[‎USER]

Hi. Im looking for some advice on choosing a new health insurance plan and I’d appreciate ur advice. I was laid off and am on COBRA until Oct. 5th.

My current COBRA plan is about $950 a month including dental. I’ll need to get ACA insurance soon. I live in MA, which has their own state health plans.

I am used to very good insurance, a PPO with a low deductible and 100% mental health coverage. I dont have any major medical problems, but i have some prescriptions and i see a therapist about twice a month.

Initially I thought I wanted a plan with an HSA, but learned the only option for an HSA in MA is a bronze plan with limited coverage.

The silver plans are discounted but still less coverage than id prefer.

I understand that I can get tax credits according to my income. I am FI and my income is $0, however, last year my investment cap gains and distributions put out about $64k and I know this factors into the subsidy calculation.

My main questions are:

What are the important considerations in choosing an ACA plan given that I would prefer good coverage and mental health benefits?

Are there any MA residents who have bought insurance through the health connector?

I’d love to hear about your experiences and recommendations particularly if you’d prefer more comprehensive coverage, even if it requires a higher premium.

Thank you for your help!

[Stacey]

You can google for pros who can help you find the perfect plan in Massachusetts, unbiased because they get paid either way.

I call the healthcare sherpas. Happy with mine.

[Ann]

If you elected COBRA, you cannot get an ACA plan until your COBRA runs out.

Your subsidy is determined by your 2025 income, if you have no income, you’d likely be referred to Medicaid if it is expanded in your state.

If Medicaid is not expanded, you’d be expected to pay full price.

ETA: remember when looking at premium cost and out of pocket cost, you’ll only have an ACA plan for Oct-Dec and then it will start over.

[Ron]

Capital gains as well as both regular and qualified dividends are a part of income for the ACA subsidy determination, even if they might be still within the zero percent LT capital gains tax bracket..

I think at $64K of these you’ll likely be priced out of any subsidy if you are a single, though I don’t know for sure.

I specifically don’t cash out any capital gains to keep my subsidy at the level I want.

Lower cost plans will come with much higher deductibles, of course.

[Wilson]

MA should have a website where you can put in your income and get an estimate on subsidies.

Assuming you have some flexibility on where you draw your portfolio income from, you should be able to land in a sweet spot to avoid Medicaid but get significant subsidies on the ACA plans.

But this will depend on your spending needs.

[Barry]

If you have $ to set aside and pay deductibles, then you may want a high deductible plan. That’s if you are healthy.

The subsidies from the pandemic era expire at the end of 2025 and those are for people making no more than 4x poverty level (60k range).

Ditch the dental and either buy your own plan or pay out of pocket unless you have dental problems ongoing.

These are just ideas for possibly saving money.

[Elizabeth]

General ACA info. Get a MA agent to help. I believe you can find one on the healthcare dot gov site. I would try to get all of your medical needs, including prescriptions before your COBRA ends.

You can get ACA until the end of the year due to loss of coverage but deductibles will start over.

Subsidies are based on the full year of ACA income and there is a minimum income threshold to meet to be eligible. At the end of 2025, unless Congress extends, the ACA cliff returns and enhanced subsidies expire.

There will still be subsidies but not as much or income as high as today. In the area I was living when we were using ACA, DFW, TX, there were only HMO and EPO options, no PPO.

My husband had to change from his good dr to a mediocre Dr for his chronic illness. So, check to see if your drs accept the plans available to you.

We are very happy to be off of ACA and on to Medicare. Husbands chronic illness got much worse right at the time of changing to Medicare and he is back to having really good drs and lots of choices.

[Author]

Posts