Health Insurance - Florida 56 yr old female truck driver - help, please

[samgood]

Hi. I sell Medicare but someone asked if I could help her find health insurance. Your ideas will be very welcome.

She is 56, good health, over the road truck driver. Slim build, forgot to ask about tobacco. She has some type of occupational accident insurance through Zurich, just needs health. Wants coverage now if possible.

In case it matters, last year or the year before there was a truck accident and she spent some time in the hospital. She was not at fault.

She needs a nationwide network due to her travels. She will have gross income this year about $110,000.
Last year was $55,000 net. She said does not mind paying $600 mo. premium but wants low deductible. I told her I do not work with this type of insurance but I believe she needs to be prepared to pay more than that. But what do I know....

So agents, your expert advice is needed, please. Thank you.

 

[bmarsh]

She'll need ACA due to her pre-ex conditions. People still think about health insurance from 20 years ago, when they can pick and choose what they wanted & needed. Some customers get upset when I tell them it doesn't matter what they want or need, I tell them what their only options are, and they can take it or leave it cause thats her situation. I just tell them i'm the messenger, they can tell their congress person if they don't like it, cause thats all the options they have.

1) She can get an ACA plan that is available for her in her Residence zip code. (If you opt for an ACA plan, i'd probably lean toward an Ambetter - with a multi state network, or a Blue plan, but even these don't have coverage in every state, outside of emergencies). I try to steer people on the road a lot toward the Virtual Care when they travel a lot. Ambetter & Oscar use Teladoc, UHC has their own Galileo online Dr's. Most have some type of virtual visit coverage.

2) She can try to get an Underwritten Short Term (Uhone/NatGen) - which will probably decline her due to the hospitalization (but she can apply and see) - doesn't cover Pre-Ex.

3) She can get a hodge-podge of mashed together indemnities - ala Manhattan or US Health, (underwritten, and no pre-ex)

3) She can self-insure

Hope that helps.

 

[Chazm]

High income and $600/month premium with a low deductible…probably won’t happen.

Brian - could she even get an ACA plan right now anyways? Sounds like no sep for her.

 

[bmarsh]

High income and $600/month premium with a low deductible…probably won’t happen.

Brian - could she even get an ACA plan right now anyways? Sounds like no sep for her.

Probably not unless, she has a lot of write-offs, and brings the income way down, or has a Medicaid denial, which is what everyone uses

 

[Davis B]

Probably not unless, she has a lot of write-offs, and brings the income way down, or has a Medicaid denial, which is what everyone uses

QUESTION: She's got high income, how could she get a 'Medicaid Denial' ?

Or does High Income automatically disqualify her?

 

[bmarsh]

QUESTION: She's got high income, how could she get a 'Medicaid Denial' ?

Or does High Income automatically disqualify her?

the high income auto disquals her

 

[Jeremy McLendon]

Individuals w/o an SEP are always challenging outside of Open Enrollment. Short Term Medical plans - STM (like UHOne or Nat Gen) will prob work unless the accident last year resulted in ongoing issues. Of course, there are a lot of states where STMs aren't available.

Sidecar is a fixed indemnity product but with a twist, and like STM, they are medically underwritten but don't need a QLE.

You can find a package of products, like Manhattan Life, that may work. There's always US Health Advisors, not a big fan myself, but works in a pinch.

Lastly, many folks go the health-sharing route, like Medishare or Sedera Health, but not everyone's cup of tea (def not mine) but it's an option.

In Florida, one of the first things to look at it is her location. Advent Health, which is strong in the panhandle and the Orlando area, is a large hospital system and has been known to be really picky so even PPO plans that use the PHCS or Multiplan network might be challenging.