Health insurance - leaving our jobs and the country
June 1, 2021 11:59 AM Subscribe
We're leaving out jobs and the US and have questions about health insurance coverage - how to find the best option in our very unusual circumstance?
We're joining the "YOLO economy" and taking our savings from the pandemic-required inability to do anything and getting out. As constructed our current plan is to leave our jobs (and employer provided healthcare) in the next 2-3 months, moving out from NYC and going impermanent for a while.
Because our international long term travel/temporary residency plans are up in the air due to [gestures generally at the world] we're looking at spending the remainder of 2021 here in the US while we figure out how and where to go next.
We will be using an address in CA as our permanent address for mail purposes (and, i suppose, tax purposes).
If you have experience with either buying insurance via Covered California as an unemployed in-mover we would appreciate hearing them. Its not clear to me whether our part-year income would count "against" us in terms of how the plan pricing works. I read the website on how to estimate income, but i am still unclear on whether the money we would have earned through the first portion of the year (before leaving/moving) would count? My understanding of the premium-tax credit is that it would be netted against what we end up owing when we file in 2021, but is that based on our federal, NY, or CA income? we dont anticipate having any california income but have been working full time here in NY prior to the move.
More important than the near term issue of how to get coverage for the remainder of this year, is what to do about our coverage when we leave. Assumptions we've been making would be that we would not keep/have domestic coverage during this time, but my initial look at Global Nomads showed it to be more than what we were looking for in terms of both coverage and cost. We're assuming that the place(s) we will be spending time (a year at least) have quality and low cost health care which will be able to meet all of our basic ongoing needs (dental cleanings and basic consults) and we have savings enough to weather some unexpected costs but want a back-stop high deductible plan that covered repatriation and care if something really bad happened. I think we'd be comfortable with a deductible upwards of 10k as we are really looking for mostly an emergency policy, but it doesnt seem like this is widely available? How do we find this? is there a specific insurer, broker, or other person you can recommend?
We're joining the "YOLO economy" and taking our savings from the pandemic-required inability to do anything and getting out. As constructed our current plan is to leave our jobs (and employer provided healthcare) in the next 2-3 months, moving out from NYC and going impermanent for a while.
Because our international long term travel/temporary residency plans are up in the air due to [gestures generally at the world] we're looking at spending the remainder of 2021 here in the US while we figure out how and where to go next.
We will be using an address in CA as our permanent address for mail purposes (and, i suppose, tax purposes).
If you have experience with either buying insurance via Covered California as an unemployed in-mover we would appreciate hearing them. Its not clear to me whether our part-year income would count "against" us in terms of how the plan pricing works. I read the website on how to estimate income, but i am still unclear on whether the money we would have earned through the first portion of the year (before leaving/moving) would count? My understanding of the premium-tax credit is that it would be netted against what we end up owing when we file in 2021, but is that based on our federal, NY, or CA income? we dont anticipate having any california income but have been working full time here in NY prior to the move.
More important than the near term issue of how to get coverage for the remainder of this year, is what to do about our coverage when we leave. Assumptions we've been making would be that we would not keep/have domestic coverage during this time, but my initial look at Global Nomads showed it to be more than what we were looking for in terms of both coverage and cost. We're assuming that the place(s) we will be spending time (a year at least) have quality and low cost health care which will be able to meet all of our basic ongoing needs (dental cleanings and basic consults) and we have savings enough to weather some unexpected costs but want a back-stop high deductible plan that covered repatriation and care if something really bad happened. I think we'd be comfortable with a deductible upwards of 10k as we are really looking for mostly an emergency policy, but it doesnt seem like this is widely available? How do we find this? is there a specific insurer, broker, or other person you can recommend?
Yeah. So you'll be leaving your job(s) and moving officially to California for some length of time, then going overseas at some point after that?
Let's say you resign in July and your insurance ends at the end of that month, you then are taking residency in California starting August 1. You'll want to sign up through Covered California where it will run through a list of questions to determine your estimated income for 2021, and pay your new premium by July 31 so that the new insurance kicks in without a gap.
The tax credits are calculated as a function of your federal income. It's a complicated formula but very basically, the system looks at the cost of a benchmark, middle-of-the-road plan in the zip code of your residence and then determines if they think this is affordable as a percentage of your income. If not, then you get tax credits to make up the difference. But it is based on whole-year income so (say) if you have $100K in income for the first six months but then only $15K after that, the credits will be calculated based on that whole $115K amount.
It's somewhat similar to how "expected family contribution" is calculated for student loans, if you ever did that for yourself or your kids.
However, a few caveats: if your monthly income is going to be zero (say you are living on savings while you figure things out for a few months), then you'll be eligible for Medicaid, and because of that you won't be eligible for the tax credits as the government will assume you will take that. Which is probably fine -- Medicaid is comprehensive coverage, and as long as you don't have complicated ongoing medical needs it should be fine for things like maintenance medications and of course hospital/ER care if something happens.
This gets kind of confusing because Medicaid is determined on a monthly income basis, whereas the ACA tax credits work on a year basis.
Also, if you're uncertain about what your income will be, you need to decide if you want to take the full amount of tax credits that you're eligible for. If you take all of them and then it turns out your income was higher than you thought it would be when you signed up, you will have to pay some or all of it back when you file taxes -- but of course, if you don't take much then you'll have higher upfront premiums (but will get the difference back when you file). It just depends on what makes the most sense for your financial situation, whether you'd prefer to pay more upfront or to pay less now but risk taking a hit at tax time next year.
Once you go overseas, you're going to want to look carefully at the situation in whatever country you land in. In more industrialized countries, the government's health care website will probably have guidance for international long-term residents.
Travel insurance may make sense in your situation once you go international, but be very careful with the fine print. It's regulated much more loosely, and you certainly don't want to be in a circumstance where you need to be repatriated or get some expensive care and oops it's not covered for reasons.
posted by tivalasvegas at 6:13 PM on June 1, 2021
Let's say you resign in July and your insurance ends at the end of that month, you then are taking residency in California starting August 1. You'll want to sign up through Covered California where it will run through a list of questions to determine your estimated income for 2021, and pay your new premium by July 31 so that the new insurance kicks in without a gap.
The tax credits are calculated as a function of your federal income. It's a complicated formula but very basically, the system looks at the cost of a benchmark, middle-of-the-road plan in the zip code of your residence and then determines if they think this is affordable as a percentage of your income. If not, then you get tax credits to make up the difference. But it is based on whole-year income so (say) if you have $100K in income for the first six months but then only $15K after that, the credits will be calculated based on that whole $115K amount.
It's somewhat similar to how "expected family contribution" is calculated for student loans, if you ever did that for yourself or your kids.
However, a few caveats: if your monthly income is going to be zero (say you are living on savings while you figure things out for a few months), then you'll be eligible for Medicaid, and because of that you won't be eligible for the tax credits as the government will assume you will take that. Which is probably fine -- Medicaid is comprehensive coverage, and as long as you don't have complicated ongoing medical needs it should be fine for things like maintenance medications and of course hospital/ER care if something happens.
This gets kind of confusing because Medicaid is determined on a monthly income basis, whereas the ACA tax credits work on a year basis.
Also, if you're uncertain about what your income will be, you need to decide if you want to take the full amount of tax credits that you're eligible for. If you take all of them and then it turns out your income was higher than you thought it would be when you signed up, you will have to pay some or all of it back when you file taxes -- but of course, if you don't take much then you'll have higher upfront premiums (but will get the difference back when you file). It just depends on what makes the most sense for your financial situation, whether you'd prefer to pay more upfront or to pay less now but risk taking a hit at tax time next year.
Once you go overseas, you're going to want to look carefully at the situation in whatever country you land in. In more industrialized countries, the government's health care website will probably have guidance for international long-term residents.
Travel insurance may make sense in your situation once you go international, but be very careful with the fine print. It's regulated much more loosely, and you certainly don't want to be in a circumstance where you need to be repatriated or get some expensive care and oops it's not covered for reasons.
posted by tivalasvegas at 6:13 PM on June 1, 2021
This (from the well respected health policy outfit KFF) is a great calculator -- you can plug in some different income scenarios and get a good sense of what you'd be looking at cost- and coverage-wise for ACA coverage.
posted by tivalasvegas at 6:17 PM on June 1, 2021
posted by tivalasvegas at 6:17 PM on June 1, 2021
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https://www.uhone.com/health-insurance/short-term-health-insurance
posted by sandmanwv at 5:29 PM on June 1, 2021