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Question from Rob:
I’m thinking about retiring at 62 years old. I’m worried I won’t be able to afford health insurance until I’m eligible for Medicare. Do you help people find individual plans? I know it’s now the Affordable Care Act (ACA) Open Enrollment. Do you have any insight for people like me?
We’re getting off the Medicare topic for a week, but it’s important I discuss health insurance for those under 65 from time to time. And yes, we do help people like Rob who are looking to retire prior to becoming Medicare eligible, those who don’t get insurance through an employer, or own a small business. And Rob, often it’s best for someone who is retiring to do so as close to January 1st as possible so coming to meet with us now would be prudent.
Rates for ACA plans are extremely affordable due to part of the American Rescue Act (ARM) of 2021 which eliminated the cap on household income to qualify for premium subsidies, also known as tax credits. There was also a significant increase in subsidies which lowered premiums for almost everyone on ACA plans.
Prior to the ARM, a single person whose annual Modified Adjusted Gross Income (MAGI) was over $52,000, and a couple who exceeded $69,000, didn’t qualify for any subsidies. Now anyone who applies on the PA Marketplace, known as Pennie, will receive them in the amount of health insurance premiums that exceed 8.5% of their annual MAGI. Here’s an example of just what a positive impact this has had for Western Pennsylvanians.
Prior to the ARM, an Allegheny County married couple in their 60’s whose MAGI was over $70,000 paid $975 a month for a plan with a deductible of $6,700 per person! A more conventional Gold plan with a $1,000 deductible was $1,563! Those who lived outside of Allegheny County paid even more!
Now, that same couple making $70,000 will pay only $14 per month for the high deductible plan and between $400 to $500 per month for those same Gold Plans, excellent prices for a married couple in their 60’s. And most importantly, there are no pre-existing conditions clauses on ACA plans, meaning companies can’t deny your acceptance based on current or past health conditions and must cover claims as soon as the policy goes into effect.
However, The ACA, applying for and choosing the right plan is extremely complicated. Ensuring an application is done correctly and income properly evaluated is crucial. Failure to accurately predict income for 2024 could result in owing the IRS a significant amount of money that could be subject to the same late payment penalties and interest as delinquent taxes if not paid in a timely manner. Also, one of the original complaints about the ACA was the smaller network of doctors and hospitals. And unfortunately, that is truer today than in 2014 when Obamacare was first introduced.
There are only two companies who sell major medical Individual health insurance in Western PA, UPMC and Highmark. UPMC doesn’t grant network access to Allegheny Health Network and those who choose some Highmark plans don’t get network access to UPMC. The lowest cost plans in Allegheny County don’t allow members network access to any doctor not employed by their health care systems. There are some plans that expand networks, but they can be thousands of dollars more per year. You don’t need to pay $2,000, $3,000, $4,000 more per year in premiums so you can see a doctor once or twice a year for $10 or $50 per visit vs $100 or $200. We can help you evaluate these types of situations so you don’t overpay for health insurance.
As I stated previously, the only two companies that sell true individual “major medical” health insurance in Western PA are Highmark and UPMC. When I say, “major medical,” I’m referring to health insurance that covers hospitalizations, outpatient surgeries, and other expensive services and procedures such as chemo, radiation, air and ground ambulance, maternity, prescription drugs, etc., while also limiting the amount of bills one can pay in a calendar year. Any other company not named UPMC or Highmark isn’t selling major medical health insurance, but what are known as indemnity plans that pay on a schedule. For example, you could choose a plan that pays $250 to $1,000 per day in a hospital, $500 to $1,000 for an outpatient surgery, $1,000 to $1,500 for each chemo treatment, $100 for an Emergency Room visit, etc., and there’s no limit to what people can be billed. Chemo can cost $10,000 to $15,000 per treatment. James Conner, the ex-Steeler running back needed 12 when he was diagnosed with Hodgkin’s Lymphoma. My guess is the billable amount to his insurance company far exceeded $100,000. With one of the more popular indemnity plans, he would have been covered for only $18,000 of chemo, leaving him responsible for the balance of $82,000 or more. I’m not going to mince words here. These plans are garbage. They’re often sold over the phone by people who get paid ridiculously high commissions, which unfortunately, can result in those selling them being less than ethical. And that’s putting it nicely. Let me make this simple and clear. DON’T BUY ANY INDIVIDUAL NON-MEDICARE HEALTH PLAN THAT IS NOT OFFERED BY UPMC OR HIGHMARK! You are setting yourself up for financial disaster or the possibility of not having access to the care you need.
Obamacare Open Enrollment started on November 1st and runs through December 15th. If you would like to make an appointment for a no cost consultation, give us a call. And feel free to email me personally, email@example.com with any questions.
Make An Appointment
If you would like to make an appointment for a no cost consultation to go over Medicare options, individual ACA marketplace plans, you’re an employer and would like a second opinion on your group policy, or are interested in life insurance, give us a call or email me personally at firstname.lastname@example.org. And keep the great column questions coming! Also, I am now licensed in over 20 states and able to help people choose and enroll in Advantage, Supplement, and Part D plans throughout the country.
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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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Fayette/Westmoreland County Area
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Connellsville, PA. 15425
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We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico Not affiliated with the U. S. government or federal Medicare program.
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.