First time on Healthcare.gov - what to know (Michigan)?

[elaine amj]

DS (22) is shopping for health coverage in Michigan. It's his first time and he currently has zero coverage. I just found that deadline for Open Enrollment ends Dec 15 if he wants to be covered by Jan 1 so we are trying to just get something basic set up for this year and figure things out in more detail next year. We are just all super busy and overwhelmed with a million must-dos right now.

Any quick tips?

He is young and healthy and has no problems with a high deductible. He just started a new job and his employer is giving him $3/hr to shop for his own plan. He does not currently go to a specific doctor/hospital and for this year, that is not a priority. My husband used to work for a hospital system but the nearest hospital is 20 miles away from DS.

I looked up navigators and agents but a little unsure. When I looked at the list of Assisters, they all seem to target ethnic groups, low income support (we wouldn't want to pull away services from someone who needs it more) or very localized communities. He works an hour away from his place of residence so we'd prefer coverage over a wide area. The list of brokers is wildly extensive.

Could really use some direction so we can get this done and quickly. I am very nervous about his being without health coverage. We had been waiting as we weren't sure how his new employer was managing healthcare and have just been told it is just an extra $3/hr to his paycheck to get it himself.

[reeshau]

I don't know about Michigan, but wide coverage is a pipe dream for ACA in Texas.  I can get the Houaton metro area, and that's it.  Of course, emergency care is covered, but anything beyond that is tough.

My tip is, once you have filled out your application and are shopping, to "Apply Filter" to select for the local hospital, potential urgent care near home and work, and any preferred doctor's offices, and prescription drugs.  I never get a plan that covers it all,  but you can buy with open eyes about what it means.

[elaine amj]

I don’t know if it is relevant, but for his 2023 taxes, his total income was $18,171 and his taxable income was $4,321.

He is now earning $17/hr for 40hrs/week (plus the $3/hr for healthcare) so $35k/yr.


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[geekette]

The best thing to do is go to healthcare.gov and plug in some numbers. Age, projected income, zip code, and go from there.

At his age, could he be on your insurance?

[elaine amj]

The best thing to do is go to healthcare.gov and plug in some numbers. Age, projected income, zip code, and go from there.

At his age, could he be on your insurance?

No, he is not covered at all now which is why I am pushing hard for him to get this done as quickly as possible.

We have started the process of creating an account on healthcare.gov. Just wanted to check to see if there are any tips/pitfalls/best-practices/things to make it better as we navigate this process in a very short timeframe. eg is it helpful to use an Assistant or go through an Agent/Broker? Are there ones with high fees to absolutely stay away from (the Edward Jones of the healthcare world)? Is an Assistant helpful?

By the time DS gets home tonight after work, it's likely too late to call anyone. Tomorrow (Saturday) I have a 2-3 hours to help him before I go out for the rest of the day/night. Then Sunday we may have a couple of hours if we wake up early in the morning and I skip church. And Sunday is the deadline. Not sure any Assistants are available on  the weekend.

Feel very clueless about this as I have never had to navigate this. The last time I looked at any of this stuff was years ago but my husband handled all the logistics and all I remember was sifting through gold, silver and bronze plans to decide the best fit. That was the extent of my involvement. My husband passed away last year so we don't even have his limited experience to tap into.

eg I had no idea that plans did not cover medical services in the entire state. I am getting the impression it is possible to purchase a plan that covers only a tiny geographical area - perhaps even only a handful of hospitals?

 I do remember reading people's complaints that they went to the ER and accidentally saw an out-of-network doctor in their in-network hospital and got billed big bucks. Pretty scary. I figure this year since we have no time and any healthcare is better than zero healthcare, we'll just jump into something and then redo it with more research in next year's Open Enrollment. He's young and healthy so he can likely get away with accessing zero healthcare in the next year.

[geekette]

We've been on an ACA plan for over a decade.  No navigator or assistant needed.  If you miss the 12/15/25 deadline, he can sign up by 1/15/25 for a 2/1/25 start.  Not ideal, but better than waiting a year..

Yes, most plans have a limited network, some worse than others.  For life threatening injuries/illness, though, they will stabilize and transfer.  Yes, there are horror stories, and there's also help for those caught up in those, and charity care is also an option, but that's just something to stick in the back of your mind. 

Have you gone to healthcare.gov, put in his zip, age, and income?  That's where you need to start.

[reeshau]

The best thing to do is go to healthcare.gov and plug in some numbers. Age, projected income, zip code, and go from there.

At his age, could he be on your insurance?

eg I had no idea that plans did not cover medical services in the entire state. I am getting the impression it is possible to purchase a plan that covers only a tiny geographical area - perhaps even only a handful of hospitals?

Yes, expect to have limited networks, too.  That's why I suggested adding a filter to include your local hospital.

The first plan we signed up with had an agreement with HCA.  We had to drive past 4 hospitals ~10 mins away to one of 2 HCA ones ~20 mins away.  Not the end of the world, but uncomfortable to contemplate asking for that if my son has a life-threatening accident.

I do remember reading people's complaints that they went to the ER and accidentally saw an out-of-network doctor in their in-network hospital and got billed big bucks. Pretty scary. I figure this year since we have no time and any healthcare is better than zero healthcare, we'll just jump into something and then redo it with more research in next year's Open Enrollment. He's young and healthy so he can likely get away with accessing zero healthcare in the next year.

There is now a national provision against " surprise billing."  Some states have their own, too.  (Texas has a surprisingly strong one)  Do pay attention to disclosures about this before procedures, though: the name is "surprise billing," not just "high billing."

[seattlecyclone]

One thing to be aware of buying coverage through the exchange is there's a breakpoint at 2x the poverty level where if you go just below that level your out-of-pocket costs (deductibles, coinsurance, copays, etc.) on silver plans can go way down. The poverty level that applies for a single person next year is $15,060, so if he can reasonably estimate an income of $30,000 or less that could unlock quite a bit of savings if he does end up needing medical care.

[elaine amj]

It’s more likely he will earn around $32-35k per year.

DS called this morning for help with quotes and deciphering all the different plans.

He ended up purchasing $232/mo (after subsidies) for a HMO plan with no deductible. The main reason he chose this over a catastrophic plan is to get national coverage since he travels to Indiana frequently. It seems to cover a wide range of hospitals near most places he is in.

It is a private plan - he did not get a Marketplace HCA plan but the guy said it was his best option as he also quoted some catastrophic Marketplace plans.

I only heard the second half of the conversation but it seems to be ok for now. The guy said he’s not a broker on commission, but paid on salary.

He is with Fast Track Health Insurance and it’s an Everest Plan 100. His coverage starts almost immediately on Dec 15 instead of Jan 1 which is comforting.

Hope all is good and legit. Not sure if it is expensive or cheap for a young male but I guess it was $432 before subsidy and he’s paying $232/mo for a plan with no deductible and a large nationwide network.

Unfortunately DS submitted a request on some broker site and got spammed with like 50 calls since yesterday. The agent helped him put his number on donotcall.com which was nice. Also suggested he figure out which website he put his number in and request that calls be stopped.


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[geekette]

One thing to be aware of buying coverage through the exchange is there's a breakpoint at 2x the poverty level where if you go just below that level your out-of-pocket costs (deductibles, coinsurance, copays, etc.) on silver plans can go way down. The poverty level that applies for a single person next year is $15,060, so if he can reasonably estimate an income of $30,000 or less that could unlock quite a bit of savings if he does end up needing medical care.

Say, by putting money in an IRA.

ETA:  I'm confused - not marketplace, but with a subsidy? 
Everest 100 - no coverage for preexisting conditions, no prescription coverage? 

Have you even LOOKED at ACA plans?

[elaine amj]

DS said he looked at plans on healthcare.gov and I *think* he found this agent through healthcare.gov. We did ask what the difference was buying from him vs the website and he said his company was on the website selling Marketplace plans too and he quoted some Marketplace plans. For $180+ he could get a Marketplace catastrophic plan that would not cover him out of state.

I cannot remember about prescription coverage anymore to be honest. Was going to ask but not sure if we did. I remember something about not being covered for admittance to a mental health facility. Preexisting is okay as long as nothing diagnosed at a doctor within the last 6 months.

DS really wanted to take the lead on this one (he didn’t even include me until the second half of the phone call) and I feel he jumped into it to get it over with. Then again, I do have a tendency to over research things. I don’t like feeling a little confused about whether it was legit or scammy. Whether he overpaid or got a good deal.

DS did say he looked at a bunch of quotes this morning and this was a good price.

The extra $3/hr his workplace offers more than covers the cost of this which made me feel better. And we really don’t have much time to research.


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[elaine amj]

Say, by putting money in an IRA.

I did read something about MAGI (still trying to understand how to calculate that). Would putting money into an IRA reduce his MAGI to under that magic $30k?


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[geekette]

Say, by putting money in an IRA.

I did read something about MAGI (still trying to understand how to calculate that). Would putting money into an IRA reduce his MAGI to under that magic $30k?

Yes, if he doesn't have a retirement account through his job.

[elaine amj]

Good to know. We won’t know what his IRA contribution is room will look like. At this point, we might look into all these ways next year. He’s paying $2784/yr for this plan.


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[FIRE 20/20]

Health care plans that do not meet the ACA minimum requirements, which this does not, are generally not worth the money.  ACA-compliant plans can't just drop you if you get sick, but non-compliant plans can (unless they have a clause in the contract that says otherwise, which most don't).  They're also not required to cover things that ACA-compliant plans are required to cover.  I'm not saying that this plan is worthless, but I would definitely do some research on non-ACA plans before he signs up for next year.  That is if the ACA exists a year from now...

I think the out-of-state issues is a bit of a red herring.  ACA plans must cover you (him) for emergencies no matter where they happen.  He just can't do things like his annual check-up or other "normal" appointments out of state.  Most plans also allow for phone or zoom visits if you're out of state but have an urgent medical need that isn't appropriate for the ER - something like a strep throat test or an ear infection.  If the physician decides you need to get the test it is possible to do out of state (this happened to me). 

I want to reiterate what @seattlecyclone wrote about the breakpoints.  I used numbers for my state, but they should be directionally similar in Michigan.  If I project my income as $30,200 / year, I can find a Silver plan for $50/mo. with a deductible of $2,600 and an out of pocket max of $7,360.  If I project my income as $30,000 / year the premium is $48 / mo. with a deductible of $100 and an out of pocket max of $1225. 

That $200 extra of projected income drastically changes the potential cost of an ACA plan.  Most people aren't aware of this, so they aren't careful about manufacturing their income to hit a specific target.  It's easy for most FIREd people to do this, but I don't know if it applies to your son. 

[elaine amj]

We are so confused at this point. Sigh.

Sounds like he grossly overpaid.

But he just saw that it covers dental, vision, and stuff like chiropractors which he is excited about as he hasn’t had coverage for any of that. Still trying to find the plan details itself.

And now I have to go out.

My poor DS. He was trying so hard to handle this stuff himself rather than relying on me all the time. And it’s backfiring on him.


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[jim555]

Just go to healthcare.gov.  It is simple. 

[NotJen]

You definitely sound confused - if it's a private plan, there are no subsidies.

If you really think you've made a mistake here, you have time to correct it.  Open enrollment for ACA plans lasts until Jan 15.

Do more research.  Entering your info at healthcare.gov is free and easy.  Compare to the plan he enrolled in.  Do the ACA plans have better prices/coverage?

If so, pick a plan that starts Feb 1.  Cancel the mistake insurance as of Feb 1.

[elaine amj]

We just went on healthcare.gov and see plans starting at $50/mo. *sigh* Apparently he thought he was on healthcare.gov but clicked on some banner saying “get free quote” and ended up somewhere else altogether.

He’s calling to see if he can cancel the plan today. If not by Feb 1.

We tracked down the certificate and it said something along the lines of “this is not comprehensive health insurance”.

So so so frustrated.


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[jim555]

We just went on healthcare.gov and see plans starting at $50/mo. *sigh* Apparently he thought he was on healthcare.gov but clicked on some banner saying “get free quote” and ended up somewhere else altogether.

He’s calling to see if he can cancel the plan today. If not by Feb 1.

We tracked down the certificate and it said something along the lines of “this is not comprehensive health insurance”.

So so so frustrated.


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Don't be fooled, lots of sites are look a likes on purpose to trick people.

[MDM]

I did read something about MAGI (still trying to understand how to calculate that).

Start with MAGI for Affordable Care Act purposes and follow the links from there.

Would putting money into an IRA reduce his MAGI to under that magic $30k?

Yes.  At that income, for IRA deductibility purposes it doesn't matter whether he is covered by a retirement plan at work or not.

[elaine amj]

I did read something about MAGI (still trying to understand how to calculate that).

Start with MAGI for Affordable Care Act purposes and follow the links from there.

Would putting money into an IRA reduce his MAGI to under that magic $30k?

Yes.  At that income, for IRA deductibility purposes it doesn't matter whether he is covered by a retirement plan at work or not.

How much can he put into his IRA? Is it a max of $7k or is it a percentage of his income? My husband always just did it through his work so we have never really paid a whole lot of attention.


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[MDM]

I did read something about MAGI (still trying to understand how to calculate that).

Start with MAGI for Affordable Care Act purposes and follow the links from there.

Would putting money into an IRA reduce his MAGI to under that magic $30k?

Yes.  At that income, for IRA deductibility purposes it doesn't matter whether he is covered by a retirement plan at work or not.

How much can he put into his IRA? Is it a max of $7k or is it a percentage of his income? My husband always just did it through his work so we have never really paid a whole lot of attention.

100% of his Compensation, or $7K, whichever is lower.  See IRA contribution limits.

Work plans, e.g., 401k, 403b, etc., are separate from IRAs and have their own rules and limits.

[elaine amj]

I did read something about MAGI (still trying to understand how to calculate that).

Start with MAGI for Affordable Care Act purposes and follow the links from there.

Would putting money into an IRA reduce his MAGI to under that magic $30k?

Yes.  At that income, for IRA deductibility purposes it doesn't matter whether he is covered by a retirement plan at work or not.

How much can he put into his IRA? Is it a max of $7k or is it a percentage of his income? My husband always just did it through his work so we have never really paid a whole lot of attention.

100% of his Compensation, or $7K, whichever is lower.  See IRA contribution limits.

Work plans, e.g., 401k, 403b, etc., are separate from IRAs and have their own rules and limits.

Thank you! Did some googling but couldn’t get a clear answer.


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[reeshau]

I think the out-of-state issues is a bit of a red herring.  ACA plans must cover you (him) for emergencies no matter where they happen.  He just can't do things like his annual check-up or other "normal" appointments out of state.  Most plans also allow for phone or zoom visits if you're out of state but have an urgent medical need that isn't appropriate for the ER - something like a strep throat test or an ear infection.  If the physician decides you need to get the test it is possible to do out of state (this happened to me). 

Emergencies = ER, but not urgent care.  But your ER copay probably won't make it pay off for you to prefer that over full freight urgent care, out of state.

You are correct, if you can do a telemedicine call; the plan probably works with one of the two big national labs.

[elaine amj]

The breakeven point discussion was super helpful. We dropped his estimated income to $30k. He is expecting $30-38k in income next year but will cobtribute the max $7k to his IRA. Plus he has the savings to pay back tax credits as needed.

He ended up choosing to pay $10/mo (instead of $0/mo) to get a BlueCross plan that has a hospital near his work plus the hospital my husband used to work at included. Plus he felt the copays, etc were handled better. I think the deductible was around $8k which is fine as the focus is on catastrophic coverage. His expectation is not to use any medical services at all but this gave him some peace of mind.

The $0/mo plan was with Ambetter and I heard all kinds of complaints about them. But of course, we know people complain about every single business out there.

He called to cancel the other scammy plan. Yesterday, the call was dropped. Today, he talked to an agent who tried to offer him a different plan and wanted to crunch numbers. When DS insisted on cancelling the guy turned a bit nasty and made a stink about hearing me offer advice in the background. DS was not pleased when the guy said, “are you going to let your mother speak for you?”. DS continued to insist on cancellation and the guys said he’s have to call back during business hours.

In the enrollment email, it states clearly at the bottom that DS has 30 days to cancel at any time and get a 100% refund. We’ll be counting on that.

DS is upset that he tried to handle this on his own but it went south. Now he’s fielding 50 spammy calls a day and it was a mess. I still feel we made the Marketplace choice a little too quickly, but it does feel better than the first choice.


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