Health insurance options, especially post-divorce are intimidating and hard to understand. Working with an insurance agent can help you find the plan that works best for you (and there is no charge). Michele Chiellini highlights mistakes many people make when getting a divorce and questions you need to ask to make sure your medical needs are taken care of.
- If your spouse is the primary wage-earner, post-divorce, you may be entitled to coverage through his/her company. Ask!
- Before selecting an insurance plan, make sure your doctors (if you like them) are on that plan
- Is Cobra an option for you? See what your state offers to you and your kids.
OUR GUEST – MICHELE CHIELLINI
Welcome to another episode of the exEXPERTS Podcast where we give you all kinds of information and tips on everything divorce. Why? We’ve lived it, so we get it! We’re Jessica and T.H.
TH: Welcome to today’s podcast everyone. We are happy to have Michele with us today. She’s been assisting her husband Ken, who’s a licensed insurance broker, for the last 15 years. She’s the one who hears all the details, the good, bad, and ugly of everybody’s stories. They sell all types of insurance, but today we’re really going to focus on health insurance. We’ll touch on some other types as well, but we’re going to focus on health insurance because it’s really important that you take care of that for yourself. Welcome to our podcast, Michele.
Michele: Thank you. Thank you so much for having me. Hello. I really think that health insurance is something we don’t think much about until we need it, or we lose it. We often take health insurance for granted because a lot of people may get it through their job. They may not know the details of that and may not research what it really means and what the details of it are. We may only have one choice when we’re getting it through a job. We don’t get into the nitty gritty of it.
TH: It’s very overwhelming. You and I spoke several weeks ago because I was thinking of looking for insurance for myself. In the end, Michele showed me that to stay where I was is really my best option right now. But as soon as there’s a lot of fine print and more than one page to read and language you don’t understand, you need someone like Michele and her husband to hold your hand and put it into real English to understand what is covered and what isn’t covered.
Why is it (insurance) so complicated?
Michele: I just think it’s one of those things that you don’t think about on a daily basis. You only think about it when you have to go to the doctor, and then maybe you come up with a question about your deductible or your copay. What’s the copay and what’s coinsurance? I think you mostly take for granted the cost of it, because you don’t really have to deal with that unless you lose your job or have another life event like a divorce. You start to then look into what is the premium payment. A premium payment is something you pay every single month, and it’s the cost of the insurance. Certainly, you don’t always know the full cost of the premium when you get it through your employer because the employer usually contributes. Then if you’re forced to go and pay that premium yourself, now you have to pay the whole boat, and it’s a lot more than you would think it is.
Jessica: So Michele, just really quickly to back up for a second, because I think that a lot of people listening who are in the circumstances of starting to get divorced or have just gotten divorced, is the initial option COBRA, and can you explain what that exactly is? I think a lot of people don’t know because they’ve maybe been getting their insurance through their spouse. Then they hear the words COBRA and I think that a lot of people just don’t know what that is.
TH: What does COBRA stand for? What does COBRA even mean?
Michele: Consolidated Omnibus Budget Reconciliation Act. What it means, COBRA was created for when people lose their jobs. That was mostly what it was created for. It’s a continuation; the first word is definitely continuation. It’s a continuation of your current plan. Usually you utilize Cobra when you lose your job, and you’re no longer at that place of employment. You have that option, and that option is offered to you when you lose your job and in the case of a divorce. In both of those instances, you are entitled to it up to 18 months. When it’s a large company, it is referred to as COBRA. When it is a small company that has group benefits, as long as they have a defined group benefit plan, then it’s called state continuation or state extension. All of those things are essentially the same. It means that you will be continuing on the current plan that you’re on, still technically through your employer, you will just now pay the employer directly or in some cases you pay a COBRA company. I think TH you’re paying a COBRA company.
TH: I’m paying my employer.
Michele: Oh, you’re paying your employer.
TH: It goes back to the company that originally hired me. I lost my job in May and I’ve been collecting COBRA. I remember when I was working at my job, I was like, god, this insurance stinks. They’re not covering anything. Then once you took me through all my options and how much it’s going to cost, I’m like, I’m staying with this crap one I’ve got. I mean it’s unbelievable how limiting your options are.
Michele: I think your options are limiting no matter what. Unfortunately, we live in the state of New Jersey. We live in the state of New Jersey, and in the state of New Jersey, if you do not have insurance through your employer, then you have to get it through individual. There are only three insurance companies to choose from, and all of the plans are in network in New Jersey only. They’re very, very limiting. So again, when you come from a job that has group benefits, you can’t compare group benefits to individual. The individual are cookie cutter plans. If you go through a group, that group can design with someone like my husband, Ken. ‘We want this deductible and we want these copays, and we’ll choose this for our dental,’ and they plan it out and they have choices. They have many insurance companies to choose from, not too many more, but more. It ends up being a better, richer plan. You don’t get that with individual. So again, when you get a divorce or you lose your job, you have two choices. You go on your COBRA or you go to individual health insurance, which is how someone like me would come into the picture. I could explore how I did with you TH, the options of individual insurance. But one thing I just want to say about COBRA, state extension, state continuation, or whatever it may be, whatever is in your divorce agreement is how the payments are made. I’ve spoken to many, many divorcees and all agreements are different. Some benefits end the day you get divorced. The payments thereafter, whether they’re on COBRA or not, are the responsibility of let’s just use the woman that got divorced. But some divorce agreements I’ve heard of, they’ll pay the first six months after the divorce and then the payments go back on the spouse. But no matter what it is, the amount that is paid is the full amount of the insurance. Something you may not have known prior to that point is how much that insurance really was because your employer was contributing.
Jessica: So Michele, you mentioned that you live in New Jersey, that you’re based in New Jersey. I’m in New York, and obviously there are people in different kinds of states. I have a couple of questions.
The first is if someone were to reach out to someone like you, is it state specific? Would I need to talk to somebody who’s already based in New York for them to be able to give me options in New York?
So that would apply to any state. Then the other thing is that I was hoping you could briefly touch on is talking to people about the benefits and downsides of a higher deductible. Because again, I think that for people who really have never dealt with insurance before and if their spouse was always the one who was getting it through their company, I’ve had both high and low deductible, I totally understand there are pros and cons to each, but it’d be great to kind of lay that out a little bit in layman’s terms for people to understand.
Michele: Yeah. So first of all, yes, all insurance is state based. We sell group plans in states like New York because we border New York. My husband did get licensed to sell group, but we did not get licensed to sell individual in New York. We only sell individual in New Jersey and because the plans are so cookie cutter and they are state based. Most states, not all, are strictly in network in that state only. It does vary, and some states have better plans, but that’s the way it works in New Jersey. As far as deductibles, it’s a really good question because I think that’s where a lot of people get lost with it all. Again, in the state of New Jersey, we have three insurance carriers. We have AmeriHealth, Horizon, and Oscar. With each of those carriers, there are three levels. There’s bronze, silver, and gold. At a bronze level, you have a lower premium every month, but you have a higher deductible usually around $3,000 and that means that you’re going to pay more out of your pocket. There are no copays until you reach that $3,000 deductible. When I say you pay out of your pocket, again, you must stay in network. So now you’re visiting an in network doctor or specialist and you don’t pay them upfront when you have a high deductible plan. You show them your card, and they’ll see that you have a high deductible plan. At that point, they don’t require any money and they submit the claim on your behalf to your insurance company. Then you get an explanation of benefits that shows what the doctor charged, what the discount is, and what your responsibility is for that visit. Unfortunately, it is not a specific percentage, it is an agreed upon amount. So it’s nothing that I can give anyone upfront knowledge of. You can’t call the insurance company and say, if I go to this doctor, and they charge $150, how much will I pay? It’s an agreed upon amount.
TH: That’s crazy.
Michele: I agree.
TH: Everything else, we know the numbers. I feel like insurance is so sneaky.
Michele: It can be. It can feel like that, but all I can tell you, we have personally been on high deductible plans for over 25 years, and we’ve been selling them 15, 20, 25 years. If you are not a person who needs to go to the doctor on a regular basis, and you start to understand the idea of a high deductible plan and that you don’t pay at the doctor, I have personally never been shocked at what I’ve been charged for whatever procedure or test or visit, because it was always less than what the doctor charged. It’s reasonable and customary because that’s what they have to charge. I would say it’s been my experience that people are a little uncomfortable with high deductible plans because you have to keep track of everything. You’ve got to keep track of the explanation of benefits, and you’ve got to keep track of your bills. You don’t pay a bill until you match it up to the explanation of benefits. They need to match up and then you can pay the bills. People say, I got a $5,000 bill. I said, well, did you pay it? And if they say yes, I say no, no, no, you don’t pay it. You don’t pay it until you get the explanation of what that charge is all about. It can be uncomfortable for some people, but when you then go up to that higher premium on a silver or gold plan, with some individuals, it could be a $400 – $500 difference per month in the premium.
Jessica: Right. If you’re not going to the doctor – if you’re healthy enough, and you’re going basically for your checkups, it might not be worth it. But then it can hit you in the ass later if all of a sudden something comes up.
Michele: Yes, it’s all about [the risk] the unknown and the what if. It is a little bit of risk, and that’s when you have to look at your maximum out of pocket. If your maximum out of pocket is $8000 or $8500, and you know there’s a hospitalization, you may be paying that $8500, but that’s your worst case scenario.
Michele: The silver and the gold plans are just so much more money. I usually do recommend them for people who visit the doctor on a regular basis. A lot of people who have younger children do choose the silver plan. The gold plans are extremely overpriced, and they just give you, again it’s a much higher premium, but it is a lower deductible and a lower copay. The only other thing I wanted to say about it before I forget is that, because you brought up primary care physician visits, women, no matter what plan you choose, high deductible or low deductible, it doesn’t matter, every single plan offers you a free checkup once per year with your primary care physician. That would include all the blood work that they do in the office. Women can go to the OB-GYN once a year for their checkup, free of charge, and mammogram, I believe it’s over 40 now; I think it’s 40 that the mammogram starts, those are covered.
Jessica: So in New Jersey specifically, technically you get two free appointments per year because you get your primary and you get your gynecologist?
Michele: Yes. Yes.
Jessica: Is that nationwide or just New Jersey?
Michele: I believe since the Affordable Care Act came out, I do believe it’s across the country, the preventative care checkup and the well visit.
TH: That brings me to something else that Michele and I talked about. As I was looking at the plans, I finally got in with this fantastic primary care physician who I’m 100% going to. Also, I have doctors in New York City who are also going to be a part of my life. All the plans that Michele was giving me don’t have any coverage for out of state doctors. There are a lot of different places to start from, high deductible vs. high premium, but also, if you are really committed to your doctors, and that’s who you want in your future, then you need to consider that when you’re looking at your plan too, because there’s no way I can go to those doctors and not have insurance contribute towards that.
Jessica: So just to be clear for people listening, whatever plan you’re on, if you have an in network only plan, then your out-of-pocket maximum only applies to those in network doctors.
If you voluntarily choose to go to a doctor out of network, you are 100% paying out of your own pocket, and it is not applied to your deductible at all. Is that correct?
Michele: Correct. Because when you have a plan that is strictly in network, that means you have no out of network benefit. Some plans, when you get them through your employer especially, they offer in and out of network. A lot of times you’ll have an in network deductible and an out of network deductible. In this case, if you choose an individual plan in the state of New Jersey, you will be responsible for any doctor that you go to out of network and it will not go towards your deductible.
Jessica: So talk to us a little bit about, I don’t know what you would call them, the add-ons? Not every plan comes with dental or eye care, or things like that. Again, I think that people don’t necessarily think about all of these things. They think you’re going to go to the eye doctor and that’s going to be a normal part of it. Can you give us an idea? And again, I know that you’re in New Jersey, but for people anywhere, sort of how the industry works with regards to that.
Michele: Again, with individual coverage, those things are add-ons, and they are not included. And again, they are strictly in network in New Jersey only for our state. They can cost anywhere from $20-$50 extra per month for those services each. $20-$50 for eye care or $20-$50 for dental. And again, you have to then use in network dentists and optometrists or eye care places.
Jessica: You know, it’s really funny, and I just want to say to anyone listening, it’s really important when it comes to those things, specifically the add-ons, to really find out from your dentist and possibly your eye doctor depending on how often you go. Because just listening to that, for example, for me for the dentist that I go to, I think generally my regular standard visits without x-rays and stuff, like just a cleaning, I think it’s $200. So for me, if I was paying an extra $20 per month for dental insurance, it’s not even worth it for me to get the dental insurance, because it’ll cost less money for me to just go and have the cleaning than it would for the insurance.
Michele: That’s right. I guess it only would come in – because we personally choose not to get dental insurance for that very reason. It just isn’t worth it. We’d rather pay out of our pockets when we go for our six month cleaning, because it isn’t worth it, and our doctors were not in the network. That is actually a very important point of the research, where we come in, that we can be very helpful on. When I work with a client, I will research all of their doctors, their dentists, their optometrists, and their eye care places, whatever they want. I make sure that those doctors are in the network that works best for them. If they think they want the Horizon product, but then I go and do the research and their doctors are not in there, we look for another plan or they try to find a doctor that they like that is in the plan. It’s very important to continue to understand. I get phone calls from people all the time, can you check this doctor for me, because they feel more comfortable having someone else do it. That’s exactly what we do. We make sure that you are stepping foot in an office that is going to take your insurance.
TH: I have a few questions. The first one is these doctors are in groups now, right? There’s a gastro practice in Englewood, New Jersey with all these doctors. Generally, are all those doctors participating in all the same insurance or do you really need to dig deeper to the individual doctor and not just the practice?
Michele: We always look at the doctor specifically. It is for the most part common for all doctors within a practice to take the same insurance. It is possible that they do not. What they will do sometimes is they will then charge you under a different doctor’s name. You may see a different doctor’s name on your insurance claim, your explanation of benefits, because that doctor participates. That’s fine, and they do that because not all of them will put in that application or that agreement with the insurance company. But when we do the research, we look specifically at the doctor that the person is asking us to research. If I am not sure or if that person, that doctor, is not coming up, I will call the office and verify.
TH: That’s the most important thing.
Michele: It is so important and that also is not always easy. The front desk doesn’t necessarily know all of the insurance companies that are participating. It is not easy to get in touch with the billing person, but it’s something that we do. It’s something that we really, really try to help our clients find out before they purchase the insurance.
TH: Also, when you and I spoke a few weeks ago, we talked about really things that women in particular should know and or whoever’s not employed in the relationship that’s soon to be a divorced relationship so that you know what your rights are as far as insurance is concerned.
I was working, but if I wasn’t working, what are the things that you would tell me that I need to know if I’m going through the process of divorce?
Michele: The most important thing to know is that you are entitled to COBRA or state extension or state continuation through your spouse’s employer. Like I said before, the agreement as far as the payment of the premium, which will be the full premium, is determined in your divorce agreement. The most important thing is to decide at that moment whether or not you’re going to utilize that COBRA. If you choose to go on COBRA, you cannot just come off of it, because you think it’s now too expensive. The only time you can come off of it is during open enrollment, which is right now during November and December of every single year. Again, that’s how it is in the state of New Jersey. I have had quite a few people call me and say, I really wanted to stay on COBRA, but now it’s too expensive. Can I just stop paying it? That is not what we call a qualifying event. A qualifying event is not that it’s too expensive. You are experiencing the qualifying event when you get divorced. Divorce is a qualifying event, so at that point is when you have to make the decision. You make the decision to stay on the COBRA or go to individual insurance, which is what we’ve been talking about and what I sell.
TH: That’s also assuming your spouse is employed? What if my ex wasn’t employed and I wasn’t employed at the time of divorce? What are your options?
Michele: To go to individual insurance. The individual insurance is specifically for people who don’t get insurance through an employer.
TH: Okay, so I would need to know that during my process, I need know that I’m entitled to insurance because he’s working, so now I’m allowed to go on COBRA that goes along with the coverage that we have had that calendar year as a family?
Michele: Yeah, and you are entitled to that for 18 months.
TH: Then what I also did in my agreement is that he has my children as his dependents. They are not mine, so Cobra was just for me, not for my children.
Michele: That the most typical.
TH: And then up to what age for your children? Are they covered under your ex-husband or ex-wife’s?
Jessica: The parent’s insurance.
Michele: Yeah, age 26.
TH: And that’s all across the country or Jersey?
Jessica: I think it’s across the country.
Michele: I think so too. I think it was again, I think that was part of the Affordable Care Act.
Jessica: So do I. So do I.
TH: Can you explain what is HealthCare.gov because I’ve been getting that? Then Affordable Care Act, where does that even come in to all of this? How do you even get that?
Michele: Affordable Care Act was what people refer to as Obamacare. He set forth requirements that health insurance had to have certain things like kids could stay on until age 26 or pre-existing conditions shouldn’t impact whether or not you are able to obtain insurance. HealthCare.gov is a place where you can go to sign up for individual insurance if you don’t have insurance. You can also obtain a subsidy if you qualify. When you go on HealthCare.gov, again, it’s the same rules as what I’m talking about. It’s all individual insurance. It’s insurance that you get when you don’t get insurance from an employer, so the same rules apply. You cannot just get it when you want. You have to have a qualifying event such as divorce, the birth of a child losing your job, or your COBRA is ending. Those events qualify you to now come on an individual insurance plan.
TH: I think my last question is if you got a job, or you’re looking for a job, you want to make sure they have good insurance [Absolutely] [Yes] based on what you’re describing here. If you’re in the middle of a divorce, and you’re looking for a new job, Michele has just outlined things that you need to be aware of. High premium vs. high deductible, are your doctors on the plan, are you willing to go to doctors that are in network, and really understand that process. There’s an opportunity to be on a plan if you get a job.
Michele: Right. You need to look at everything, you really do. You need to educate yourself and ask questions.
TH: What are the biggest mistakes people make when looking at health insurance?
Michele: I think the biggest mistake they make is not looking at a doctor and making sure they’re in network before they go. Then they’ll get a bill, and the bill will indicate that they went to an out of network doctor, and then they’re responsible for that bill if they don’t have out of network benefits. I think it’s the biggest mistake that people make. I understand that everyone wants freedom to go wherever they want. I would like it too, but it’s just not the way it works. You have to stay within the confines of your plan. If you don’t, there’s really nothing that can be done at that point. Like anything else, I think it’s about educating yourself and researching and knowing what you have. I do really think that it’s something people just pay for every single month, and they don’t really take a look at it because most people get it through their employer and the employer contributes. It doesn’t really impact –
Jessica: It’s also taken out of your paycheck, so you don’t even see it.
Michele: You don’t even write the check so you don’t think about it.
Jessica: Yeah. Totally.
Michele: Like anything else, something that you are either contributing for or paying for it, you need to research and understand what you have.
Jessica: 100%. We have so many more questions for you. I feel like we’re going to have to have you back for more, but this has been so enlightening. It’s such important information. Everybody out there needs to have health insurance of some kind, and you need to understand what your options are. So, Michele, for people out there who are listening who happened to be from New Jersey, if anybody wants to reach out to you directly, what are the best ways for them to find you?
Michele: I think our email is the easiest way. It’s firstname.lastname@example.org. If you email me, I will email you right back. I can actually give you a quote through the email if I just have your birth date and your zip code. I can email you the quote, and we can discuss the quote and find out the best plan for you.
TH: Great. Thank you so much.
Jessica: If you’re around in New Jersey, just know that there are people like Michele near you. It’s always really helpful and beneficial to speak to someone who is an insurance expert that can direct you into the right places.
TH: Wait, I’m sorry, one more quick question.
Is there a charge (to use an insurance agent)?
Michele: You know what? I was just going to say that too. I think that’s what’s so important to understand. There is no charge. We get compensated through the insurance company, so it’s only to your benefit to use a broker because then you have someone that you can just pick up the phone and call or email personally and get answers.
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