String on a Stick asked a good question earlier this week:
what is the best approach to choosing an ACA plan when you are not quite Medicare age, is there a system or a designated professional service provider that can help with navigating the choices minefield?
Great question!
First, go talk to an insurance agent. If you can find an agent that you pay a consulting fee for their expertise instead of the agent collecting commission based on what they sell to you, that would be ideal. If you can’t find an agent that you can work with, call a navigator.
If you know roughly what meds you need and what doctors and hospitals you highly value, you’ll want to wait until open enrollment begins and then use the plan assistance tools on either your states’ marketplcae (Healhcare.gov or a state specific website) or use a third party vendor. I use HealthSherpa.com all the time as I like their user interface and user experience. Disclaimer, I talk with the Health Sherpa folks and I have a data request in with them that I need to check in with my co-author to see if we’re still at all interested in the question. But you can enter your meds and desired docs and hospitals into a search tool which will present only plans that have all of the desired criteria. I think that would be useful to narrow down the possibility space to where the decision can be reduced with a decent degree of confidence to trade-offs of premiums, cost-sharing and insurer-specific characteristics.
I want to broaden this out a little bit now.
Choosing insurance is tough.
I think about insurance way too much. I am quite confident that if I had to buy insurance on a competitive ACA exchange that I won’t make a horrendous choice. I am quite confident that I am unlikely to make an optimal choice. I’ll be leaving money or at least exposure to money on the table prospectively. And I’m okay with that. I’m human with all of the foibles that entails even as I think about insurance and insurance choice too frequently and too deeply. So if this is where I’m at assessing my personal decision making capacity, please don’t expect to make perfect choices and give yourself grace. The objective is to avoid absolutely shitty choices and being indifferent to perfect choices compared to pretty damn good choices.
With that said, the big things to consider when making a choice for an ACA plan are the following considerations:
a) Am I subsidy eligible, not quite subsidy eligible but could engineer my income down to subsidy eligibility, or soooo not subsidy eligible?
b) What do I prioritize — minimum monthly expenditures or minimum OH SHIT total expenditures or something in between?
C) How much medical services do I know that I need next year? What drugs, doctors visits, surgeries/treatments am I 95% likely to need. Will the insurer allow me to get those services at a reasonable cost?
D) How important is it that I keep my docs/hospitals? This is going to vary a lot by your situation. Right now at this point in my life, I minimally value this as I see my PCP once every couple of years and that is it. I don’t have a long-standing relationship with a doctor who understands me and my medical concerns as I have minimal current medical concerns. However my mom who is a medical zebra with several 1 in a million conditions in her chart, greatly values stability as she has a team of docs who know her and her history very well.
E) What do I value in optionality? One of the big advantages of a large network vs. a small network is option value. We don’t know our unknown future health states. A large network is more likely to have the right docs/hospitals in-network and readily accessible than a small network (not always the case but usually the case).
F) What are the reputations of the insurers involved? Does Insurer A have a reputation of running people through the ringer on everything while Insurer B is easy to work with? That is valuable distinctions that can justify paying a bit more per month for a better experience.
These are the basic questions I would be asking myself if I had to buy a plan on the ACA exchange.
As open enrollment creeps ever closer, please feel free to ask questions in comments or e-mail me and I will help point you in the right direction if I can.
Wildfire Check-in: Wednesday Edition
Ghost of Joe Liebling*s Dog
Hi David –
I think you’ve disclaimed Medicare expertise in the past, but if you or anyone here knows where and how to start figuring that out – or who to consult – I’d be grateful.
I’ll be 65 later this year and have health insurance through my employer, a large company. I’m lucky enough not to have any health concerns or need any ongoing prescription drugs right now, and I’ve been satisfied with my current provider, a large HMO.
Right now all I know (or think I know) is that I need to sign up for Medicare before my birthday, that there are several “Parts” I need to select or decline, and that there’s a lifetime financial penalty for getting it fouled up.
I don’t know if I can keep my employer-subsidized plan (or if I should) or … well, anything much, yet. Time’s ticking away and I’m fumbling around with “where do I start”?
Thanks in advance to you (and more thanks for years of your writing here) and to anyone with good advice on how to navigate this.
Mary G
I am getting an ad for ‘Faith-Based Healthcare’ that has ‘Lowest Costs for Healthy People’ on this post atm. Feel insulted that the algorithm thinks I am stupid, healthy, and susceptible to fake religion.
lahke
@Ghost of Joe Liebling*s Dog:
Hi: your biggest question is whether you will keep working past 65. If so, you just need to sign up for part A (pretty sure it’s A), and will really keep using your employer’s plan. You’ll continue to get solicited by Medicare Advantage insurance companies, though.
lahke
Also, since no other pedants have stepped up, may I note that it’s “wringer” in this context, not “ringer”. Just shows that you are too young to recognize an old-fashioned washing machine term.
Hope that your niece is doing well.
WV Blondie
You’re always my go-to, David, and I’ve got a question that I can’t find an answer for: My husband and I are currently on a bronze ACA plan. But I move to Medicare as of Oct. 1. I called the ACA Marketplace and they told me to contact them on Sept. 30 to end my coverage – but they couldn’t tell me what to do about my husband’s coverage. And while he’s [mumble] years younger than me, so Medicare is some time off, his health has been worse. What do I do about making sure he stays covered? Who do I call? Can it go into effect Oct. 1, like mine?
Poe Larity
@Mary G: I’ve been hearing stories in the tech world about special plans that claim some kind of religious based exemptions but are really just using that as a cover. Akin to pagan-health for glibertarians. Super low premiums that meet minimum ACA requirements.
What happens when you make a claim, idk.
satby
Even on Bernie’s magic solution “Medicare for all” the questions, costs and confusion continue. I signed up for part A and B Medicare (which is automatic if you already get SS, as I did) and selected the AARP plan G supplement rather than an Advantage plan in May on my 65th birthday, and it’s already almost open enrollment time again. I have no idea if my selections roll over or if I have to affirmatively pick each year. I’m really not looking forward to having to weigh these complex choices every year as I age and presumably loose some cognitive agility.
J R in WV
Satby, I don’t think you need to make another affirmative choice every year, but you can make changes if you want.
I retired, and went with my former employer’s Medicare supplemental with Humana, as I hope and expect they did their best to cover their retirees.So far it has worked out OK, with minimal out of pocket costs for my joint replacements.
But David will know the real scoop. I just know I get lots of mailer ads for other plans, but never do anything to retain my current plan.
dnfree
@satby: your choices will roll over if you take no action. You will particularly want to check your part D drug coverage. If you currently don’t take medications and didn’t sign up for part D, you should, and just take the cheapest plan with the biggest deductible. If you ever are diagnosed with some chronic condition, there’s a permanent penalty you’ll be paying because you waited. It’s like not buying homeowners insurance and then trying to sign up for it when the house is on fire.
I’ll say again what I have before. When I went to the presentation by the Advantage plan salesman, he even said “IF you have preexisting conditions and IF you can afford it, you’re better off on a supplement plan.” I believe you can switch to an advantage plan, but then if you develop some condition and want to go back to a supplement, they can reject you. So you’re better off where you are. We used to have plan F but now have G.
David Anderson
@Ghost of Joe Liebling*s Dog: Give the local Area Agency on Aging a call. They can walk you through everything
AARP has a good explainer here as well:
https://www.aarp.org/health/medicare-qa-tool/do-i-enroll-in-medicare-age-65-even-if-still-working/#:~:text=As%20long%20as%20you%20have,penalties%20if%20you%20enroll%20later.
David Anderson
@WV Blondie: If you are both on the Bronze plan, removing you from the plan effective October 1 will have no impact on his coverage for the rest of the policy year. he’ll need to go and shop for a new plan during Open Enrollment but that is business as usual.
WV Blondie
@David Anderson: but will it cut the premium? I hate to be so money-conscious, but …
Eljai
This is really helpful as I am planning to relocate in a few months and will have to navigate this stuff. Thanks, David!
@lahke: My parents used my grandmother’s washing machine with wringer when I was a kid. One time, I put my hand in the wringer, because of course I did. I think it was by accident but my mom may remember it differently. Anyway, she pounded on the thing and it stopped and I pulled out my hand, which was sore but unharmed. Fortunately for me, the machine was really old by then and not as efficient, otherwise it could have done some damage.
Ruckus
A number of years back (mumble, mumble) I bought group plans for my employees and myself. My broker would bring me 10 or so offers and after reading 8 of them I was ready to shoot someone, almost anyone. I could see advantages to most of them, each one had some particular point that was an advantage. But my employees varied from late teen to 60 yrs old, with me in the middle. I didn’t want to screw any one of them, or me for that matter because of a hole in coverage that saved me money. After 2 or 3 yrs of the above I told my broker, here are my employee’s ages, etc, give me a max of 5 plans and the +/- of each. Tell me the one that you would buy and why. I actually never went with his choice and when I explained why he understood and liked my choice. I never did ask him his cut but I imagine it was bigger than zero. I’ve looked at various plans over the last 6 yrs, for others and just to see how bad/difficult it is to make a choice. And I’m in CA and used the state site, which is good but not as informative as I’d like. My one observation after all of this is that anyone involved on the sales side at least attempts to make this process as poorly informing as possible so that any decision seems like flipping a coin would be smarter.
DAVID ANDERSON
@WV Blondie: yes. Your component of the premium disappears for October, November, December.
Given that you are older than him, expect more than a 50% reduction in gross premium.
Pyre Light
So back when the unemployed were getting $600 a week extra that money counted for ACA subsidy calculations but not Medicaid eligibility. What’s the status of the $300 a week from the President’s executive order that may have replaced it? What if you’re about to get a lump sum for several weeks that weren’t paid while the state jiggered it’s systems but are now being covered retroactively?
StringOnAStick
Thanks for answering my question, David.
satby
@J R in WV:
@dnfree:
Thanks to you both. I was pretty sure I signed up for a D plan too, but don’t think it was ever referenced again in all my stuff. So I need to check that.