Episode 21: Health Insurance Update & FAQs

Isaac Wright: Well, welcome back to another episode of Wright Money Tips. As we go through the fall and wrapping up 2021, we thought it was really important to have a conversation and more importantly, just some good FAQ’s around the health insurance marketplace today. A lot of people are going to start gearing up with decisions on whether or not they’re going to keep their plan for 2021.
Whether or not, there’s going to be nice options available to maybe make some improvements going into 2022. Of course, health insurance in and of itself can be pretty confusing. But with that being said today, I want to introduce our guest, Josh Viles. Josh, welcome to the program.
Josh Viles: Thanks for having me.
Isaac Wright: Josh is the owner of Viles Insurance and has had an independent insurance agency now going on for eight plus years. He has helped literally hundreds of families. But most importantly, it has a good take on the health insurance landscape today. So, this should be a really nice conversation for all of you listening, viewing us today. I think you want to pay close attention.
We’re going to really focus in on the individual side of the fence because a lot of people have either changed jobs, outright going out, opening their own businesses and some people of course are retiring as well. So, looking at the landscape of health insurance, you and I were talking about this before we came on air, but a lot of the health insurance let’s say in today’s world really have been focused on some of the Affordable Care Act plans.
A lot of you may remember that being called, Obamacare. The main thing I want to take away here real quick is that in addition to these Affordable Care Act plans, there is a landscape outside of those plans. And today we’re really going to have that conversation just to kind of feel you out a little bit about what’s your take is on these plans and relative to maybe what’s out there on the marketplace, that’s not necessarily, the Affordable Care Act.
So, with that in mind, maybe let me just say this. It’s probably good for the viewers and listeners, let me just step back here and ask you, when you look at the health insurance market today, maybe fill us in with your opinions about what you find with Affordable Care Act plans and whether or not there’s an improvement to be made outside of that if you go on the private insurance away from that.
Josh Viles: So, with the marketplace plans and there’s too many names, Obamacare Marketplace, Healthcare.gov. It’s all, the individual market, there’s plans outside of the ACA in the marketplace.
But they are by and large, the same exact plans, same exact networks, same prices. So, the marketplace is mainly for people that are not getting it from their employer or their self-employed, and it’s really an income bracket, a chart that kind of flows up. So, if you’re under, if you’re in the right range, you’re going to get tax credits and you should go after that because it’s usually hundreds of thousands of dollars.
Isaac Wright: So, I remember basically, and I think a lot of you probably remember this or have seen this. If you’ve looked at individual health based on your income, you could have a substantial credit towards your healthcare premiums. And I know that’s been a big deal for a lot of people dependent upon that income bracket. Let me just say this, with the income situation that you see with people that have ACA plans, where does that fall or what do you feel like that looks like relative to the private insurance out there today, if they want to look at other options?
Josh Viles: Right. So, a child under 14 years of age is about $250-$300 private and marketplace. And a lot of people can’t afford that. If you have two kids, that’s 500 bucks right there. The tax credit really cuts that back. And so, you want to get that if you can’t. You were talking about income, kind of. It used to be for a single filer $51,000. You kind of had to be under $51,000.
Now since the most recent stimulus bill, the increase, the tax credit about a hundred dollars for everyone, that’s what it seemed like. And now it’s like 60 or 70, you can still get tax credits. It’s based on a lot of different things, but older people are more likely to get more tax credits in that higher income range.
Isaac Wright: So, what you’re saying really is now heading into maybe even next year as that healthcare credit continues to increase it almost would think that that is going to start pushing more and more people towards the ACA plan. So where does that leave private insurance? I mean, at what point do people look at that as an option? I guess, I’m assuming they would look at that if they don’t get that credit.
Josh Viles: So right above the income bracket, and it’s different for each household, household size. If you’re right above that tax credit, you either pay full price, which could be $1500 a month for a family of four. Or you go with a catastrophic kind of short-term plan, which I relied on last year and it got a lot of people onto short-term plans. I was hoping to do the whole year, but the legislature just curbed that and moved them down to three months. They’re trying to stop the short-term plans. So, six months is the max you can do with the short-term plans. Outside of that, like the private, if you went to Anthem and wanted to just the private plan in the individual market, you could get that. But it’s the same as being on the market. It’s the same plan and benefits and prices on the marketplace. And if you’re on the marketplace, you’re not getting any tax credit, which you can do.
You can pay full price in the marketplace. If halfway through the year, your income went down, for some reason, you’ll get the tax credit when you do your taxes. You want to be on the marketplace if you’re an individual, because an income loss could equal the tax credit down the road.
Isaac Wright: That’s really good to know. So, my take on what you’ve said, basically, I mean, ACA plans by default are going to be your go-to plan in a low-income situation. If you all are listening here and if let’s, say your income is above some of these brackets, you can consider individual insurance. However, you may not really get a lot out of that, I guess, based upon the fact that the income, especially if your income shifts in the middle of the year. Kind of sounds like you’ve got to take that into consideration.
Josh Viles: If your income’s close, if you’re making a lot of money and there’s no way you’re going to go under, you could go with preempt private insurance, but it’s essentially the same.
Isaac Wright: How many private insurance plans, at least in this area, Virginia. I mean, don’t know if you know that off the top of your head, but is there a decent amount of options in private health care? I feel like that really got consolidated down once we had the ACA.
Josh Viles: Obamacare kind of put more regulation on it. And so, if you’re offering major medical insurance, which, it has to follow the regulation, there’s not that many private. I mean, it’s just the major players in the marketplace that are offering those private individual plans. And so, actually next year, we’re getting a lot more companies on the marketplace. We’ve got United and I think Bright Health is coming into Richmond and one more. We’re going to have like 11, 12 companies.
Isaac Wright: It would be nice to have some extra options. I’ve seen a lot of people complain about the fact that there really is no option.
Josh Viles: There’s 30 plans, but a lot of them are very similar and expensive.
Isaac Wright: Well, that’s great. So, you said one other thing that I want to kind of reiterate for people that are looking for short term major medical. Now you’re telling me that a lot of these plans are being reduced down to three months.
Josh Viles: Short-term isn’t major medical. Okay. There’s more, yeah, there’s more stipulations. But you can do six months in a year. You can do three months and then renew and do another three months. And those are super cheap because it’s a shorter term and there’s more stipulations. They’re not going to pay for certain things. And they’re only going to pay a million dollars to your health claims.
Isaac Wright: Are you finding people going after some of that dependent upon maybe, let’s say a window between Medicare? I’m sure there’s situations where that.
Josh Viles:Yeah. If there’s only a few months, so right now, if you sign up for a major, if you sign up for marketplace, so we’re private insurance, they all reset January one. So there’s not much time to accumulate your deductible and so we will put people on those if they’re just in between stuff.
Isaac Wright: That’s great to know, man. Hope all of you are taking good notes and paying good attention here. You know, again, I will say even here at our office, we have a lot of people that walk into having a change of jobs, maybe even being let go, not really able to keep their health insurance for various reasons. We’ll have Josh’s information here at the end of the program today and we’ll have that also on our site. But you know, Josh, let me just switch gears real quick before we move on, because I want to ask you about Medicare before we wrap up today.
What do you find though has been like the biggest mistake you personally have seen with people when it comes to looking at health insurance? So, as we talk about all these plans, maybe stepping back from all the plans in general, like what do you see as the biggest mistake people make when it comes to figuring out their health insurance?
Josh Viles: So, there are a ton of mistakes people make, but the main one is just not working with a broker. So, you can’t really research and know all of the information that you’re trying to consume to make an educated decision and brokers are in it every day. See a lot of people call me and they put their phone number into a website and they’ve gotten a hundred calls from people. And a lot of people will say this, don’t put your phone number in the website, but find a broker, contact me. We just are in it every day and know the networks and know the reputations of the businesses. Are you really working for you and not the insurance companies?
Isaac Wright: Well, I mean, you’ve done a good job for the few folks that we’ve been able to have a chat with. And wanted to also just kind of talk about, because as we’re focused on individual health, of course we have a lot of families and a lot of people watch, hear and listen that are either going on Medicare or they will be eventually going on Medicare and turning 65 under most circumstances.
When you look at Medicare and I know that we’re not going to be able to cover this tremendous depth today, but you know, most people as you go on Medicare and you turn 65, you have a decision to make about what kind of health insurance you want to supplement. That Medicare Part A and Part B, which covers roughly about 80% of your doctors, hospitalization is covered with some deductibles. But you can fill in those gaps with a Medicare supplement or also called a Medigap policy. Some of you all may have heard that term before. But also Josh, we also have found that let’s say other than the supplemental, the plans that are out there, that are kind of help me out here.
Josh Viles: It’s the Medicare Advantage.
Isaac Wright: Yes. So, if we can talk a little bit about the supplemental versus the advantage plan for those of us listening today that would like to understand a little bit more about that Medicare option.
Josh Viles: So the supplement is kind of the richer benefit. I’m usually talking about Plan G. There’s different letter plans, but the supplements generally the richer benefit and has a cost.
And the advantage is the cheaper, a less rich benefit and it’s usually free when there’s actually one plan that will reimburse you $50 of your Part B premium. The Advantage Plan HMO regional networks and you need to stay in network. There’s no out of network. And then the supplement plans are any Medicare doctor, any doctor that takes Medicare will, can do the supplements.
Isaac Wright: Basically, you spend a little bit more for the flexibility of being able to go to any doctor you want to, if you’re trying to be more cost-conscious, kind of wrap yourself up into like an HMO style with an advantage plan.
Josh Viles: Usually when I talk to clients, I try to just get their whole situation, figure out their whole situation, like with income, but also if they’re going to the doctor often or taking prescriptions. If they’re a family that doesn’t go to the doctor, often the Advantage Plan might not, might be a good fit, a good fit for them.
Isaac Wright: Okay. I get you now. I’ve seen some of the plans. I saw on a commercial on one where you get a gym membership. So, I mean, they’re definitely going to be opportunities where some people are going to want those extracurricular benefits if they’re in really good health. Can you change, let’s say you pick an Advantage Plan one year. And let’s say two years later, you have two or three big medical concerns and you want to go to a supplemental plan so you don’t have the restrictions. How was that viewed? Is that able to be done?
Josh Viles: You can do that, but you would have to answer health questions for the supplement. So, when you turn 65 and if you get on the supplement, then you don’t have to answer health questions. So, it’s like a guaranteed issue thing. So, it’s good to jump right on the supplements, if you can afford it. And you have to answer the health questions.
Isaac Wright: Once you get past that point, and if you’ve had those medical concerns, you may be relevant to stay on an Advantage Plan.
Josh Viles: You might not be able to get into G, but there’s probably another plan that they’ll say, “This plan will, we will let you into this plan.”
Isaac Wright: So, anything else, fire away, man. I mean, I feel like you’ve done a good job of briefly covering Medicare Advantage Plans that many again, you can sit here, probably talk to me for two hours on this. But just trying to get that information out to people because I think the open enrollment comes up here not too long from now.
Josh Viles: November 1st is open enrollment and I think they extended it through January 15th. Get in touch with the broker during that time period to if you’re an individual. If you’re on the marketplace now, or if you just want to look at your options. I wanted to mention, we were talking earlier about those people above the income limit. The other thing I do with people is just put them in a one man group. So, Virginia two years ago, passed the law that said that you could be an employer if you have 1099 income. So, anyone can sign up for the employer-based plan. And that’s better than the marketplace for those people because it’s a bigger hospital network and you can pick from a bunch of different other plans. And like I said, that’s only for people above the income bracket as well. They also have to have 1099 income, or own a business, or we have to submit tax documents.
Isaac Wright: Health care has just become such an expanse of what it used to be. Well, ladies and gentlemen, I want to say thank you all for tuning in today. I hope for all the information that we covered today, relative to health insurance, and granted, we fired away quite a decent amount of it. I’m going to have Josh’s information here. Again, it’ll be on the tag. We’ll have a couple places where you can find this. We’ll have it at the bottom here. But just know that coming up on open enrollment, few other things that are going on when it comes to some of the health insurance landscape, you just mentioned, feel free to reach out and talk to Josh.
And for those of you also just more generally if you have any concerns about your finances, your lifestyle, getting a financial plan together. Of course, health insurance is a part of that. We appreciate you being a part of the show today and look forward to talking to you soon.
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