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Suddenly in need of insurance and lost with options
Old 12-08-2015, 03:42 PM   #1
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Suddenly in need of insurance and lost with options

So having had Cadillac health insurance through employers I am a complete neophyte. After all, the most we have ever had to do is pick between a few great plans and pay nothing. That has been fortunate but left me ill prepared for now.

Now is we are suddenly retired. Well, I am not working now and my wife has to retire the end of this year (in 3-ish weeks!!!!). She has a SLIP account that can pay premiums until it lasts. The choices are single ($650) or family ($1500). Obviously we will use single for her until her SLIP runs out, but certainly I can find an insurance plan for less than $800 for a single for myself! Every year there is an open enrollment where she can add me back on if we ever need to (and may when she hits medicare age before me).

Me: 47
health: overweight but otherwise healthy with one common prescription and a couple cremes for psoriasis
Dr. visits: annual physical and usually 1-4 visits depending on the year. Though it seems like every 2-3 years I break some bone somewhere (a klutz I guess)

Questions after looking at ehealthinsurance.com and the healthcare.gov sites:

1) The plans that are 40% copay for something like a hospital stay generally become 0% copay once you reach your out of pocket maximum?
2) No way would our 2015 income (6 figures) qualify for a subsidy, our 2016 pension income is around 25k, a vacation payout will be another 15k, and then we will have some money come from investments to fill out our spending levels (around $50k a year + whatever insurance is going to be). I'm guessing we won't qualify for any subsidies which I am fine with, almost feel guilty for taking any...but then again, fill bad for paying more than we would have to too. If we do qualify with what I assume would be our projected adjusted taxable income, how do we go about proving it would be that?
3) I am lost, any good resources to read up to help select a plan?
4) My state (Iowa) I don't think participates on the exchange, but I assume I can go through it, or ehealthinsurance, or some local company too.


Sorry for such an embarrassing shout out for a direction but up until last week I thought we had another year to decide this stuff...but life happens.
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Old 12-08-2015, 04:14 PM   #2
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Quote:
Originally Posted by Sunny View Post
So having had Cadillac health insurance through employers I am a complete neophyte. After all, the most we have ever had to do is pick between a few great plans and pay nothing. That has been fortunate but left me ill prepared for now.

Now is we are suddenly retired. Well, I am not working now and my wife has to retire the end of this year (in 3-ish weeks!!!!). She has a SLIP account that can pay premiums until it lasts. The choices are single ($650) or family ($1500). Obviously we will use single for her until her SLIP runs out, but certainly I can find an insurance plan for less than $800 for a single for myself! Every year there is an open enrollment where she can add me back on if we ever need to (and may when she hits medicare age before me).

Me: 47
health: overweight but otherwise healthy with one common prescription and a couple cremes for psoriasis
Dr. visits: annual physical and usually 1-4 visits depending on the year. Though it seems like every 2-3 years I break some bone somewhere (a klutz I guess)

Questions after looking at ehealthinsurance.com and the healthcare.gov sites:

1) The plans that are 40% copay for something like a hospital stay generally become 0% copay once you reach your out of pocket maximum?
2) No way would our 2015 income (6 figures) qualify for a subsidy, our 2016 pension income is around 25k, a vacation payout will be another 15k, and then we will have some money come from investments to fill out our spending levels (around $50k a year + whatever insurance is going to be). I'm guessing we won't qualify for any subsidies which I am fine with, almost feel guilty for taking any...but then again, fill bad for paying more than we would have to too. If we do qualify with what I assume would be our projected adjusted taxable income, how do we go about proving it would be that?
3) I am lost, any good resources to read up to help select a plan?
4) My state (Iowa) I don't think participates on the exchange, but I assume I can go through it, or ehealthinsurance, or some local company too.


Sorry for such an embarrassing shout out for a direction but up until last week I thought we had another year to decide this stuff...but life happens.
#4 It doesn't matter if your state has an exchange or not. If it doesn't, you'll use the regular healthcare.gov website to select a plan from a list of plans available in your part of Iowa
#2 I was on the exchange a couple of years ago (between jobs) and you basically estimate your MAGI for the coming year and then the subsidy is calculated. If, during the year, you find out it's much higher, it's always best to contact the exchange and let them know and your premiums will then be adjusted. In my case, I went to work mid year and cancelled the policy. When tax time rolled around, I owed all of subsidy back due to the amount I ended up earning at the new job. That would be the case either way - if you underestimated or overestimated, it gets reconciled at tax time. I was never asked to prove my estimate - if you have a highly variable income dependent on investments in a taxable account, it can be tough. Best to monitor as you go, which you'll do anyway if you have to do quarterly tax filings.

Good luck!
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Old 12-08-2015, 04:44 PM   #3
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welcome to the other side. Most plans will have a deductible and an out of pocket max. ie they don't pay anything until deductible hits (unless you have a co-pay plan) and then they pay some of it until you hit the out of pocket max.

you will need to check if the drug you take is a Tier 1/2/3/4 and which companies treat it as such.. ie my DH drug is Tier 2 ($40 co-pay) via UHC but Tier 3 ($75) co-pay via BCBS. If you go through the healthcare.gov it will give you a general estimate of what it will cost you.. broken bones can be more costly than you think and if you think you may need therapy, make sure you factor that in.

I use the High Deductible plan as I never go to the doctor so most years it would be just the premium and I use the HSA to funnel more money into none taxed funds. My DH uses the copay plan because of his 1 expensive med and his frequent sprained leg muscles from running and the therapy after.. which adds up really quick when your pay out of pocket $85-165/session vs. a $20-35 copay.

Then you have to figure out what doctors are in or out of network to be sure you can keep your doctor (if that is important to you).

I actually suggest you use eHealthinsurance to narrow down a few plans/providers and then call each of them direct. We were able to find a different plan for DH last year that wasn't listed on either site. The other thing is they have agents to try to help you navigate the whole thing, just be sure you have all your questions answered before you sign up.

Lastly, you have to be signed up be Dec 15th to get coverage starting by Jan 1st...and if you miss the window to sign up during open enrollment and if you don't have a qualifying event, you CAN NOT get insurance.. that's what they told us in 2015 when we had to enroll out of open enrollment and was having problems getting the paperwork to prove a "special condition"...else the agent said we would have been hosed.
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Old 12-08-2015, 05:05 PM   #4
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I felt the same way. It can feel overwhelming. I went back and read lots of ER forum posts about ACA from the last year. Also did some reading online. Got an idea of what we would need, then got an appointment with an insurance broker listed on the state website. Hang in there. You can do it.

Kindest regards.
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Old 12-08-2015, 05:27 PM   #5
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It might help to go on ehealthinsurance.com and enter your zip, gender and age and get some quotes. This will let you know what is available off exchange as well as on. (Off exchange means you buy directly from the company which you can do if you don't expect any subsidies to help with the cost of the insurance.)

That site has a lot of helpful information, terminology, etc.
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Old 12-08-2015, 05:45 PM   #6
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Iowa appears to use Healthcare.gov as its exchange. You need to finish signing up by Dec 15th in order for coverage to start January 1, 2016. After that you'll have to wait another month. It is fairly easy, but they run an identity check that could take a while.

It is also possible to go directly to insurer websites and buy from there, though plans and costs are pretty much the same.

#1 is make sure the network offered by the insurer suits you, with your doctors and hospitals listed as in-network. Same thing with your drugs.

If you expect to use a lot of healthcare pay close attention to the premiums + out of pocket maximum of your choices. That may favor the higher cost plans, though not necessarily.

If you don't expect to use much healthcare place more weight on just the premium costs. That will favor the high deductible plans, and an HSA eligible plan is a nice way gain a tax deduction and a Roth-like account. You may find that premiums + out of pocket maximums for high deductible plans are close to those of the low deductible plans, making them a fairly safe bet if you are comfortable paying 100% at the start.
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Old 12-08-2015, 07:01 PM   #7
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There are some great threads on this from when the PPACA first came into play. Try this one.
Bronze, Silver and Coinsurance/Copay

There's a spreadsheet in there that can help you decide, based on your medical needs estimate, which plan would be best for you.

All the best. It is a steep learning curve.
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Old 12-08-2015, 07:26 PM   #8
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Thank you everyone for the responses...quite helpful.

I've been reading and pouring over the ehealthinsurance quotes. I don't anticipate a lot of medical expenses so some of the pricier gold plans don't seem to fit.

Hopefully this logic makes sense:

A) My one medication plus psoriasis creme run $190 a month w/o insurance (called the pharmacy), which means any plan that doesn't offer prescription drugs until after you meet a several thousand dollar deductible (that I hope to not reach) has to have $190 added to the premium. So they are out, as that prices them more than the ones that cost $130 or so more and both meds are a $5 copay.

B) Now I have a whole crop of plans withing $20 of each other premium wise...all with stuff I may or may not need with differing levels for differing events that I hope to not ever need. Seems sort of like planning for retiring and wondering if you have enough money....tell me when you are going to die and your spending and I'll let you know. In insurance, tell me if you are going to have minor or major even or need to go to the urgent care and I'll tell you the best plan. LOL. So nowI suppose it is a best guess as to what I may need assuming my doctor is in the network. Or maybe the cheapest even if it is only $5 a month cheaper.

Quite the friendly forum around here!!!
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Old 12-09-2015, 06:02 AM   #9
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Quote:
Originally Posted by Sunny View Post
Thank you everyone for the responses...quite helpful.

I've been reading and pouring over the ehealthinsurance quotes. I don't anticipate a lot of medical expenses so some of the pricier gold plans don't seem to fit.

Hopefully this logic makes sense:

A) My one medication plus psoriasis creme run $190 a month w/o insurance (called the pharmacy), which means any plan that doesn't offer prescription drugs until after you meet a several thousand dollar deductible (that I hope to not reach) has to have $190 added to the premium. So they are out, as that prices them more than the ones that cost $130 or so more and both meds are a $5 copay.

B) Now I have a whole crop of plans withing $20 of each other premium wise...all with stuff I may or may not need with differing levels for differing events that I hope to not ever need. Seems sort of like planning for retiring and wondering if you have enough money....tell me when you are going to die and your spending and I'll let you know. In insurance, tell me if you are going to have minor or major even or need to go to the urgent care and I'll tell you the best plan. LOL. So nowI suppose it is a best guess as to what I may need assuming my doctor is in the network. Or maybe the cheapest even if it is only $5 a month cheaper.

Quite the friendly forum around here!!!
Wife and I are calling it quits in a couple months and appreciate your position. I've been doing lots of research on this and find there is no one right answer. The way I look at it is the worse case is you make a bad selection for one year. If plan doesn't fit your needs you'll be able to change next year.

While premium and out of pocket is obviously important, what you won't know is how good the insurance company is in providing service and approvals for payment. Do research on the insurance company as well to find reviews from others on how good or bad the company is with servicing.

Best of luck.
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