Navigating the complexities of healthcare insurance is challenging enough when everything stays the same. But when your spouse retires and you are self-employed, it can feel like a whole new ballgame. Suddenly, you’re faced with the question: Where can I find affordable medical insurance now?

If this scenario sounds familiar, you’re not alone. Many people find themselves in this position, wondering where to turn for affordable, comprehensive healthcare coverage. The good news is there are options available—whether through the Health Insurance Marketplace (Healthcare.gov), Medicare, or a combination of both for one household.

At our agency, we help families and individuals in Oregon navigate these choices, ensuring you find the right coverage that fits your specific needs.

1. Understanding Healthcare.gov and the Marketplace

For self-employed individuals like you, Healthcare.gov is often a key player in securing medical insurance. It’s a federally run marketplace where individuals and families can shop for health insurance plans. These plans are offered by private insurers but are regulated and standardized through the Affordable Care Act (ACA).

Key Considerations When Using Healthcare.gov:

• Subsidies: One of the major benefits of using Healthcare.gov is the availability of subsidies based on your income. If your household income falls between 100% and 400% of the federal poverty level, you may qualify for premium tax credits that lower your monthly premium payments. With your spouse retiring, your household income may change, which could make you eligible for a higher subsidy.
• Coverage Options: Plans on Healthcare.gov come in different tiers—Bronze, Silver, Gold, and Platinum. The higher the tier, the higher the monthly premium, but the lower your out-of-pocket costs. As a self-employed individual, consider your annual medical expenses and how much coverage you’ll need for routine care versus unexpected medical events. We see a lot of self employed people use Health Savings Accounts or HSA’s to build a savings account of pre-tax money just for medical expenses.
• Open Enrollment: Be mindful of open enrollment periods, which typically run from November 1st to January 15^th each year. However, qualifying life events—like a spouse’s retirement—may allow you to enroll outside of this window.

2. Medicare for the Retiring Spouse

If your spouse is retiring and they are 65 or older, Medicare will likely be their go-to option for medical coverage. Medicare has several parts, and understanding which ones they need can feel like navigating a maze. Our agency can help ensure that he’s covered in all the right ways.

Medicare Parts and What They Cover:

• Medicare Part A covers hospital stays, skilled nursing facilities, and hospice care.
• Medicare Part B covers doctor visits, outpatient care, preventive services, and some medical equipment.
• Medicare Part D provides prescription drug coverage.

For those looking for additional coverage, there’s also the option of Medicare Supplement Plans (Medigap) or Medicare Advantage Plans (Part C).

3. Medicare Supplement (Medigap) vs. Medicare Advantage: What’s the Difference?

Deciding between Medicare Supplement Plans (Medigap) and Medicare Advantage Plans is crucial. Both options provide additional coverage beyond Original Medicare, but they work differently.

Medicare Supplement Plans (Medigap):

• Medigap policies are sold by private insurers to help cover the “gaps” in Original Medicare. These include out-of-pocket costs like copayments, coinsurance, and deductibles.
• Medigap plans allow you to see any doctor who accepts Medicare, which can be a huge benefit for those who want flexibility.
• These plans come with higher monthly premiums but fewer out-of-pocket costs when you need care.

Medicare Advantage Plans (Part C):

• Medicare Advantage Plans are an “all-in-one” alternative to Original Medicare. These plans typically include Parts A, B, and D and may offer extra benefits like dental, vision, and hearing.
• Medicare Advantage Plans often have lower premiums but may have more restrictive networks. You may be required to see doctors within a specific provider network, and you’ll have copays or coinsurance for services.
• For some people, Medicare Advantage Plans offer excellent coverage at a lower cost, especially if they don’t need a wide range of provider options.

This is where our experience comes in. We can review your husband’s specific needs, ensuring he selects the best plan for his healthcare requirements and budget.

4. What Happens When You Turn 65?

As a self-employed individual, you’re likely wondering how your own healthcare situation will change once you turn 65. When you reach this milestone, you’ll become eligible for Medicare as well. But transitioning from a marketplace plan to Medicare can be confusing, and penalties for missing deadlines can be costly.

Our agency offers complimentary annual reviews to help people like you navigate these transitions, ensuring you’re not only covered but also getting the most value from your plan.

Planning for Your Medicare Options:

• Initial Enrollment Period (IEP): When you turn 65, you’ll have a seven-month window (your IEP) to enroll in Medicare. Missing this deadline can lead to late enrollment penalties, so it’s critical to stay informed.
• Oregon Medicare Birthday Rule: If you already have a Medicare Supplement plan, Oregon’s unique Medicare Birthday Rule allows you to switch Medigap plans within 30 days of your birthday without medical underwriting. This is an excellent opportunity to review your coverage every year and ensure you’re still getting the best deal for your healthcare needs.

5. Making the Right Choice for Your Family

Every family’s healthcare needs are different, and there’s no one-size-fits-all solution. Your spouse’s retirement and your self-employment status may mean exploring multiple options to secure affordable, comprehensive coverage. This is where professional guidance can make all the difference.

How We Can Help:

• Personalized Plan Reviews: We’ll review your unique healthcare needs, budget, and any upcoming life changes to recommend the best plan for both you and your spouse.
• Extensive Knowledge of Oregon’s Insurance Market: Whether you need help navigating Healthcare.gov, selecting a Medicare Supplement Plan, or switching to Medicare Advantage, our team understands the nuances of the Oregon insurance landscape.
• Ongoing Support: Even after you’ve chosen your plan, we provide ongoing support with annual reviews to ensure you’re always getting the best value for your money.

Make an Appointment Today

If you’re located in Oregon, we’re here to help you find the most affordable and comprehensive healthcare coverage available. Schedule an appointment with our team today to review your options and ensure that both you and your spouse are covered during this transition.

Navigating healthcare can be tricky, but you don’t have to do it alone. Let our agency guide you through the process, so you can make informed decisions with confidence.

Bancorp’s insurance agents are available to provide you with a free review and consultation.  Contact Us – Bancorp Insurance Call 800-452-6826