Health Insurance

As someone who hasn’t used a dollar of health insurance so far in 2019, I’m supposed to pay 18% more for health insurance coverage in 2020. Read More

Today marks the first day that you can enroll in health insurance through HealthCare.gov, the US government’s health insurance exchange. Open enrollment in 2018, for insurance that is effective January 1, 2019, is from November 1 through December 15. If you don’t have health insurance available to you through your employer, or any other source, then you want to make sure that you enroll in a marketplace plan before December 15 so that you have coverage for 2019. If you fail to enroll in a plan by December 15, and you don’t have a qualifying event in 2019 that makes you eligible for a Special Enrollment Period, then you’ll be without health insurance for the whole year or will have to resort to an option such as short-term health insurance, which is less than ideal.

Navigating the health insurance marketplace is very confusing, as I wrote about in September when I turned 26 and had to find a marketplace policy for myself. There are many things to consider such as costs, the type of plan offered, and if your preferred physicians are in the plan’s network.

Different Kinds of Plans

There are several different types of health insurance plans that provide different benefits of which you should be aware. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point-of-Service Plans (POS), and High-Deductible Health Plans (HDHPs).

All of these names seem pretty complicated and don’t really appear to mean much on the surface without diving into them. Out of the 22 plans available through HealthCare.gov in Indiana, the only two types available are HMOs and EPOs, so we’ll focus mainly on these two types of plans. Of those plans, two are HSA-eligible – one is an EPO and one is an HMO.

Here are some important things to know about each type of plan available in Indiana:

Health Maintenance Organizations (HMOs)

• Typically, you must choose a primary care physician and first consult with them before being able to see a specialist.
• Without a referral to a specialist from your primary care physician, you’ll have to pay all costs out-of-pocket.
• HMOs limit you to receiving care from physicians that are contracted with them – this is commonly referred to as the “network”.
• If you receive care (other than emergency care) from an out-of-network physician, then you’ll have to pay out of pocket for those services.
• HMOs can provide cheaper premiums than some other types of health insurance (such as PPOs) since they direct patients towards in-network physicians for an agreed upon amount.

Exclusive Provider Organization (EPO)

• Similar to HMO but may provide a different network.
• May not require that you have a primary care physician.
• Doesn’t require referrals from your primary care physician to see a specialist.
• EPOs limit you to receiving care from physicians that are within the plan’s network (except for emergency services). Otherwise, they won’t pay for the care.
• May provide a larger service area than an HMO.

HSA-Eligible High Deductible Health Plans

• A HDHP is a health insurance plan with a high deductible. Duh. The deductible is the amount that you have to pay before insurance kicks in.
• In 2019, the minimum deductible that a plan can have for self-only coverage to be considered an HDHP is $1,350 and double that at $2,700 for family plans.
• The maximum out-of-pocket expenses for HDHPs in 2019 is $6,750 for individuals and $13,500 for families.
• There are two HDHPs on the marketplace in Indiana – one is an HMO and one is an EPO.
• These plans are the only plans on the market in Indiana that are eligible to be paired with a Health Savings Account (HSA). Even those other plans that have deductibles high enough to be considered “high deductible” plans are not HSA-eligible.
• The 2019 HSA contribution limit for individuals is $3,500 for self-only coverage and $7,000 for those with family coverage.

Choosing between the HMO and EPO really comes down to which network works for you and if you want to be able to see a specialist without a referral from your primary care physician. You can visit each insurance company’s website to review their networks and see if your physicians are in them.

Don’t Go Without It

Don’t wait until December 15 to apply for health insurance coverage for 2019. Login (or create) an account and get a lay of the land. Take some time to figure out what plan is the best for your situation before applying to make sure that you’re making the best decision for you.

Some may think that they’ll just forgo the cost of health insurance since they could save so much and use that money for other things. That’s not a very good idea.

Life is unpredictable, and tragedy could strike at any moment. It’s not what we want to think about, but we must consider that something like a serious car accident is a potential for those of us who drive or take a ride sharing service to work every day. Even something as small as slipping and falling, or anything else that could lead to an emergency room visit, could result in extremely costly medical bills that could be devastating without insurance.

Just as the old saying goes, insurance isn’t something that we like paying for but it’s something that we’re glad is in place once the time comes that we must use it. Yes, health insurance is expensive, but paying for an accident without health insurance is much more expensive.

Earlier this month, I turned 26 years old which means that I’ll no longer to be covered under my parents’ health insurance as of the last day of September. Since I work for a small business that doesn’t provide insurance, it’s up to me to find coverage for myself. Navigating the health insurance landscape is very confusing so I wanted to document my findings and hopefully make the process easier for others, whether you’re aging out of coverage on your parents’ policy or you’ve lost coverage for any other reason. This isn’t going to be an exhaustive review, but hopefully more of a helpful guide to point you in the right direction and offer some of the insight that I’ve found through my research.

Special Enrollment Period

If you’re losing coverage under someone else’s plan, such as your parents’, then you have a Special Enrollment Period (SEP) which starts 60 days before you lose coverage and ends 60 days afterwards. The marketplace requires you to choose a plan and pay the premium by the last day of the month that you’re losing coverage to ensure that your new plan coverage is in place on the 1st of the next month.

There could be a gap in coverage if you wait to enroll in a new insurance plan until after the last day of the month that you will lose coverage. For example, since my birthday is September 7th, I have to choose a plan by September 30th to ensure that I will have coverage in place October 1. Your new plan will either start the first day of the month after you lose coverage if you enroll before you lose coverage, or will start the first day of the month after you pick a plan if you enroll after you lost coverage.

You don’t want to get in a car accident, break a bone, or get hurt exercising and not have health insurance to help pay for your bills. A serious injury or illness could be catastrophic to your financial situation.

Health Insurance Options When You Don’t Have Employer-Provided Coverage

You can read a bunch of articles telling you about all of your options, but they’re limited. Essentially, at this time, you’re limited to the options I’ve listed below. Before we start, here are some considerations to keep in mind when evaluating potential health insurance options:

• Are your doctors in the plan network?
• Are your prescription drugs covered?
• What are the premiums?
• What is the deductible?
• What is the coinsurance rate?
• What is the max out-of-pocket cost?

Health Insurance Marketplaces

This is likely where most people who are losing health insurance coverage will land. While some states have their own marketplaces, most, including Indiana, use HealthCare.gov. You can find out if your state has its own marketplace or uses the federal marketplace by going to HealthCare.gov and entering your zip code.

Currently, CareSource & Ambetter are the only options on the marketplace for people who don’t have group benefits available to them in Indiana. The HealthCare.gov marketplace serves less than 10% of insured people, which is why health insurers have continued to drop out. They  can make so much more money offering group policies than offering individual policies with expensive government mandates.

Since insurers continue to pull out of the marketplace, most of these plans will probably not provide these same level of benefits as the coverage that you’re losing (or COBRA) and will likely be more expensive than what you were used to. Nevertheless, this is the health insurance landscape in which we live.

HSA-Eligible High Deductible Health Plans

As I’ve written before, High Deductible Health Plans that are eligible for use with a Health Savings Account (HSA) can be extremely beneficial for some people. I’m one of those people.

Don’t be fooled – most plans on the marketplace that you’d think would be HSA-eligible at first glance actually are NOT. In fact, there are only 2 plans that qualify as HSA-eligible in my area. Even though there are many more of these plans that have high deductibles, which you’d think would make them qualify as HDHPs, they don’t qualify because they provide additional benefits above and beyond those that HSA-eligible plans are allowed to offer.

That’s right. They provide too many benefits to be HSA-eligible.

Healthcare Sharing Programs

Healthcare sharing programs are not health insurance, but they usually act a lot like it.

Along with the traditional health insurance marketplaces, I believe that most people will find replacement coverage through one of these first two avenues. Healthcare Sharing Programs are faith-based programs which share medical expenses among members. Most Healthcare Sharing Programs will require you to sign a statement of faith and agree to live by their guidelines. They function very similarly to insurance but, technically, aren’t insurance. However, they do meet the IRS guidelines to ensure that you won’t be penalized for not having insurance.

The benefit of Healthcare Sharing Programs is that the premiums typically are much less expensive than traditional health insurance since they expect their members to take care of themselves and to pay most costs out of pocket, including preventative services. Coverage under these plans is usually more limited than health insurance and healthcare costs related to “unbiblical” acts are not covered.

Although these programs don’t provide coverage for many services such as preventative care, many healthy people will still end up ahead when compared to exchange plans due to the very low premiums. However, this can be a case-by-case and program-by-program basis, so you need to do your research and make sure that you know the particulars of the one that you’re considering.

One downside to these plans is that they currently do not qualify to be paired with an HSA, even though many of the deductibles are well above the HSA-eligible HDHP limits. Additionally, many of them don’t provide prescription drug coverage. To help with that, you can use a website such as goodrx.com to find coupons for prescription drugs.

There are a ton more details about these programs (there are many options based on different faiths and belief systems) that you can read about here.

Catastrophic Health Insurance

As the name suggests, these policies don’t provide a great deal of coverage. Catastrophic health insurance plans are limited in that only those who are under 30 years old, or those with a hardship exemption or affordability exemption, are eligible to purchase them. Additionally, these plans have low monthly premiums and very high deductibles – $7,150 in 2017. Just as the name implies, they’re really only in place to cover catastrophic events.

Short-Term Health Insurance

Short-term health insurance is a cheaper alternative to traditional plans that offers much less comprehensive coverage than exchange plans. Just remember with these plans – you pay for what you get. Yes, the premiums are extremely cheap, but that’s because these are very similar to catastrophic health plans that offer less benefits and protection than traditional insurance. If you decide to pursue one of these plans, then make sure that you read the fine print carefully.

Catastrophic health plans can last up to one year (many are 3-month plans) and can be renewed for up to 36 months beginning October 2018.

Benefits of these plans are that you can apply at any time and get coverage very quickly. They can be used to make sure that you don’t have a lapse in coverage if you’re changing jobs or will be without health insurance for a short period of time. Some potential downsides to short-term health insurance plans are that they don’t have to offer coverage to everyone like exchange plans do. Those who apply must go through medical underwriting which means that a preexisting condition or bad medical history could keep you from getting coverage.

Most short-term health insurance plans don’t provide prescription drug coverage and many also exclude other coverages such as maternity, hospital coverage, and mental health care. Some don’t even cover preventative care. Also, the deductibles can be extremely high on these plans – I saw some with deductibles of up to $10,000!

These plans do not meet ACA coverage mandates to avoid the tax penalty. They’re called short-term for a reason. This type of insurance is designed to cover gaps between jobs or short lapses in health insurance coverage.

Student Health Plan

Many universities offer basic health insurance to students, which counts as qualifying coverage. This doesn’t apply to me, and is dependent as to what each university offers, so I didn’t explore this in-depth.

Medicaid

Medicaid is government-provided health insurance (free or low-cost) for those considered low-income and those who are disabled. You can find out if you qualify for Medicaid by visiting your state’s Medicaid website.

Trade Organization or Association

I saw this as an option a couple of places, however, health insurance isn’t available to me through any of the organizations and associations that I’m a part of.

Off-Exchange Plans

You’ll read articles telling you that you can find off-exchange health insurance plans. These articles are out-of-date, at least according to the research I’ve done regarding the health insurance landscape in Indiana. There are only a handful of insurers on the Federal exchange (Indiana doesn’t have its own marketplace) and those that used to offer off-exchange plans now only provide group plans due to the costliness of providing off-exchange plans to individuals.

COBRA

COBRA allows you to continue your current employer-provided coverage for 18-36 months (depending on reason for loss). However, the kicker is that you’ll have to pay the full cost of the coverage – the part that the employer was paying as well as part that the you were paying as the employee. In my case, this was to the tune of $765 per month for a HDHP or $930 per month for a PPO plan. No thanks.

Dental & Vision Insurance

When you lose health insurance coverage, you’re going to lose dental and vision coverage as well. The dental insurance plans that I found on the exchange were less than stellar, to say the least. So, I called my dentist’s office and asked about private paying for my dental costs.

I was informed of the Cigna Dental Savings Plan which is a discount program negotiated with dentists. I’ll pay $96 for a year of the Cigna plan and receive discounted prices through my dentist office. Based on the information provided by the person I spoke to on the phone, the $96 more than pays for itself just for the basic dental expenses that I incur on an annual basis. Obviously, you’ll want to use the Dentist Search feature and make sure that your dentist accepts this plan.

I’ve not pursued it yet, but I know that there is private vision insurance as well as discount vision plans available similar to the Cigna Dental Savings Plan.

Conclusion

I’d recommend researching your options if you’re aging off of your current health insurance coverage or your currently don’t have coverage. However, keep in mind that Special Enrollment Periods are limited and, if you’ve missed it, you could have to wait until Open Enrollment to pick up a marketplace plan. Hopefully, I’ve given you a decent overview of what’s available to you and what to look out for as you choose a health insurance plan.

Good luck and let me know if you stumble across anything that I missed!