Should I consider health insurance via the ACA?
May 9, 2017 9:27 PM Subscribe
I'm making a career move, destination TBD. How strongly should I weigh employer-provided health insurance?
Scenarios include freelancing, freelancing as a contractor working for a company that provides benefits, working for an employer that provides health benefits, working for an employer that does not provide those benefits but might provide other supports, and extended travel.
Is getting health care on an exchange a terrible idea right now given the volatility in Washington? What should I be looking at to minimize risk over the long run?
I'm a young adult woman with no plans for pregnancy and few health problems. I mainly use my insurance for dental care, eye exams and physical therapy.
I'm interested in knowing the situation for California, Minnesota, DC, and the chance I wind up abroad.
Scenarios include freelancing, freelancing as a contractor working for a company that provides benefits, working for an employer that provides health benefits, working for an employer that does not provide those benefits but might provide other supports, and extended travel.
Is getting health care on an exchange a terrible idea right now given the volatility in Washington? What should I be looking at to minimize risk over the long run?
I'm a young adult woman with no plans for pregnancy and few health problems. I mainly use my insurance for dental care, eye exams and physical therapy.
I'm interested in knowing the situation for California, Minnesota, DC, and the chance I wind up abroad.
Also, if you're using PT, I assume you have some sort of pain or condition that would require PT? Whatever that condition is, if you end up without insurance for two months, would likely be uncovered in the future for at least a year after your coverage gap if the GOP has its way. That would be what I would want to hedge against, at least while the GOP has congressional power.
posted by lazuli at 9:45 PM on May 9, 2017 [1 favorite]
posted by lazuli at 9:45 PM on May 9, 2017 [1 favorite]
The good news is that dental and eye exams are pretty easy to budget and plan for, as they're not typically covered by health insurance plans. Employers may also offer dental and vision plans, but they're separate, and not necessarily as good a deal as you can get just paying for the exams directly. Dentists and optometrists will tell you up front what an exam will cost without insurance, even on the phone before you go! Physicians may not be able to do that. Health insurance is weird. In any case, vision and dental aren't the things you need to worry about.
Maintaining health insurance as a precariously-employed person got a lot easier in 2014. If the ACA were guaranteed and we hadn't all slipped into a worse timeline, no-benefits employment would have been a more reasonable option. It's not, and we did. I can't advise taking a job that doesn't offer health insurance in the current political climate, unless you don't have an alternative.
And yeah, if you don't have employer-provided health insurance, definitely get a plan via state exchange. It's unlikely​ that plans will be canceled midstream, so you'd still be good for the year with a plan that's required to actually cover things. If pre-existing conditions become a thing again, avoiding a coverage gap is important. Good luck.
posted by asperity at 10:07 PM on May 9, 2017
Maintaining health insurance as a precariously-employed person got a lot easier in 2014. If the ACA were guaranteed and we hadn't all slipped into a worse timeline, no-benefits employment would have been a more reasonable option. It's not, and we did. I can't advise taking a job that doesn't offer health insurance in the current political climate, unless you don't have an alternative.
And yeah, if you don't have employer-provided health insurance, definitely get a plan via state exchange. It's unlikely​ that plans will be canceled midstream, so you'd still be good for the year with a plan that's required to actually cover things. If pre-existing conditions become a thing again, avoiding a coverage gap is important. Good luck.
posted by asperity at 10:07 PM on May 9, 2017
Also, with respect to physical therapy, that's one of those benefits that historically has been limited (visit limits, etc.), and the way the AHCA would work (which won't be the final GOP healthcare law, but it could be close), PT would not likely be subject to the lifetime and annual limit restrictions or out of pocket maximums under the ACA - and this would be true even if you didn't have a gap in coverage. The GOP proposals also rely heavily on HSA expansion, meaning a lot of high deductible plans.
posted by Pax at 1:32 AM on May 10, 2017
posted by Pax at 1:32 AM on May 10, 2017
I wish I could tell you to pursue the career you will enjoy most. But from a practical perspective, I advise you to take the job that offers the best insurance, unless it will make you actively miserable. I think it's likely that ACA protections will be significantly reduced and we'll go back to the pre-ACA status quo, which was extremely precarious for anyone without employer-provided insurance.
I and my spouse are currently doing these risk calculations and landing on "Pursue jobs with good health insurance."
(Also, does "no plans for pregnancy" mean "never" or "later"? If "never," then at least you don't need to evaluate how insurance would cover kids, maternity care, or fertility treatments. If "later," then you probably do want to evaluate those things just to keep your options open. If the ACA is gutted, I expect a swift return to the days when individual insurance plans did not cover any maternity care without a "maternity rider" that would double your premium. My first insurance plan in 2004 was like that.)
posted by snowmentality at 4:52 AM on May 10, 2017 [3 favorites]
I and my spouse are currently doing these risk calculations and landing on "Pursue jobs with good health insurance."
(Also, does "no plans for pregnancy" mean "never" or "later"? If "never," then at least you don't need to evaluate how insurance would cover kids, maternity care, or fertility treatments. If "later," then you probably do want to evaluate those things just to keep your options open. If the ACA is gutted, I expect a swift return to the days when individual insurance plans did not cover any maternity care without a "maternity rider" that would double your premium. My first insurance plan in 2004 was like that.)
posted by snowmentality at 4:52 AM on May 10, 2017 [3 favorites]
Do not, do not, do not have a gap in coverage. Do whatever you need to do to avoid that. I would strongly suggest remaining on an employer sponsored plan just to be on the safe side, we really do not know what steaming pile of shit will come out of the Senate.
posted by lydhre at 5:44 AM on May 10, 2017 [2 favorites]
posted by lydhre at 5:44 AM on May 10, 2017 [2 favorites]
Response by poster: "No plans for pregnancy" means no current plan but if several conditions were in place I'd consider it. Not sooner than 1 year from now but not more than 10. If it were going to happen, it would probably be five years from now.
The physical therapy supports my quality of life but isn't critical for it.
Sounds like I have maybe a year of pretty good ACA options and should definitely make sure I'm on an employer-sponsored plan after that.
posted by ramenopres at 6:52 AM on May 10, 2017
The physical therapy supports my quality of life but isn't critical for it.
Sounds like I have maybe a year of pretty good ACA options and should definitely make sure I'm on an employer-sponsored plan after that.
posted by ramenopres at 6:52 AM on May 10, 2017
The physical therapy supports my quality of life but isn't critical for it.
Yeah, it doesn't matter. You've been seeking medical treatment for a condition. If you have two-month gap in coverage, anything that could ever possibly be related to that condition would be considered a pre-existing condition, for as long as Congress says (right now the bills say for one year from the coverage gap). So if you're being treated for neck pain now, for example, and you have a coverage gap, and you get into a car accident and get whiplash a month after you get re-covered, future insurance companies can argue that any neck pain at all stems from the neck pain you're being treated for now. (This is how insurance companies used to work. They would look for any excuse to declare even new conditions simply extensions of previous conditions, so that they wouldn't have to cover treatment for them.) That's why continuing coverage would be important.
posted by lazuli at 7:07 PM on May 10, 2017 [1 favorite]
Yeah, it doesn't matter. You've been seeking medical treatment for a condition. If you have two-month gap in coverage, anything that could ever possibly be related to that condition would be considered a pre-existing condition, for as long as Congress says (right now the bills say for one year from the coverage gap). So if you're being treated for neck pain now, for example, and you have a coverage gap, and you get into a car accident and get whiplash a month after you get re-covered, future insurance companies can argue that any neck pain at all stems from the neck pain you're being treated for now. (This is how insurance companies used to work. They would look for any excuse to declare even new conditions simply extensions of previous conditions, so that they wouldn't have to cover treatment for them.) That's why continuing coverage would be important.
posted by lazuli at 7:07 PM on May 10, 2017 [1 favorite]
If you have two-month gap in coverage, anything that could ever possibly be related to that condition would be considered a pre-existing condition, for as long as Congress says (right now the bills say for one year from the coverage gap).
Sorry, that should have been a hypothetical -- that's what would happen if the ACA repeal happens in a way consistent with what the House just voted for. If it were me, I would be worried that would be the risk as long as a Republican is in the White House with a Republican Congress.
posted by lazuli at 7:11 PM on May 10, 2017
Sorry, that should have been a hypothetical -- that's what would happen if the ACA repeal happens in a way consistent with what the House just voted for. If it were me, I would be worried that would be the risk as long as a Republican is in the White House with a Republican Congress.
posted by lazuli at 7:11 PM on May 10, 2017
Response by poster: Following up to say I got on an ACA plan and was careful to avoid a gap in coverage. Happy with my plan now. Thank you.
posted by ramenopres at 12:45 PM on November 25, 2017 [2 favorites]
posted by ramenopres at 12:45 PM on November 25, 2017 [2 favorites]
This thread is closed to new comments.
Having insurance. The GOP has really been pushing the idea that if you're without insurance for 62 days, then you'll be subject to insurance companies declaring any prior issues as "pre-existing conditions" that would not be covered, or would cost extra money to cover. Insurance companies have, in the past, been pretty ruthless about trying to label any new symptoms/diagnoses as linked to previous pre-existing -- and therefore uncovered -- conditions. Having even crappy insurance would most likely save you from denials of coverage in the future.
The projections all seem to think that ACA coverage premiums will increase if the GOP gets its way; the uncertainty about whether that will happen also seems to have made insurance companies nervous, which means ACA rates may also go up as insurers pull out, especially in states that haven't embraced the ACA. Personally, I think an ACA plan would be a risk, but it would be one I would take versus not having insurance.
Also, California is often held up as a state where the ACA is working, because the state fully embraced it. Premiums have been pretty stable here. If I were looking at a job where I'd need to get ACA coverage, California would be a state I'd be willing to make that gamble.
posted by lazuli at 9:42 PM on May 9, 2017 [2 favorites]