A few thoughtful tips before completing your Health Insurance during Open Enrollment
We did a poll last month and the topic on many people’s minds in November is early enrollment for Health Insurance. The information I received from my HR department was very confusing.
If you are confused or just looking for the best insurance for your needs, join the club. But, guess what, today we have a few tips from an expert.
Sarah Bolton Is a US Health Advisor, a true Texas girl. She is all heart and has a lot of money-saving ideas to share!
Click and listen to Our Podcast Here: Sarah Bolton Advisor Extraordinaire, Your first call for Health Insurance
You may also read or download this blog for written content to refer to.
Deborah and WilcoWellness-
Hi Sarah, thank you for joining me today.
How long have you been helping people navigate health insurance?
Sarah Bolton:
I’m going on almost three years.
A friend of mine was in the health insurance industry as an independent advisor. I talked to her about it, then took the leap of faith and got into the field of Health Insurance Advising. It’s been fascinating learning all the time, so much about how insurance works. The medical field in itself seems to be doctors versus health insurance these days. So, I really dove into all the nooks and crannies of how Insurance processes billing, and what each type of health insurance policy offers. I am fascinated by all the letters and acronyms and what they stand for. I really love that research piece of my job.
My Advisory career is being able to explain all of that to my clients because you’re right, it is very confusing.
Deborah:
Sarah, let’s start with the topic – Insurance and a Single parent with children
You shared a little with me about how income levels affect what is available. Divorce decrees and the custodial rights and taxes also affect what a person needs to consider for their family’s health insurance. As if raising kiddos was not complicated enough.
Sarah:
Absolutely. One thing I want to mention is if you are employed and your employer offers health insurance and you go through that employer, it’s completely different than the scenario that we’re going to talk about.
Your H.R. person should normally help you with that. A lot of times they’ll do a big presentation for everybody and just walk you through the plans. I don’t mind actually helping a person break down those plans if your HR person is not available or knowledgeable enough for an individual’s certain situation. I really love to help educate and improve people’s circumstances with the information I can offer.
In the scenario that we’re going to talk about, Deborah is like a single parent that maybe is self-employed, a hairdresser, a nail tech or, a nurse practitioner that is a traveling nurse, that kind of thing.
If you are self-employed and you’re looking at insurance individually and you’ve got kids
you’ve got to think about, in that divorce decree, the non-custodial parent is supposed to hold onto the insurance for the kids. Well, if that person is also self-employed and they’ve got to go through like the ACA (Affordable Care Act) marketplace, the ACA is going to look at whoever claims the children on the taxes to determine if the children can be added to the adults’ “family” plan.
I’m not a lawyer by any means, however, the Government plans (ACA) are tied to income taxes, and this changes how individuals may decide to manage their children’s health care and the custodial management decisions in a divorce decree. So, one consideration may be, the custodial parent that claims them on taxes is taking care of the health insurance with the non-custodial parent then reimbursing for health care coverage through child support.
Income level is also taken into account to possibly get your savings
It’s called a tax subsidy. Depending on your age, how many kids you have in the family, and what your income level is, you may be eligible for a tax break. This tax break may be taken monthly, making your monthly premium more affordable for you. So, if you’re a single mom and you’ve got two or three kids at home and you’re only making $45,000.00 a year, you can get a substantial break on the marketplace to be able to afford those premiums.
If your income is in a lower bracket, you might even be able to put the kids on Medicaid or CHIP, which are going to be those state-sponsored health coverage options. I can help you kind of walk through that, and know on the marketplace, what your options are and what is the best path to choose for your children and their needs.
Deborah:
What is the Affordable Care Act?
Sarah:
You can find more information about ACA at the website from the government at HealthCare.gov. ACA is the Affordable Care Act that President Obama initially passed. It’s now managed as an insurance marketplace. You can also go to Sherpa Health as another insurance marketplace. Every state has its own insurance rules and laws. Both of the Government marketplace websites will base your coverage on your state and zip code. This year there is something special, open enrollment dates have been extended. Normally, it’s November 1st or December 15th. President Biden has extended it through January 15th of this year.
Deborah:
Sarah, tell us what options are available for the self-employed entrepreneur with no children, maybe a spouse
Sarah:
Most people jump to the ACA plans and find they are too expensive due to an individual’s income. There are private options and marketplaces to research. If the ACA premiums are too high or do not include a deductible that works for you. Then there are other options available like PPO plans not based on income.
There are other options out there for self-employed folks, that may seem like a good choice at first,
but end up taking your money and not offering the coverage you can use. That’s why I love educating my clients. Different options on the internet include:
- Health Share with a particular affiliate – an example might be Christian Ministries. – this is getting health coverage in a cost-sharing environment. A few things to know is, health share programs are not insurance. They are just what they state, a cost-sharing network. So, your doctors may not take it. You might wind up having to process paperwork on your own, and they don’t guarantee to pay any claims. My advice is to read the details and be careful of the loopholes.
- There are also short-term plans that most people get if they’re going from one job to another and they’ve got 90 days, 30, 60 before their new coverage starts. I do know some folks that have tried to stay on their short-term plans for several years and have been successful. However, I call them Swiss cheese. They do have a lot of holes. They may not take care of wellness, or specific procedures or care stays in a hospital. So, beware of those kinds of plans and just really have somebody explain to you what the plan is going to cover so that you’re not caught in a catastrophic situation.
Every individual is different. Say You are a 50-year-old man and there’s the maternity coverage available for you on your marketplace plan.
This is probably something you do not need. Mental Health care may be more important to you. Perhaps you are athletic and very careful with your nutrition and self-care habits, there are private insurances that better suit your needs.
I understand and can help guide a person to the other options that are private insurance options. They are very customizable to your needs, and you can pick and choose what you need. We consider the full scope of care options you may need. Perhaps lower on the doctor visit side and then a manageable deductible available for catastrophic.
That’s a small example of the kind of things I like to explain to my clients. And then we just really talk about what’s going to be best for them and their family or their small business.
Deborah:
Are you saying that outside of the large Health Insurance companies like UHC, there are smaller more “niche” companies available that a person should consider?
Sarah:
There are many kinds of niche health insurance markets.
It is possible now for an individual to pick how many basic doctors care – physicals, year self-care tests like colonoscopies for example -that they want. A person can select an insurance that better suits their pharmaceutical needs. A person can also pick their deductible in their co-insurance and mix and match. You know, maybe you want a super low premium and you’re OK with a high deductible because you’re super healthy, you take care of yourself. And it really, truly is just the “what ifs” that you’re worried about. We can really tailor the insurance down depending on your needs.
Advisors understand the fine print in each Insurance option
Some of the “shared” plans require you to do the legwork, get the bills and file them in certain time parameters to get reimbursed.
Something else to watch for is preexisting clauses. Some companies will hold to a pre-existing health event for up to 5 years. Let’s say you’ve had a heart attack and now you’ve completely changed your lifestyle and you’re eating healthy and you’re exercising and everything else. They may require that you have at least five years since that heart attack before they’ll cover you or anything related to heart problems.
My job as an advisor is to go the extra step and know the little details that are not in bold print. I drill down the information on the website and sometimes even call and ask.
Deborah:
I think I am understanding your point. The reason to go to an adviser is to find a health insurance knowledgeable “guru” who knows what questions to ask and the options available. I just thought I had two choices the government or whoever my employer-provided, and that was pretty much it.
Not correct at all. There are several options that can save a person money. I just tried the Sherpa website ad found I can get insurance for as low as $40 a month with a reasonable catastrophic deductible.
Our third group is the over 50, early retiring folks
Some are very healthy, but as you said, they may have had a heart attack and now they are taking care of themselves. They have changed their lifestyle overall. Then you have the over 50 that have all predisposing diabetes, health issues that are inherent from their family. What is something that folks like that really need to take into consideration, My generation who is just recognizing we are not getting much younger these days?
Sarah:
Yeah, there’s a lot of that. You know, the almost retired, but not quite to Medicare age. A lot of people are retiring earlier these days. And are worried they may not be covered.
If you are on a company-sponsored plan and you’re getting ready to retire, you can take your Cobra option
And Cobra is that extension of your employer’s health care that you can take for up to 18 months. If you have had a lot of preexisting conditions or you’re in the middle of treatment or something. Yes, it’s going to be more expensive. But you cannot afford to lose coverage. Just remember that whatever your employer was covering, comes out of your paycheck from your employer, you will pay at least three times that amount because you’re now going to be covering the entire premium. But honestly, if you need that much care, you need to stay on your plan because there’s nothing worse than having to find new doctors who explained situations and all of that again. So, I always suggest to those on the cusp of being ready to hit Medicare with health problems, just go ahead and stay on your cobra. And then once that cobra runs out, if you still have a little bit of a gap, we can help you find something.
The marketplace does have some really great plans
If you’ve been self-employed and you’re hitting that over 50 mark, you know the market and you have again, preexisting conditions. There are marketplace (ACA) plans which are very good and affordable. Biden put in some subsidies for higher income levels. You may still get a subsidy even if you’re a couple 50 to 60 years old and you’re making over $200000 a year, you might still get some sort of tax credit and subsidy so I can help people work through that.
But really and truly, you know, if you’re healthy, you’re out playing golf, you’ve had no preexisting conditions, you’ve been taking care of yourself. You’re healthy financially and you’re healthy, you know, physically, then we can definitely look at some of those private options.
Deborah:
Lastly, how about the over 70 groups, the Medicare people?
How does their current health level affect insurance and what they can look for
Sarah:
Once you turn 65, your Medicare that you’ve been paying into your whole working life will kick in. I don’t do anything over 65 personally, but I’ve got a couple of really great referral sources, one of which just took care of my mother-in-law for me. I trusted him enough to be able to refer her for health insurance advice. Medicare is really confusing because there are lots of different parts. You know, all the alphabet, part A, Part B, D, all of those. They take care of different things. I always refer somebody to a Medicare specialist to make sure that they’re getting what they need.
Another thing in that age bracket, maybe you’ve got a couple and somebody hitting Medicare age, but the other one is still under 65
I am able to split them up and I help them as well. Keeping the younger person on the private plan. While helping that 65-year-old get on to the Medicare plan. Not everybody, not all families are on the same insurance plan anymore these days, especially when you’re looking at your bottom line and how much money you’re spending every month. I love being able to help clients do that. I’ve got several clients who are on an employer-sponsored plan and the employer helps to pay for their subs or their premium every month. However, the spouse and the dependents come out of that person’s check at 100 percent premium. We can change or help adjust the cost with other plans. I have several clients where I’ll take the spouse and dependents and put them on a private plan. And we keep the employee on that employer plan since they’re helping to cover some of the premiums.
Having an agent, an advisor work with you is just paramount
Our job is to be able to understand what your options are. Private insurance is a tool and advisors know what part of that tool is the best for the job at hand. In the private workspace, for sure. You have to know how to use it, where to get the best bang for your insurance dollars, how to keep the most money in your pocket, and how to possibly provide your small group of employees the best insurance. In the event of a catastrophic situation, I am also available to help navigate the insurance questions as they arise. Your 800 number on the back of your card, is not going to do that for you.
Deborah:
Sarah, you step outside the box when it comes to customer care. Thank you! I love finding people like yourselves that do exactly that, and I’m so thankful for knowing you and for the service that you do.
Sarah:
If it’s something any of my clients have a question about, or if I can help their friends, it just takes a phone call. I don’t mind doing that at all, because it is it’s a service, and I truly love to serve and help other people understand their insurance so that they don’t get caught up in the weeds.
I’m self-employed also. It is important that folks know, I don’t tie myself to anyone’s company as far as my name recognition or my title is concerned because I do help in other ways.
Better Coverage with Bolton is my business connection.
I also have an active Facebook Business page and responded to messages there.
Email me at: Sarah@bettercoveragewithBolton. com
Deborah:
Perfect. I’m sure if you get overwhelmed and you’re super busy, you have other people that you can refer to.
Sarah:
I do.
One thing I wanted to mention to you to I don’t mind working after hours. I know a lot of people work during the day. So, if you needed me to touch base after hours, I am available. I have a little one at home, so please not too late. I’ve talked to people at nine o’clock at night before because that’s just what worked best for their schedule. I don’t mind talking on Saturday. I try to keep Sunday as family day but you know, even if it’s on a Sunday, and that’s the only time my clients have, I absolutely don’t mind putting that into the schedule.
I’m available. I mean, I’ve had people text me at nine o’clock saying, where’s the best E.R. in network, I’ve got to take my kid for stitches? I’m probably a little too available, sometimes to my own detriment. But again, that’s just my servant’s heart wanting to make sure that, you know, people are taken care of. I am licensed in 24 states. Texas obviously is my home, but I can help people across the country too. If you’ve got somebody that you know or like you said, you’ve got a family member in another state, I might be able to help them out as well.
Deborah:
Thank you so very much. I hope there will be lots of now educated people coming your way with more questions. I know I’ll be giving you a call, or my mom will be giving you a call when she shifts here from Michigan to a bonified Texas resident.
Hopefully, we’ve helped answer or opened the door to insurance questions and options. Health Insurance Advisors are our friends. People who know the insurance ropes and want to see their clients get the best medical insurance care for the best price. They are important friends to have!
No matter what your situation is, it is wise to have a well-educated agent to help you walk through your insurance needs. Agents are there to help you. You may think you do not need the help but they can advise you on all your options and save you money and be sure you are getting what you need.
Thank you very much, Sarah, for spending a little time with Wilcowellness today. We hope this information is helpful to the viewers. Insurance can be expensive and it is important to take a little time and make the right choices for you and your family.
At Wilco Wellness, we believe that health is a state of physical, mental, and social well-being. It infuses positive energy into the body, mind, and spirit. The best journey is living to support a complete state of harmony.
Thank you for taking a little time to learn more about Insurance Advisors and the choices that are available to you. If you are looking for a health care provider we encourage you to look through our Directory. We are positive you will find a clinician that is able to guide you through your health journey.
