Can You Get a Health Insurance Exemption?

Can You Get a Health Insurance Exemption? =If you don’t want to pay a penalty tax, you’ll either have to have health insurance after December 31, 2013, or you’ll have to get a health insurance exemption.
One of the provisions of the Affordable Care Act, the individual mandate, penalizes people who go without health insurance by making them pay a penalty tax called a shared responsibility payment. There are only three ways around this penalty:
  • Have health insurance coverage that meets coverage rules.
  • Get an exemption.
  • Belong to a group the government views as having health insurance coverage, whether or not you actually do have coverage.

 

Who Is Exempt From the Individual Mandate’s Penalty?

You’re likely exempt from the individual mandate health insurance penalty if you:
  • Aren’t in the United States legally.

  • Are in jail or prison, unless you're incarcerated pending disposition of charges.

  • Are an Alaskan Native or a member of an Indian Tribe.

  • Have a small enough income that you’re not required to file income taxes
    How much income can you have before you’re required to file income taxes? For 2012, individuals could earn $9750 before they had to file, and couples could earn $19,500. But, it changes every year. If you’d like to know the filing threshold for any particular year, it’s found in IRS publication 501 for that year, which you can get from the IRS Forms & Publicationswebpage.

  • Have a religious conscience objection to insurance
    To qualify for this exemption:
    1. You must be a member of a recognized religious sect.
    2. You have to waive all of your Social Security benefits.
    3. The Commissioner of Social Security must agree that your religion opposes insurance for things like death, disability, and medical care.
    4. The Commissioner must find that members of your religion have made arrangements to provide for their dependent members since they aren’t using insurance as a safety-net.
    5. The sect must have been in existence continuously since December 31, 1950.
    David Emery, the About.com Guide to urban legends, addresses this area in more detail in“Are Muslims Exempt from ObamaCare Health Insurance Mandate?

  • Are a member of a health care sharing ministry
    Health care sharing ministries are religion-based groups of people who assist each other with paying medical bills. You can learn more about health care sharing ministries from The Alliance of Health Care Sharing Ministries. Your membership won’t make you exempt from the individual mandate unless your sharing ministry has been in existence since 12/31/1999. Additionally, the ministry's yearly accounting audits must be available to the public.

  • Can’t afford coverage
    To be considered unaffordable, your contributions toward job-based coverage must be more than eight percent of your household income. For health insurance from your state’s health insurance exchange to be considered unaffordable, your contribution toward the annual premium of the lowest cost bronze plan available in the individual market must be more than eight percent of your household income.

  • Have gone less than 3 consecutive months without coverage
    You’re only allowed to use this exemption once per year, and only the first occasion each year is exempted. For example, if you’re uninsured for two months in February and March, then again for three months in August, September, and October, you’ll only be exempt for the February and March period. You’ll owe the shared responsibility payment penalty for the August, September, and October period.

  • Have a hardship that legitimately prevents you from getting health insurance
    Your health insurance exchange must decide that you have a hardship affecting your ability to get health insurance. Exchanges use rules and guidelines to make this decision. You can learn more in, "How To Get a Hardship Exemption."

How Do I Get a Health Insurance Exemption?

Your state health insurance exchange is responsible for exemptions based on hardship and religious conscience objection. Apply with the exchange; it will make the eligibility decision and issue the exemption if you qualify.
You can claim exemptions based on the following when you file your federal tax return:
  • coverage costing more than eight percent of your income
  • membership in a healthcare sharing ministry
  • membership in an Indian Tribe
  • being incarcerated
If you prefer not to wait until you file your taxes, the exchange can also address the above exemptions. You might choose this option if you have questions or if you're not sure if your situation matches the criteria exactly.
Exemptions due to being uninsured for less than three months will be taken care of when you file your income taxes.
If your exemption is due to having a small enough income that you don't have to file federal income taxes, you don't actually have to apply for the exemption; it's automatic. If you file taxes even though you don't have to, for example because you want to get a refund, you won't have to pay the penalty tax.

I Don’t Qualify for a Health Insurance Exemption; How Can I Avoid the Penalty?

The government treats some people as though they have minimal essential health insurance coverage, even if they don’t. While not exactly the same as being exempt, the effect is similar in that those people don’t have to pay the health insurance penalty tax, even if they don’t have health insurance. You’ll be treated as though you have health insurance coverage if:
  • For at least 330 days of the year, you live outside of the United States and maintain a tax home outside of the United States
  • You are a resident of Guam, American Samoa, Northern Mariana Islands, Puerto Rico, or the US Virgin Islands, and you don’t have a closer connection to the United States or a foreign country than you do to the US possession where you’re claiming residency.
If none of those things applies to you, but you don’t want to owe the penalty tax, your best bet for avoiding it is to get health insurance coverage.
If you’re unemployed or can’t get health insurance through your employer, your next best option is to try your state’s health insurance exchange. All of the health insurance plans sold through the exchange will meet the rules for minimum coverage. The exchange will also check to see if you’re eligible for any subsidies or tax credits to help you afford coverage, and apply those credits before you have to pay for the insurance.
Before you shop for health insurance at your state’s health insurance exchange, learn how to pick the health insurance plan that’s the best fit for your healthcare needs and your budget in, “Before You Buy Health Insurance—What You Need to Know When You’re Shopping for Health Insurance.”
If you don’t qualify for a health insurance exemption, you’re not living abroad or in a U.S. possession, and you’re not going to get health insurance before January 1, 2014, then you’re probably going to have to pay the shared responsibility penalty. “How Much Is the Health Insurance Penalty for an Individual?” and "How Much Is the Health Insurance Penalty for Families?" will help you figure out how much you’ll owe.

When is the best time to buy life insurance? Probably not when you think….

When is the best time to buy life insurance? - One of the more frequent questions surrounding life insurance is ‘When is the best time to buy?’ As a fee-only financial advisor, I no longer sell life insurance but was previously licensed to sell life insurance in all fifty states.  I am also a Chartered Life Underwriter (CLU) which is the highest-level designation available in the life insurance industry.
My experience with clients and prospective clients has been that people usually wait to purchase life insurance until they feel they need it. This ‘need’ usually involves a life event such as getting married, having children, or losing a job.  While this approach is beneficial in that you are not paying for coverage before you feel that you need it, the big drawback is that when you do decide to get coverage it is typically more expensive than when you were younger and you run a higher risk that you could be placed in a substandard rate class or denied all together. 
A past client’s story is illustrative here.  I worked with a dentist who was diagnosed as a Type I diabetic in his late twenties.  The good news is that he bought a little bit of coverage in dental school - the bad news is that it wasn’t enough to cover a growing income, a wife who didn’t work outside the home, and three young children.  While he was still insurable, the dentist had to pay substantially more in premiums than he would have, but for the diabetes.
Rather than the ‘wait until you need it’ approach, my contention is that you should buy a policy as soon as practicable.  For most people, this means when you get your first full time job after completing your education.  While insurance companies will typically write policies on children or college students, underwriting often imposes restrictions on both the type of policy that can be purchased as well as the size of the policy.
As you shop for life insurance, here are a few things to keep in mind:
  1. Buy more coverage than you feel you need, especially if you see things like buying a home and starting a family in the future.  Term insurance is very inexpensive for someone purchasing in their twenties.  You do have to jump through some hoops such as having a blood draw, giving a urine sample, and providing your medical history. If you’re going to go through these steps, you might as well buy a large enough policy to last you for a while, rather than one you’ll have to replace in a couple years (and go through the underwriting process all over again).
  2. If you’re healthy and a non-smoker, it might be cheaper to buy a stand- alone policy than to take it as an employee benefit.  It is common to take life insurance from your employer as an employee benefit because it is as easy as checking a box during open enrollment. Also remember with employer policies, is that they usually go up in price every five years.  What’s cheap now becomes more expensive, especially when you enter your 40’s and 50’s.  The final thing to keep in mind on this point is that a policy that you buy on your own will stay with you, regardless if you change employers or become self-employed.
  3. While each life insurer prices and underwrites their policies a little differently, in general terms the cost of waiting is a slight increase in prices up until age 35. At the 35 the premium increases become noticeable, and at 45 those increases will be even greater.  As such, the cost of waiting until your mid 30’s to buy life insurance is not so much based on age, but on a greater chance that the rate classification you’ll be eligible for won’t be as good as one you would have qualified for at a younger age. This can be due to things such as weight gain, higher cholesterol levels, having a medical condition, or having a parent or sibling be diagnosed with a serious medical condition.
  4. Make sure that any Term policy you choose has good convertibility options. Most term insurance now is what’s referred to as ‘level’ term coverage – meaning that the monthly premium will stay the same for however long a term is chosen when the policy is initially purchased. At the end of that level term, you can either:
    1. Drop the policy altogether if you no longer need coverage
    2. Pay the astronomical renewal premiums for a term policy
    3. Apply for a new term policy, based on your age and your health at that time
    4. Convert your policy to a permanent, cash value policy.  The benefit of converting to a cash value policy is that it locks in the rate class you were at when you originally purchased the policy, even if your health has deteriorated.
  5. A good resource to check out term life insurance pricing is www.Term4sale.com.  I’ll post another time on places to buy life insurance from.
While this posting primarily discusses term insurance, I’m planning on including future postings to include a discussion of when to opt for permanent insurance instead of term.

Should I Buy Life Insurance On My Children?

Even though I’m a fee-only financial advisor who doesn’t benefit either directly or indirectly from my clients purchasing any type of insurance, I’m a big advocate of purchasing life insurance on your children. I’m also disturbed about the amount of bias and inaccurate information floating around. The prudent, responsible thing is to always carry enough coverage for a child’s funeral expenses. Also, if you’re in a good place financially by not having consumer debt and being on track for your retirement, it also makes sense to at least consider using a policy as an accumulation vehicle.  In case you’re wondering, yes, I carry life insurance on my children that is very similar to what I recommend here.
Let’s start by looking at some of the big reasons that you’d buy coverage.
At its most basic level, the purpose of life insurance is to indemnify you for the financial expenses of a child passing away. While there is another view that holds you should only buy life insurance to replace lost income, this ignores that there are economic losses incurred in addition to a loss of income. It has become standard practice to buy life insurance on non-working spouses when you have minor children, why should you not buy insurance on the children themselves? Consider the following:
  • Final expenses can easily top $10,000 once factors such as casket, grave site, memorial, and funeral costs are factored in. Do you live in a place other than where you’d want your child buried? If so, have you factored in this additional cost to your planning. Are you in a position to write a check for this? If not, how would you come up with the money if the unthinkable were to happen?
  • Time off of work. Speaking for myself, if I lost one of my sons, you wouldn’t see me back at work tomorrow.  While I’m fortunate in that I have wonderful clients and love my job, it’s difficult to say how long it would take me to get back in the saddle. How much vacation time do you have? Does your employer allow other employees to donate sick or vacation time to you if tragedy should strike?  While the hit TV show Breaking Bad adds a dramatic spin to what can happen at work if you are grieving, it also underlines the fact that there are better places to grieve than at work. Would you have the ability to come back to work on your terms or would you have to go back for financial reasons?
  • Counseling. No two ways about it, you and your family will need counseling if a child dies.  What sort of mental health benefits does your health insurance have? Are you positive that those benefits will be enough to cover the need?  If not, are you in a position to pay out of pocket?
  • Replace money spent on education. I’ve had clients get angry at me for bringing this topic up, but it still need to be discussed.  College is an investment, but what happens if the student dies before the money that is spent on education is recouped through higher earnings?  Yes, this is a very steely eyed way of looking at the world.  Any federally-guaranteed student loans will be forgiven, but anything that you pay out of pocket or from a 529 plan will be ‘lost’.
  • Charitable intent. I’m tearing up as I write this, but the biggest way that I would honor my child would be to use their memory to bring as much happiness into the world as I could. This is a luxury that might not be affordable without life insurance.  We’ve had two friends who have lost children to rare medical conditions and the charitable works done in that child’s name make the world a better place and have helped friends and family with the grieving process.
A second big reason to buy a policy on a child is to lock in future insurability.  Once a life insurance policy is underwritten and put in force, it will stay in force regardless of changes in the child’s medical condition.  And as I’ve written before, the younger you are typically the better your health is.  By buying life insurance on a child, you won’t have to worry about the following items:
  • Developing an adverse medical condition that makes coverage more expensive, if it doesn’t render the child uninsurable. The classic example is juvenile diabetes – most insurers won’t ever insure you if you have juvenile diabetes and were diagnosed prior to age 10.  Another common teenage medical issue that has a long standing impact on insurability is depression and the use of anti-depressants.
  • Drug or tobacco use. Tobacco use won’t render you uninsurable in most cases, it will just double the rates that you’ll pay. The impact of drug usage will vary from carrier to carrier.  Marijuana use will typically put you in a higher rate class and might render you uninsurable depending on frequency and recency of use, while using harder drugs can make you permanently uninsurable.
  • Avocation factors such as being a private pilot or extreme sports. Both of these will affect rates and possibility insurability if a policy is purchased as an adult. Insurers will even consider scuba diving to have an increased mortality rate depending upon how deep you dive.  If coverage is bought on a minor, these types of activities are immaterial.
  • Family history. I hesitate to even include this as it doesn’t affect a minor’s insurability, but it will have an impact on an adult’s rate class. Different carriers view this differently – some only want to know if a parent died before a certain age of a certain cause such as cancer or heart disease. Other carriers are looking for any incidence, even if non-fatal, and at any age and in any immediate family member including siblings.
  • Most people in their 20’s won’t buy life insurance no matter what. As I’ve mentioned in other postings, the best time to buy life insurance is long before you need it, typically as soon as you can.  The problem is that most people in their twenties think that they are invincible and usually wait to buy a policy until their 30′s when they start having families and appreciate their own mortality a little more. The biggest impact to waiting is not that rates will go up based on age, but that you’ll be less likely to qualify for a preferred rate at age 35 as opposed to age 25.
The third reason to buy a policy is that it makes an attractive accumulation vehicle:
  • Preferential tax treatment in that cash values grow inside of a policy tax free and death claims will be paid out tax free in most cases.  There are limits to what how much you can pay in premiums into a policy and when you can pay in those premiums.  Any policy that has too much paid into becomes a Modified Endowment Contract (MEC) and loses some of its tax advantages.
  • A source of liquidity. You can borrow against a life insurance policy’s cash value without a credit check or paying taxes but be aware that the loan might affect the policy’s longevity.  Also, you can withdraw what you’ve paid in premiums tax free and pay income tax only on gains if you choose to surrender the policy.
  • Compound interest. Everything else being equal, the longer you have money working for you, the more you’ll ultimately have. The key to building wealth is to start saving early enough where your assets will have a chance to fully utilize compound interest. Unlike a college savings account or retirement plan that has a 20-30 year life span, a life insurance policy can stay in force 80 years or longer!
  • Ability to get higher yields, and a vehicle that will behave well in a rising interest rate environment.Even though interest rates have come up from all-time lows in the early part of 2013, CD’s, money markets, and savings accounts are still paying miniscule amounts.  A life insurance company invests its premium dollars in long term bonds to get better yield and then also places some guarantees on the cash values so they are not subject to market or interest rate fluctuations. As a result, rising interest rates work in your favor as the cash value of a policy earns a higher rate of return without losing like value like individual bonds or bond mutual funds do. Right now policies are earning around 4.5% and have done even better historically.
  • Watch out for fees. The access to a higher earning vehicle doesn’t come without some costs however.  You have to pay for the cost of insurance, various administrative fees, and possibly commissions. Some policies also have surrender charges which limits your ability to extract cash value if you decide the policy is not for you and want to surrender it. Before buying a policy work to understand what your policy charges and how this affects longevity and performance. Universal and Variable Universal Life policies do a much better job of breaking out policy costs where Whole Life products are a black box in that not much is disclosed about their internal cost structure.
  • Possible preferential financial aid treatment. I’m aware that cash value has been sold as an alternative way of paying for college, but as mentioned above watch out for the fees.  It will definitely be more expensive than a low-cost 529 plan. The other thing to keep in mind is that while the FAFSA doesn’t factor in life insurance cash values among other things, more and more private colleges and prestigious public schools are using the CSS PROFILE which does. If your child is under age five there is no telling what financial aid officers will look at by the time your son or daughter reaches college.
  • Ability for the parent to control the policy past the child’s 18th birthday. There are three parties to a life insurance policy: the policy owner, the named insured, and the beneficiary.  What typically happens is that the parent will buy the policy and be the owner and beneficiary and the child will always be the named insured.  The policy owner always has the right to change the beneficiary at any time for any reason and the policy owner can also be the owner indefinitely – it’s not like a UTMA/UGMA custodial account that technically becomes the child’s property at the age of majority. What I advocate doing is not giving your child ownership of the policy at age 18 as they will probably surrender the policy and take the cash value and do something stupid with it.  Instead, I advocate not even telling your children about the policy and then giving it to them as a wedding gift or when they have their first child and are more likely to appreciate what they have been given.
How do I buy life insurance on my child?
There are three ways of getting life insurance on your children, I’ll list them here in increasing order of desirability.
You take it as employee benefit if offered by your employer.  A lot of times, I’ll see employers offer between $10,000 to $15,000 for free or minimal cost and you will have the ability to buy a little more, typically no more than $25,000 in total coverage. Coverage of this amount will pay for final expenses but it won’t leave money for anything else that needs to be taken care of. There is little, if any, underwriting done on this type of coverage. Often, you have to proactively opt-in to this employer coverage, as it doesn’t automatically cover your children. Make sure that you have opted in!
You can add your children as a rider to an existing life insurance policy that you own.  This will be a little more expensive than employer offered insurance although it can cover all children for one price so if you have more than four kids it can actually save you money.  There will be some underwriting, but that underwriting usually consists of broad health questions. The advantage with any type of privately held policy is that it is portable, meaning that it stays with you regardless of what your employment status is.  Child riders are typically in the same range as employee benefit coverage, $10,000 to $25,000 per child, but they frequently include the ability to buy coverage on the child over and above this amount at a later date regardless of medical condition.
Finally, you can purchase a stand-alone policy on the child.  Broadly speaking, you can buy a policy with a face amount between $25,000 and $500,000, while most people opt for between $50,000-100,000 in coverage. Typical pricing for a $50,000 – 100,000 policy is between $50-100/month depending on the child’s sex, age, and if you intend to pay more for a shorter time period. You can get a policy for as little as $20/month for a smaller policy on a young child. Underwriting is a little more in depth than on a stand-alone policy but no blood work or urine sample is needed.
What types of policies are available on children?
Life insurance comes in two forms: term insurance and permanent insurance.  Term insurance does not build any cash value and only lasts for a fixed number of years, usually no more than 30, before it disappears. Term insurance is not sold on children as it would run out in their peak earnings years and also due to company pricing constraints – it costs more to underwrite and service a policy than a company could collect in premium. 
The other type of life insurance policy is a permanent, or cash value policy. These types of policies come in different shapes and sizes which I’ll get to shortly, but the big differentiator is that they can accumulate a cash value and can also last a lot longer.  Currently, for new policies, every insurer that I know of is using the 2001 mortality table that projects life expectancy out to age 120 and it is possible to structure a cash value policy to provide coverage up to that age as well.
One type of permanent policy is a whole life policy.  A whole life policy is a fixed-premium policy, meaning that the premium you are committed to pay has little, if any, flexibility.  When premiums are paid into a whole life insurance policy, part of the premiums pay for the death protection (technically known as cost of insurance) and the other part of the premium is added to the policy’s cash value and invested on your behalf by the insurance company.  The thought behind a whole life policy is that over time, there is more and more cash value in the policy so there is less pure insurance to buy as the insured becomes older and the cost of that insurance is more expensive.  For instance, if I buy a $100,000 whole life policy on my one year old son there will be no cash value to start with but at age 30 it might have $30,000 in cash value, and at age 50 it might have $50,000 in cash value.
Whole life policies can either be participating or non-participating.  A participating policy means that if the company makes more money on their investments than they predict or fewer insureds die in a given year, some of those excess earnings are returned to policy owners in the form of dividends. A non-participating policy means that the company’s earnings are immaterial – the policy’s premium is cast in stone at the time the policy is taken out.  Typically mutual companies are the only companies who sell participating policies.
There are two things to keep in mind with participating polices. The first is on participating policies, the policy is illustrated with and funding levels (called target premiums) are determined based on an assumed interest rate, not a guaranteed interest rate. For instance, a policy might guarantee three percent earnings on cash values, but it can be illustrated at earning five or six percent. If the policy earns less than is assumed in the illustration your cash value won’t be as high as in the illustration and you might have to pay more in premiums down the road.
Second is that the policy owner on a participating whole life policy has a choice on how to use the dividends paid by the policy.  There are several options but two of the more typical are premium reduction and to buy paid-up additions.  Premium reduction means that if your target annual premium is $1000/year and the policy pays a $300 dividend you only have to come up with $700 out of pocket to pay the premium, the other $300 is covered by the premium. Buying paid up additions means that you use the $300 in this example to buy additional coverage that requires no further premium payment.  Neither option is inherently better than the other – paid up additions are better if you’re trying to grow the death benefit and cash value while reduction of premium is better for people who are trying to minimize out of pocket costs.
The second type of permanent life insurance policy is a Universal Life (UL) policy. In some states, UL is called “Flexible-Premium Adjustable Life Insurance”. The biggest thing with a UL policy is that it has flexible premiums, meaning that to a certain degree you can control how much goes into a policy and when. On a UL policy, any money paid in as premiums will have a little money deducted up front for things such as premium taxes and possibly sales commissions, the remainder will be added to the policy’s cash value and invested with ongoing expenses of the policy such as administrative charges and the cost of insurance deducted from the policy’s cash value.
There are some more moving parts with UL policies, however. A subset of UL policies are called Variable Universal Life (VUL) policies.  Let me explain the difference as plainly as I can.  In a standard UL policy, the cash value is invested for you by the company and you earn interest at varying rates.  The cash value is guaranteed against investment loss (however the cash value can still go down if the ongoing expenses of the policy are greater than the interest earned) and there is also a minimum interest rate that the policy will earn. As I write this in August 2013, most UL policies are paying in the neighborhood of 4-5% with guaranteed minimums on new policies of 1-3%.  The guaranteed minimum stays in force for the life of the policy and has been trending down with lower interest rates.  There is no ceiling on what a UL policy will earn, but interest rates are closely tied to what long term bonds earn so don’t expect it to perform like the part of your portfolio that’s invested in stocks and stock mutual funds.
A VUL policy on the other hand has some choices about how the cash value is invested.  In addition to a fixed sub-account which is invested by the life insurance company just like in a UL policy, there are also variable sub-accounts which carry investment risk and can invest in stocks, bonds or a combination of the two.  Most sub-accounts are managed by differing mutual fund companies but have a life insurance ‘wrapper’ around them. Allocating part of your cash value to one or more variable sub-accounts can give your policy the potentially earn more, but it also means that the cash value can go down. Like all investing, the more risk you take, the higher your highs will be but also the lower your lows will be as well.
The big danger with having money in the variable sub-accounts is that when the markets are down, more shares of the variable sub-account has to be sold to pay the policies ongoing expenses which could affect the policy’s long term viability.  Unlike investing for a far off goal like retirement where you can just let a losing investment sit and wait for it to recover, a VUL policy is always consuming money, either in the form of new premium being paid in, earnings on the cash value, or sale of sub-account shares. Stated another way, ongoing policy costs can force you to ‘sell low’ if there isn’t additional premium money being paid in.
The other big decision on any type of UL or VUL policy is choosing the death benefit.  Most policies will give you two ways of structuring a policy: as an Option A or level death benefit; or as an Option B or increasing death benefit.  Assume that you have a policy with $50,000 in cash value and a $1,000,000 face amount. Just like a whole life policy, the Option A policy will just pay out the face amount ($1,000,000), regardless of how big the cash value is while an Option B policy will pay out both the cash value ($50,000)in addition to the face amount ($1,000,000).
Since the amount of pure insurance on an Option A policy decreases as the cash value grows, it’s best for people who want to pay policy premiums in small amounts out of monthly cash flows. Option B coverage on the other hand will always have $1,000,000 in pure insurance coverage regardless of how big the cash value is, making it more expensive to own and a better choice for someone who wants to pay in policy premium in big chunks. An important point to note is that all insurers require evidence of insurability to move from an Option A to an Option B policy since the insurance company will be taking on more risk, while not every company requires evidence of insurability to move from an Option B to an Option A policy.
Okay, you’re still with me.  You see the need to have some coverage on your child and the benefits to buying a stand-alone policy for that child.  The question now becomes: what should you look for when buying a policy? Here are some things that you should keep in mind:
  • Financial strength of the company matters. It the policy is held until the child’s death, it could be in force for 70-80 years or longer.  While life insurance is a highly regulated industry and all companies have to meet minimum financial requirements, life insurance companies have been known to fail. You want to make sure that your insurer will be around for the long haul.
  • Make the policy as big as you can.  Even though the death benefit amount might seem excessive now, remember that inflation will reduce the purchasing power of that death benefit over time. The other reason to buy a big policy is that since mortality rates are so low for juveniles, a large proportion of premiums go to pay fixed administrative and overhead expenses. Buying a larger policy will spread these fixed expenses out more.  Some policies do allow you to buy more coverage on a child down the road through a future insurability rider, but my opinion is that it’s better to buy a bigger policy off the bat as there are limitation as to when you can exercise the option to buy more insurance and it becomes more expensive to buy additional coverage the older the child becomes.
  • If at all possible, overfund the policy.  Overfunding means that you are paying more into the policy than is needed to keep it in force. That excess premium gets added directly to the cash value in the case of UL or buys paid-up additions in a Whole Life policy and, in turn, the cash value will then earn more. The Holy Grail with any permanent life insurance policy is to have the cash value become large enough where the earnings on the cash value are enough to pay for all of the policy’s costs, essentially making the death benefit free. The IRS does limit how much can go into a policy based on the insured’s age and sex so make sure that you check with your agent or the insurance company to know what this number is.
  • Have your child go through full medical underwriting as soon as they turn age 18. As mentioned earlier, unlike adults who require a blood draw and a urine sample to get coverage, on children the underwriting is much simpler.  As a result, companies often will put children in their own rate class.  This rate class is better than the rates that a tobacco user or someone with medical issues will get but not as preferential as the rate structure for someone who is healthy and goes through full underwriting.  There is no cost for you to do the underwriting and there is no risk that the policy gets up-rated, as once a policy has been in force for more than two years it becomes uncontestable on medical grounds.
  • Make the policy as flexible as possible. It’s impossible to predict everything that will happen in your lives, the financial markets, and interest rates for the many years the policy will be in force.  What might make sense now might not make sense twenty years from now. As an example of keeping a policy flexible, if you decide to go with a UL policy as opposed to Whole Life, I’d urge you to buy a VUL even if you have no intention to use the variable sub-accounts for the foreseeable future.
  • Bring in a fee-only financial advisor or fee-only insurance consultant.  Yes, I’m highly biased on this point, but hear me out.  Life insurance is a very opaque topic to begin with and most knowledge is concentrated in the hands of people who sell it for a commission. Additionally, a lot of the best carriers only sell directly to the public or through captive agents so it’s difficult to get information on all the options that are available. A fee-only advisor can give you an objective opinion on how much coverage to buy as well as what type to buy. Additionally, they will have relationships with commissioned agents and direct to consumer companies to make sure that you’re working with someone who has your best interests at heart and you aren’t taken advantage of.
  • Design your policy based on what you’re trying to accomplish and how you’re going to fund it.  There are different ways of designing policies based on having the largest possible death benefit as opposed to maximizing cash value growth.  The other factor to keep in mind is funding – how much are you planning to put in and for how long?  Are you going to pay premium out of existing assets or monthly cash flow? All of these questions will help focus on designing a policy that’s right for you.
Where does child life insurance fit in big picture?
In summary, the prudent, responsible thing to do is to carry some sort of coverage on your children. Insurance is the perfect way to protect against events with a low probability of occurring but with a devastating impact if they do happen.  If you are on track for your retirement goals and find cash building up in your bank account, I’d encourage you to look at using a policy as an accumulation vehicle as well. Be sure to keep an eye on the internal policy fees though!


Higher-Cost Obamacare Plans Don't Guarantee More Choice

Higher-Cost Obamacare Plans Don't Guarantee More Choice

The number of in-network hospitals on health plans in California is often unrelated to monthly premiums.


------------------------------------------------------------------------------------------------------------

A U.S. News analysis of health plans currently available on California's new insurance exchange found little correlation between the monthly price a consumer pays for a plan and the number of hospitals in the plan’s network. The findings indicate that, with careful selection, it’s possible for most Californians to buy an Obamacare plan that offers some freedom in choosing a hospital without paying top dollar in monthly premiums.
U.S. News examined so-called qualified health plans in the silver tier of the CoveredCalifornia exchange, using network data that was previously available on the exchange website. (It has since been removed.) The goal was to determine whether consumers who purchase a lower-priced plan tend to be restricted to a narrower hospital network. U.S. News compared each plan to others offered in the same rating area; California's regulators have divided the state into 19 rating areas that in many cases include several adjacent counties.
In almost every California rating area, the analysis revealed, at least one mid-priced health plan rivals or equals the most expensive plan in terms of network breadth. In Contra Costa county, for example, the networks of three different plans – Blue Shield’s PPO, Contra Costa Health Plan’s HMO and Health Net’s PPO – include five of the nine hospitals in the rating area. In each case, four of those hospitals, including the two that perform best on the quality measures U.S. News uses to evaluate hospitals, are in all three networks. But the plans charge very different rates. A 21-year-old nonsmoker who doesn't qualify for a federal subsidy and who opts for the most expensive plan, Health Net’s PPO, will pay $434 more per year in premiums than an identical individual who purchases the Contra Costa HMO, and $658 more per year than an identical Blue Shield PPO customer.
"Sometimes," says Gerald Kominski, director of the UCLA Center for Health Policy Research, "you just pay more" – without necessarily getting access to more providers. Kominski reviewed the U.S. News results.
Premiums (gray, for a 21-year-old nonsmoker) for Obamacare plans available in Contra Costa county, Calif., have little correlation to the percentage (blue) of the county's nine hospitals that are in each plan's network within the rating area.
Premiums (gray, for a 21-year-old nonsmoker) for Obamacare plans available in Contra Costa county, Calif., have little correlation to the percentage (blue) of the county's nine hospitals that are in each plan's network within the rating area.  
Differences in monthly premiums may in part reflect the rates negotiated between different insurers and their respective providers, such as hospitals and doctors. “Certain plans are focused more on hospitals and other plans are focused on physicians,” says Jeff Rideout, a senior medical advisor to CoveredCalifornia. U.S. News was unable to obtain reliable data on doctor networks.
Provider networks may be a more important source of plan-to-plan differences in California than elsewhere, because California regulators don't allow for significant variation in cost-sharing structure amongst plans of the same metal tier. But insurers, which often maintain online provider directories, rarely make network information public in ways that facilitate comparisons among different insurers' plans. That means the tedious task of comparing networks falls squarely on consumers. 
The challenge of this task was recently addressed in a letter by the Centers for Medicare and Medicaid Services, which proposes that for 2015, insurers submit a list of "hospital systems" and other providers to CMS so the agency can determine whether each network provides "reasonable access" to providers. The letter also says that CMS is looking into how to create  "a search engine function for consumers to search for providers." 
The current lack of transparency makes the task of identifying which doctors and hospitals are in a plan’s network time-consuming and challenging – even in California, where at one point, the exchange made plan provider listings public. CoveredCalifornia recently took down the files after finding errors in the doctors lists. UCLA’s Kominski says consumers must be able to compare provider networks if they’re going to make an informed choice when they’re picking a health plan. “How can you expect people to shop between five and fifteen different bronze plans unless you know which doctors and hospitals are in the networks?” he asks.
“We don’t know if a narrow network is a good or bad [network],” Kominski says. ”What really matters is: ‘Is my doctor or hospital in my network?’” Making an informed choice, experts say, is especially difficult for exchange customers who are first-time buyers. In a recent Kaiser Foundation poll, a little over half of those likely to purchase an Obamacare plan would choose a plan with a narrower network over one with a higher monthly premium. But when respondents were asked whether they'd still prefer a cheaper, narrower network if it excluded providers "they normally use," approximately a third changed their minds.
Network size arguably matters less than the quality of the hospitals and doctors in it. In a follow-up analysis, U.S. News found that broader hospital networks are more likely to include hospitals that excel on the kind of quality measures, such as patient safety scores, that underpin the U.S. News hospital rankings. But there are exceptions, so narrowness cannot be equated with poor quality. While the U.S. News methodology focuses on high-acuity patients rather than average health care consumers, it offers a basis for objectively comparing hospitals on different networks.
Consumers, says Stanford University economist Alain Enthoven, shouldn't let themselves be fooled by a high sticker price. “I do think the average consumer thinks higher price is somehow better.” Down the road, he says, the goal is “to make it so easy [for consumers] to make a choice that people don’t worry about the fine print.”
TAGS: health insurance hospitals insurance Affordable Care Act health care reform California.