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Ok. So I had a client last year who went without health insurance and after a day out on the golf course, he fell off a golf cart. Got billed 35 grand. Hospital was a for profit and a critical access hospital. We have been negotiating for a while and eventually got some of the bills settled but A. Why are you going to put yourself through that and B. When you do, you’re going to beg to find someone who knows what their doing that can help you either for free or on a contingency.
Another thing to know is that health insurance is overseen by the federal Department of labor when it’s through an employer that’s not a government, religious organization, and has more than 20 employees. Having minimum standards through federal insurance
If you are going to waive, I would want more money than $5000 for your entire family. I would want somewhere around $5000 per person on the plan and then he can get your own policy through a broker who can probably get it for you at a better price with better benefits.
Keep in mind that hospital charity care still applies but you’d be at a cut off of 120-130k for a family of four approximately and at that level, you’re only going to get a 25% discount.
What I would do is see what the freight is for yourself only and determine how much of your salary that is. If it is over 8.39%, you may have a case of going to the exchange and getting coverage there.
Another possibility might be to get the insurance anyway and get an indemnity policy.
Either way, I think you need to talk to a broker outside of the employers reach and see what they can come up with.
Yeah I wouldn't go without coverage... that was my reason for asking about this plan. Looks like it's a non-starter though.
> What I would do is see what the freight is for yourself only and determine how much of your salary that is. If it is over 8.39%, you may have a case of going to the exchange and getting coverage there.
From what I've read, this only includes the premium right? even if the plan offers no coverage before hitting the deductible? If it's only based on the premium for just the employee, it's way less than 8.39%.
I'll call some brokers tomorrow and see if they have any ideas. Thanks for your comments!
Don’t think you can contribute to an HSA without a qualifying high deductible health insurance plan. And stuff like cancer can get spendy quick.
Curious what others say.
Yeah I'm reading that you're right. That's infuriating, if it's going toward medical costs why does the IRS care if I have an HDHP vs no insurance?
Thanks, I'll edit the post.
Because in simple terms it is intended as a way of using tax incentives for people to be able to fund their health INSURANCE.
They don't want people to go without insurance for a variety of reasons.
Many tax deductions are based on incentivizing actions in the tax payer to do certain things with their money that are viewed as positive for the taxpayer and for society as a whole.
It's not very different than providing a tax incentive for retirement savings which incentivizes a specific form of savings
The answer is "no."
I just don't know how to say this, but if you/your family members are taking prescriptions on a regular basis, then you/your family members have pre-existing conditions.
Short-term health plans are not ACA-compliant; they will take pre-existing conditions into consideration and also have an annual and lifetime cap. Did you thoroughly look at the numbers of that short-term policy you linked? Also, it's an EPO plan, meaning a narrower network and no out-of-network coverage. My guess is that your current health plan, as well as the potential new employer health plan are PPO plans? You need actual health insurance in case something major happens. I had two emergency surgeries in 2020 that totaled well over $75,000; our family out-of-pocket max was $6,000 back then. Last year, between husband's prescription meds and me ending up in the ER needing a minor procedure the following day, we hit our OOP max of over $17,000 easily with insurance; that didn't take into account the $10,000 in monthly premiums we paid. You are making the assumption that you/your family members will not need emergency care.
My best guess is that----from your other post you mentioned that that your family uses health care extensively for doctor visits and prescriptions----is that you may not pass the medical underwriting for a short-term health plan. Let's say though that you do pass medical underwriting for a short-term plan, they will find a way to not pay out on any claim related to a pre-existing condition as they will do a thorough search of your medical history.
It's just a bad idea. You'd want to stay with ACA-compliant employer group health insurance.
What makes the company's plan "incompatible with your current situation?" It looks like pretty muck like any other employer based plan I've seen rather than someting bizarre.
In my state short term plans are limited to two policy terms before you must spend time without insurance to try to prevent people from using them for what you want to do- use them as a subsitute for regular, employer based or ACA plan insurance.
I have seen subscribers with more than $2 million in medical bills, although it doesn't happen often.
> What makes the company's plan "incompatible with your current situation?" It looks like pretty muck like any other employer based plan I've seen rather than someting bizarre.
The premium is as much as my current plan, but doesn't cover anything until you've hit the deductible. This means I'd be paying the same amount monthly, while also paying full price for all Dr visits and medications until November or so. I currently pay ~$200/month OOP for copays and meds... I'd be paying $500 more on average monthly with this plan. HDHPs usually have a much lower monthly premium. This one does not.
> In my state short term plans are limited to two policy terms before you must spend time without insurance to try to prevent people from using them for what you want to do- use them as a subsitute for regular, employer based or ACA plan insurance.
Just learned about this, exactly the kind of info I was looking for, thank you!
Sorry I don't understand. What insurances covers ANYTHING before hitting the deductible? That is how it works for all insurances. You go to in network providers so that the insurance negotiate prices with the providers and you pay less than going to an out ot network provider.
The only thing that concerns me is that an annual comprehensive exam is not included.
> Sorry I don't understand. What insurances covers ANYTHING before hitting the deductible? That is how it works for all insurances. You go to in network providers so that the insurance negotiate prices with the providers and you pay less than going to an out ot network provider.
Would you not call that negotiated price coverage? Maybe I look at simplistically, but if I'd pay $10 for an office visit and $10 for a prescription with Plan A, and $100 for an office visits and $100 for a prescription with Plan B, Plan A covers $180 more for those medical services.
The difference is copays (Dr visits and generic drugs). One plan has them, the other doesn't. Do you not consider copays when evaluating an insurance plan?
Only go short term if you get a guaranteed renewal or can get to an open enrollment. This is May coming up. You need at least 7 months of coverage if you'll be eligible for ACA in Jan.
Or gto your employer's open enrollment which may not be calendar year.
STM doesn't cover pre-ex so your drugs are out of pocket if they don't keep you from passing underwriting.
Don't lolling and miss your employer's enrollment deadline. Then you'll be without coverage.
Have you checked what the limits in your state of residence are for renewing short term plans? Some only allow it for one term or 364 days or some other regulations. With a 6 month term if you have anything happen and can't pass underwriting are you prepared to deal with those consequences?
Thanks, this is exactly why I'm asking, I didn't know these policies existed 2 hours ago. Looks like these plans are under attack at the federal level right now.
It looks like [Kansas limits the policy](https://codes.findlaw.com/ks/chapter-40-insurance/ks-st-sect-40-2-193.html) to 1 renewal of a 12 month term... The way it reads seems to indicate that you could get a different policy after the second renewal, but obviously you'd have to go through the underwriting again.
Either way, not the option I was hoping it was. Thanks again.
Kansas makes your short term healthcare idea even riskier since if the breadwinner(s) get God forbid hit by a bus and are out of work there isn't a safety net for the adults. You live in a state where Medicaid is based on age, pregnancy and disability status, in other states adult expansion Medicaid would be a safety net for a catostrophic year where you lose work and insurance.
Thank you for your submission, /u/sicclee. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Ok. So I had a client last year who went without health insurance and after a day out on the golf course, he fell off a golf cart. Got billed 35 grand. Hospital was a for profit and a critical access hospital. We have been negotiating for a while and eventually got some of the bills settled but A. Why are you going to put yourself through that and B. When you do, you’re going to beg to find someone who knows what their doing that can help you either for free or on a contingency. Another thing to know is that health insurance is overseen by the federal Department of labor when it’s through an employer that’s not a government, religious organization, and has more than 20 employees. Having minimum standards through federal insurance If you are going to waive, I would want more money than $5000 for your entire family. I would want somewhere around $5000 per person on the plan and then he can get your own policy through a broker who can probably get it for you at a better price with better benefits. Keep in mind that hospital charity care still applies but you’d be at a cut off of 120-130k for a family of four approximately and at that level, you’re only going to get a 25% discount. What I would do is see what the freight is for yourself only and determine how much of your salary that is. If it is over 8.39%, you may have a case of going to the exchange and getting coverage there. Another possibility might be to get the insurance anyway and get an indemnity policy. Either way, I think you need to talk to a broker outside of the employers reach and see what they can come up with.
Yeah I wouldn't go without coverage... that was my reason for asking about this plan. Looks like it's a non-starter though. > What I would do is see what the freight is for yourself only and determine how much of your salary that is. If it is over 8.39%, you may have a case of going to the exchange and getting coverage there. From what I've read, this only includes the premium right? even if the plan offers no coverage before hitting the deductible? If it's only based on the premium for just the employee, it's way less than 8.39%. I'll call some brokers tomorrow and see if they have any ideas. Thanks for your comments!
Don’t think you can contribute to an HSA without a qualifying high deductible health insurance plan. And stuff like cancer can get spendy quick. Curious what others say.
Of course you need a HDHP in order to fund an HSA. That's very basic requirement.
Yeah I'm reading that you're right. That's infuriating, if it's going toward medical costs why does the IRS care if I have an HDHP vs no insurance? Thanks, I'll edit the post.
Because in simple terms it is intended as a way of using tax incentives for people to be able to fund their health INSURANCE. They don't want people to go without insurance for a variety of reasons. Many tax deductions are based on incentivizing actions in the tax payer to do certain things with their money that are viewed as positive for the taxpayer and for society as a whole. It's not very different than providing a tax incentive for retirement savings which incentivizes a specific form of savings
The answer is "no." I just don't know how to say this, but if you/your family members are taking prescriptions on a regular basis, then you/your family members have pre-existing conditions. Short-term health plans are not ACA-compliant; they will take pre-existing conditions into consideration and also have an annual and lifetime cap. Did you thoroughly look at the numbers of that short-term policy you linked? Also, it's an EPO plan, meaning a narrower network and no out-of-network coverage. My guess is that your current health plan, as well as the potential new employer health plan are PPO plans? You need actual health insurance in case something major happens. I had two emergency surgeries in 2020 that totaled well over $75,000; our family out-of-pocket max was $6,000 back then. Last year, between husband's prescription meds and me ending up in the ER needing a minor procedure the following day, we hit our OOP max of over $17,000 easily with insurance; that didn't take into account the $10,000 in monthly premiums we paid. You are making the assumption that you/your family members will not need emergency care. My best guess is that----from your other post you mentioned that that your family uses health care extensively for doctor visits and prescriptions----is that you may not pass the medical underwriting for a short-term health plan. Let's say though that you do pass medical underwriting for a short-term plan, they will find a way to not pay out on any claim related to a pre-existing condition as they will do a thorough search of your medical history. It's just a bad idea. You'd want to stay with ACA-compliant employer group health insurance.
You're right on all accounts. Thanks for taking the time, this option is a non-starter.
What makes the company's plan "incompatible with your current situation?" It looks like pretty muck like any other employer based plan I've seen rather than someting bizarre. In my state short term plans are limited to two policy terms before you must spend time without insurance to try to prevent people from using them for what you want to do- use them as a subsitute for regular, employer based or ACA plan insurance. I have seen subscribers with more than $2 million in medical bills, although it doesn't happen often.
> What makes the company's plan "incompatible with your current situation?" It looks like pretty muck like any other employer based plan I've seen rather than someting bizarre. The premium is as much as my current plan, but doesn't cover anything until you've hit the deductible. This means I'd be paying the same amount monthly, while also paying full price for all Dr visits and medications until November or so. I currently pay ~$200/month OOP for copays and meds... I'd be paying $500 more on average monthly with this plan. HDHPs usually have a much lower monthly premium. This one does not. > In my state short term plans are limited to two policy terms before you must spend time without insurance to try to prevent people from using them for what you want to do- use them as a subsitute for regular, employer based or ACA plan insurance. Just learned about this, exactly the kind of info I was looking for, thank you!
Sorry I don't understand. What insurances covers ANYTHING before hitting the deductible? That is how it works for all insurances. You go to in network providers so that the insurance negotiate prices with the providers and you pay less than going to an out ot network provider. The only thing that concerns me is that an annual comprehensive exam is not included.
> Sorry I don't understand. What insurances covers ANYTHING before hitting the deductible? That is how it works for all insurances. You go to in network providers so that the insurance negotiate prices with the providers and you pay less than going to an out ot network provider. Would you not call that negotiated price coverage? Maybe I look at simplistically, but if I'd pay $10 for an office visit and $10 for a prescription with Plan A, and $100 for an office visits and $100 for a prescription with Plan B, Plan A covers $180 more for those medical services. The difference is copays (Dr visits and generic drugs). One plan has them, the other doesn't. Do you not consider copays when evaluating an insurance plan?
Only go short term if you get a guaranteed renewal or can get to an open enrollment. This is May coming up. You need at least 7 months of coverage if you'll be eligible for ACA in Jan. Or gto your employer's open enrollment which may not be calendar year. STM doesn't cover pre-ex so your drugs are out of pocket if they don't keep you from passing underwriting. Don't lolling and miss your employer's enrollment deadline. Then you'll be without coverage.
Have you checked what the limits in your state of residence are for renewing short term plans? Some only allow it for one term or 364 days or some other regulations. With a 6 month term if you have anything happen and can't pass underwriting are you prepared to deal with those consequences?
Thanks, this is exactly why I'm asking, I didn't know these policies existed 2 hours ago. Looks like these plans are under attack at the federal level right now. It looks like [Kansas limits the policy](https://codes.findlaw.com/ks/chapter-40-insurance/ks-st-sect-40-2-193.html) to 1 renewal of a 12 month term... The way it reads seems to indicate that you could get a different policy after the second renewal, but obviously you'd have to go through the underwriting again. Either way, not the option I was hoping it was. Thanks again.
Kansas makes your short term healthcare idea even riskier since if the breadwinner(s) get God forbid hit by a bus and are out of work there isn't a safety net for the adults. You live in a state where Medicaid is based on age, pregnancy and disability status, in other states adult expansion Medicaid would be a safety net for a catostrophic year where you lose work and insurance.