Tag Archives: Individual Insurance

Federal Agencies Release Final Regulations for Short-Term Limited Duration Insurance Coverage

August 8, 2018


The Departments of Labor, Health and Human Services, and Treasury recently released final regulations for short-term limited duration insurance policies (STLDI) that make several changes to the existing STLDI rules and also affect how these policies interact with other laws.  The final regulations become effective this Fall.  STLDI coverage is intended to provide individuals who experience short-term gaps in medical coverage with a cost-effective alternative to the more comprehensive and expensive coverage available through the public health insurance exchange (the “Marketplace”), COBRA, or through other coverage continuation laws.

Offering STLDI coverage to employees (or former employees) is not a viable employer strategy as the coverage will lose its STLDI protection under the final regulations.  Under the final regulations:

  • STLDI coverage is not required to meet the ACA’s plan design mandates, meaning it may have annual or lifetime dollar maximum limits, pre-existing condition exclusions, exclusions for ACA-mandated benefits, etc.
  • The permitted duration for an STLDI policy increases from 3 months to 364 days, and it may be renewed for up to 36 total months.
  • STLDI coverage does not qualify as minimum essential coverage (MEC) for the purposes of satisfying the ACA’s individual mandate tax penalty.  This penalty is charged when a taxpayer fails to maintain MEC for the tax year. The Tax Cut and Jobs Act of 2017 eliminates the penalty starting in 2019, so this issue will go away.
  • Insurance carriers are permitted to subject applicants to underwriting and may decline coverage.
  • A loss of STLDI coverage will not trigger mid-year election rights through the Marketplace.

Insurance carriers are not required to offer STLDI coverage.  Insurance carriers are required to provide a notice with the application materials to educate applicants about the limitations of these plans.  The final regulations also note that states can mandate additional limitations.


This alert was prepared by Marsh & McLennan Agency’s Employee Health & Benefits Compliance Center of Excellence.  The information contained herein is for general informational purposes only and does not constitute legal or tax advice regarding any specific situation. Any statements made are based solely on our experience as consultants. Marsh & McLennan Agency LLC shall have no obligation to update this publication and shall have no liability to you or any other party arising out of this publication or any matter contained herein.  The information provided in this alert is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency is not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions. © 2018 Marsh & McLennan Agency LLC. All Rights Reserved.

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What the 2017 Tax Reform Actually Means for Employers

January 5, 2018


On December 22nd President Trump signed the 2017 Tax Cuts and Jobs Act, marking his administration’s first successful modification to the Affordable Care Act (ACA). Two core aspects of the ACA are the employer mandate and in the individual mandate. The individual mandate requires U.S. citizens have minimum essential coverage for each month, qualify for an exemption, or face a tax penalty. Contrary to popular news, the tax act did not repeal the individual mandate. Rather, it took the teeth out of the law by making the individual mandate penalties $0 as of 2019. Individuals will still need to either have qualifying coverage or pay a penalty for the 2017 and 2018 filing seasons.

The employer mandate was left untouched by the bill. Applicable Large Employers (ALEs) will still need to offer affordable, minimum essential coverage providing minimum value to their full-time employees and their dependents. This means employers likely won’t be affected until 2019 when healthy individuals may decide to forgo coverage absent a penalty. Some speculate employers may have adverse enrollment effects as a result of losing healthier employees.

There’s been some uncertainty if Congress will launch another repeal effort in 2018. Senate Majority Leader Mitch McConnell suggested in late December that the Senate will give up ACA repeal efforts in 2018 due to the difficult odds of repealing and replacing with a 51-49 Senate party division. But other Republicans, including Senator Lindsey Graham (R-S.C.) and House Speaker Paul Ryan (R-Wis.) expressed support for another attempt at reform. Ultimately employers will need to wait to see if Congress will pass other changes to the ACA.

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The Family Love Letter

December 29, 2017


I am fortunate to work with quite a few estate and retirement planning professionals in providing their clients with senior life, long-term care and Medicare health insurance products.  One of the items I’ve noted that my experts recommend their clients prepare is a “Family Love Letter”.

The Family Love Letter is both a document and a file.  The letter is not a legal document like a will or trust; it is a plain language letter that gives your family all of the practical information they’ll need when you pass away or if you’re incapacitated.  The file should include the necessary documents and information to assist them in managing the details of your life.  These days, it’s usually some combination of paper files and a password protected online information vault.

In preparing your file, you should include;

-An up-to-date contacts list for your experts; personal attorney and/or estate attorney, financial planner and investment advisors, trust administrator, bankers and insurance brokers.

All of the documents related to your Will and Trust, or their location (such as a safe deposit box or online document data storage site).

-Passwords for your virtual life; anything related to banking, investments and retirement accounts, credit cards, insurance products, data/document storage, as well as personal sites like Facebook, LinkedIn, I-Tunes and Instagram, as well as all active email accounts.

-Information on life insurance, long-term care and disability coverage, including the location of in-force policies and premium invoices.  As referenced above, the contact information for your insurance broker is important.  But it is imperative that you retain a copy of your life insurance policies.

-Investment information, including 401k statements, bank account summaries and related documents.  The same advice for life insurance applies here- retain copies of all key documents for your family.

-Local, state, federal tax filings and any related personal or real property tax documents.

For the letter, you should outline everything that’s included in the file, as well as any practical guidance that gives your family clarity in managing these details.  For both the letter and the file, neatness counts; online sites and tools are far better than scribbled notes and faded documents.

I hope this information moves you to start your estate planning.  Somewhere in the middle of your love letter you’ll likely find that you’ve overlooked some details, lost contacts and documents, or forgotten to do something important (like update your life insurance beneficiaries).  This is where I would encourage you to engage professionals to review your will, your insurance policies, and your estate plans.

If you have questions on this article, would like to provide your perspective on the family love letter, or request a referral to a professional in my network, please call or email.

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Medicare Part B Premiums Rise Next Year?

December 20, 2017


CMS Medicare has announced that the standard Medicare Part B premium will remain at $134 per month in 2018. The headline is comforting for retirees, as it appears that premiums are not increasing.  But read further down the press release and one notes that for many enrollees,  42 percent to be precise, they’ll see their Medicare premiums grow to $134 because the cost-of-living adjustment to their Social Security benefit eliminates a previous hold- harmless protection that kept  their Part B premiums at or under $107 per month.

The news isn’t favorable for our higher-income Medicare enrollees, either. With a five-tier chart of premiums that rises above $134 on incomes that exceed $170,000 for married couples, roughly 10% of Medicare enrollees have paid higher Part B and D premiums for quite a few years.  The change for 2018 that’s drawing considerable notice is that the top two earnings tiers have dropped, with income thresholds more than $100,000 lower than 2017.  This puts more enrollees in higher Part B premium categories.

With most enrollees paying Medicare premiums out of their Social Security checks, these increases can go unnoticed. It pays to be informed!  For details on the premiums you’ll pay to Uncle Sam for Medicare next year, please go here: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html .  And, call us when you have questions on Medicare costs and coverages.

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Preventing Medicare Identity Theft

October 19, 2017


It shouldn’t surprise anyone that a card kept in our wallet and handed out to strangers at every medical facility represents a significant identity theft exposure.  In an effort to reduce healthcare related fraud, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandates the removal of the Social Security Number-based Health Insurance Claim Number (HICN) from Medicare ID cards.

Centers for Medicare & Medicaid Services (CMS) will mail out new Medicare ID cards beginning April 1, 2018 through April 1, 2019. The HICN, which contains the SSN, will be replaced with a Medicare Beneficiary Identifier (MBI).

Impact to Employers
Employers and their HR departments do not need to make any changes unless they capture and use the Medicare HICN for active employees or retirees.

Impact to Medicare Beneficiaries
Medicare beneficiaries who have a Medicare ID card will be required to use the new number on Medicare-related documents, including claims submission forms with medical providers.

Until the new ID card arrives in a beneficiary’s mailbox, the usual cautions on providing personal information apply.  See here for Medicare’s common-sense suggestions; https://www.medicare.gov/forms-help-and-resources/identity-theft/identity-theft.html

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Cost-Share Subsidies: Back Again?

October 17, 2017


*UPDATE: After announcing and praising – just yesterday – the deal struck by Republican Senator Lamar Alexander and Senator Patty Murray, the President tweeted this morning:

Continued uncertainty surrounding the payment of the cost share subsidies will likely drive premiums higher and frustrate insurers participating in the public exchanges. Which may be the point, as the President has repeatedly tweeted about watching the ACA implode after Congress failed to repeal the law this summer:


Last week, President Trump announced that his Administration would not pay the cost-share subsidies to insurance companies offering plans on the public exchanges. Today, however, the President announced a bi-partisan Senate deal that he said would fund the cost-share subsidies for “a year or two years.” The deal reportedly gives states “more flexibility in the variety of choices they can give to consumers.” It would also reportedly restore $106 million in ACA outreach funding that was cut by President Trump.

The deal would still need to be approved by Congress, which is not a given. It may face opposition in the House. House Speaker Paul Ryan, in particular, praised the President’s decision to end the subsidies last week.


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Discontinuation of Cost-Sharing Subsidies in the Marketplaces

October 13, 2017


Also on October 12, the Trump Administration indicated it will stop paying cost-sharing subsidies immediately to insurance carriers in the Marketplace.

The cost sharing subsidies are available to individuals making 250% or less of the Federal Poverty Level (FPL). They are designed to fund lower out of pocket cost for these lower-income individuals.  Insurance carriers that offer a silver plan in the Marketplace are required to offer 3 variations of that plan for individuals that qualify for cost sharing subsidies. The variations have lower cost-sharing than the standard silver plan option. This is required by the ACA.  The government reimburses the insurance carrier for the cost associated with the lower cost payments in the form of subsidies.

The Trump administration ended the subsidies, but insurance carriers are still obligated to offer the 3 other plans with lower cost sharing.  Carriers anticipated the loss of these subsidies and submitted two sets of rates for approval by the Marketplace. The rates assuming no cost-sharing subsidies are approximately 20% higher.

It is important to note, the premium subsidies are unaffected.  If an individual qualifies for a premium subsidy, the cost for coverage under the second lowest cost silver plan is set a percentage of the individual’s household income.  The Federal government pays the remaining premium.  The 20% premium hike will be paid by taxpayers for those that receive premium subsidies.  Accordingly, the by ending the cost-sharing subsidies, the Federal government will likely pay more to supplement the individual’s premium, rather than splitting the difference with the insurance companies. Approximately eighty-five percent of individuals purchasing coverage in the Marketplace receive a premium subsidy. Premium subsidies can still trigger employer mandate penalties.

The cost-share offsets are authorized by statute but payments are not appropriated annually, which was challenged by former Speaker of the House John Boehner in a lawsuit that is still ongoing. That lawsuit is currently being appealed, and several states have intervened and defended the subsidies. Those states will likely argue that the Trump Administration’s decision to stop paying the subsidies is invalid. Additionally, State Attorneys General from Kentucky, Massachusetts, Connecticut, California and New York have filed a separate lawsuit challenging the Administration’s decision.


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Questions to Ask If You’re Considering a HealthCare Sharing Ministry

March 9, 2017


With the Affordable Care Act (ACA) driving premiums on individual health plans out of reach for many families, we’re getting more inquiries on HealthCare Sharing Ministries. These are programs administered by religious affiliated organizations in which members agree to share healthcare costs, much like the mutual aid societies of earlier generations.  The growing interest in “med share” programs comes from that fact that monthly contributions are often significantly lower than premiums for health insurance.  And, members in some med share programs are exempt from ACA tax penalties levied by the IRS on the uninsured.

Because these plans aren’t insurance products, we won’t offer an opinion here on their merits. But as professional risk managers, we do want to offer some questions to ask when considering enrolling in one of these programs.  Specifically:

  1. Who’s in charge? What organization is offering this med share program? Does the website for the sponsoring organization list the names of the executive leadership and board members, provide bios outlining their qualifications, and give telephone, email and physical contact information?
  2. What happens to my money? Does the sponsoring organization publish professionally audited annual financials? When reviewing insurers, we always check to make certain a carrier has reserves that are sufficient to pay large claims.  How does the med share plan you’re considering prepare for catastrophic exposures?
  3. How are my medical bills paid? Med share programs do not guarantee payment to providers. Your shared monthly contribution is held in escrow and paid out to providers following a set of payment rules created and administered by the organization.  Are these rules and timelines for paying providers clearly defined and provided to potential members in writing?  Does the organization provide a consumer bill of rights, and a transparent process for resolving disputes?
  4. What does my doctor think about this program? Your providers may have never heard of a med share program. Will they refuse to provide services?  Do they consider a med share member uninsured and bill full retail cost for services?
  5. Do I have a “Plan B”? Keep in mind that an employer group health plan may prohibit you from enrolling outside of the annual open enrollment period. Similar gatekeeper enrollment rules hold true for ACA-compliant individual health plans, as well.  Leaving a med share plan once you’ve joined may pose a unique set of challenges.

Human nature has shown us that when we don’t know what to ask, we end up relying on the one question which we know has a clear answer; how much does it cost? We hope that the questions in this blog post will help to start a conversation that leads to a clear understanding of what you’re buying, and perhaps put the cost question at the back end of the discussion where it belongs.

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Life Insurance Awareness Month

October 5, 2016


Millennials are defining their generation in a number of ways – record student loan debt and deferred marriage, parenthood, and homeownership being some of the most notable trends.

While these trends might convince our younger population that life insurance does not apply to them or shouldn’t be a priority, they could be making a big mistake. With Life Insurance Awareness month coming to a close, we take a look at some of the reasons 20 to 30-somethings should consider taking advantage of the benefits of life insurance.

It’s true, term life insurance is often purchased to cover the cost of a mortgage or a child’s future college tuition. While homeownership is at an all-time low and the mean age at first birth is at an all-time high (U.S. homeownership fell to 62.9% in the second quarter – the lowest since it began being tracked in 1965, and the CDC released data earlier this year showing the mean age at first birth rose to 26.3 years in 2014), millennials are not exempt from leaving behind debt to those closest to them.

Student loan debt borrowed on a private loan could be left to a co-signing parent, or even a spouse who did not co-sign. A term life policy could easily be used to protect against private student loan debt, and can include a decreasing payout over time as many mortgage policies do.  Likewise, the policy could also be used to cover credit card debt and auto loans.

Millennials also have the advantage of being able to lock in lower rates now, for both term and whole life policies.

In the 2016 Insurance Barometer Study, a combined effort from the non-profit Life Happens and LIMRA, the Life Insurance Market Research Association, millennials are, as expected, shown to be the least covered generation – 51% vs. 62%, 67% and 65% respectively for gen x, baby boomers and seniors.

Also noted in the survey, however, ‘burdening dependents if I die prematurely’ was tied for the second greatest financial concern of millennials, after ‘paying monthly bills’.  They also showed the greatest interest in purchasing a combined life and long-term care product, with 40% being very to extremely likely to choose a packaged product, as compared to 25% of gen x and 10% of baby boomers.

Although Millennials may not be covered now, the outlook is a positive one.

Conversation on benefits and affordability will continue to build a more secure financial future for our loved ones. If you have questions or need additional resources, please reach out to your JW Terrill consultant.

You can download the 2016 Insurance Barometer Study here: 2016 Insurance Barometer Study | Life Happens

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6 Medicare Mistakes to Avoid

July 8, 2016


With over 55 Million enrollees, Medicare is a massive federal health program that touches nearly everyone. If you’re not enrolled or planning on joining, you probably have a loved one or friend taking part.  If so, then you’ve already heard some of the horror stories about problems, oversights, and miscalculations that leave folks with too little coverage, or painfully high premiums.  With so much bad information out there, I’d like to outline a few of the common mistakes and pitfalls I’ve seen clients struggle with over the years.

Missing Your Initial Enrollment Period  

For most enrollees, Medicare eligibility begins at the start of the month in which you turn 65. Guidelines provide for a 7 month enrollment window; 3 months prior, the month you turn 65, and 3 months after.  If you miss that enrollment period, you may have to wait until the next General Enrollment period, and you may have to pay a penalty.

Enrolling in Medicare is usually an opt-in process.  You can visit www.SSA.gov to find the local Social Security Office and enroll in person, or you can enroll online at www.Medicare.gov.  Please note however, that if you’re receiving your Social Security retirement check when you first become eligible for Medicare, you’ll be enrolled and receive your Medicare ID card automatically.

Enrolling In Medicare Part B When You Don’t Need It

If you have group health coverage through your employer (or through your spouse’s employer), and that employer has 20 or more workers, you can delay enrollment into Medicare Part B until employment ends. In this scenario, there are no penalties or waiting periods for delayed enrollment.  And, since there’s a monthly premium for Part B, you could be paying for something you don’t need (if you have both Part B and employer group health coverage).  Go here for details: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/employer-coverage/i-have-employer-coverage.html#collapse-5567

Failing To Enroll In Part B When You Have COBRA or Retiree Medical Coverage

Even though COBRA looks like a straightforward continuation of your former employer’s group health plan, federal rules make COBRA coverage a secondary payer to Medicare. This means you could have a significant, uncapped out-of-pocket exposure for any medical bills if you haven’t signed up for Part B.  You may have penalties and a waiting period for enrollment, too.

Retiree plans have a variety of rules and regulations that make one-size-fits-all guidance impossible. For many retiree plans, Medicare is your primary payer.  For some, Medicare isn’t even necessary.  When planning for your retirement, reach out to your employer HR department or union health and welfare fund administrator as early as possible to review their written rules and guidelines.  It’s a good idea to review coverage costs against market alternatives such as Medi-Gap plans, too.

Skipping Part D Coverage

Part D drug insurance plans should not be viewed as optional coverage. If you miss your initial enrollment opportunity, you’ll not only have a late entry premium penalty when you join, but you’ll have to wait until next January for coverage.  With all the expensive break-through drugs coming into the market, you could have some difficult choices to make if you’re without a Part D plan.

Choosing Cheap Over Good When Buying Medicare Insurance Products

Maintaining our health in retirement should be one of our most important goals. When we’re choosing Medicare insurance plans, we need to put quality ahead of cost.  Medicare Advantage plans with insufficient provider networks or high out-of-pocket exposures, drug plans with small formularies and poor customer service, MediGap plans from insurers with questionable financial stability are all hard-to-spot deficiencies that can leave us regretting our buying decisions. 

Trying the D-I-Y Approach

In taxes, law and finance, we know that well informed decisions are easier when we hire a professional CPA, attorney or financial planner. In much the same way, utilizing a Medicare specialist insurance broker will prove helpful and keep you out of do-it-yourself traps.  Your broker is your advocate and will support their recommendations with well-reasoned explanations, plain language consumer resources, and transparent cost information.  Look for the same professional criteria from your broker as you would the rest of your advisor team- experience, reputation, transparency and knowledge.

Getting the best available health coverage out of your Medicare enrollment shouldn’t be like peeling an onion, with layer after layer of tear-inducing effort that leaves you with nothing but a mess to clean up. Plan ahead, know your rights, rely on your experts and you’ll find the right path to great coverage in your retirement.

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The Drug Problem

April 14, 2016


When Turing Pharmaceuticals raised the price of Daraprim from $13.50 to $750 overnight last September, they were brought under tremendous scrutiny – though it was not the first increase of its kind by a pharmaceutical company on a newly acquired drug.

Turing argues the price change will have little effect on the market, and profits will be used to develop new drug therapies with fewer side effects.  The opposition claims the pharmaceutical industry as a whole is grossly convoluted and requires some form of additional regulation.

One of the most prevalent of these regulations is to allow Americans to import drugs from Canada or other foreign countries – a possibility strongly supported by both Democratic Presidential contenders Bernie Sanders and Hillary Clinton.

With price restrictions set in force by the Canadian government, prescriptions can be sold at 55% less than what Americans are paying just over the border.  If you think it sounds pretty tempting, you’re not alone – despite FDA regulations outlawing re-importation, the states of Vermont, Illinois, Wisconsin and Minnesota are already doing it.

Even if your state does not allow it, regulations for the rest of us are vague.  Individuals have long been allowed to import drugs for personal use provided they have a prescription for a required treatment not yet available in America, and do not take in more than a three month supply at a time.  Though lower price is not an approved reason, it is left to the discretion of the customs agent whether to allow it through, and they will often look the other way.  With the addition of online pharmacies, foreign drugs are even more accessible to individuals without much of a threat of consequence.

So, is it a good idea?

I lean towards outright allowing individuals to import their prescriptions for personal use.  Those that are willing to do so on their own should be able to.  This is in line with the Safe & Affordable Drugs from Canada Act of 2015 which was re-introduced to Congress earlier this year.

I do not believe that pharmacies and wholesalers should be given the same pass, as Bernie Sanders has proposed.  Allowing importation on that scale is a roundabout way of enforcing our own government price ceilings, meddling with core economic pricing of supply and demand and the ability to fund new research and innovation.

Other proposed regulations to control rising drug prices include lowering the biologic (specialty) drug exclusivity period from 12 to 7 years, giving FDA approval priority to specialty drugs with only one or two competitors available, and prohibiting anti-competitive “pay-for-delay” deals between brand and generic drug makers.

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I’m In College, Do I Really Need Health Insurance?

July 7, 2015


Life as a college student is all about navigating the maze that is the transition from childhood to adulthood.  Learning how to walk, talk and pick the best health coverage option like an adult is a daunting task.  Reading through health insurance plans can be like trying to read a book in a foreign language.  I’m sure this is by design, a cunning approach by the Healthcare industry to mystify the business.  You might start thinking you should just skip it all together and pick one randomly to avoid trying to translate all of that into plain English…don’t. Let’s walk through the options so you can make an informed decision on which plan will work best for you.

Option 1: Stay on your parents’ health insurance plan

In 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Often referred to as the ACA or Obamacare, this act allows any child (married or not, employed or unemployed) to stay on their parent’s health plan until the age of 26.  This means you get to extend your childhood a few extra years post-graduation!  Keep this fact in your back pocket for future financial negotiations with your parents… Family health plans are often a good option because a parent’s company may contribute to part of the premium (the amount you pay per person for coverage) or drive down the costs of benefits in other ways.  Large corporations, simply because of their scale, can significantly drive down the average cost of healthcare premiums.

By staying on your parent’s plan during and after college, you will benefit from a wide range of coverage. But there is a caveat here.  You should look into its limitations if you are going to school or living far away from your parents. Their plan might not cover any of your local providers, and in particular, your school health center.  Avoid using the dreaded “Out of Network Providers”, which have much higher deductibles and general costs. This may not be an issue for you unless you have a chronic condition and require doctor’s visits throughout the school year. If you only need to see your doctor or other health care providers once or twice a year then you could easily just schedule appointments while you are home.

Option 2: Use the plan your school offers

On a school plan, you will be able to find coverage conveniently on and around campus. You don’t need to be on the school’s health plan to be able to see a campus doctor for a flu shot or a sinus infection, but be aware that there will be a fee to pay for those that are not.  On your school plan, if you ever need to go to the emergency room because you slipped at a party and got a concussion or you got a little too excited at a pickup basketball game and broke your ankle, you‘re in luck!  Or what about chronic colds and viruses that rip through a dorm; maybe even Mono and dare I even mention STI’s?… Student Health Services are extremely convenient, and there will be a hospital nearby that is on your school’s preferred providers list.  God forbid you ever have to deal with a serious hospital visit from an unexpected accident, whether or not that hospital is an In Network Provider (In Network refers to a hospital that your insurance provider has a relationship with and agrees to cover) can mean the difference between thousands of dollars in medical bills and serious debt for some families. School plans are convenient, but can cost more per year than staying on your parent’s plan so make sure to read through each plan before making a decision.  Fortunately in my case, the school plan was less expensive than my parent’s plan, so this was the obvious choice.

Option 3: Buy your own insurance through an exchange

One key implementation of the ACA is a health insurance marketplace. Basically, insurance providers compete with each other to offer an array of coverage options.  The ACA created these markets to get more individuals covered who are below 400% of the poverty line.  The act also implemented minimum criteria each plan has to meet.  These criteria prevent insurers from discriminating against preexisting medical conditions or gender, not enforcing any kind of annual spending caps on essential health benefits, and offering certain essential health benefits like maternity care, mental health, and substance abuse services.

You can put your information into the online exchange for your state and choose which option looks best to you from the five-tiered options available.  Each tier from bronze to gold offers increased coverage at a higher premium.  A fifth option in the exchange, called a catastrophic plan, is available but not something that many people choose.  This is only something to look into if you want a plan that is cheaper and you only plan to use it for a serious injury or illness and absolutely nothing else.  Prescription drugs and other doctor services (excluding annual preventative visits) are not covered at all and the deductible or the amount a plan says you must pay before the benefits kick in will be very high on this type of plan. You never know what might happen while you are away at college so I wouldn’t recommend this unless you are ready to take on that kind of risk.  But overall, looking into your health insurance marketplace is a great option and the best thing about a health insurance exchange is that all of this is in one spot so it’s easy to see which option will work for you!

Option 4: Apply for Medicaid

Since the ACA made changes to health care reform in 2014, anyone under age 65 with an income of up to 133 percent of the federal poverty level can qualify for Medicaid.  Check to see if you are eligible on www.medicaid.gov.

So What Do I Do Next?

To answer the question of “Do you need health insurance?”…Yes.  Don’t risk everything hoping to never get hurt or sick. Do the research and protect yourself now; you will thank yourself later. Take a deep breath, it’s not that hard.  Educate yourself a bit.  Seek out the assistance of a qualified, experienced professional that works on a fee basis to offer transparent guidance, ongoing service and who is focused on you. Figure out, in general, the type of needs you have and what kind of plan would best suit you.  Lay out the costs, including the premiums and any co-pays or deductibles.  Take a look at when the money is due – some premiums are payable monthly, some in advance of each semester.  Then make the best decision based on affordability and convenience.  Finally, share what you’ve learned with your parents and friends!   They’ll be impressed with all the legwork you’ve done and might even learn a thing or two.

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