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Individual Health Insurance 2022

 

Introduction

     Selecting the right Individual Health insurance plan in Oregon is a challenge, considering there are about 67 plan options available offered with 6 companies.  The provider networks vary by company and some companies 2 or even 3 different provider networks. Understanding and qualifying for tax credits can also be challenging to accurately understand.

    Before you dive in deep, you may just want to set up an appointment with me.  In a brief conversation I can help you narrow down the 67 plans being offered to the best few to consider.   I can help you quickly sort plans by company and providers.

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

CLICK to make an appointment with Dan Neils 


 

PREVIEW PLANS AND PRICING for 2022


     You can determine your eligibility for a tax credit and view the 67 plans available by clicking the link below.     

 

CLiCK HERE to preview plans &
pricing at www.healthcare.gov
 

 

How much can I earn in 2022 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 2022, and your *household size for 2022.  *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 2022?

*INCOME DEFINITION:   What is your best guesstimated  of your combined, household 'adjusted gross income' for all those on your tax return for 2022

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.  As an example, a couple age 60 can earn up to $220,000 AGI and still qualify for a tax credit.

     O
K, now that you have browsed the plans and pricing....

 

How to sort the 67 plans down to just one? 
 

1.  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.

2.  IS YOUR PREFERRED HOSPITAL IN NETWORK?

   In general, only company for 2022 that contracts with the Providence Hospitals are the Providence plans. Kaiser only uses Kaiser providers. PacificSource & Regence LPN use the Legacy Hospitals.  Moda, PacificSource, Regence, & Bridgespan use the OHSU hospitals.  My 'Provider Directories' page helps you search doctors and other providers year around.  

3. NO FAMILY DISCOUNTS,  AND EACH PERSON HAS THEIR OWN DEDUCTIBLE:     


NO FAMLY 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, with the exception of HSA-Eligible plans.   However, if you have more than 3 kids the 4th kid is free if you are insured under the same policy.

MIX & 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.  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 website.

4. PAY ATTENTION TO THE TERM:  OUT OF POCKET MAXIMUM   


   Note that in a big claim, you pay your annual deductible first, then a percentage, called the coinsurance, then the when 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?)   This is your safety net.  Also be sure to always try to see providers in your contracted network or you will always pay more and/0r may not be covered.

EXAMPLE:   Let me try to illustrate the OOP with a 50 year old male in Oregon City, Oregon who qualifies for no tax credit because he's rolling bank.

PLAN 1:  Providence Standard Bronze plan:  The deductible is $8700 and  out of pocket maximum is $8700.  Once you reached $8700 out of pocket in the calendar year, the plan would pay 100% of most covered services for the rest of the calendar year and then it resets in January.   His premium is $473 per month, or $5676 annual.

Plan 2:  Providence Standard Gold plan:  The deductible is $1500 and the out of pocket maximum is $7300.  Once he reaches the $7300 the plan will pay 100%.  His premium is $686 per month, or $8232 annual.

QUESTION:  Is the Gold plan worth an extra $2556 per year in premiums?. Over 3 years that would be $7668 more in premiums.  Sometimes it is worth it and other times not.  These are the kinds of conversations I have with my clients...difficult issues to sort out.

 What if you have super-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.     

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.

     

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 know, you'd rather have root canal...)

I have a page to the Left devoted to each insurance company ( The Providence Page) for example.  Here you can browse the 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:

    I have done literally thousands of these application and doing it us together will better insure it gets done correctly and without misunderstandings that can lead to  tremendously negative consequences come tax time. 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 a professional helping you complete the enrollment?" .  Should you work through it on your own I would appreciate your saying yes, then adding in broker Dan Neils  NPN 757811.  This is how I am compensated for my services (including this web site 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.   Bring a mask if you would.  I sanitize after each meeting.

 

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 2022 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!) 

2.  COMPLETE THE APPLICATON:  Compete an Oregon application, including info on everyone on your tax return for 2022, 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.

 

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.govHowever, 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.  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

 

1.  THE OUT-OF-POCKET MAXIMUM
   Most plans only cover you when you are seeing 'In Network' providers, with the exception of Emergency Room visits, which are covered nationwide.   The only PPO plan with true out of network coverage is PacificSource.

     The 'Out of Pocket Maximum'  includes the care you receive at 'In Network' providers that applies towards your deductible, coinsurance, and covered prescription drug costs for services performed 'In Network' in a calendar year.  For example, if your plans out of pocket maximum is 800

     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.  In my own home I have a Kaiser HSA plan, my wife has a Providence Choice plan and my son has a Short Term Medical plan.  Ask me about this.

 

 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

 

 

 

 

 

 

 

 

 

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