Currently trying to budget for this and having kids it is a big issue for me. What are full time folks doing on this front?
I know that the ideal structure for group health under new laws is 10-50 employees and was wondering if folks had ever created a corp/association for traders to avail themselves of the benefits of hitting a group plan in that sweet spot?
Anyone have any recommendations on coverage, policies, structuring etc.? Is it best to form a company and get a small business group plan so pre-exstings and coverage cant be dropped?
I have a health insurance business and while it looks like you are in MD where I am not appointed, I could answer your general questions and point you somewhere beneficial.
In IL 2 qualify as a "group". However almost all 2 person groups are created because someone will not qualify for individual/family coverage. Group health insurance is typically WAY more expensive than comparable and similar individual coverage.
The major carriers in IL will not write an "association" group. In many cases that language should be a warning that you are looking at an indemnity plan NOT major medical health insurance. Additionally there are quite a few items that are required to create a group. That means the grey areas that you might think would allow you to get it done are quite black and white.
Depending on your state there will be sponsored options that your kids may qualify for. Also, if you are a sole prop and making some money an HSA compatible plan will give you a decent above the line deduction to agi (tax break).
Most states have a plan for people that have exhausted COBRA continuation benefits and have no other access.
As far as the children and pre-ex go...because of PPACA Obamacare the carriers must issue coverage the includes all children regardless of pre-ex....but it will probably cost more than an arm and a leg as the idea like most of that "law" where terribly ill-conceived. Remember that some pre-ex for adults will have a waiting period of 12 months so it is better to have the rest of you covered than none of you at all.
There are a few conditions that are deemed "auto-decline" meaning that the carrier will not issue coverage at any price.
If you want to talk specifics of your situation send me a PM. I'll try to help sort things out if you like. DB
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are guaranteed issue, meaning that they can NOT eliminate coverage for pre-ex. So their risk profile generally is wider than plans that can just say no.
Also maternity MUST be included in group where that is often an elected coverage on the individual side.
The FIRST consideration should always be...Is the carrier a name I recognize and is that a name I can trust. Next you look for info on how they pay their claims...an easy way to do that is ask the billing person at your docs office who is best and fastest paying there claims? Who is the easiest to deal with for you? Those two questions will generally reflect the culture at those companies. The giant companies generally have too much to lose by jacking people around.
IDK about which plan type because IDK your specific situation financially or health wise.
Generally if you are earning or have a bit of money and are reasonably healthy I would say that you want to align your position in the relationship as closely to that of the underwriter at the carrier. They spend millions to do the math that prices their product in a way that should maintain their margins.
My family has Blue Edge Individual HSA 2600 individual ded/5200 family deductible with 80% co insurance. We have had that plan since 2004 and just now pay $500 per month in premium.
We contribute the legal maximum to our HSA account to grab the best tax advantage possible. I invest the HSA balance in SPY and occasionally use options for that purpose. When my market assumption is strong I pay my medical expenses with my regular check book and let the tax free HSA deposit accrue. When I don't have any idea or suck at executing I use the tax free dollars to pay claims under my deductible.
Smallest, most manageable expense footprint (premium) and the greatest option for other advantage to include lower agi and a nice tax deferred market return.
next time im in chitown on business i owe you dinner....
interesting so you basicly go out of pocket for basic maintenance and pay that with pre tax cash...
"IDK about which plan type because IDK your specific situation financially or health wise."
3 kids family in perfect health so far no pre-exists.. know that wont last.
"Generally if you are earning or have a bit of money and are reasonably healthy I would say that you want to align your position in the relationship as closely to that of the underwriter at the carrier. They spend millions to do the math that prices their product in a way that should maintain their margins. "
I dont understand "align your positoin in the relationship as closely to that of the underwriter at the carriers"?
Argentina - LOL - Ill float that by the boss. another state is going to be a tough sell but i guess i could just give her the option of getting a full time job and see how that flies.
Go to the Blue Cross Blue Shield of Maryland site directly. Do NOT type your personal information into a collection site on the net....you will get 5 calls before a minute passes and those agents are generally not sage experienced pros.
You can purchase directly from the carrier and I would recommend that unless you have or can identify a trusted adviser in your local community. Do not integrate with the carriers HSA. Use HSAbank out of Sheboygan WI or someone like them....where their ONLY business is HSA accounts. You national or local bank will SUCK as far as information and service. At HSAbank, I think they have a selection of brokers that you can link too.
Choose an initial deductible that does not cause you or your wife undue stress if you had to write a check to cover that amount. Move your deductible higher every year as your deposit balance in the HSA account grows until you have the 5000/10000 deductible. Start with that plan if you can swing the maximum deposit of 6000 and 4000 from another source if you had a big claim. The idea is to keep your money in your control and optimize the benefit you get from your effort.
By being on the same side as the actuary...what I mean is they have access to all the data. Their job is to look at historical claims and the breadth of their risk book and determine rates for each product that round their business in a way that meets their margins.
A simple statement that the average claims per person is running about 1400 per year should point you initially to the first deductible higher than that.
If you look at the cost in premium versus the additional risk of a higher deductible you should get a basic view of the sweet spot for consumers.
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