Cobra running out - I need health insurance!

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rmcelwee

Recycles dryer sheets
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My cobra runs out in three months and I have no idea how or where to get health insurance. I'm 56 and live in TN. My wife and I will probably show an income of around $120K each year (LTCG, 401K, Roth) so I think that means ACA is out but I am not sure. I've done some google searches and looked around here but I can't seem to get to square one. Can someone point me in the correct direction?


FWIW, my former employer gives me $1K per month for healthcare until 65. It probably doesn't matter for this topic but I have around $220K in an HSA (I don't think you can use that for insurance premiums).
 
You can get HI through the ACA no matter what your income is. You may not get a subsidy with high income, but I don't think $120K is too high while the ACA cliff is not in effect. Go to healthcare.gov or healthsherpa.com and see for yourself.
 
+1
With ACA, the 400% cliff has been eliminated through 2025.

As such, you should not pay more than ~ 9% of your MAGI income for HI Premiums no matter what level your income is (assuming you purchase the second lowest cost silver plan and receive the appropriate subsidy to make up the difference) -- at least until 2026 under current law.

-gauss
 
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ACA is more or less your only option as an individual. You'll just pay more for it than those who can manufacture the necessary income for cheap premiums.
 
teej1985 said:
ACA is more or less your only option as an individual. You'll just pay more for it than those who can manufacture the necessary income for cheap premiums.
Click to expand...

I went to healthsherpa and found 77 plans through four different companies. I always thought that those would be better coverage, etc than ACA but I really don't know. Did you say "your only option" because it is well known that ACA is good insurance compared to private companies? I haven't really read up on it.
 
You could look at insurance elsewhere but the couple times I did, rates were the same.
 
When I originally was considering getting an ACA plan, I pulled my current policy details to compare it to the policies they offered. The Silver plan that I chose with my same insurer (Anthem Blue Cross) had identical deductible, copays etc at a far lower cost than my Cobra coverage.
 
Gauss is correct. We live in Tennessee and have income in your ballpark. We receive an ACA subsidy of about 50% of our premiums. The 400% cliff has been eliminated through 2025
 
rmcelwee said:
I went to healthsherpa and found 77 plans through four different companies. I always thought that those would be better coverage, etc than ACA but I really don't know. Did you say "your only option" because it is well known that ACA is good insurance compared to private companies? I haven't really read up on it.
Click to expand...

Time to do some reading. The ACA is the broad healthcare law, and almost all HI plans are complaint, and will be the same on the exchange directly, via health sherpa, or via brokers. There are non-compliant plans but those are usually short term and carry more risk. There are no better private options for traditional comprehensive coverage. You buy off the exchange (healthcare.gov) if you want to qualify for any subsidy, but the plans are the same if you buy elsewhere.

Estimate your early income, converted to monthly, in the enrollment process.

ACA compliant plans are what most of us have. You can enroll as soon as you like knowing that cobra is ending, so you have a planned start date, as that is a qualifying event.
 
Are you planning to get HMO or PPO ?? HMO is cheaper, but no out-of-network coverage.
 
rmcelwee said:
I went to healthsherpa and found 77 plans through four different companies. I always thought that those would be better coverage, etc than ACA but I really don't know. Did you say "your only option" because it is well known that ACA is good insurance compared to private companies? I haven't really read up on it.
Click to expand...

What you will probably find is these are not really 77 plans, they are 8-10 plans, each with 8 or so different combinations of deductible, copay, coinsurance and total out of pocket.

ACA mandates specific levels and types of coverage and all ACA plans must comply, so they all cover much of the same thing. The biggest differences are 1) PPO vs HBO, and 2) the breadth and depth of their provider networks. Then, the numerous different combinations of premium and cost sharing.
 
House Divided said:
You can get a short term policy 6 - 12 months, but it doesn't cover preexisting conditions.
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And no subsidies would be available for this type of policy -- regardless of the premium cost or your income. It might be a useful comparison point though.

-gauss
 
MichaelB said:
What you will probably find .....

ACA mandates specific levels and types of coverage and all ACA plans must comply, so they all cover much of the same thing. The biggest differences are 1) PPO vs HBO, and 2) the breadth and depth of their provider networks. Then, the numerous different combinations of premium and cost sharing.
Click to expand...

To this I would also add the ability of the insurer to negotiate (relatively) low rates for in-network services (ie Physicians / Hospitals / Lab Tests etc). This is important while your are in your deductible range of the policy.

If I am not mistaken, Health Insurers are now required to actually disclose this on their web sites in a machine readable form.

This could be an advantage if there is a dominant insurance provider in your market.

-gauss
 
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Just for kicks I went to healthcare.gov and used a zip code in Knox County with you and your wife assuming you both are age 56 with 120K income and it estimated a monthly subsidy of $815. Monthly premiums started at about $400 for bronze and about $800 for silver plans and it pulled up a ton of plan options.
It's very easy to just shop the healthcare.gov site before actually applying and you can add your preferred doctors and hospitals to narrow your search. You can also click Plan Detail to get more information on any plan than you might be interested in.
One thing to keep in mind, at tax time you will receive a form 1095-A which is needed to reconcile whether you received too much or not enough Premium Tax Credit based on your actual income. Your tax program can handle this for you.
 
gauss said:
To this I would also add the ability of the insurer to negotiate (relatively) low rates for in-network services (ie Physicians / Hospitals / Lab Tests etc). This is important while your are in your deductible range of the policy.

If I am not mistaken, Health Insurers are now required to actually disclose this on their web sites in a machine readable form.

This could be an advantage if there is a dominant insurance provider in your market.

-gauss
Click to expand...
Good point, thanks.
 
Find a reputable ACA agent in your area to help you and it's free. You can start with Healthcare.gov as well as friends and/or coworkers who went through ACA for reference.
 
I am in the same situation - my benefits run out at the end of August. I am working with a private advisory company called PinnacleCare. I am in the process of giving them our medical providers and they will present us with various options for medical coverage - they will then walk us through the enrollment process. We live in New Jersey but will change residency in 2024 to Florida - so we will need to do this all again next year.
 
I went off Cobra and didn’t feel comfortable navigating HC on my own so I used a broker. He showed us how to evaluate policies on the healthcare exchange. In the second year I did it on my own and still managed to save money from year one by using an HSA qualified plan. We pay $767/month, M/F 60 and 62. Reported income in the low 6 figures.
 
xlf11 said:
Find a reputable ACA agent in your area to help you and it's free.
Click to expand...
COcheesehead said:
I went off Cobra and didn’t feel comfortable navigating HC on my own so I used a broker. He showed us how to evaluate policies on the healthcare exchange.
Click to expand...
+1

An experienced local health insurance broker can help. It's similar to using a broker for homeowner's insurance or auto insurance.

It costs you nothing as the commission is already built into the premium whether you use one or not and it's spent in your community helping other local businesses. Here is a recent ACA thread from another Tennessee member.

https://www.early-retirement.org/forums/f38/aca-questions-117939.html
 
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