Health Insurance: Making Progress!

Our journey towards obtaining health insurance continues. I’m happy to report that Mr. FireDesired and I have health insurance coverage that will start on April 1. Insurance for our two kids is still pending because they’re not eligible for the GetCoveredNJ marketplace. However, things are progressing for them, and we need to be patient. Our kids are potentially eligible for CHIP and our application to NJ FamilyCare was automatically initiated after we applied to GetCoveredNJ. I’ll discuss some of our experiences in this post.

Health Insurance for the Parents

In my last post, things weren’t going so swimmingly. We were having trouble avoiding a gap in coverage, and the customer service representatives this past week at GetCoveredNJ were giving me some inconsistent information.

In the end, I was able escalate our start date issue and ultimately get it resolved. We’ll have health insurance in April, and I’m so happy about that! Some take-aways for me from the process include the following:

  1. You can’t always trust the first-line customer service representatives at GetCoveredNJ. They seem to be right only half the time. One representative in the past week told me that I couldn’t get an earlier coverage start date because I hadn’t yet submitted our income verification documents. In reality, I had 90 days to submit them. Another representative told me that 15th of the month was some magical cut off that prevent changing the start date. (It wasn’t.) If something doesn’t seem right, politely end the call and try again.
  2. Be persistent in talking to a supervisor if you need to check on an escalated issue. First-line reps don’t have access to any tickets regarding escalated issues. They can initiate a ticket escalation, but they’re unable to check on tickets that were created by other first-level reps. I had to go through multiple first-line reps before one would transfer me. One of them said I had to wait at least 72 hours, even though another rep the day before said that it would be taken care of by the end of the business day. (It wasn’t!)
  3. In spite of the frustration, trust the system. The folks at GetCoveredNJ want to help, but sometimes they don’t have the tools to do so. Be ready to be persistent and keep trying. Know that you should eventually get to a rep that can and will help.

Estimating Income For GetCoveredNJ

Estimating our income was part of the application, but we weren’t exactly sure how to do this, and we’re still not sure we did it right. We found this link related to how to estimate income for, so we started with that and just did our best. We entered the following as our estimates for 2021 income in the application:

Income Estimate GetCoveredNJ March 2021

The rent looks low because, after depreciation, we don’t usually make much on paper. This year, we even had a repair that will probably lower that amount even further the next time we file our taxes. The Job indicates what we expect to be Mr. FireDesired’s income before stopping work. The Investment income comes mainly from CDs, low-interest checking and savings accounts, and dividends from our brokerage accounts. Finally, the Self-Employment amount is almost made out of thin air. Some of it is from ad revenue paid out of a hobby site. The bulk of it is from contract work that Mr. FireDesired may or may not get this year. If he doesn’t end up getting it, we plan to start our Roth Ladder early, and convert an amount that brings our annual income close to what we estimated.  

Even if we do find a difference in our reported income vs. reality, we can update our information through the GetCoveredNJ dashboard. We may have to pay higher or lower premiums accordingly, but I feel better knowing that this option is there. It’s hard estimating income, especially if some of that is through self-employment.

income verification for getCoveredNJ

Another part of the application process is verifying our income. Until you do this, all enrollments are marked “pending” or “conditional”. We planned to submit a few items to prove our income, but we didn’t need all of them in the end.

We submitted three documents via the GetCoveredNJ dashboard:

  1. Our 2020 joint 1040 federal tax return.
  2. The current pay stub from Mr. FireDesired. (We expect one more in April, so this is the second to last one.)
  3. A letter from the HR department of Mr. FireDesired’s soon-to-be former place of employment stating that employment will end on March 31 and that all of our health coverage will end along with it.

I had planned to submit at least two more documents later on, including the final pay stub. Instead, we received notification later in the day via email that the documents had been accepted. When I logged back in to check, I found that the upload link had disappeared. Also, the “conditional” and “pending” statuses had either disappeared or switched over to “enrolled”.

picking a package for GetCoveredNJ

The image up at the top shows that we ultimately chose Horizon as our provider at a premium of just under $200/month for both Mr. FireDesired and myself. Even when we were insured through Mr. FireDesired’s place of employment, we never knew what to choose during annual enrollment. For us, we feel like it’s the luck of the draw. Some plans have higher premiums for lower deductibles. Some plans have lower premiums for higher deductibles. In the past, we haven’t used health insurance much beyond routine check-ups, so we went with this one.

Our income projection on the health insurance application came in just below $55,000. This got us subsidies from both the federal and state levels of about $615 in total. The $815/month premium got reduced to $200/month. I definitely wasn’t expecting that when I was planning for FIRE. I always assumed that we’d spend at least $500 or more for health insurance per month. I was wrong, and I’m glad about it.

We did end up also adding $40 for dental. So, our monthly premiums will be about $240.

Other Loose Ends for the Parents’ Insurance

Some final things left for us are the following:

  • Wait for the actual insurance cards. We can see our ID number from the dashboard, but the cards will make it easier when we finally start making doctors’ and dental appointments again.
  • Double-check payment. During this process, with all the calls to GetCoveredNJ’s customer service, we made multiple changes to our enrollment, application, etc. We called Horizon to make sure the amount we already paid would be applied to the correct account. So far, things look good, but we need to wait until after coverage starts before we can create an online account through Horizon’s website to view our account and monitor our billing. I found out there’s also a 30 day grace period for the first month’s payment. Hopefully, things will be smooth on this front, but we’ll have time to sort it out if it isn’t.
  • Pay for dental. We still haven’t gotten any correspondence from the dental insurance. We’ll have to wait on that.
  • Automate the bills. Once the dust settles, we’ll need to automate payment if possible.

Health Insurance for the Kids

As I mentioned before, we found out in this process that our kids weren’t eligible for insurance on the GetCoveredNJ marketplace. Instead, we would need to insure them through CHIP via NJ FamilyCare.

The process for this is unfortunately out of our hands. No matter how many reps I call at NJ FamilyCare, they are consistent about this. We need to be patient and wait. Once we applied for GetCoveredNJ, our information took about 4-5 days to get to NJ FamilyCare.  There was nothing I did on my side to apply in addition to the GetCoveredNJ application. The most I could do was call their automated system to check on whether or not our SSNs and DOBs were recognized.

At this point, our application is still being processed. If they need more information from us, they’ll call us at the number we left in our GetCoveredNJ application. Once a decision is made, we’ll receive a letter in the mail. If all goes well, a case worker will be assigned to us. Standard processing time for all of this at NJ FamilyCare is roughly 45 days. Once we do get insurance for our kids, it’ll be back-dated to April 1st. (They actually said March 1st because we applied in March. We’ll see.)

I’m not sure what happens in the worst case scenario — if our kids need to see a doctor during this transition period and we’re ultimately denied coverage. I think we still have COBRA as an option, but we’ll have possibly wasted some of the insurance premiums we’ve already paid. I’m really not sure.

As of today, though, we have no reason to believe that we’ll be denied coverage for our kids. According to

“Children with household incomes up to 350 percent of poverty are eligible for CHIP in New Jersey.  This is one of the most generous thresholds in the country.”

According to their site, NJ FamilyCare covers the kids in families of four even with income over $90,000. That’s way more than the $55,000 we’re projecting for us this year and the $50,000 going forward. In general, it seems like NJ is a great state in terms of making sure kids’ health are taken care of. The maximum premium per family is $150/month, which covers both medical and dental. At our income level, we expect to pay about $50/month. I was originally expecting to pay more per month to insure my kids when planning for FIRE, and I was again surprised to find out otherwise.

our Journey continues

In total, we now estimate our health insurance costs to be about $300/month for the whole family.

All in all, things are looking good, but we need to be patient for our kids’ insurance. I’ll update once we have more progress. 

Since we’re waiting anyway, the next goal that I’m thinking about tackling is our asset allocation for the next few years.