Will narrow HI networks keep you from ER?

[FinanceGeek]

The ACA has drastically limited the availability of individual HI plans with large provider networks / out of network benefits (e.g. PPOs). This is occurring regardless of whether the plans are sold on or off the exchanges. Given the ACA's limits on excluding pre-existing conditions, controlling network size is the central way that insurance companies are able to keep costs down.

Group plans, even small-group, still commonly offer wider networks and options for coverage out of network. For people who have or develop life threatening illnesses, the ability to have access to the right doctors / care centers (as opposed to what's covered on your plan's narrow network) can easily become a life or death issue.

We all thought ACA would be a key enabler folks with pre-existing conditions to retire before Medicare, but maybe the truth is that retiring early will now require a willingness to do things like:

• Establish some small home based business, just to qualify for purchase of a small group policy
• Invest in a small business in order to buy yourself a low duty / no show job with access to group HI.
• Choose where you live in retirement taking into account which areas (ACA networks operate on a county basis, not a state basis) sell individual HI plans with wider networks.
• Not RE until you are Medicare eligible, or within a COBRA period's throw of eligibility? This was the main pre-ACA tactic...
• Stint work - take a part time job with group health insurance just to become COBRA eligible, than quit. Take time off. Just before COBRA runs out, find another. Also a pre-ACA tactic...

Some articles on the topic:
2017 exchange market: Plan type trends | McKinsey on Healthcare
http://healthcare.mckinsey.com/sites/default/files/2017-OEP-Plan-Type-Trends-Infographic_VF.pdf
https://healthpayerintelligence.com/news/narrow-insurance-networks-can-limit-options-for-cancer-care

 

[Sunset]

Before ACA, people with pre-existing conditions couldn't retire as there would be no coverage, as you state in bullet 4.

I know folks that pre-ACA established a small business, simply to buy HI, so nothing has really changed, except that ACA has made it easier for retired folks to get HI without a job.

 

[FinanceGeek]

I know folks that pre-ACA established a small business, simply to buy HI, so nothing has really changed, except that ACA has made it easier for retired folks to get HI without a job.

My concern is that the policies available to individuals lack comparable provider networks versus employment based group HI. This can be a very serious issue for those who have (or develop) serious medical conditions.

I think the quality of individual HI will depend on exactly what state (and county) you RE in. Do people have opinions about which areas are likely to offer the most choice?

 

[FIREd]

How many employees do you need to qualify for a small group policy?

I could see us trying to establish a small business or join an existing small business to get access to group insurance if the individual market collapses in our area. I am also open to the idea of moving to a place where decent health insurance remains available to individuals (we have already made preparations for a potential move).

 

[photoguy]

I think the quality of individual HI will depend on exactly what state (and county) you RE in. Do people have opinions about which areas are likely to offer the most choice?

I'd start by looking at this list: https://www.kff.org/other/state-ind...-the-individual-health-insurance-marketplace/

and examine states with the most issuers. Then narrow it down to where you might live in each state and go on the exchange. For longer term viability, you might want to look at the demographics in each state, presumably those with younger healthier populations and greater provider competition will have longer term viability.

Personally I've been pretty happy with ACA in SoCal. Still on a blue shield PPO. But I haven't seen the rate increases for 2018 yet.

 

[MichaelB]

My concern is that the policies available to individuals lack comparable provider networks versus employment based group HI. This can be a very serious issue for those who have (or develop) serious medical conditions.

I think the quality of individual HI will depend on exactly what state (and county) you RE in. Do people have opinions about which areas are likely to offer the most choice?

I have a different view WRT your opening post. I had small company coverage for 6 years prior to ACA implementation, and the policy options available to us beginning in '14 were a major improvement. My current ACA policy has one of the largest networks in the US (BCBS BlueCard) and is definitely better (broader and deeper) that the policies that each of my DD's have from their small business employers.

I do agree with your statement that where you live matters most. Some regions and states have worked with insurers to ensure better policy options for individuals, others have not done so well.

How many employees do you need to qualify for a small group policy?

I could see us trying to establish a small business or join an existing small business to get access to group insurance if the individual market collapses in our area. I am also open to the idea of moving to a place where decent health insurance remains available to individuals (we have already made preparations for a potential move).

Most policy offerings for very small businesses are very similar to individual, and insurance companies treat them as the same. State regulations and insurers define the size requirements and policy options for very small and small business.

 

[ziggy29]

It depends a lot on where you live. In many urban areas there are still several insurers with dozens of options. In many rural areas, there is only one choice, and perhaps none, though I doubt that will be allowed to happen.

Where we live now, no, I would not rely on the ACA for retirement as things have turned out. We live in rural Texas and where we are, there is only one insurer, and all their plans are HMOs with limited networks (notably missing MD Anderson).

But if we moved elsewhere, perhaps to a state that I thought was more committed to seeing the law survive (especially if future changes put more control into the hands of the states), I might be more inclined to trust that the worst case was unlikely to happen.

 

[rodi]

Totally agree that it depends on where you live. We have many choices here in sunny San Diego through CoveredCA. And while our premiums are going up at faster than inflation rates - they're typically under 10%/year... unlike some of the other folks reporting here.

 

[FIREd]

Most policy offerings for very small businesses are very similar to individual, and insurance companies treat them as the same. State regulations and insurers define the size requirements and policy options for very small and small business.

Thanks. I checked for my state, the minimum number of employees is 2 (including the business owner). But... employees must work a minimum of 30 hours a week to qualify.

 

[BarbWire]

My current ACA policy has one of the largest networks in the US (BCBS BlueCard) and is definitely better (broader and deeper) .....

That's what I had before ACA, and what I would love to have again. Last year in TX my choice was limited to a BCBS HMO with no out of network coverage. For 2017 I "moved" to FL to get better insurance (less expensive, and with out-of-network caps) but the out-of-network coverage is vanishing in 2018.

["Moved" in quotes because I travel full time. I just need a legal domicile.]

So, is there a website where one can search for BCBS Blue Card PPO plans? Or any plans with nationwide networks and out-of-network coverage? I can "move" anywhere for 2018 ....

Five more years of the "moving" dance before Medicate. Or I just become an ex-pat, which I consider a better option than going back to 40 hours in a cubicle.

 

[FUEGO]

Thanks. I checked for my state, the minimum number of employees is 2 (including the business owner). But... employees must work a minimum of 30 hours a week to qualify.

Wait, do they have to work, or can they "work" 30 hours per week?

I mean, what's to say you aren't in the business of professionally reviewing hiking trails, restaurants, Netflix shows/documentaries, good books, and the specifics of the inside of your eyelids? Those things require my attention well in excess of 30 hours per week, even in slow weeks.

 

[LARS]

I have been considering establishing a foundation for charitable work and in turn have the ability to get small business insurance.