Help me find affordable medical insurance in a red state.

April 3, 2017 8:48 AM

We are at a loss as to what to do concerning our medical insurance and need some options for elderly business owners living in a red state.

My husband and I are 60 and 61 years old. We live in Tennessee where Medicare was not expanded, and own our own business. Our youngest child is 25 and will be able to stay on our policy until January of 2018, so she's dropping off fairly soon. Our annual income is too high for ACA subsidies on individual medical insurance. We had Blue Cross Blue Shield and were fairly happy with it even though the premiums were rising dramatically every year. They dropped out of the individual market and now we only have one option for an individual policy this year, Humana, and the premiums are almost $1700 per month with a $10,000 deductible. The policy pays NOTHING until the deductible is reached. So the math is simple, if we get sick we would pay $27,000 in medical bills this year, at the very least. Our Republican governor has made it clear that he will not be expanding Medicare, and of course we have no idea what fixes might be in store for the future.

It seems that a non-ACA-compliant catastrophic policy would be the way to go for us. Is this correct? If we are paying out of pocket for our meds and doctor visits now, what we basically have is an expensive catastrophic illness policy! If we changed over to a non-ACA-compliant policy it seems that we could possibly pay up to $4000 in penalties, but if the math works out it might be feasible.

Tell me how you've navigated this!

posted by raisingsand to Health & Fitness (12 answers total)

Since you're business owners, have you checked into small group insurance plans? Based on my own limited experience in the pre-ACA era, it probably wouldn't be any more affordable than the Humana plan you mention, but at least it might provide you with more than one option.
posted by XMLicious at 8:56 AM on April 3, 2017

Hi there. Tennessee didn't expand Medicaid. This may help you in your search.
posted by mochapickle at 8:57 AM on April 3, 2017 [1 favorite]

Definitely look into small group plans. They operate under different rules for tax credit eligibility, so you may quality for a credit as a business that you don't as an individual.
posted by givennamesurname at 9:20 AM on April 3, 2017

Some states have a small employer health insurance availability act. For example, an act mandating that any health insurer operating in the small business market in that state must offer insurance to ANY small business with 2-50 employees and limiting the rating variables that a company may use to things like geography, tobacco use, family composition, etc. If your state has legislation like this, it should open up a few more plans to you.
posted by HotToddy at 9:22 AM on April 3, 2017

Have you looked at Get Covered Tennessee? They have a line for local help that might be useful to you.
posted by Medieval Maven at 9:59 AM on April 3, 2017

As a business owner, I suggest that you explore hiring a payroll company such as TriNet to handle your payroll and benefits -- by doing so, you can get group health insurance through them. There is a fee involved, but in my case, the savings on health insurance more or less offset the fees for their service, and I got much better insurance than was available to me via the ACA marketplace to boot.
posted by spilon at 12:28 PM on April 3, 2017 [1 favorite]

Response by poster: Sorry, I thought I covered all the bases but evidently not. My husband and I are the only employees. It is our understanding that small business insurance is only available if you have an employee that is not a family member.
posted by raisingsand at 12:48 PM on April 3, 2017

small business insurance is only available if you have an employee that is not a family member

Just guessing here, but might this be dependent upon how your business is incorporated? I.e., changing that might open more alternatives.
posted by she's not there at 1:05 PM on April 3, 2017

When I was looking at small group health insurance ten years ago, the minimum number of members (employees or business owners) covered varied dependent upon what state you were in, based on state law. My state allowed a small group to contain just one person.
posted by XMLicious at 1:10 PM on April 3, 2017

Yes, my state allows a small group to contain just two people, and they can be related (I know this for a fact because my husband and I qualify as a small group). Definitely check on this.
posted by HotToddy at 1:53 PM on April 3, 2017

My husband and I are the only employees.

If you pursue this through a payroll company as I suggested upthread, your number of employees doesn't matter. You become part of their group.
posted by spilon at 3:08 PM on April 3, 2017 [1 favorite]

In addition to the excellent suggestions above, have you tried to find a reputable insurance broker? They would walk through all of this for you, at no cost to you (the insurance companies pay them a commission for making a sale). While rules do vary state to state, that is what I did when I set up the plan for a two employee operation (albeit a nonprofit in a blue state), and it worked very well.
posted by postel's law at 6:39 PM on April 3, 2017