private health insurance

[ripper1]

My wife turned 65 in July and thank God one of us is in medicare. I turn 65 in 01/21. So 1 year more of ACA. But I have been looking at these short term health plans and have been thinking maybe I should do my last year in one of these plans. I guess I could get up to a year. I'm pretty healthy and have only gone the last 2 years for my wellness visit. I don't have any pre existing conditions unless you could consider someone who is a celiac. The ACA penalty is gone so no worries there. Anyone in or considering short term plans?

 

[njhowie]

We bounced from one short term plan to another for daughter between ages 18 and 22 as she was living in states which had them.

Be aware, that they are generally only 90 to 180 days maximum in length, so you will have to reapply/renew during the year. Also, if you are likely to need to use your health insurance coverage during the year, whether intentionally for preventive care, or unexpectedly for an emergency room visit, be aware that it will likely be more expensive than if you had a normal ACA plan. Deductibles are usually high. And remember, since it is only 90 to 180 days, your deductible and out of pocket maximum are going to reset each time you renew.

Now, if you are a healthy individual who rarely goes to the doctor, the short-term plans are a great thing. I haven't been to the doctor's office in over 15 years, and the last time was for a routine physical. Unfortunately, my state does not offer them and won't.

We had a very well rehearsed plan for daughter, and it worked out very well - the insurance was only for major emergencies - where hospital visit was required. Her plan of attack when needing care was 1. CVS Minute Clinic, 2. Always know where the closest Urgent Care clinic was, 3. Emergency room. She never required more than CVS Minute Clinic - they were very efficient and extremely affordable. She used it 2 or 3 times a year. Good thing with Minute Clinic - when they prescribe drugs, it's right there.

One unexpected benefit with the first short-term plan we had when she was living in Columbus, OH - it included physical therapy. Daughter is a dancer, and routinely requires physical therapy during the year. The first short term plan included it - obviously intended for rehab from a bigger medical necessity. However, daughter went to the Ohio State University sports medicine center (big state of the art facility where all their athletes go) and the short-term insurance paid for it!

From your description, it sounds like the short-term plan may be a good fit for you.

 

[MBSC]

So 1 year more of ACA. But I have been looking at these short term health plans and have been thinking maybe I should do my last year in one of these plans. I guess I could get up to a year.

Although federal rules now allow Short-Term Medical (STM) plans up to 364 days, states can have tighter restrictions. Your post indicates you live in Chicago. Illinois limits STM's to 180 days and prohibits renewals with the same insurer. If you develop a medical condition during the first 180 day period, the new insurer for the second 180 day period may exclude coverage for that condition as pre-existing. Depending on the condition, you may not qualify for another STM and losing STM coverage is not a qualifying event to gain ACA marketplace coverage.

If you are currently paying full price for an ACA-compliant plan (no subsidy), there is a loophole where one can qualify for an ACA-compliant Catastrophic Plan when the cheapest Bronze plan available in your zip code is more than 8.30% (2019) MAGI or 8.24% (2020) MAGI. The term catastrophic is a little misleading as they are basically Bronze plans that are not HSA compatible.

ACA-Compliant Cat Plans: https://www.healthinsurance.org/faqs/what-is-the-acas-catastrophic-plan-and-who-is-eligible/

Enter your demographic information on this website (no login required) to view Cat Plans and premiums in your area. https://finder.healthcare.gov/

Lawmakers in Illinois considered legislation (HB1337 HA1, as amended by the House) to limit short-term plans to three months, and prevent renewals. But that limit was considered politically infeasible, so lawmakers instead focused on HB2624, which passed in the legislature and was sent to the governor in late June. The amended version of HB2624 limits short-term plans to durations of less than 181 days, prohibits renewals, and prevents an enrollee from purchasing a new short-term plan from the same issuer within 60 days of the termination of a previous short-term plan. Governor Rauner vetoed HB2624, but lawmakers overrode his veto in November 2018 and the bill became law.

Source: https://www.healthinsurance.org/so-long-to-limits-on-short-term-plans/

Importantly, loss of coverage under a short-term policy during the year does not make people eligible for a special enrollment period (SEP) to switch to an ACA-compliant marketplace policy. They will have to wait until the next Open Enrollment period to buy a plan that cannot turn them down.

Source: https://www.kff.org/health-reform/f...or-consumers-considering-short-term-policies/

 

[bingybear]

It's all a matter of risk and you need to decide what risks you are willing to take... and what you will save. I was pretty healthy until I wasn't. All of a sudden my AV node became intermittent. Solution was a pacemaker. No... I did not have a heart attack. Heart muscle is good. Just an electrical problem.

I use to get my annual physical and they did not see this coming even with EKG once a year.

In many ways it is rolling the dice.

Just remember you are healthy until your are not.

 

[ripper1]

I do live in Indiana now and they do offer 364 days.

 

[ripper1]

It's all a matter of risk and you need to decide what risks you are willing to take... and what you will save. I was pretty healthy until I wasn't. All of a sudden my AV node became intermittent. Solution was a pacemaker. No... I did not have a heart attack. Heart muscle is good. Just an electrical problem.

I use to get my annual physical and they did not see this coming even with EKG once a year.

In many ways it is rolling the dice.

Just remember you are healthy until your are not.

Thanks bingy. It is something to think about. I am going to be 64 and not getting any younger. Health has been pretty good but I guess you never know.

 

[ShokWaveRider]

It's all a matter of risk and you need to decide what risks you are willing to take... and what you will save. I was pretty healthy until I wasn't. All of a sudden my AV node became intermittent. Solution was a pacemaker. No... I did not have a heart attack. Heart muscle is good. Just an electrical problem.

I use to get my annual physical and they did not see this coming even with EKG once a year.

In many ways it is rolling the dice.

Just remember you are healthy until your are not.

So True, My AV Node packed up one morning, same story, now on second Pacemaker. Getting poor/sub par insurance is like playing Russian Roulette with your health (And RE Nest Egg).

 

[ncbill]

Can the OP bank enough cash during the rest of this year to allow them to "manage income" next year & thus become eligible for ACA subsidies?

 

[NoMoreJob]

I'm pretty healthy...

You are until you aren't and it can happen out of the blue with no warning. I know this from experience.

Don't take the risk, not with your health. Get the best insurance you can afford.

 

[ripper1]

Can the OP bank enough cash during the rest of this year to allow them to "manage income" next year & thus become eligible for ACA subsidies?

NO. Way over. Thanks

 

[ripper1]

You are until you aren't and it can happen out of the blue with no warning. I know this from experience.

Don't take the risk, not with your health. Get the best insurance you can afford.

Oh hell...what's one more year. I guess you can be frugal with much but apparently not with your health. Thanks