the link for all the other insurances they have as well: http://www.bluecrossma.com/visitor/plans-products/index.html. What I couldn't get over was how expensive it was for that age group who is not making that kind of money yet.
BCBS is one of the pricey ones out there ,my other job offered it ..but i declined .Its like come on ..I have to live too .Fallon does reimburse for fitness and nutrition programs but its usually when its through your provider.
DeleteBreanna, thank you for replying. A lot of changes have happened, from the mandatory Massachusetts health insurance, and now ObamaCare, whatever that means. However I received my insurance through the years through employment. I guess now if you don't have health care through employment, you have to buy your own. I had gotten laid off and had no insurance in 2012, so I called the Mass Health Connector - it was fairly new and they sent me information and I could not make heads or tails out of it. The end result was even though my income was very low, I could not get MassHealth because I was a student, it didn't matter how old or young I was, but I was a student and therefore I had to choose from a University Plan.
DeleteA lot of this information is overwhelming, some great points are made by all about access and cost. Tufts Navigator is our insurer and the coverage is comprehensive. I feel fortunate when reading these blog entries .Compared to what I have read here we pay a pittance ( not even $400 per month for employee and family coverage) and yet just a few short years ago we paid about $150 month for the same coverage. It covers less and co pays and other associated costs have risen dramatically over the years. Now my two older children are in the workforce and they honestly cannot afford good healthcare . The Affordable Care Act has protected their coverage over the last few years. My son aged out this month and his coverage expires on October 31st , He will need to navigate through this mess known as healthcare on his own now .Working two part time jobs , neither of his employers offer insurance and he will have to pursue other options. Hopefully he can afford it .
DeleteTo all: Forgive me for getting sucked into the media version of The Affordable Health Care Act, which was pegged ObamaCare. Sorry to have used that terminology in some of my posts - Christine
DeleteHmmm I know what you mean ..I think its a good program and I obviously didn't read the entire thing but some aspects that I seen made sense to me .The program used the same policies Masshealth does ...It was tailored similarly to masshealth but on a larger scale..And since I find Masshealth as such a beneficial porgram ,i m yet to critcize it .Its Obamacare ...but it works ..like most programs there are bound to be some aspects that need to be revisited ..but until then ,I ll still be an advocate for anything that helps our vets ,elderly ,student and those that need the help.
DeleteThe two insurance companies I compared this week was NHP Prime HMO and Blue Choice New England Plan 2 PCP. The biggest differences between these two companies are how you acquire them, prescription plans, and the out of pocket expenses. NHP Prime is an application process based on income and this Blue Cross option was from an employer. There is not a prescription plan offered with this Blue Cross plan, but NHP Prime did have one with a copay and deductible. I was a little shocked that this Blue Cross plan did not offer prescription coverage because that is such an important aspect for most people. A lot of people take many medications and they depend upon coverage in order to help pay for them. Not very many people could pay for even one medication out of pocket because of budget constraints. Also the Blue Cross plan’s out of pocket expenses were almost double the NHP Prime plan.
ReplyDeleteAs far as which option to choose, that’s a tough choice. I know over the years I have had many different insurance plans. I was not really happy with any of them. They each had their pros and cons and some were more frustrating than others. When I moved back home last year, I did not have any insurance so I had to scramble to get some. There were not many options to choose from. With a limited income and no time, my only option was NHP Prime. Thankfully I have not needed to use it for being ill, but the one time I did call to make an appointment I got the runaround. “No, the doctor you’ve been assigned no longer works here and no one else is accepting your insurance.” So I call the helpline to get another provider, they were happy to help and assigned me another. The other day, I got a letter in the mail saying that my provider was changed once again and the address they gave me for my new provider is the address where they were not accepting any new patients. A little frustrated is not the word to describe how I felt after getting that letter. Now the fun begins.
Nena T.
Hi Nena: One observation: While many people need prescriptions, others do not. Prescription plans are expensive. I do not need a prescription plan, so therefore I do not want to pay for it in my deductible. These scenarios have been dealt with by groups of people going to Human Resources and expressing their disinterest in forcing us to pay for something we don't need. So having it is a rider is best...for me and for many. Certainly it should be offered at a reasonable rate, as they don't typically cover very expensive prescriptions anyway.
DeleteI have had the scenario of having an insurance and going to a doctor that was not "my doctor" because she didn't accept that insurance. So I had to travel to this doctor further, and explain who I was and my expectations of care. He was young, and impressed with my "stats", but shortly thereafter, he was not longer there, and shortly thereafter that, my company in midstream changed insurance...two more times of this "game" and in the end: back to where we were in the beginning, back to my own doctor. I think I would be more frustrated shopping on my own though, so I do not envy you. I wish you the best, Nena, in your insurance endeavors!
After comparing both insurances (mass health and BCBS of illinois) I have learned about what each has to offer. I have had experience in pharmacy as well as working in a dental office and I understand how complicated and frustrating it can get. I am pleased that we have something to be able to allow everyone to have health insurance. I don't think that anyone should be ashamed to apply to MassHealth everyone has different situations and sometimes people need help during certain times, and nowadays that isn't uncommon. Fortunately, I have never had MassHealth, but I have family members who have had it and it was a great help.
ReplyDeleteVi
I agree Vi. everyone's situation is different and any little help goes a long way.
DeleteFor this week's assignment, I compared my insurance, which is Harvard Pilgrim HealthCare with MassHealth. I am fortunate enough to still be covered under my parent's health insurance which is sponsored by my mother's work! I deal with health insurance issues and struggles with patients every day... I work at CVS pharmacy as a pharmacy technician. I know how hard it is for some people to afford the healthcare that they need. I love MassHealth. I think it is an awesome way to help people who are in need! I also don't think that anyone should be ashamed because of the insurance that they have-- insurance is a messy and hard process to work with! Being a public health major, I think that I think that it’s so important that every person receives the health care that they need to keep themselves, their families, and the others around them as healthy as possible. Overall, I really enjoyed this assignment and I think that it is great that MassHealth can offer so many people a hand.
ReplyDeleteMy own insurance currently is through the University Plan through Worcester State. I had no other means to purchase insurance, and I was in a gray area as a student. So I have Student Blue - The Blue Care Elect Preferred 80 Co-pay Student Blue Plan through University Health Plans, Inc. I have Financial Aid and Financial Aid lends me the money to pay for this insurance...therefore I guess I'll have to pay it back. I had no other choices except for more expensive plans. This is my third year having this plan, and each year the price has gone up, but this year, co-pays went down...amazing.
ReplyDeleteIt is basic medical insurance, any additions for dental, vision, prescription, etc.; I would have to pay more. The price is comparable to what I was last paying at my place of employment in 2011, maybe a little more money with a little less coverage. However, I can choose my own doctor and my own specialists without asking. There are benefits of staying in-network however.
I didn't search for a plan online that was comparable, but I asked a few people about their insurance. Most said I have this or that, and you don't know what you are covered for until you use it. One of my friends came through for me, and told me about her turning 65 and taking social security, therefore having Medicare for insurance. Medicare is the oldest health plan in America, and is part of the federal government. Medicare has to be supplemented by insurance, and is called Medigap. The insurances offered by Medigap are private, the companies that under 65 would look to for health insurance, such as Tufts, Fallon, BlueCross, etc. However, they must abide by certain rules which fall under the Medicare plan. She further had to buy a prescription plan.
I estimated that her plan without the prescription plan of $27.95 per month, was still $50 more than my Student Blue plan, but was very comparable to the coverage with a few more benefits. Since getting the Medigap, she has noticed that she doesn’t have to pay copayments and has not received any billing for laboratory work. I also took notice that there were some safety nets laid out in purchasing Medigap insurance, such as having an extra 365 allowable days to be in a hospital, and the first 3 pints of blood in a year. With my varieties of insurance in the past, and in looking at these two different needs insurance – The Student – The 65 or older groups – I find many similarities, and feel that they are both “grouped” unwittingly. I am not convinced that it is completely in one’s favor to be advised into The Student plan or the Medicare Plan.
I find it amazing that very few people know what their health insurance covers. Health insurance is not cheap - if your buy from an employer, the money comes out of your paycheck every week, you receive a small tax benefit from it (the deduction for health insurance decreases your taxable income), but it's still a lot of money. By law, your employer must provide paperwork that succinctly explains the plan, how much is costs, what is covered, etc. Most employer have benefit specialist that can explain the plans to you if you do not understand the paperwork. Understanding your health insurance will not only save you money, but it will increase the quality of your healthcare - whether you have basic student insurance, a government subsidized insurance, or a employer program. Knowledge is power.
DeleteMy employer offers several different health insurance options. Blue Cross Blue Shield Healthmate Coast-to-Coast, United Healthcare Choice-Plus, and United Health Care Consumer Directed Health Plan (CDHP). I am enrolled in two-person coverage under the Blue Cross Blue Shield Plan. There are no deductibles, I can see my primary care physician for free once per year, free OBGYN visit once per years, and copays for specialist are only $10. The total cost of the plan is 1212.64/month, but the university subsidizes the cost based salary - on a tiered scale. Because I work in human resources and have to explain the health plans to employees all day long, I am very aware at how fortunate I am. The plan I am enrolled in is what the federal government considers a "Cadillac Plan." Virtually every service is covered by the plan - and it is coast-to-coast, so I am covered at any doctor in the US and territories that will bill to Blue Cross. I compared this to a Blue Cross High-Deductible plan that I had with a former employer. With high deductible plans, you have to pay out of pocket up to a certain amount (under this employers plans my deductible under employee-only coverage, was $3000 - the lowest amount offered on the plan.) The coverage was in a small network of doctors in RI and I was very limited in the hospitals that the plan permitted. The deductible was particularly problematic for me because I have a neurological disorder that requires me to see a neurologist 4 times per year. Each visit was over $300, so I basically worked to cover my medical expenses. Previous to that I had no insurance for several years, so I was thankful to have any coverage at all.
ReplyDeleteHigh Deductible Plans and Consumer Directed Health Plans are difficult, specifically for lower income families. It is hard to predict what health care costs are going to be - you never know when you might be in an accident or contract an illness, or need surgery. Planning how much money to put in a FSA (flexible spending account or HSA (health savings account) is hard, especially considering money put into an FSA will be lost if you don't spend it all. And many families would have to decide between putting that money away for health expenditures or use it for current bills. A deductible of $3000 for a single person or $6000 for a family is a budget crusher. Some of the healthcare reform items are addressing the disparity between plans, but overall, the system is broken. Billing practices and regulations are confusing and difficult to interpret. I spoke to a woman this week who was crying because of an EoB (Explanation of Benefits - that is the sheet of paper that the insurance company sends to you in the mail after consuming some sort of medical service.) She had received and MRI and got the EoB in the mail and thought that she was being billed for $3000. It wasn't actually a bill, the service was completely covered by her insurance, but the paperwork is not friendly for the average consumer.
Hi Brittany,
DeleteI can completely agree, learning what your health insurance covers exactly can be tricky, and many people dont take the time to find these things out until it is too late. You are lucky to be working in Human Resources because this helps you understand the plans and what you are paying for. I think another problem is that so many people are trying to save money that they go for the cheapest plan, and then if somethign unforeseen happens they are in over their heads in medical bills. Another thing I hear so many young people (especially guys) say is "I dont know whay its manditory to have health insurance, I never go see my doctor". If we are paying all this money then why wouldnt we at least take advantage of getting a check up once a year?!
Brittany ,
DeleteOur family has used an FSA for quite a few years . It has been a great bridge between my health insurance and out of pocket expenditures. You are correct in warning that it can be difficult to determine exactly how much to contribute . We started off small and increased it each year. If I have money left at the end of the year I go on a CVS shopping spree , they have end of the year sales specifically for that purpose. You can definitely find something to spend it on contact solution , heating pads , automatic blood pressure cuffs are among some of things I have purchased with mine. Additionally if you have to travel a considerable distance for an appointment you can submit a claim for mileage reimbursement.
Hi H.Grant,
DeleteI appreciate my FSA too... I wouldn't have previously been able to visit my neurologist or afford my medications without it! I think that because many people don't understand their health plans or what they cover, it can be hard to understand how the FSA or HSA works, when the funds expire and how it can supplement the health plan.
Health insurance has been pricey but it depends on what you have I guess. I have Tufts Navigator health plan through the State of MA. This get deducted from my paycheck and It is very expensive. I got the chance to talk to one of my coworkers who has Mass Health and she was explaining to me that I can call Mass Health and they can help me with my Premium. When it comes to Health insurance I do not know much. However,I decided to call Mass Health and they working on it to help me out. I am glad I did this comparison of health insurances because I would not have known that Mass Health can help families out when they pay a lot for their health insurance.
ReplyDeleteBarbara,
DeleteI have the same health plan and it is very inexpensive for us comparatively speaking . We pay under $400 per month for a plan that covers employee and family , my husbands employer subsidizes the coverage and he works for the Commonwealth. We have low deductibles and comprehensive coverage . It is interesting to say the least that the same plan is offered a widely varying costs . That seems innately unfair.
The two health plans that I looked into were Blue Cross Blue Shield, PPO deductible plan (which is one of the options that my job offers) and Tufts Medicare Preferred HMO Basic RX Plan (which I found online). The two plans did not seem very different from each other in too many ways. BCBS offered an individual plan with a deductible of $3,500 max, for $71.00 and Tufts offered an individual plan with a deductible of $3,400 for $65.50 a month. Both plans offered $150.00 eyewear benefit and a $150.00 gym membership benefit. There was a difference in emergency room visits, where BCBS charged $150 and Tufts only $65.00. Both plans had tiered drug prescription costs that were about the same. Both plans also offered routine doctor visits with no co-pay but BCBS cost $20 per visit for other office visits and $20 for specialists visits and Tufts was $15 per visit for PCP and $30 for specialist visits.
ReplyDeleteOverall, both plans seemed to be similar, or not far off from each other. Aside from the plans themselves, I know that sometimes depending on your employer can make a difference. I know that my company will reimburse the employee after the employee pays the first $500 in their deductible for the $3,500 plan. Meaning hte employee pays the first $500 of their deductible and the company will reimburse for anything after that, up to $3,500.
Also, aside from these two plans, I have had Masshealth when I was younger for my daughter and I. The good thing about that was that we never had a co-pay for any doctor visits or prescriptions, we did not have to pay a monthly amount and I did not have to pay anything when I was in the hospital for giving birth to my daughter. Now, having a different health insurance, I get hit with a sizable bill after giving birth! I know that being able to get Masshealth depends on many things, and that it has helped a lot of people. The part that I struggle with is, even if you begin to make just a little bit more money, you can become "no longer eligible" to recieve these benefits.
I completely understand where you are coming from about Masshealth. I've applied for healthcare before through Masshealth and have been told I am ineligible for coverage because I make too much, or that I will still be required to pay monthly under certain plans. It's so frustrating to me because at the time I was a part time employee attending community college part time, and yet I felt like I was being punished for making just above the qualifying amount of money. Also you are very lucky to work for a company which provides that kind of cost coverage for you.
DeleteI compared the health insurance I receive through my parents who work for the state which is Tufts Navigator to Mass Health. The insurance my parents have covers 80% with them paying 300 a month plus co-pays when visiting a doctor. I never really understood how expensive it was to receive healthcare because my parents have been working for the state for over 25 years. At an early age I assumed everyone was getting the same amount of treatment and medication whenever they needed it at a reasonable cost. It wasn’t until I had multiple surgeries when I realized how expensive the procedures would have been without insurance. I think Mass Health is great in order to help people who are in need. Not everyone is fortunate enough to have a decent paying job with benefits to support a family. There is nothing wrong with Mass Health and people who don’t like it probably don’t understand what it’s like not to get exactly what you want when visiting a doctor or filling a prescription. The out of pocket cost for these simple things without insurance is ridiculous. Everyone should have healthcare in order to stay as healthy as possible. It’s not fair for some to get the treatment they need while others suffer.
ReplyDeleteAndrew,
DeleteMy health care costs about the same each month...just about $330 and has us paying co-pays as well. Like you, I never was truly aware at the costs of health insurance until I was in an accident. Its outrageous what we would be paying without it. I can add to your prescription comment that is insane how costly they can get without coverage. My father has cancer and is taking multiple, and I mean multiple oral chemotherapy pills and just one of them would be in the thousands without coverage. I cant even imagine the total on them all without coverage, its nauseating.
-Andrea D
I agree. Health insurance is great because it allows that sense of peace. There is nothing wrong with MassHealth either because the patient is getting the treatment deserved and the doctor is able to provide it. Tufts is a great plan to have too. You and your family are also covered with what you pay!
DeleteFor this assignment I chose to compare Neighborhood Health Plan (my current insurance) to Fallon Community Health Plan (provided by my previous employer). Up until I was 26, I like many took advantage of being able to obtain healthcare coverage through my parents insurance, so up until recently I never really had to deal with the headache that is health insurance. After I turned 26 I was without health insurance for a year because I worked for a state employer which didn't offer coverage to part time employees, however Mass Health claimed that I made too much money to qualify for insurance coverage which was affordable to me. I was so frustrated for that year because I am required to have health insurance, yet at the time I had no way of paying for it along with my other financial responsibilities, such as school and rent. I realized through this assignment that the two healthcare providers I researched turned out to be not necessarily one better than the other in terms of benefits and services, but rather which one was more cost efficient for me for whatever life situation I was in at the time. I guess I should just consider myself lucky that I work for an employer who offers health insurance, and thus far I have been able to get the services I need when I need them.
ReplyDeleteFor this activity I decided to compare my current health insurance, which is Fallon Select, to my prior insurance, which was Tricare Prime. Tricare prime is only available to Military personnel, and their dependents. I loved the coverage - as I paid little to nothing out of pocket. Fallon Select has expensive premiums, deductibles, and copays. Fallon select has maternity deductibles and copays, where as Tricare prime did not.
ReplyDeleteIn March of 2013, I was in a terrible car accident (due to another running a stop sign), where my jeep flipped a few times. I broke four vertebrae, and has a serious TBI. I was in and out of the hospital for care, along with physical therapy. Fallon select sent me a bill for $250 total, where as my initial care cost over $16,000. I am truly thankful for the health insurance, and care I have received from them. However, both insurances has suited my needs at the time, and have so much to offer.
Jennifer,
DeleteFallon is the coverage I chose to compare to mine (Blue Cross) and I noticed that it is very expensive but I am so happy that you did have it. $250 is a beautiful price compared to $16,000. I was in an accident in 06 and needed multiple dental surgeries which were not covered by my insurance or many others, my bills are ridiculous. So glad you are okay, it sounded like a very terrifying accident...always one of my biggest fears.
-Andrea D
Hi Jennifer:
DeleteI hope your recovery for your TBI went smoothly. I have a lot of information and empathy for TBI's - feel free to reach out to me if you need. Breaking 4 vertebrae is no easy recovery either. Your advantage is your youth and your Insurance! It is nice to hear that you were able to benefit from the insurance coverage you had. It balances out the "bad talk"....here's to continuous healing and continuous health insurance coverage!
For this activity I compared my insurance, HMO Blue Cross, with Fallon Community Direct Platinum Plan A that I found while searching online for other insurances. This activity really opened my eyes to just how expensive health insurance really is. I never needed to really know before this assignment because I have always been under my mothers and I was something I didn’t worry about. While investigating I found that our insurance is $83 a week. If I was paying this right now I would be broke; I could not afford this along with rent, utilities, food, and my coming student loans. This makes me extremely grateful that I am covered until I am 26 years old. Under this insurance I get free yearly visits to my primary care doctor, for eye exams, and visit to the OB/GYN. After the yearly’s I have to pay a co-pay of $20 per visit and $25 for a visit to a specialist which I need a referral too. Two things I wish my insurance did cover is more dental and reimbursements for wellness. I had a bad accident in 06 and needed dental implants, multiple bone grafts, and multiple skin grafts and none were covered. I will paying for those bills my whole life. Secondly, I spend a good chunk of money a year on gym memberships and wellness programs and only get a very small amount of money back. This is what I like more about Fallon. This Fallon plan covers wellness programs completely. Other than that it had yearly deductibles that could not be exceeded, higher copay, and less visits allowed to doctors. Health care is something that I think is completely a mess in this world. It would work so much smoother if everyone just got the same insurance and was covered for the same things, sadly I know it would never be that way, not with our economy.
ReplyDelete-Andrea D.
For this assignment, I compared my student Blue Cross Blue Shield with my parent's Network Health plan. Network Health is a plan through MassHealth and commonweath. However, one thing that should be noted is some of these plans still require a monthly fee as well as co pays. This was the first time my parents have had health insurance and it was bought through Obama's marketplace. Their plan is very similar to mine minus the fact they also have a vision plan as well as they have higher co pays however they pay less per month than I have. Honestly, it's nice to have health insurance and be covered by doctor's rather than my parent's who paid for everything out of pocket being business owner.
ReplyDeleteI chose to research Medicaid and Blue Cross HMO Blue Essential. I have Medicaid. I obtained it when I learned I was pregnant, and was transitioning off of my very expensive Blue Cross Student plan. I got Mass Health almost right away, I must have applied at the right time. I never have to pay for my medications, which would add up to about $500 a month. I never have to pay for lab work/fees, copayments, anything. The one downfall is there isn’t dental coverage. Luckily, my mother is a manager at a dental office and I get free care including cleanings and fillings. They are, however, coming up with a dental plan that covers the basics, which will come in handy. I still qualify for Mass Health because I am a young mother who is below the income limit. Sometimes I’m very, very thankful for my little surprise over here because even though he costs a whole lot to take care of, I don’t have to worry about paying thousands of dollars every year for health insurance.he Blue Essential plan is one of the plans I probably would have had to be on if I didn’t have Mass Health. Blue Essentials Out of pocket minimum is $12,900/year per family. Its sad to say that I don’t even make that much in a year, so how would I even afford that? Mass Health isn’t free care, its paid for by the state and you still pay very little taxes for it. Everyone deserves health insurance, but not everyone can afford it. Some people may be embarrassed by it but I’ve never had a problem with it, I’m just grateful to say I know I’m in great hands and that I’m safe because I have a reliable health insurance.
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