What is Health Coverage Mitigation?
Mitigation is defined as the action of reducing the severity, seriousness, or painfulness of something. Nothing’s more painful than securing affordable health insurance if you don’t have access to an employer-based plan – especially in Florida! Health coverage mitigation reduces the pain involved in securing affordable health insurance and puts you back in control. And in most cases, at a savings of 40%+, and offering better benefits, less out of pocket, and income protection. Basically, health coverage mitigation is designing custom health insurance coverage based solely on the needs of the client.
Traditional Method of Health Coverage
Currently, if you’re not covered by an employer-sponsored plan and you’re not eligible for Medicare; you must purchase your own health insurance. In Florida, we have the Health Insurance Marketplace which requires you to purchase during Open Enrollment or have a Special Enrollment Period. Some insurance companies sell private health plans outside Open Enrollment that count as qualifying health coverage. If you buy outside the Marketplace any time, you can’t get premium tax credits or other savings based on income. Regardless, all of these plans have monthly premiums, deductibles, coinsurance, and max out-of-pocket charges. That adds up to you paying thousands of dollars before your insurance pays for much of anything!
In 2018 I was diagnosed with stage 4 colon cancer. In 2019, my wife had to have emergency gall bladder surgery and a 4-day hospital stay. We paid almost $36,000 in premiums (over 50%), deductibles, coinsurance, and max out-of-pocket charges.
Alternative Method of Health Coverage
Insurance was invented to protect you from the BIG financial hit, while this may be an oversimplification, the crux of the statement is true! I develop plans based on keeping my clients safe from the big hit while providing them with basic health coverage.
Prior to 2018, if you didn’t have ‘Minimum Essential Coverage’ as dictated by the ACA (Affordable Care Act) you were responsible for paying a monetary penalty. That has since been removed by Congress, giving health insurance buyers many more options.
Below are 3 situations I encountered in the 2020 AEP/OEP.
The Growing Family
I was contacted by a gentleman in Jacksonville who had a major problem. He and his wife make about $150k annually and have 4 children ages 12 to 2. Having just left his position to start a new venture, he had decided to COBRA. He was paying $2400 per month after years of paying $100 monthly for his portion on his employer-sponsored plan. So this was totally unacceptable!
Initially, I went to the Marketplace. But the least expensive plan was still going to have a monthly premium of $2136. And it offers nothing until the deductible is paid ($17,100).
I ended up designing a custom solution. For the healthcare portion, we chose a 6-month short-term plan. It offers office visits, a copay for Urgent Care & emergency room visits. He added a dental/vision plan, a hospital plan, an accident plan, and a critical illness plan. Total monthly premiums: less than $1100!
Now he has a total deductible of $15,000 for the family, negotiated rates for primary care visits. Protection should anyone be hospitalized, and in the event of a critical illness, they will receive a lump sum of cash. $50K (each parent) and $30K (each child). He is responsible for 20% coinsurance, but for the most part that will be taken care of by the supplements.
The Medicare Mistake
A couple contacted me panicked because they had just received a letter from his employer-sponsored plan. Seems because he was eligible for Medicare they would only pick-up 20% of any medical bill starting in December. He was 66 and unfortunately, he had not signed up for Medicare Part B and was on the hook for the other 80%! It would be seven months before he would be eligible for Part B. If you’re 65+ in the US you only qualify for Medicare!
Since this was a pure insurance play, I signed him up for a critical illness policy and an accidental hospitalization plan. In six months we’ll enroll him in Medicare Part C and drop the accidental hospital plan for a senior hospitalization plan.
NOTE: When you qualify for Medicare, sign-up for Medicare Part B immediately, it will save you a ton of headaches in the long run. Visit www.FloridaMedicare.online for information on Florida Medicare.
Snowbird Problems
In Florida, snowbirds (those who relocate to Florida for the winter) are a fact of life. I had a couple contact me who spend 6 months a year at their Florida home and the remainder at their northern residence. The problem was, their insurance was an HMO so nobody down here took it.
I priced out plans on the Florida exchange but they were almost three times more than they were paying for their plan from up north. So we decided on a short-term plan and added an accident supplement plan. They now pay a premium that’s a little cheaper than what they pay for their plan up north and they have more coverage.
Health insurance takes a big chunk out of the budget of most Florida families. But by using your imagination, you can have great healthcare coverage and a little bit more cash in your pocket! To discuss your options for Florida health coverage mitigation, please visit www.FloridaHealthInsurance.online.
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