Best way to get ACA quotes married/separate

[ArkTinkerer]

I saw some people had gotten two policies instead of one family policy under the ACA. They did this to get reduced deductibles which sounds great. The problem I am seeing is that after filling out the info for the family how do you get the quotes as two policies instead of one? Do you have to go thru a broker to get it all worked out? The online system remembers me and I don't see an easy way to change the data about my family.

 

[rodi]

I can tell you how I did it in CoveredCA - but I don't think you live in California...

For CoveredCA - they have a "shop for plans" button - at that point you are getting estimates (and are not logged in). I could price my husbands policy separate from the policy for myself and 2 kids. The prices were pretty close to what I eventually chose once logged in and purchasing.

Does your state have it's own exchange or is it using healthcare.gov? I've heard you can fairly easily purchase separated policies on healthcare.gov - even if you have premium assistance. Under CoveredCA I could not enroll in 2 separate policies for our household *and* receive premium assistance... so I estimated my income above the premium assistance level and it allowed me to enroll the two separate policies.

 

[ziggy29]

When I was shopping around for 2014, before I knew my wife was going to be covered by her employer, when I went through all the screens and such the system told me we should purchase separate individual policies and priced them as such. Does it not do that now?

 

[Sue J]

On healthcare.gov there is a place to designate groups. It's after you get your eligibility letter, I think. I'm not on the site right now, but it's before you choose plans.

I put DH in one group and myself in a second group. Then you choose a plan for each group.

This is how we did it for 2015 and we have 2 individual plans. We each get half of the subsidy. I pay 2 premiums each month which is not a problem.




Sent from my iPad using Early Retirement Forum

 

[reubenray]

How do you separate the income? I am the main income maker with my SS and 401k retirement funds,

 

[Nunthewiser]

I put DH in one group and myself in a second group. Then you choose a plan for each group.

IIRC, its during the eligibility process and it's easy to miss. It doesn't reduce your deductables, per se, but you don't get them stupidly combined into a family jackpot, which takes twice as long to pay off.

 

[ziggy29]

How do you separate the income? I am the main income maker with my SS and 401k retirement funds,

You don't separate the income. It's all based on total household income. If you purchase two separate policies, the tax credit is divided... but the total household income is considered first, regardless of whether you have one family policy or multiple separate ones.

 

[Theseus]

I've been trying to wrap my head around the family vs individual plan dilemma for 2016. For 2015 it made sense to go with two individual plans, as even if we both hit our max OOP (which we did) at least we were eligible for $50 more in HSA contributions.

But, with the 2016 changes it is a bit different now. Self-only coverage changes from 2015 to 2016 - HDHP deductible lower threshold unchanged at $1,300, max OOP increased by $100 to $6,550. HSA deduction unchanged at $3,350. Family coverage changes from 2015 to 2016 - HDHP deductible lower threshold unchanged at $2,600, max OOP increased by $200 to $13,100. HSA deduction increased by $100 to $6,750. From https://www.irs.gov/pub/irs-drop/rp-15-30.pdf

And - to put a twist on family coverage for the betterment of the high volume medical care consumer, 2016 rules for "embedded" cost sharing limit the max OOP for any one individual on a family plan to $6,850, see thread 2016 ACA "Embedded" Cost Sharing Of course this will benefit only those who select high OOP plans, i.e. a 2016 family HDHP with a $13,100 max OOP becomes a $6,850 max OOP for either of a family of two to first reach that OOP, and then $6,250 OOP for the second. If the second doesn't reach that level of OOP, all the better for them. This could be a strategy for couples with expected high expenses for only one member. It gets more complicated for larger families, and also doesn't apply if the plan deductible is greater than $6,850. See Family Plans Must "Embed" Out-of-Pocket Limits in 2016

For 2016, even with the extra $50 HSA deduction pendulum swung towards family plans I think it might be best to stick with the same $3,500 deductible no co-pay individual plans we had for 2015. High OOP plans are appealing due to the lower premiums, but with a couple of tests/appointments already set I know what our minimum expected HC costs are for 2016 so it has become more of a certainty than a roll of the dice.

 

[MBSC]

I found the following browsing plans on HealthCare.gov and HealthSherpa without logging in. For TX zip 75758, the BSBSTX Silver HMO 103 family plan has $10500/$10500 Deductible/MOOP.

If you browse for only one family member, the same plan is $3500/$3500, so two individual plans total $7000/$7000 for the price of the family plan. Plan Summary: http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF

 

[ivinsfan]

I've been trying to wrap my head around the family vs individual plan dilemma for 2016. For 2015 it made sense to go with two individual plans, as even if we both hit our max OOP (which we did) at least we were eligible for $50 more in HSA contributions.

But, with the 2016 changes it is a bit different now. Self-only coverage changes from 2015 to 2016 - HDHP deductible lower threshold unchanged at $1,300, max OOP increased by $100 to $6,550. HSA deduction unchanged at $3,350. Family coverage changes from 2015 to 2016 - HDHP deductible lower threshold unchanged at $2,600, max OOP increased by $200 to $13,100. HSA deduction increased by $100 to $6,750. From https://www.irs.gov/pub/irs-drop/rp-15-30.pdf

And - to put a twist on family coverage for the betterment of the high volume medical care consumer, 2016 rules for "embedded" cost sharing limit the max OOP for any one individual on a family plan to $6,850, see thread 2016 ACA "Embedded" Cost Sharing Of course this will benefit only those who select high OOP plans, i.e. a 2016 family HDHP with a $13,100 max OOP becomes a $6,850 max OOP for either of a family of two to first reach that OOP, and then $6,250 OOP for the second. If the second doesn't reach that level of OOP, all the better for them. This could be a strategy for couples with expected high expenses for only one member. It gets more complicated for larger families, and also doesn't apply if the plan deductible is greater than $6,850. See Family Plans Must "Embed" Out-of-Pocket Limits in 2016

For 2016, even with the extra $50 HSA deduction pendulum swung towards family plans I think it might be best to stick with the same $3,500 deductible no co-pay individual plans we had for 2015. High OOP plans are appealing due to the lower premiums, but with a couple of tests/appointments already set I know what our minimum expected HC costs are for 2016 so it has become more of a certainty than a roll of the dice.

My first year for the exchange and I didn't really understand a thing you just wrote, I think I going to follow brewer's lead and go to a broker...I feel completely over my head....

 

[bingybear]

I saw some people had gotten two policies instead of one family policy under the ACA. They did this to get reduced deductibles which sounds great. The problem I am seeing is that after filling out the info for the family how do you get the quotes as two policies instead of one? Do you have to go thru a broker to get it all worked out? The online system remembers me and I don't see an easy way to change the data about my family.

I thought they had fixed that this year. The plans I've looked at don't force an individual to meet the family deductible in a family plan if they just meet the individual deductible. Last year there were plans both ways.
So are people still finding this happening, or just reaction from what was out there last year?

 

[reubenray]

I checked to see what happened if we got separate plans and the wife's (59) cost was three times what mine (64) is. The separate combo cost was more than the together plans.

Why is this?

 

[MichaelB]

Three times is the maximum difference allowed by the ACA from the lowest to the highest premium (age 26 to 64), so the difference between premiums for ages 59 to 64 should be much less. Likewise, the cost together or separate should be exactly the same.

Is there a subsidy in one and not the other? Are you comparing the same policy?

 

[bingybear]

I checked to see what happened if we got separate plans and the wife's (59) cost was three times what mine (64) is. The separate combo cost was more than the together plans.

Why is this?

Not a clue... but maybe a guess. Did you have a subsidy on the combo? That is how did you distribute you income when you did the separate plans?
I did not try running it this year and with our ages being effectively identical it would not show what you saw.

 

[reubenray]

It did show a subsidy for both of them, but the wife's was lower. I split the income in half. The only thing different was the age and sex.

 

[MichaelB]

It did show a subsidy for both of them, but the wife's was lower. I split the income in half. The only thing different was the age and sex.

Are you supposed to split the income? From other threads, I think you're supposed to use total household income for each of you.

 

[bingybear]

It did show a subsidy for both of them, but the wife's was lower. I split the income in half. The only thing different was the age and sex.

so, why are you looking at separate verse combined? Are the deductibles and max OOP embedded or non-embedded in the plans you are looking at? From what I've seen on the ACA (looking at hdhp) they were embedded, but I had to look carefully through the plan brochure to find it (summary was not sufficient).
I do find your results interesting. I may see if I see the same with local plans here. It could be subsidy as I think the family has a step (cliff) that is not as pronounced in the individual.

 

[gauss]

Value Penguin has the best tool that I have found for quickly accessing this type of information. I believe that it covers all 50 states.


The link is: Affordable Care Act (Obamacare) Health Insurance Exchanges


-gauss

 

[reubenray]

so, why are you looking at separate verse combined? Are the deductibles and max OOP embedded or non-embedded in the plans you are looking at? From what I've seen on the ACA (looking at hdhp) they were embedded, but I had to look carefully through the plan brochure to find it (summary was not sufficient).
I do find your results interesting. I may see if I see the same with local plans here. It could be subsidy as I think the family has a step (cliff) that is not as pronounced in the individual.

Being I will turn 65 this year it was suggested on this forum that individual plans may be best.

 

[reubenray]

I checked into a family plan vs two individual plans for Alabama (moving there in January) and the two individual plans are a $100 cheaper than the family plan. The prescriptions and doctor visits are even lower. This is even a $100 less than what I am paying now for a Louisiana family plan. All of these are with BCBS.

I guess I will be doing an Alabama plan for 2016!!!

 

[Theseus]

My first year for the exchange and I didn't really understand a thing you just wrote, I think I going to follow brewer's lead and go to a broker...I feel completely over my head....

Apparently I didn't understand what I wrote either! Or the source I used didn't understand, or they changed the rules. It looks like the embedded deductible for one family member is 50% of the family plan deductible - which OMG, makes sense.

Ran into another gotcha that caught me by surprise. When selecting my 2015 plan, the oncology specialist I see 2x a year was on the in-network list of providers. He retired at 2014 year-end, and the 19-member practice he was from gave me two choices for a replacement, and a quick check of the first name showed up as in-network so that was who I picked. First appt was on me as I had not yet hit the deductible, but EOB came through normally with in-network discount applied. By the second appt I had met deductible & OOP, now the EOB came though saying not in network, and no discount. Called insurance co. and oh, even thoguh that doc is in-network at three nearby locations, because I saw him at the satellite location nearest me, he was not. They 'educated' me on in-network being specific to a provider's location, not the provider themselves.

I shall have my revenge though. Doctor was busy with another patient that day, so I actually saw a practitioner instead. And that practitioner is listed as in-network at that location. I called practice business office and they told me standard procedure is to submit claim under the name of the supervising MD at a location for that day. But, they could submit under the (in-network) practitioner's name - when I explained the situation they said they'd be happy to do that. Apparently the MD not being in-network at that particular location, for my insurance company, had fallen off their radar screen.

 

[sengsational]

... the EOB came though saying not in network, and no discount. Called insurance co. and oh, even thoguh that doc is in-network at three nearby locations, because I saw him at the satellite location nearest me, he was not.

I'm not one to call for legislation very often, but this is yet another trick in their shell game that needs to be tamed; the providers and insurance companies hold all the cards and we're left to navigate the rocky shoals without a map.

As to the OP, as others have said, they now released a "clarification" to require an embedded deductible and max OOP. This hits close to home for me because the BCBSNC rep told me I was getting an embedded deductibles plan when buying my policy for 2014. Then it turned out that wasn't the case and I was $5,500 poorer as the result of that rep's misrepresentation. Then they "lost" the transcript/recording of my call. Yeah, right. But under an embedded scenario, though, even though you have one policy, you don't have to hit the family numbers before they start paying. What this means is that it's more advantageous to get a single policy since, if something bad happens to one person (they cause the policy to hit the family max OOP), the healthy person(s) would get free medical. Under the split scenario, both would have to hit individual numbers. In the case where no body on the policy has a high likelihood of hitting the max OOP, we are probably talking about a miniscule increase in expected value (chance of hitting family OOP by one member times the expected health expenditure of the healthy one). So split would only mean a bit more overhead in billing.

 

[bingybear]

I'm not one to call for legislation very often, but this is yet another trick in their shell game that needs to be tamed; the providers and insurance companies hold all the cards and we're left to navigate the rocky shoals without a map.

As to the OP, as others have said, they now released a "clarification" to require an embedded deductible and max OOP. This hits close to home for me because the BCBSNC rep told me I was getting an embedded deductibles plan when buying my policy for 2014. Then it turned out that wasn't the case and I was $5,500 poorer as the result of that rep's misrepresentation. Then they "lost" the transcript/recording of my call. Yeah, right. But under an embedded scenario, though, even though you have one policy, you don't have to hit the family numbers before they start paying. What this means is that it's more advantageous to get a single policy since, if something bad happens to one person (they cause the policy to hit the family max OOP), the healthy person(s) would get free medical. Under the split scenario, both would have to hit individual numbers. In the case where no body on the policy has a high likelihood of hitting the max OOP, we are probably talking about a miniscule increase in expected value (chance of hitting family OOP by one member times the expected health expenditure of the healthy one). So split would only mean a bit more overhead in billing.

You have me a bit lost here. You talk about under an embedded case that one person hits the individual deductible but then (being real sick) runs expenses up to the family max OOP. See link
From the link I'm guessing in 2016 that max OOP should be embedded too. If both deductible and max OOP are embedded, I'm not sure the advantage of individual policies are for two people unless they want different plans.
Or am I just not understanding your point?

 

[sengsational]

You have me a bit lost here. You talk about under an embedded case that one person hits the individual deductible but then (being real sick) runs expenses up to the family max OOP. See link
From the link I'm guessing in 2016 that max OOP should be embedded too. If both deductible and max OOP are embedded, I'm not sure the advantage of individual policies are for two people unless they want different plans.
Or am I just not understanding your point?

I think it is that both deductible and max OOP are embedded. In the HDHP's I look at, the deductible and max OOP are so close as to make them one thing, from a modeling perspective.

There is no advantage to individual policies, as far as I can tell. What I was trying to say was that there was a slight disadvantage. It was slight because a lot of negative stars had to align to make it any different at all from the family policy.

 

[ziggy29]

There is no advantage to individual policies, as far as I can tell. What I was trying to say was that there was a slight disadvantage. It was slight because a lot of negative stars had to align to make it any different at all from the family policy.

It's an unusual case, but American Indians below 300% of the household poverty line and no "affordable" employer group coverage available to them can purchase an Exchange plan -- *any* plan, even the cheapest bronze HMO -- and have *no* cost sharing whatsoever, at any provider. So if you are in a situation where one spouse is AI/AN and the other isn't, you need separate policies in order to avoid cost sharing on one of them. If you were in a family plan together, you would both be subject to the deductibles and OOP costs.