Health Care: 2018 - 2019

Updated: Jan 11, 2019

While researching my health insurance options, I could not find a single first hand account of anyone researching their health insurance options. There is a plethora of information in magazines, newspapers and the internet about health care insurance (and how to make an informed decision), but little or no information about peoples actual health care decisions (most articles are long on theory and short on reality). I decided to document my health care decision with as much detail as possible.


On July 23, 2018, after 21 years working for ExxonMobil (and after year long "sabbatical") I decided to resign. Since I was only 52 years old I was not entitled to retiree health insurance and therefore needed to find my own health insurance.


Before I even started my search I quickly realized I had made my first mistake. I had been on my one year "sabbatical" for a little over 11 months, when my boss emailed and asked when I would be returning to work. I decided to play this straight up and inform him that I would be resigning effective Aug 15. I figured that since I had already paid my August ExxonMobil health insurance premium ($111.42/mo.) I would be covered through August 31. Part of me wanted to wait, but the other part felt it was important to give him some notice so that he could plan accordingly. He wished me well . . . and then HR immediately accepted my resignation and canceled my health insurance effective July 31. I contacted my boss and tried to understand what had just happened - he was quite understanding, but it was out of management's hands and HR guidelines were HR guidelines. When I mentioned that I was owed August's health insurance premium, he told me to contact HR benefits. I was off to a rather unsettling start.


According to the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) I thought I had 60 days after loss of my benefits to elect to pay for COBRA coverage, but ExxonMobil informed me that I only had until September 15 (with coverage retroactive to August 01). At $796/month I knew that this was probably not my best option, but an option none the less. And since I could retroactively use COBRA, I could continue to research my options (if I did suffer an illness or an injury between now and September 15, I could initiate COBRA after the fact). Until then:

My Options:

1. COBRA: While ExxonMobil had a very good health insurance plan, $796/mo. was more than I wanted to pay.

2. My wife's retiree health insurance: I had done some research years earlier about this option and thought I understood it. I could join my wife's retiree health insurance if I had a "Qualifying Event" and my Loss of Insurance was one. Unfortunately I never confirmed what the premiums would be. I had always assumed that I could join my wife's retiree health insurance at the same premium ($463/mo) that she paid (as it would be if she was still working). Well I was mistaken. If I did join her plan it would cost me $812/mo. I realized how naive I was to think this, but the idea of my wife's former company (a "family" as she seriously said to me numerous times) sticking it to spouses was unexpected to say the least (it appeared that my wife's former company was making spouses pay the full rate - no subsidies for spouses)

3. Healthcare.gov: I reviewed all the options for my zip code (and to be honest since my wife and I were traveling, I reviewed some other ones where I could theoretically live) I found a Bronze plan from Molina Health Care for $465/mo. One thing I didn't like was having to pay health insurance premiums on September 15 for August and half of September for coverage that was in the past (and therefore no longer needed). I understood the logic and the fairness, but just didn't like it.

4. Short Term Health Insurance through December 31, 2018 (to get me to Open Enrollment 2019): Since I was fairly healthy and had no preexisting conditions, this was a serious option. Many of the short comings (no mental health coverage, no maternity care, no prescription drugs) would not be an issue for me. I had read about problems some people had with ST health insurance:

-being covered for an initial illness, but not for a subsequent relapse which was classified by the insurance company as a preexisting condition.

-obtaining 90 days of mental health care medication under a more comprehensive plan, then buying ST health insurance, but then not getting a job 90 days later, running out of mediation and not being able to purchase mediation that now was much more expensive.

So I typed in "short term health insurance" in my browser and started the search. Two options looked promising:

a. UnitedHealthCare (Underwritten by the Golden Rule Insurance Company) at $256.62 (total) would cover me from Nov 17 - Jan 02 (46 days):

AMOUNT PAYABLE

Maximum Benefit Limit

Per covered person................................................................................................$600,000

DEDUCTIBLE AMOUNT, per covered person, per policy term

Network Provider........................................................................................................... $12500

Unless otherwise stated, the network provider deductible amount will not apply to

covered expenses subject to a copayment amount.

COINSURANCE PERCENTAGE

For eligible expenses in excess of the applicable deductible amount..................................60%

(Not applicable to covered expenses subject to a copayment amount, unless otherwise

specifically stated)

NETWORK COINSURANCE OUT-OF-POCKET MAXIMUM

Per covered person, per policy term.............................................................................. $10,000

b. Lifeshield (underwritten by Lifeshield National Insurance Co.) at a cost less than the UnitedHealthCare (I'm not sure the exact amount). The problem with this policy was that benefits for Kidney Stones, Appendectomy, Joint or Tendon Surgery, Knee Injury or Disorder, AIDS, and Gallbladder Surgery are limited to specified amounts shown in the Schedule of Benefits. The problem being that I could not find the mentioned Schedule (and these were injuries I would most likely incur).

5. No insurance: Not really an option.

After reviewing the above I decided to go forward with a combination of 3. and 4. On September 14, I used HealthCare.gov to sign up for Molina Health insurance knowing that I would not have to pay any premiums until Oct 28 and would be covered retroactively until August 01. Then on Oct 26, I applied for the UniteHealthCare ST health insurance. There was a problem though, one of the questions asked during the application process was "Does any applicant now have hospital or medical expense insurance that will not terminate prior to the requested effective date? The person(s) named will not be covered under the policy/certificate." So I needed to cancel my Molina health insurance prior to starting my UnitedHealthCare ST health insurance. So now what? I was concerned:

-that if I cancelled my Molina, what if UnitedHealthCare for whatever reason didn't process my ST health insurance - I would be out in the cold.

-What if Molina couldn't cancel immediately, then I might have an overlap which most likely would void my UnitedHealthCare ST health insurance. While a gap in coverage could be a problem, what if there was overlap and therefore UnitedHealthCare refused to process a subsequent claim. I knew from my research that ST health insurers will use any excuse to void your ST health insurance and not pay a claim.

I ended up waiting for Molina to officially cancel my health insurance due to lack of payment and then applied for UnitedHeathCare ST health insurance on November 15. During this gap I was extra cautious (looking both ways before crossing, cross at the green - not in between, an apple a day, etc). As I look back at it know, it was rather irresponsible. UnitedHealthCare emailed my an acknowledgment of my application and charged my credit card for the first premium a few days later on Nov 17. But to add to the unease of the whole situation, never emailed my any confirmation of coverage. I tried calling them five times but could never get any information (was put on hold, transferred to no-one, transferred to someone who was in the wrong department, etc). Finally on Nov 30 I received a confirmation and ID card via mail. I made it! Until Dec 31, that is.


Next step was finding health insurance for 2019. I basically had three options:

1. Continue with ST health insurance, which due to changes made by the Trump administration allowed for longer term short term heath insurance. This seemed to be an irresponsible option.

2. My wife's retiree health insurance, which at a now increased premium of $485/mo, 5% pricier than it was a few months earlier. Too expensive.

3. Healthcare.gov: Molina Healthcare again was the champion. A Molina Marketplace

Molina Bronze - No Deductible for PCP Visits (Plan ID: 45786TX0020003) at $437.48/mo. There was an HDHP (HSA compliant) plan @ $650/mo., but the economics just didn't justify this plan.

The winner is . . . Molina Bronze! I made my first payment via credit card @ Dec 28 (prior to the required Dec 31). True to my health care experience of the prior three months, Molina did not email (or mail) me any confirmation of coverage or ID Card. I had to call them on the phone (no wonder health care costs so much) to confirm coverage - during which they informed me I could go online and log into molina.com to get my ID card. Of course when I tried, I realized I did not have a member number and had to call them back.

Well that's it - Mission Accomplished. It was not as straightforward as I would have liked, but then what is? What is your experience with enrolling in health care? Please email and let me know. Maybe the details of your enrollment can help my enrollment.

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