ACA -Vs- Temporary -Vs- Defined Benefit Plan

[Luck_Club]

What am I missing?
Ages 51 & 52 - So long way to medicare and need to provide insurance. So we don't qualify and wont qualify for subsidies. We have no pre-existing issues, and are relatively healthy. After endless dealing with fake websites, that don't provide quotes, and confusing "agents". We have weaned it down to 3-4 basic options in Florida:

1) ACA high deductible plan @roughly $13,284 per year Max out of pocket approximately $21,184. Max benefit assumed to be about $1-2 million, with typical $25 well visits.

2) United Health Temporary insurance @ $5236 per year Max out of pocket $10,236.26. Max benefit is $2 Million, and you pay for everything from dollar 1 up to $5,000. Needs to be renewed every 12 months.

3) Defined benefit plan (cignet & united health) @ roughly $8760 per year and capped benefits. Some of the caps appear to restrictive, and put the risk for expensive stuff on you. Like heart bypass surgery, strokes and cancer. You know the kind of stuff you really want to insure against. Positive is no new renewal every year.

4) health ministries - approximately $6,000 per year, but I'm cautious due to the fact I like a drink in the evening, so they are off the table in my eyes.

I'm leaning heavily towards the second choice, understanding I will only be able to keep the plan for 34-36 months with some annual frustration to re-enroll. I also understand that should an event happen while on the plan, I will need to go on the ACA the following year, unless new options are available.

Am I missing something or is it obvious given the situation 2 would be the best choice? Anyone out there see a plan that has a high benefit, that doesn't require an annual renewal and risk of being dropped?

[pb4uski]

Quote:

Originally Posted by Luck_Club What am I missing?....1) ACA high deductible plan @roughly $13,284 per year Max out of pocket approximately $21,184. Max benefit assumed to be about $1-2 million, with typical $25 well visits.....

Unlimited max benefits for ACA plans as I recall. We went with ACA based on a budget (in 2011) of $900/month. It has ended up being much less, but we are lucky to live in a state that prohibits age rating.

[COcheesehead]

I need to make this decision in two years. Leaning toward a high deductible tied to an HSA, but everyone I talk to told me it all changes so fast. So will re-evaluate in two years.
The faith based ones seem cheap, but they are unregulated and have not been around long.
I don’t think I can keep my income under the limits so an ACA policy, if they even exist in two years, is probably out of the question.

[ivinsfan]

On number one I'm not sure how you came up with the max benefit amount I thought ACA plans didn't have a cap. Is number one useful for a family HSA? This would lower the cost somewhat.

Number 3 is a no go IMO..it should be cheaper as it basically shifts the cost to you.

Number two could offer a decent short term solution.

Number 4 generates a lot of controversy here but I think if you dig deep you'll find at least one company that doesn't bar drinking. If you have any pre existing it might not be the best choice. You say you don't, so if you are seriously thinking about this plan the sooner you go on the better. Everything should be covered.


Any finally you haven't mentioned if you travel at all or what networks locally these plans use and if you have options for treatment if something big happens.

[ivinsfan]

Lets not turning this into a bashing of the number 4 solution please? That won't really help the OP much. That topic is a hot button around here. Now if a poster has an example where they actually got the run around on a plan like that, that's valuable info.

I don't think you'll get much disagreement that regular old insurance companies can be a PITA too when it comes it approving procedures and sorting out bills properly.

[MRG]

I'd go 1 or 2, 3 is too risky for me.

There's zero chance of me considering option number 4. Couldn't sleep at night. You have zero recourse if something happens.

[Texas Proud]

Please add some info... is your max OOP separate from the premiums? I am thinking your are combining your premiums with what insurance calls max OOP and putting that down as your max...


As someone else mentioned there should be no max benefit from the ACA plan...


Would not know enough about 3 or 4 to give any real insight but it seems you do not like either...


So the question is between 1 and 2 with 1 having no max benefit and 2 having it set at $2 mill... I would guess it would be something really big to get to $2 mill so I might go with #2 as the savings are pretty large...

[MBSC]

Quote:

Originally Posted by Luck_Club 1) ACA high deductible plan...Max benefit assumed to be about $1-2 million.

ACA compliant plans do not have an annual or lifetime cap. This includes the off-exchange ACA plans bought directly from the insurer.

Quote:

Originally Posted by Luck_Club 2) United Health Temporary insurance @ $5236 per year Max out of pocket $10,236.26. Max benefit is $2 Million, and you pay for everything from dollar 1 up to $5,000. Needs to be renewed every 12 months. I'm leaning heavily towards the second choice, understanding I will only be able to keep the plan for 34-36 months with some annual frustration to re-enroll. I also understand that should an event happen while on the plan, I will need to go on the ACA the following year, unless new options are available.

STMs use national PPO provider networks so traveling isn't an issue. While you will only be able to keep the UHC plan 36 months renewed annually, you can then switch to another reputable carrier such as National General for 36 months then switch back to UHC.

They can be "loose" with the definition of pre-existing condition. For example, six months after enrolling you are diagnosed with cancer and start chemo. Some have been known to say the cancer was already inside you when you enrolled and deny coverage as pre-existing. Even with this caveat, I agree with your assessment.

Quote:

Originally Posted by Luck_Club 3) Defined benefit plan (cignet & united health) @ roughly $8760 per year and capped benefits. Some of the caps appear to restrictive, and put the risk for expensive stuff on you. Like heart bypass surgery, strokes and cancer. You know the kind of stuff you really want to insure against. Positive is no new renewal every year.

This is the opposite of insurance. Insurance should be to protect against catastrophic loses and these policies cap payments.

[ivinsfan]

Quote:

Originally Posted by MBSC ACA compliant plans do not have an annual or lifetime cap. This includes the off-exchange ACA plans bought directly from the insurer. STMs use national PPO provider networks so traveling isn't an issue. While you will only be able to keep the UHC plan 36 months renewed annually, you can then switch to another reputable carrier such as National General for 36 months then switch back to UHC. They can be "loose" with the definition of pre-existing condition. For example, six months after enrolling you are diagnosed with cancer and start chemo. Some have been known to say the cancer was already inside you when you enrolled and deny coverage as pre-existing. Even with this caveat, I agree with your assessment. This is the opposite of insurance. Insurance should be to protect against catastrophic loses and these policies cap payments.

Do you have personal knowledge of STM"s denying people coverage under these circumstances? This is a big deal if there is hard evidence to back it up.

[MBSC]

Quote:

Originally Posted by ivinsfan Do you have personal knowledge of STM"s denying people coverage under these circumstances? This is a big deal if there is hard evidence to back it up.

See below.

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Despite showing evidence she was unaware of the cancer when she bought the policy, the insurer didn’t pay for Jones’s treatment, leaving her with a $400,000 medical bill. But the judge sided with Golden Rule and dismissed the case in August, finding the policy agreement clearly stated that preexisting conditions wouldn’t be covered, even if the customer was unaware of the condition. Jones wasn’t diagnosed until after she bought her policy. Reference: Customer feuds, claims denials mar health plans Trump backs | Pittsburgh Post-Gazette See also: https://www.protectourcare.org/fact-...rm-junk-plans/

[ivinsfan]

Quote:

Originally Posted by MBSC See below.

Your first link is interesting and concerning. Oddly enough this is the scenario that people site when they don't like the so called Christian plans.

Your second link calls them short term "junk" plans so appears to be pretty biased.


If you want all the protections of an ACA plan, you are going to have to pay for an ACA plan. I guess that what it boils down to in the end.

[travelover]

Quote:

Originally Posted by ivinsfan ..........Your second link calls them short term "junk" plans so appears to be pretty biased..........

Based on all the posts I've read here, MBSC knows more about health care insurance than the rest of the forum, combined. just sayin'.

[ivinsfan]

Quote:

Originally Posted by travelover Based on all the posts I've read here, MBSC knows more about health care insurance than the rest of the forum, combined. just sayin'.

I don't disagree, I just liked his first link better, it seemed a little more unbiased. I don't think I'd ever buy a short term plan.

We have a lot of good well informed posters here and for better or worse we've all had to increase our study of health insurance options...

Did you ever think that HI would continue to get more confusing and pricey every year? You have to wonder how long this can continue.

[MichaelB]

Quote:

Originally Posted by ivinsfan Did you ever think that HI would continue to get more confusing and pricey every year? You have to wonder how long this can continue.

How long can it go on? Two answers, both originally intended for other situations, but may apply here. John Kenneth Galbraith said this:

Quote:

The market can remain irrational longer than you can remain solvent.

Phil the weatherman shared this

https://m.youtube.com/watch?v=TReCZ2auRkE

[braumeister]

Quote:

Originally Posted by MichaelB John Kenneth Galbraith said this: Quote: The market can remain irrational longer than you can remain solvent.

A great quote. A similar one I've always liked is this:

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Trends often go on for far longer than seems reasonable.

[travelover]

Quote:

Originally Posted by ivinsfan .........Did you ever think that HI would continue to get more confusing and pricey every year? You have to wonder how long this can continue.

I'm personally not surprised given all the moving parts and power of entrenched interests. That said, I believe in equilibrium, or as Buffett said, "trees don't grow to the sky". At some point equilibrium is reached.

[Luck_Club]

Quote:

Originally Posted by Texas Proud Please add some info... is your max OOP separate from the premiums? I am thinking your are combining your premiums with what insurance calls max OOP and putting that down as your max... As someone else mentioned there should be no max benefit from the ACA plan... Would not know enough about 3 or 4 to give any real insight but it seems you do not like either... So the question is between 1 and 2 with 1 having no max benefit and 2 having it set at $2 mill... I would guess it would be something really big to get to $2 mill so I might go with #2 as the savings are pretty large...

I understand my initial post may have been slightly confusing. The first number was the annual premium, and the second larger number was max out of pocket for a year assuming 1 has a bad year.

So I'm evaluating it as if I have a normal year IE two physicals and blood work. being $50 with option 1 & 3 and probably $500 for option 2. two sick visits for anti-biotics $25 for option 1&3 and free tele-medicine for option 2.

In my eyes it really boils down to $2 million should be enough, so the annual premium and out of pocket costs are the biggest factor.

Situations like MSBC put out about plans calling un-diagnosed condition as pre-existing is pretty frightening, but probably very un-common.
At least I hope they are rare.

[Sarah S]

I think you may be underestimating the costs of preventive care a tad. I just looked and my physical full price bill was 350. This did not include gyn. Is your wife going to skip periodic gyn? Mammograms? Colonoscopies for both of you? Immunizations? Will it make a psychological difference to you in following recommended screening whether you have to pay?

You commented in one of your early thread about having a concern about family genetics impacting your quality of life after 70. The groundwork for minimizing the effects of most genetic predispositions is best started years earlier. Lifestyle is key but good screening and counseling helps

[Texas Proud]

Quote:

Originally Posted by Luck_Club I understand my initial post may have been slightly confusing. The first number was the annual premium, and the second larger number was max out of pocket for a year assuming 1 has a bad year. /snip/

What I was asking is YOUR definition of max OOP..... is it premiums PLUS the max you have to pay... or is it the max OOP listed by the insurance which does not include your premiums..

[Luck_Club]

Quote:

Originally Posted by Texas Proud What I was asking is YOUR definition of max OOP..... is it premiums PLUS the max you have to pay... or is it the max OOP listed by the insurance which does not include your premiums..

The definition for the various options for Max OOP is: Premium + deductible payments & co-pays =Max out of pocket