Premier Choice being suggested by agent for health insurance

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doug4523
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Premier Choice being suggested by agent for health insurance

Post by doug4523 » Wed Jun 08, 2016 4:21 pm

We recently lost employer health insurance due to my wife quitting her job. In shopping for health insurance I ended up doing one of those sites that offers you quotes but really just gives your information to agents so they can contact you. The only agent that contacted me gave me several quotes on various products, but specifically recommended "Premier Choice on PHCS Multiplan and Cigna's PPO network." I had been leaning heavily toward an HSA eligible PPO plan (Personal Choice PPO through Independence Blue Cross) due to the tax benefits and the fact that our family is very healthy. In a couple of conversations with him he seemed to be against any plan other than this Premier Choice plan. To be fair, it was the cheapest option I have seen and seems to give good-great benefits. Though I still have not gotten a summary plan description from him to confirm everything he is saying. The kicker is that this health insurance plan is NOT ACA compliant as far as the individual mandate goes. Again, to be fair, he was upfront about that.

However, he seems pretty out of the loop as far as the penalty goes and the benefits of an HSA account. He said the savings I would get would be worth the penalty for not being on an ACA plan because the max penalty per family is $2,045 (doesn't seem to be true, my penalty looks to be much higher). And he said if I were looking to save money on taxes I should talk to an accountant or CPA and they might be able to figure out another way. That seems like a cop out answer because he's not acknowledging the fact that I would save about $2,000 a year in taxes, and HSA's can have the rare triple tax benefit.

When I spoke with him on the phone, he admitted that technically speaking I would be required to pay the penalty, but in his experience (he uses the plan as well) when you are filling out your taxes or talking to your accountant you just need to answer yes when asked if you have health insurance. While I know that is generally true for those of us not getting a subsidy, I'm also sure that wouldn't hold up if it were audited and might even be considered fraud? He said it's not lying because I would have health insurance. This post is getting a little lengthy so I'll try to sum it up quickly with some comments and a few questions.

Situation:
Family of 4 (31, 37, 3, and 1 year old). Spouse not working, I work as a consultant and gross around $275,000/year. Max out all available retirement accounts already and would have room to contribute to an HSA if eligible.
Recommended plan: Premier Choice at $634/month. Seems to offer benefits without having to meet a deductible and is accepted by our pediatrician. Not on the Obamacare exchange and not compliant as far as the individual mandate goes
Plan I am considering: Independence Blue Cross Personal Choice PPO at $750/month. HSA eligible. Deductible $6,400 individual/$12,800 family (same for OOP limit), preventative care is the only thing covered before deductible limit is reached. I am aware this could be costly if an accident/major illness occurs. In the 28/33% tax bracket so tax savings would be about $2,000 per year.

So doing the math (assuming no major illnesses):
Premier Choice premiums: $7,608/year
PPO plan premiums: $9,000 (minus $2,000 in tax savings) = about $,7000. Not to mention the fact of the growth of the HSA being tax free and withdrawals tax free.

Seems kind of obvious to me that I should go with the PPO but I'm not an expert in health insurance purchasing.

1. Anyone have experience with Premier Choice?
2. Anyone have experience with getting a non-ACA compliant plan and not paying the penalty?
3. Any comments about going with a high-deductible plan?
4. The agent kept saying the Obamacare plans will rise at least 10%/year, if not much more, but the plan he recommends would only be 2-3% because they are for healthy people only. The underwriting is strict he said. Any comments about a 10%+ premium increase each year?
5. Any other ideas/suggestions?

Thanks for reading/input.

BruDude
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Re: Premier Choice being suggested by agent for health insurance

Post by BruDude » Wed Jun 08, 2016 4:43 pm

DO NOT buy that plan, it is total garbage, it's not health insurance, and you'd still have to pay the penalty for non-compliant coverage on top of that. Those plans work the opposite way of how health insurance works since all of the large claim risk is on yourself instead of the insurance company (it's not even insurance and there is a disclaimer in very tiny print which confirms that). Ask him how much you'd owe if you wound up with a $500k bill and see if he'll give you a straight answer. Any agent suggesting that plan does not have your best interest in mind.

I repeat, DO NOT buy it.

doug4523
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Re: Premier Choice being suggested by agent for health insurance

Post by doug4523 » Wed Jun 08, 2016 4:54 pm

Thanks, that's certainly the vibe I was getting. Posted on here for some other input.

pifferpuffer
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Re: Premier Choice being suggested by agent for health insurance

Post by pifferpuffer » Tue Dec 06, 2016 10:48 am

This plan has been recommended to me as well but I am coming up with a different conclusion than the other posts. I feel like this is a great plan for several reason. First, to answer a question as to what would happen if you ended up with a $500K medical bill. It wouldn't be that bad. It depends on how your policy was build but the way mine was built, I would only have to pay $500 out of pocket for an accident and $5,000 for a major illness like heart attack, stroke, etc. This amount is far less than any ACA plan is offering. With an ACA plan, if I break my arm and the bill comes to $5,000, I have to pay that amount out of my pocket because my deductible (and almost all Obamacare ACA plans) is $6,850. With Premier Choice, I will only pay $500.

With regard to the tax penalty. I will be able to file an exemption because the best bronze plan is not considered affordable based on the 8.13% rule afforded by the IRS for 2016. Almost all of my friends are in the same boat. The guy making $275K/year is in the top 3% of income earners (according to CNN Money) so the exemption isn't for him.

Homer
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Re: Premier Choice being suggested by agent for health insurance

Post by Homer » Fri Dec 09, 2016 11:46 pm

Any update on this? Or does anyone else have any thoughts?

HIinvestor
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Re: Premier Choice being suggested by agent for health insurance

Post by HIinvestor » Sat Dec 10, 2016 3:01 am

Insurance plans are contracts. You have to carefully read the terms of the contract to find out what IS and IS NOT covered and in what amounts. You also have to find out if your providers/MDs are in or out of network and how much you are likely to pay out of pocket/year under each plan.

We are covered by a PPO BCBS plan and have no deductible. We have never had a high deductible plan, but S did for a few months and didn't see any providers during that time because he didn't want to pay everything out of pocket. Once he was covered under our family plan again, he saw all of his providers again.

pintail07
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Re: Premier Choice being suggested by agent for health insurance

Post by pintail07 » Sat Dec 10, 2016 3:05 am

Ask the agent how much the premium increases if you need to exercise the stop loss rider? These are plans offered through US Health Advisors and underwritten by Freedom Life, just google reviews and complaints.

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grabiner
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Re: Premier Choice being suggested by agent for health insurance

Post by grabiner » Sat Dec 10, 2016 10:31 am

doug4523 wrote:When I spoke with him on the phone, he admitted that technically speaking I would be required to pay the penalty, but in his experience (he uses the plan as well) when you are filling out your taxes or talking to your accountant you just need to answer yes when asked if you have health insurance. While I know that is generally true for those of us not getting a subsidy, I'm also sure that wouldn't hold up if it were audited and might even be considered fraud? He said it's not lying because I would have health insurance


He is asking you to commit tax fraud, and you should not have anything to do with him.

Every item on the tax form has a legal meaning, and must be filled out according to that meaning. You must report "income" on your taxes in many situations in which you did not make any money. You may have some medical costs which are not "medical expenses". You must report as "long-term" certain capital gains and losses when you held the asset for less than a year. You may have a contract which does not qualify as "insurance" even though it provides an insurance benefit.

In all of these cases, the tax laws (as explained by the instructions for the tax forms) will tell you what to enter on the form. For example, "If you sell inherited property, your capital gain or loss is long-term regardless of when the property was purchased; report the purchase date as 'Inherited' on Form 8949." If you make an entry according to the common meaning of the word, you are violating the tax laws, and if you do so, knowing the law, with the intention of reducing your tax, that is tax fraud. At the bottom of the tax form, you (and your paid preparer) swear that you filled out the form correctly to the best of your knowledge.
David Grabiner

BruDude
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Re: Premier Choice being suggested by agent for health insurance

Post by BruDude » Sat Dec 10, 2016 11:44 pm

pifferpuffer wrote:This plan has been recommended to me as well but I am coming up with a different conclusion than the other posts. I feel like this is a great plan for several reason. First, to answer a question as to what would happen if you ended up with a $500K medical bill. It wouldn't be that bad. It depends on how your policy was build but the way mine was built, I would only have to pay $500 out of pocket for an accident and $5,000 for a major illness like heart attack, stroke, etc. This amount is far less than any ACA plan is offering. With an ACA plan, if I break my arm and the bill comes to $5,000, I have to pay that amount out of my pocket because my deductible (and almost all Obamacare ACA plans) is $6,850. With Premier Choice, I will only pay $500.

With regard to the tax penalty. I will be able to file an exemption because the best bronze plan is not considered affordable based on the 8.13% rule afforded by the IRS for 2016. Almost all of my friends are in the same boat. The guy making $275K/year is in the top 3% of income earners (according to CNN Money) so the exemption isn't for him.


"It wouldn't be that bad" - what happens when you have an autoimmune disorder? Spinal surgery? Blood clot? Kidney stones? Chronic back pain? COPD? Any other number of health issues that are not under the categories of accident/heart attack/cancer/stroke?

I've been selling insurance for 11 years. I can't sell these policies in good conscience. People don't understand how they work, they don't understand the risks of purchasing one instead of real health insurance, and most of the salespeople for these policies have no idea either because they will let anyone that can fog a mirror sell them. Even someone that claims they understand all of that when you're buying the policy still has the right to sue you when their claim isn't paid or they wind up with a bill for $500k because they really didn't get it. If you understand all of that and are making a conscious decision to buy it anyway, that's fine, but these plans are NOT health insurance and they are often described by their salespeople as being health insurance, which is 100% illegal.

pintail07
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Re: Premier Choice being suggested by agent for health insurance

Post by pintail07 » Sun Dec 11, 2016 3:05 pm

These guys own most all the sites on the internet and feed their agents the leads. I've talked to many of them and none I have spoke to tells the truth. They will hire anyone that can talk and really some uninformed folks.

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celia
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Re: Premier Choice being suggested by agent for health insurance

Post by celia » Mon Dec 12, 2016 2:13 am

Ignore that salesman.

Call Blue Cross for your state yourself and they will likely give you a choice of plans you are eligible for, including an HSA-compliant one. I believe they have some that correspond with the Bronze, Silver, etc ACA plans but are not ACA. This is to help you make a fair comparison. If you have a Kaiser facility near you, give them a call too.

Buccaneer82
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Re: Premier Choice being suggested by agent for health insurance

Post by Buccaneer82 » Tue Oct 17, 2017 3:16 pm

I've just been quoted this for my wife and two kids who are downgrading from BCBS platinum since we had our daughter this past March. Found this thread and confronted agent about it. He claims Trumps executive order makes penalty null and void. Anyone shed light on this or is it total BS?

BruDude
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Re: Premier Choice being suggested by agent for health insurance

Post by BruDude » Tue Oct 17, 2017 4:31 pm

Buccaneer82 wrote:
Tue Oct 17, 2017 3:16 pm
I've just been quoted this for my wife and two kids who are downgrading from BCBS platinum since we had our daughter this past March. Found this thread and confronted agent about it. He claims Trumps executive order makes penalty null and void. Anyone shed light on this or is it total BS?
Penalty still exists, may not be enforced.

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TomatoTomahto
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Re: Premier Choice being suggested by agent for health insurance

Post by TomatoTomahto » Tue Oct 17, 2017 4:41 pm

BruDude wrote:
Tue Oct 17, 2017 4:31 pm
Buccaneer82 wrote:
Tue Oct 17, 2017 3:16 pm
I've just been quoted this for my wife and two kids who are downgrading from BCBS platinum since we had our daughter this past March. Found this thread and confronted agent about it. He claims Trumps executive order makes penalty null and void. Anyone shed light on this or is it total BS?
Penalty still exists, may not be enforced.
I’m not discussing future legislation or enforcement of existing legislation, but another thing I’m not doing is placing my family’s healthcare on red and spinning the wheel. Go mainstream on healthcare insurance.

pintail07
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Re: Premier Choice being suggested by agent for health insurance

Post by pintail07 » Tue Oct 17, 2017 4:46 pm

You must really understand all the moving parts. Their biggest problem is the agents. They lie about everything.
You can have rider that you can exercise that limits out of pocket to 5000. However, you will have an additional premium of the lowest cost bronze plan you must pay till end of year then you won't be able to renew without underwriting. If short term plans are extended to one year that is a possible alternative, if not many folks will buy this plan.

BruDude
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Re: Premier Choice being suggested by agent for health insurance

Post by BruDude » Tue Oct 17, 2017 4:54 pm

pintail07 wrote:
Tue Oct 17, 2017 4:46 pm
You must really understand all the moving parts. Their biggest problem is the agents. They lie about everything.
You can have rider that you can exercise that limits out of pocket to 5000. However, you will have an additional premium of the lowest cost bronze plan you must pay till end of year then you won't be able to renew without underwriting. If short term plans are extended to one year that is a possible alternative, if not many folks will buy this plan.
Most people peddling these plans don't even understand how they work or are willfully blind to their limitations. I don't know a single respectable agent that sells limited benefit plans.

pintail07
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Re: Premier Choice being suggested by agent for health insurance

Post by pintail07 » Tue Oct 17, 2017 5:11 pm

I have two nephews that sell the product and tried to show them my concerns. They are making so much money it clouds their decision. They tell me they are overwhelmed with business and it isn't even OEP. They have a typical monthly premium of 400, they get 25%, 100 and then get the whole commission of 1200 fronted to them. They often sell 2 a day.

Buccaneer82
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Re: Premier Choice being suggested by agent for health insurance

Post by Buccaneer82 » Tue Oct 17, 2017 7:54 pm

Thanks everyone I think we will cancel and just add them to our small group bcbs plan at work.

BonnieDallas
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Re: Premier Choice being suggested by agent for health insurance

Post by BonnieDallas » Fri Oct 27, 2017 12:43 pm

I don't understand, you state this is not really an insurance company..........It walks and talk just like an insurance company. I'm at the point that I don't care if I'm ACA compliant as long as I have health insurance.

Low down
$460 per month first 15 months no increase and then 5% increase yearly depending on the amount of claims

Day to Day insurance:
They pay 55% I pay 45%, I receive 3 accident and 3 sickness per year that pays $75.00 per visit.

Accident Insurance:
I pay $500 per occurrence (I guess) they pay up to $10,000 then it goes to catastrophic

Catastrophic:
worst case $7,000 out of pocket if the issue will be handled over a year
simple case $4,000 deductible if the issue will last only 90 days (amount of care needed)
Unlimited

Please help me understand what I'm not understanding here.............

pintail07
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Re: Premier Choice being suggested by agent for health insurance

Post by pintail07 » Fri Oct 27, 2017 4:36 pm

Ask for a sample policy and one for the stop loss rider. Post it here if you get one, bet you won't.

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grabiner
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Re: Premier Choice being suggested by agent for health insurance

Post by grabiner » Fri Oct 27, 2017 6:30 pm

Welcome to the forum!
BonnieDallas wrote:
Fri Oct 27, 2017 12:43 pm
I don't understand, you state this is not really an insurance company..........It walks and talk just like an insurance company. I'm at the point that I don't care if I'm ACA compliant as long as I have health insurance.
What matters is that if the policy is not ACA compliant, and you don't meet the ACA exemptions, you have to pay the penalty in addition to the insurance premium.

And it also matters what it pays. You don't really have health insurance if your plan doesn't actually cover you when you have the wrong medical issues, or leaves you with much higher bills than you were expecting.
Day to Day insurance:
They pay 55% I pay 45%, I receive 3 accident and 3 sickness per year that pays $75.00 per visit.
55% of what? If the plan has a network of doctors who will charge no more than the plan allowance, then this isn't great, but it is reasonable. If the plan pays 55% of some allowed amount determined by the plan, you might well have a doctor charge $200 and the plan pays $55 of what it thinks should be $100.

Likewise for prescription drugs. Do they count towards the catastrophic limit, and can you fill your prescriptions at an in-network pharmacy so that you pay only 45% of the negotiated cost?

And "3 accident and 3 sickness": does this mean that you are only covered for three such visits per year, or three such conditions? If you are injured and need 20 physical therapy sessions, will only the initial visit to the orthopedist and the first two physical therapy sessions be covered, and everything else out of your pocket?
Catastrophic:
worst case $7,000 out of pocket if the issue will be handled over a year
simple case $4,000 deductible if the issue will last only 90 days (amount of care needed)
Again, what matters is what counts towards "out of pocket". $7000 is a reasonable catastrophic limit if the plan actually covers the costs of your cancer treatment. But if you have to pay the difference between the plan allowance and what the oncologist bills, and it doesn't cover your chemotherapy drugs at all, then it is a poor policy.
David Grabiner

BonnieDallas
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Re: Premier Choice being suggested by agent for health insurance

Post by BonnieDallas » Mon Oct 30, 2017 6:38 pm

Thanks Pintail07 and David Grabiner for your thoughts, it does make me question myself..............I can not believe that this is so difficult and the scams that's out there. I'll ask for the sample policy and see what they say. Guess I'll see how much the rates are going up on Wednesday.

I do want to mention on thing about the Premier Choice, if this means anything. It is a US Heath Group Insurance and is underwritten by Freedom Life Insurance of America. (Freedom Life is a approved carrier in Nevada)

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