What do you use for your own health insurance? & What would you recommend for my situation?

[Paul Massey]

If any of you are looking for a good PPO that is off of the marketplace, I can help you with that! It is a fixed indemnity plan through Manhattan Life. It is for healthy people that make too much for an ACA plan to make sense. Check out the attached brochure that outlines the details of the plan and it also has a price sheet. I am currently licensed in OH, VA, NC, SC, AL, OK, TX. Just let me know if you have any questions, like to get coverage, or if you would like to get contracted with them.

 

[Fisher]

If any of you are looking for a good PPO that is off of the marketplace, I can help you with that! It is a fixed indemnity plan through Manhattan Life. It is for healthy people that make too much for an ACA plan to make sense. Check out the attached brochure that outlines the details of the plan and it also has a price sheet. I am currently licensed in OH, VA, NC, SC, AL, OK, TX. Just let me know if you have any questions, like to get coverage, or if you would like to get contracted with them.

Are you telling actual prospects that this is a PPO plan?

 

[Paul Massey]

Yes. It uses Aetna's network. It is called "First Health Network." If the doctor or facility does not accept the First Health Network, then they just simply upload the receipt or EOB to Manhattan Life for reimbursement, because it is a fixed indemnity plan. It pays out no matter what per service. I do tell my clients that it is a fixed indemnity plan and what that means and that their policy is going to say that "it is not a major medical plan." I go over that it is not going to cover pregnancy and mental illness and that is the reason that it is not an ACA compliant plan.

 

[Yagents]

Gotta have cajones to sell indemnity only plans without a major medical attached. Selling it as a PPO is misleading if that is your pitch.

 

[Paul Massey]

This is a very strong indemnity plan! It pays out thousands for things like hospital stays, surgeries and things like that. And it pays around $100 or more for doctor office visits, so for the client, it is much like a co-pay on their end for the remaining balance if any. It acts much like a major medical plan. It is not like a typical med sup that only pays a couple of hundred here and there for services to help cover deductibles. Self employed medium to high earners love this plan vs an ACA. Much cheaper and it is actual coverage for them. Check out the attached brochure from above for the details.

 

[Dave G]

Here is a bit different take on how to do this.

First, I'm an advocate for HSA type plans....lets you self-fund out-of-pocket health costs on tax-deductible/tax-free basis. It doesn't get any better than that. Every month you spend less for healthcare than the extra premium for a "gold" level plan, you are money ahead. For a 20-something I assume you have many years of good health ahead of you.

Now for a couple of wrinkles you may not have considered. At healthcare.gov for suburban Chicago zip codes I found this....assuming you get no ACA premium subsidy based on male age 28 / female 26 :

Ambetter of ILL HSA Bronze level $13,800 deductible (2 people) rate is $527.55 mo. As you know, HSA plans require the ENTIRE deductible be met before EITHER person is reimbursed for covered expenses. So....I suggest you instead EACH get your own policy.

Separate plans for same coverage looks like this: You $6900 deductible at $271.65 mo. and for your spouse $6900 deductible at $255.90 mo. You would do this to have a lower individual deductible to meet vs. having to satisfy the higher combined HSA deductible.

You can still EACH have your own (separate) HSA accounts and contribute up to the max for each person. Also, you do NOT have to have earned income to contribute to an HSA. If your wife returns to "university" you can still contribute to an HSA for her.

Now the last wrinkle: You don't mention having a family....BUT if so routine maternity costs run high. So your wife can later CHANGE to a Gold Level plan for a lower deductible. She can currently get a Gold level plan with a $2,000 deductible for $342.98 per mo.

So, use separate HSA type plans to start and be sure to fund at least her HSA account. Switch her to Golf level plan at the appropriate time and then use her HSA account to pay her Gold plan deductible.

Btw, I would NEVER rely on a "Med Share" arrangement for healthcare you might need to save your life. Those things are NOT insurance plans and provide NO contractual right to claim benefits. If you want to have one of those PLUS a Bronze level insurance plan that might work.

Hope this is helpful to you or someone you know!

 

[Lee Vena]

Gotta have cajones to sell indemnity only plans without a major medical attached. Selling it as a PPO is misleading if that is your pitch.

I get where you are coming from, but technically he is correct. A PPO is not an insurance plan, rather it is a network of providers. Use the network provider, get higher reimbursement. Works on health insurance plans as well as indemnity.

 

[Truce]

"As you know, HSA plans require the ENTIRE deductible be met before EITHER person is reimbursed for covered expenses. So....I suggest you instead EACH get your own policy."

Don, The IND limit of $6900 will still apply inside that $13800 family deductible. No need for separate plans for this couple/that reason (although there ARE situations where it does make sense to split).

 

[Dave G]

Truce...that's a new wrinkle to me (separate deductibles inside a joint HSA-type plan enrollment.) Separate policy idea still good where he keeps HSA type plan and she enrolls in Gold level while needing maternity services.

 

[Truce]

I think people get it confused at lower deductible levels. Suppose there is a $2500 deductible for a single and $5000 for a family. If it's two people on the plan, its considered family,and YES one person would have to hit the whole $5000 family deductible before insurer pays, even though if they had an IND plan it would reach deductible at $2500.

But with bronze level high deductible plan at the family level, you are not increasing the exposure of any one person beyond the individual max out of pocket by choosing a family option. The insurer will track the expenses for each person and stop at the IND max, effectively making that the most one one person could contribute to the family deductible.

RE the GOLD plan split for Maternity: Maybe, maybe not. Little kids have lot of medical bills and many ACA plans run ER through a deductible. If mom's entire delivery alone counts toward a family deductible and let's the rest of the family get billed post deductible for the rest of the year, it could be a huge waste to have her bills separated from the rest of the family maximum, essentially doubling the maximum risk.

And since this is the senior forum, I'll try to say something that's actually useful.

Get that Medicare eligible spouse OFF the group/ACA HSA plan at open enrollment if they are doing a family HSA plan with just two people and will be leaving in the next few months anyway. If you spend ONE MONTH on an HSA plan at the family level, then drop a spouse to join Medicare so only one remains on the HSA plan for the next 11 months, that single person must meet still the FAMILY deductible the rest of that plan year. Fun stuff - and maybe they'll blame YOU for not bringing it to their attention as you wax on about how great Medicare will be.