This week’s question from Jamie
My self-employed husband is on the plan provided by my employer. His income is typically less than $40,000 per year. It has a 7,500 Max Out of Pocket (MOOP) and a 3,500 deductible. Due to the fact he must have 2 more surgeries in 2022, we will hit that max again this year. Can he purchase a plan through your company that may provide him with a lower deductible and MOOP? I continue to pay 2021 bills as they keep rolling in and I’m anxious over this coming year’s bills as well.
Answer
The Possible Issue with Employer Plans
I don’t blame you. Receiving $15,000 in medical bills over a two-year period can tend to cause stress.
Unfortunately, however, if one is offered insurance from their own or a spouse’s employer and it provides the “10 Essential Benefits” as defined by the Affordable Care Act (Obamacare), no matter the cost, deductible, or size of the MOOP, he or she cannot get a subsidy to purchase a plan from the Marketplace. And without subsidies, ACA plans aren’t affordable or competitive.
That being explained, I want to send a message to employers; Unless you’re paying 75 percent of spouse’s premiums, it’s quite possible you aren’t doing your employees a favor by offering insurance to their significant others, and it may be best not to offer them health benefits. That way, spouses can get subsidies to purchase a plan on the Marketplace, which are generally very affordable due to provisions in American Rescue Act that eliminated income limits and increased premium subsidies. As I discussed in last week’s column, for some employers, it may also be a win/win not to provide health insurance at all, depending on the average wage of your employees. If it’s $25 or less, eliminating the group insurance plan altogether and giving a raise in lieu of health insurance could very possibly save tens of thousands of dollars per year while lowering the cost for employees. You may be able to save enough money to provide other benefits to help recruitment and retainment as well. We often recommend using a portion of the savings on an allowance for employees to spend on their choice of AFLAC policies such as life, disability, accident, or indemnity. Very few employers do this, and it can help you stand out from the stiff competition. Myself, our group health expert Jennifer Chaney, and our Life Insurance specialist Tony DiRoma will assess your group and come up with a plan that makes sense for everyone. And you can cancel your group policy and move to Marketplace plans at any time of the year. You aren’t locked into group coverage all year long. If you own a business and aren’t supplying health insurance, contact us so we can put together a plan to get your employees enrolled in Marketplace plans and ensure they have the best value. In either situation, we can come to your place of business and do the applications for everyone if our research dictates it’s the smartest decision.
What To Consider
Now back to Jamie’s husband. She mentioned his annual income, which is the number one determining factor in the cost of Marketplace plans, is usually under $40,000. By himself, his premium for a plan with a $0 or $1,000 deductible would only be $134 to $163 per month. However, all household income must be included, even in the case where only one member needs to get a Marketplace plan. That means we would have to include Jamie’s income as well, which would increase her husband’s premium. As you can see, the Affordable Care Act (ACA) is not anywhere near as simple to navigate as we were told it would be back in 2013. I distinctly remember one of the biggest misstatements in history; “It’s going to be as easy as buying a plane ticket online.” It’s not. In fact, trying to do it on your own without the help of licensed, trained, and experienced agents like we are at The Health Insurance Store is a big mistake that can cost thousands of dollars.
Here are a few very important pieces of information for anyone who has or will need individual health insurance in 2022:
1) If you don’t currently have any health insurance, your last day to enroll for 2022 coverage is January 31st. If you don’t do it by then, you will not be able to until 2023 unless you qualify for Medical Assistance for which the income limit is 138% of Federal Poverty Level or less.
2) Those who lose employer provided coverage or Medical Assistance can apply at any time during the year either 60 days prior to or after coverage ends.
3) The only companies selling true major medical individual health insurance in Western Pennsylvania are UPMC and Highmark. If you have purchased a plan from any other company, you do not have health insurance as you know it. In fact, it will state that right on your card. Companies advertising or soliciting plans other than UPMC or Highmark are not selling those that will protect assets in the event of the following: chemotherapy, a lengthy hospital, critical care, complications from surgery, extremely expensive medications, or other costly services. We never sell stand-alone indemnity policies. They’re a waste of money. I have no opinion or experience on what are known as “Faith Based” plans and have never sold them.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.