Health Insurance Questions

Discussion in 'Health Care Reform Forum' started by Kaptan, Jun 4, 2015.

  1. Kaptan
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    Kaptan New Member

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    I’m a permanent resident (non-U.S. citizen) returning in July, after a twelve-year absence as an expat in Turkey, UAE and Hong Kong (where my family and I are currently based). I’m an insurance professional myself (currently the regional head of product innovation for a European insurer for their Asia region), but having been away for so long, I can’t say I’m on top of things when it comes to health insurance in the U.S, especially with the changes that have happened with Obamacare in recent years.

    I will not be transferring with my company, so the first order of the day will be to buy individual health insurance for me and my family. We will be based in New Jersey until I find new employment, which could be anywhere in the country. There are some things I find a bit confusing and was wondering if there are some health insurance agents/brokers here who can answer them:

    1. Is there an advantage to buying from an exchange vs. from an agent? I believe with the ACA any plan launched since when the system first started last year would have to accept anyone with a pre-existing condition and they would not be able to charge higher premium for it either, whether or not that plan is bought from an exchange. Is my understanding correct? The only additional benefit I was able to see about the exchanges is that you can get it at a discounted price there. Is this correct, or are there other differences?
    2. I’m a bit old fashioned and would prefer a face-to-face interaction with a multi-carrier producer, such as a broker, rather than buying online because there are usually other things about carriers such as service quality that would not show up on a comparison site. The problem is, I cannot seem to find any NJ-based health insurance agents or brokers, no matter how many different ways I’ve Googled. I’ve even tried the yellow pages. I keep getting listings for auto agents that don’t sell health insurance. When I click on “get local help” on the exchange, all I get is the name and email of some people who are supposed to be agents but no physical address. Can anyone recommend a good agent/broker that specializes in NJ (Union City/Newark areas)?
    3. I played around on the exchange a little bit and realized that one of the fields I have to enter is “income.” The thing is, since we will be moving without any jobs, our regular income will be “0” for some time. Should I put the US$ equivalent of my most recent Hong Kong salary? Would I need to prove how much I make (or don’t)? Would I be forced into buying Medicaid because I don’t yet have any U.S. income?

    Appreciate any light you may be able to shed on the above.

    Thanks!
     
  2. FLM2
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    FLM2 Guru

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    While you ask some good questions my guess is that it will be difficult for you to find an experienced broker to help, there just isn't enough compensation available to make it worth anyone's time.

    To answer one question, though, subsidies are based on 2015 U.S. income and you need to file a tax return for 2015 in order to obtain a subsidy so my guess is you don't qualify (and, in all fairness, you shouldn't as you haven't lived here in 12 years, are not a citizen, and pay no taxes).
     
    Last edited: Jun 5, 2015
  3. Ann H
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    Ann H Guru

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    1. The exchange offers the same plans (at the same price) as OFF-Exchange plans. So, there is no advantage to buying from the exchange unless you are eligible for a subsidy (more about that below).

    2. You are wise to find a broker, and seek personal advice from them. I've seen brokers on this forum who are from New Jersey, and I'm sure one of them will post here soon.

    3. The income is being asked to see if you qualify for a subsidy to help you pay the premium. If your 2015 family household income will be less than 400% of the Federal Poverty Level for your family size, it is possible that you could qualify for a subsidy. This doesn't mean the $0 you are earning right now while you are between jobs. It means the amount your household earned to-date for 2015, plus the amount your household will make for the rest of 2015. FLM2 is correct that you must file a tax return for 2015 in order to get the subsidy. However, if you plan to live in NJ and earn money in the US as a permanent resident, your income will be taxable.

    4. If you might qualify for a subsidy, you should buy (EDIT) ON the Exchange. An agent/broker who is licensed to use the Exchange can help you do that.
     
    Last edited: Jun 5, 2015
  4. russelltw
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    russelltw Guru

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    I think Ann meant to say either:
    4. If you might qualify for a subsidy, you should buy on the Exchange. An agent/broker who is licensed to use the Exchange can help you do that.

    4. If you will not qualify for a subsidy, you should buy off the Exchange. An agent/broker who is licensed to use the Exchange can help you do that.

    Please correct me if I am wrong Ann.
     
  5. Ann H
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    Thanks for catching my mistake. I went back into my post and edited it. You are correct. If you might qualify for a subsidy, you should buy ON the Exchange.
     
  6. MaryDallas
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    Hopefully, a N.J. agent will comment shortly. The agents that you see on the marketplace list of agents are certified on the marketplace in New Jersey. You may want to contact a few and interview them: How long have you been in insurance? (No one has been certified on marketplace more than 2 years so that is not a factor.) What carriers do you write?

    These agents have all gone through the same certification as many of us on the insurance forum and are licensed in New Jersey. You will find the person you want to work with in that conversation.

    TIP: Do not rely on calling the marketplace and getting advice from a CSR. They are not licensed and have made massive errors and have given poor advice. They are just that: customer service representatives. Rely on your licensed agent/broker preferably a broker appointed with multitudes of carriers to add value for you.

    All of us that are certified are on that list as well in the state we are certified. I have over 20 years in insurance and the only thing that shows up about me is my name, phone number, and email address. The same would be true of Ann H. and she is highly qualified as well.

    As Ann H. commented: this is not something you want to attempt yourself. You need a licensed agent to help you with all of the pluses and minuses of ON or OFF marketplace. There are multitudes of rules and regulations as well as variations of the health insurance plan.
     
  7. LGilmore
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    LGilmore Guru

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    Use the exchange if your finances call for it. If not, it simply isn't worth the time spent.

    Are you coming to work here? If so, maybe selecting $0 income isn't wise. When you file for 2015 and your income is above the threshold, any monies provided you for premiums is taken back from tax returns. So you may get temporary relief, but they come get it back pretty quick.
     
  8. Kaptan
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    Kaptan New Member

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    Thank you all for your answers.

    So it sounds like if I am not going to qualify for a subsidy there is no point buying it from the exchange. It also sounds like I won't qualify for one, since I will want to buy a plan right after I arrive, long before I can file my 2015 taxes. Therefore, my guess is that I will have no other answer than "$0" when asked what my U.S. income is - unless I'd be able to provide an "estimated" amount I might earn during the rest of the year, but even then that would be before I could file my 2015 taxes so I guess wouldn't matter anyway. Please correct me if I am wrong. If my understanding is accurate, then the next question would be; would I be forced into getting Medicaid, or could I still get a regular plan, just with no subsidy?

    @MaryDallas: Thanks for the tips regarding the agents listed on the exchange. I will write an email to a few of them and see what happens. What I am a bit surprised about is that none of them seem to have a physical office (I Googled a few of them and no other information came up). Does everyone work from home these days? If I want to buy an auto policy, I can go to, say, a State Farm agent, who would have a physical office with a signboard and I would be able to buy a policy right then and there. When it comes to health insurance, though, I have yet to find a single agent/broker in NJ who has a physical location that I can find on a map, drive down to and buy a policy. And the carriers don't seem to have direct sales offices either. This is so different than any other part of the world I've worked in. All this research and I am still not clear on whether an agent will visit me, or if I will visit them, or if I will be buying online or over the phone.
     
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