Individual Health Plans
Open Enrollment 2018 has ended, but you can still buy health insurance if you missed out.
If you missed the December 15 deadline to buy health insurance for 2018, there are still good policies that you can buy now to insure yourself. Please visit my 'Short-term medical' page for more information: I really like the National General plan.
Special Enrollment Situations
You can buy an ACA-qualified plan if you have lost, or will lose, coverage in the next 60 days. Common Special Enrollment situations are losing group coverage, including COBRA, Loss of Oregon Health Plan coverage, a 26-year-old losing coverage on a parents plan, new baby, adopted child, and other situations.
ARE YOU ELIGIBLE FOR A TAX CREDIT?
Before you browse my plan comparison worksheets, start by clicking on the link below to see if you qualify for a tax credit. A tax credit is available only if you purchase coverage through the Federal Marketplace (not direct with the carrier).
Please read the notes below before you click on the link:
HOUSEHOLD: A 'Household' is defined by who will be on your tax return for 2018, not those who live in your home.
INCOME: They are asking what you expect your 'Modified Adjusted Gross Income' to be for 2018. This should be close to line 37 on your 1040 tax return. Best guess.
Oregon offers about 50 health insurance plans for 7 different companies. Most plans are offered through the Federal Marketplace, but some are only direct-written, like Regence. On this web page, I help you reduce the options from 6 companies to one to further examine. After studying the 60 plans being offered, you can view the top 6 plans I recommend by type: Bronze, Silver, and Gold. (least to most expensive)
BROWSE MY TOP 6 LOWER-COST BRONZE PLANS
Bronze Level plans offer the lowest premiums, yet cap your out-of-pocket for in-network coverage nearly the same as the Silver and Gold plans. The Standard Bronze plan is HSA-Eligible for 2018. Click on the link below to see the plans compared side-by-side with rates:
Dan's Top 6 Bronze Plans Compared for 2018.pdf
Browse my top 6 Silver Plans
Silver level plans offer a deductible range from $2000-$3500, unless you qualify financially for the 'Cost Sharing' reductions through the Marketplace. Click on the link below to view my recommended Silver plans compared side-by-side:
Dan's Top Silver Plans Compared for 2018.pdf
Browse my top 6 Gold Plans
Gold plans offer from a $0 to $1000 deductible, and often the best first-dollar coverage for prescription drugs. They are also the most expensive in premium. Sometimes a Silver Level plan with 'Cost Sharing' offers a lower out of pocket than a Gold plan. This is confusing by I can help make it clear. Click on the link below to view my the Gold plans compared side-by-side:
Dan's Top Gold Plans Compared for 2018.pdf
CONSIDER PARTNERING A BRONZE PLAN WITH AN ACCIDENT POLICY
It can be painful coming up with the $6550 deductible should have an Accident or Critical Care situation. Personally, I have a Bronze HSA plan, but I also buy a $6350 Accident plan. (See plan below)
I like a plan underwritten by Madison National Life. The cost for the Plan B policy is either $30.69 for an individual, or $54.87 for more than one person insured. It's a good choice if you lead an active life or are accident prone like I am.
You can read the brochure and enroll any month using my link below:
Here are a few Key Ideas Relating to Individual Plans
1. The OUT-OF-POCKET MAXIMUM
Most people focus on the deductible, which is important to understand. Another key is understanding the term "Maximum out of Pocket" for In-Network covered services. This number includes the deductible, coinsurance, and covered prescription drug costs for services performed 'In Network'. This is assuming all the services are covered, and In-Network. When you meet your plans 'Maximum out of pocket', the plan will cover at 100% your covered expenses for the remainder of the calendar year.
2. 'COST SHARING' FOR SILVER PLANS
For those getting a tax credit, there is extra help for some people where the deductible, copays and out of pocket is reduced only on the Silver-level plans through the Marketplace.
For example, instead of your plan having a $2500 deductible, the Marketplace plan my show your deductible reduced to $1000, $500, $250 or even lower. This is another way the ACA helps out those with lower-middle class incomes afford decent coverage.
3. MIX AND MATCH PLANS
There is a separate rate per person and each person has their own deductible. Consider mix and matching plans and companies to meet each person's need. After consulting with you, I may recommend one person pick one plan, and another a different plan as your needs for the year or budget may require it.
4. TAKE YOUR TIME BECAUSE YOUR DECISION IS CONSEQUENTIAL
I know it's really painful to think about health insurance, and only the most dedicated can stomach taking the time to read the fine print. Health insurance is one of your largest bills each month. Take the time to ask questions and understand what you are buying. One couple I helped quickly signed up with a carrier directly after their COBRA ended. Only 2 years later did they discover they were missing out on $12,000 per year in tax credits. This is one result of not having enough information to make an informed decision and a good reason to work with an expert broker.
5. WHAT IF ALL PLANS ARE UNAFFORDABLE?
For some of my clients who don't qualify for tax credits, thoughts come to just go without insurance. I have another option that costs 50-60% of the cost of the Bronze plans--it's a Short Term Medical plan from National General. Read my Short Term Medical page for more information.
READ THE FINE PRINT AND LIMITATIONS
Now that you've taken a high-level look at the plans comparisons, please visit my provider pages below to:
- Browse the company brochure and read the limitations and exclusions
- Read about the provider networks: I include some useful information you may not know.
- Learn how best to make application and other useful information.
MORE ABOUT THE TAX CREDITS:
With rapidly rising premiums it is critically important to understand exactly how much you can earn and qualify for a monthly tax credit. For example: in 2017 (in Portland area), a couple age 60 can earn about $64,000 adjusted gross income to qualify for a $804 monthly tax credit, but earning $65,000 they qualify for $0 tax credit. That knowledge could save this couple $9648 on their health insurance if they planned to reduce their taxable income.
Consulting with my clients about issues like this is one of the many reasons to work with a broker like myself. Web-brokers and Marketplace representatives just cannot help you understand the many issues beyond the price and coverage.
Try not to worry about how things may change in the future.
All we can do is plan one year at a time.
APPLY DIRECT VS MARKETPLACE
Each year I am increasingly convinced that purchasing your plan through the Marketplace is to your advantage compared with buying direct.
1. TAX CREDITS: You can only qualify for a tax credit if you have coverage through the Marketplace. You may start the year not eligible, then life changes and you are.
2. COVERAGE FOR KIDS: If your children qualify for the free healthcare (Oregon Health Plan), buying through the Marketplace is the way to easily enroll them in one step.
3. EASE OF APPLICATION--NO PAPERWORK: With the Marketplace, you can enroll without renew your plan or enroll without paperwork. It is also easy to place different family members on different plans (if you know what you're doing that is).
4. FLEXIBILITY TO CHANGE PLANS: If you have a major income change mid-year, you MAY be able to change plans if your coverage is through the Marketplace. Buying direct robs you of this flexibility.
6. INITIAL BILLING: If you buy from Kaiser direct you need to pay at the point of application. If you buy Kaiser through the Marketplace you do not need to pay at the point of selecting the plan, but prior to the date of coverage beginning.
WHERE TO START
IF YOU'RE ONE OF MY CLIENTS NOW:
The best thing to do is to call myself or Lee at 503-650-4325 to schedule a phone visit, or in person visit between November 1-December 15. I'll be available 8:00 am to 7:00 pm Monday-Saturday, excluding Thursday's after 6:00 pm. Although the rate increases are painful, I try to make your renewal experience not so.
IF YOU'RE NOT MY CLIENT NOW
I'm happy to help, but need to talk with you before I can make a specific recommendation. Just so you know I am only compensated for my services if you list me as your agent on your direct-application or Marketplace application at no cost to you. How about we start with a phone call to talk over your situation. I am best reached at 503-650-4325 or you can email me at firstname.lastname@example.org
Dan's Top Bronze Plans Compared
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Dan's Top 6 Silver Plans Compared
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Dan's Top 6 Gold Plans
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