This past Open Enrollment was one of the most tumultuous as of yet! Major changes were sticker shock for many as we reverted back to the pre-Covid limits (400% FPL cap) that was the norm for the first full decade of Obama Care. The harsh reality, the changes in the ACA that Covid brought along had us spoiled for 5 years and had simply come to a screeching halt for 2026. Believe it or not, Obama Care, or the Affordable Care Act, has been around right at 16 years. A tremendous amount has changed in the health insurance world over that period of time. Yes, some very good changes, and of course we can all agree, some not so good changes. It’s easy to accept the good changes such as “maternity”, automatically included whether you are male or female. Yes, men are paying for maternity because part of these changes were no differential in cost of premiums for male vs. female. The ACA also made sure that “nervous and mental disorders” are now a covered event, certainly a good thing for many. Many other benefits, such as “pediatric dental“, totally free “wellness visits” on your annual doctor’s visit, and the big one, all “pre-existing conditions” are covered from day one of coverage. There are actually 10 EHB’s -Essential Health Benefits (you may wish to Google if you’re really bored?). Most of these benefits are very nice and generally protect us as consumers, BUT one thing is for sure, it definitely has come with a price. And price matters!
The ACA was designed to help support with subsidies (advanced tax credits) that do just that, subsidize this very expensive coverage for many Americans that are at a certain income level. And for those, the ACA is often times a true godsend, making their health plan very affordable. For others that are just right over the limit (above the 400% FPL-Federal Poverty Level cap) can be paying through the nose. Bottom line, if you are 50+ earning $85K plus annually as a couple, you are definitely feeling the pain. So, what might be the answer, are better yet, the solution to this predicament for many Americans. If you are self-employed or retired you may have a little bit of control over your “shown” income, that is your AGI-Adjusted Gross Income (generally line 11 on your 1040), you may be able to fenagle your income to some degree, of course, only within legal tax limitations. However, W-2 employed incomes are really hard to adjust, it is what it is. One quick hint for self-employed, invest in your SEP-Self Employed Plan account annually to potentially offset your annual AGI (again, consult your CPA). All that being said, I have no desire to be your CPA or to give out financial advice, so please consult the proper professional for the proper financial advice.
Let’s suppose you have done all you can to control your annual income, and you are still getting no subsidies to help with these crazy premiums. Then the next best step may be to simply “Call Kevin!” All I can do is explore your options at that time. We can explore STM-Short-Term Medical (via Allstate Health Solutions) as a viable option for those healthy enough to qualify. In general, you want to have no major, nor significant pre-existing conditions in the past 5 years. Short Term is not for everybody, but it can literally cut many individuals healthcare cost in half. And some good news, there is no need to wait until open enrollment, you are welcome to call most anytime. So, if you are dealing with ridiculous month-to-month premiums, and you feel like you are healthy enough, it is definitely worth the conversation.
So, to answer the title question above, “The Best Way to Earn a $50 Amazon Gift Card?” is to simply have a conversation with anyone you may know that might be suffering through sometimes absurd health premiums, and tell them, “You just might want to Call Kevin!”
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