How Do You Find Health Insurance?

[fureverywhere]

Really, this is something I never had to figure out before. We were perfectly healthy and had Medicaid for years. My son turned 21 and BOOM even though he still lives at home we are officially three people now. So with me working again we'll be over poverty level instantly.

That doesn't mean we can begin to afford all the medication and doctor appointments my husband needs. But I'm befuddled by all the different insurance choices. I'm 54 and he'll be 60 in December. We need something with reasonable monthly payments. Where to start?

 

[RustyatMMC]

Fureverywhere,
You will want to start looking at the Affordable Care Act as soon as possible. Losing Medicaid is a qualifying life event (QLE), which triggers a special enrollment period (SEP) as long as it happened with in the last 60 days. You can call the Marketplace (800-318-2596) to find out if you get a subsidy and what plans are available, but I would not let them help you pick a plan. They are not licensed and don't know the ins and outs of the different companies in your state. They can submit an app for you on the Marketplace, but you want to talk with someone who has experience with the different companies offering coverage. They can tell you what each company is like, if the networks are good in your area, or if there are any hidden gotchas. Also, you HAVE to check doctors and medicines to make sure they are covered.

I would look for a broker who represents all the carriers in your state. Finding one might be hard because many of the companies no longer pay for special enrollment cases. Unfortunately, brokers don't work for $0. In NC, where I am, I have given a lot of free advice to people to point them in the right direction and help educate them on what to do. If you cannot find someone who will submit the app for you, you might find someone who will help show you what is important to know so you can do it yourself. Since brokers have submitted many apps before, their advice could help you avoid some pit falls.

If you cannot find a broker to help, you can try to do it yourself. You will want to check to see if all your doctors are in the plan's network. Ask your doctor what ACA (Obamacare) plan they accept. You want to check to make sure your medicines are also covered under the list of drugs covered by that particular plan.

If you have access to group insurance through an employer or a spouse's employer; you might not qualify for a subsidy. It's called the "family glitch" and it stinks.

https://www.healthcare.gov/see-plans/ - here is a link to get some idea of prices and plans available. If you get a subsidy, make sure you review the "silver" plans. They are the only plans that get a "free upgrade (better benefits)" with no additional costs. Depending on your income level, the silver plans could be as good or better than gold or platinum level plans.

As long as your son is under 26, you can still claim him on your taxes and put him on your plan.

I wish you the best! Sorry about the sudden change in situation.
Rusty

 

[Butterfly]

Wow, Fur -- I thought you were planning to be covered by a plan from your work. I guess that's not the case, though. Any chance of coverage from your husband's work? One ofo those would sure be the easiest.

I don't know anything about how things work where you are -- but DO start seriously looking into this right away. I remember what a godawful hassle it was for me when I lost my insurance coverage at 59 and had to really scramble to find something. That was before the ACA, of course. I did find a broker that helped me find something, and helped with the application.

 

[fureverywhere]

Thank you darlin', now can somebody help me break it down to steps? I can apply through the manufacturers for some medications. The Parkinson's groups might know subsidy shortcuts for my husband. There are just so very many options I'm still cross-eyed.

 

[Dudewho]

On exchange companies for 2017 in New Jersey info for you.

The four carriers that will offer plans in the New Jersey exchange for 2017 have proposed the following rate changes:

AmeriHealth HMO: Average increase of 26.3 percent

AmeriHealth Insurance Company: Average increase of 12.1 percent
Freelancers CO-OP (Health Republic Insurance of NJ): Average rate increase of 8.5 percent. (Freelancer’s is one of just seven surviving CO-OPs nationwide, as of August 2016).

Horizon BCBS: Average rate increase of 6.2 percent for HMOs, 7.6 percent for EPOs, 1 percent for catastrophic plans, and 4.8 percent for OMNIA Alliance plans.

Oscar Insurance Corp. of NJ: Average rate increase of 10.6 percent

 

[RustyatMMC]

If you qualify for a subsidy, the increases mentioned might not impact you as much. Subsidies reduce the effect of increases considerably. The law says you can only spend a certain % of your income on health insurance. That % is determined by household size (# of people on your tax return), income range (has to be between 100-400% of the federal poverty levels), where you live, and most importantly if you have access to group insurance through an employer or spouses employer.

If you have access (you might not even have it) to group insurance through an employer or spouse's employer; you will likely not get a subsidy. There is a way, but in my experience, it rarely happens.

Here are your steps:

1. Do you have access to group insurance through an employer or spouse's employer? The law only looks at what the employee pays for their portion of health insurance (not child, not spouse; only the employee's portion). It can cost $10,000 to cover the spouse or child; but it's still considered "affordable" under the law (ie "the family glitch"). See link below.
https://www.healthcare.gov/have-job-based-coverage/

2. Review rates on the link https://www.healthcare.gov/see-plans/. If you do get a subsidy, pay special attention to silver plans.

3. Check with your doctors, hospitals, to see if they are in each network.

4. Check with the plans to make sure the meds are covered.

5. Pick the plan that best covers you and call the Marketplace to enroll (800-318-2596)

OR

Find a broker that reps all of those companies listed and get their help.

For those who are interested - Here is how the law works. If you can get access to other coverage (medicaid, group, medicare, va) first, you have to go there. If you don't have access to those, now it depends on your income. If you are between 100-400% of the Fed. Poverty Level, you can get help. THe closer to 100% the better you coverage will be.

Say the law says you can only spend $50 a month on health insurance. The subsidy is calculated to be whatever $ amount it takes to reduce the cost of your health insurance to $50. So any rate increases are offset by subsidy increases in most cases...as long as you are getting a subsidy.

As far as the rates mentioned by Dudewho, those who make 400% (350% will be hurt too) and above on the Federal Poverty Level are becoming the "new uninsured." They make too much money to qualify for a subsidy to reduce the cost and have to pay the full amount. Those people I really feel for right now. I hate telling my clients in that situation what's coming. They will have to deal with the full rate increase, which many simply cannot pay.

Good luck!
Rusty