Open Enrollment is Close!

If you are happy with your current health plan, feel free to skip this blogpost. If however, you are like most self-employed people and are frustrated with expensive, low benefit options then this post might be a help for you.

Two significant changes in health insurance this year are the removal of the individual mandate, meaning after January 1 2019, you will not be financially penalized for not having an ACA plan. The second change is the rollback of Short Term Medical limitations. Carriers can once again offer Short Term Medical plans for up to 360 days in most states.

This is important because Short Term Medical (STM) plans often offer benefits that are just as good as long term plans and are significantly cheaper. STMs are not for everyone, however. Here are some reasons NOT to go this route.

  1. You are planning on getting pregnant or are already expecting a child. STMs will not cover maternity benefits so don’t pick an STM if you are or think you might get pregnant.
  2. You have a chronic condition that needs regular medical care. STMs do not cover preexisting conditions in most cases so if you have expensive maintenance medications or have been informed by a doctor that you need medical attention for a condition you already have, these plans are not for you.
  3. You are planning on leaving the country for an extended period of time or have been out of the country for most of the last year. There are plans that cover international travel, but most regular STMs will not offer coverage outside the U.S..

If none of these apply to you, an STM might be a fit. In many cases these plans are 2/3 to 1/2 the price of equivalent ACA plans and generally have better doctor networks.

Something to look into!


Your Employees are Hurting

Unhappy manager     If you don’t provide health insurance to your employees it’s probably because you’ve decided you just can’t afford it. While it’s true that groups aren’t always cheaper there is another really important thing to consider. There is a dramatic difference between individual health insurance and group health insurance, and now more than ever. Here are 3 ways your employees will benefit from a group policy over the choices they now have on the individual marketplace:

Perhaps they really can keep their doctor.

     We all remember the famous promise that proved untrue. That’s because each carrier created separate doctor networks for their ACA Individual Marketplace plans and many doctors have opted out of those networks (or were asked to leave), in favor of other networks that offered more flexibility in managing care. For example, United Healthcare’s ACA network is called Compass Balanced whereas the network for their group plans is called Choice Plus. The Choice Plus network is considered a much better network. This applies to every major carrier in the industry. It’s more likely that your employee will find their family doctor in the Choice Plus network than the Compass Balanced.

They might save money.

Most groups are billed compositely, which means that older employees are going to benefit from being in a group with younger people. I recently wrote a group policy for a title company in Texas. One of their best employees was struggling because her husband had been diagnosed with cancer, couldn’t find an ACA plan that had MD Anderson in network, and was paying $1,800 in monthly premiums. Once the new plan was in place, MD Anderson was in network and her paycheck deduction was reduced to just over $600! Now how loyal do you think she feels about her employer?

They will typically get better benefits.

Group policies often provide benefits that you just won’t find on the individual marketplace. Nowhere is this more evident than with dental plans. I rarely recommend dental policies on the individual marketplace. The coverage is typically very limited, have long waiting periods, and simply do not cover things like orthodontia.

Most small businesses compete for the best talent and health insurance is one of the best ways to do it, especially since Obamacare has struggled to live up to the hype. Group insurance isn’t for every small company, but for some it may be the difference between keeping or losing your best people.