Health Insurance Hacks with Nylene Ellingsone
Have you ever wished for guidance in effectively growing your business and managing your finances? Or wonder what it takes to succeed as a female entrepreneur in finance? Then this is the podcast for you. Welcome to Women of Law, where generational wisdom meets ambition. I'm Allie Romo, your millennial host.
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Hawley Woods Gray:Hey, wealth warriors. Are you ready to redefine wealth and master your money mindset? Welcome to Women of Wealth. I'm your Gen x host, Hawley Woods Gray.
Allie Ramo:And I'm your millennial host, Allie Ramo.
Hawley Woods Gray:Today, we'll we'll be talking with Nylene Ellingsone about health insurance and marketplace insurance.
Allie Ramo:So, Nylene why don't you start us off by introducing yourself and share a little bit about how you, became an insurance broker?
Nylene Ellingsone:You bet. Thank you guys so much for having me on the show today. I was about ten years ago, I was a dental hygienist, and I loved what I did for work. But then I was introduced to the insurance world by my sister and her husband, and they kept talking about how awesome and flexible it was, especially since I'm a mom. I have four children and a husband.
Nylene Ellingsone:And so, eventually, when I finally looked at it, I realized it seemed like a great fit. You got to help people understand the confusing world of insurance. And I think one of the things I love best about what I do is besides getting to guide people or hopefully help find them better plans at a lower cost, I don't have to charge anybody for my services. I get paid by whatever company they choose, and I work with many, many companies like Aetna, United, Cigna, Humana, so many companies. So I don't have a preference what people choose, but I can give them guidance.
Nylene Ellingsone:So that's kind of how I got started about nine years ago in the health insurance world.
Hawley Woods Gray:Yeah. So you come very highly referable from, one of my, colleagues here at Appreciation Financial, Cristenie Lee Gonzalez. She's in Texas, and she's been raving about you for a number of years. I know she was in similar situation with me. Like, she had health sharing plan, and that just wasn't cutting it for her her, her husband, and their four children.
Hawley Woods Gray:I think they have, yeah, four children now. So I just think it's great that, you know, you have some different types of programs that are available, for us that are self employed. So what are some of the options out there for self employed individuals?
Nylene Ellingsone:Great question. So my husband and I have always been self employed or employed by small businesses. Like, when I worked for a dentist, they didn't offer insurance. So pre before the marketplace insurance, people used to have some good grandfathered plans that kinda no longer exist, or they're getting really pricey because they're trying to, like, force people off of them. So I would say nowadays, if you are self employed or don't have something through work, your options are either the marketplace, also known as Affordable Care Act plans.
Nylene Ellingsone:Those are typically the companies we're used to the big names, UnitedHealthcare, Cigna, Banner, Aetna, you know, just lots of different ones, SelectHealth. So you have your marketplace options, which most everybody can view by just going to healthcare.gov. You can see the usually, like, hundred plus options in your county, and they all are either a bronze, silver, or gold plan. And, typically, that's all people know of as their option. Krista, the person who you said referred me to you, she's on what I choose to be on, which is not a marketplace plan, because we'll talk about a little bit of the pros and cons to different types of insurance in a minute.
Nylene Ellingsone:But so the other type of plan is doing something that's off market, And my family has been on this alternative type plan for about five years now, and we love it. We actually left a grandfathered plan that was pre Affordable Care Act to be on what I'm on now, and and I absolutely love it. But the first thing I always like anybody who speaks to me to understand is there is never a perfect insurance. Most of us hate insurance. It's there to, like, profit at our expense.
Nylene Ellingsone:Right? So finding out what your options are, what fits your needs, and your budget is really important because a lot of times people find out what they have isn't meeting their needs after the fact, and they're left with a huge bill. So I just love to be a source for someone to realize. Besides the type of plan that I'm on, I will mention a couple of other options, and I don't sell these other options. You mentioned a health share, and Christa was on a health share plan.
Nylene Ellingsone:Health shares are not insurance. I know a lot of people that are on them and have been happy with them. I I've heard a lot of I have a lot of clients who have had good and bad experience. So if someone's looking at a health share, I I can point them toward the ones that I find have the best reputation for actually paying their claims. But the way a health share works is everybody kind of pulls together their money.
Nylene Ellingsone:You always cash pay, and you're gonna hope that they pay that bill. But they're not regulated by the Department of Insurance, so you don't really have a guarantee that those bills will be paid. Many times they are, and, unfortunately, many times they're not paid. So there's health shares. There's the type of plan I'm on through a life insurance company, and we'll get into that.
Nylene Ellingsone:And then there's all of your marketplace options.
Allie Ramo:Can you tell us a little bit more about having, like, a health care plan through a life insurance company?
Nylene Ellingsone:Yes. So it's these two types of plans, like I said, you have your marketplace options, and then you have an alternative. And the type of plan I'm on is what's known as an indemnity insurance. It is insurance. It is regulated by the Department of Insurance, but it's very different.
Nylene Ellingsone:And so it pays first on everything. You can use this insurance in or out of network, but it has a very, very large national Aetna network is what it uses uses. But like a PPO plan, you can go out of network. It's just probably gonna cost you a little bit more, but the plan will pay. There's no deductible on this type of insurance unless you have a hospital stay.
Nylene Ellingsone:So if you have a outpatient surgery, my husband, about two years ago, tore his meniscus, and he needed knee surgery. We didn't owe a deductible before our insurance would pay. They paid first, and if what they were willing to pay didn't cover it, we would've owed something. But we are on their top level plan, and we owed absolutely nothing for his knee surgery. We still got to go to the best specialist that was recommended to us and had no out of pocket costs.
Nylene Ellingsone:So another couple of things that I like about it that a lot of my clients do is it will pick chiropractors and naturopaths, which is not always a common thing on major medicals. So that's something. And you still can benefit from the few areas that are known as very valuable to use cash pay. So a lot of times when people are on a health share, they realize how inexpensive some things are cash pay, and I'll give you an example. An MRI or a CT, most of us know, is very expensive imaging, usually a couple thousand dollars.
Nylene Ellingsone:They are, generally speaking, under $300 cash pay if you're not doing it at the hospital. So, like, if I go to SimonMed and pay $260 for an MRI, you only get that price if it's cash pay. If you cash pay on a marketplace plan, you're just out the money. They're not gonna give you anything back. You just got a better deal.
Nylene Ellingsone:If you cash pay on the type of insurance I choose to be on, you can submit that receipt, and about two weeks later, you get back what they were willing to pay, which on my plan is $720. And all you have to do is upload your receipt, and about two weeks later, you're reimbursed. I know. Yeah.
Hawley Woods Gray:I think it's incredible that people don't realize how expensive the insurance price is for things because that's similar to you know, we have several different moving pieces for our health insurance. We also have been business owners for, you know, twenty almost twenty five years. So we have come up with a system that works for us, but doesn't mean that it's perfect by any means, and it's only for those people that are able to submit their bills and, you know, get credited back for things, that they do pay money out for. But it does give you an ability to take advantage of some things like health savings plan and some other things that are available for, for those of us that are self employed. Now let's talk a little bit about the enrollment period for these types of plans, or can someone get enrolled anytime they want to?
Nylene Ellingsone:So on the marketplace, there are enrollment periods, and that's typically, November 15 till January 15 for most people. If you have a low enough income, you can enroll anytime of the year. And if you have a life changing event, you can. Like, say, you got married or something like that. So that's the marketplace insurance.
Nylene Ellingsone:For the for the alternative type plan, when we're talking that is kind of really great for business owners and things like that, It is year round enrollment. That's one of the perks. Somebody can get on any time of the year they want. It is subject to a few questions they'll ask, and I'll tell you a couple of the knockout questions. If someone is diabetic and they're on just prescriptions, it's fine.
Nylene Ellingsone:But if they're type one insulin diabetic, they wouldn't qualify for this insurance. If they had a heart attack or a stroke in the last ten years or internal cancer in the last five years, those are some typical knockouts. Otherwise, most of the people I talk to, they qualify for it, and the benefit of being on it is once it clears underwriting, which takes about a week, it can be effective anytime after that. So a lot of flexibility with enrollment.
Allie Ramo:Naelene, what about dropping insurance? So you mentioned type one diabetes, and some of some of the other severe illnesses. But can are there rules to be aware of for being dropped?
Nylene Ellingsone:So once you're on an insurance, you're typically never dropped unless you fail to pay your premium. And that's how how both Marketplace and this Philadelphia American plan work. That's the name of the life insurance company. There are a lot of indemnity plans, and I've seen them by many, many companies. I would never look at an indemnity plan from any other company.
Nylene Ellingsone:And I don't say that because I'm captive to Philadelphia American. I say it because the benefits do not even compare. So once you're on the plan, it is guaranteed renewable, meaning you can never be dropped. If you develop cancer or anything, the only way you're gonna be dropped is to cancel it anytime you want or from lack of paying your premium.
Allie Ramo:So what are some of the benefits that differentiate the the company you work for with, versus some others that are available out there?
Nylene Ellingsone:Yeah. Absolutely. So I'll I'll start with the Affordable Care Act because there's always good and bad with everything, right? So some of the pros to doing a marketplace plan is, they take anyone of any health condition. If you just had internal cancer and you don't have an employer plan, Affordable Care Act is the only thing you're gonna qualify for.
Nylene Ellingsone:They take anyone of any health condition. Because they do that, the premiums are outrageous if you don't qualify for a subsidy. So another pro is if your income is low enough, and honestly, you'd be surprised how high someone's income can be to still qualify for subsidy, the government will subsidize it. So it's not uncommon for me to meet with people who only have to pay between like 0 and $30 or a hundred dollars for their family's insurance because of subsidy. So subsidy is a pro for them.
Nylene Ellingsone:There is no waiting periods on preexisting conditions on the marketplace, And it's really gonna be your best thing for really costly prescriptions. So if you're on Ozempic or Eliquis or something that's more expensive, that's probably gonna be the best route. Having said that, most of the marketplace plans ask you to pay your deductible before you get help with super costly drugs. And those deductibles usually are around 5 to $8,000 So sometimes it's not very helpful even when you have a expensive prescription. So pros, take anyone, cover your preexisting from day one, and if you qualify for subsidy, it might be very inexpensive.
Nylene Ellingsone:Some of the cons to the Affordable Care Act plans most people are aware of, the high cost of the plan. If you're not subsidized and you make a decent living, it's very expensive. And I'll give you a couple of examples in a minute. The cost is, I would say, my biggest downfall, as well as sometimes the limiting doctor network. And that's something that's always valuable about meeting with a broker like myself is looking up all your doctors and prescriptions and finding which of the many plans cover those things for you.
Nylene Ellingsone:Because if you just enroll on a plan without checking doctors, you may have enrolled on a plan that you can't go see the doctors that are most important to you. They just don't take it. So the network can be limiting. They don't like to cover you out of your network unless it's a life threatening emergency. So it's kind of crazy what I have seen Affordable Care Act call not life threatening.
Nylene Ellingsone:I had a call from someone one time. She was from Arizona. She was in Florida and got meningitis and was hospitalized for a week. And the Affordable Care Act plan she was on denied all of her claims. They said this was not life threatening, and you were out of your network.
Nylene Ellingsone:I I can't believe someone told her that. I had another client that fell down some stairs in California, broke her ankle, tore her knee. Again, they said you were out of your network. And she said, but this was an emergency. And they're like, but it wasn't life threatening.
Nylene Ellingsone:So I don't know what they expect them to do, drive across state lines just because they know this isn't gonna kill them, but they need treatment. Like, so that's kinda one of the things. If you're out of your network, you have no coverage on the Affordable Care Act. So that's a con to me. And if your income increases over the year from what you projected it would, because it's not based off last year's income tax.
Nylene Ellingsone:It's based off what you think you'll make for the year you're covered. So if your income goes up, you owe back the subsidy that they gave you. So many people call me up and they won't look at Affordable Care Act because they've been burned in the past where maybe in December they found out they owed back $18,000 for their family's subsidy that they no longer qualified for. So it's kind of one of those things where you that they no longer qualified for. So it's kind of one of those things where you wanna plan for the full price of the policy, even if you are being subsidized, if you think your income's changing, which with many of us self employed people, your income can vary a lot.
Nylene Ellingsone:That's finding some of the pros and cons of the Affordable Care Act. Any questions on that, you guys?
Hawley Woods Gray:So I was just curious, like we talked a little bit about, if your income changes, is there a range of, like, where the lowest level of income is to the highest level so that people can be aware of falling within that range?
Nylene Ellingsone:Absolutely. So when you go to healthcare.gov, you can type in your ages, your estimated income, and based off that number so even, like, just a normal person can hop online, type in the number you think will be your income, and it will the next step will calculate how much subsidy you qualify, if if any. You can then go back and type in a higher income, like, hey. It might be this much, and then it will also recalculate and show you how much subsidy. So you can kinda play with it on your own and see.
Nylene Ellingsone:But, yeah, there's a big difference. And when someone has a low enough income, they can qualify for what's called CSR plans. It might take the same Aetna plan, and now you have, like, a fraction of the co pays deductible and max out of pocket. So if your income's overly low, the plans get actually beautiful. Instead of, like, a $5,000 deductible per individual, it might be 300, but it is all income related.
Nylene Ellingsone:So it's just something it is worth having somebody to help you navigate because what you see on paper doesn't necessarily tell you all the ins and outs about what hospitals are in your network and things. And sometimes people don't really know how to search that. So Affordable Care Act, it's just very heavy on the income side. I have lots of people that will call me up and say, I don't qualify for a marketplace plan, which is so funny because anyone can have a marketplace plan. What they're really saying is, I don't qualify for a subsidy, and so these prices are insane.
Nylene Ellingsone:So just like real quick, I'll give you a 35 year old male that's looking for some insurance in Nevada based off I think is it Clark County?
Hawley Woods Gray:Mhmm. Yes.
Nylene Ellingsone:It's been a ZIP code. A bronze plan without subsidy is about $304. And on a bronze plan, this is with a company called Imperial, he'd have a $50 co pays at his primary visit. All preventative is free, which is one of the nice things about marketplace. Like, all the things billed as preventative cost you nothing.
Nylene Ellingsone:But as deductible is $7,500 before you start to have help on anything like a diagnostic x-ray, diagnostic lab work, anything other than a doctor visit or an urgent care visit, those are your only co pays. And then your max out of pocket is $9,200 if you stayed in your network. On a silver plan, say with Aetna, instead of three zero four, it's a little over $400 Slightly lower deductible, 6,500 with an 8,000 instead of a $9,200 max. So you can see that the plan improved a little. And then a gold plan with Blue Cross Blue Shield, same county, dollars $6.29 for this individual, slightly lower co pay at the doctor, ten dollars, a lower deductible by a lot, 1,100 deductible, and a 6,800 max out of pocket.
Nylene Ellingsone:So that's just for one person. And then if you said he had a wife and two kids, the price is crazy. It starts at about $9.95 for the lowest level plan, mid level plan, 1,300, and a gold plan, $2,054 per month. That's a lot of money. Now, if the person's subsidized, I highly recommend Affordable Care Act plans.
Nylene Ellingsone:If it works good with your doctors and things, and maybe that person's premium is only $150 they only see a few doctors and most of it's preventative for their kids and things, then it can be great insurance. So it really just depends on what the person's needs are, what their income is, who the doctors they like to see are. So that's kind of a little bit about Affordable Care Act pros and cons.
Allie Ramo:So you brought up the family plans through the marketplace. How do plans, are are they charged for families? Is it based off of the oldest person in the house? Is it based off of each member of the house? How how does that
Nylene Ellingsone:work? Perfect. So on the marketplace, it doesn't matter as much how old the person is. It's more about bodies. On the other type of coverage, the one through Philadelphia American, let's talk about its pros and cons and then what it costs.
Nylene Ellingsone:Since we just discussed costs, I'll mention that first. So typically I would say you'll see about a 20 to 50% reduction in premium if you're not subsidized. So we're talking full cost plans on both types of insurance. So for that 35 year old, if you wanted to do like a silver level plan, it would be about $197 instead of $4.00 2 and the best about 247 instead of, what did we say the gold plan was for him? Can't find it.
Nylene Ellingsone:Oh, $6.29. Yeah. So for the gold plan, $2.47 instead of $6.29. And on these plans, there's no deductible to me. If you need an MRI, my husband's had two.
Nylene Ellingsone:We didn't pay a dime. We actually made money back. And so that's just for an individual. If we look at the family, instead of it being between, $9.95 and $2,000 a family plan with this other company is between 617 and 768. That's if there's no rate ups for, like, health conditions.
Nylene Ellingsone:So let me talk about some of the pros and cons because that's a big difference in premium, not to mention what I consider, like, are the perks of being on this. So some of the pros on this other type of coverage is you don't have a deductible in your unless you're hospitalized. Many of us never hit our plan's deductible. I was on my old grandfathered United plan for fourteen years with four kids, and the only time I hit my deductible was when my daughter was hospitalized for pneumonia. Every other year, all we did was pay toward the deductible.
Nylene Ellingsone:So it's very depressing. You're paying a big premium and everything to your deductible. So on this type of plan, you only have a deductible if you're hospitalized and it's 5,000. You can make it lower, but most of my clients choose 5,000. You have a very large network, and you're never out of luck with your insurance if you're out of your network.
Nylene Ellingsone:They will pay any provider or facility in The United States. So you're always gonna have coverage. You're not limited to, like, not being able to go to Mayo or things like that. And then you're not worrying about subsidy. There is no subsidy, so that could be a con, but you also never owe back subsidy.
Nylene Ellingsone:All of their premiums are based off your age and your health when you got on the plan. So like if I was a diabetic, I would pay 30% more than if I had no diabetes, but they're never gonna rate you up once you develop diabetes, if that makes sense. And then they're guaranteed renewable. You're never gonna lose it. So those are some of the the pros that I like.
Nylene Ellingsone:I also like that if I go to a provider that doesn't bill insurance, like my chiropractor, there are hundreds I could choose from that are within the network, but my specific chiropractor doesn't bill insurance. When I go, he charges $60 cash. I ask him for an itemized bill. The bill has to show what was done at that appointment. And when I upload it to my insurance, they send me back what they were willing to pay for the visit, which is a hundred and $60.
Nylene Ellingsone:So that's another thing I like about being on it. But some of the cons. On this plan, it's what's called a fixed benefit health plan. So it tells you what you were willing to pay. So in that example, it was willing to pay $160 for that doctor visit.
Nylene Ellingsone:If it was more than that, that's when I would owe. But if the doctor visit is less than that, you'll get back a check. And my chiropractor's the only doctor I cash pay. Everybody else, I hand over my card, they bill, my insurance pays the doctor, and if there's leftover, I also get a check. So that's kind of how that is.
Hawley Woods Gray:So when you oh, so when you apply for this insurance, then are you having to take, like, a medical exam, or how does that work?
Nylene Ellingsone:Not at all. So there's health questions. So they're gonna ask you a few things, like if you have diabetes, if you had cancer in the last five years. So you're answering the questions, and the only thing they're gonna do is they're gonna pull a prescription history sometimes and very rarely. Most people are very honest on their applications, but sometimes you'll get a counteroffer because a medication you're on threw up a red flag for a condition that you didn't disclose.
Nylene Ellingsone:And sometimes it's just because you're taking that medication not for that condition that's concerning. So there might be a counteroffer based off something in your history if they find something, but I don't run into that very often. And if there is a counteroffer, they tell you what the new price would be and you agree to it. Go ahead, Allie.
Allie Ramo:Yeah. So do you have a if you're going to the chiropractor, let's say you go once a week or once every other week, is there a limit to how many times you can go see this provider? How many X rays? What if you're an extreme sportist and skateboarding all the time and you're always breaking something? Is there a limit to what you can use?
Nylene Ellingsone:Good question. So, yes, there are limits because this plan pays pays really well. So the top level plan, what I choose to be on, gives you 20 covered doctor visits each calendar year. Six can be used for chiropractic, so you can't go once every week. And but when I go to my six visits, the excess money I'm getting back would pay for 12 more visits.
Nylene Ellingsone:So it's kind of like I could have that many visits covered at no cost. They will also pay 20 additional therapy visits, like if you needed mental health or physical therapy. So you have therapy visits, like if you needed mental health or physical therapy. So you have two categories of doctors. And if you did their mid level, kind of like their silver plan, you have 16 covered doctor visits instead of 20 each year per person.
Nylene Ellingsone:So, yeah, also X rays, since you mentioned that, they do. They limit your X rays at four per year. Beyond that, they're not paying first dollar, but you'd still have the negotiated discount. So let me give you an example of negotiated discount because this is insurance and they have negotiated rates. The last time I took my daughter into the pediatrician, he saw her for strep throat and he did a lab, and he would have billed a hundred and $25 But because of the negotiated rate with the insurance company, the entire visit was $64 My plan was willing to pay $2.80.
Nylene Ellingsone:So they paid that doctor within one week of me being there, and then I got a check back for the difference. It's kind of awesome. I don't ever want people to think that you're just making money, but if you understand how it works, that's pretty much been my experience and why you can see I get so many referrals for this. But let's talk about some of the cons because people will say this sounds too good to be true. It's not.
Nylene Ellingsone:The cons, well, first of all, it's not subsidized. So the older you are, the more expensive it is. If you're 63 years old, it's more like the Affordable Care Act plan prices. Like, it's not cheap. Some people still prefer to be on it when it's expensive because they have so much flexibility in using it.
Nylene Ellingsone:So it's not subsidized. There is no max out of pocket on the health plan. Everything in their brochure that they list tells you what they're willing to pay. And if it's more than that, you owe. So there's not a max out of pocket in your worst case scenario, which is why I recommend two additional products when I sell this insurance.
Nylene Ellingsone:And I'll tell you a little bit more about them. It really gives you more coverage for those what if I got cancer, what if I had a stroke. And then, honestly, it's mostly just depending on your income. It may be more or less than Affordable Care Act. So let me give you an idea.
Nylene Ellingsone:Whenever I sell this insurance, I love the health insurance. My husband's had two surgeries. We haven't owed a dime, and we had excess money back. One was for a excess money back. One was for a deviated septum.
Nylene Ellingsone:One was for a torn meniscus. My daughter just broke her finger playing dodgeball at church. Yeah. And our health plan paid all of the bills. Right?
Nylene Ellingsone:She's 14. Her finger's sticking out to the side. Well, one thing I like people to know on this type of insurance is you avoid the ER at all costs, and I will say that across the board on any insurance. If you've ever had experience with the hospital, there's nothing that regulates billing. And even on the Affordable Care Act, you might have a $75 copay at urgent care, but the ER is subject to your deductible of 7,500 on that bronze plan.
Nylene Ellingsone:You don't wanna be there if urgent care can do the trick. So when she broke her finger, even though I'm not on an Affordable Care Act plan, I know the ER is overpriced and I'd wait there for hours. So it's very helpful to be aware of the urgent cares in your area that do x rays. So kind of just being little bit mindful of things that are more reasonable. I could have taken her to the ER.
Nylene Ellingsone:I have an additional accident policy and anybody listening, it's the best policy I've ever seen for what you pay. For an individual, it's $31.05 and hasn't gone up a dime in a decade. What this accident policy does is it pays in addition to any insurance you have or no insurance. It will pay up to $4,000 in medical bills, an additional 10,000 for an ambulance or airlift. Many times people on work plans or affordable care act plans are told that their ambulance was not in network and you owe the whole cost.
Nylene Ellingsone:That's ridiculous. Like, you even get to pick an ambulance in your network. So having extra coverage for that is great. Pays a hundred thousand death benefit. So if a family member died due to an accidental anything, you're not on GoFundMe for the funeral.
Nylene Ellingsone:And then it pays a few other little things. So in this situation, my daughter broke her finger, all of the X rays, resetting it, splint, everything was paid for by our health plan completely. But the accident policy said, well, that's an accident. What were the total charges after the negotiated rate? So what were we billed?
Nylene Ellingsone:And it paid all of that, which was just under a thousand dollars. On my husband's knee surgery, our health plan paid all of the knee surgery. Our accident plan said, well, a torn meniscus is an accident, and we're paying out the whole 4,000. So it pays whatever your bills reach with a max of 4,000 per incident, no max to how many incidents you may might have in a year, and it hasn't gone up in ten years in price. It's really a cool policy.
Nylene Ellingsone:So that's another one I layer with this insurance. And the third one is a little product they sell for diseases. So you have an extra quarter or half million dollars per year if you were to have something like a stroke, a heart attack, things that have really big expenses. So you have your health plan that's paying a set amount. That set amount may or may not have covered all your bills, but if it's disease related, I have absolutely no worries that I would owe anything if my child had cancer right now.
Nylene Ellingsone:So it's kind of three policies wrapped in one is what I recommend. Not everybody does it, but most people do. And those three things together is what I just quoted. That family of four who's about 35 year old parents, best policy is $768 That's with the accident, with the extra disease, and with their top level health plan.
Allie Ramo:Wow.
Hawley Woods Gray:That's great.
Allie Ramo:Yeah. You mentioned that there's a brochure that has all of what the the indemnity plan is willing to pay. I'm curious. What does family planning look like? Do they help with, like, insemination things?
Allie Ramo:Do they help with pregnancy? Is there I know with the health sharing plans, I think it was six months or a year before being pregnant. You'd have to be in their plan. So what does that look like with your plan?
Nylene Ellingsone:I am so glad you brought that up. So pregnancy, if you're not on a major medical, you basically aren't gonna have pregnancy. It's one of the few things I tell people if you're looking for something very affordable, HealthShares does usually cover that well. But when it comes to pregnancy and deliveries and things with this type of plan we're talking about, there is none. Pregnancy is an exclusion.
Nylene Ellingsone:A couple other exclusions would be like, birth control. That's not considered medically necessary. Vasectomies, cosmetic surgery, typical things, but pregnancy is an exclusion. So here's what here's my spiel for pregnancy. I have four kids, and when I had my kids, I was on a major medical with maternity coverage.
Nylene Ellingsone:And like a lot of people have realized, when I had my first baby at the hospital, I gave them my insurance. And before I even left the hospital, I found out that if we would have self paid, we would have saved over $2,000 instead of using our insurance. So even after insurance paid, we were out 2,000 more than if we would have cash paid our baby. So whenever people are looking at having babies, I like them to understand their options because you can always get on an affordable care act plan when you're pregnant. So say you're two months pregnant and enrollment time rolls around, you can get on, your delivery will be covered as of the January 1.
Nylene Ellingsone:You can also drop it anytime you want. But the way those plans look is let's say that you're on a bronze plan. You have a 7,500 deductible before they're helping with those delivery costs. I can cash pay a baby today at a local hospital for under $7,500 So it doesn't mean don't go on a major medical. It means maybe if you're going on major medical, you're gonna jump on a gold plan with an 1,100 deductible because you know you're gonna have a baby.
Nylene Ellingsone:So lots of things to look at. I wouldn't be scared to be on my insurance even if I was still having babies, but I'd be aware that I'm just cash paying everything. And I would look at those costs before I decide which insurance I would want to be on. And when it comes to fertility treatment, in vitro, things like that, I would love to see the insurance that does cover that. I mean, I really don't know anybody who has that covered by insurance.
Nylene Ellingsone:It's very, very rare to have a plan that helps with with fertility things.
Hawley Woods Gray:I think the only one that I know of is, like, a, a state agency. There's a couple state agencies that I know of that have health insurance. I don't know what the plan is, but they do cover up to a certain point. But the thing about that too is, I don't know if I asked you this before, but are you able to keep a, health savings plan with this insurance?
Nylene Ellingsone:No. And the reason is it's not major medical. That's one reason. And it doesn't have a high deductible. There's no deductible for outpatient and your hospital deductible's less than any of the Affordable Care Act ones for the bronze and silver.
Nylene Ellingsone:So it's not a high deductible health plan. So we were on a health savings plan prior to being on this. But what I find is we we save way more than if we were on a actual HSA plan. Now if you have a health savings account, you can still use all of what's been put in there. But, technically, if this is your main insurance, you're not supposed to be contributing to an HSA anymore.
Hawley Woods Gray:Now do you know anything about health matching accounts?
Nylene Ellingsone:Do you
Hawley Woods Gray:know about those?
Nylene Ellingsone:Very little. I mean, I would probably refer you to someone who does that more, but, they're I'll tell you this. I have a friend who did a lot of health matching account stuff, and it was great. And they would use it a lot for, mommy makeovers and maternity. And most of those have cut down to where those are not covered anymore.
Nylene Ellingsone:You know? So, like, things have tightened up. So health matching accounts can be great.
Hawley Woods Gray:Yeah. That might be an option for you for you guys, Ali. We can talk more about that later.
Allie Ramo:Yes. So if I were a business owner and I had employees, would this be something that business owners are able to provide for their employees?
Nylene Ellingsone:Absolutely. So when it comes to business owners, they have all the options. Right? The typical rule of thumb is if you have at least two employees now that can't be the owner and his wife, you know, unless they're paid totally separately and things. But when you have two employees, you can do a major medical group plan.
Nylene Ellingsone:So there's always your major medical options through all the companies you know of, UnitedHealthcare, things like that. So you can look at those options, and and you should. If you have a lot of employees, chances are not all of your employees would pass underwritten plans. You know, somebody might be an insulin diabetic or have had recent cancer. So there's always your major medical options, but this option, I have so many business owners that do it.
Nylene Ellingsone:From dental offices to construction plans. I just got a group that just sent over 12 new employees for me to put on their company plan. And when they reached out to me several years ago, they said, hey. We have looked at all of the options, and it is so expensive for our company and the deductibles are so high that we don't even feel like it's a benefit to give. And it's not uncommon for me to see that where businesses offer insurance and the actual owners don't even participate in it because they feel like it's a waste of money.
Nylene Ellingsone:So definitely look into your major medical options, especially if you need to for health reasons. But this option is so affordable and because it's not, government insurance, the employer has all the flexibility in the world with from payment to how much they wanna pay. They might say, hey. We're gonna pay 50% or a %, or, hey. If you've worked here under five years, we're gonna cover this much, and they can do anything they want.
Nylene Ellingsone:I have employers who put it on their bank draft and they want it deducted from their bank account and they write it off. I have employers that say, hey, we just wanna cover half of it. We want it to come out of the employee's bank account so when they leave, they can have it and we're just gonna contribute half of whatever plan they choose. So it's really, really flexible. They can add people any time of the year they want.
Nylene Ellingsone:People can drop any time of the year they want. One thing to note about this insurance is there is a sixty period to do preventative, so you can't just hop on it and go out and do your colonoscopy or your mammogram. You have to wait sixty days for those things to be covered, and there's a twelve month wait on preexisting.
Allie Ramo:And
Nylene Ellingsone:the way they define that is anything that that person has been tested, treated, or taking a prescription for in the last twelve months has a twelve month wait. So it doesn't mean that your well visit's not gonna be covered, but if you have a thyroid condition and that doctor bills your visit as specifically for your thyroid, it's not gonna be covered. And so you'd still have a negotiated rate on that visit, but they're not paying for it. So something to be aware of, the way that prescriptions work on this plan is the only part that is not insurance. You get a discount card very similar to the GoodRx.
Nylene Ellingsone:So like my daughter's last antibiotic was 40 cash pay, but with the GoodRx, it was $4.80. If you pay it and upload your receipt, you get $15 back for generic and 30 back for branding. There are a couple of plans where you could have double that amount, so it just depends. But, it's it's worked really well for our family's prescription needs over the last five years. We haven't had to pay a single prescription that we've had filled, but it is not the right plan if you wanna be on Ozempic.
Nylene Ellingsone:So wouldn't
Hawley Woods Gray:you agree it's kinda like your anything else that a lot of people don't really understand, like retirement or saving money or life insurance? It's like like health insurance can be affordable and can really benefit your family, but most people just don't understand how it works.
Nylene Ellingsone:Yes. And, honestly, if you're somewhat healthy, the major medical options aren't gonna benefit you until you have a catastrophic event. They're really designed to just take, take, take unless you're hospitalized. I have many even medical professionals, doctors, and things that have an insurance and go cash pay a shoulder surgery because it's less than their deductible. When my husband had his knee surgery, I did ask what cash pay was even though I didn't need the cash pay.
Nylene Ellingsone:Cash pay for everything, the surgeon, facility, and anesthesiologist was $4,700 That's cheaper than their work deductible, and so they cash pay it. The only downside to that is you didn't hit your deductible if you have anything else that happens in the year. So I kinda love this insurance because it is insurance. It will always pay what they say. You're never gonna be told, sorry, not paying on that, unless it's a preexisting for the first year.
Nylene Ellingsone:But you can benefit from the few areas that cash pay is a huge value. And I will tell you the ER is one of those. Anybody who goes to the ER, if you say, I am cash pay, you don't pay the bill on the spot, but when the bill comes, you will see two different amounts. And when you're on a type of insurance like this that tells you what they're gonna pay, benefits you to be somewhat smart about how you use it. So my last client that had kidney stones went to the ER, had a CT, lots of lab work, and said he's cash paid.
Nylene Ellingsone:They asked him to pay $300 on the spot, not a big deal. When the bill came about two months later, he sees that they were gonna bill over $7,300 like 3,200 for a CT, eight hundred in blood work, two thousand four hundred for the facility. And I see that all the time when people owe their entire marketplace deductible or their work plan deductible with kidney stones. But what this gentleman did was he said he was cash pay. When the bill comes, he can still bill his insurance when he sees that bill, but instead he saw that cash pay took off over $6,000 and his new bill was a total of $1,300 So he decided to do cash pay because he knew by looking at his plan brochure exactly what they would pay for that visit, and he got back more than 1,300.
Nylene Ellingsone:Not much. He was on the mid level plan, not their best, but he didn't owe for that ER visit. He didn't owe a deductible. And because of cash pay, they took $6 off your network discount, is never gonna equal what cash pay would at the hospital. So that's one of the things I like people to know is there's a value in saying cash pay at the hospital when you first go.
Nylene Ellingsone:If that freaks you out, don't do this insurance. But everything else I do with my family, I don't cash pay. I show my card at the dermatologist. When my kids get a surgery and have a wart removed, that dermatologist gets paid and I get usually over $300 back from my insurance. It's kind of the coolest thing.
Nylene Ellingsone:So I have a
Hawley Woods Gray:question about, families. So if you do have someone in the family that isn't all that healthy, or maybe they're much older than the rest of the family, can you just do the plan for, like, say, a wife and her child instead of doing the husband on it? Like, maybe he could be ten or fifteen years older than the wife.
Nylene Ellingsone:And
Hawley Woods Gray:it makes sense for them not to get him on because maybe he has some preexisting or something like that.
Nylene Ellingsone:Or maybe he can't have it. Right? So Yeah. Perfect question. Whether it's because you don't want to or they have something through work, I see so many times teachers who have great insurance for them.
Nylene Ellingsone:It's free. But to add the husband and children is a fortune. So yeah, you can put just a few people on. You can put anything you want. You could put just a child on.
Nylene Ellingsone:That little accident policy I was talking about for a kid is $20 a month. All the time I see my friends that are at the hospital from injuries. I had someone, and her husband works at Phoenix Children's Hospital. He's a surgeon. And she said, We have the worst insurance.
Nylene Ellingsone:And I'm like, How can that be? Like, he's a surgeon at a major hospital. And what she said was, they have six children who are all doing sports and they are constantly meeting the individual deductible. So they haven't paid enough to hit the family deductible, but the deductible applies to each individual unless two people have hit it and then the family's covered. So she was just experiencing all these costs for broken bones.
Nylene Ellingsone:And I said, all you need, your insurance is actually good. All you need is this little accident policy for your family, which will pay the first four thousand of every injury. And she was like, oh my gosh. You're right. That would solve everything I hate about my insurance.
Nylene Ellingsone:So the main thing to understand from all of this discussion is it is my job to know insurance companies and plans. I test and represent over 10 companies, well over that, but, and products. Like, I represent over a hundred Medicare plans. It just meet with someone who is tested every year on this stuff, who has to to know the stuff to even represent it. If you pick something just based off healthcare.gov, you may not understand it well.
Nylene Ellingsone:By meeting with someone like myself that's an independent broker, you're not paying for our service. We're just trying to guide you into the plan that meets your needs the best, and then that company pays us. So just know we're very unbiased unless you're talking to someone who works for one company. Oh. They're gonna tell you why that company's the best, but just talk to someone who works with lots of different companies.
Nylene Ellingsone:Find out what works good for your company, or your family, and and your needs change. It's not uncommon to be on one plan and then realize, hey. I'm gonna have a baby, and I'd really like to just know that I'm a plan on a plan with a maximum out of pocket. Well, you can double up. You can switch and drop one.
Nylene Ellingsone:There are so many options out there.
Hawley Woods Gray:Mhmm.
Allie Ramo:Well, thank you so much, Nylene. This has been very insightful, and I feel like we could have a whole other episode with all of the information that you've given us. And then before we go into the lightning round, if people are interested in getting more information from you, where can they find you?
Nylene Ellingsone:So best is, just emailing me so that they might put it in a chat or something on here, but it's nylene@sysbroker.com. So my insurance agency is called Senior Insurance Specialists. It's me and one of my sisters that specialize in insurance, and so that's why the acronym is SIS. So you can either email me or call or text me at (480) 216-6426. I am always happy to answer questions even if you don't wanna make an appointment or look at switching your plan.
Nylene Ellingsone:Even if you're like, hey. Could you help me understand what I have? Like, I've had this policy and I kinda just don't get it. Totally happy to help you. Also, sometimes there's lots of programs out there that people would qualify for that they don't even realize.
Nylene Ellingsone:And so I'm just a good resource for things like that as well. So much knowledge, you guys. I would love to help anybody who has questions about things.
Hawley Woods Gray:Great. Well, again, thank you so much. We will put your contact information in the show notes, so make sure you check that out if you're listening to us on any one of the, ways that you can download our podcast. Ali, you wanna jump into the lightning round?
Allie Ramo:Yep. Alright. Nylene, so we're gonna have, several questions. And just like it sounds, it's a lightning round. So short answers, no explanations needed.
Allie Ramo:So the first one is cash or credit? Cash. Real estate or stocks?
Nylene Ellingsone:Real estate.
Allie Ramo:If you won a million dollars today, what would be the first thing you'd do with the money?
Nylene Ellingsone:I have no idea. I guess you may take a vacation with my family.
Allie Ramo:Okay. What's a fun impulse buy you've recently had?
Nylene Ellingsone:I am not an impulse buy or shopper, so I think nothing.
Allie Ramo:What a great habit to have. What's one money savings tip that you swear by?
Nylene Ellingsone:I would say tip is just, like, don't get something if you can't afford it. So that's where I go back to cash or credit. Like, it's really easy to to get things based off what we want and not what we can do at the time, I guess.
Allie Ramo:What's your biggest financial fear?
Nylene Ellingsone:I guess probably being not planning well, being broke when I retire, which I'm not really afraid about. I think I'm smart, but, like, that would be scary. I work with all oh, sorry. You don't need any explanations.
Allie Ramo:That's okay. We can get carried away here too. What's your biggest financial goal for the next year?
Nylene Ellingsone:Oh.
Allie Ramo:You don't have to say a a dollar amount, but you can say, you know, a 30% more than last year or whatever it may be. You don't have to have a specific dollar amount in mind.
Nylene Ellingsone:I think I would say more my financial goal this next year is trying to help the agents that work with us become financially stable. So not necessarily one for me, but for the people that I work with.
Allie Ramo:I love that. Yeah. Me too. What a great leader.
Nylene Ellingsone:Thanks. We we love it.
Allie Ramo:Well, it's been a joy getting to know you and what you've you provide people, and we definitely need to meet, maybe not this year, but in the future.
Nylene Ellingsone:No problem. Thank you all for having me on and for just trying to giving your listeners a little bit more idea that there are options out there for everybody. So thank you so much.
Hawley Woods Gray:Thank you.
Hawley Woods Gray:Thank you for joining us on
Allie Ramo:this week's episode. We'd love to
Hawley Woods Gray:hear from you, so make sure to follow and tag us on Facebook and Instagram at women of wealth podcast.
Allie Ramo:Your support means the world to us. Until next time. Remember, your financial future is in your hands.
Hawley Woods Gray:Stay informed, stay inspired, and embrace your wealth. See you on the next episode.
