#7 Open Enrollment and Health Insurance with Om Sukheenai
Om and Doug talk about key dates regarding open enrollment, changes that have been made to the Affordable Care Act (ACA) and resources for finding help.
You can connect with Om at www.chehaleminsurance.com
YouTube Video of Episode: https://youtu.be/cLhpqqtiScs
Doug's business specializes in partnering with companies and non-profits to capture overhead cost savings without layoffs to fund growth and strengthen financial results.
Schedule time with Doug to talk about your business at www.MeetDoug.Biz
<<Transcript>>
[Music]
[Introduction]
Welcome to the terminal value Podcast where each episode provides in depth insight about the long term value of companies and ideas in our current world. Your host for this podcast is Doug Utberg, the founder and principal consultant for Business of Life, LLC.
Doug: Okay, welcome to the terminal value podcast. I have a guest with me. Her name is Om. And I met her at the local Chamber of Commerce for Shah Alam Valley, which is where we both live. And we actually have a very timely topic today, which is health insurance and open enrollment. So because open enrollment, oh, you can tell us when open enrollment runs, particularly, but there are a lot of insurance. There's a lot of insurance information and acumen that people need to have. Because the old days of everybody having insurance through their employer kind of disappearing. I mean, some people still get insurance through their employer, but some people are in the gig economy. Some people are entrepreneurs, some people retire early and say, you know, they're 58 years old, and they don't qualify for Medicare yet. Well, if you don't know what's going on with insurance, that can be that can be really daunting. Because I know speaking for myself, you know, going through the entrepreneur finding insurance process, it's a lot of work. And it's really expensive. And a lot of times your coverage isn't all that good. So on Please introduce yourself. Yeah, help everybody gain some awareness here.
Om: Thank you so much, Doug. And good afternoon, everyone. This is om Sukheenai. My agency name is Chilean insurance associates. And so happy to be here. You mentioned about the open enrollment, it is very timely, because if we divide into two groups, one is 65. And up, we call manual enrollment period, and therefore people have Medicare. And that begins on October 15. And run to December 7, that people who are on Medicare Advantage plan on prescription drugs can change their plan, looking into going back to original Medicare, or you know, do something different that suit their needs. But for 64 order to Sarah or newborn baby, this is the also call open enrollment period will begin on November 1 to and run through December 15. Once YouTube meets this deadline of either December 7 465. Enough or December 15. And you're kind of out of luck.
Doug: Okay, well, well. So what are some of the things that people really need to keep in mind? Because, I mean, you even if you have employer sponsored health care, I'm sure there's things that you still need to keep in mind. So what should people make sure to be doing before the year is over Om?
Om: So there's the things you know, I think, Doug we have to come into why people need health insurance, even though there is no penalty for people to have health insurance. Health insurance people like you entrepreneurs, you just said you need it because is kind of like air to breathe, who know was something the what is gonna happen to you. And once you have the health insurance or health coverage, the financial burdens kind of like you know, I don't have I don't have to pay for everything our pocket, we have the insurance company coming into it and recognize this if you don't get coverage to your employers, and the premium has been increasing every year even though it's not excruciating increase like in the past we go back about seven years ago and that's because of the government as we know you know, kind of nicknamed Obamacare as the correct the correct name is Affordable Care Act has come in in place to have a family they're looking to their demographic or the family members the area you live, the zip code and adjustable gross income.
Doug: Okay.
Om: Is not gross income adjusted gross income. For example Doug. Let's say you are family of four, and your gross income could be a lot a million but you adjust for gross income could be about 100,000 or let's say below 100,000. Because you take opportunity of everything to write out. You could be easily qualify for financial assistance that we call premium tax credit.
Doug: Okay.
Om: What it does, then the premium tax credit will help you pay lower premium. The government will say out of federal marketplace, we're telling you that Hey Doug I'm going to give you for example $200
Doug: Okay.
Om: tours lonely premium. And let's say if your premium were to be $1,000 for the whole family, you will pay 800. And that $800 premium, you can get tax write off, because it's coming to a business expense depends upon your entity of your business, right? And your income, the family even have a low income because it's scaling, you can have something that not only is the government or the marketplace help you to lower your premium is also called cost sharing. You will see the CSR cost sharing reductions.
Doug: Yeah,.
Om: So it reduce the deductible and our pocket and concept copay. coinsurance will be reduced. So is this something that people who sometime hear the word, Obamacare Affordable Care Act? Oh, my gosh, I've got you know, something against it. I'm not talking about politics. However, like, you know, I don't want to do this daunting, just like you said, and I don't know who can help me. And it's going to be expensive, because kind of the wording are so expensive and so expensive. And I never gone to the doctor, I'm going to not having health insurance. So I would encourage everyone, do not just skip that just at least talk to the health insurance agents and we have it all, you know, all over or argand? Or if not, just give me a call. And then I will help you to find out if you were to be eligible for premium tax credit or not
Doug: That sounds that sounds great. And yeah, just just filling out a kind of a couple of things that people might have questions about. So when the Affordable Care Act went into effect, what, and correct me if I'm wrong in your here but when the Affordable Care Act went into effect, what happened was there was a penalty if you did not carry an ACA compliant policy, and one of the things that happened recently was that penalty was revoked. So you can legally or you actually, I suppose you could legally not have insurance before you just had to pay a penalty. Now you don't have to pay a penalty for not having insurance, but what you're saying is that it's still a good idea to have insurance, because you don't want to have some kind of a medical emergency come up and not have coverage. I think and that's kind of that's amazed that a lot of us.
Om: Yeah.
Doug: Are trying to navigate because of course, you know, I I'm married, I have a family, I want to make sure my family's taken care of. But it's also really expensive. And it's really hard to, it's really hard to figure out what the coverage is, because a lot of times you don't know whether something's covered until you go to the medical office. And then they do that what happens is you'll have the clerk who says, Oh, I just ran your insurance, and you're not covered. By the way, here's a bill for $500 and say, Wait a second. Now, why am I big for insurance? And I think it's a very opaque system. I mean, and I don't know, this isn't within my power. But I would absolutely love if there was some way to get more transparency so that I can know what I'm buying, and then what isn't isn't going to be covered.
Om: Right? So you nail it, you know, because when the penalty has been rewarded, and I think that's fair, but if you don't mind, let's come back to why the insurance premium health insurance premium has been so expensive. Let's take a look into this, you know, is insurance premium expensive, it's not just because of the insurance company want to increase the premium everything has been regulated by a state, but is increasing because the health care technologies, you know, we want to get care of we want to be careful, all these diseases and technology it is enhanced and is caused, you know, to get that high tech to detect earlier of disease. So everything is money, everything tying it all together.
Doug: Yeah.
Om: So and when the Affordable Care Act coming in, I want to remind everyone that at that time, there ReWalk there are provisions of pre existing conditions, meaning everyone who can have health insurance, even though they're dead on the on the deathbed, you know, on, you know, written they can come out to have health insurance. And when you look into the scale, open them let's say you open up the market and you say everyone can buy your including group six, but you know, the way have we rated the premium we have to read it all of this people who seek is going to come in and utilize the plan. So you will see that you know in the last seven years of premium increasing dramatically.
Doug: Yeah.
Om: Because at that time we lack of the gap of invincible people like you Doug people who don't just like to never go see doctors. This is why the whole country the whole nation is one every community to be healthier and living better to have health insurance. So, you know, the more we have people come into the tent, you know the average of the guests spread it out the price gets to be stable. So let's understand about how the insurance work. Let's say, I'm going to use your case you have a family of four.
Doug: Okay.
Om: So and either you get premium tax credit or not. Assuming you don't have a premium tax credit, you're going to buy the AC plan. An AC plan is cover everything is covered. Emergency cover doctor visits, cover pregnancy, cover everything that people who need medical care will need it. And sometimes this kind of is kind of you know, it's kind of strange because you as men have to pay for a pregnancy into the AC plant. That's why the premium card you know, into something new you pay for some other people too but cut into the point let's say if you were to be needing to go to hospital and my job my clients though my job is this kind of kind of because I love to eat I said you know all families have a great day anniversary, when kids birthday, you go out and eat in the fancy restaurant or come home that night. Oh my gosh, everyone got you know, diarrhea got some sort of feeling like food poisoning in the middle of the night. What would you do? You will rush yourself to go to the emergency room, right?
Doug: Yeah.
Om: Right. And emergency room you're gonna pay. If you don't have insurance. I don't I kind of look at you. And just like, yeah, we take you but you're kind of like.
Doug: I can tell you you'll pay. I do have insurance. Because I think there was a few years ago, one time my son fell off the monkey bars square
Om: Yeah.
Doug: And they were the teachers were really afraid. So they called an ambulance. And they took it down to the Newberg hospital. And so he was going to school and to ensure what now for everybody who's out of state. We live it we both live both home and I live in the town of Newberg and Sherwood is probably about, I don't know, 810 miles away or something like that. It's pretty close. It's not that far away. Well, so anyway, it was about maybe a 10 minute ride. And then I think he was in the ER, I think the doctor talked to him for all of five minutes, because basically, they gave him some really simple tests. And then they said he's fine. And then he got to go. So and then I got a bill for, I think, $800 for an ambulance. And then the emergency room tried to tried to give me a bill for like $3,000 or something. And so basically what I did was to call him up and said, hey, look, I'm not paying this. So we can negotiate something that's reasonable, but I'm not paying this.
Om: Right. So yeah, you can negotiate that you know, but in reality, the hospital or the clinic or any flexibility is medical would prefer for you to have insurance. My point of this is with the Affordable Care Act, every policy has a stop loss
Doug: Yeah.
Om: Before maximum our pocket. Even though you know, your policy would have a deductible, copay coinsurance everything, if you go see the doctor in network and the policies in describe and the contract show you have a stop loss.
Doug: Yeah.
Om: For example, the year 2020 the stop loss for individual is 8150 that including alcohol pay prescriptions, coinsurance, and deductible. In the year 2021 the copay added maximum out of pocket would increase to 8150. However, a family of four let's go back to my job after you know, my dark job Have you ever been let's say everyone have to be in hospital because you know, the oyster Did you eat was not very fresh, you Everyone have to be in hospital and hospital stay one night could be about 10,000. So you have a family of four Tom for 40,000 because of the Affordable Care Act, you will have the responsible of 1150 for one member and a family could be only two. So you just come in 8150 times to become worth 17,000. And that will cover one up out of this stop loss. The insurance cover you for the whole year of the year 2020 and the deductible that our pocket will begin to gain when the New Year come January 1 2021. And people will say oh my gosh, even 17,000 there's still a lot for me. And then that's, you know, that we'll be talking about you can negotiate with your hospital, because at that time we can take a look into it. You know because I have to go into the hospital, you know, my income change I can do I cannot do the job. It might help you know, with the income that you put it into their marketplace applications. So I would absolutely encourage everyone don't go without it. I think you're gonna feel like you have some protection like an armor over you even though you don't use it and have insurance and They have a level of tears on the photo, there are metal tears. So yeah, if the invincible people they can some insurance company depends upon how they offer catastrophe, that means, you know, men are not going to use it. But if you need it, we're going to give you the three times to go see doctors without have to pay the deductible. And then the lowest level would be bronze does mean you know the premium would be lower. But if something where you needed medical services, you know that you're going to pay higher our pocket, and then the civil plan, and then the goal plan. And then some insurance company offered a platinum plan. And you can see, you know, the higher tier platinum, like you know, if you give someone a diamond ring with platinum, this, you're gonna get the load faster than the bronze one. So just say same thing. So you pay higher premium, you call your hair insurance company, responsible lubricity of me, I'm willing to pay you higher premium is something but I do not suggest we won't go to goal or go to go to bronze. We're looking to case by case when you work with insurance agent, this is how our expression, expertise coming belong to your cares. We're looking to your director, your tech, and we tell you, hey, we suggest or we guide you that hey, this time I suitable for you. Take a look into it.
Doug: Okay, excellent. Yeah, I mean, well, and because I'm speaking for myself, right, the ACA plans are pretty expensive. But like you said, the out of pocket maximum is it is a pretty big deal. Because, like, for example, when my daughter was born, she was in neonatal neonatal intensive care unit for five weeks. I think when I when I got the bill for that it was something like $170,000. Now, you know, Now granted, I think what I did was I think I had a family out of pocket maximum of $10,000. So I do not know checking when we're done. Actually, I think we lower that was like $6,000 for the family or something like that. We had a really good plan. I didn't know how good it wasn't, it was not any ordinary. But yeah, so I just wrote a check for 6000 bucks, and we were done. But that's the thing, if you don't have that backstop, you can actually have your medical costs can rise really, really fast. Now, it's a completely separate topic about why does everything medical have to be expensive. But but yeah, just bearing that in mind, medical cost can rise really quick. So I think your point is absolutely valid, which is that it can be tempting to try to go without coverage, but it's really a good idea, especially if you have a family to be able to carry coverage so that you can use so that you at least have that backstop if you need it.
Om: You know, and also that most people don't know that they qualify for the premium tax credit.
Doug: That's a really good point. How do you find out more about that
Om: Well, let's see. I want to give credit to a state of Oregon we always be a proactive state. So Oregon State of Oregon really work with Asian and promoting the Asian.
Doug: Yeah.
Om: To help because we have a system or website we can simplify the process. But most people feel like they can figure it out. They can go to oregon.healthcare.gov and they can punch in information.
Doug: Okay.
Om: And by and find the information exactly the same thing but you know, when you punch it in information, you're going to feel like oh my gosh, this is so daunting just like you just say it's loss of information. And this is why I said Morgan said there you go talk to the agent who got trained and got certified to do this. And there are quite a lot of lists on that website healthcare.oregon.gov.
Doug: Okay.
Om: If I local help punch in your zip code. And this is for Oregon, but most of each state has the same thing.
Doug: Okay.
Om: Except watching they're on their own.
Doug: Okay.
Om: Run their own things. So yeah, I would encourage you want to try that. And premium tax rate is is something that is not going to hurting you anything, it's just help you lower the premium. And but you just have to report quite close to the actual income because on the application, I would ask students if your income were too low, and then we found out that their income is higher than you put it in, you might have to pay back.
Doug: Gotcha.
Om: And in the fact...