Episode 370
Aug 20, 2021
Michael brings on an insurance broker, Matt Allen, to discuss how to navigate through the health insurance options for self-employed individuals.
Listen to "E370: Navigating Health Insurance Options for Self-employed Massage Therapists (with Matt Allen)" on Spreaker.
EPISODE 370
Weekly Roundup
Discussion Topic
- Navigating Health Insurance Options for Self-employed Massage Therapists
Quick Tips
Sponsors
Transcript:
Sponsor message:
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Michael Reynolds:
Hey, everyone. Welcome to the Massage Business Blueprint Podcast where we help you attract more clients, make more money, and improve your quality of life. I'm Michael Reynolds.
Matt Allen:
I am Matt Allen.
Michael Reynolds:
We are your hosts today. As you have discovered by now, Allissa's taking some much deserved time off this month, and I'm having a lot of fun bringing on these guest co-hosts in my network to join us to talk about specific business topics in their area of expertise. As you've heard, my co-host today is my friend, Matt Allen, with Iconic Insurance. Matt, how is life going for you right now?
Matt Allen:
Life is great. There has been some changes as there always is in health insurance, but some good, some just different. As long as we learn about them and we understand who they're good for, I think change is good.
Michael Reynolds:
Nice. Well, I'm glad to have you. Obviously, we have worked together in other ways, and you're a local to me here in the Indianapolis area. I'm really excited by the topic because health insurance for self-employed practitioners, it comes up a lot in our private member community, in questions, just in general people just wondering, "What are my options, and are there no good options, and what do I do?" So it's a great time to be discussing this.
Michael Reynolds:
Before we jump in, let's hear a little bit more about you and what you do. Your business is called Iconic Insurance, which is iconic-insurance.com. Do you mind giving us the 30 to 60-second summary of what you do for people?
Matt Allen:
Absolutely. Six years I've worked to help individuals. That's self-employed people, contractors, 1099. Basically, anybody who doesn't get their health insurance through the government or through an employer, I help them look at every option that's available on the market in their particular area or region, and then we just get the best fit. There's lots of people in different situations. There really isn't a good one size fits all. And so, we find the exact right thing for their unique situation.
Michael Reynolds:
Awesome. What I really like about you is your... At first hearing, some people might say, "Oh, well, Matt's an insurance agent. He sells X," and that's not true. What you do is you're very holistic in your approach. What I've noticed is, first of all, you're extremely objective and neutral and caring, quite honestly, about your clients. You have a lot of different options at your disposal. You have a knowledge of a lot of different paths. People can take even as far as mixing and matching options together in ways they haven't maybe otherwise thought of.
Michael Reynolds:
And so, I really appreciate that about you. You're not an insurance agent in the typical sense. You are truly a healthcare benefits consultant, specifically for self-employed people, and you have a lot of tools in your toolbox to find the best tool for the situation. You're too humble to really say that, I think, in that way. So I want to say it for you because I really appreciate that about you.
Matt Allen:
I appreciate that. I do want to put a quick disclaimer in there. I used to be an insurance agent. I was [inaudible 00:04:03]. I sold a particular product and I actually still really enjoy that product, and I still do sell that product. But now I sell everything. Since I founded Iconic Insurance, I've been able to be a true fiduciary in the sense that you are, Michael. I truly do just educate and, typically, the right solution, it will stick out. It will stand out. And people will say, "Oh yeah, that's me," and they'll be able to self identify. So that's nice.
Michael Reynolds:
Awesome. All right. Let's jump into our episode today. As I've given Matt the background, he knows our three-part agenda. So we'll jump in with Weekly Roundup and What Are You Reading? Before I get to mine, Matt, what are you reading right now? Anything that's come across your radar that you're reading, watching, listening to? Anything jump out at you?
Matt Allen:
I am the type of person who is reading usually six to seven books concurrently.
Michael Reynolds:
Wow.
Matt Allen:
And I often don't always finish them all. I try to get the gist of them. But so I am reading Titan right now, which is the biography about John D. Rockefeller. It's a little dry though, so I'm also reading my favorite novel ever, which is Catch-22 by Joseph Heller about just the silliness of bureaucracy, or [inaudible 00:05:19] of bureaucracy. And so, it keeps it light because the Rockefeller's a little bit heavy.
Matt Allen:
Then I'm also reading a book called Unaccountable, which is by Dr. Marty Makary. He's one of my heroes because he is working on the inside, telling people and sharing stories and sharing strategies of how we can still work within this fractured healthcare system that we have in the US, and he's telling it from the physician side, "Hey, these are the problems." But he also offers solutions, which is great.
Michael Reynolds:
Interesting. Well, working in the healthcare system, you're no stranger to bureaucracy.
Matt Allen:
No. Oh, no, no.
Michael Reynolds:
Well, so I picked one thing that I'm watching or listening to, that I thought was appropriate for today, which is I recently saw the John Oliver piece on Health Care Sharing Ministries. As soon as I watched the whole piece, I sent it to you, man. I was like, "Hey, Matt, what do you think of this?" Because you had mentioned this before and you gave me a really well-balanced, really thoughtful answer about some of the pros and cons. Especially I appreciated your point of John Oliver's job is to be sensational and you shock value.
Michael Reynolds:
There have been other episodes where... I mean, I love John Oliver. He's fun. He's entertaining. He brings up a lot of interesting points and stories and uncovers stuff, but there have been other episodes where he has also sensationalized things past the point of being completely neutral. So you made some good points. I know we're going to talk about some of that in the episode as well, so we don't need to get into it quite yet. But that's one thing I watched recently that I thought was interesting.
Michael Reynolds:
He just shredded the industry of Health Care Sharing Ministries. So I appreciate your balanced approach that you shared with me in advance. And then, also, during the episode, I'm sure will come up.
Matt Allen:
Right. Yeah. I think, yeah, the main takeaway to that is cost sharing programs that's been thrown around this idea that they're a yield sign. Slow down, make sure you get it. You can go if you want, but slow down at first and let's make sure we wrap our heads around it.
Michael Reynolds:
Yeah. We'll dig into that for sure. But first, let me give a shout-out to our first sponsor today, which is the Original Jojoba Company. Our listeners know how much we love Jojoba. Jojoba is the only company in the world that carries 100% pure first press quality jojoba, and we are thrilled to be partnering with them.
Michael Reynolds:
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Michael Reynolds:
If you would like a 20% discount off the price of jojoba, you can use our link, which is massagebusinessblueprint.com/jojoba. Again, that is massagebusinessblueprint.com/J-O-J-O-B-A. All right. Let's jump in. What we've been doing this month is, prior to these episodes, we've been posting in our private community saying, "Hey, we have this expert coming on to talk about topic XYZ. What are your questions?"
Michael Reynolds:
We got a ton of great questions, especially for this episode. What I usually find works best is if we jump into the questions first, and that usually uncovers a lot of great conversation. Then at the end, you can maybe tell us what other things we have missed, or maybe help people understand how to navigate deciding on self-employed health insurance options. Does that sound all right?
Matt Allen:
Absolutely.
Michael Reynolds:
Let's do it. All right. We're talking about health insurance options for a self-employed massage therapist today. The first question that we got from our community is, what can you tell us about the new income limit changes in subsidies for health exchange plans that were part of the American Rescue Plan? How does this impact people who buy insurance off the exchange? And how frequently should people be comparing private and exchange plans to determine what fits best for them? We've got a heavy one right out of the gate.
Matt Allen:
There is a lot to unpack with this. American Rescue Plan Act, first of all, came into effect, I believe it was May 1st or June 1st. Basically, it extended and enlarged the group of people who can now receive a premium or advanced premium tax credit. What does that actually mean? At the end of the year, when you file your taxes, if your income was in a certain limit, and by income, they want your MAGI, which I'm sure you're familiar with, Michael, the modified adjusted-
Michael Reynolds:
Yeah. Modified adjusted gross income.
Matt Allen:
And so, Michael can help you with that. Based on that, you would get a tax credit if you had one of these Affordable Care Act plans that you applied for and have through the marketplace. What this allows you to do is advance the premium tax credit. So instead of taking it at the end of the year when you file your taxes, you can apply it throughout the year. What a lot of people used to run into though, is that there is a cap. It's based on the federal poverty line.
Matt Allen:
Before the American Rescue Plan Act, as long as you were at 400% or lower of the federal poverty line, you qualified for a premium tax credit. What ended up happening, with a lot of self-employed people and small business owners, is that they would end up having a better year than expected. They wouldn't even think to go in and change and update their income. Then come tax time, they would realize they don't qualify anymore because maybe they were 500% of the federal poverty line. They would then owe back that entire tax credit that they were advancing throughout the year.
Matt Allen:
My worst horror story I've had from that was a small marketing firm, who actually is in our networking group, Michael. They owed over $10,000 back at the end of the year, which was extremely unexpected to them. One of the changes with the American Rescue Plan Act is there is no longer that 400% cliff. It is a slow, steady, gradual scale down to zero where none of the health insurance plans, silver or bronze, can be more than eight and a half percent of your adjusted grossing.
Matt Allen:
So what we're finding is people who used to look on the exchange and not even come close to qualifying for a tax credit, now are going on there and they're realizing, "Oh, wow, we now qualify for enormous tax credit." The people who already had this tax credit are now finding that their tax credit is larger. The only way you can actualize that tax credit though is you do need to go back on the exchange and you do need to reapply.
Matt Allen:
The government is not automatically adjusting your tax credit because of that. So anybody who is at 250% of the federal poverty line or lower now gets a free silver plan. Anybody above the 250% pays anywhere from two to eight and a half percent of their adjusted gross income per month for their, health insurance. But that's the cap on it now. So for some people, that's still way too high of a premium. But for a lot of people who in previous years didn't qualify for a tax credit, they can find an affordable plan now.
Matt Allen:
They're starting to bring back, with this American Rescue Plan Act, the affordable part of Affordable Care Act. There was one other question. Oh, comparing the private and exchange plans. It really just depends on your budget. If you've reached a pain point where your monthly premium for your health insurance on the exchange is just becoming something where you throw your hands up, or you don't think there's a lot of value in it, certainly reach out to an individual health insurance agent like myself and let's at least give you some options to let you look at it.
Matt Allen:
How frequently you should be doing it, probably whenever your income changes. If you see a stark contrast and you're doing better, you have more clients, especially for massage therapists. Maybe your marketing plan went really well and now you have an influx of clients and your income goes up, that's always a good time because your tax credit may have gone down if you're on one of those exchange plans. Does that make sense?
Michael Reynolds:
Yeah. Thank you.
Matt Allen:
Probably talking [inaudible 00:13:51] wordy and jargony there, but-
Michael Reynolds:
Oh, we'll have more chances to dig into the same thing in a minute.
Matt Allen:
All right. Good. [crosstalk 00:13:57]-
Michael Reynolds:
Tell me this, just an opinion. The Affordable Care Act and the exchange gets criticized a lot by certain political sides of the spectrum. Not to make this political, but it gets criticized a lot. What's your opinion of the exchange? Is it a decent program? Has it gotten better? Has it gotten worse? What's your opinion in the overall scheme of insurance?
Matt Allen:
Okay. It's difficult to not get political, so I won't try to shy away from it too much. But I believe the idea and the spirit of it was wonderful. It gave an avenue for people who otherwise couldn't get health insurance before. It gave them an avenue to get it. I think the spirit of that is wonderful. I think, as with anything in politics, we have to please both sides of the aisle. So I think that spirit got muddled because they just couldn't agree. They couldn't come to terms with it.
Matt Allen:
The exchange, I believe, is a half measure, whereas I personally believe either no measure or a full measure would have been better for the American public. But now we have this half measure where, for certain people who... Who am I talking about? I'm talking about people who have severe pre-existing conditions, that otherwise could not get a private underwritten health insurance plan. The exchange is wonderful.
Matt Allen:
I am so glad it exists because I take those people right away to there and I say, "They don't care about your health," is what I tell these people. They can't ask you any questions. It's guaranteed issue. I think that's marvelous. And then for people who are looking at a private insurance plan and they see, "This is just out of our budget. We can't afford this," and their income, that modified adjusted gross income is under a certain threshold, a lot of times that advanced premium tax credit can make it so affordable for them.
Matt Allen:
And so, now they have this avenue where they can get health insurance. I think it is great. I do think, unfortunately, that the exchange is getting worse on the whole as far as quality of plans. For a growing segment of the population who are maybe more health conscious and who maybe have a higher income, or for a lot of self-employed people, have an unpredictable income, the exchange just is not a good option anymore for them.
Matt Allen:
For people who don't use the healthcare system a lot, they are more so looking for something that is catastrophic in coverage. They want their good health to be effected in their premiums. They want to be asked the health questions because they can say, "No, I don't take any medications. No, I don't smoke. No, I'm not obese." They want to be able to say that because then they're less risky and then their premiums go down. So as far as how I feel about the exchange, I'm very glad it's there, but I am also very glad that I know of options outside of it, for the people who are not a good fit for it.
Michael Reynolds:
Got you. Yeah. I personally would love to see a single payer universal health care of some sort. But that's obviously a very controversial topic. I agree with you. I think doing it halfway can sometimes cause a lot of issues where if... Obviously, there's certain people want to see us go all the way to a single payer system, and yeah, there's problems with every system. But, I mean, I feel like that would be really good for small business because you would have so many more options for self-employed people to start a business and run a business without worrying about losing their health insurance. So I think it's a very small business friendly thing to do to make a single payer universal healthcare system.
Matt Allen:
Well, in your job, I mean, you always asked to talk to people who are in transition and you probably see a lot of people who don't make the transition into a passion of theirs, or self-employment. Or they're attached to their job, their 9:00 to 5:00 office job, partly because of the benefits that are included. A lot of people don't want to make the leap because it's scary out there in the free market, in the open market, when you're dealing with something like health insurance.
Michael Reynolds:
Yeah. For listeners who aren't familiar, Matt's referring to my other career as a financial advisor. That's what Matt's referring to when he says "Working with clients". Our listeners do know that. I bring it up all the time.
Matt Allen:
Okay. All right. Good. Yes.
Michael Reynolds:
Yeah. Yeah, that's great insight. I appreciate it. I'm going to move this other question back up to the second here, because it's basically on the exchange some more.
Matt Allen:
Okay.
Michael Reynolds:
You've touched on a lot of the stuff already. This listener is asking, more general sense, how does the exchange work? You've already talked about what income is used. Their question is what income is used. How do the tax breaks work? Are tax breaks helpful or detrimental? This is a part of the question as well. As a self-employed person, when does a person opt in to insurance or change plans? And then, one more add-on if that was enough, does moving to a different city within the same state impact the exchange insurance?
Matt Allen:
Your listeners have some very good questions.
Michael Reynolds:
Yeah. Yeah.
Matt Allen:
How does the exchange work? I'm going to take that as a, how do we get a plan on the exchange?
Michael Reynolds:
Yeah, I've heard that as well. What's the mechanics of using it? Like the logistics of getting signed up, I guess.
Matt Allen:
You can go to healthcare.gov, or you can have someone help you with that, somebody like me. I help people with that a lot. It's actually pretty simple. It's gotten a lot better. You can preview plans and prices. All they'll ask for is your zip code, the number of people who need the coverage, their ages, whether any of them are tobacco users. Then they will ask for that, what income is used.
Matt Allen:
Next question, they'll ask for that modified adjusted gross income for the household. If you don't know it, they ask you to project it. They ask you to estimate. They are not concerned with past years. They use that only as a way to estimate. They care about what your income is for the year that you are getting the insurance. That's what matters when dealing with the tax break.
Matt Allen:
What else is great about the exchanges, if you enter all that information and you verify your identity with them, you get the plan. There's no underwriting. You don't have to wait to hear back from the company, to see if you're accepted. You're in no matter what. The only thing that changes your premium, again, is based on what income is used. That's where this next question comes in about the tax breaks.
Matt Allen:
Now, there is one caveat that I want to touch on really quick. Oh, excuse me. That was one of the next questions. It's about when. When can you do it? So there are limitations on that. Typically, there is a OEP, which is called the open enrollment period. That has classically been between November 1st and December 15th of each year. During that 45-day window, you select a plan based on the healthcare.gov instructions I described earlier, and your coverage will then start January 1st of the following year.
Matt Allen:
Once the coverage starts, you are unable to switch plans. So it's a good idea to speak with an advisor when you're going through it to make sure it's a good choice. The other time that you can opt into one of these plans is during what's called an SEP, which is a special enrollment period. That's when you have some type of major life change. You have a baby, you get married, you have a drastic increase in income, or you have a drastic decrease in income. If you move to a different state, if you move to a different county where your current plan is no longer accepted.
Matt Allen:
Then the biggest one is if you change jobs. If you lose your group coverage, or maybe you go through a divorce where you lose the group coverage through a spouse, you qualify for this special enrollment period where your coverage can start the first of the next month any time of the year. But if you don't have one of these major life events, you are pigeonholed to that November 1st to December 15th, to get one of these exchange plans.
Michael Reynolds:
Our listener did ask, and you touched on this, our listener asked, does moving to a different city within the same state impact the insurance from the exchange? And you said different county. So is it county by county?
Matt Allen:
It's county by county. With a different city, if it's [inaudible 00:22:34], it's probably typically in a different county. So if it's in a different county and the plan that you're currently on is not allowed in that county, then yes. The reason being I think Indiana has 92 or 94 counties. That's the state where I live and I operate mainly. For example, Anthem Blue Cross Blue Shield offers exchange plans only in four of those counties. For whatever reason, it's only in Florida.
Matt Allen:
If you happen to be in one county with that Anthem plan, and you move to, say, Hamilton County, where we live, and there is no Anthem plan, you then qualify for one of those special enrollments here.
Michael Reynolds:
So you re-enroll. Okay.
Matt Allen:
Exactly. Yeah, and you can freely move to a different plan, yeah, with no penalties.
Michael Reynolds:
Okay. Got it. Thank you. Obviously, a lot of interest in the exchange, but I want to make sure our listeners know we're getting to... There was more than one option here. So we're going to talk more about that. Actually, the next question touches on this.
Matt Allen:
Yes.
Michael Reynolds:
Which you can lose to my John Oliver episode I'd mentioned at the beginning. This listener says I've heard about... It's that two-part thing, so I'm going to [crosstalk 00:23:37]-
Matt Allen:
You want to talk about the tax breaks quickly?
Michael Reynolds:
Oh yeah. I'm sorry. Yes. Tax breaks comment's in here.
Matt Allen:
I wanted to make sure. The tax breaks, what that actually means is it's a tax credit, and I talked about this earlier. Michael, you could probably speak a little better to this, but a tax credit isn't a deduction. It's money that you get when you do your taxes, for having certain things. Like there's the earned income tax credit. There's the child tax credit. This is one of those where if you've had an exchange plan and your modified adjusted gross income allows you to receive a tax credit, what you can do is advance the tax credit so that you're not waiting till you file your taxes to get the tax credit. You can apply it to your monthly premiums to make them affordable throughout the year.
Matt Allen:
I personally think tax breaks are incredibly helpful if you truly do qualify for them. What you run into sometimes is when you're a self-employed person and you are trying to project what your income will be. Let's say you project it's 50,000 for the year, and you are the breadwinner for a family of four, you are going to qualify for an extremely large tax credit to help pay for your health insurance premiums. If throughout the year, however, you end up with a modified adjusted gross income, due to whatever reason, of 100,000.
Matt Allen:
Let's say business is booming and you're doing wonderfully, and you don't happen to notify the marketplace of that increase in income, when you go to file your taxes for that year, you're going to owe back a substantial amount of that tax credit because now they will see, "Oh, hey, John and Mary, you actually didn't qualify for that tax credit because your income was a hundred thousand. That's where the tax break can be detrimental, is when you go to file your taxes and you owe four, or five, six thousand dollars back that you weren't expecting. That's the only time I really think they can be detrimental.
Michael Reynolds:
Got it. Thank you. Very helpful. Next let's talk about Health Care Sharing Ministries. This question relates to that. This listener says I've heard about health insurance groups where people are all of a certain religion. Is that a viable option for those who ethically don't want to swear to that because they're atheists, or is there a non-religious alternative to these health share ministries?"
Michael Reynolds:
Also, the second question, which I'm going to expand on a bit, which you may not quite... says, "Can the massage membership organizations like ABMP or even Massage Business Blueprint, which is us, have group insurance? So it's really two questions. I'm going to hold the second one and come back to it. The first one though, tell us about the healthcare sharing organizations. Are they always all Christian-based? Do you have to be a certain religion? Can atheists join? How do they work? A lot of stuff to unpack, but give us your best here. What's your opinion?
Matt Allen:
Perfect. No. I mean, this is really important to talk about. The question is worded in a way that I really want clarify because the listener said, "I've heard about health insurance groups where people are all certain religions." It's really important to remember that all of these, and I label them cost-sharing plans instead of groups, but it's not insurance. It's very important that you know that.
Matt Allen:
It may seem like a small detail, but it isn't a small detail. I think it's very, very important for people to understand that. What that means is, while they operate very similarly to insurance, when a product cannot be called insurance, it's because of the federal department of insurance and the individual state departments of insurance have not gone through and looked at the product to make sure it's viable. So they have not done a cash reserve balance sheet on it. They haven't looked to see, hey, are you charging enough for this? Or, hey, are you charging too much for this?
Matt Allen:
Whereas a company, I'm just picking one, like Blue Cross Blue Shield, when they want to come out with an insurance product, they have to go through a rigorous audit of the product, of the market, of actuarial tables, all the boring math stuff to make sure it's a good feasible product. Long story short, what that means is these cost-sharing plans do not have a legal obligation to pay anything because it's not insurance. So if you are a member of one of these and you have a large claim, and it gets denied for whatever reason, the only recourse you really have is with the Better Business Bureau because the departments of insurance will have no legal say on any of that.
Matt Allen:
Whereas if this Blue Cross Blue Shield plan doesn't pay, you have an incredible amount of recourse. You can go to the department of insurance. You can write a letter to the commissioner and they have a 90% plus overturn rate. Companies will just pay that claim right away because they don't want to deal with the commissioner. They don't want to get in trouble. So that's just something to really understand about these. That being said, I love these plans. I think they are wonderful, and I think they are what a lot of people are looking for.
Matt Allen:
The main four that have been around for decades are Christian based. Certain ones ask you to have an attestation of faith. They would like to know where you attend church. Some of them have had said that they ask you to live a biblical lifestyle, however that is determined. If you file a claim with them and if they see that you are not living biblically, they have all the rights to deny your claim. And so, I don't think it is in your best interest as an individual, if you are not religious or you do not believe the things that they ask you to attest to.
Matt Allen:
I don't believe you should sign up for that, simply because it's not a group for you, it seems like. And so, is there a non-religious alternative? Absolutely. It's actually one of my more favorite ones. It's called Zion Health. It's one of the newer ones. It's very sleek looking and their customer service is wonderful. They basically sat back and saw how cost-sharing plans were working, and they also saw how they weren't working. So they created this product based on what they liked and what they wanted it to be.
Matt Allen:
They wanted it to be very customer friendly. They wanted it to be very anybody-can-sign-up-for-it-friendly. And so, it's one of my favorite ones. It's a little more expensive than some of the other ones, which a lot of people think is a bad thing. I personally think that it's still inexpensive. But I like that it's a little more expensive because that, to me, says it's more quality.
Michael Reynolds:
Yeah. That would reassure me, actually.
Matt Allen:
I feel better about it when I'm looking at one that's $78 a month for any age. A 60-year old person can get this one for $78 a month. That concerns me that, well, obviously they aren't paying something. But when Zion has one that's $220 a month, okay. Well, now I understand. I'm a little, like you had said, Michael, a little more reassured with that. So there's absolutely non-religious alternatives. And there are others. This is just one that I happen to like. I will look at any of them.
Matt Allen:
So it's really important to read through those though, because they are not a good fit for everybody and they have their limitations, and the main one being that it is not insurance.
Michael Reynolds:
Got it. Thank you. We'll get to this in a minute, but I know that sometimes you... You personally I think have shared this. You design plans that combine different things. Before we get to that, though, I do want to touch on the second part of this question, which is... And this may be a big one to unpack. So if it's too much to unpack, just say, "We'll talk about it some different time." But this listener is half jokingly saying, "Hey, can Massage Business Blueprint offer group health insurance?"
Michael Reynolds:
What does it take for like a membership organization to do that? We're a small organization. We have 150, 200 or so members. Very tiny. At what level does it make sense for some kind of association or membership organization to offer a group health insurance? Is it a pretty high bar?
Matt Allen:
It is a lot to unpack. So I'll do some cliffs notes and we can definitely unpack it at a [crosstalk 00:32:25]-
Michael Reynolds:
Have and I kind of consultation.
Matt Allen:
Absolutely. It would be a situation where you would simply offer a group plan, and the burden of the premium would be put onto the members. The Massage Business Blueprint, obviously, wouldn't be contributing to it because they are your members, they are not your employees. When you have a large group such as that, spreading out the risk among 150, 200 members is great because it can lower cost. But the minimum bar for premium is going to be quite high simply because these group plans have to be very robust. We'll put it that way, due to the Affordable Care Act legislation.
Matt Allen:
And so, they can often be bloated and they can often be very expensive. You can get cheaper ones, something called a MAC Plan, minimum essential coverage. It's exactly what it sounds like. It's a very minimal. I wouldn't recommend it to something like that.
Michael Reynolds:
So it's tough to do unless you have a lot of members.
Matt Allen:
It is. The short answer is yes, and the long answer is, well, it depends.
Michael Reynolds:
Yeah.
Matt Allen:
Again, something I'd love and be able to talk to you about, but there's a lot of layers to it.
Michael Reynolds:
Got you. Okay. Well, the hour is going really fast, so let's move on.
Matt Allen:
Wow. Okay.
Michael Reynolds:
This might be a quick one. This question is, is there ever a way to combine policies for a parent and a dependent adult child over 26 who's not in college?
Matt Allen:
Not really. The legislation is pretty clear about that. But when you're dealing with the alternatives outside of the Affordable Care Act, when you're dealing with alternatives outside of that, that I specialize in, it's very simple for... A parent could still pay for the plan of a dependent adult who's 27. The bill could just be [inaudible 00:34:24].
Michael Reynolds:
Okay. I want to wrap up with this. The last question really is a way of asking this, and I want to wrap up with some generalized scenarios and paths. I'm going to see if we can pack this into an efficient point here. If you could take us through the top options you see... We've talked about the exchange. We've talked about healthcare sharing organizations. There are some other things you're going to mention I know. Can you briefly give us a short list of the most common, specific products or options you see?
Michael Reynolds:
And then, can you walk us through a few scenarios on how you tend to mix and match them? What you see are some case studies and how they work well for certain cases. Remember, our audience is typically either single self-employment massage therapist, or self-employed with a partner who may or may not be also employed or self-employed. That's who we're working with typically.
Matt Allen:
All right. The typical way that I do that is I always look at the Affordable Care Act first. And so, in this scenario, I believe we were saying that that's not really what we're looking for. If we rule out the Affordable Care Act, this is where I would typically go. I would go to what's called a private underwritten health insurance plan. What is great about these products is that they are underwritten and they are customizable.
Matt Allen:
These types of plans, you can use your health to your advantage and get lower premiums. They're also customizable, so you do not have to pay for coverage that you do not want. Different members within a family can also have different benefits. The other benefit of plans like these are that it is the individual or the family who is insured. There is no network restrictions to worry about. These plans travel with you and you can go wherever you want to get care with them.
Matt Allen:
The issue is going to be that they are underwritten. That's my favorite part and it's also my least favorite part, is that not everybody qualifies for it. It is not guaranteed issue. If you are sick, they are either more expensive or they are unavailable depending on your condition. They simply do a medical underwriting check to see. The other issue with this, and this is a deal breaker for some people, is that these types of plans and situations are limited in the benefits that they give.
Matt Allen:
The limits on the benefits are very large, and when you use them properly, I think they are plenty. But some people like the no limit unlimited benefits option. That, with the current legislation for individuals, is only available through the Affordable Care Act, to have that stop loss there, unlimited. And so, in certain situations where people are very adamant about having something on the back end, they like the idea of these private underwritten health insurance plans. They like the idea of being able to see any provider. They are healthy, so they qualify.
Matt Allen:
They like being able to customize it. They're saving money on that. But they're worried about the limits. That is when having someone like me walk you through a scenario is where one of these cost-sharing plans can come in. So if any of these limits are ever exceeded on any type of incident or scenario with one of these private underwritten health insurance plans, if the limit ever goes over, we have one of those cost-sharing plans, one of those low-level, $78 a month cost-sharing plans that I spoke about to sit there in the drawer and hopefully collect them.
Matt Allen:
Hopefully, we never pull it out because if we pulled it out, we have a big medical expense that exceeded the limits of the private underwritten health insurance. But we have it there to limit your exposure. We have it there to limit your liabilities, for the people who are very risk averse. That is when I would pair the private health insurance with one of the cost-sharing plans. It's sort of an umbrella, sort of a supplement, sort of a capping our liability situation.
Matt Allen:
Zion Health has been a very useful tool in allowing people to cap their exposure while still having a health insurance product, like the underwritten products. The only other really popular thing that's out there are things called short-term plans or try term plans. They can be up to three years. You can have them. My issue with those is that they don't cover pre-existing conditions. And so, if you have something as little as a blood pressure medication that you're taking, your cardiovascular system isn't covered.
Matt Allen:
That concerns me greatly because there's a lot of people with just a small prescription like that. And if you have a major medical health insurance plan, like a short-term plan, and your cardiovascular system isn't even covered, then do you really have health insurance? I would venture to say, "No, I don't believe you do." And so, that's where in particular situations I do like the short-term plans. But on the whole, let's get those pre-existing conditions covered, which we can do with the ACA, which we can do with cost-sharing plans, and which we can do with the private underwritten health insurance.
Michael Reynolds:
So cost-sharing plans do cover pre-existing conditions, or sometimes they do at least?
Matt Allen:
As long as they are well-maintained and there is no active... They have different terminology. But if there's not actively in treatment. If you have high blood pressure and you've taken it for years, and your dosage only slightly changes and it's under control, absolutely, your cardiovascular system will be covered. Now, if you're bouncing all over the place and you've gone in for EKGs three times in the last six months, it will not be considered controlled and it will have a waiting period on them.
Michael Reynolds:
What I like about what you do is help people think outside the box, to use some jargon here. So a lot of times, people think, "Okay, I need to find the one health insurance plan," and that's the default we all go with. But what you've described to me in different conversations we've had is I think you've described a scenario where you can actually combine, for example, three different products.
Michael Reynolds:
Product one might be the first line of defense, maybe I'm a concierge, a physician service. Could be your regular checkups, your prescriptions, your, "Hey, I need an antibiotic for a sinus infection," that kind of stuff. Then your second line of defense would be your private health insurance. I know that you represent different companies. Kemper is one of them, and they do these individualized underwritten plans for the next level of stuff in severity.
Michael Reynolds:
And then your third level, your catastrophic stop gap might be something like a health share organization. I think a lot of people don't realize that there's not necessarily just a one thing for everybody. You can often mix and match and ladder and cascade these different options together. Is that true?
Matt Allen:
Absolutely. That is true. That actually is how I do my personal health insurance. I'm 35. No smoking. No medication. So for all intents and purposes, I'm an ideal client for a health insurance company because I'm low risk. But I still layer mine. I think that's a really good way to put it. The first line of defense for me is something called direct primary care, also known as concierge care, where I pay a monthly subscription to a physician and I have unfettered access, so that it absolutely is the first line of defense. And hopefully that's all I ever need.
Matt Allen:
But in case there's something my doctor cannot do, like a surgery, or if I have an accident or I need to go to urgent care, the emergency room, or hospitalized, that is where I have my individual private underwritten health insurance through Kemper. It allows me access to any facility, any provider, any surgeon. That's for the [inaudible 00:42:14]. If I get a disease, if I have an accident, if I need a surgery, they will cover me extremely well.
Matt Allen:
But going back to our last segment, it has limits. Now, these limits aren't very high, but it does have limits. That's where, like you had said, with the health share, the cost-sharing plan, that is my third and last line of defense that limits my out-of-pocket exposure. It's my stop loss. I could take whatever Matt Allen owes after I have gone through my surgery, my hospitalization, whatever it is. Whatever I owe, I take to the cost sharing and they help me satisfy that bill and I have a maximum out-of-pocket with them.
Michael Reynolds:
Awesome. That's really informative. I really appreciate what you've shared today. It's obviously tip of the iceberg because if someone is really interested in optimizing their insurance, I mean, I'm just going to say it, they should talk to you or someone like you.
Matt Allen:
Right.
Michael Reynolds:
We'll share it again at the end, but let's go ahead and do it now because I'm sure some people are interested. The best place to find you is probably going to be iconic-insurance.com. Correct?
Matt Allen:
That is correct.
Michael Reynolds:
Okay. You've told me a lot of insurance is very state specific, so you may not necessarily be able to help every single person with very state-specific things. But in general, you'll talk to anybody in all 50 states. Is there a fee for the initial consultation? Is that complimentary? How does that work?
Matt Allen:
What is nice about working with me is there's never a fee. It's always a free consultation. What a lot of people also tend to not realize, which I didn't realize for a while, is that if anybody ever gets a product through a broker such as myself, it's never more expensive. The price of the commission that I would receive for helping you get on it is already built into the price of the product. So not only is there no consultation fee, the products are never more expensive when working with someone. So if you ever want an extra set of eyes, absolutely reach out to an independent insurance broker like myself.
Michael Reynolds:
I think also the exchange as well. If you help someone get set up on the exchange, you're compensated, but they don't pay any more, right?
Matt Allen:
No, absolutely not.
Michael Reynolds:
Wonderful. That's great to know. Yeah, you've been really helpful to a lot of people. I've referred to you as well. Again, really appreciate what you do for people. So thank you for sharing this today and-
Matt Allen:
Absolutely.
Michael Reynolds:
... all the great information. Anything else you would add before we move on to the last part of our episode today? Anything we've left out that squeeze in?
Matt Allen:
Well, you did touch on the varying states. And so, each individual state health insurance market will be different. And so, while I'll be able to speak high level about any type of health insurance no matter where you live, if you happen to live in a state where I'm not too familiar with the marketplace, I may not be the best person to talk to. But I'm a very good person to first talk to, and then we can direct you in the right direction and get you the [inaudible 00:45:13].
Michael Reynolds:
Wonderful. Thank you.
Matt Allen:
Yep.
Michael Reynolds:
All right. Well, before we wrap up, let me give a shout-out to our sponsor ABMP. ABMP says they're proud to sponsor and partner with us, and we believe them. I'm going to talk about the Massage and Bodywork Magazine today, which is one of many benefits you get from ABMP. Their award-winning magazine is included in print for all ABMP members, and it is gorgeous. It's available for free as well online at massageandbodyworkdigital.com.
Michael Reynolds:
Just so happens that Allissa and I write for the Massage and Bodywork Magazine as well in our Blueprint For Success column, as well as some features every now and then. So you can find that. In fact, we have a really great series that we put out last year called The 2020 Money Series. So if you go to I think it's abmp.com/money, you'll find that whole series. It's a really beautiful professional journal. Includes techniques, in depth features, video tie-ins, all sorts of amazing stuff for massage therapists and bodyworkers.
Michael Reynolds:
That's at massageandbodyworkdigital.com, or a print version with your ABMP memberships. If you're not a member, consider that. All right. Quick tip time. I've got a quick tip. Anything you would throw in as a random quick tip for our listeners? If not, I can jump to mine. But what have you got?
Matt Allen:
I think this is a great quick tip. I need it myself.
Michael Reynolds:
Can you hear mine? Okay.
Matt Allen:
[crosstalk 00:46:33] on the show notes.
Michael Reynolds:
My quick tip is this, and this comes from my friend Robbie Slaughter, who runs a company called AccelaWork here in Indianapolis. They're a productivity and leadership consulting firm. On Twitter, he posted this one, "Always carry a pen and paper everywhere you go so you can write down ideas." I like that because often, I mean, how often do we get ideas when we're out and about somewhere and we were like, "Oh, that's a great idea. I want to capture that." And we just say, "Oh, I'll remember later," and then later we don't remember what it was.
Michael Reynolds:
So, for me, it's my phone. I just have a place where I can easily jump open my phone. I can put things on a list. I've got a preset place for that. But for some people, it might be a small notebook. So it's a great tip. I think we should all carry around some way to capture ideas so we don't lose them.
Matt Allen:
I love that. Yeah. That's a great tip.
Michael Reynolds:
All right. Fantastic. Well, we are wrapping up there. Anything else you want to add, Matt, besides where to find you, obviously?
Matt Allen:
I would say iconic-insurance.com. You can find my contact information there. There's a link in Calendly to talk to me, set up a time, set up a call. You can just text me as well. But I would say to people, there's still a large segment of the population who doesn't have health insurance. A lot of them consider it a... They might just be scared to look because they think it will be painful. They think, "Oh man, I don't even want to see what that's going to be like."
Matt Allen:
But an ounce of prevention is worth a pound of cure. Please, just at least look because there could be issues going on with your health that will only get worse if unattended. A thousand dollar bill now could turn into a hundred thousand dollar bill in a couple of years. So do not hesitate. Your health is... At the end of the day, it's one of the only things that you have. So please at least reach out. Look and try to find something to get that coverage because I just really believe if you don't take time for your health now, you will take time for your sickness later. Yeah, I truly believe that.
Michael Reynolds:
Great advice. Thank you, Matt. All right. Pleasure having you on. I'm sure you'll be back at some point. Thanks everyone for joining us today. We appreciate you being a listener as always. You can find us on the web at massagebusinessblueprint.com. Reach out with any questions there. Have a great day and we'll see you next time.