Rethinking health insurance and LTC

[bingybear]

Not sure if this belongs in this forum or "fire and money", but here goes.
Our original plan was to get ACA HSA plans and fund the HSA to fund LTC (at least in part.
However, now that we are reaching the end of COBRA, other thoughts and issues have come up. First DW may be eligible for a private plan which could get her much better insurance, but not ACA compatible which could trigger a "fair share fee". This plan would also not be HSA compliant.
I would likely need to buy health insurance for myself either through the exchange or directly from the insurer due to pre-existing conditions.
Now that I look closer at the ACA plans, the HSA plans have narrow in state only networks. However, for a little more $ there are PPO plans that are not HSA compatible that have broad nationwide networks.

On of the poster on these forums has noted that he gets and exemption from the insurance mandate and buys catastrophic plans in his state where catastrophic plans are note adjusted for age. My state does adjust catastrophic premiums with age...so that has little advantage for me.

So the questions... can I get away with getting an exemption for insurance, but still buy ACA compatible for me?

If we go with ACA compatible plans (more expensive for DW), would you go with HSA plans (geographically limited). I should note that we plan on travelling and doing backwoods hiking and camping.

If we go with the PPO plans, how would you suggest saving for LTC since the HSA is out of the picture? We would not be able to add to it and would loose the income reduction for the HSA contribution.

There are a fair number of moving parts in the problem. I have to commit to a short term choice shortly as cobra will be ending. Obviously I can rethink it for next calendar year.

Opinions and Insights are encouraged and appreciated.

 

[pb4uski]

You would be exempt from the penalty if lowest cost health insurance more than 8.13% of your income.

The lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.13% of your household income.

https://www.healthcare.gov/exemptions-tool/#/results/2016/details/marketplace-affordability

https://www.healthcare.gov/exemptions-tool/#/results/2016/details/employer-affordability

 

[rodi]

We (my sons and I) are in a closed network HMO (Kaiser Permanente) that is an ACA/HSA plan. We have been able to be covered when travelling in the past - in the US. We called Kaiser and they either advised us to go to the closest hospital, or referred us to a specific hospital or urgent care. They covered it the same as if it was a Kaiser facility.

My understanding is that if you only need emergency care while travelling - any plan will do. But if you need to see a doctor for ongoing conditions, while travelling, you'll need a plan that allows that.

If you have two homes - in different states - having a more national plan makes sense.

In Europe we've either gone to the local hospital, or talked to a pharmacist. Pharmacists in Italy can dispense some meds without seeing a doctor.

 

[bingybear]

We (my sons and I) are in a closed network HMO (Kaiser Permanente) that is an ACA/HSA plan. We have been able to be covered when travelling in the past - in the US. We called Kaiser and they either advised us to go to the closest hospital, or referred us to a specific hospital or urgent care. They covered it the same as if it was a Kaiser facility.

My understanding is that if you only need emergency care while travelling - any plan will do. But if you need to see a doctor for ongoing conditions, while travelling, you'll need a plan that allows that.

emergency care is a loose term. I talked with my present provider, but asked about the ACA plans with the one state network. The defined emergency care as life threatening emergency. A basic broken bone would not qualify. A compound fracture (broken bone protruding outside the skin) would. There have been a number of cases where the ER visit was not deemed life threatening and the patient ended up with a big bill.

I did look further and there is a HSA compatible PPO plan... lots more $$

 

[MBSC]

My understanding is that if you only need emergency care while travelling - any plan will do.

The defined emergency care as life threatening emergency. A basic broken bone would not qualify.

Even if the out-of-network emergency is covered, you can still be balanced billed the difference when the event occurs in a state that permits balance billing.

I would just go with the best combination of non-compliant and compliant plans that will get you through the remainder of 2016. It sounds like you are expecting these same options to be available in 2017 and beyond.

If the non-compliant plan is a renewable short-term plan, be aware HHS recently released a 2017 proposed rule that would limit them to three months and non-renewable with the same insurer.

HHS Proposed Rule Public Comment Period

The adoption of standardized exchange plan designs could reduce the availability of HSA eligible options within the exchange. The article below offers a counterpoint to that and a link to the original argument.

http://www.healthinsurancecolorado.net/standardized-plans-health-savings-hsa/

 

[bingybear]

Reading a little more online. I think the private plan my be greatly over stated by the selling agent. Some postings call it a scam. I have asked for plan documentation and a copy of the application form. Well... that would be DW plan.
The PPO plan looks to have not just national, but international coverage. Its max out of pocket is similar to hsa compatible plans. Cost delta in 2016 about $150/mo for both of us.
Still need to sort out LTC. Maybe not in an HSA... Roth or IRA?

 

[MBSC]

The non-compliant plan sounds like USHealth Advisors. If so, run away. I do not allocate expenses to certain buckets so I cannot assist with that aspect.

 

[bingybear]

The non-compliant plan sounds like USHealth Advisors. If so, run away. I do not allocate expenses to certain buckets so I cannot assist with that aspect.

yep... that was my conclusion. It is USHealth Advisors and I hear alarms ringing. The scary thing was the number that went to them was on Aetna's site for if you had health insurance questions. I expect I will never see plan documents.