Home > How a Brilliant Insurance Agent Saved Me $$$ on Obamacare

How a Brilliant Insurance Agent Saved Me $$$ on Obamacare

November 27th, 2013 at 02:44 pm

For the last two months, I'd been TRYING to sign up for health insurance via my state's healthcare exchange. I managed to register and view my insurance choices online, but I did have some questions I wanted answered before I signed up.

The exchange's hours are 8 am to 6 pm, which is a problem when you work and have no privacy to have this kind of conversation.

Once I tried calling right at 8 a.m....15 minutes before I have to leave for work, but after she insisted she had to ask ME questions, she then put me on hold for a licensed agent and I had to hang up after waiting too long.

I tried calling from work by going into the stairwell at my 10-story office building and climbing to the top (vacant) floor so I could sit on the stairs and call, but again, I used up my entire half hour lunch on hold.

Whenever I tried logging onto the website I encountered frequent problems.

The ONE day I had to call them was this past Monday, which was the first time I was able to work at home due to having a doc appointment. But the handyman also came to do his thing and AT&T came to check out a line that's causing dropped UVerse connections (they ended up rewiring the whole thing) and then I had an appointment with my mother to see a lawyer to get power of attorney, so I simply RAN OUT OF TIME to call the state health exchange.

So I was at the end of my rope when I decided to make an appointment with a local insurance agent here in town who advertised that he was health exchange-certified and could help walk people through the process.

I've had 6 jobs in 2013 (p/t, contract or freelance) so calculating this year's income was a bit tricky, but I estimate I will only make about $41K. What they really look at, though, is 2014 income, and I calculate (carefully) that my 2014 income will be about $51,000, just $5,000 over the threshold of $46,000 income under which I'd qualify for a healthcare subsidy.

I met with this agent for an hour-and-a-half last night after work. Without his help, I would have settled for a Bronze plan with Anthem paying $500 a month in premiums with a $6300 maximum out of pocket cap and a $6300 deductible that includes pharmacy as well as medical. This is not good, since the very expensive medication I take for my MS is nearly $3,000 a month. So this means that I'd essentially have to shell out $6,000 in the first 2 months of 2014 before getting any kind of medical or pharmacy coverage.

But the insurance agent came up with something I would never have thought to do. If in 2014 I make the maximum IRA contribution (with the catch-up for being over age 50) to a TRADITIONAL IRA, I will have lowered my adjusted gross income to $44,500. Bingo. We revised my 2014 income to that rate on the state website and now I qualify for a substantial subsidy.

Not only that, but I'm now signed up for a GOLD plan where I pay just $404 a month with a $1,000 deductible and $3,000 maximum out of pocket cap.

The only hitch is that at least right now, my neurologist does not appear to be on that plan although my primary care doc and gyno are. The other thing that is a little unsettling is that the plan I signed up for is a NEW (non-profit) health insurer. While a lot of people might shy away from signing up with an unproven insurer, I decided to go with them because more of my regular doctors are in their network compared to another plan with a better known company.

So I'm paying $589 a month now on the exceedingly lousy Charter Oak (state Medicaid) plan. In 2014, I will save $189 a month in premiums with the other benefits I just mentioned.

There IS just one potentially problematic issue. As you may know from reading my blog, my current contract job at the bank is at least right now only intended to extend to July 2014. So when I calculated my 2014 income before deducting for the planned IRA contribution, I had just calculated bank income through July and then added unemployment benefit income for the rest of the year, assuming I had no other job lined up. This is the worst case scenario that assumes the bank doesn't extend my contract, as they do for many contractors, by 3 months or 6 months, or even possibly offer me a perm job, as they have also done for some others.

So based on this worst case scenario of losing the bank job in July, my health insurance at least would remain somewhat more affordable, at $404 a month.

And of course, if in July the bank offers me a perm position, then I will leap into their arms and sign up for THEIR health plan as quickly as I can and wave goodbye to everything related to the healthcare exchanges and probably get away with paying $200 or so a month.

HOWEVER, there are many shades of grey here. If in July the bank says, Patient Saver, we'd like to extend your contract for 3 months, then I will have to report the change of income on the state healthcare exchange website. That will cause me to exceed the $46,000 income threshold to receive the subsidy.

At that point, I would then have to pay the full price of the Gold plan, which is $700-something a month, for the remaining 5 months of the year. So for the latter 5 months of the year, I would have to pay at least $3500 just for the premiums.

(Quick calculation: An extra 3 months of bank income would roughly gross $17,000, pushing my annual 2014 gross up to about $68,000. 7.5% of of that is $5,100, so i guess to the extent that my healthcare expenses exceed that, I can deduct in on next year's tax return.)

But anyway, back to the scenario of getting a 3-month extension on the job but losing the subsidy. Working full-time, I guess I could afford to pay $700-something a month for health insurance, although when or if I lost the job after the extension, I'd have to report change of income AGAIN and probably wind up on the Medicaid option which I decidedly DO NOT want to be on as I've already experienced how difficult it is to obtain coverage on it, despite what they claim.

To actually have to be talking about paying $700-something a month for health insurance sounds like insanity to me, but that's the way it goes. And unfortunately now with the subsidy, what's good for me job-wise will not be good for me healthcare expense-wise, unless I get a perm job and I can go on the employer's plan.

So it's hard to know what the heck to wish for!

Anyway, I am still extremely grateful to this insurance agent who found a creative solution to help me lower my healthcare costs, at least for the first 7 months of 2014. On my list of things to do is to get him some sort of gourmet gift/food basket and have it delivered to his office.

9 Responses to “How a Brilliant Insurance Agent Saved Me $$$ on Obamacare”

  1. TashaC. Says:

    wow- you had a lot of questions answered and many more still to get answered! My question is WHERE DID YOU FIND THIS INSURANCE AGENT? I want to set up a meeting with someone like this.

  2. PatientSaver Says:

    I only learned about him by seeing an ad he posted in the local newspaper. Any regular insurance agent can do it if they take training and get healthcare exchange-certified. If you don't see one advertising, you might call around to a few and see if they're doing it.

    I thought I could handle this on my own but I am so glad I went to see him. He was very knowledgeable and knew the ins and outs of the law and the state exchange much better than me. And best of all, no charge.

  3. TashaC. Says:

    Thanks! Does he get commission on the back end?

  4. Petunia 100 Says:

    That's great. Smile Even if you do get stuck paying $700+ for the second half of the year, you will still come out ahead with that 1k deductible (vs 6k).

    Here's another small wrinkle: the floor for medical expenses is going from 7.5% to 10% for those under age 65, beginning with tax year 2013.

    I wish I could find an insurance person who knew the ins and outs of the California exchange.

  5. PatientSaver Says:

    He gets a commission from whichever insurance company i ultimately go with, i believe.

  6. Xtreme Thunder Says:

    That's awesome you found someone who can help!

    I have employer sponsored health insurance, but I have poked around on both Gov't and State health plans, and how can they call this "affordable"? There are people who can't make ends meet now, nonetheless with health insurance. Even the cheap Bronze plans, as you found out, have ridiculous deductible, coinsurance and maximum out-of-pocket expenses, and some don't mention up front, it's hidden in the fine print!

    I am for health care for all, but at least make it actually affordable, right? $700+ a month is not affordable to me. I realize there are subsidies, but what about the person that makes $46K vs. their neighbor in the same boat that makes $47K? Outrageous. Sad really.

    As Petunia 100 mentioned, how convenient the floor for medical expenses is going from 7.5% to 10%. :rollseyes:

    Sorry for the mini rant in your comment section! I am not sure what I would do in your specific situation.

  7. PatientSaver Says:

    Petunia, I did not know the rate for deducting medical expenses was rising to 10%. Sigh. I don't think my expenses will be that high...

    Thunder, to be fair, all the health plans clearly spell out the deductible, coinsurance and maximum OOP. At least they do on my state exchange. But you're right, even the so-called "cheap" Bronze plans are not really all that cheap.

    I agree it is very upsetting to be right on the income borderline that determines whether or not you get a subsidy. I suppose they have to draw the line somewhere. Believe me, I don't mind the rant at all. I hope they manage to work out all the kinks in the plan and that once we get well into 2014, people like the way it works. I guess my overall concern is that if rates start out where they are now, what's to stop insurers from raising them in 2015? Have we really accomplished anything? I'm afraid that so far it appears that the only ones really making out with this new health plan are the insurers themselves, who stand to gain thousands who never had health insurance before.

  8. ceejay74 Says:

    Well, Obama tried his best; unfortunately the plan was significantly undermined by changes made during negotiations, compromises to get SOMEthing passed. There are benefits besides the price of premiums, like free well visits, no lifetime maximums, free birth control medication, no being thrown off or rejected for preexisting conditions.

    And, worst come to worst, if you absolutely can't afford it, the penalty is 1% of your salary. And, that's only if you could afford the lowest-priced coverage. If the lowest plan would be more than 8% of your salary, there's no penalty.

  9. Buendia Says:

    I think it's brilliant that you found someone to help you work all of this out! I went with a plan through our current insurer. I also couldn't figure out what our income will be... there are a lot of variables. I am now wondering if we would have gotten a subsidy if we'd gotten insurance through the exchange. One of the variables is whether or not my husband will be insured through work or not. And then I'm not at all sure how they work out the subsidy, since we are married filing jointly (so if I buy insurance for me and my daughter, but he gets it through work - ????). Would love to have someone like you found to help with this.

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