Although no industry seems to have been unscathed by Covid-19, it has been interesting to see how this pandemic has impacted each industry so differently. I talk to people from all walks of life and in the last several weeks, unfortunately, the hot topic has been how to handle health insurance while out of work, furloughed or simply because the pandemic has intensified the need for health coverage. Now more than ever people want and need to have some form of health insurance in place. You have several options to keep coverage for yourself and your dependents. This is how I’ve been consulting my clients and responding to inquiries:
1. Keep Your Current Employer Sponsored Benefits
In many cases your health benefits may continue through your current employer and they may even be willing to cover the cost of your premiums while you are out. This is your best option for good, continuing coverage and you should consult with your HR representative to understand how your company is handling the cost of your benefits.
2. COBRA Plans
If you had health insurance coverage through your employer, you will have access to COBRA, which is essentially the ability to maintain your current policy, however you will be responsible to pay for the full premiums which may have been subsidized or discounted by your employer. If you know you will be working again soon, although generally very expensive, this is a solid option to maintain coverage with your current plan. By law you can keep COBRA coverage for up to 18 months (in most cases) as long as you pay the premiums on time. If you are healthy, there are less expensive options that may save a significant amount and still give you the coverage you need.. If you are unsure, I recommend opting for the COBRA plan while looking for something more affordable - that way you maintain coverage for you and any dependents. You can always sign up for COBRA and cancel it at any time but you cannot sign up for COBRA once the enrollment deadline has passed.
3. ACA Plans
ACA plans (Affordable Care Act or Obamacare) are an option when you have a “qualifying event” like loss of employment. These major medical plans (traditional HMO high deductible plans) definitely have their place. The good, you can always get one of these plans no matter what pre-existing conditions you or a dependent may have. They do have limitations though. There really are not many insurance carriers available, as most insurance companies have pulled out of the ACA plans, and the available plans are both expensive and in many cases very difficult to utilize; the networks are small and not widely accepted. Some plans may only cover you in your county and none of them will go beyond state lines. Frankly, you need to do your homework to confirm you can find a doctor who accepts the plan you are looking at, and can give you the care you need. Many don’t realize all ACA plans are HMO plans.
4. Cost Share
You’ve probably heard the ads for Cost Share plans and may have thought they sound a little too good to be true. They are generally affordable, but keep in mind that they will have exclusions on pre-existing conditions. They are programs, not health insurance. If you are used to traditional health insurance and like having the stability and backing of a nationwide brand like United Health Care, Blue Cross, Humana, Aetna or the others, you may not like the “unknowns” that come with cost share programs. There are a variety of programs out there so do your research - I definitely have a preferred Cost Share plan. With some programs the members are cash paying patients and only get reimbursed if over a certain amount, while others function as a “traditional” plan where you are responsible for a small amount (like a copay).
5. Private Insurance
Believe it or not you can still get private insurance through traditional health insurance companies without going through the ACA. These plans feel familiar to most people who have had traditional plans with a major health insurance carrier. Although the plans are contingent on your health history, they come with many options. Many people like these plans because they provide a lot of flexibility when you consider your budget; you are able to customize the plan based on your needs while keeping monthly premiums manageable.
Create a Combo Deal. Just because you are one family, don’t think you have to all go on the same plan. I approach each situation with the goal of acquiring the best health coverage for my clients that meets current health needs and still fits the budget. With so many options available, I’ve been able to make health insurance affordable for people who thought it was impossible. That may mean you and your children are one one plan, with your spouse or significant other on another. Or you select your employer health benefits, (because your employer contributes to your costs) but the rest of the family is on a private plan. It really doesn’t matter as long as you’re all covered. What we’ve learned so far from this pandemic is that even though we never plan to get sick or injured, it’s really not in our control. So make sure you have a plan that not only protects you when you need it, but let’s you sleep well when you don’t.
Gone are the days when you’d hear people bragging about their amazing health benefits. It’s more likely that you hear people griping about it. But if you have a company sponsored group health plan, maybe you should be bragging. Those without that option certainly would be jealous.
Bottom line, health insurance is ridiculously expensive regardless of who you are and how you buy it! If you get your insurance through a company, you’re participating in a larger group policy which provides greater discounts. And usually the employer is paying for the employee’s monthly premiums or a majority percentage of it. So as the employee, if you have your spouse and/or children on your plan, the dollars deducted out of your paycheck are most likely going towards their premiums and the company is covering all or part of your premium. It truly is a company subsidized plan. It costs them a ton so employers have gotten smarter about displaying how much they contribute to your premiums on your paycheck to demonstrate just how valuable the perk is.
Here’s why a lot of employees don’t recognize just how valuable their company benefits are. Because premiums steadily increase each year, and have been for over a decade now, individuals with a company or group sponsored health plan pay more each year for their benefits. In many cases it is significantly more. And because we all look at our “take home” pay as what we earn, it looks like you’re earning less each time you go through open enrollment. It’s frustrating and can start feeling like your salary is getting a demotion. The reality is that your company is probably paying more than they were just a few years ago, as they too feel the pinch of escalating health insurance costs. Not to mention, most companies have had to move to high deductible plans which means even if you can handle your monthly premiums, you’re most likely paying “out of pocket” for your medical expenses. Remember going to the doctor and paying a small copay like $15 each time? Well, hold on to that fond memory because you’ll probably never experience that again. And by the way when you do say that out loud, you start sounding like your grandfather, “back in my day a movie was just fifty cents”.
When you start to feel angry or frustrated about how “bad” your company health benefits are, I know just the thing to make you feel better and it may even make you like your employer more. Try going out to HealthCare.Gov (ObamaCare) and experimenting with the alternative. This is where the rest of America goes to get health insurance. And by “the rest of America” I don’t mean the poor; it’s for working professionals, those that are self-employed or who work for a small company – plumbers, dentists, CPA’s, attorneys, mortgage brokers, realtors, hair stylists, electricians, writers, entrepreneurs, advertisers and anyone who may work for them.
Just recently I went through the arduous process to determine the cost of ObamaCare for my family. Ready for the numbers? I promise it will make you feel better about whatever your company offers!
Crazy, right? But this is the reality for millions of working professionals and small business owners. And it’s worth mentioning that you only have one choice – a plan you’ve never heard of and no, you don’t get to keep your doctor, and in fact, you’ll have a hard time finding a doctor who will accept it. This is the mess that’s been created. If you have a company or group sponsored plan, next time you think about complaining to your friends, you just might want to keep it to yourself and remember how much others are paying. Take a closer look at what your company is offering you and you’ll discover that although it’s not what it used to be, it definitely has real value.
And if you’re lucky enough to be self-employed or your small company does not offer health insurance, just know that there are options to help make insurance more affordable.
Health Plan Source: (healthcare.gov – Maricopa County, Arizona – 2 adults + children, 8/2017)