Health Care Advisors?

[Midpack]

After a lifetime under military and then corporate health care, our healthcare picture will be complicated in 2019. I’m just starting to educate myself, and I’m not trying to solicit comprehensive free guidance here - but I’m wondering if there are qualified advisors that might help us navigate our way to maintain coverage? In 2019:

Jan: both covered by DW megacorp
Feb-May: both under Obamacare (we’ll recheck Megacorp COBRA and private HC, but I expect they’re both way more expensive).
Jun-year end: I’m eligible for Medicare mid-May, DW still Obamacare (she’s not Medicare eligible until Fall 2021)

AND: just to make it more complicated, we’re planning to relocate to another state in 2019, presumably a different ACA exchange

 

[cathy63]

Check the exchanges in both states to see if they have in person help. CoveredCA has a page to find Agents, Enrollment Counselors and County Human Services Agencies.

 

[FIRE'd@51]

I may be stating the obvious, but for you I would recommend Original Medicare with a Supplimental (Medigap) plan and Part D (drugs) plan, as opposed to a Medicare Advantage Plan. This will give you the most flexibility upon relocating.

 

[Mr._Graybeard]

My independent health insurance agent brokers plans in dozens of states for both ACA coverage and Medigap. I suspect he's not alone.

Since he gets a commission from the provider, his service is free to the consumer. Again, I think that's SOP for the industry.

 

[Accidental Retiree]

Your Medicare coverage will start May 1, as long as you enroll within the 3 months ahead of time.

 

[MichaelB]

After a lifetime under military and then corporate health care, our healthcare picture will be complicated in 2019. I’m just starting to educate myself, and I’m not trying to solicit comprehensive free guidance here - but I’m wondering if there are qualified advisors that might help us navigate our way to maintain coverage? In 2019:

Jan: both covered by DW megacorp
Feb-May: both under Obamacare (we’ll recheck Megacorp COBRA and private HC, but I expect they’re both way more expensive).
Jun-year end: I’m eligible for Medicare mid-May, DW still Obamacare (she’s not Medicare eligible until Fall 2021)

AND: just to make it more complicated, we’re planning to relocate to another state in 2019, presumably a different ACA exchange

Midpack, there are lots of well-informed members who can help with Cobra, individual insurance and Medicare. What specific questions do you have?

 

[SumDay]

Our Advisor was actually a Farmer's agent. He does this in addition to his regular sales, but gets compensated through whomever he enrolls you with. I don't think he's getting rich off it. And, I honestly didn't feel like he pushed us towards any particular company or plan. We changed our minds 2-3 times before we finally let him pull the trigger.


I needed the guidance - well worth our time spent.

 

[NoMoreJob]

We also found a local independent agent who has been very helpful as we have been in similar circumstances transitioning from ACA to Medicare with an interspersed interstate move. I had never used an agent before but after running into difficulties due to incompetent Marketplace personnel and convoluted policies we enlisted the help of the agent. He has been extremely helpful to us and many others in our 55+ neighborhood. I would highly recommend that you seek someone out who can give you some guidance, help you navigate the system(s) and keep you from causing yourself problems (which we did at one point by being too up-front with information). Sometimes less is more.

 

[Freedom56]

After a lifetime under military and then corporate health care, our healthcare picture will be complicated in 2019. I’m just starting to educate myself, and I’m not trying to solicit comprehensive free guidance here - but I’m wondering if there are qualified advisors that might help us navigate our way to maintain coverage? In 2019:

Jan: both covered by DW megacorp
Feb-May: both under Obamacare (we’ll recheck Megacorp COBRA and private HC, but I expect they’re both way more expensive).
Jun-year end: I’m eligible for Medicare mid-May, DW still Obamacare (she’s not Medicare eligible until Fall 2021)

AND: just to make it more complicated, we’re planning to relocate to another state in 2019, presumably a different ACA exchange

I would start by researching the best hospitals and doctors where you plan to re-locate to and see what insurance they take. Keep in mind, for basic care you can go to most places, but the moment you have something serious you really need to go to a quality facility for a better outcome. We wanted to stay with our current doctors at UCLA after retirement and took the lowest cost EPO/PPO that they accept. We do all our preventive screenings at that facility and we have access to all our medical records online. So far we bought our insurance directly from the insurance companies since we get no subsidies. We also keep a note of the in-network facilities covered by our insurance company in Florida and Europe in the event of an emergency when we are there.

 

[Midpack]

Midpack, there are lots of well-informed members who can help with Cobra, individual insurance and Medicare. What specific questions do you have?

I guess mostly I’m wondering about all the Obamacare ‘changes in status’:

• starting Obamacare in Feb (apply during open enrollment since were not starting in Jan, though I’m sure that’s manageable?),
• then changing to me on Medicare and DW on Obamacare starting May-June,
• and most likely changing states/exchanges on top of it all sometime in 2019, when/how to apply for that.

Just trying to avoid lapses in coverage, penalties or avoidable extra costs.

Right or wrong, I’m assuming Obamacare will be lower cost/better value than COBRA or private HC insurance. Bad assumption?

 

[Midpack]

Check the exchanges in both states to see if they have in person help. CoveredCA has a page to find Agents, Enrollment Counselors and County Human Services Agencies.

Will do, thanks.

 

[RobbieB]

Are you moving to CA?

 

[Dash man]

We were on DW’s COBRA for the entire 18 months because it was much cheaper than any other health plans we could find. Now we are on my MegaCorps retiree health plan, which at $2,404/mo is still cheaper than the other plans available. Subsidies from ACA are not an option for us. In three years we go on Medicare.

 

[NoMoreJob]

Right or wrong, I’m assuming Obamacare will be lower cost/better value than COBRA or private HC insurance. Bad assumption?

It may be cheaper but it may not be a better value. In our area we're down to a single ACA provider with a very few available plans - all of which are very expensive (unless you're subsidized) and none of which have particularly good networks or coverage. Do your research or you could be in for a rude awakening! We had good choices when we moved but they quickly dried up.

 

[Midpack]

Are you moving to CA?

No, NC.

It may be cheaper but it may not be a better value. In our area we're down to a single ACA provider with a very few available plans - all of which are very expensive (unless you're subsidized) and none of which have particularly good networks or coverage. Do your research or you could be in for a rude awakening! We had good choices when we moved but they quickly dried up.

I have looked periodically for years knowing this day would come, and while Obamacare was expensive (we won’t be eligible for any subsidies until we’re both retired, if then), DW’s COBRA is even more. I’d probably opt for the highest deductible plan available no matter what provider we end up with.

 

[Telly]

I'm assuming you have already thought about this path...

ONLY YOU go onto DW's COBRA, which coverage-wise for you is no change from the present situation, rather than you doing an insurance double-changeout in less than a year. And your DW goes on ACA, as she will be on it for quite a while (if the program survives).

 

[Midpack]

I'm assuming you have already thought about this path...

ONLY YOU go onto DW's COBRA, which coverage-wise for you is no change from the present situation, rather than you doing an insurance double-changeout in less than a year. And your DW goes on ACA, as she will be on it for quite a while (if the program survives).

I hadn’t considered that route, but I will now, thanks.

 

[MBSC]

I'm assuming you have already thought about this path...

ONLY YOU go onto DW's COBRA, which coverage-wise for you is no change from the present situation, rather than you doing an insurance double-changeout in less than a year. And your DW goes on ACA, as she will be on it for quite a while (if the program survives).

I assume your military service does not qualify for TRICARE which becomes primary when DW's group plan ends. Expanding on the above, 2/1/19-4/30/19 is less than 105 days so you only need to pay COBRA premiums if you become sick during that time.

Electing COBRA is a 105 day process broken into two parts. First, you will have 60 days to decide if you want to return the election form to accept COBRA. Return the form on day 55. The postmark date is used when mailed and some let you submit by internet/phone.

Then, you get 45 days from the date you returned the form to decide if you want to pay the first premium and be covered retroactively to 2/1/19. Don't make the first payment by day 100 (55+45) if nothing major happens. Pay cash to a 'doc in a box' for something minor.

Circling back to the election form. Consider completing it, placing it an envelope, and leaving it with a trusted relative with instructions to mail in case you and DW are incapacitated in a car accident on day 50 and unable to mail it before day 60. Otherwise, retrieve the form on day 55 and submit it yourself.

If you do not qualify for TRICARE For Life (TFL), North Carolina Medigap plans and rates can be found here: http://www.ncdoi.com/medisupp/Search_new.asp

Q14: How do I elect COBRA?

Qualified beneficiaries must be given an election period of at least 60 days during which each qualified beneficiary may choose whether to elect COBRA coverage. This period is measured from the later of the date of the qualifying event or the date the COBRA election notice is provided. COBRA coverage is retroactive if elected and paid for by the qualified beneficiary.

Q16: How long do I have before I have to submit my first COBRA payment?

A group health plan cannot require payment for any period of COBRA continuation coverage earlier than 45 days after the day on which the qualified beneficiary made the initial election for continuation coverage.

More information: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_qna.html

 

[urn2bfree]

I assume your military service does not qualify for TRICARE which becomes primary when DW's group plan ends. Expanding on the above, 2/1/19-4/30/19 is less than 105 days so you only need to pay COBRA premiums if you become sick during that time. http://www.ncdoi.com/medisupp/Search_new.asp

Not blaming anyone for gaming the system this way. The lawmakers set it up this way to give people time to sort things out, but this is why COBRA is so expensive.

Insurance is about spreading the risk, and cost of insurance is related to the risk. This ability to not pay anything if nothing happens for the first 30% of the risk period creates a higher risk pool to insure by definition.

Imagine what price car insurance would be if you only paid premiums after you had an accident.

 

[MichaelB]

Right or wrong, I’m assuming Obamacare will be lower cost/better value than COBRA or private HC insurance. Bad assumption?

Hard to say. An ACA policy is age rated, so a 60 year old pays 3x the rate of a 30 year old. With Cobra you can be charged the full rate plus 2%, but employer group insurance is typically not age rated, so it may cost less.

If you are looking for comprehensive health insurance, you need to see what is available in the geography of your intended destination. When comparing options, most of the thread discussions focus on insurer network and premium, so before comparing premium rates you need to understand how the provider networks compare. To compare premiums, Animorph built an excel spreadsheet, here http://www.early-retirement.org/for...nd-coinsurance-copay-68965-3.html#post1374536

 

[Aerides]

My COBRA is the equivalent in coverage of the best of the Gold ACA plans, or close enough. For us in FL, it is about the cost of an unsub-d Silver ACA plan. FL has a lot of providers, Blue being dominant.

There are so many variables with ACA that are different from COBRA/Employer plans: ACA deductible is usually bigger, docs are more limited, etc. When switching mid-year, you lose any accrued deductible (your new plan still requires you to meet the full deductible to kick in, no matter if you've already spent $2k on care ytd).

I took Cobra because of income from 2017 being too high from severance, funded it with some of the HSA money I'd stock piled. We'll go to ACA for 2019, since cobra ends in Feb, and now we have a good idea for post-ER income. We could have estimated of course, but eh. I'll probably drop down to a Bronze/subbed plan for our first year on it (we are low-consuming at this point) and adjust annually from there.

 

[cathy63]

Not blaming anyone for gaming the system this way. The lawmakers set it up this way to give people time to sort things out, but this is why COBRA is so expensive.

The reason COBRA is expensive is because the employer chose an expensive plan, not because a small fraction of people signed up after having a health issue. By law, the maximum price of a COBRA policy is 100% of the actual premium plus up to 2% administrative fees. If the price is higher than an ACA plan, well that's what it actually costs to have the fancy health insurance plan your employer chose for you.

 

[Rianne]

We had a Health Care Advisor for 2018. She walked us through several plans and went into the minutia of co-pay, out of pocket, out of network, co insurance and HSA. We asked about several situations that could occur, more catastrophic. She knew the HI industry and how coding works. She was so valuable to us and we'll call her for 2019. The HC plan we ended up choosing paid her fee.