New rules for small group plans in Tx

[Skyler]

Hello, long time lurker, first time poster.

I thought this might help someone. Apparently, the rules to get group coverage in Tx has changed for the self employed. Before now, in order to get small group coverage it had to be the owner and at least 1 employee.

I'm being told by my agent that this year if you have a single member LLC, file a schedule C, and file married filing jointly you will be eligible for a small group plan.

I've submitted my info to the agent and she said it would take a couple of days to get me some quotes. I'm still not sure if it will save me any money over what's offered on the exchange or through an individual policy, but I'm hoping it will.

We don't get a subsidy and both self employed. Our BCBSTX least expensive plan offering this year is $1125 per month. Up from $932.

I know most of you are retired, but some are still in the accumulation phase like me. Please pass this along to anyone you know that it might help.

 

[Earl E Retyre]

Please let us know if you find out that the group health plan is a lot less expensive.

 

[Skyler]

I got the quote back from my agent yesterday and the savings are staggering!

I can get a PPO for $980 with nation wide in network coverage throught BCBS

I can get an HMO that's HSA compatible, with the same network I have now for $632

That's for both of us. I think we'll end up going with the HMO. I've never had an HSA before, but read a lot about them and it sounds pretty good.

 

[travelover]

......... I've never had an HSA before, but read a lot about them and it sounds pretty good.

HSAs are a smoking good deal. If you use the money for medical, dental or eye care you never pay any taxes on it. Also, it can be used for some Medicare expenses / premiums later. Or, after age 65, pay taxes on it and use it for anything.

 

[Earl E Retyre]

I got the quote back from my agent yesterday and the savings are staggering!

I can get a PPO for $980 with nation wide in network coverage throught BCBS

I can get an HMO that's HSA compatible, with the same network I have now for $632

That's for both of us. I think we'll end up going with the HMO. I've never had an HSA before, but read a lot about them and it sounds pretty good.

Wow, that is incredible. Do you happen to know if there is a minimum income that must be received by the LLC to qualify for group insurance?

 

[Skyler]

I have no idea, she didn't mention anything about a minimum income.

 

[FinanceGeek]

Our BCBSTX least expensive plan offering this year is $1125 per month. Up from $932.

Was the original plan you were offered an HMO? Are PPOs available on the individual market in your state?

 

[Skyler]

Yes, the original ACA plan was an HMO. 2017 there was one company still offering a PPO, but off exchange. For 2018 there's no more PPO plans in the individual market at all.

 

[FinanceGeek]

Yes, the original ACA plan was an HMO. 2017 there was one company still offering a PPO, but off exchange. For 2018 there's no more PPO plans in the individual market at all.

Pre-ACA, small group offers access to HI for those with pre-existing conditions.
Post-ACA, small group offers access to HI for those who require broad provider networks.

Its deja vu all over again!

 

[MBSC]

The BCBSTX HMO "Advantage Plus" exchange plans have a 50% coinsurance for out-of-network services. Is the small group HMO the same or is it their basic HMO with no OON coverage?

Thanks in advance.

 

[Skyler]

I'm not sure. There were so many plans I was offered, I only mentioned the ones I was considering. I know there were some offered to me that had that network. I didn't look at those because they excluded the Texas health hospital network.

 

[Skyler]

The one I'm getting for $632 has the regular Blue advantage network with no OON coverage.