I'm trying to figure out the safest choice available at a reasonable cost for this open enrollment period. This is what I have reasoned out so far, your situation may certainly vary. I appreciate suggestions to make it safer or cheaper which do not require defaulting on debts, going back to work, or assuming a government always acts reasonably.
Background: I'm class of 2013, retired in NH when Cobra would bridge to ACA after the Supreme Court upheld it. I would have retired earlier but the only insurer in my state issuing individual policies back then declined to issue me a policy. Wife and I are currently on an HSA compatible healthcare.gov policy but are not getting a subsidy. I've been doing partial Roth conversions and capturing 0% capital gains instead of trying to manage income below 400% of poverty. I'm still 10 years from Medicare under current rules. Younger wife was insurable pre-ACA and probably still is, but is also more than 20 years from Medicare. For the rest of this post I'm ignoring possible changes to Medicare.
Had I enrolled last week, I would have selected another HSA compatible family policy from either Anthem or Harvard Pilgrim via healthcare.gov. Now I'm assuming that some unknown portion of the PPACA will be repealed in 2017, and that some unknown provisions will be enacted as replacements. I'm basically trying to hedge my risks without panic spending.
My price checking indicates Anthem and Harvard Pilgrim have very different approaches to on/off exchange policies. As far as I can tell so far, Harvard Pilgrim is offering all their on-exchange policies off the exchange at the exact same price.
Anthem offers First Class policies off-exchange, and Steerage policies on-exchange in NH. We used their Silver HSA ACA offering the first year. Apparently Anthem's ACA policies squeeze providers on price (not all bad for an HSA policy), has a narrower network for ACA policies, and automates interactions with their ACA customers in cases where off-exchange policy holders would talk with a human.
So far based on which networks include my doctors, HSA compatibility, and cost I've narrowed my choices to these policies:
Provider | Metal | Annual Premium (Best Case) | Premium + OOPM (Worst Case) | on/off exchange? |
Anthem | Bronze | $9,390.00 | $22,490.00 | on |
Harvard Pilgrim | Bronze | $9,414.72 | $22,314.72 | both |
Harvard Pilgrim | Silver | $10,820.64 | $20,820.64 | both |
Anthem | Bronze | $12,867.96 | $25,867.96 | off |
I can not guarantee what if any pre-existing condition protection will exist in the future. However, probably the weakest form of pre-existing condition protection is a requirement that insurers let sick people renew their policies. So I am inclined to follow the advice
“I would advise people who are sick to get good coverage now and hang onto it,” said Jost.
from
Concerned About Losing Your Marketplace Plan? ACA Repeal May Take Awhile | Kaiser Health News
As I wrote in post 33 of
http://www.early-retirement.org/forums/f38/healthcare-insurance-and-retirement-again-84072-2.html#post1798671
By definition, if the healthcare.gov exchange goes away exchange policies go away. So there is no possibility people with exchange policies can be grandfathered on their existing policy.
Unless the market crashes I don't expect to want a subsidy in 2017. While I am certainly willing to buy through healthcare.gov doing so is at best a minor advantage. Thus it seems safest to purchase an off-exchange policy.
Provider | Metal | Annual Premium (Best Case) | Premium + OOPM (Worst Case) | on/off exchange? |
Harvard Pilgrim | Bronze | $9,414.72 | $22,314.72 | both |
Harvard Pilgrim | Silver | $10,820.64 | $20,820.64 | both |
Anthem | Bronze | $12,867.96 | $25,867.96 | off |
Harvard Pilgrim did not write individual coverage in NH prior to the ACA. Anthem was NH's only individual market insurer and turned me down prior to the ACA. I am more confident that Anthem will continue to write individual policies in NH than I am about Harvard Pilgrim. I'm particularly sensitive to that because my current 2016 insurer withdrew and will not be writing any policies in NH for 2017. However, the point of buying an off-exchange policy is that I might be stuck with it for a long time. I wouldn't have FIRED if I didn't avoid recurring charges, so paying an extra $3,453.24/year for a bronze Anthem policy is just too expensive. I believe I'll be cheap and pick a Harvard Pilgrim policy.
Provider | Metal | Annual Premium (Best Case) | Premium + OOPM (Worst Case) | on/off exchange? |
Harvard Pilgrim | Bronze | $9,414.72 | $22,314.72 | both |
Harvard Pilgrim | Silver | $10,820.64 | $20,820.64 | both |
The prices in the table above are for a family policy covering both of us. However, at least from Harvard Pilgrim, the cost of two individual policies for 2017 is exactly the same as one family policy. To preserve flexibility getting two individual policies seems like the risk free choice. Before the PPACA shopping for better rates was a great way to save money if and only if you were healthy. I also don't know if my wife could stay on a family policy if I died or enrolled in Medicare. So maintaining flexibility for free seems the obvious choice.
I have not found one offered in NH for 2017, but I wish I could select a PPO policy with a nationwide provider network. My current insurance company (formerly Maine) Community Health Providers offered such policies, but decided to withdraw from the NH market for financial reasons. Maine Community Health Providers was one of the coops created by the PPACA. I wonder what will happen to the coops when/if the PPACA is repealed.