What People Need to Know Before They Buy Health Insurance This Year

Telemedicine is particularly useful when compared to going to urgent care or, in some cases, the emergency room. In these situations, we are not going to see our primary care physician anyway. So why not opt for convenience and perhaps save some dollars along the way?

There are many telemedicine apps available. One popular app is Doctor on Demand, backed by Dr. Phil. Doctor on Demand provides over 1,400 board-certified doctors who will video consult with a patient for just $40.The company also provides psychology and lactation consulting.

Teladoc is another provider of telemedicine. Its users can either talk on the phone or video chat over the internet. According to the company website, the average doctor call-back time is 16 minutes.

Instead of waiting for days or hours to see a doctor, patients can visit with one remotely without having to leave their home or office.

Though telemedicine is gaining in popularity, it is problematic in some states. Not all states allow this kind of medical delivery, and some that do have restrictions. Still, it is worth looking into.

House Calls

What’s better than video chatting with a doctor while being in the comfort of your home? How about having a doctor come to your home?

Heal is a smart phone app that provides on-demand service similar to Uber. But instead of bringing a car for hire, it brings a doc to your doorstep for $99. The doctors are on call seven days a week from 8 a.m. to 8 p.m. Heal launched in Los Angeles and is expanding.

Pager provides similar services to people in New York City. Chicago-based Go2Nurse is another company that brings health care services to your home.

The telemedicine and house call on demand market is growing. Clients should be made aware of these services, and those interested should find out if their insurance company covers these charges. If not, it might be time to change carriers.

Cost of Insurance

The first year of the individual mandate was 2014. Many people’s premiums were actually lower or just slightly higher than those of the previous year. However, what stunned a lot of people was increased co-pays and deductibles. We may see something similar this year.

Clients need to realize that the true cost of health care is more than just insurance premiums. Co-pays and deductibles can run into the thousands of dollars. Many people pay these costs with after-tax dollars because of the 10% AGI hurdle on Schedule A.

For those clients who can afford it, a higher-premium Gold or Platinum plan is perhaps better than a lower-premium Bronze. This is especially true for the self-employed who generally can deduct all of their premiums but not necessarily other medical expenses. Clients should also consider whether a Health Savings Account (HSA) makes sense.

Even those who work for large employers or are members of unions should not be surprised to see increases this fall in their premiums, co-pays and deductibles as employers are bracing for the 40% “Cadillac tax” that hits high-value plans in 2018.

Gotcha!

Last year many people were surprised to discover that their doctors were not on the plans they purchased through the Exchange. Before buying insurance, individuals should make sure their doctors are on the plan. Just checking the insurance company website is often not enough because it probably won’t indicate whether their doctor is on the plan for next year. They likely need to call and confirm with their doctor.

Premium Tax Credit

The only way to win the lottery is by buying a ticket. The only way to get the Premium Tax Credit is by purchasing insurance on the government Exchange. Since the Premium Tax Credit is based on modified AGI and not assets, very wealthy clients may qualify for the credit.

If a client’s doctor is covered under an Exchange plan and if the premiums are the same, then why not buy on the Exchange? The open enrollment period for 2016 begins on November 1.

COBRA

Many Exchange-based plans are cheaper than COBRA plans. If a client is on COBRA now, he can’t move to an Exchange-based plan until the open enrollment period. If a client is leaving the employer and has not yet signed up for COBRA, he can enroll in an Exchange-based plan even though it is outside the open enrollment period.

The health care landscape including insurance is changing. By sharing this information with our clients, we can help them not only save money but also make certain they have the coverage they desire.

 

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John Stevko, CPA, is a regular contributor to Thomson Reuters Checkpoint Learning. He operates a tax and consulting practice serving individuals and small businesses. Mr. Stevko is a sought-after speaker on tax topics for CPAs and other accounting professionals across the country. He has been instrumental in Thomson Reuters health care reform offerings, authoring and presenting courses via seminars, webinars and the new Checkpoint Learning Health Care Reform Virtual Conference as well as contributing to the creation of the Checkpoint Learning Health Care Reform Certificate Program™.