Since Day 28 of our 30 day countdown falls on a Saturday, we will celebrate the weekend–and shift focus away from the company and instead explore how to prepare for your renewal as an Individual or Family consumer.
Much news has been made about the exit of Aetna, Humana, Scott & White, Oscar and United Healthcare from the Individual Exchange.
Less choice and higher prices will force many individuals to re-evaluate and re-visit the Employer or Individual options.
Let’s oversimplify things and make a quick Pro’s and Con’s list to review the different methods an individual can purchase a plan.
From an Employer:
Pro’s:
- The Company pays the majority of the Employee’s costs.
- In almost every scenario, this is the cheapest option for the employee.
- Covering dependent’s is an option too.
- Money spent through Payroll Deduction is “Pre-Tax” on many types of coverage (and almost all versions of Health Insurance).
Con’s:
- The Employer chooses the plan design and provider network—you have to work within their choices.
- Leaving your employer–means you can only keep your coverage temporarily (COBRA), and at full price.
From an Insurance Company Off-Exchange:
Pro’s:
- Ability to choose Benefits and Provider Network from available options.
- Ability to keep same plan when changing jobs.
- As a Self-Employed Sole-Proprietor, Small Business owner or 2% greater shareholder–these plans are 100% Tax-Deductible.
Con’s:
- Choices are lessening
- No effective tax-deductions here unless you spend over 10% of your income-– and then only the amount over 10%.
On-Exchange (Healthcare.gov):
Pro’s:
- Subsidized Plans are your cheapest options when a plan isn’t available from an Employer.
- Plans can be enhanced for consumers with a household incomes under 250% of Federal Poverty Level.
Con’s:
- Choices are lessening drastically
- HMO’s and Restrictive network EPO’s are the only types of coverage left.
- Doctor’s Offices and Medical Providers are not as likely to accept these plans.
Other items to consider: Short Term Health Plans or Religious base medi-share Plans:
- No Pro’s and Con’s list here
- Plans don’t meet requirements under Healthcare Reform–i.e. they incur tax penalties
- Several plans claim Tax-Penalty exemption, but only if you file a required religious exemption form.
- Do the math–but factor in the tax
- Focus on high-impact items that are the most important to you
- Be flexible, you may need to make peace with choosing a new doctor or paying cash
- Supplemental TeleMedicine and Advocacy plans are a good idea.
Mike Davis
Consultant
About the author: Mike has a passion for people. That's why he is at AG Insurance. Mike has the kind of talent and passion that you want on your team and in your corner. It doesn't hurt that he also has a very strong accounting background as well as having spent time in a CFO & leadership role in his previous company. With Tax and Accounting practices having a bigger and bigger impact on his clients--so does Mike. And not to be forgotten, Mike is also a Baseball Guy and a Rangers Fan--which goes a long way in our culture.
About AG Insurance: AG Insurance (www.agiainc.com) helps employers and their employees with solutions focused on positive organizational impact and improved employee experiences.
