Health Insurance Options in the USA

[Palmettokat]

I have 33 years experience as life and health agent. NOT TRYING TO SELL ANYONE INSURANCE HERE, only trying to help. Only talking about options in the USA and some options vary from state to state however with the Affordable Care Act (ACA, Obama Care) and the Medicare Advantage Plans those are Federal Plans and rules are mostly Federal with little affect by State Laws compared to some other products. My experience is in the individual/family, self employed small business under fifty employees.
Health insurance is an important topic and was being discussed in another thread so I felt it needed its own.

Under the ACA rules all Major Medical Plans must meet those rules and standards. So the belief I will buy a plan that is not ACA and it be a major medical is not going to happen. The ACA rules have driven health care cost greatly up and have affected providers also greatly, as we have seen major mergers trying to survive those rules also.

All the ACA plans cover the same conditions. What is different is the ratios they cover at and if they have copays or not. Truly each case is different, each person needs to study their needs.

I have for years sold health insurance with calculator. If you can raise your deductible or Max Out of Pocket (MOOP) and the premium reduces by a larger amount you probably should do it. ie, raise your MOOP by $2,000 and your premium reduces by that amount or more you probably should do that. Look at the benefits of Health Savings Account (HSA). For most people the money the placed in the HSA is tax free, much as tax deductible IRA is. If you use the money for "QUALIFIED" expensive it does not count as income. (If you use it to buy a tractor sure hope you have a Doc to write a prescription for it.) For those who may be or are eligible for a Tax Subsidy to help pay their premium this lowers your income, so may help you qualify for larger Subsidy. Remember you are working with TAX CODE. If you are self employed, your health insurance premiums probably are tax deductible as a business expense. If you are self employed and have any dependent if you are the primary insured the premiums for them is also normally tax deductible if they are on your coverage.

If you or your spouse has "qualified group" coverage available through work normally you will not qualify for a tax subsidy. This would apply to the full family. NOT ALWAYS for there is a formula used to determine if it is "AFFORDABLE". To me it is terrible the way the law is written here but it is based upon the amount the coverage is for the employee.

A small business today ought to be looking at both group insurance and the individual ACA plans for their employees. One disadvantage the Individual Plans have compared to group is smaller Provider Net Works. They may have less medicines covered also.

I hope other agents will join in.

 

[Workerbee]

I appreciate your willingness to even talk about this health plan issue. Being self employed I can tell you that it certainly isn’t easy to understand everything and answers to questions are not always easy to get and sometimes conflicting. When I was younger it wasn’t a real issue to pay premiums or keep much better coverage than available now and not feel like one was being raped for it. Obama sure changed all that, or should I say the health insurance industry did? They are who wrote the bill.

 

[NHSleddog]

They may have helped write it but there is only one group in America responsible for ramming it down our throats.

There are less people insured in America now than there was before the ACA and unfortunately, most of the ones without now, had it before. This is how it was planned.

The ACA really screwed up our insurance market.

 

[dalola]

My wife is looking into some of the medi-share plans. Any thoughts on those?

 

[Palmettokat]

My wife is looking into some of the medi-share plans. Any thoughts on those?

If you are looking into Medi Share the last I looked at them are a fine company. Just be sure you understand their standards and they are not a true insurance company and some providers are hesitant with the fact they are different. Would I be comfortable with them for myself or my family, YES.

 

[Palmettokat]

Well it is obvious there is a lot of misinformation on health insurance here.
There is many who benefited by the ACA plans and yes MANY the law hurt.
When considering health insurance for yourself or your family there are certain categories you will most likely fit into one but maybe two of them.
1)Have insurance through work or available to you. Normally it is group but can be individual plans.
2) Under 65 and must purchase your own coverage.
3) Age 65 and eligible for Medicare.
4) Under 65 and eligible for Medicare due to disability or have certain diseases such as End Stage Renal Disease.
5) Eligible for Medicaid for a variety of reasons.

First recommendation is find out your options. A lot of employers offer more than one plan. If they do compare the price of each, the benefits of each and their networks and formulary differences.

Look at the High Deductible Plans and the benefits of a Health Savings Accounts. Often these are the best options. It really requires comparing the price to the coverage difference.

If you have more than one insurance company option compare them. BUT VERIFY their provider network.

If you are eligible for Medicare it probably is your best coverage option. Now most people must apply for Part A and Part B. Use to be you were auto enrolled but that has slowly changed. SSA.gov is website to enroll. You have option with Medicare Supplements and Medicare Advantage Plans.

 

[Palmettokat]

For those who wondering about being eligible for a tax subsidy to help pay for their ACA individual/family plan try this web site. KFF.org and search for Subsidy Calculator. Very simple once you try it. You input your state to get most correct numbers, age of people to be insured and annual income. It will give you results in seconds. Reason I like this site it is simple and quick and DOES VERY ACCURATE calculations. When you use it input different income amounts than your income is by a few thousand and see how much the subsidy can change by a small change in income. The subsidy is a tax credit, it does have what I call trip points where it changes by a lot. You need to know where your income is to those points.

Had a case where had client to do max investment into a pre tax IRA and max fund his Health Savings account when he was doing neither and he lowered his taxable income by enough the tax subsidy equaled those two amounts. Friends you are working with tax code.

For those who are self employed and not pleased with the plans for the family, check to see what your state law is on group size for health insurance. Think the ACA law made it TWO in all states, so what makes up the TWO? Can be you as business owner and a hired person. You may find it can be you or your spouse as business owner and their spouse if they was W2 employee. In South Carolina we are able to do that. You may can still use group in couple if both show the business income as their joint income, ASK. Also there is some flexing for small business with a Jan 1st effective date groups. Ask about a "Shop Plan". The obligation on contribution and participation is less or more flexible but think those plans must have effective dates of Jan and no other months. An insurance company does have the ability to offer the flexibility with their standard plans as the Shop Plans and here BCBS does.

You may have more options than you knew.

 

[SilvainStiles]

From my own experience, I remember when I first started looking into health insurance for my small business. I struggled with the same issues you mentioned—deciding whether to go with a higher deductible to lower premiums and understanding the benefits of HSAs. I found that raising the deductible made a significant difference in my monthly premiums, and the HSA turned out to be a valuable tool for managing healthcare costs. Also, when it came to life insurance, I learned that adjusting coverage can make a big difference in financial planning. Balancing costs and coverage needs is key, and your tips are a great guide.

 

[Benhameen]

Thanks for providing this info. These plans can be confusing to me. I’m about to get married and get on my wife’s insurance and looking through the options gives me a headache,lol.
Had a case where had client to do max investment into a pre tax IRA and max fund his Health Savings account when he was doing neither and he lowered his taxable income by enough the tax subsidy equaled those two amounts. Friends you are working with tax code.

As a self employed person I already contribute the max to a pre taxed IRA and was thinking the best option for me would be as you described, max into a health savings account with a higher deductible insurance plan.
Tax code, another thing that makes my head hurt.guess that’s why I pay an accountant. Hahaa
Thanks again

 

[Henro]

They may have helped write it but there is only one group in America responsible for ramming it down our throats.

There are less people insured in America now than there was before the ACA and unfortunately, most of the ones without now, had it before. This is how it was planned.

The ACA really screwed up our insurance market.

I would like to see a reputable reference on that point. Not my understanding.

Glad wife and I are on Medicare.

edit: Except for being at the age to qualify for it! LOL!

 

[lugbolt]

at my income level which is similar to many (average to slightly below), my marital situation and living arrangements, I qualify for nothing. Been through this several times in the last few years.

The least expensive plan for me is a very high deductible and moop, and still $722.00/mo. between that forced rate hike and the irs's handling of a situation of which I had no involvement in, also proven fault by the same administration, I have zero trust in them or their party affiliation. None whatsoever. And no I do not have insurance.

Note that I don't expect free insurance. I also do not appreciate a rate hike of 189%, thus I cancelled my plan. I can't afford it and neither can a lot of other people.

but their idea was to make insurance affordable. "Affordable" care act. My foot! More like "unaffordable", well unless you can't or don't work, or if you do you don't get a w2 (cash). What bothers me so much about this is that there are people out there who choose not to work, and they can--because they qualify for government assistance. And they make money on that assistance. I've seen it happen in front of my own eyes. Guy goes into the grocery store, load up the buggy with stuff, lots of meats, pays with EBT (in front of me) and goes outside, sells the meats to whoever, right in front of the store. What's he gonna use the money for? Girlfriend knows who he is....known crankhead in the area. Probably buys speed with money they make from EBT. Make them take a drug test, and restrict their benefits if they can't pass a random test. "Oh but that takes food off their table"...GOOD...how else they gonna learn a lesson? Slap on the hand? Stand in the corner? Pisses me off to think about it.

What are the biggest buildings downtown? Banks, insurance companies, and anything government. Ask yourself why.

 

[Biker1mike]

Between retirement and medicare my policy was 1500 a month.

 

[mikester]

Move to Canada for free health care.

Starting in 2025 the federal government announced it is bringing in 500K new immigrants every year!

As our population grows older we need more young people to work to care for them. FYI our provincial healthcare systems are only designed to handle a much younger population from 25 years ago. And our nurses are leaving due to overworked conditions caring for elderly sick people filling all the available hospital beds, mandatory overtime to cover labour shortages, and better pay in the US.

 

[Biker1mike]

EBT cards
In the past 40 years there are very few meals I ever missed. Wish I could say the same for my childhood. There are a lot of hard working people just trying to make ends meet that need that little extra to help put food on the table. I hate that some people abuse the system but I stay fully aware that some kids still go to bed hungry every now and then because the groceries ran out before the week did.

Unintended consequences: Parent falls the random drug test so punish the child with a missed meal or two.

 

[lugbolt]

EBT cards
In the past 40 years there are very few meals I ever missed. Wish I could say the same for my childhood. There are a lot of hard working people just trying to make ends meet that need that little extra to help put food on the table. I hate that some people abuse the system but I stay fully aware that some kids still go to bed hungry every now and then because the groceries ran out before the week did.

Unintended consequences: Parent falls the random drug test so punish the child with a missed meal or two.

yep it can be turned around to mean something different than I originally talked about. I've seen this argument. The deal is, if they can't feed the kids because of their choice to use a substance that is often illegal, they have no business with kids. Simple. But the argument there is "they didn't have no choice but to have kids". Yes they did. They had a choice. It starts at conception. Adults have an obligation to use the brain to think about what could happen; and some don't.

iF they can't feed the kids because of an illegal substance, then they also have to make the choice. Kids or dope. Sadly, the allure of dope wins sometimes.

 

[Biker1mike]

Lugbolt,
I did agree with you that the system is broken ! The guy selling his EBT goods should lose the benefit. They get away with because as a society we are just apathetic. Store owner or locals that know him have the ability to turn them in. Instead they turn a blind eye.

 

[Biker1mike]

Back to cost. Money talks.
I have a teen living with us. Absent parents and medical insurance in another state. THC overdose created a life altering event.
Second hospital vist and we were told she has to go in to a rehab hospital. Only bed in NY sytem was in the city of XXX. Doctor walked us into the hall and said do what ever you have to do to NOT let her in to that institution. Wink and a nod and that conversation never took place.
Found a private rehab hospital that decided it would take her. It was open to debate between their staff as to whether or not to admit. A lot of phone calls and a non insurance ambulance run at a cost of 2 grand plus a 100 dollar tip to the driver and emt.
Once at the facility they took kid and said she will be more or less knocked out for the next 72 hours but will be well taken care of. Go talk to admin.
Really nice women set it out in plain English. They have a great staff to deal with insurance companies and will contact out of state insurer but it does not look good. This was Saturday. She said on Tuesday they will know if this visit is covered. Please make arrangements for a payment of $15000 if they can not get insurance. If we can not write a check they will get us a very short term loan with a life sucking interest rate. Black and white. Check or take kid home.
Right then and there without discussion my wife pulled out the checkbook and wrote a check for 15 grand.
I did get most of it back in the long run.

Now, I am long in the tooth and have a healthy amount of savings to cover just such emergencies. How many younger families could handle this ?

In the end. Kid is doing well, back on honor roll, a part time job, drives to therapy once week and has a future if she stays clean and sober. I feel for the kids without a strong support system that would have been lost in the system under the same conditions.