Individual Health Plans
Open Enrollment ended 12/15/18. However, if you are without insurance there is a path to get you covered within a few months. Please call Dan at 503-650-4325 to discuss your situation. Read on.
Evaluating the myriad of plans out there can be intimidating to anyone. You need to evaluate the coverage, the various plan networks, and other factors to narrow the many choices down to the best one. I work really hard each year learn and understand all of the options you have available. Both the coverage and cost changes annually.
ARE YOU ELIGIBLE FOR A MONTHLY ADVANCED-TAX CREDIT?
Premium tax credits that help pay your premiums may be available based on your income projection for 2019, as well as your family size (who will be on your tax return in 2019). Before you browse my plan comparison worksheets, start by clicking on the link to see if you qualify for a tax credit.
A 'Household' is defined by who will be on your tax return for 2019.
If someone in your home will be on their own tax return for 2019, they should have their own Marketplace account, even if you intend to pay the premium.
The tax credits arebased on what you expect your 'Modified Adjusted Gross Income' to be for 2019. This should be close to line 37 on your 1040 tax return. It's a guesstimate for a self-employed person. You can use your 2018 tax return as a guide to your thinking. Ask me if you need some help with this calculation as it can get complicated.
INTRODUCTION TO THE 2019 PLANS
Keep in mind as you browse my plan comparisons that your premium may be much lower if you qualify for a tax credit, and the Silver Plans may look different on the Marketplace, depending on your income.
Each year I study the 50 or so plans offered from the 7 individual companies in Oregon. I carefully compare benefits and networks, then I create a spreadsheet to show you side-by-side comparisons of my top recommended Bronze, Silver, and Gold plans.
You may notice I don't have every plan from every company in my comparisons. I narrow the many options down to the best 6 of each type. I'm happy to share why each plan was included and others omitted.
BROWSE MY TOP 6 LOWER-COST BRONZE PLANS
Bronze Level plans offer the lowest premiums yet cap your out-of-pocket costs (for in-network coverage) nearly the same as the Silver and Gold plans.
Please note that the Standard Bronze plan will not be HSA Eligible for 2019. A plan is only HSA-Eligible if there is an HSA in the name.
Click on the link below to see the plans compared side-by-side with rates:
Browse my top 6 Silver Plans
Silver level plans offer a deductible range from $2500-$3500, unless you qualify financially for the 'Cost Sharing' reductions through the Marketplace (determined by income). In the Marketplace, the Kaiser $3500/30 plan was the least expensive plan for 2019.
Click on the link below to view my recommended Silver plans compared side-by-side:
Browse my top 6 Gold Plans
Gold plans offer deductibles ranging 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' may offer a lower out of pocket than a Gold plan. This is confusing by I can help make it clear when we talk.
Click on the link below to view my the Gold plans compared side-by-side:
2019 Dan's Top_5_Gold_Plans_Compared.pdf
A NOTE ABOUT THE CATASTROPHIC PLANS
The lowest cost plan for kids under 20 is the PacificSource Catastrophic plan, which is $112 per month. The plan has a $7900 deductible (Yikes!) but covers an annual exam in full, plus your first 3 visits per year to a Primary Care is a $0 copay, which is great! The plan also has a $500 Accident Rider which picks up 100% of the first $500 in expenses related to an Accident, which is also great, as kids are clumsy and have accidents!
Another twist of the Catastrophic plans is you can't get a tax credit if you select one of these plans, and can only apply directly to PacificSource. You can enroll directly on my PacificSource page for this plan.
Buy Direct with the Carrier or use the Federal Marketplace?
With Individual Health Insurance you have an option of buying directly from a company--like Kaiser of Providence, or through the Marketplace at www.healthcare.gov . However, you can only qualify for a tax credit if you purchase through the Marketplace--the cost is the same.
For most people I recommend purchasing through the Marketplace, even if you earn too much for a tax credit. The process is paperless, and if your life and income change, the Marketplace offers you far greater options compared with applying direct.
Here are a few Key Ideas Relating to Individual Plans
1. THE OUT-OF-POCKET MAXIMUM
Assuming the services you are receiving are both 'In Network', and all 'covered services', your Out of pocket Maximium is supposed to be the most you will pay out of pocket for that calendar year before the company pays 100%.
The 'Out of Pocket Maximum' includes the deductible, coinsurance, and covered prescription drug costs for services performed 'In Network'. In practice this is harder to count on when you get into huge claims. When you meet your plans 'Maximum out of pocket', the plan should contractually cover 100% of your covered expenses for the remainder of the calendar year. (OK, I'm sounding like an attorney here, but have you ever tried to read an insurance contract?)
2. 'COST SHARING' FOR SILVER PLANS
For those qualified for a tax credit, there is extra help for some people where the deductible, copays and out of pocket are reduced--but only on the Silver-level plans through the Marketplace. (I could spend a page trying to explain this...)
For example, instead of your Kaiser KP 3500 plan having a $3500 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. Is it complicated...yes.
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.
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 (like an illness that affects income, or loss of employment)
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 paperwork and easily reenroll each year. 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
Give Dan a call at 503-650-4325 and we can discuss your situation.
Dan's top 5 Gold Plans
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Top 6 Silver Plans
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