Plans That Will Pay Deductible + OOP Costs?

[Happy Texan]

Allen:
The NLPH plan is a supplement to the self-funded employer plan, in that it pays first and pays first dollar, with no deductible.
The patented Health Matching Insurance builds fast, and accelerates over the first 36 months.
But it does take 36 months to build $50,000 of benefits, with no claims filed , at $300 per month.
Any claims filed are deducted from the balance, which resets to the month corresponding with that balance.
Don Levit

 

[KennyWest]

As a follow up, the plans we have with I posted rates for, etc. are also first dollar but with no minimum lives requirements, individuals are OK! I can say from our customers experience they work very well with ACA plans and group as well!

 

[AllenChicago]

Allen:
The NLPH plan is a supplement to the self-funded employer plan, in that it pays first and pays first dollar, with no deductible.
The patented Health Matching Insurance builds fast, and accelerates over the first 36 months.
But it does take 36 months to build $50,000 of benefits, with no claims filed , at $300 per month.
Any claims filed are deducted from the balance, which resets to the month corresponding with that balance.
Don Levit

Happy Texan, you've given me an idea to use in the Individual Market. A tax-deferred savings account that can be used to pay the deductible. Thanks!
Now it's time to do some research and discover what options are available.
ac

 

[Yagents]

a tax-deferred savings account that can be used to pay the deductible

h........................s...........................a

 

[houcoogster]

Medico had a webinar a few months ago where they introduced their indemnity plans and they were just outrageously priced. The one to cover the 5k deduct was crazy high. So far it seems if they want a lower deduc the cheapest way is to just buy that plan.

 

[KennyWest]

Re: Allen's last post in response to mine.

True Allen but you have to have a balance. From your post you want a plan where a customer goes to Dr. office and the supplemental plan picks up their deductible. This can be done but would be hugely expensive. A better way is to have a fixed dollar benefit of say $75 for the dr office call and add'l benefits for DXL. Their out of pocket would be minimal in most instances if anything. AND the benefits paid would go toward satisfying their deductible as well.

The primary components which all push each other one direction or the other are:
Benefits
Waiting periods
Premiums
Commissions

Increase benefits IOW pushes some or all of the others in one direction or the other....

 

[Happy Texan]

Re: Allen's last post in response to mine.

True Allen but you have to have a balance. From your post you want a plan where a customer goes to Dr. office and the supplemental plan picks up their deductible. This can be done but would be hugely expensive. A better way is to have a fixed dollar benefit of say $75 for the dr office call and add'l benefits for DXL. Their out of pocket would be minimal in most instances if anything. AND the benefits paid would go toward satisfying their deductible as well.

The primary components which all push each other one direction or the other are:
Benefits
Waiting periods
Premiums
Commissions

Increase benefits IOW pushes some or all of the others in one direction or the other....

How much interest does a tax deferred savings account earn?
Maybe two percent a year
The Health Matching Insurance pools benefits rather than crediting interest
Assuming claims for groups of 200 or more are standard the vast majority of employees and dependents will earn more benefits than they use even at no deductible
Interest is credited at 8 percent a month and each ensuing contribution earns an additional eight percent a month
In month 34 the interest credited is 300 percent in that month
So with a. $300 contribution and a $900 match they accumulate $1200 of benefits that month
What savings account earns 300 percent
in one month?
The keys are benefits grow thru pooling not thru investments earned on reserves and that people need to be patient enough to grow benefits over time
HMI is a defined contribution plan not a defined benefits plan which was detailed earlier
Don Levit
Treasurer of NPLH

 

[junkman]

Premiums will always be a function of claims and overhead and commissions. People that have a difficult time paying premiums will have a difficult time paying OOP.

Write the most insurance that the client is willing to pay for given the subsidy. The agent can't make OOP and premiums go away at the same time.

For unsubsidized the sweet spot in TN is the Blue Cross $5000 deductible 100% plan. I've had it for years & pay all OOP out of an HSA. There is ~30k sitting there that would have been paid in taxes or premium. It's the best deal out there but only helps the broke people in that the premium is the lowest possible.

I had a guy fuss & fume about how he hates Obama Care and doesn't want to be forced to buy insurance. This particular ingenious individual has no coverage, makes ~ 15,000/yr and takes 2 meds that would total $700/month. He gets the meds through some program the drug company has available for $3/RX. He also skips Dr appointments because he "can't afford it".

 

[Sherota1]

I've tried to find a similar plan. Instead of trying to find a plan that covers 100% OOP expenses, I try to focus on helping my client understand how to pick a plan that will cover most of what they need based on what they can afford. An example is choosing a plan that has co-pays before deductibles. some of the bronze plans do offer this option. The Metal Gap Plans are for covering major unexpected medical expenses. It's all about educating the client about how to use their policy and teaching them a little
personal responsibility. Just as with Med Supps the more the plan covers the more expensive they become. If a plan such as the one you are looking for we're to be offered it maybe too expensive for many people. There are some indemnity plans offered that include discounts for doctors office visits and first dollar expenses such as Assurants Health Access Plans which I've been told can now be paired with other insurance since there is no coordination of benefits.

 

[AllenChicago]

Thanks to everyone for your advice and experience! I finally did locate a real GAP policy that would pay the deductible and Out-of-Pocket at 100% for Inpatient, and 50% for Outpatient. It's from United American. But unfortunately, it will only be issued to applicants who have GROUP coverage. Not an Individually owned policy.

BTW..as you probably know, the better plans are not cheap. But, they're good for people whose employer wants to provide an extra perk and is willing to pay the premium.
ac