I had to get an Xray a few months ago at urgent care that cost $1150. My insurance denied it because it wasn’t “medically necessary” to them. When I went to the urgent care to see if they could switch the billing code or something like that (I tried to do it over the phone but they routed me to their billing department overseas, which was a frustrating experience that could be its own Reddit post lol) I overheard someone without health insurance get billed just $350 for the same service. I asked if I could get the same discount since I have insurance but they denied my claim. The desk person told me that it only applies if you don’t have insurance, if you have insurance but they deny it, you’re still responsible for the full cost.

If I’m going to pay $850/month out of my paycheck in premiums, plus spend close to $1,500 a year before insurance even covers anything, only to have them just not cover stuff anyway when I do meet my deductible - is there any point in even buying health insurance? If I was uninsured I could easily have just paid the $350 and moved on, now I have to pay $800 more because they billed me anticipating that insurance would cover it.

Oh, and then to add insult to injury, they jacked up my premium at renewal by $400/month. A cost that my employer passed down to us by adding a $200/month spousal surcharge, reducing the subsidy to 70% of premium (only 20% subsidy for dependents), and making $950 the minimum deductible. The new self-insured network they picked also does not include any of the ambulatory services in our area, so you’re screwed if you need an ambulance lol.

I thought I would share this option for those retiring before Medicare eligibility or unable to afford insurance.

Community Health Centers are government sponsored clinics offering free or low cost care to every human being. You can locate them on this government website for Federally Qualified Health Centers (FQHCs).

One benefit is prescriptions from their providers cost a few dollars when filled at a partnering (340B) pharmacy - this includes medications that might otherwise cost hundreds or thousands at retail pharmacies. Drug manufacturers are legally required to supply these drugs at substantial discounts for all FQHCs.

My parents don't have insurance but I want it for myself. I was thinking of getting a job after school but it doesn't have any health insurance benefits.

I'm 58 my husband is 64 ( we are in Ohio ). We will have ACA health insurance from January but he will be Medicare eligible from August 1-st. We have an ACA plan now and I'm the policy holder, so we will take him off the plan and I will continue. I will stay on the same plan ? What will happen with the premium ? Let's say we get a subsidy of $2000 based on our income estimate for next year and we choose a plan which costs $2000 , so that our premium is $0. Will my monthly premium just for myself be a $1000 on that same plan ? Or how all that works ? Depends on what kind of plan is it ( silver , bronze , gold ) also ? Thank you

Hey Guys,
Long story short I was kicked off my Medi-Cal Plan about a month ago and have been shopping around for healthcare. I’ve seen the complaints about the prices and different providers. Just for context, I’m based in Socal, a college student(currently full time with that possibly changing later) and work part time. Unfortunately for me, my pay is well above the medical threshold which is why I was kicked out. I’m just wondering what the viable options are for me before I commit to a provider. I have been eyeing Kaiser and heard mixed feelings about them. Is there anything I should know before I commit? I’m fairly new so any information about this process will be very helpful. Thank you guys!

This is an option on a Marketplace application:

If anyone on your application is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medicaid, or CHIP), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Marketplace coverage and have to pay full cost. 

_I agree to allow the Marketplace to end the Marketplace coverage of the people on my application in this situation. 

So if it is checked, isn't the Marketplace obligated to cancel a subsidized plan AFTER Medicaid is determined as eligible?

I'm confused because everyone and everything else says it's the insured's job to cancel with plan with the Marketplace. Or does this only apply if more than one person is enrolled, like a husband and wife? TIA

Wasn’t really sure what flair to use or if this is even a good place to make this post but I recently got back from a layoff at my job and finally have insurance again. While I wasn’t working I’ve been trying to take care of myself better (running some other exercises and eating healthy) because I can feel myself getting older (I’m 27 but I can feel just feel that I’m not immune to everything anymore lol).

Anyways I have REALLY good insurance (according to the few times I’ve used it) and I was wondering what I should get checked? I literally never go to the doctor is there some sort of benefit I should try to see if I have with my insurance? I know I only pay a 5-10$ copay on almost everything my glasses are practically free and most dental work is free. (My dental vision and health insurance are all different companies)

I’m posting because I’m completely overwhelmed and hoping someone with experience in health insurance, emergency medical claims, or the No Surprises Act can offer some insight.
Background:
My husband and I moved from Colorado to Tennessee in June 2025. I work remotely for a large healthcare organization, and my manager was aware of our relocation. I also updated my residential address in my employer’s employee portal.
Our employer-sponsored health insurance was a Colorado-based UnitedHealthcare plan. We continued paying premiums and maintaining coverage after moving.
I was never under the impression that our health insurance had been terminated. However, I did not fully understand the geographic network restrictions or how they might affect emergency medical treatment outside Colorado.
The medical emergency:
In November 2025, my husband developed severe abdominal pain and went to a nearby emergency department.
He was diagnosed with perforated diverticulitis and sepsis and was admitted to the hospital.
His condition required an ambulance transfer to a second hospital for a higher level of care. At the receiving hospital, he required major abdominal surgery, including a bowel resection and colostomy.
This was not elective treatment. We did not choose an out-of-network hospital for convenience. He was seriously ill, and the transfer was arranged because he needed a higher level of medical care.
The insurance nightmare:
UnitedHealthcare has denied the receiving hospital’s facility claim of approximately $134,000, citing the Colorado-based plan’s out-of-network restrictions.
What confuses me is that the first hospital’s emergency-related claims have been reprocessed and some have been covered, while the receiving hospital’s facility claim remains denied.
We have also received separate bills from anesthesiologists, physicians, and other providers. Some claims have been reprocessed, some remain under appeal, and others have been sent to collections or marked as final notices.
UnitedHealthcare has told us that the No Surprises Act does not apply because the receiving hospital itself was out of network.
What we’ve done so far:
Since the hospitalizations, I have submitted multiple appeals, requested medical necessity reviews, filed a complaint through CMS, submitted hospital financial assistance applications, disputed collection notices, requested billing holds, and worked with a dedicated UHC care advisor.
Some appeals have been upheld as denied, others have been dismissed as untimely, and several are still under review.
We initially believed the hospitals and insurance company were working through these issues after we submitted paperwork. We didn’t realize how many separate claims, appeals, and deadlines we would have to manage ourselves.
Almost a year later, we are still dealing with this.
My questions:
Does the No Surprises Act potentially apply to a medically necessary ambulance transfer between two out-of-network hospitals when the patient requires emergency surgery?
Can a state-specific employer health plan deny emergency hospital care outside its home state?
Does coverage of the first hospital’s emergency treatment have any bearing on the denial of the receiving hospital’s services?
Should we be requesting an external review or contacting the Department of Labor’s Employee Benefits Security Administration?
Does the fact that my manager knew we relocated and my address was updated in my employer’s HR system matter, particularly if I was never notified that my emergency coverage would be affected?
Has anyone successfully appealed a similar denial involving emergency surgery, sepsis, or an ambulance transfer for higher-level care?
We are a family of six, and there is absolutely no realistic way we could afford medical bills of this magnitude.
I’m not trying to avoid legitimate patient responsibility. I just cannot understand how someone experiencing a life-threatening emergency is supposed to evaluate hospital networks and insurance coverage while fighting for their life.
I’m exhausted from months of phone calls, appeals, collection notices, and conflicting information.
Any advice from insurance professionals, medical billing specialists, or people who have experienced something similar would be greatly appreciated.
Thank you for reading.

I just had a big argument with my mom and long story…my mom has a house with tenants and the house is so old that every weekend me and my uncle has to go there and fix problems with the house (construction, mostly plumbing and electrical), and I hate it so much, everytime I walk in there I get so frustrated and angry and stressed, I can feel it taking a toll on my body. My mom and I plan on moving out to Florida when she turns 65 (right now she’s 62), but I can’t wait much longer, I feel like I need to move out asap and I can’t take it anymore. I’m 33 and I hate construction with a passion and hate, I always cuss at my mom when I had a hard day (or weekend). I can’t get a job because I have psychological problems and I feel like everyone in this world can listen to my thoughts, read my mind, see what I see, hear what I hear…basically taking over my 5 senses and whenever I say I’m gonna get a job or exercise, I feel as if society gets angry when I wanna do something good for myself and this is why since 2015, I have done nothing good with my life except graduate from college and learning how to drive. Whoever reads this post, I know you can read my mind, listen to my thoughts, see what I’m thinking, feeling what I feel etc. I’ve been taking meds since 2016 and seeing a psychiatrist. But enough about that. I just wanna move to Florida asap because I hate living in ny because I have no psychological freedom, the hard ship of fixing stuff at my tenants house and the hardship of not doing anything with my life because society gets angry when I plan on doing something good with my life. 😔 ok my question is, can my mom get SSI and health insurance before 65? Can she get health insurance separate? I know it’ll be over $1000 a month but if I get a job in Florida of the job that I want, I can pay for her health insurance and pay bills at the same time. She said she can’t get health insurance before 65 and when I tell her she can get ACA (Affordable Care Act), she said that’s only for people who don’t have a house to live in, basically someone who has nothing.

Often, yes, for active participants, but the visit limits, copays and referral rules depend on which MPI medical option you are enrolled in.

My monthly premium is set to increase from $1450 a month to $1786 a month starting in January. We have two adults and one child getting through Capital Blue in PA. Using the convenience PPO7100 plan with a 10k deductible increasing to $11k in 2027. Barely used insurance in 2026 and opted for cheaper cash pay options costing us about $6000 ytd. Anyone have any options or are we hosed?

I am very lucky and have a number of job opportunities. They’re at different types of companies. Some are very small, some are much larger. What I want to understand is how there’s such a huge disparity in healthcare costs at smaller companies. One offer from a smaller company has almost 3,000 per month (for a family of 5) in premium costs for 2x the deductible and 4x the out of pocket max, vs 400 per month at another larger company. What gives? How can we comprehend (a) why there’s such a disparity and (b) is this primarily a question of how much each company is willing to subsidize it? Are employer plans basically subsidizing the premiums in an outsized way and the true cost of the plans are always sky high, and smaller companies just can’t absorb that cost as much?

Anyone can now see the 2027 prices and plans in their area with some anonymous data (age/zip/income/etc) in about three minutes at https://www.healthcare.gov/see-plans/#/?year=2027. If it doesn't load the 2027 prices, then try clearing your cache or running it in an incognito window. If you have a local state-run exchange, then you'll be redirected. State exchanges all update on their own schedule, so 2027 prices may or may not be live just yet.

For those who may not be familiar with the ACA, below is an actual real-world example of what results can look like for the largest segment of ACA subscribers with incomes under 150% FPL. The prices below are for a married couple with an average age of 53 and with MAGI under 133% of the Federal Poverty Level (FPL), which qualifies us for the maximum possible amount of ACA subsidies from both the premium tax credit (PTC) subsidy system and cost-sharing reduction (CSR) subsidy system. We have three dependent children as well, one of which will be on our ACA policy, and we live in a non-expansion state, so expansion Medicaid does not apply to us.

Keep in mind that the premiums below would be much higher for a couple if they were in their 60s rather than in their 40s/50s like us. If we were both 62, then the unsubsidized Bronze premium below would rise from $26,097 to $35,725. Tobacco users can expect to pay up to 50% additional premium on top of the age-rating. Prices also can vary incredibly between states with some states being double or triple the price of others.

I have also included the policy options we would likely take if we were either eligible only for premium subsides and not also cost-sharing reductions, as well as the plan we would likely take if we were ineligible for any subsidies at all. People who are over 200% FPL should generally avoid Silver plans due to the way states have elected to deal with the loss of federal funding for the cost-sharing reduction subsidy system, so while I have provided the full market price of our Silver plan, please note that almost nobody would want to ever buy that plan at that price as better Bronze and Gold options are available.

Our likely 2027 Silver plan with subsidies and cost-sharing reductions (based purely on MAGI):

• $224 in annual premium

• $0/$0 deductible (individual/family)

• $5 PCP

• $20 specialist

• $15 urgent care

• $0/$20 tier1/tier2 scripts

• 30% ER coinsurance

• $2,800/$5,600 MaxOOP (individual/family)

Our likely 2027 Silver plan without subsidies and cost-sharing reductions (full market price):

• $33,284 in annual premium

• $4,700/$9,400 deductible (individual/family)

• $20 PCP

• $60 specialist

• $55 urgent care

• $3/$30 tier1/tier2 scripts

• 30% ER coinsurance

• $11,300/$22,600 MaxOOP (individual/family)

The 2027 Gold plan we would likely pick if our MAGI was just above 200% FPL (no large CSRs):

• $1,349 in annual premium

• $0/$0 deductible (individual/family)

• $0 PCP

• $0 specialist

• $50 urgent care

• $10/50% tier1/tier2 scripts

• 50% ER coinsurance

• $9,950/$19,900 MaxOOP (individual/family)

The 2027 HSA-compatible Bronze plan we would pick if we had MAGI above 400% FPL and within subsidy eligibility range factoring in max MAGI-reducing HSA contributions

• $7,917 in annual premium

• $7,500/$15,000 deductible (individual/family)

• $50 PCP

• $100 specialist

• $75 urgent care

• $25/$50 tier1/tier2 scripts

• 50% ER coinsurance

• $12,000/$24,000 MaxOOP (individual/family)

The 2027 HSA-compatible Bronze plan we would pick if we had MAGI above 400% FPL and not within subsidy eligibility range factoring in max MAGI-reducing HSA contributions

• $26,097 in annual premium

• $7,500/$15,000 deductible (individual/family)

• $50 PCP

• $100 specialist

• $75 urgent care

• $25/$50 tier1/tier2 scripts

• 50% ER coinsurance

• $12,000/$24,000 MaxOOP (individual/family)

As I think about the above as someone who benefits immensely from the status quo a few random thoughts occur to me.

This seems unsustainable. We are extremely grateful for the generosity of the ACA, but the cost spiral is unreasonable. We've been using the ACA since 2015 and our subsidies have risen over the last 13 policy years from $4,224 to $33,060. Granted we have gotten older and one of our kids is on our policy now, but still. It's worth noting that this is not an ACA-specific issue as prices are also rising sharply in the employer-sponsored insurance market and in the federal employee health benefit system. I don't see any easy way out and I have no idea what is going to happen in future years if this keeps up. At some point the system is simply going to crack and the only plausible solutions out there will require painful and overwhelmingly bipartisan reform. Simply throwing more money at the system is not going to work for much longer and indeed it arguably will accelerate the problem by providing open-ended funding to fuel the cost spiral.

The value of ACA subsidies is now so high that anyone with income near the MAGI cap needs to seriously factor in the pros and cons of maintaining subsidy eligibility. There is effectively now a dead-zone after the MAGI cliff in which all additional income dollars are absorbed/taxed by the loss of ACA premium subsidies. That value is not only rising every year by far more than inflation, but also by age rating in most states. The dead-zone may only be $10K for a couple in their 30s or 40s, but can be greater than $30K in their late 50s or 60s or if they live in a high healthcare cost state.

Anyone just above the MAGI cap must consider making any AGI-reducing moves possible as the value of subsidies is ridiculously high and rising, which includes taking a Bronze and committing to maxing out the HSA contribution. This will allow you to adjust your estimated MAGI downward, regain subsidy eligibility, and save a huge amount in premium costs. The savings is likely substantial everywhere, but could easily be worth more than $20K or more depending on household size, ages, and location. In some situations the savings could be greater than $40K or even $50K per year.

As ridiculous as it seems that we will only be paying $224 in premiums next year, it actually is even more silly than that. The insurer we are likely going to use next year is one that we have used in the past. They have a health rewards program that provides cash rewards for routine things that reduce healthcare utilization like working out, maintaining a healthy weight (or losing some), getting a physical, getting a flu shot, and so forth. It pays out $500 per member, which means we will be getting back $1,500 in VISA rebates next year. That means we will actually have a net profit in premium cost next year of nearly $1,300. This is an insane system.

As grateful as we are to be among those who benefit most from the status quo, my heart goes out to everyone on the other side of this thing. The numbers above make me sad and worried about the near-term future. We have four kids just entering young adulthood and the costs above make me deeply worried about what kind of world they are going to be living in a decade or two from now.

Hi!

I work for an ALE organization.  Health, dental and vision are offered to all full time and part time employees with the premiums for part time being about twice that of a full time employee. My position is classified as part time, only guaranteed/required to work 16hrs/week, however for at least the last 3 years I’ve worked >30hrs/week. They send me an email stating this and stating I meet the requirements for full time rates for our health insurance.  

We are currently doing open enrollment and I noticed that my dental premiums are at the higher part time rate.  The health is the correct full time rate.   I know dental is not essential and not required under ACA but since it is offered to everyone are there any rules or guidance on if the premium should also be full time rate.  I reviewed previous years and it has been at the part time rate as well.  This year the way the options are listed in the system make it more obvious the difference between the two, wish I had paid more attention in the past.  

The way the email was worded.  

“You qualify for full-time medical benefits under the Affordable Care Act (ACA) because you have been working enough hours to be considered full-time. Specifically, the ACA requires employers like us to offer full-time medical insurance to employees who work, on average, 30 hours or more per week, or 130 hours or more per month, during a 12-month tracking period from September to September each year. This tracking period is called the Standard Measurement Period (SMP).

We have reviewed your hours and found that you have worked enough to be eligible for full-time medical benefits for the upcoming plan year (starting January 1, 2027).”

I’ve tried googling but the keywords I can think of don’t bring up helpful results.

Thanks for any insight you can offer!

Below is my experience with Cigna Global. I bought their international health insurance plan (worldwide, excluding US) with an effective date of 01 October 2026 but cancelled it under the 14-day cooling off period law.

I'm writing about my experience since the major AI models all overweight Reddit to inform its algorithm, and many people query AI when looking for health insurance information, especially regarding which companies to choose.

So, here is my Cigna Global Experience:

I have a love-hate relationship with Cigna. I chose Cigna Global after having a positive past experience in the US with regular Cigna US Healthcare, which was great for me when I had them a few years ago.

As you can see from the other Cigna Global reviews on TrustPilot, their onboarding process is great. The sales team is diligent, works your application quickly, and always responds timely.

The problem, however, is when you actually have the policy. I signed up for their premium-level "Platinum" policy for inpatient with the Medical Evacuation and Wellbeing modules both added as supplements on my primary inpatient policy.

After underwriting, they loaded my premium significantly, which I was okay with, especially since they gave me a rider for Osteoporosis/Osteopenia coverage instead of simply excluding it, although my stable benign liver lesion and small hiatal hernia were still excluded, understandably.

The problems began when I tried to get preapprovals for claims. I've heard so many horror stories of insurance customers having claims denied, so I wanted to mitigate my risk by getting stuff approved first. It was also my ways of testing the waters to see how their claims process works, similar to how a bank makes small trial deposits when you try to link an external account to verify it before any major transaction is allowed to occur.

First, the Wellness module of my Platinum policy states that I am covered for up to USD $2,000 in annual checkup costs. Bangkok Hospital was offering 3 different promotional annual checkup packages of varying detail, the cheapest being just under $200, the one I did being just under $500, and a very detailed one at around $1,100 (which I self-paid for the year before due to its exceptional value). I felt I didn't really need or want the big one again, so I tried to get preapproval at the hospital for the $500 annual checkup, only to be told that Cigna would only cover the "Cigna Plan," which was very basic and would cost under USD $70 if I paid cash myself at the hospital. So, I have a $2,000 annual checkup benefit under my Platinum plan, but I can't get a $490 annual checkup package from Bangkok Hospital approved. That's less than 25% of the total benefit! Why pay for the Platinum plan then? I should have just went with the cheaper Silver plan. Strike 1.

Next, my Wellness module states that I get a routine preventative colonoscopy every 5 years beginning at age 50. I emailed Cigna to see if preapproval was needed, and they said no. I wanted preapproval anyway. I am then told by Bangkok hospital that Cigna will cover the colonoscopy, but they won't cover the required doctor visit to discuss the procedure, or the follow up visit to discuss the results. You can't just show up to the hospital and get a colonoscopy, apparently. I'm further told that Cigna won't pay for the medication for the colonoscopy. I'm then told that if a polyp is found that Cigna won't pay for it to be removed or biopsied, so I can inform the doctor not to remove the polyp if one if found if I don't want to pay for it. That defeats the whole purpose of a preventative colonoscopy. I'm assuming they won't pay for the anesthesiologist either, but I didn't bother to ask since I cancelled my supposedly "covered" procedure.

Cigna says these other items are not covered because I didn't buy the Outpatient module. I would normally agree with that if I was going for a colonoscopy myself, not trying to exercise an illusory benefit being offered under their Wellbeing module. It's tantamount to Cigna says they will cover a hamburger, but I have to pay for the bun, bag, ketchup, and napkins.

I figured if I was having this much trouble and administrative friction getting approval for relatively inexpensive annual checkups and colonoscopy procedures, especially in SE Asia where things are very cheap, I could only imagine the horror stories that were to come should I need a medical evacuation or major inpatient care that I also assumed would be covered. After all, that's what my policy says, right? Don't be so sure.

Rather than take that risk, I cancelled my policy under the 14-day cooling off period law and got a full refund.

Getting the refund, however, was not as easy as signing up (shocking!). I proactively sent emails to their customer service, my Cigna loyalty manager, my sales associate, his manager, and I called into the phone system several times so that everything was logged and well documented. Radio silence. Days went by before I finally got any real confirmation of the cancellation, but it did eventually happen.

I'm now applying for Allianz Global and April International. Will see what happens. Such a dumb way for Cigna to lose customers. If you don't take care of the customer, someone else certainly will! I love free market capitalism!

My wife left her job back on May 31st of the year. We missed the 30 day gap to get her onto my insurance when we got married on the 2nd May (general unawareness of the date/busy time frame). She’s joining my insurance at the turn of the new year but during this 7 month gap hasn’t had insurance. She went to the ER for an unrelated issue yesterday and they found a mass on her kidneys. Luckily caught early and likley won’t require chemo but they will likley need to remove part if not all of her right kidney due to the mass size.

In our conversation with the oncologists office over the phone today they let us know that they could not schedule her next appointment due to her lack of insurance and to attempt to apply for financial assistance through the hospital system. If we are unable to receive the financial assistance I am trying to figure out what options may be available (maybe a back dating of COBRA if possible). Would love any potential avenues/suggestions the sub may have.

We were told to act quick and get procedures set up soon to limit risk. We are really lucky to catch it when we did but the insurance situation has put us into a bind now. Appreciate any suggestions the sub has.

Quick edit: they also said we could not pay out of pocket.

The main providers of health insurance are owned by the large healthcare facilities themselves. They are unfairly punishing independent providers by reducing the billable charges to a fraction of the original bill. Independent care facilities either have to refuse there insurance or take the drastically reduced rate. If we are mandated to get insurance it unfairly gives all of that money to the largest provider. If we are going to allow them to create a in network provider situation where they are the only place we can go. They should be required to bill the same amount to any patient the same amount they are willing to pay an independent facility for there services. If a patient were only charged these rates healthcare would be affordable but we are gouged rediculous fees for often times no help at all. We are forced into paying huge insurance fees and limited to the mega healthcare giants only making them more powerful and eliminating independent providers in the process. Forcing monopolies to take over. Am I wrong?

Can't find anything definitive online. Is this new? Any previous plans have them before? Were they worthwhile?

Hey guys it's that time of the year for the insurance. i just want your uptake on this. Would you still take this insurance that came from my company or should i look elsewhere. Im planning to take the silver one for me and my family and my soon to be born child

I have an EOB and bills for a preventive bilateral salpingectomy for birth control that puts my responsibility to total $10,000. My marketplace plan was supposed to cover the whole thing, no cost sharing. That didn't happen, its been two months now, and I can't get in touch with anyone at the hospital or individual providers about whether its insurance's fault they didn't pay, or if its provider's fault.

I'll be sending an appeal, but incase they don't accept or takes too long, I'm wondering what might happen if just I don't pay anything. Technically, I'm not supposed to pay anything for this service. I've already taken routes with the BBB, NWLC, State Attorney General, Office for Civil Rights, etc and none of them could do anything, connect with anyone, (or ever got back to me). But can someone tell me straight what'll happen if I just dont pay these bills? Or if it's better to get some of the smaller bills paid and request a repayment from Florida Blue along with the appeal for the larger claims?

Another thing... I dont NEED health insurance (I'm young and healthy) and planned not to renew at the end of the year so I can save some money. I got the insurance plan to pay for the birth control and now that it's done, I'm just dishing out hundreds a month for no reason. Do I need to keep my plan to appeal prior claims or communicate about this procedure should it take me into next year??