Ask The Health Insurance Specialist
QUESTION:
Question from Mary Anne: Love reading your column each week in the Pittsburgh Post-Gazette. Does your company offer advice on individual health insurance plans?
ANSWER:
As I wrote about three months ago, from time to time when we get questions regarding the other types of insurance we sell, individual and group health plans as well as life policies, I do change the title of the column. Thank you, Mary Anne. Yes. We do offer Individual health insurance and have been doing so since 2008. However, the market really changed when the Affordable Care Act was enacted and then began in 2014 as far as how we purchase plans and the industry regulated as well as what kind of plans and networks are offered. And probably the biggest change is how monthly premiums are determined, with the biggest factor being one’s annual household Modified Adjusted Gross Income (MAGI).
In case you weren’t aware, there was some very big news regarding the ACA last year. As part of The American Rescue Plan (ARP), subsidies were increased quite dramatically for those who qualify. It isn’t uncommon at all to help people apply for plans with premiums that are literally a dollar and change. The larger subsidies are still in effect today and I’m confident they will be made permanent at some point. In addition, the income limits to receive subsidies were removed, which was an absolute boon to people who were paying full price for plans and is an opportunity for those who didn’t think they could retire prior to Medicare age to do just that.
Prior to the ARP, a married couple in their 60’s living in Allegheny with a MAGI 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 live outside of Allegheny County paid even more!
After the ARP, that same couple making $70,000 pays only $14 per month for the high deductible plan and between $395 to $489 per month for Gold Plans that have deductibles of $0 and $1,000, respectively. The lower the income, the lower the cost. Most importantly, there are no pre-existing conditions clauses on ACA plans, meaning companies can’t deny your acceptance into a plan based on current or past health conditions and must cover claims as soon as the policy goes into effect.
The ACA, applying, and choosing the right plan isn’t simple, however. Ensuring an application is done correctly and income properly evaluated is crucial. Failure to accurately predict income for the year one wants to be insured could result in a shock when taxes are filed. 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 it was first introduced. But this is where we come in. The agents at the Health Insurance Store will see to it you don’t overpay for a plan and help you choose one which provides access to the doctors that are most important.
One other change for Pennsylvanians that began in 2021 was the move to a state-based Marketplace, called Pennie, as opposed to the Federal exchange. It’s much easier for agents to navigate and there have been almost no glitches. In addition, the representatives are more knowledgeable and helpful when issues arise. Another nice aspect of the move to Pennie is that anyone who would like to change their agent of record can do so easily. This means if you purchased your plan through the Marketplace on your own or went through another agent or agency who hasn’t given you the service or attention you think you deserve, you can request to be moved over to The Health Insurance Store and get all the great client services we offer, including receiving our annual recommendation letter each Annual Election Period that runs from November 1st to December 15th. We make sure plans don’t take a drastic turn for the worse, something that has happened in the past. Like our Medicare clients, we always make certain those with ACA plans are on one that offers the best possible value each and every year. If you would like us to be listed as your agency of record, give us a call.
Lastly, I want to point out that only Highmark and UPMC sell true major medical individual health insurance in Western PA. If someone is trying to sell you a plan from any other company, it is not health insurance as you know it! These are indemnity plans and pay on a schedule. A cancer diagnosis, lengthy stay in the hospital, critical care, complications due to surgery, the need for expensive drugs, among other costly services will almost certainly result in tens, even hundreds of thousands of dollars in bills because indemnity plans pay a set dollar amount for services regardless of what they actually cost, and there is no Maximum Out of Pocket. Do not buy an indemnity plan!
Again, if you have an ACA plan you didn’t get from us and would like to become a client or if you want to make an appointment for a no cost consultation for individual, employer group health, Medicare, or life insurance plans give us a call or reach out to me personally at aaron@getyourbestplan.com.