Need help buying health insurance

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
Post Reply
Topic Author
chessmaster
Posts: 60
Joined: Sat Sep 07, 2013 8:56 pm
Location: Auburn Hills, MI

Need help buying health insurance

Post by chessmaster »

I'm trying to get health insurance before April 1st since I recently found out that United Healthcare is cancelling my father's plan that I was part of. I don't want to get hit with the government fine.

I am 24 years old, non smoker, good health and employed in North Dakota

I had a few questions:

1) What is the government subsidized healthcare and should I get a government plan or get a normal plan? What are the pros, cons of each?
2) I thought the Affordable Health Care Act made it illegal for employers to not offer health care. Can somebody explain more on this? I am employed through a contractor but I don't think they offer health care
make_a_better_world
Posts: 292
Joined: Mon Mar 18, 2013 11:55 pm

Re: Need help buying health insurance

Post by make_a_better_world »

I am a physician and even I have trouble understanding these things sometimes.

This is a very primitive explanation, but essentially the law has changed so that insurance companies cannot use pre-existing conditions anymore. Insurance will also now be sold through exchanges, where insurance companies must clearly outline the plans and compete with each other. The problem with all this so far is that there have been many difficulties with getting everything running.

We are currently in kind of a limbo period. Private insurance companies are still allowed to sell insurance privately using pre-existing conditions to risk stratify for one more year. When you do an application like this, there will be pages upon pages of detailed medical questions, doctor visits, any medications taken for any reason, etc. for the last 5 years. They may deny a payment if something you claim later was not adequately disclosed up front. If you do disclose something, they may increase your premium or even deny you coverage.

You may also now sign up through the exchange with an application that does not use pre-existing conditions (healthcare.gov). The problem with this currently is that the website does not work well and you may end up on the phone or an online chat several times to get signed up.

After a year, this is supposed to change to where no private insurance companies can use pre-existing conditions at all.

The insurance plans through healthcare.gov are similar (if not the same) as if you bought them privately in terms of what they cover when you have a policy. For you there will likely not be much difference in cost since you are so young and low risk. That being said, you may qualify for a tax credit to pay for the insurance if your income is low enough. The only way to receive this credit is to sign up through the exchange.

For someone like your dad who is much older and may have some existing medical conditions, he may want to check out the exchange to see what price he can get. The main way risk is stratified in the exchange is based on age and variables such as being a smoker.

For your second question, employers are being required to offer insurance, but only if they meet certain requirements (such as number of full time employees). Many businesses will not be required to offer insurance, or will find a way to restructure so that they do not have to. This is the rationale behind the tax credit to help people pay.

Hope that helps.
Tony_L
Posts: 92
Joined: Tue Apr 07, 2009 8:13 pm

Re: Need help buying health insurance

Post by Tony_L »

I don't think you will get hit with a fine. Obama administration said today that "If you like your plan, you can keep your plan" supposedly until 2017 - after the next presidential/national elections. I assume then that you will not be subject to a fine until at least then. I'm not positive of all this but it's how I read the latest set of changes. Lord knows what tomorrow will bring!
yosh99
Posts: 240
Joined: Thu Apr 19, 2012 8:44 pm

Re: Need help buying health insurance

Post by yosh99 »

1) What is the government subsidized healthcare and should I get a government plan or get a normal plan? What are the pros, cons of each?
There are no Obamacare government plans. All the plans are private. The only government plans are Medicare, Veteran's Health, and the health care plans offered to government employees. Obamacare is a law that sets up rules private insurance companies have to follow, one of the most important of which is that pre-existing conditions cannot be considered. It also offers subsidies based on your income, but to get these subsidies, you need to sign up through one of the government exchanges. You can go to healthcare.gov, pick one of the PRIVATE insurance plans offered and see if you get a federal subsidy. If you make a lot of money and aren't eligible for a subsidy, you can go directly to the website of any insurance company in your area and apply directly. They are the same policies at the same prices.
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Need help buying health insurance

Post by cheese_breath »

Is your father going to get a new plan, and can you get on it?
The surest way to know the future is when it becomes the past.
goaties
Posts: 542
Joined: Fri Jan 29, 2010 3:15 pm

Re: Need help buying health insurance

Post by goaties »

deleted
Last edited by goaties on Sat Nov 19, 2022 11:43 pm, edited 1 time in total.
User avatar
frugaltype
Posts: 1952
Joined: Wed Apr 24, 2013 9:07 am

Re: Need help buying health insurance

Post by frugaltype »

Tony_L wrote:I don't think you will get hit with a fine. Obama administration said today that "If you like your plan, you can keep your plan" supposedly until 2017 - after the next presidential/national elections. I assume then that you will not be subject to a fine until at least then. I'm not positive of all this but it's how I read the latest set of changes. Lord knows what tomorrow will bring!
http://www.nytimes.com/2014/03/06/us/po ... icies.html
Topic Author
chessmaster
Posts: 60
Joined: Sat Sep 07, 2013 8:56 pm
Location: Auburn Hills, MI

Re: Need help buying health insurance

Post by chessmaster »

cheese_breath wrote:Is your father going to get a new plan, and can you get on it?
He's near the poverty level so probably not
User avatar
frugaltype
Posts: 1952
Joined: Wed Apr 24, 2013 9:07 am

Re: Need help buying health insurance

Post by frugaltype »

chessmaster wrote:
cheese_breath wrote:Is your father going to get a new plan, and can you get on it?
He's near the poverty level so probably not
If he's near the poverty level, he may be able to get basically free insurance through the exchange. Please do tell him that.

I don't know if that covers kids, however.
Topic Author
chessmaster
Posts: 60
Joined: Sat Sep 07, 2013 8:56 pm
Location: Auburn Hills, MI

Re: Need help buying health insurance

Post by chessmaster »

frugaltype wrote:
chessmaster wrote:
cheese_breath wrote:Is your father going to get a new plan, and can you get on it?
He's near the poverty level so probably not
If he's near the poverty level, he may be able to get basically free insurance through the exchange. Please do tell him that.

I don't know if that covers kids, however.
I will mention it to him, thanks
rkhusky
Posts: 17763
Joined: Thu Aug 18, 2011 8:09 pm

Re: Need help buying health insurance

Post by rkhusky »

Tony_L wrote:I don't think you will get hit with a fine. Obama administration said today that "If you like your plan, you can keep your plan" supposedly until 2017 - after the next presidential/national elections. I assume then that you will not be subject to a fine until at least then. I'm not positive of all this but it's how I read the latest set of changes. Lord knows what tomorrow will bring!
The Individual Mandate has not be delayed (although the House just voted to do that, it probably won't pass the Senate or President). You are still required to have insurance or pay the alternative tax.
yosh99 wrote: The only government plans are Medicare, Veteran's Health, and the health care plans offered to government employees.
The health care plans offered to government employees are also from insurance companies.
cubedbee
Posts: 312
Joined: Tue Aug 04, 2009 11:13 am

Re: Need help buying health insurance

Post by cubedbee »

chessmaster wrote:I'm trying to get health insurance before April 1st since I recently found out that United Healthcare is cancelling my father's plan that I was part of. I don't want to get hit with the government fine.

I am 24 years old, non smoker, good health and employed in North Dakota

I had a few questions:

1) What is the government subsidized healthcare and should I get a government plan or get a normal plan? What are the pros, cons of each?
2) I thought the Affordable Health Care Act made it illegal for employers to not offer health care. Can somebody explain more on this? I am employed through a contractor but I don't think they offer health care
You should log onto the ND Exchange and see if you qualify for a government subsidy. As others have said, unless you are eligible for Medicaid (133% fpl if ND expanded, for a single male could be much much less, like 33% fpl, if they didn't expand), you are buying private insurance. The exchange will determine if you are eligible for Medicaid, or if not if you are eligible for an exchange subsidy. There are two types of Exchange subsidies---APTC ( advance premium tax credits) and CSR (cost share reduction). If you are eligible for both, you will be able to get good benefits with cheap costs by buying a silver policy in exchange.


If you're not eligible for subsidies, you should look at off-exchange policies and compare network. A given metal level like silver has to cover the same basic % of total claims on or off Exhange, 68%-72%. But the off-exchange could very well have a broader network of doctors so you can get the insurance company to pay that % at more places

It is not illegal for employers to not offer health insurance. Employers <50 can do so with no penalty ever. Employers >50 can do so as well--in 2014 there is no penalty. In 2015 there is currently supposed to be a penalty of 2K or 3k per employee if the employer mandate aspect of the law doesn't get delayed again---there are news reports it might. But even if the employer mandate happens, they can choose not to provide coverage and pay the fine. All the fines are related to full-time (30+ hours for ACA purposes). 51+ employers pay no penalty for failing to provide health insurance to part timers.
User avatar
magellan
Posts: 3489
Joined: Fri Mar 09, 2007 3:12 pm

Re: Need help buying health insurance

Post by magellan »

make_a_better_world wrote:Private insurance companies are still allowed to sell insurance privately using pre-existing conditions to risk stratify for one more year. When you do an application like this, there will be pages upon pages of detailed medical questions, doctor visits, any medications taken for any reason, etc. for the last 5 years. They may deny a payment if something you claim later was not adequately disclosed up front. If you do disclose something, they may increase your premium or even deny you coverage.
As I understand the law, as of January 1, 2014 insurers are not allowed to consider health status or ask about preexisting conditions on applications for new health insurance. Premiums charged on new policies can not be based on prior health status. Period.

The recent exceptions and extensions that we're reading about have to do with existing policies that folks bought before the January 1st cutoff date. If you don't have a policy already, these exceptions don't apply.

In summary, when purchasing new health insurance coverage, your premiums will not be based on your medical history and the insurance application won't ask about your health status. I don't believe there are any exceptions to this.

Jim
rkhusky
Posts: 17763
Joined: Thu Aug 18, 2011 8:09 pm

Re: Need help buying health insurance

Post by rkhusky »

magellan wrote: In summary, when purchasing new health insurance coverage, your premiums will not be based on your medical history and the insurance application won't ask about your health status. I don't believe there are any exceptions to this.
They can ask if you are a smoker or not and how old you are. They can charge you more/less depending on your answers.
jwa
Posts: 219
Joined: Sat Aug 04, 2012 3:53 pm

Re: Need help buying health insurance

Post by jwa »

I didn't take the time to read every post so perhaps someone has already mentioned this. What state are you in? Perhaps your state adopted expanded medicare at the beginning of this year. Most states did and if in one of those states with a near poverty level income you should qualify for free coverage via medicaid. The federal government web site will direct a person in which way to go.

Good luck!
jeff1949
Posts: 876
Joined: Mon Mar 05, 2007 9:43 am
Location: Salem, OR

Re: Need help buying health insurance

Post by jeff1949 »

Have you tried the national marketplace website for health care? They have a FAQs section that should answer many of your questions.

https://www.healthcare.gov/all-topics/

https://www.healthcare.gov/marketplace/b/welcome/
Last edited by jeff1949 on Thu Mar 06, 2014 12:45 pm, edited 2 times in total.
Topic Author
chessmaster
Posts: 60
Joined: Sat Sep 07, 2013 8:56 pm
Location: Auburn Hills, MI

Re: Need help buying health insurance

Post by chessmaster »

I am in Fargo ND and my father is in KS.

So as I understand the government subsidizes already existing policies from insurance companies by offering a tax credit? How is this beneficial seeing as the people that need it don't really see much benefit from getting a tax credit at the end of the year, they usually need that money for rent etc. Is there something I'm missing?

I tried using the Kaiser Family Calculator and the money I made in 2013 qualifies me for a subsidy but the money I expect to make in 2014 doesn't (or it might if I can't find another job at the end of my contract). How do I work around this seeing as I'm not entirely sure how much money I'll make in 2014?

Also what does the term Obamacare actually mean? Seeing as there is no government insurance, it's just government subsidys of already existing insurance plans.

Thanks for the help
rkhusky
Posts: 17763
Joined: Thu Aug 18, 2011 8:09 pm

Re: Need help buying health insurance

Post by rkhusky »

chessmaster wrote: Also what does the term Obamacare actually mean? Seeing as there is no government insurance, it's just government subsidys of already existing insurance plans.
Among other things, Obamacare created the requirement to have health insurance, put new rules on what insurance companies had to cover, let children 26 and under remain on their parents insurance, removed pre-existing condition criteria, put limits on the premium that could be charged to smokers and older customers, created a system of need-based subsidies, created new taxes to (partially?) pay for the subsidies, created a web site to help people connect to insurance companies, and created 3 or 4 levels of insurance with differing costs, deductibles and co-pays.
Last edited by rkhusky on Thu Mar 06, 2014 12:43 pm, edited 1 time in total.
TheGreyingDuke
Posts: 2219
Joined: Fri Sep 02, 2011 10:34 am

Re: Need help buying health insurance

Post by TheGreyingDuke »

If your income is low enough, you don't wait until the end of the year to get your subsidy, your premium is discounted up front
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
J295
Posts: 3401
Joined: Sun Jan 01, 2012 10:40 pm

Re: Need help buying health insurance

Post by J295 »

The process is admittedly challenging. You may consider trying to locate a trustworthy local agent to help you choose a plan. I understand from personal experience that some agents will assist in this process inasmuch as they can be designated as agent of record with the insurance company and receive a commission irrespective of whether a subsidy is involved (and the customer cost is the same with or without an agent).
AspiringDoc
Posts: 20
Joined: Sun Jun 23, 2013 4:14 pm

Re: Need help buying health insurance

Post by AspiringDoc »

J295 wrote:The process is admittedly challenging. You may consider trying to locate a trustworthy local agent to help you choose a plan. I understand from personal experience that some agents will assist in this process inasmuch as they can be designated as agent of record with the insurance company and receive a commission irrespective of whether a subsidy is involved (and the customer cost is the same with or without an agent).
http://www.nd.gov/ndins/healthcarereform/

I don't know anything about North Dakota specifically, but what I have read on the news about Kentucky's navigators, it seems that if you can get an appointment with one, it's well worth it.
make_a_better_world
Posts: 292
Joined: Mon Mar 18, 2013 11:55 pm

Re: Need help buying health insurance

Post by make_a_better_world »

magellan wrote:As I understand the law, as of January 1, 2014 insurers are not allowed to consider health status or ask about preexisting conditions on applications for new health insurance. Premiums charged on new policies can not be based on prior health status. Period.

The recent exceptions and extensions that we're reading about have to do with existing policies that folks bought before the January 1st cutoff date. If you don't have a policy already, these exceptions don't apply.

In summary, when purchasing new health insurance coverage, your premiums will not be based on your medical history and the insurance application won't ask about your health status. I don't believe there are any exceptions to this.

Jim
It looks like you are correct, Jim. And now it's two years instead of one that existing policies can be renewed.
bluemarlin08
Posts: 1561
Joined: Wed Aug 29, 2007 12:18 pm

Re: Need help buying health insurance

Post by bluemarlin08 »

If you don't have any pre existing conditions, don't need maternity coverage or anticipate needing nervous/mental disorder treatment, consider a short term medical plan. Although you will have to pay the penalty, premiums are dramatically less than ACA plans.
yosh99
Posts: 240
Joined: Thu Apr 19, 2012 8:44 pm

Re: Need help buying health insurance

Post by yosh99 »

chessmaster wrote:I am in Fargo ND and my father is in KS.
If you live in Fargo, consider moving across the river to Moorhead. You'd be absolutely amazed at how much better the health care systems are in Minnesota.
Last edited by yosh99 on Thu Mar 06, 2014 6:33 pm, edited 1 time in total.
denovo
Posts: 4808
Joined: Sun Oct 13, 2013 1:04 pm

Re: Need help buying health insurance

Post by denovo »

You don't need an agent, try your luck on the exchange.
"Don't trust everything you read on the Internet"- Abraham Lincoln
bluemarlin08
Posts: 1561
Joined: Wed Aug 29, 2007 12:18 pm

Re: Need help buying health insurance

Post by bluemarlin08 »

Most of the independent agents I know will not write business on the exchange. Carriers have reduced commissions over 75% since this bill passed. Many have left this portion of the insurance business.
donall
Posts: 1079
Joined: Tue Mar 13, 2012 6:45 am

Re: Need help buying health insurance

Post by donall »

Assuming you have no other dependents, see if you can stay on your dad's health insurance policy (there should be another policy if the current one is cancelled) until you turn 26.
If your income is between about $16K to $45K then explore the Marketplace plans to see what type of subsidy is available. If your yearly pay is less than $30K, Silver plans may be most cost effective as they have subsidies and cost sharing, that can reduce deductibles, etc.
If you make more than $45K, then go to an insurance broker or just register online or on the phone with a large insurance co (such as Blue Cross Blue Shield) in your area.

Since you are young, your health insurance premium will be low, so you will do fine no matter which way you decide to go.
User avatar
magellan
Posts: 3489
Joined: Fri Mar 09, 2007 3:12 pm

Re: Need help buying health insurance

Post by magellan »

donall wrote:If you make more than $45K, then go to an insurance broker or just register online or on the phone with a large insurance co (such as Blue Cross Blue Shield) in your area.
Even if you're over the income limit, shopping on the exchange may be the easiest way to compare costs from multiple providers and even apply for coverage.

Things at BCBS should be better now, but back in December I thought I'd avoid the healthcare.gov fiasco and apply for coverage directly through BCBS. It was a huge fiasco that cost me several phone calls and many hours waiting on hold. I never got confirmation that they had my application. As the deadline approached, I eventually reapplied for the same policy through healthcare.gov and that process went off without a hitch.

Jim

(edited to clarify that I reapplied for the same policy on healthcare.gov)
Last edited by magellan on Fri Mar 07, 2014 9:13 am, edited 1 time in total.
goaties
Posts: 542
Joined: Fri Jan 29, 2010 3:15 pm

Re: Need help buying health insurance

Post by goaties »

deleted
Last edited by goaties on Sat Nov 19, 2022 11:42 pm, edited 1 time in total.
BostonPickEm
Posts: 37
Joined: Wed Mar 05, 2014 10:05 am

Re: Need help buying health insurance

Post by BostonPickEm »

Lot's of good advice on this one. My $0.02: explore whether or not you are eligible for a subsidy. If you are, consider purchasing a plan through healthcare.gov, which is the exchange for ND given that it did not establish an exchange on its own. As another poster mentioned, bear in mind the networks when selecting a plan. If a plan's pricing appears "too good to be true," it probably is. Healthcare.gov is transparent, but medical insurance is complex and difficult to understand. I don't know much about ND, but I think most of the state is quite rural. Local HMO's may have broader networks than the national carriers there (BCBS, Aetna, UHC, Cigna, etc.), but not sure. If you are not eligible for a subsidy, and do not have any pre-existing conditions and are comfortable with being individually underwritten, consider purchasing insurance directly through the carriers and compare pricing to the exchanges. I personally don't think I would use an independent agent for purchasing healthcare.

If you make less than ~$46, you're likely eligible for some type of subsidy, which as another poster mentioned, is discounted up front. The other price points for exchange-based health insurance are age, smoker/tobacco status and location. There are many different types of plans from many carriers available on the exchange, you should be able to find something that makes sense for you. Healthcare.gov is very usable at this point as I understand.

I hope that helps.
User avatar
magellan
Posts: 3489
Joined: Fri Mar 09, 2007 3:12 pm

Re: Need help buying health insurance

Post by magellan »

BostonPickEm wrote:If you are not eligible for a subsidy, and do not have any pre-existing conditions and are comfortable with being individually underwritten, consider purchasing insurance directly through the carriers and compare pricing to the exchanges.
Once again, medical underwriting is illegal on all new healthcare policies.

It doesn't matter if you apply through an exchange or directly with private insurers, you cannot be asked about your medical history, preexisting conditions, or health status.

The only personal factors that impact the premiums on a new policy are your address, age, and whether you smoke.

Jim
Post Reply