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Boomers - The Decade before Retirement


The pre-retirement decade for Baby Boomers can prove to be a challenging time in light of managing your healthcare needs.  Boomers in this group of 55-64 year olds comprise about 12% of our country’s population.  This societal group contains a “mixed bag” of those who are still an active part of the labor force and those who are able to retire early.  Therefore, not all are eligible for Medicare and may still have to choose their own healthcare plan, as fewer companies provide retirement benefit packages that will include a health plan.

The Metallic Series

Those non-elderly people who find themselves without health insurance or inadequate insurance are looking for answers as to what to do next and what viable solutions are available in light of the new healthcare laws and provisions. If you need a non-group plan because you do not have a health plan from an employer, you will find you are now required by law to have an approved ACA (Affordable Care Act) plan starting in 2014. These plans can be purchased on the public exchange called the Marketplace or off the exchange from insurance companies that have been approved to carry these plans. They are referred to as the Metallic Series and include Bronze, Silver, Gold and Platinum. There is also a Catastrophic Plan available for those under the age of 30 and those with hardship exemptions. No subsidies can be applied to the Catastrophic Plan. To see if you have any of the circumstances that would affect your ability to purchase health insurance coverage check out https://www.healthcare.gov. Details as to what each plan offers and what companies offer such plans can be found in a link to your state at qqbenefits.com

It will be to one’s advantage to shop around for the best type of plan to purchase. Questions to ask one’s self should include:

  • Am I looking for the best, most inclusive care?
  • Am I looking to keep my current doctor?
  • Am I looking for the lowest premium only? Along with this answer consider the availability of funds set aside for the out-of-pocket expenses such as deductibles and copays.

According to the 2014 “Guide to Health Insurance for People with Medicare” developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) “. . .the Marketplace, a key part of the Affordable Care Act, is a new way for individuals, families and employees of small businesses to get health insurance but Medicare isn’t part of the Marketplace.” So once you are enrolled in Medicare you are covered to meet the ACA’s requirement for insurance and thus you will avoid any penalty that could be imposed by the government and the IRS. What you won’t find offered in the Marketplace are policies for Medicare Supplement Insurance or Part D prescription drug plans.

Most people in this age bracket who have struggled to get access to health coverage prior to the implementation of the ACA will now find there are options. For instance, you might have considered starting your own business and now you won’t have to be concerned about healthcare insurance. Because coverage is required to insure what is described as the Essential Health Benefits, insurance companies may not reject a person nor exclude medical conditions based on pre-existing medical conditions. There should be a plan that will suit your current needs as well as future health issues that may arise.

Essential health benefits must include items and services within at least the following 10 categories for all plans: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, which includes oral and vision care.

Though there are four tiers of the metal plans available, not all plans are required to be offered by all the insurance companies that participate in the Marketplace. However, ACA-approved insurance companies will at least offer the Silver and Gold Plans, whether on or off the exchange. These plans basically pay for 60-90% of your healthcare costs, depending on the plan and the amount of services you actually use during the year. Here is a brief summary of the four tiers. The Bronze Plan pays 60% of your healthcare costs, Silver Plan- 70%, Gold Plan – 80% and Platinum Plan- 90%. In addition, the Catastrophic Plan pays less than 60% of total average cost and is available only to people less than 30 years old or who have a hardship exemption.

Overall, you will want to choose a plan that fits your budget and meets your family’s needs. Premiums should be the same for the same plan on or off the exchange with the big difference being whether you would qualify for a subsidy that could significantly reduce your monthly premiums. To qualify for a subsidy you must be making less than 400% of the Federal Poverty Level (FLP). The Federal Poverty Level is a measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits. The amount of a qualified premium tax credit depends on your income and family size. The lower your income is the bigger the credit you qualify for. The current 2013 levels being used for individuals it is $11,490 to $45,960. For a family of 4 the current levels are $23,550 to $94,200. The guidelines are issued in January for the previous year so they are subject to change each year. The subsidy is not significant until you get to 300% or less of the FLP. Also, per the healthcare.gov site these are “advance payments of tax credit that can be used right away to lower your monthly premiums. You may choose how much advance credit payments to apply to your premiums each month, up to the maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess payments with your tax return.”

You may want the Bronze Plan if you do not expect to use the medical services very much and you do not have monthly prescription costs. The Silver Plan may be the best value if you qualify for lower out-of-pocket costs, but you also expect to use medical services on a limited basis. Both the Gold and Platinum Plans offer more coverage and less out-of-pocket expenses, but the premiums are calculated higher to cover the costs of the level of the more complete care you would like.


SHORT TERM OPTIONS

Another option to consider is the Short Term Medical Plan, especially if you are nearing the eligible age for Medicare. These plans are not ACA approved so you may be subject to the penalty; but since the premiums are significantly lower, you could come out ahead for monthly outlay and still receive sufficient coverage for you and your family while maintaining your own peace of mind that you have chosen a good option. The Short Term Plan has an expiration date of a few months to close to a year from issue date and a 7-part health questionnaire for pre-qualification. If you have no need to be concerned about pre-existing conditions, this type of plan could save you significant $$$ and is worth looking into. They can be purchased directly from an insurance company in your area, from an insurance broker or agent or even from a private exchange that is not run by the government. You will find these plans typically are effective within 24 hours from submission and are accepted by a wide range of hospitals, doctors and healthcare professionals across the country.

Disadvantages of short-term health insurance might include that they are not guaranteed renewable, wellness or preventive care such as dental and vision are not included and such temporary health insurance may subject you to a tax penalty as of 2014. Further investigation as to whether this type of plan would qualify as a good fit for you is warranted. Top carriers across the country carry the Short Term Health Plan as options for you.

The latest reports coming out are indicating there might be an influx of more companies participating in the Marketplace and, therefore, more plans available in 2015. This can only help the consumer as it would result in more options and lower premiums. Not only as a health-conscious consumer but also as a health-conscious citizen, you will need to stay abreast of the latest news from the healthcare market as more updates are issued and the information can be evaluated on a broader basis.

One good place to inquire is at http://www.qqbenefits.com online site where you not only receive additional information to review but also personal assistance from a friendly, licensed, qualified agent who will be happy to assist you by guiding you to the plan that has the best fit for you. It doesn’t matter where you live, the agents at QQ Benefits will know what is available in your state. You can be confident that the assistance you receive will be accurate. Premiums are regulated by law so it will be the same whether you utilize the capable assistance of a qualified agent at QQ Benefits or complete the process on your own.


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