Many of us, including my personal self, had a rude awakening to healthcare premiums that shot up, in some cases dramatically! Yes, I feel your pain, I went from $466 monthly to $1,131 per month for the “crappy” bronze plan. For some folks, the only good news is that Medicare at age 65 may be just around the corner. However, that does not help the situation as of right now. The big question is, “why is this happening?” The short and simple answer is “Covid.” For the past 5 years we have been in a Covid pattern of extra subsidies that were quite generous for the past half-decade. The simple truth is, after a half decade, America has gotten spoiled on these “Covid enhanced subsidies.” And of course, the plans that used to have a MOP-Max Out of Pocket of $6K to $7K, are now in excess of $10K. Yes, I know, in some cases, it feels like you don’t have any insurance at all with such high deductibles and MOP. The reality is that premiums don’t get ridiculous until you reach typically the 50+ age threshold. And pricing can get downright stupid in your sixties. So, what might be the answer to this healthcare crisis for some? In some cases, there really is no good answer. Many might start searching the internet for answers and find some very questionable alternatives. Namely, “Fixed Benefit” policies that promise the moon, and can often fall short on delivery when you most need it. So, this makes me recall Michael Brady of the Brady Bunch warned “caveat emptor” translated to “let the buyer beware.” So generally, I would recommend staying clear of these type of plans.
Now for some, there may be an excellent alternative referred to as STM-Short-Term Medical Plans. The good news is that these plans are generally half the cost of a full-priced ACA / ObamaCare style plans. That was the good news, but here are the facts. It’s not designed for everyone. You must be in reasonably good health, with no diabetes, no recent heart attacks, strokes, or truly any major or significant medical issues. Generally, with a five-year clean history, then you should be good candidate to apply. These plans may be called STM-Short-Term Medical plans; however, they are actually not so short any longer. Policies can now be written to provide coverage for up to three consecutive years without any need to re-apply. And you even have the option to fix your exact premium for a period of 36 months. Multiple carriers offer these plans. I personally utilize the Allstate Health Solutions who now have been in the STM sector of the health coverage for about a decade. The apps are very straightforward, with results in a matter of hours, not days. Other features offered are Urgent Care at a nearly half-off, and TeleMedicine at zero cost, and unlimited use 24/7. Most plans offer a full One Million in coverage for each policy period. And next day coverage if coverage needed right away. And best of all, you can apply anytime throughout the year, with no QLE-Qualifying Life Event necessary. If you need to cancel because you got a new job that offers coverage, then just cancel anytime, no long-term commitment at all. This is no doubt the best possible alternative for those individuals as well as families that no longer are eligible for subsidies via the Marketplace, and in pretty darn good health. So, if you are faced with premiums in 2026 that are simply UN-affordable, give Kevin a call, and let’s see what we can do to help improve your situation.
And just to be clear, these STM plans are not ACA compliant, that does not mean they are not true Major Medical policies. You are fully covered for as much as $5 Million on the co-pay plans, and $1 Million on the Enhanced Plans, with a specific defined MOP-Max Out of Pocket just like an ACA plan. Some might refer to them as “catastrophic” style plans. Short Term plans do not cover pre-existing conditions, maternity, and nervous mental disorders. And wellness would not be $0 dollars like an ACA plan. You still will receive the “network discounted rate” that will provide a significant discount on any out-of-pocket medical expenses. And one of the better features, Allstate has partnered with the Aetna PPO Nationwide Network the offers over 690,000 providers throughout the nation.
As always, I am here to help in any way that I can, let’s discuss your personal situation, look at some options if available, and see if we can make this “health crisis” a little bit more palatable.
Best regards,
Kevin F. Gourgues
This is a new addition to the “What the Health?” newsletter that I will try to keep brief and to the point. Hopefully, this may help shed a little light on a somewhat complex health insurance world.
You’ve got Q’s, I hope I have your answer! Always feel free to call Kevin most anytime. Text or call 985-778-0072.