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Individual Health Insurance

 

Introduction

      My goal in this page is to help you reduce the 40 or so plans I highlight down to one plan.   I can better help you do this by phone, but take some time to browse or study while you are here.   Here is the process I use, which starts with narrowing your choice of Providers:

1. PacificSource:  
   The Hospitals in the Portland area include Emmanuel, Good Samaritan, Meridian Park and Mt. Hood Medical.   The covered doctors/provider network is called the PacificSource Navigator Network.   

2. Providence: 
   The Hospitals in the Portland area include St. Vincent,  Glisan St., Willamette Falls, and Milwaukie Providence.    The covered doctor/provider network is either Providence Choice (larger) or Connect (slightly smaller), depending on the plan you select.   You will need to select a 'Medical Home' clinic after you enroll in one of these networks.

3. Kaiser:
  
The Hospitals in the Portland area are either Kaiser Sunnyside or Hillsboro.  The doctors include all of the Kaiser doctors/providers, and all the providers in the non-Kaiser Portland Clinic offices. 

4.  Moda:
   The Hospitals in the Portland area include OHSU, Tuality, and Adventist.   The doctors/provider network is called the Beacon Network.

 

   ARE YOU ELIGIBLE FOR A MONTHLY ADVANCED-TAX CREDIT?

    Under ObamaCare, many people qualify for a premium tax credits that helps to pay your monthly premium.  This help is based on your age, family size, and projected 'adjusted gross income' for 2020.

    Before you browse my plan comparison worksheets, start by clicking on the link to see if you qualify for a tax credit.   This link will also let you browse plan costs.

     https://www.healthcare.gov/see-plans/ 
 

DEFINITION OF 'HOUSEHOLD': 
    A 'Household' is defined by who will be on your tax return for 2020.
If someone in your household will be on their own tax return for 2020, they should have their own Marketplace account, even if you intend to pay their premium (like and adult child).   Include household members not enrolling in coverage such as kids on OHP or a spouse on Medicare, VA, An employer plan, or Medicare when using the estimator tool.  Please ask me about this if you are uncertain.

PROJECTED YOUR 2020 INCOME:  
    The tax credits are based on what you expect your 'Modified Adjusted Gross Income' to be for 2020.  In addition to this number, add in Social Security income if you receive it
.  This number is difficult to get to, particularly if you are a self-employed person.  You can use your 2018 or 2019 tax returns as a guide to your thinking.  Ask me if you need some help with this calculation as it can get complicated.


INTRODUCTION TO THE 2020 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 Plan coverage may look different on the Marketplace, depending on your income.       

     2020 will have about 43 plans available on the Marketplace.  You can review these spreadsheet in the links below show side-by-side comparisons of my top recommended 21 Bronze, Silver, and Gold plans.    You will note that there is a different rate per person based on your age.   You can mix and match plans to meet your family needs.
 
 

BROWSE MY TOP 8 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. 

     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:

2020_Dan's_Top_Bronze_Plans_Compared.pdf

 

Browse my  top 7 Silver Plans

   Silver level plans offer a deductible range from $3500-$4500,  unless you qualify financially for the 'Cost Sharing' reductions through the Marketplace (determined by income).   

Click on the link below to view my recommended Silver plans compared side-by-side:
 

2020  Dan's_Top_Silver_Plans_Compared.pdf

 

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:

2020_Dan's_Top_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 $8150 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.govHowever, 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?)  Practically, if you have services provided out of network, your out of pocket costs can be much higher.

2. 'COST SHARING' FOR SILVER PLANS
   
For those qualified for a tax credit, those that select a 'Silver' level plan often receive extra help with their deductible, copays and out of pocket costs.   Before you select a plan be sure to review the Silver-Level plans on the Marketplace.

    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 YOUR PLANS EXCLUSIONS AND LIMITATIONS

 

    Now that you've taken a high-level look at the plans comparisons, please visit my provider pages to review the plan brochure.  Example:  If you want a Providence plan, visit my Providence Page and browse the Providence Brochure, where you can read about 

 

'OK DAN, I DON'T QUALIFY FOR A TAX CREDIT, BUT I CAN'T AFFORD THE LOWEST COST BRONZE PLAN EITHER, WHAT SHOULD I DO?'

     I totally 'hear you!'.  I pay over $900 for the lowest cost, high deductible plan myself.   What I do to save some money is to buy a 90 day Short Term Medical plan from October-December.   This cost me only about $380 per month.    You have to say 'No' to the plan 6 qualifying questions, and you should read close to see what you are getting into.   For more information visit my web page, Short Term Medical.

 

 

Try not to worry about how things may change in the future.
All we can do is plan one year at a time.

 

 

 

 

Marketplace Advantages



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.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     

2020 Dan's Top Silver Plans

Click filename below to access file

2020_Dan_s_Top_Silver_Plans_Compared.pdf

2020 Top Silver Plans Compared

Click filename below to access file

2020_Silver_Plans_Compared.pdf

2020 Top Gold Plans Compared

Click filename below to access file

2020_Gold_Plans_Compared.pdf

Dan's Top Bronze Plans Compared

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2020_Dan_s_Top_Bronze_Plans_Compared1.pdf

Dan's Top Gold Plans Compared

Click filename below to access file

2020_Dan_s_Top_Gold_Plans_Compared.pdf