Question from John:
I was separated by my employer in January after 31 years of service. I have employer paid health coverage through March 31st of 2024. At that point I will be 63 and need to acquire another policy until I qualify for Medicare. Are you able to help me do this? And when is the best time to begin my search to bridge the gap in coverage?
Answer
John, helping those like yourself who retire prior to going on Medicare, the self-employed, or employees who don’t get coverage through their job get health insurance is one of our areas of expertise. We’ve been doing it since we opened in 2008 and understand the Affordable Care Act (ACA), aka Obamacare, better than anyone. It’s very confusing and there are many pitfalls for those who aren’t careful. Trying to choose a plan and enroll on one’s own or over the phone is not wise. And there’s no reason to attempt it because just like with Medicare, all consultations with me or another agent at The Health Insurance Store are no cost and premiums are no different when using our services versus going straight through an insurance company.
Let me first explain there are only two companies who offer individual “major medical” health insurance in Western Pennsylvania, Highmark and UPMC. Major medical limits how much one can be billed for medical services and prescription drugs in a calendar year. I can’t stress how important that is. Companies not named Highmark or UPMC do not sell Major Medical policies. They offer either indemnity plans, which pay on a schedule and rarely cover anywhere near the full cost of services, or faith-based plans which also cannot guarantee full payment for care. DO NOT BUY THESE TYPES OF PLANS! Those who do are putting themselves at risk of tens, if not hundreds of thousands of dollars in bills in the event of cancer, a lengthy hospital stay, complications from surgery, the need for expensive medications, and other high dollar services.
Individual health plans through the ACA are surprisingly affordable for most people because as of March 2021, income limits to receive tax credits were removed and subsidies that help pay for premiums increased. Let’s use John as an example. I’m going to assume he’s married, and his wife is also 63. If their Modified Adjusted Gross Income is going to be $80,000 in 2024, their premiums would be between $0/month for a high deductible Bronze level plan, to $481/month for a $0 to $1000 deductible Gold level plan. ACA premiums are almost 100% determined by income. If John’s income were going to be lower in 2024, so would his premiums for a Gold plan, the most popular choice among our clients. If his income is going to be larger than 80K, the premiums would be as well.
John asked when is the best time to begin his search? For those considering retirement before turning 65, doing so at the end of a year is usually a good idea if possible, and the planning should start around six months prior to the last day employer coverage ends. Although he doesn’t need the new insurance until April 2024 and he can’t apply for coverage until February 1, we scheduled his appointment for the end of September. We did so because there are legal loopholes we can use to limit income in the years he’s going to need coverage which can possibly save him thousands of dollars in premiums as well as co-pays and deductibles. I want to go over some scenarios and premiums based on different income levels to give him plenty of time to talk with his tax preparer and financial advisor. I wish I had the space to explain this in more detail. But as I wrote above, it’s all very complicated. If you have questions, reach out to one of our offices or email me personally.
One other very important fact I want to mention and something that is making headlines is that up to a million Pennsylvanians and 14 million Americans are expected to lose Medical Assistance (MA) in the coming year due to the COVID State of Emergency ending. These people wouldn’t have qualified to stay on Medical Assistance had it not been for COVID. Those who are currently on, but no longer meet the criteria will get notice in the mail about two weeks prior to their renewal date stating that if they no longer qualify or do, but don’t send in the necessary documentation, they will lose coverage at the end of the following month. It’s so important that those who don’t qualify apply for an ACA health insurance prior to that MA end date. If you know anyone who is currently on MA, please remind them to watch out for this letter or call their caseworker to see what month they are scheduled to renew. If they will indeed be losing coverage, they need to call us so we can help them choose a plan. So many people have become used to getting MA without needing to reapply, they’re being caught off guard and end up without insurance. Those who no longer qualify need not worry, especially households who are just over the income limit for MA, which is 138% of the Federal Poverty Level. Plans for those under 200% have low premiums and little or no deductibles along with very affordable co-pays for medical services.
A reminder to those of you who enjoy the columns, we have a Facebook group with the same name. Those who join will have access to exclusive content, Truths, Tips, and Tricks where we briefly go over rules, regulations, and intricacies of Medicare and how to navigate them so not to waste money, and Feel Good Friday’s where we describe an issue one of our clients had and how we fixed it to remove that stress and financial burden. Go to our website and click on the banner at the top of the page to join. Thanks for reading everyone!
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 aaron@getyourbestplan.com. 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.
Introducing New Facebook Group
Don’t forget to join our new Facebook group, “Ask the Medicare Specialist”, which has the same name as the column, where we post exclusive content and information. Go to our website, getyourbestplan.com, and click on the banner on the homepage to become a member. Thanks for reading everyone!
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.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
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Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
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Albuquerque, NM 87121
Phone: 505-200-0069
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Serving These Areas
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.