I don't have insurance now, and open enrollment doesn't start for months. I need to get surgery soon. What can I do to proactively manage this situation and make sure I don't end up with a crazy medical bill?

I don't have insurance now, and open enrollment doesn't start for months. I need to get surgery soon. What can I do to proactively manage this situation and make sure I don't end up with a crazy medical bill?
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#1

I am a young male who needs hip replacement surgery. I live in Texas but am willing to travel to find something affordable.


#2

First I would contact an insurance broker to discuss your personal options with your budget. My advice is to read the policy you do get very carefully, as some have waiting periods before they will pay for surgery, tests or certain procedures.  Be honest and forthright when answering questions on your health questionnaire about your existing conditions.

After you get insurance, you will need to do some investigating to make sure all the doctors involved in your care for the surgery accept your insurance plan. If any do not, you can ask for other providers, and/or pre-negotiate an "in network" rate.

Hope this helps. Good luck


#3

Pre existing conditions are no longer reasons to deny any claim or enrollment, this therefore will not be an issue as you can only be signed up for a ACA-compliant ("Obamacare") policy as of 1/1/14. Pre existing condition denials were banned as of this year. 

You may still be able to sign up through your state's exchange if you either qualify for Medicaid, or under certain circumstances such as losing a job or dropping off someone else's policy.

Your best bet is to either contact your state's exchange or go on the website, fill out an application and see what the system calculates. You might be pleasantly surprised. 

If not eligible at this point, and if your surgery cannot be put on hold, getting a private policy is always possible. You may just lose any premium subsidies by not going through the exchange, but can switch policy or insurance at the end of the year.


#4

You might consider contacting an insurance agent in your area. There are many factors that affect eligibility and cost and it depends on your current income and whether or not you qualify to enroll in a health plan now (before the open enrollment) based on a qualifying event.


#5

Sorry to hear that you find yourself in a difficult situation.
The suggestions offered is good advice but I would also like to suggest reach out to area hospitals and find out if you would be eligible for financial assistance and/or charity care which would be based on your household size and income.
Most hospitals will provide a 100% write off if you make under 250% of the federal poverty level.
Wishing you the best!


#6

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