Husband Retires With Younger Spouse

[somarco]

Are there any real major med plans off exchange? My impression is they are all indemnity plans, require underwriting and pre-ex.

And isn't there a penalty for primary plans that are not ACA compliant?

EGH should be the primary plan and any individual plan pays according to COB rules.

Maybe I am all wrong but I have been away from the U65 market for 15 years.

This is a new prospect and I don't have any health information on either of them. Husband hit me with the supplemental insurance request today. I don't think either of them thought this through before he retired.

I have no idea if she can pass underwriting or not and I have no desire to suggest an indemnity or STM plan.

 

[rmhaire]

Are there any real major med plans off exchange? My impression is they are all indemnity plans, require underwriting and pre-ex.

And isn't there a penalty for primary plans that are not ACA compliant?

EGH should be the primary plan and any individual plan pays according to COB rules.

Maybe I am all wrong but I have been away from the U65 market for 15 years.

This is a new prospect and I don't have any health information on either of them. Husband hit me with the supplemental insurance request today. I don't think either of them thought this through before he retired.

I have no idea if she can pass underwriting or not and I have no desire to suggest an indemnity or STM plan.

I do a little ACA when it comes up but nothing off exchange.

And I don't do that indemnity stuff either. I usually go with ACA in a situation like this.

Pretty sure @Jim Wright will know.

 

[axeman462]

Are there any real major med plans off exchange? My impression is they are all indemnity plans, require underwriting and pre-ex.

And isn't there a penalty for primary plans that are not ACA compliant?

EGH should be the primary plan and any individual plan pays according to COB rules.

Maybe I am all wrong but I have been away from the U65 market for 15 years.

This is a new prospect and I don't have any health information on either of them. Husband hit me with the supplemental insurance request today. I don't think either of them thought this through before he retired.

I have no idea if she can pass underwriting or not and I have no desire to suggest an indemnity or STM plan.

It's possible I may be using the term "off-exchange" incorrectly. I only recently started to dabble in the U65 market. Not sure I like it, but it beats referring my clients to unreliable brokers and agents that end up trying to poach my business.

And I suppose it can vary widely by market as well. But here in the Florida, Florida Blue and I believe Ambetter offer plans that don't qualify for subsidies. (I guess that makes them off-exchange?)
I have one myself. It is HSA eligible, and I don't pay any kind of a penalty for it.
It's something I've suggested to people before that are very anti-obamacare and they seem more open to the idea.
Maybe Georgia doesn't have an option like that?

Sounds like either way you may be having a tough conversation Monday morning. Good luck!

 

[annon123]

Are there any real major med plans off exchange? My impression is they are all indemnity plans, require underwriting and pre-ex.

I don't sell in that market and my state didn't expand medicaid so there are some people who don't make enough for ACA care but need insurance. Last I knew there was only 1 plan (with "normal" benefits for a health insurance plan) available in this state for those folks and the premiums are crazy high for older people (at least they were, don't know if they still are, because they are allowed to charge up to 3x the rate for older people than they charge for younger people.). Likely she'd be paying more than she'd be paying for ACA care.

That is what pretty much wiped me out financially with cancers 2&3 in one year and I didn't make enough for ACA after I lost my job over that. There was no underwriting nor waiting periods (but then again I went from COBRA to that without a gap). The MOOP was reasonable but the premiums for one (fortunately the kid was covered by CHIP) were more than rent. I realize may not be much help as I don't have updated info so there may not be any more companies willing to write for that..

 

[Jim Wright]

Are there any real major med plans off exchange? My impression is they are all indemnity plans, require underwriting and pre-ex.

And isn't there a penalty for primary plans that are not ACA compliant?

EGH should be the primary plan and any individual plan pays according to COB rules.

Maybe I am all wrong but I have been away from the U65 market for 15 years.

This is a new prospect and I don't have any health information on either of them. Husband hit me with the supplemental insurance request today. I don't think either of them thought this through before he retired.

I have no idea if she can pass underwriting or not and I have no desire to suggest an indemnity or STM plan.

All off ex plans are ACA compliant. Typically same plans and network but direct to carrier apps instead of through the marketplace.

There IS a penalty for primary plans but they made the penalty $0 so that doesn't really exist anymore.

Off ex plans will not have underwriting.

One issue you may run into is network. If they are in GA, there is no national PPO network available. The only PPO you can get is Alliant and they aren't available everywhere.

 

[somarco]

@Jim Wright , so the off exchange plans are mostly the same as exchange with exception of Alliant who offers a PPO plan?

I glanced at exchange plans and all seem to be HMO and crazy expensive . . . $500/mo and up.

 

[Jim Wright]

@Jim Wright , so the off exchange plans are mostly the same as exchange with exception of Alliant who offers a PPO plan?

I glanced at exchange plans and all seem to be HMO and crazy expensive . . . $500/mo and up.

Sorry, I didn't clarify that well.

Yes, off exchange are typically the same.

In many states, you can get access to the national Blue PPO off exchange but Anthem of GA doesn't offer that.

You can get that Alliant product on and off exchange. There are a few states that have on ex PPO's but not many.

I also wouldn't rule out a subsidy super quickly. I've seen some older folks with 1 or 2 kids get subsidies at $300k in income. But every situation is different.

If you want me to check out some options for you, shoot me a DM and I can help do some research.

 

[axeman462]

@Jim Wright , so the off exchange plans are mostly the same as exchange with exception of Alliant who offers a PPO plan?

I glanced at exchange plans and all seem to be HMO and crazy expensive . . . $500/mo and up.

$500 is crazy expensive?

 

[kgmom219]

She's going to be offered COBRA for 36 months.

What's the income post-retirement? ACA may be super cheap.

(I'm assuming Georgia)