ACA marketplace options for APC

[meowlicious99]

HI, My father recently had his Permanent Residence ( Green Card) approved to USA. He is a chemo naive mCRPC patient with current PSA of 3.41 ( full case history in profile) .

However, he isn't eligible for medicare due to insufficient residence and employment requirements. We are hoping to buy insurance for him on ACA marketplace. I don't have too much insight into ACA but they do seem to have a plethora of options that i am researching now. Wondering if this is even a viable plan or if should continue his treatment in India.

Thank you for your help!

[Adendino]

Keep in mind that the ACA plans typically are state specific which means you can’t travel out of your state if you want treatment elsewhere. If he hopes to travel to Mayo Clinic or out of GA for treatment, I’d read the fine print.

[Fred312]

I was able to retire at 59 and after 18 months on COBRA, have since been on an ACA PPO policy. It is a Blue Cross Blue Shield policy that allows me to go anywhere in the US as long as that doctor/hospital accepts Blue Cross Blue Shield. It paid for my $36000 prostatectomy at an out of state teaching institution, except for the deductible.Each state has their own list of policies. Some have PPO plans available, others don't.

[DrawingSnowmen]

Unfortunately the ACA plans in Georgia are not very good because it doesn't participate in the federal system. All of the available plans are HMO's as I recall. You can check what's available at healthcare.gov

[tango65]

He may qualify for Medicaid.

medicaid.gov/medicaid/index...

[pakb]

My family has been on ACA (we are in PA) for the entire time my husband has had Pca- 6 years. We can travel where necessary and he gets great care. Each year I just make sure anything we need (our docs and meds as we have a daughter with Crohn's and I had early stage breast cancer) acceot our plan. But we have never had an issue going out of state either if necessary. We have an Independence Blue Cross plan. And thank goodness for the ACA in our family.

[TJGuy]

When people say each state is different it's more than that. Each county in the state can and often is different as well. You need to get a PPO plan. These allow you to get treatment anywhere in country. So for BCBS they have what is called "Blue Card" and it is exactly that wording, that means that the hospital and doctor file BCBS claims through their own states BCBS and that will get you coverage if you have a BCBS PPO plan.There are many tricks to this whole ACA coverage which you'll never be aware of if you don't get a good insurance broker. Many brokers are not good at all. See if your hospital can recommend one that will have your needs in mind not his own or some insurance company's.

If on Medicare NEVER and I repeat NEVER get a advantage plan as you will doom yourself to substandard care. Don't fall for the free this or free that or get money back. They are taking you off your guaranteed Medicare healthcare if you do. Making you give up your rights NEVER EVER do that. Google for yourself MAYO Medicare Advantage warning and other Medicare advantage warnings.

So you might have to go off that ACA plans if no PPO is available in your county. You may end up with a high deductible BCBS plan that's also like $1200 or more a month, with $7500 deductible. That good insurance broker your hospital can recommend can help you with these as well if you want to go out of county/ state for your care.

The broker can type in the hospital and each individual doctor you see to see if you'll be covered by BCBS.