Ron Bliss: New policy is breath of fresh air for those who don’t get subsidies

Back in March, I suggested that something was needed — in the form of a major medical plan — that allowed individuals to pick and choose their coverage, yet still qualify to avoid the fine for not having an Affordable Care Act-qualified plan.

The ones most hurt by Obamacare were those who made just enough money — $65,000 per year for a family of two — to not qualify for a subsidy on the federal exchange, and those who didn’t qualify for a subsidy simply because their spouse had affordable coverage through his or her company. In such cases, while the spouse got help from his or her company, the partner and children did not and it was not affordable, as a result. Now, as Congress struggles to find an acceptable alternative to Obamacare, North American Health Plans has come up with such a plan.

The Texas healthcare company got just such a plan approved for Nevada in May and brokers like me have started to sell it.

Something that is extraordinary about it is that it meets ACA requirements for minimum essential coverage, yet allows the individual to get as little or as much coverage as they want — 12 months of the year.

I saved a lady in Battle Mountain $320 a month for a plan that has NO deductibles and includes accident coverage for her son who plays high school sports. The cheapest plan she could get on the open market was $687 for a bronze plan with a $6,700 deductible.

Her plan includes hospital coverage, accident coverage, plus the six minimum essential coverages for preventive tests. Disability was also available, but was not selected. Also available, but not selected, was a critical illness plan.

There are some holes. It does not cover pre-existing conditions for the first 12 months, but does after that time. Also, currently there are no prescription drug plans that have been approved for use with the policy in the state of Nevada. They are also waiting to get a dental and vision plan approved.

Individuals can choose from $100,000 coverage in a year, to $250,000 and $1 million. ACA plans have no lifetime guarantees. This policy carries a lifetime limit of $5 million. A positive: there are no networks. Choose any hospital and any doctor. In so many words, if you like your doctor, you can keep him! Everything is indemnity, so there are no deductibles or networks.

There are separate amounts available for sickness and injury hospitalization, for outpatient procedures and for specific surgeries. You can choose $50, $100 or $150 payment for a doctor’s visit in event of either sickness or injury.

There are also indemnity payments for the MEC tests, based on what procedure used.

Cost for the MEC coverage is just $68.50 for an individual, $112.50 per month for parent and child, $121.85 per month for a couple or $165.50 per month for a family. A 1095 is provided at the end of the year for months covered to avoid any fear of being fined for not having coverage.

Another client I completed a plan for had not had coverage for a year and a half and was tired of paying the fine.

Disability coverage is available as part of the accident plan and pays either $1000 per month or $2000 per month for either 12 months or 24 months, depending on what you are willing to pay.

So if you are in good health, but paying too much to simply avoid the fine, or without coverage, give me a call and I will see what can be done to save you money while keeping you compliant.

Ron Bliss is an independent insurance agent in Carson City, NV who assists individuals with healthcare of all types both on and off the federal exchange and also does short-term plans, health supplements, dental-vision-hearing plans and Medicare Supplements and Medicare Advantage. You can reach him as 775-224-7169.


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