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Individual Health Insurance Policy

TS0104TS0104 1106 replies29 threads Senior Member
edited January 8 in Parent Cafe
Hello! My husband is self employed and we have purchased individual health insurance policies for 15 years. When we got our annual end-of-year letter with our premium increase, it went up $300 per month...which is a LOT...usually its around $90 per month increase annually. The letter says this "affects everyone that has the same plan as you, not based on individual claims", and we did not have any significant medical claims or changes in 2019 besides a broken arm which we paid for out of our (very high) deductible.

So...$300 increase per month is enough to cause me to start shopping again, we've had this plan and company (United/Golden Rule) for about 10 years and have been happy until now. My agent is retired and the new contact he sent me to said I cannot change until Nov/Dec open enrollment as I do not have a qualifiying event. Is this true? I used to shop around whenever I wanted, as before finding this plan we changed several times, often after these end of year premium increase letters. Also, how is it fair that they can send a letter 12/20, increasing premium by almost 30%, and I would have to shop around and find a new plan in the next 7 or so days, during holiday season?

I'm hoping this new contact was wrong. He said that I can only change plans within the current company (United/Golden rule) but otherwise am stuck until Nov/Dec. Is this correct? And how can it be legal/ethical to allow people one week to shop and get a new plan after the end of year premium increase notifications?

Thank you for any thoughts or advice.
edited January 8
28 replies
Post edited by MaineLonghorn on
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Replies to: Individual Health Insurance Policy

  • ChedvaChedva 18901 replies11703 threads Super Moderator
    Contact your state's insurance commission or consumer affairs department and ask these questions.
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  • MaineLonghornMaineLonghorn 39927 replies2196 threads Super Moderator
    It's tough. I don't imagine you have any recourse, but it can't hurt to try.
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  • thumper1thumper1 76432 replies3379 threads Senior Member
    edited January 8
    My understanding is now you can only change plans during the open enrollment period (which in most states has ended) of if you have a qualifying event like moving to a different state. I believe your contact is correct...the next open enrollment period is November/December 2020.

    But you certainly can call the insurance commissioner in your state to find out for sure.

    The open enrollment in CT has been extended to January 15. Maybe your state has an extended deadline as well.

    Post ACA, this open enrollment time is fact.
    And how can it be legal/ethical to allow people one week to shop and get a new plan after the end of year premium increase notifications?

    I could be wrong...but I’m betting if you had been shopping for coverage during the open enrollment period, you would have seen your 2020 pricing.

    It sounds like you didn’t shop for insurance until after you got your premium notice.
    edited January 8
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  • Twoin18Twoin18 1838 replies18 threads Senior Member
    Does you plan predate the Obamacare cutoff in 2010 (ie was it an underwritten individual plan based on your health records)? If so then you need to think *very* carefully before moving to a new Obamacare compliant policy. The old plans are usually much cheaper (because you had to qualify by being healthy) and have protections (such as not being able to change which doctors/hospitals are in network) that aren’t applicable to new plans. Our costs for a new plan would be more than double what we are paying (>$2500 vs $1200 per month for a family), for a worse plan with higher deductibles. OTOH you can’t get exchange based subsidies for the old plans if you are lowish income. But if you give up the old plan then you can’t ever go back again.

    One thing to note is that there is a big jump in rates every five years when the primary policyholder moves into a new age bracket. If you/your spouse turned 50/55/60 in 2019 then that would explain the change and there is really nothing to be done about it.
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  • TS0104TS0104 1106 replies29 threads Senior Member
    Thank you all for the helpful advice. I emailed our state insurance commission, and will call if I do not get a response soon.
    @thumper1 , so now I know that I cannot change any time, like I have in the past (my last change was pre ACA). Good to know. I never expected such a large premium increase in my annual December letter, I was expecting my usual $90 or so. I'm not sure what you mean by I would have seen my 2020 pricing, since this letter (always a later December arrival) is how I am notified of my premium increase. I suppose it is my fault for not knowing that ACA took away my ability to change plans at any time, even when I am not on an exchange plan. But it still seems pretty shady...sending large premium increases days before (or maybe even after!) the deadline to get a new plan.

    @brantly, I definitely didn't get earlier letter...trust me I would remember this shocking increase. And it is always this time of year for this letter. Interesting about the timing, I didn't realize open enrollment ended 12/15. I have an off exchange plan that I have had since pre ACA. I will see what the insurance commission says. Thanks for the terminology info!

    I don't have any sort of qualifying event and am not low income. No one turned 50/55/60/65 in 2019 either!

    @Twoin18 , you bring up a good point. I do have a pre-ACA plan. I have looked at some exchange plans every couple of years, and they were always more expensive than what I was paying. Subsidies won't be a factor, but you have explained to me why those exchange plans were always higher, and possibly why I won't find anything better, even given the large premium increase.

    Thanks again!
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  • doschicosdoschicos 22654 replies237 threads Senior Member
    The current administration, in a move to help undermine the ACA, has cut the enrollment period the past few years., as well as funding for notifying the public.

    "The enrollment period for ACA 2020 this year was shortened from 3 months to only 6 weeks, terminating on December 15th"

    https://www.forbes.com/sites/claryestes/2019/11/23/we-are-midway-through-acas-2020-enrollment-period-but-the-trump-administration-is-hoping-you-wont-notice/#589f672f6bb1

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  • kjofkwkjofkw 806 replies95 threads Member
    I'm with you on anger at insurance companies. We really need to keep writing our representatives.
    Our LTC premium had yet another increase. When we purchased, we were told (but of course not promised), that rates had never gone up in their history, so we planned for some increases, but hoped for few. The minute we hit 60 years old, it started rising rapidly -- 75 % over a 5 year period. Didn't plan for that one.
    I was also angry with our Drug Plan. We did a lot of research to determine the best choice. Studied the costs of our particular drugs as they were posted in December 2019. Went to fill a prescription in January 2020 (with the new plan), and found they raised the price 20% over what they posted in December. Can't change plans until next year.
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  • brantlybrantly 4067 replies72 threads Senior Member
    edited January 8
    @doschicos raises an interesting point. Before the current administration's changes, open enrollment was from November 15 to February 15. I actually remember being in Florida in early February the first year of ACA implementation and looking at plans while lounging at the pool.

    Anyway, I'm thinking that your insurance company has always sent it's end-of-year letter in mid or late December, and there was still plenty of time to shop for a new plan during open enrollment. But when open enrollment was shortened, your company did not retrofit the timing of its notification.

    Here are all the open enrollment periods going back to the beginning.
    https://www.peoplekeep.com/blog/annual-open-enrollment-periods-2015-2020

    I think it would be reasonable for you to request of your state's insurance commission that you (and others affected by the late notification) be granted a special enrollment period.
    edited January 8
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  • tdy123tdy123 1033 replies18 threads Senior Member
    edited January 8
    @TS0104 In many states qualifying events include loss of coverage including loss due to a large increase in rates making it unafordable.

    Alternatively, being self-employed can make it easier to have a technically "qualifying event" for insurance purposes. I've seen a DBA name change or filing, LLC name change or filing, and S corp or partnership formation all qualify as "events."

    See a new broker with current experience in the small business/self employed health area in your state.

    If your previous plan was an off-exchange individual plan, you might have additional options including a small business plan, or individual on-exchange plan.

    Insurance has gotten increasingly complex, particularly for the self employed.
    edited January 8
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  • TS0104TS0104 1106 replies29 threads Senior Member
    THanks @brantly and @doschicos , I think you have explained to me why I feel so blindsided over this. If the open enrollment window used to be through Feb, then I'm sure I was in that window in my previous "shopping" over the years, and never knew that I was restricted to that window.

    Hoping the state insurance commission has some remedy.
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  • thumper1thumper1 76432 replies3379 threads Senior Member
    I'm not sure what you mean by I would have seen my 2020 pricing, since this letter (always a later December arrival) is how I am notified of my premium increase

    We have family members who buy their own insurance. They start to check plans when the info becomes available which is usually just prior to the November start of the open enrollment period. Things they have found...one year, their plan was totally eliminated by their state. So the had to find a different vendor. Regardless, they knew their next year’s rates at the start of the open enrollment period.

    Maybe this varies by state, but where I live, the health insurance companies need to get their rate increases approved before the open enrollment period starts.

    I’m sorry this has happened to you. The landscape of health insurance coverage has changed, and likely will continue to change.

    Another suggestion...there are brokers for health insurance. Perhaps they can help you in some way even if it’s only to find a less costly plan with your current vendor.
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  • brantlybrantly 4067 replies72 threads Senior Member
    edited January 9
    Great to get it sorted out! Not only would I file a compliant, I'd contact your insurance company directly to complain to them. Someone there screwed up.

    You discovered what I discovered a few years ago. I get the plan with the cheapest premium because in the end, they all have same or similar out-of-pocket limits. The OOP limit is the only thing that matters because we never meet the deductible. And we pay our OOP with pretax dollars (HSA). It's almost like having one the old "major medical" plans.
    edited January 9
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  • Twoin18Twoin18 1838 replies18 threads Senior Member
    "The second more positive development is that my current plan will adjust my co insurance down to 70/30 (from 80/20) which will give me a new lower monthly premium that ends up $100 lower than my OLD rates...so negates the increase, plus some"

    Be careful to check if your adjusted plan is still classified as a pre-ACA "grandfathered" plan with the protections that includes. We were told that it is not possible to make any changes to things like deductibles without moving to a new ACA plan (although it is possible that some insurers may have converted everyone to an ACA plan without making you fully aware of it). In particular, the protection that it is not possible for the insurer to change which hospitals/doctors are in-network has been very important to us, because the large teaching hospital near where we live has been dropped from almost all individual ACA policies that are now being sold.
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  • TS0104TS0104 1106 replies29 threads Senior Member
    Thanks @Twoin18 . I guess I don't know if my grandfathered plan has been converted or not over the years. That is a good thing to know about ACA vs grandfathered, although we have many good hospitals in our city and no particular relationship/needs with any specific one. Our GP is about to retire too, so I guess we don't really have any strong connections that we would want to maintain...we are fortunate in that way. But I guess I should not assume that the hospitals that have been in network for us over the years are still in network!
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  • doschicosdoschicos 22654 replies237 threads Senior Member
    TS0104 wrote: »

    Finally, the insurance commission and everyone I have spoken to says that insurance premiums did take a big jump for 2020. (Great)

    Just for the record, that really varies by one's location. Here's a good map of year over year pricing differences from 2019 to 2020 by county in the USA but the Kaiser Family Foundation which is, IMO, a very good resource on healthcare and health insurance.

    https://www.kff.org/health-costs/issue-brief/how-aca-marketplace-premiums-are-changing-by-county-in-2020/

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  • MaineLonghornMaineLonghorn 39927 replies2196 threads Super Moderator
    Our cost went up 6% this year. We're paying about $1,330 for the five of us, but it would have been about $700 more a month if DH wasn't on Medicare.

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  • TS0104TS0104 1106 replies29 threads Senior Member
    Thanks @doschicos that is a great resource! Our cost definitely went up by more than $9 (well was going to without my coinsurance adjustment), but I guess seeing the big picture helps me feel better.
    @MaineLonghorn , that makes me feel better too. Our premium was going to be 1400 for a family of 5, high deductible, no chronic health issues.
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  • MaineLonghornMaineLonghorn 39927 replies2196 threads Super Moderator
    Oops, I misspoke. That should have been $1,330 for the FOUR of us! Oldest son is on Medicaid because of his severe mental illness.
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