Individual Health Insurance 2023

Introduction

     Selecting the right Individual Health insurance plan in Oregon is a challenge, considering there are about 61 plan options available offered with 6 companies.  The provider networks vary by company and some companies 2 different provider networks for you to figure out. Understanding and qualifying for tax credits can also be challenging to correctly understand.

    Many online companies offer slick plan comparison tools, but it is hard to wrap your mind around the varying provider networks without a little guidance.

You can set up an appointment with me by clicking on the link below
or call Dan at 503-650-4325

Click Here to  schedule an appointment with Dan

Preview plans and pricing for 2023

     Before you consider applying for coverage, take time to browse the plans and pricing by using the estimator tool below.   You can determine your eligibility for a tax credit and view the 61 plans available by clicking the link below.     

Click Here to preview plans at www.healthcare.gov 

How to determine if your doctor is 'In Network' for a plan.  Once you can see the plan options, select the 'filter' button, and add in the names of your physicians.     

How much can I earn in 2023 and still qualify for a tax credit?

        When using the estimator tool above, you will see the extra help you qualify for. This comes in the form of an advanced tax credit.   Qualifying for a monthly tax credit is determined by your age, zip code, your *projected household income for 2023, and your *household size for 2023.  *The chart below will show you how much you can earn based on your family size.

*HOUSEHOLD DEFINITION: 
Who will be on your tax return for 2023 (even if they are not applying for coverage)?

*INCOME DEFINITION:   
   What is your best guesstimated  of your combined, household 'adjusted gross income' for all those on your tax return for 2023.  Your Adjusted Gross income is what is on line 11 of a 1040 Federal Tax Return.    Include social security if you qualify.

EXAMPLE:  If your qualify for a $500 per month tax credit, and your plan selected cost $800, you will be billed $300 per month for the insurance.  The limits to qualify have increased in recent years, so now a couple age 60 can earn up to $220,000 AGI and still qualify for a tax credit.

How to sort the 61 plans down to just one? 

Is your doctor in network?

    Is it essential that your doctor is 'In Network'?  If so then when looking at the plans available click 'Filter plans' then 'Add Medical Providers', and then filter the plans by plans that accept your doctor.   This will shorten the list of prospective plans.  You can also filter by plans that accept your prescription drugs if you are on expensive ones.

Is your preferred hospital in network?

  In general, the only company for 2023 that contracts with the Providence Hospitals is the Providence Health plans.   Kaiser only uses Kaiser providers. PacificSource & Regence  use both the Legacy & OHSU Hospitals (The Legacy LHP plans only use the Legacy Hospitals).  Moda uses OHSU, Tuality Community and Adventist.  This knowledge is pretty general, but important to consider.

 My 'Provider Directories' page helps you search doctors and other providers year around.  

NO FAMILY DISCOUNTS,  AND EACH PERSON HAS THEIR OWN DEDUCTIBLE  

No family discount:   
       There are no family discounts:  Each person has their own rate premium based on age, and each person has their own deductible to fulfill for 2023.      However, if you have more than 3 kids the 4th kid is free if you are insured under the same policy.  If you have a tax credit and select different plans, they apply part of the credit to each person.

Mix and match plans: 
       You can mix and match plans to meet your family needs.  For example in my home, I have a Kaiser HSA plan, and my wife has a Providence Connect plan, and my son is on a Short Term Medical plan (This was true a few years back  anyway).  You can ask me about this if you like. 

        This is where having a broker is helpful, to point out some of the subtle things you may miss when visiting the websites on your own.  Ultimately Coverage is subject to the terms and conditions of the insurance contract, not your understanding of it.

Understand 'Cost Sharing' in the Silver Plans:
     If you use the estimating tool above, and you qualify for a tax credit, often times the Silver level plans offer an 'additional savings' benefit that makes the plan lower out pocket than the more costly Gold plan.   Why so?  Based on your family size and income, the government may help to pay down your deductible and out of pocket costs, but they help  with this extra help only in the silver-level plans.

    For example, instead of your Kaiser KP 3500 plan having a $3500 deductible,  the Marketplace plan my show your deductible reduced to $1000, $500, or $250, depending on your 2023 income.     This is another way the ACA helps out those with lower-middle class incomes afford decent coverage.

Pay attention to the term Out Of Pocket Maximum   

     Note that in a larger claim situation (like a hospital stay or surgery), you pay your annual deductible first, then a percentage, which is called the coinsurance, then after you reach your Out of Pocket Maximum usually the plan will pay 100% of your following expenses for the rest of the calendar year. (Confusing, right?)   Costs will always be more if you go to an out of network provider.  Emergency and Urgent Care visits should be covered nationwide if you need emergency care.

 Do you have any expensive prescriptions?   

     Generally the 'Standard Silver or Standard Gold' plans with any company will offer the best prescription drug coverage without having to meet a deductible first on any covered drug.  Each company has a different list of covered drugs--with some drugs always excluded.  If you take an excluded drug, your doctor can try to appeal to the company and request a formulary exception.   If you get a drug denied, you can always try an appeal again if your doctor things this drug is best for you. 

GOODRX.COM  SAVINGS for RX: 

        When looking at prescription drug costs, first go to the website www.gooodrx.com to see what the best 'cash' price is for the drug.  Sometimes using goodrx.com is less expensive than the cost under the insurance plan.    For example, my gout medication was $15 with the insurance and only $8 using Goodrx pricing.  

READY TO APPLY?

      That's great!  There a lot more I think is important to consider before making application--like reading the full plan summary and reviewing the plan 'limitations and exclusions' sections.   

I have a page to the Left devoted to each insurance company ( The Providence Page) for example.  Here you can browse the 2023 plan brochure, which includes the plans  a partial list of the plans limitations and exclusions.  I also include links to do nurse video visits, the nurse hotline number, and customer service and claims contact numbers.

WHERE TO APPLY?

     I assist my clients apply for coverage through www.healthcare.gov  While most people could manage to navigate this site and enroll on their own here are a few benefits of working through with me:

1. REDUCE COSTLY ERRORS:   
       When I help you complete the application the odds of a costly mistake goes down. Particularly if you misunderstand the income of dependent parameters.  I can also help you complete the enrollment in about a quarter the time it would take to correctly apply on your own.   

2.  NO COST EXPERT HELP:  
      Fortunately, I do not need to charge for my services.  But I am only compensated if you list me as your broker on your enrollment.  Broker commissions are paid by the insurance carriers, not the consumer, but I am only compensated if you lists me as your broker.  

3.  IF YOU DE DECIDE TO APPLY ON YOUR OWN, THAT'S FINE:    
      The application does ask "Is anyone helping you complete the enrollment?"   

I would appreciate your checking YES, and adding in broker Dan Neils  NPN 757811

     This is how I am compensated for my services (including this website education) and this come at no cost to you.  It appoints me as your broker, I'm available to you 12 months a year should you need assistance or guidance.  I also will get involved if you are having a problem with the insurance company or a rejected claim.

     SCHEDULE AN APPONTMENT WITH DAN 

1.  MAKE AN APPOINTMENT USING MY ONLINE LINK:   
    To get on my calendar for a phone or in-person appointment,  I have a online calendar link to set up an appointment.   

CLICK HERE to make an appointment with Dan Neils 

2.  GIVE ME A CALL TO SET UP AN APPOINTMENT:   

    My office number is 503-650-4325  If you don't like calling for appointments, email me at danneils@gmail.com with a day and time or two and we'll work it out.   

3. HOW LONG DOES IT TAKE AND HOW CAN I PREPARE TO APPLY?

     Start to finish I can complete a Marketplace enrollment in  10-20 minutes if you have your dob, ss numbers, and projected 2023 income ready to go.  The brief steps include:

1.  CREATE AN ACCOUNT: 
    Go to www.healthcare.gov and create an account.  Your email used is your login and you are asked to create a password and security questions.  (please write these down, as well as the security question answers).   

2.  COMPLETE THE APPLICATON: 
    Including in your application everyone on your tax return for 2023, even if they are not applying for coverage.   At the end of this you receive a determination whether you qualify for a tax credit or not.

3.  SELECT A PLAN: 
    The final step is selecting a health insurance plan for each family member enrolling.   They offer an option of adding a dental plan as well.  You would be wise to consult with me before your final plan selection as the provider networks can be hard to follow from plan to plan.

APPLY Directly 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.   

    For most people I recommend purchasing through the Marketplace, even if you earn too much for a tax credit.  The process is paperless, and no money down is required and the coverage is identical.  If  your life or income changes, the Marketplace offers you far greater options compared with applying directly to the carrier

Here are a few more things to consider relating to Individual Plans

 If health insurance stresses you out...

 Try not to worry about how things may change in the future:

All we can do is plan one year at a time.
 

Matthew 6:24   'Therefore do not worry about tomorrow, for tomorrow will worry about itself.   Each day has enough trouble of it's own'.   --Jesus