Napa's Health Insurance Guys: Sandwich generation seeks health insurance

Dear Kyle, Tom and Alan:

It has dawned on me recently that I'm part of the "sandwich generation" — my kids are in their twenties, my folks in their sixties.

Meanwhile, my wife and I are in our forties. The kids are on their own and my parents are doing fine and very independent. Can you give me a thumbnail sketch of what health insurance might cost?

Thanks.

Mitch

Kyle: As a matter of fact, we can! In our last column (2/15/23) we went over the fact that open enrollment was over and the only way to get coverage now would be if you were eligible for a "qualified life event."

Al: Actually, we pretty much beat it to death because we referred to a four-page listing from Covered California going over each of the special events that could guarantee getting a plan.

Kyle: Correct. The most common events are things like losing an employer plan, moving, changing marital status, etc. Anyway, going direct to an insurance company is an option, but the most lenient is Covered California due to the many exceptions. For each age group, we compared only the Bronze, Silver and Gold plans. Platinum is available, but is by far the most expensive.

So, here go the thumbnail sketches:

For a household of two, aged 24 and 25, earning an annual household income of $60,000, the monthly subsidy is $496.02. Remember that a subsidy is only available through Covered California, and, you must be very accurate in reporting your income and changes to your income!

For this couple, the least expensive plan is the Kaiser Bronze 60 HDHP HMO with a monthly premium of only $152.87. The Anthem Blue Cross Silver 70 EPO is $332.41, and the Kaiser Gold HMO is $417.76.

Tom: FYI, HMO means Health Maintenance Organization which means a very defined and limited network plus a Primary Care Physician (PCP) through whom all things are managed. The acronym HDHP means High Deductible Health Plan which means you are allowed to set up a Health Savings Account (HSA). The acronym EPO means Exclusive Provider Organization which usually means a larger network than many HMOs.

Kyle: OK, back to the thumbnail sketches. For the "sandwich" couple, aged 44 and 45, $100K income, the subsidy is $469.17 per month. The Bronze 60 HMO through Kaiser is $466.88; the Anthem Silver 70 EPO is $705.28; the Kaiser Gold HMO is $826.27.

Finally, we put the grandparents at 63 and 64 with an annual income of $120,000. Their subsidy would be $1,616.91 monthly (yes, that's a big one!).

For them, the Western Health Advantage Bronze 60 HMO is only $344.15 per month; the Anthem Silver 70 EPO is $843.59; and the Kaiser Gold HMO is $1,097.98. By the way, Western Health Advantage has a much smaller network than Kaiser.

Al: The Governor's office has announced that there is an additional Special Enrollment Period (SEP) due to "severe weather" conditions in the state. So, in addition to all the qualified life event exceptions to closed enrollment, you can add one more to the list. It appears that this SEP will work even if you go direct to the insurance company.