HOW WE DETERMINE YOUR PLAN

The right health insurance plan considers the right balance of considering your financial picture, your health history, and your expected annual income(taxes). Between these variables and how your insurance is used can help you dial down the plan that's right for you.

 

 

OUR PROCESS

DISCUSS

1. Complete our intake

2. Review what your needs are

3. Discuss our process

ANALYZE

Review intake, medical conditions, formulary/Rx, Financial situation, tax returns

ADVISE

Plan education. Advise on best course of action.

Income reduction planning to find affordable health insurance

ENROLL

Per your signed agreement, we will manage enrolling you in the plan you have determined best suits your needs.

SUPPORT

As your Advocate, we will assist year round with Marketplace, Insurance and healthcare questions.

 

FINANCE

UNDERSTANDING FINANCES IS THE FIRST STEP TO YOUR INSURANCE PICTURE

EMPLOYMENT

  • Are you self employed? Learn how being self employed can actually help lower costs. Different treatments for LLC, Sole Prop, S-Corp and C-Corps

  • Are you retiring? Social Security, Roth IRA's, Savings and 401(k) accounts are all treated different when it comes to calculating income.

  • Have you just lost your job? Medicaid may be an option for you.

BUDGET

  • Monthly Expense. What target monthly payment can you afford?

  • What if? What impact would a cronic illness have on your lifestyle?

RESERVES

  • High Income Earner? For the self employed, sometimes the biggest compremise in finding affordable health insurance is giving up a low deductible. Do you have reserves to handle this?

HEALTH

UNDERSTANDING YOUR HEALTH IS THE SECOND STEP TO YOUR INSURANCE PICTURE

HEALTH HISTORY

  • Medical Conditions How do you use your health insurance? How often do you go to the doctor? Do you see a specialist regularly? At what frequency? How does that impact your out of pocket costs?

MEDICATIONS

  • Understanding the formulary. Which recurring medications are you taking? It's important to ensure the medications you take are on the drug formulary for the insurance plan you pick.

  • Tiers. Is your medication Brand Name or Generic. This distinction can make a large different in Prescription costs.

DOCTORS

  • Network? Depending on the complexity of your conditions, it's crucial to choose a plan that allows you to stick with your providers who know your health conditions intimately. In addition, depending on region, a local health insurer may not work with the provider networks.

  • Don't Have a family doctor? You may be a good candidate for an HMO or EPO if you buy insurance purely for the "What if" but don't go to the doctor often.

EVENTS

  • High Expenses. Do you anticipate a major healthcare expense while on this plan. It's important to plan for that. Whether a knee replacement, hernia operation, or a pregnancy. These are important to plan for.

TAXES

UNDERSTANDING YOUR MAGI( Modified Adjusted Gross Income) IS THE THIRD STEP TO YOUR INSURANCE PICTURE

INCOME SOURCES

  • Earned Income In order to qualify for subsidies you must project, by the end of the year you want to be insured for, what will your income from all employers be? Change jobs mid year, calculate income from both employers. Have a dependent living with you, calculate with and without their income.

  • Self Employed Income Self employed income is purely concerned about Net Profit or Loss that is brought from your Schedule C to your 1040.

  • Rental Income Again, Net Profits are added.

  • Social Security Income Both the taxable and tax free portions of social security must be included as income.

  • Distributions/Gains 401(k) and IRA distributions must be included, as non-qualified capital gains. Distributions from your Roth IRA/401(k)'s or cash in your savings that you use to supplement income have already been taxed, and can be a great source of income for pre-retirees trying to keep their income low.

APPROVED DEDUCTIONS

  • Self Employed? If you or someone in your household is self employed, you are allowed to deduct buying qualified health insurance from your income. 

  • Retirement Plan Contributions. Contributions to a tax deferred 401(k), SEP, SIMPLE IRA, and Traditional IRA are deductible in the year the contribution is made.

  • Health Savings Account. If your insurance plan is eligible, contributions to an HSA are also deductible in the year they are deposited to the plan.

NON-APPROVED DEDUCTIONS

  • Child Support. A common mistake to income planning is trying to deduct child support. If you receive child support you do not pay tax on that money as the co-parent is responsible to pay tax on that income. Equally, if you pay child support you do not deduct that from your taxes as it is your income.

  • Mortgage Interest. Mortgage interest and other itemized deductions are filed on a schedule A that is tallied on page 2 of your 1040, after your MAGI is calculated. 

MAGI VS FPL

  • FEDERAL POVERTY LIMIT The above should give you a general rule of thumb for your projected income. This combined with your household size can determine whether or not you qualify for subsidies. 

**This information is general in nature. This is not intended to be tax or legal advice. Please speak to your accountant about your specific needs.

PLAN OPTIONS

YOUR FINAL STEP IS COMBINING THE ABOVE ROADMAP TO DETERMINE THE PLAN THAT IS RIGHT FOR YOU.

ON EXCHANGE MAJOR MEDICAL

  • If you are subsidy eligible, the plans available to you are through the Federal Marketplace. Depending on where you fit on the federal poverty limit their are additional incentives to opt for Silver based plans that further lower your premium, deductible, co-pays and out of pocket limits.

OFF EXCHANGE MAJOR MEDICAL 

  • If your income is above the subsidy limit, but you have preexisting conditions, our job is to find plans off of the Federal Marketplace that satisfy your needs with full coverage, but are affordable.

SHORT TERM MEDICAL

  • For our clients who are young, healthy, and have income above the Federal Poverty Limits, short term medical may be an option for you. It does not cover pre-existing conditions, you can only be enrolled for 3 months at a time, and it does not satisfy the qualification for "Qualified Health Insurance" to avoid the penalty. But, depending on prices on the Marketplace you may get an "affordability" exemption and get coverage at a fraction of the cost of off exchange plans to hold you over for a year.

FAITH BASED PLANS

  • It's important to understand that Faith Based Plans are NOT health insurance. It is a ministry that brings people of the same faith together to pay into a pot to use for claims. These plans are much cheaper than unsubsidized insurance but can cause high expenses to participants in a high claim year. With understanding the risk, this still may be a great option for you.

ALTERNATIVE

  • Outside of the above options, there are innovative companies, sometimes in your back yard, that offer a unique approach just for you. Our job is to do the due diligence and ensure they are properly filed so you aren't in a plan that does not meet your needs. Rather, there are traveling doctors, PPO Faith Based Hybrids, and Telemedicine companies all designed to keep your annual costs down.

MEDICAID

  • Depending on your state, if your income is low enough (either 138% of FPL or 100% of FPL) you may qualify for medicaid. These plans are zero premium, low out of pocket plans designed to hold you over until your circumstances change.

 

PA Health Advocates is a leading Fee Only health insurance advising company assisting clients across the United States. We make it simple for everyone to find affordable health insurance and keep their year-round health costs down. We combine Tax, Insurance and Financial principals to bring a holistic approach to health insurance planning. Your options are limitless when you understand the Federal Healthcare System.

717.400.1244 // Info@PaHealthAdvocates.com // Lancaster, PA

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