Non-ACA individual Health Insurance in ER?

[Aerides]

I ER'd last summer, with severance + full medical through this August. Yay, timing... we're more than a decade away from Medicare, and budgeted pretty well for HC, assuming the world doesn't completely go insane.

Original plan was to ACA in August-17 under a qualifying change due to job, or maybe COBRA for a couple months and see what ACA 2018 looks like. We would not qualify for subsidies until at least 2019 - even then doubtful/borderline as I have a very small business, so that + taxable gains mean we may still be above subsidy level for a few years.

Given how ACA is up in the air right now, am I thinking right that I should be shopping around more in the open market outside the exchange? For example, my current provider is Aetna - they don't do ACA in FL, but they do offer regular individual plans (half the cost of cobra). Initial review they seem competitive with non-subsidized stuff from BCBS on the ACA. I plan to get quotes from all the biggies, and compare contrast etc. My main "must have" is to keep Cleveland Clinic in network.

Interested to hear from others who are on individual plans outside the ACA or why you didn't do that, anything I should be concerned about with this approach?

 

[bingybear]

how are you defining ACA. ACA compliant? On Exchange?

Are these Aetna plans ACA compliant? Are they short term plans that are not compliant?

When I RE, I used Cobra for as long as I could. Then I used compliant off exchange first, on exchange later.

The way I've seen the ACA plans (in Ohio)... not much keeping the CC in network. Don't know about Florida.

 

[Aerides]

From what I've read, all new plans must be ACA-Compliant, but I'm defining here as non-exchange, non-subsidized individual plans.

The one I'm looking at with Aetna does include CC. Keeping Cobra the full 18 months is definitely an option, but still that only puts me until the start of 2020, at a cost difference for premiums in excess of 10k difference in premiums (yes, far less potential out of pocket, but we are still at the point where our main stuff is just check ups/annuals, etc.). But yes one major event during that 18 months could make it even....

 

[nun]

If the promises are going to be kept healthcare will be universal, cheaper and better. I can't see how that can be true for all of the US as healthcare will be very state specific under the GOP legislation.

Unless there is new legislation MA will revert to Romneycare.....individual mandate and all. The real question is around Medicare/Medicaid. Those are the biggest government health schemes and it will be interesting to see where Trump's promises to protect them intersect with the legislation coming out of Congress.

 

[socca]

For 2017, I have an 11-month non-ACA compliant policy ('short term'), underwritten by National General & using the AETNA preferred provider organization. My premium is $200 / mo, as opposed to $550 / mo from the lowest-cost Bronze plan in my area.

Google 'short-term medical plan' for more info. Here's an interesting link: short-term medical plan sales could surge

These type of plans may or may not be appropriate for your particular situation. Good luck!

 

[ownyourfuture]

Keeping Cobra the full 18 months is definitely an option. But yes one major event during that 18 months could make it even....

For what it's worth, I stayed on *Cobra* for the full 18 months when I retired.

If the additional funding isn't going to hurt you too much financially, I would suggest staying on it.

You can't put a price on knowing you have the exact same coverage for 18 months, especially considering all the uncertainties related to healthcare right now.

 

[bamsphd]

When I fired I used COBRA to bridge us to the first ACA open enrollment. Then I used family ACA exchange polices covering myself and dear wife, but we have not collected any ACA subsidies. After the election I read articles talking about worst case scenarios where exchange policies might be cancelled mid-year during 2017.

So I planned for the worst case scenario and purchased two individual off-the-exchange ACA compliant policies for myself and my wife for 2017, primarily to maximize our flexibility if pre-existing conditions and medical underwriting came back. The plans I picked for 2017 cost the same on or off the exchange, and purchasing two individual policies cost the same as a family plan. So as far as I can see the only thing I gave up for my paranoid flexibility was the possibility of ACA subsidies in 2017.

I don't know for certain, but I don't think insurance companies prorate things like annual deductibles and annual out-of-pocket maximums. If you go with a HSA qualified plan, I don't think it would still be HSA qualified if the maximums were prorated. So in your place I would probably continue my current insurance with COBRA for the calendar year and tentatively plan to select an ACA compliant off-the-exchange policy for 2018 during regular open enrollment. That way you would have a full 12 months to meet annual policy limits. Also by then we should all have a much better idea about how Washington will change healthcare this year.

In fact we should know a lot more in July about Washington's changes. If at that time you think jumping directly to an ACA policy saves you significant dollars, especially if the insurance company says they will prorate deductibles, then skipping COBRA is probably reasonable.

 

[broadway]

I don't know for certain, but I don't think insurance companies prorate things like annual deductibles and annual out-of-pocket maximums.

They don't prorate. I have never seen it.
If you just happened to start on September as I did with one employer and November with another employer, those deductibles and out-of-pocket maximums did not budge.

 

[Aerides]

Thanks, that makes great sense to stay on COBRA at least Aug-Dec, and then shop for 2018 plans. I'm not excited to shop for a mid-2017 plan and then potentially have to change for 2018.

We do not hit deductible amounts even under employer plan, but it is good to remind me that Jan-July expenses would not count when moving to a new one mid-year.

I don't like the idea of the short term policies, and I'd like to stay in the bigger networks and keep my docs, all at the CC (the one stop shop aspect is just so nice, and the CC facility is like a 5* resort).

 

[broadway]

I didn't ER, but when I left megacorp without another job in hand, I stayed on COBRA for three months and then went on the exchange for 2014.

In hindsight it was nervy on my part given the problems they had with Healthcare.gov website. It also ended up not making sense because I made enough money at a contract to job to make me ineligible for subsidies.

But had I stayed on COBRA, I would have switched over in 2015 to the exchange even though I would have three more months to go on COBRA.

I much prefer starting fresh at the beginning of the year.

 

[2017ish]

From what I've read, all new plans must be ACA-Compliant, but I'm defining here as non-exchange, non-subsidized individual plans.

....

They need not be. For example, Tennessee's Farm Bureau health plans are non-compliant and perform medical underwriting. (We recommended it to a young friend who could not afford the family coverage available through either spouse's job.) See discussion here: Farm Bureau Health Plans