ACA Enrollment Question

[Livefree]

I'm planning on enrolling for Insurance starting in June. I've been in touch with an Insurance Agent who claims that he can help me navigate the process with a conference call with the state, and not to try it myself, as it's difficult and dealing with these people isn't easy

He says he's paid from the state to help, and doesn't receive any compensation, but I'm just leery of sales people in general!

He also said the people he can put us in touch with are different than if I make the call..

Am I being paranoid?

 

[MichaelB]

The agent is paid by the insurer, so there is no additional cost to you. Before you sign, though, you should make sure the agent represents all the insurers in your state, and will get you access to all the policies, both on exchange and directly with the insurers.

 

[foxfirev5]

Do your currently have insurance through your employer? Is COBRA offered? Please check out your options.

 

[broadway]

I'm planning on enrolling for Insurance starting in June. I've been in touch with an Insurance Agent who claims that he can help me navigate the process with a conference call with the state, and not to try it myself, as it's difficult and dealing with these people isn't easy

He says he's paid from the state to help, and doesn't receive any compensation, but I'm just leery of sales people in general!

He also said the people he can put us in touch with are different than if I make the call..

Am I being paranoid?

If you have insurance now, the suggestion to remain with your current insurer through COBRA is a very good one.
Once you start over with a new policy even if it is with the same insurance company, your deductible resets.

In which state do you reside?

It really isn't that hard to sign up through HealthCare.gov website.
I have been on ACA for 4 years.

 

[Livefree]

If you have insurance now, the suggestion to remain with your current insurer through COBRA is a very good one.
Once you start over with a new policy even if it is with the same insurance company, your deductible resets.

In which state do you reside?

It really isn't that hard to sign up through HealthCare.gov website.
I have been on ACA for 4 years.

I'm in Mass. My company's insurance is expensive. Right now I pay $1050 per month for my wife and I, and Cobra would be about $1300 I believe.

I understand the deductible/out of pocket resets, but I'm trying to stay within 250% of FPL to keep that manageable by loading up my 401k at work, and also because I pay so much for insurance now, my taxable income is low.

 

[Livefree]

The agent is paid by the insurer, so there is no additional cost to you. Before you sign, though, you should make sure the agent represents all the insurers in your state, and will get you access to all the policies, both on exchange and directly with the insurers.

That's good to know..Thanks.

 

[Sarah S]

I think the MAhealthconnector is relatively easy to navigate and you can browse plans now.

I do not believe you can buy individual plans direct from the insurers in MA. It looks like you can when you go to the website but when you start you get redirected to the exchange. So your choice is connector ( exchange ) or Cobra

I also think your choice of plans gets more limited if you are claiming cost sharing That may not matter to you but be aware there is a lot of difference in provider networks among plans and tufts has 2 types - premier which is the normal network and direct which is limited Neither my pcp nor my one specialist takes direct neither do the specialists I would pick if I developed issues. Some of the direct doctors are great but you might not get your top choice

 

[Livefree]

I think the MAhealthconnector is relatively easy to navigate and you can browse plans now.

I do not believe you can buy individual plans direct from the insurers in MA. It looks like you can when you go to the website but when you start you get redirected to the exchange. So your choice is connector ( exchange ) or Cobra

I also think your choice of plans gets more limited if you are claiming cost sharing That may not matter to you but be aware there is a lot of difference in provider networks among plans and tufts has 2 types - premier which is the normal network and direct which is limited Neither my pcp nor my one specialist takes direct neither do the specialists I would pick if I developed issues. Some of the direct doctors are great but you might not get your top choice

The insurance agent mentioned Tufts and Neighborhood Health Plan as two of the options available. My current plan is Aetna and the deductible and out of pocket is $6000 and $6400

 

[brewer12345]

My state has its own exchange and it is easily the most benighted, incompetent organization it has ever been my misfortune to deal with (and I say that as a taxpayer and former regulator). Without the help of my agent I think I would have firebombed the exchange headquarters by now. The help is free, so make sure they are competent and take advantage of it.

 

[Sarah S]

You can see the prices for your zip on the website. For my area tufts premier silver for me is 687 a month for one person. 2000/ 7150 ( I think) deductible and max. I am 60

I like tufts to deal with and the premier network is better than neighborhood health. Check the formulary if you take/ might take meds

Blue cross has the broadest formulary but they make more drugs specialty with inflated copays than tufts does

 

[MBSC]

The agent is paid by the insurer, so there is no additional cost to you.

Most health insurers have stopped paying commission outside open enrollment. The agent hopes the client returns for his Medicare supplement or Advantage plan selection and refers friends to the agency.

At the very least, the OP should go to the State health insurance exchange website and print a list of the plans offered. The agent should be able to explain why the one he chose is the best instead of the others.

“It’s a monumental change in our industry, for sure,” said Bradley Smith, vice president of Inspro Insurance’s Omaha office. Agents miss out after Blue Cross drops commissions on Affordable Care Act plans in Nebraska | Live Well Nebraska | omaha.com

The moves by nearly every major insurer over the last few months are often focused on times of the year and plans that attract the sickest people. https://www.usatoday.com/story/news...rict-when-and-what-plans-people-buy/82210946/

Three of the largest insurance companies in the country announced they would not be paying broker commissions for consumers that sign up for plans after the open enrollment season deadline. The actions come amid criticism from insurers on “special enrollment periods” that allow consumers to shop for insurance outside of the designated window each year. Because they cannot bar consumers from signing up, however, they are pushing back by dissuading agents – who have been instrumental in enrolling customers to their plans – from taking the time to do so. Three of the largest health insurers axe broker commissions | Insurance Business

Some insurers — including Cigna and Aetna — will not pay licensed agents and brokers a commission for helping people enroll in individual health insurance coverage for 2017 in many states, while others have reduced their commissions.
As Insurers Cut Brokers’ Commissions, Consumers May Have One Less Tool For Enrollment | Kaiser Health News

Blue Cross Blue Shield of Texas (BCBSTX), announced the elimination of Broker commissions for new individual health insurance policies for the under 65 market, which applies to both the Exchange and non-Exchange market. Health Plans Continue to Cut Broker Commissions for New Individual Insurance Policies | Healthcare Exchange

 

[rodi]

Since you are just retiring you may not qualify for subsidies since you have a partial year of income. That's why I did Cobra for the remainder of the year when I retired June 2014.

 

[Livefree]

Since you are just retiring you may not qualify for subsidies since you have a partial year of income. That's why I did Cobra for the remainder of the year when I retired June 2014.

I'm trying to keep my taxable income low enough to qualify, by maxing out 401k and my Medical Premiums are also Pre-Tax resulting in a low taxable income from my job.

 

[Carol1862]

I had checked the policies online myself before going to my agent. She had a large board up and we put in various plans, prices and comparisons to help with our choice. She told us after she gets no commission from this. She said she depends on word of mouth and hopefully we'll recommend her to someone needing life insurance or some other product that she does get commission from.

 

[jim584672]

If you have a bunch of income in the front of the year, say severance and unemployment, a drop in income in the last part of the year may qualify you for Medicaid in those low income months. This can get you to the next open enrollment period.

 

[SheitlQueen]

It really isn't that hard to sign up through HealthCare.gov website.
I have been on ACA for 4 years.

It really is simple. We don't have a state exchange so I signed up through the HealthCare.gov website.

 

[zinger1457]

If you have a bunch of income in the front of the year, say severance and unemployment, a drop in income in the last part of the year may qualify you for Medicaid in those low income months. This can get you to the next open enrollment period.

I'm certainly not a medicaid expert but everything I've seen in my state shows that qualifying is based on your MAGI for the year so it shouldn't matter when you earned the money during the year. If the money you earned at the beginning of the year puts you over limit then you wouldn't qualify for the no/low income months.

 

[jim584672]

I'm certainly not a medicaid expert but everything I've seen in my state shows that qualifying is based on your MAGI for the year so it shouldn't matter when you earned the money during the year. If the money you earned at the beginning of the year puts you over limit then you wouldn't qualify for the no/low income months.

That is true for the subsidies but not for Medicaid. I thoroughly researched this question and the law is written as monthly income for Medicaid. I dropped into it mid year when my UI ran out and even though my annual income was over the limit.

 

[zinger1457]

That is true for the subsidies but not for Medicaid. I thoroughly researched this question and the law is written as monthly income for Medicaid. I dropped into it mid year when my UI ran out and even though my annual income was over the limit.

So someone retired could take a $100K 401K/IRA distribution in January and sign up for medicaid for the other 11 months? If that were possible I'm sure it would be a popular topic on this forum.

 

[jim584672]

Most people do whatever it takes to avoid Medicaid so it has never been popular on the forum.

 

[Livefree]

I think the MAhealthconnector is relatively easy to navigate and you can browse plans now.

I do not believe you can buy individual plans direct from the insurers in MA. It looks like you can when you go to the website but when you start you get redirected to the exchange. So your choice is connector ( exchange ) or Cobra

I also think your choice of plans gets more limited if you are claiming cost sharing That may not matter to you but be aware there is a lot of difference in provider networks among plans and tufts has 2 types - premier which is the normal network and direct which is limited Neither my pcp nor my one specialist takes direct neither do the specialists I would pick if I developed issues. Some of the direct doctors are great but you might not get your top choice

You're right about the Tufts plan. My agent said to take the Tufts Direct and save almost $300 per month over Neighborhood Health and with the $3600 per year savings you can go to a doctors visit that isn't covered and just pay for a physical etc. from this savings and still be ahead

 

[Sarah S]

True but what if you need surgery or expensive treatment and the doctor you want is not covered? It is not the planned or minor things, it is the big ones and 3600 will not take you far especially if you are paying list price.

As a retired internist I know who I would want for various serious events. Most of them don't take direct. There was thread quite recently with someone in another state who needed spine surgery. None of the doctors she wanted took her insurance.

Direct is probably fine because you will probably be fine. I am not willing to gamble even though I too would be better financially to pay for my current usage of non Direct providers in cash. It is the what if. YMMV

 

[Livefree]

True but what if you need surgery or expensive treatment and the doctor you want is not covered? It is not the planned or minor things, it is the big ones and 3600 will not take you far especially if you are paying list price.

As a retired internist I know who I would want for various serious events. Most of them don't take direct. There was thread quite recently with someone in another state who needed spine surgery. None of the doctors she wanted took her insurance.

Direct is probably fine because you will probably be fine. I am not willing to gamble even though I too would be better financially to pay for my current usage of non Direct providers in cash. It is the what if. YMMV

You make a good point. What have you heard about Neighborhood Health plan?

 

[Livefree]

My state has its own exchange and it is easily the most benighted, incompetent organization it has ever been my misfortune to deal with (and I say that as a taxpayer and former regulator). Without the help of my agent I think I would have firebombed the exchange headquarters by now. The help is free, so make sure they are competent and take advantage of it.

I agree. Whenever I call I get someone else that doesn't really understand the process. They don't understand the concept of Adjusted Gross Income, and it's frustrating.

For instance I get Rental Income, and I'm pretty sure I'm allowed to use the Depreciated Income from that, which is much lower than the gross or net proceeds but they have a hard time with that.

 

[Sarah S]

I checked my choices for general surgery and neurosurgery on the NHP website and they were listed so it looks better than direct at a quick glance. I would take a good look though and imagine what hospitals and specialists you might want in various scenarios.

If you take any medications try to find what send away pharmacy you have to use.