Ask the Medicare Specialist

Question from Tammy: I really enjoyed your New to Medicare Series that's been running in the Daily Courier. Thank you. I'm still a couple years away from turning 65 and would like to retire soon, if possible. I'm just not sure what I would do about health insurance for the next two and a half years. Do you help people like me find reasonable priced health insurance? What are my options? Can you give me some advice?

Answer: For those of you who want to read the New to Medicare series, you can find it on our website, www.getyourbestplan.com as well as our Facebook page which is also titled Ask the Medicare Specialist. If you're going to be turning 65 or going on Medicare Part B in the near future, the series is designed to walk you through the process, from start to finish, on how and when to sign up for Medicare, to choosing the right plan that fits your needs and budget, and everything in between. The Facebook page also has 3 other fun and educational weekly series that those on Medicare will find very helpful.

The licensed agents at The Health Insurance Store do indeed work with people like Tammy who want to retire early, the self-employed, and those who may not get health insurance at their job. We have helped thousands of clients enroll in individual health insurance. Anyone who will be losing health coverage from their job, be that voluntary or involuntary, from Medical Assistance or the VA can apply at any time during the year.

Most people are surprised how affordable individual health insurance is. This is due to federal subsidies, or tax credits as they're sometimes referred to, that help reduce premiums. According to an AI overview, 93% of Affordable Care Act applicants qualify for a subsidy.

Let me give some examples. A Fayette County married couple, age 62, who will have a Modified Adjusted Gross Income of $50,000 a year, qualify for a high deductible health insurance plan for as little as $0/month. That is not a typo. This policy isn't what I would advise the majority of people to choose, but those in good health may want to consider it as an option.

The plans we recommend most for Fayette County residents are with UPMC. For the same couple, one of my favorite UPMC plans is under $3 per month. It has a higher deductible and is designed to be paired with a Health Savings Account (HSA) which provides some nice tax incentives. I insure myself and my family this way. HSA compatible plans also aren't for everyone, so for those who want a more conventional plan with lower deductibles, they're also reasonable. A $1,000 deductible plan would have a premium of $124/month and a $0 deductible plan $255/month. These prices are the total cost for both husband and wife, not per person. For many these premiums may be less expensive than the coverage from their employer.

Please be advised that the rules and regulations of the Affordable Care Act are complicated and there are some very important facts that everyone needs to know.

In Western Pennsylvania there are only three companies selling true major medical individual health insurance that puts an annual limit on out-of-pocket medical bills. In Fayette, those are Ambetter from PA Health and Wellness, UPMC, and Highmark. It's just UPMC and Highmark in many other counties. Any other company marketing plans not named Ambetter, UPMC, or Highmark IS NOT selling health insurance as you know it! They're indemnity plans and can leave you exposed to tens of thousands, even hundreds of thousands of dollars in medical bills and/or the possibility of not being able to access to the necessary care in the event of a serious diagnosis such as cancer, a bad accident, sudden heart attack, or any other issue that would result in a lengthy hospitalization or need for ongoing outpatient services. Those on indemnity plans can't apply for other coverage outside the ACA Open Enrollment Period that generally runs November 1st through December 15th. Once Open Enrollment ends, only those who are losing health coverage from a job, Medical Assistance, or the VA are eligible to enroll in an ACA Plan other times during the year.

For the prices I quoted today in the column, I used a married couple making $50,000 a year. Those who earn less would have lower premiums for the $1,000 and $0 deductible plans. Those with incomes greater than $50,000 would pay more.

I do not advise trying to navigate this process and applying on your own. Failure to properly estimate income or other errors made on an application can result in owing significant money to the IRS. You could also find yourself not insured well as I just described. Give The Health Insurance Store a call or visit us at our office if you would like additional information, a quote, or have questions. There's never a charge for our services.

Feel free to email me personally as well at [email protected].