Self Insuring for Healthcare

DEC-1982 said:
Going through this thread, I was slightly unclear about the exceptions to the once a year ACA enrollment.

I left MegaCorp in mid 2015 but as part of the severance package I get insurance through MegaCorp till mid 2017. Can I apply for ACA in mid-2017 or do I have to apply at the beginning of 2017 (or very late 2016)?
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I need the answer to this also. I left my employer in Jan 2015. We have a provision that allows us, instead of getting a lump sum for vacation and sick time, to receive the money as a regular paycheck and during that time we stay on employer insurance. We can also receive half pay for twice as long which is what I did.

So I will get paid and have insurance until Feb 2016. I assume that when I officially stop getting paid and lose my insurance in Feb, that that is an event that allows me to get insurance mid year under Obamacare?
 
Loss of employer coverage does indeed make one eligible for the special enrollment period. Individual coverage is programmed to begin on the 1st of the corresponding month and payment must be received no later that the 15th of the previous month, so candidates should begin the application process at least a month before they wish to begin coverage.

Employer based insurance usually runs through the end of each calendar month, but not always, so the exact last day of coverage should be verified in each case. This is usually directly with the insurer or the benefits manager.
 
Just to throw this out there--you can still buy catastrophic health insurance. Something with a $10K deductible is available for about $250/month for a family. It doesn't qualify under the ACA so you still have to pay the penalty but at least you would have catastrophic coverage.
 
Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
 
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NW-Bound said:
Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
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"The penalty" is a watered down nothing. Just make sure you never get a refund on your tax returns and you never pay it. Nothing they can do about it. No civil penalties and no other mechanism to collect on. That being said mine is compliant until I cant afford it! :)


Sent from my iPad using Tapatalk
 
Back in 2006 when we left the megacorp safety net, we were faced with getting our own health insurance. We quickly discovered how expensive it was, and also how large the premium was between the one that provided the coverage we were accustomed to and the $10K deductible mentioned above. Even with two children at home, one in late teen and one college aged, the high-deductible (HD) plan was less than $500 then.

As we had not been using much healthcare other than the annual and routine checkups, we decided to go with the HD plan, and banked the difference in premium in an HSA account. This account grew to more than $30K in 2012, when we first made big claims due to unexpected illnesses. By the time the smoke cleared in 2014, we cost our insurer around $200K.

Could we self-insure for $200K? Yes, but it turned out to cost much less to pay the monthly premium. And it could have been a lot worse than $200K. And we had no preexisting conditions, took no medicine, had no chronic problems.
 
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NW-Bound said:
Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
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The max individual deduction is somewhere just north of $6K.... so $10K would not qualify...

The other problem with buying these short term plans is that there is no guarantee of renewal.... and they exclude preexisting conditions...

I signed up for one for a few months at the beginning of the ACA until the site worked... then found out they did not accept me, but did DW and the kids... it was really cheap... like $250 per month.... went to a $600plus plan in 2014 and now $815 this year... figure I will be closing in on $1000 per month next year....
 
Unless I am very mistaken, the one I bought pre-ACA said nothing about being short-term. Regarding renewal, I could have continued and they could not kick me out. And the rate increase is regulated too. Yes, they do exclude preexisting conditions. I also could not be a motorcyclist. There could have been some other restrictions that I forget.
 
NW-Bound said:
Unless I am very mistaken, the one I bought pre-ACA said nothing about being short-term. Regarding renewal, I could have continued and they could not kick me out. And the rate increase is regulated too. Yes, they do exclude preexisting conditions. I also could not be a motorcyclist. There could have been some other restrictions that I forget.
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Yes, before ACA there were many other options....

I would be surprised that there was no ability to kick you out... that was one of the complaints people had with the individual market... if you got sick and cost them a bunch they did not want you going forward...


Just as an example... I had car insurance with a company probably 30 years ago... they told me they could not cancel and it would renew as long as I paid.... and their rates were regulated.... so everything was good until they lost money and decided to leave the state.... yep, they cancelled everybody's insurance because they could not cherry pick under the policy they created.... I think I got 30 days notice...
 
It is true that they cannot cherry pick and have to leave the state. This makes sense though because you cannot force a business to stay open if it keeps on bleeding red ink.
 
NW-Bound said:
Until this year, the above was what we had, a $10K deductible plan but it cost the 2 of us $600/month. And when we started this policy with them many years ago, we had no preexisting conditions. The plan was extremely simple: under $10K we paid everything, above $10K they paid 100%. There was no copay. The $10K is also your maximum out-of-pocket (OOP) cost.

So, if you can get something like this for $250/family, it's a steal. I did not know one would have to pay a penalty to hold a policy like this. That is just terrible, because one can have as high a deductible or OOP under ACA. What is the difference? Or is the penalty exempted for continuing policies?
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$10K is too high for ACA deductible. Doesn't cover any visits or prescriptions until the $10K is met. Has a cap of either $1M or $2M. (Slight cost increase for the $2M plan) Pre-existing conditions not covered.

So it doesn't qualify as an ACA plan. You have to pay the penalty for being uninsured if this is your only plan. The penalty would be pro-rated for the number of months you were on this plan out of the year. You could then start an ACA qualified plan Jan. 1 of next year.
 
FreeBear said:
DW and I are on ACA Bronze and pay almost $800/month. The deductible is $ 5K per person, so we're essentially self-insured for the first $ 5K per person per year.

You probably can find cheaper insurance, but you may be spoiled by low cost, the nice benefits and low deductible on your old plan, at least when it was largely subsidized by Megacorp or Big Gov'mint.

So yes, leaving Megacorp subsidized health insurance was a rude awakening, but we couldn't afford to go without HI. In my view, health insurance protects against catastrophic costs, not insure that health care is reasonably priced or even effective! It's an ugly business....
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Although you are paying the deductible the first $5K you aren't entirely self insured because everything is billed at the rate negotiated by the insurance company. My husband's cholesterol labs cost less than half as much under our ACA plan than under my former employer's plan. And the premium is 60% less than COBRA would have been.


Sent from my iPhone using Early Retirement Forum
 
Assurant offers two Bronze PPO plans in Lake County, IN.
Link: https://www.healthsherpa.com/insura...6#c18089/ppl62,62/cspremium/mbronze/pPPO/hhs2

Edit: So sorry, I forgot Assurant was the company leaving the industry. My apologies. UnitedHealthcare has EPO plans which are a hybrid HMO/PPO. These have a provider network for non-emergency care but you do not have to choose a PCM and do not need a referral to see an in-network specialist.
 
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Cheapest Bronze HMO plan in Florida for our 3 person family is $566.
Cheapest Bronze PPO plan for us is $971.

Looks like we are going to an HMO :(
 
utrecht said:
Cheapest Bronze HMO plan in Florida for our 3 person family is $566.
Cheapest Bronze PPO plan for us is $971.

Looks like we are going to an HMO :(
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LOL... yes, that happened to me last year... but even going to the HMO my premiums went up 40%+.... worried about next year....
 
ArkTinkerer said:
$10K is too high for ACA deductible. Doesn't cover any visits or prescriptions until the $10K is met. Has a cap of either $1M or $2M. (Slight cost increase for the $2M plan) Pre-existing conditions not covered.

So it doesn't qualify as an ACA plan. You have to pay the penalty for being uninsured if this is your only plan. The penalty would be pro-rated for the number of months you were on this plan out of the year. You could then start an ACA qualified plan Jan. 1 of next year.
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Here's another case of the gummint knowing what is best for you. Next, they will require everyone to have life insurance?

Anyway, does this mean that if one likes his pre-ACA insurance, he still cannot keep it? It sounds like you can keep it as long as you pay the gummint the penalty.

PS. I just read the ACA mandate again, and it appears to me grandfathered plans are acceptable. However, as these plans cannot sign on new patients, their pool will shrink due to attrition and eventually disappear when they are no longer economically feasible for the insurer.
 
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The healthcare threads tend to be more helpful when they stick to the thread topic. :)
 
I am not sure if anyone mentioned this but you can also get free quotes on ehealthinsurance.com to compare. We self insure and don't qualify for a subsidy. We pay about $750/month for a family of 3. I met the OOPM last year due to an unexpected surgery and was really happy with our coverage.

Also, if you have a small business, even freelance consulting, you can deduct your health insurance premiums on your taxes if you self-insure. That has been a great help for us.
 
outdoorgirl02 said:
I am not sure if anyone mentioned this but you can also get free quotes on ehealthinsurance.com to compare. We self insure and don't qualify for a subsidy. We pay about $750/month for a family of 3. I met the OOPM last year due to an unexpected surgery and was really happy with our coverage.

Also, if you have a small business, even freelance consulting, you can deduct your health insurance premiums on your taxes if you self-insure. That has been a great help for us.
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I think the original poster's definition for self insurance is no health insurance. They would pay for all medical expenses out of pocket.
 
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