Just Your 19th Nervous Breakdown (or 19 tips for buying insurance on the exchange)

Everyone keeps asking me about buying a health insurance policy under the ACA, but really, I’m just like everyone else on this one, scratching my head and trying to make the best deal I can for my family; hoping I don’t screw up and choose the wrong thing!  Besides being a financial planner, I’m also a little compulsive thorough.  so I’ve been doing my homework, calling the exchange, my doctors, the insurance companies, accountants and insurance agents, trying to get answers.

To start with, let me reiterate that ultimately, I favor a single payer solution, but the ACA has so many tremendous improvements over our current system, that I am willing to overlook it’s imperfections, and celebrate it’s triumphs.  

I started by looking at our potential healthcare spending.  Now that all preventative services are covered at 100%, my husband kids and I will have to pay nothing for annual checkups, vaccines, mammograms, pap-smears, and all kinds of other things that used to cost a lot of money.  Also, I’ve learned to go to Urgent Care centers instead of ER’s whenever possible (my 8 year old son made 2 trips to the ER last year and the bill was crazy!).  So really, I want to not have to pay a fortune if I do have to go see a doctor, and I want to make sure that if one of us is in an accident or gets cancer, the bills aren’t the thing that kills us.   We currently pay about $1,100 a month for really skimpy coverage, so my goal is to somehow pay less in monthly premiums AND have better benefits, if at all possible.

Instead of long prosaic paragraphs, I’m just going to give you a list of things I have learned about all this that you might find helpful.

1. If you are self employed in some way, run all the expenses you legally can through your business, and you may very well qualify for some government subsidies, which will reduce your monthly premiums (especially if you have kids).

2. Have kids (they will help you qualify for subsidies).  Also, maternity is now covered by all policies.

3. you don’t have to buy a plan on the exchange, but if you buy a non-exchange plan, you can’t get subsidies, so you have to pay the entire premium no matter how much you make.

4. You don’t have to buy exchange plans on the health insurance exchange website!  You can buy it through an insurance agent who has gotten certified to sell exchange plans.

5. Applying for coverage is a breeze.  For anyone who remembers applying for private health insurance in the past, where you had to fill out pages and pages of embarrassing details, it’s pretty great to only have to give your date of birth, social security number and zip code. no one can be disqualified for a preexisting condition.

6.  ALL the health insurance plans now sold MUST cover certain services considered preventative at 100%.  No matter which plan you buy, you get a free annual check up, free vaccinations, and free cancer screenings.  That means that all those premiums you pay are going to actually pay for your service, rather than just part of it.

6. Bronze level plans are the cheapest, but after the free stuff, you have to hit the $5,000 deductible before your insurer pays 60% of your bills ($10k if you’re a family). Your out of pocket max is $6,350 for an individual, and $12,700 for a family, so you’re paying 40% of the costs between the $5,000 and $6,350  or between $10,000 and $12,700 for a family, and then you pay nothing after that.

7. Silver plans cover 70% of the expenses between the $2,000 deductible and the $6,350 out of pocket max ($4,000 and $12,700 for families) BUT, unlike the bronze, lots of services are not subject to deductibles.  Doctor visits, labs, x-rays, generic drugs and urgent care visits are all just a straight co-pay amount, but that amount doesn’t go towards your deductible.  Only hospital stays do.

8. Gold plans: No deductible at all!  lower co-pays for everything, 80% coverage of services up to out of pocket max (which is same as bronze and gold plans).

9. Platinum: No deductible, lower out of pocket max, cheap drug co-pays, you only have to pay 10% of your hospital bills up to the out of pocket max.

10. conclusion: If you know you have massive medical issues, and use a lot of medications and services, get the gold or platinum plan if you can because it may turn out to be way less expensive than a lower tiered plan with a lower premium and less benefits in coverage.

11. If you’re a regular person who has no idea how much medical services they may require in a given year, this is all a little ridiculous, but the good news is that your downside is really limited now no matter which plan you get by the out of pocket maximum.

12.  If you live in Los Angeles, you should know that Cedars Sinai isn’t contracted at this point with any insurer except HealthNet.  The UC system and it’s hospitals and doctors are not contracted with Blue Shield.  This may very well change, but take this into account when signing up.  For this reason, I chose Anthem.

13. Call your doctors and ask which exchange plans they’re taking.

14. They’ll probably tell you they don’t know.

15. You can search on the insurer’s websites to see if your doctor is contracted with the exchange plan you want.  

16. Anthem is only selling an “EPO” in LA County, which is an “exclusive provider organization” (EPO), which is smaller than a Preferred Provider Organization (PPO).  On Anthem’s website, anything called “essential” means silver, anything called “core” means bronze, anything called “preferred” is gold and anything called “premier” is platinum.

17. There are a lot of unknowns at this point.  Will Anthem and Blue Shield make a deal with Cedars?  Will more doctors sign up with these exchange plans? Will the state insurance commissioner be granted the authority to regulate insurance premium increases?

18. If you screwed up by signing up for a plan that turns out to be really awful for you, you can change plans next year.

19. Good Luck! (no pressure of anything)

To Be Happy, Is To Suffer

You think you had a bad day?  

You know the answer.  It will be a description of a day far worse than yours.

You know the routine.  It's a competition.  Whose day was worse.  Who suffered more.

And if the other guy's day was worse, do you feel better?  No!  You feel worse, because you lost the competition!  You didn't suffer half as much as the other person, so you deserve less sympathy, less attention, and less love.

But does how much you suffer not only dictate how much love you should receive, but how much you deserve to be paid?  If a person is making a lot of money, but they're also more miserable than you, doesn't that seem fair?  What if they were making more money than you and not suffering?  What if their days were fun an easy and they were making a lot of money?  You might hate them.  Somehow, if they're suffering it's ok.  If a young lawyer works 80 hour weeks and never sees his family, we think it's ok that he makes lots of money.  At least he's suffering.  There's justice.

What if you're both suffering equally, but one of you is getting paid better?  Where's the justice in that?  No, you should get paid in accordance with how much you suffer. Every price must be directly correlated to a measure of suffering.

They have these pay-what-you-want type restaurants now.  There are no prices on the menu, and you just pay what you think the meal was worth.  What if we paid an amount in accordance with how much we think the waiter suffers?  Or the cook?  Because if the cook was having fun, and making lots of money, we might hate him and think he is undeserving.  If the cook said, "You think you've had a bad day?" and followed it with a description of going to a nice farmers' market and having to choose beautiful produce, and then cooking it up into something tasty and wonderful that he really enjoyed making, among a really cooperative kitchen staff, you might say, "Yeah, I did have a really bad day, actually!  In fact I had a much worse day than you did.  Don't think you can compete with my suffering with tales of shopping at the farmers' market, ok? And I'm pretty sure that according to all the generally acceptable ratios of human suffering to income, you owe ME money."

The cook may not pay you, but maybe he'd give you a hug and other loving feedback and support, which may or may not make you feel better.

If you're not making as much money as you'd like, perhaps you need to work harder at cultivating an image of suffering.  Then people will think you're working really hard, and not having any fun at all doing whatever it is you do, and they will pay you more.  

In a bit of free association, this reminds me (as do so many things) of the Woody Allen Film, "Love and Death", and the scene where Sonia (played by Diane Keaton) says, 

“To love is to suffer. To avoid suffering one must not love. But then one suffers from not loving. Therefore, to love is to suffer; not to love is to suffer; to suffer is to suffer. To be happy is to love. To be happy, then, is to suffer, but suffering makes one unhappy. Therefore, to be happy one must love or love to suffer or suffer from too much happiness.”  

Feel better about your misery now?  No? Well at least you can use that displeasure to seem more deserving of a higher income.

Give it Away, Give it Away, Give it Away Now

We are constantly told to be grateful.  We have so much abundance in our lives, and we should be grateful to god, or the universe or other people, for all we have.  And really, if you're reading my blog, you have access to some kind if electronic device with Internet access, and you are literate, so you are probably better off than the vast majority if the world's population. Still, even in the midst of all this abundance, most of us don't feel rich.  Are we just ungrateful, superficial materialists with an insatiable need to acquire more stuff?  Or are we never quite sure we have enough to get us through whatever life flings at us?  People come to me and ask how much money they need to retire, and really, the answer to that depends in large part on how long they plan to live.  There's no way of knowing for certain that you have enough, so in essence, we are all somewhere on the continuum between feeling pretty sure we'll be ok, and being absolutely panicked at all times.   

The other night I watched a movie called In Time, staring Justin Timberlake.  Short version:  Bleak, alternate reality in which people have digital clocks embedded in their arms, which start ticking at age 25, counting down one year, after which the clock stops, and the person dies.  It seemed like it was just a Logan's Run remake, but the twist is that time is the currency of this alternate world.  People are paid in time for their work, so they can extend their lives, and time is used to pay for things (Coffee costs 4 minutes, the bus costs 2 hours, a very fancy sports car costs 57 years).  No one ages; they all look 25 and beautiful forever.  The very rich live in a different time-zone, they have the luxury of doing things slowly, and they control the cost of all goods, so the poor can never rise above their circumstances  (kind of how the evil Cohaagen controlled oxygen on Mars in Total Recall).   One day, a very wealthy man who has tired of living after 100 years, gives Timberlake his remaining116 years and then dies, leaving Timberlake, who has always barely subsisted on less than a day, to suddenly ponder abundance.   After hanging out in the time zone of the wealthy and enjoying some pleasures and comforts, he eventually realizes abundance can be empty and meaningless, and the only real pleasure is the joy of giving it away to others.  So Timberlake hooks up with a beautiful, but sad heiress and they go on a Bonnie & Clyde style rampage to redistribute the wealth to the masses.

Is this the best movie ever made? No, but stick with me, there's a point to all this.

Back in our own world, we don't have a time stamp we can look at, and we'll never know for sure if we're going to run out of time or money first.  Even though running out of money doesn't mean you die, the idea feels pretty scary.  So how much is enough? I once watched an episode of Mr. Roger's neighborhood with one of my kids, and he explained that it's nice when you have enough for yourself and also some to share with someone else.

I wasn't in a great mood today.  I had a lot of things to take care of, including getting rid of some old stuff that was left over from a bathroom remodel. I gave a sink away to  a really nice woman who answered my Craigslist post under Free Stuff.  She could hardly believe I was really going to give her a sink for free, and she was so happy!  She thanked me profusely, and then she gave me a great big hug.  Made me feel so good.  

I guess I should feel grateful to the universe for blessing me with an abundance of sinks, but right now I just feel grateful for that hug.

Money for Nothin'

This is what I heard myself say to my husband yesterday:

"Honey, I put all of our telecom and internet expenses on the Ink card because they're giving 5X the points for every dollar. Use that one for any office supply stores too because that's also worth 5x the points, oh, and they give 2x the points on gas, so buy gas with it too, but use the Freedom card for the three reward categories they're having right now, which are restaurants, movies and Lowes (not that we ever go there), but only until June when the categories change and they give 5% cash back on something else, and then put everything else on the Venture card because they give 2 miles per dollar.  Oh, but use the Venture card at Trader Joe's because they're giving 5x the points there, but only until the end of July.  Have you got all that?  Honey?

The Amex card?  No, I'm not using that one anymore.  The rewards weren't as good."

Have you noticed how complicated shopping has become?  Last year I wrote about this, and I swear it's now gotten much worse.  The banks have figured out how my irrational brain functions, and they know they can tease me with the promise of getting something for free, so I will spend a ridiculous amount of time figuring out which is the smartest way to pay for things.  If I need some t-shirts, I can go to the Gap and buy them, or I can go to the Gap website and buy them using the coupon code they emailed me for a discount, and I can start from the Upromise portal so that 5% of my purchase goes towards my kid's college fund,  or I can go check through the shopping function of each of my credit cards to figure out which will give me the greatest point bonus for shopping through their site --- points that I can use for travel, if I could ever actually make that work, or the massage that I will need after all this insanity.  And I can spend an hour or so trying to turn a 5% contribution on a $50 purchase into $2.50 to be split among the college funds of my three kids.  Great use of time!

And then you look at the other rewards you're killing yourself to earn.  I spent $67 at Trader Joe's one day, and I was so happy because I was going to get 5 bonus points per dollar by using the Venture card, and that's 335 points, which is really exciting until you realize that in the CapitalOne system, you move the decimal point over two places, so you're getting a whopping $3.35 in miles.  WOOHOO!

But still, I can't not do it.  Even though I know the payoff for all this effort is low, my brain can't get past that promise of getting a better deal.  I know it's irrational, and yes, compulsive.  

My poor husband.  I know he stands there at the cashier and thinks, wait, which card was I supposed to use for guitar strings?

Parenting and Behavioral Finance

My kids will do anything for a donut.  I was trying to get one of them to finish his homework, and the situation had been devolving into something between demanding, cajoling and begging, when it occurred to me I could try dangling a donut incentive. The savvy child in question made a counteroffer with his preferred terms, a deal was struck, and the room fell silent apart from the sounds of pencil writing. 

There are parents who object to this sort of thing, claiming that all external motivation, like rewards, punishment, or praise lead children down the path to eternal unhappiness because they will never do anything for any good, authentic, internal reason, but only for empty external rewards.  But that's silly.  I don't have to offer donuts to compel my kids to be kind and caring, or to draw piles of wonderful pictures, or to ask endless questions about how and why things in their universe function, but like all humans, when it comes to things we don't want to do, there really has to be an incentive. 

The incentive doesn't necessarily have to be material (or edible).  It can be a feeling of accomplishment that comes from completing a task, or the sense of satisfaction at seeing the results of your labor.  I'm endlessly gratified by the appearance of tomatoes on the vine I plant and tend each year, and it motivates me to replant the next year.  I also feel very satisfied by the sense of calm I experience after practicing Yoga.  Do I do Yoga because I will get a donut afterwards?  No, I am motivated by knowing I feel great afterwards.  Of course, if you want to make me go to a 5 year old's birthday party at Chuck E Cheese, I might need an external motivator.

These days I'm actually thinking a lot more about DIS-incentives.  More specifically, how do I avoid having a child who never realizes his potential because he lacks motivation.  What will motivate my children to achieve anything?  I think of all those people whose grown kids are living at home and not getting jobs, and I'm pretty sure giving them all donuts won't solve this problem.  Clearly, constant ease and comfort is not a great motivator to make changes.  Why ever leave mom's couch if she does your laundry and cooks fabulous meals for you, right?  Why would you want to change that? Especially if you haven't experienced the pleasure that might come from doing those other things you don't want to do.

Some parents won't contribute to the funding of their child's education because they believe the child will be more likely to work hard and do well if he himself is taking the financial risk and bearing the future financial responsibility for the debt.  But that relies on a motivation which is too abstract.  An 18 year old doesn't begin to know what it feels like to be 35, with a family to support while still paying off college debt, so he can't really be motivated by the desire to avoid an unknowable pain.  And where do you stop with this thinking?  Should I stop feeding my 7 year old in order to motivate him to become independent and self actualized?  If we stop cleaning the house does it incentivize our kids to start cleaning, or does it merely familiarize them with living in filth?  Rather than saving for college, should we just focus on making our kids miserable so they'll want to move out and make something of themselves?

I know that getting an education and a job and a life will bring my kids more fulfillment than the alternative.  I also know now that flossing more would have had a really good payoff, but these conclusions are based on experience rather than a mysterious intrinsic motivation.

So what should a parent do?  Here are the choices:

1) Bribery:  "Go to college and I'll buy you a car"

2) Dis-incentivize inaction (I know, that's a double negative): "If you don't go to college I'm taking that car away."

3) Do nothing, and wait for the kid to discover an internal motivation: "Would you like another donut, honey?"

4) A little bit of love/a little bit of hate:  "I'm going to make you do this thing you don't want to do so you can have a small taste of the potential payoff. Then I hope to bask in the glory of hearing you say 'I'm glad my mom wouldn't let me quit taking karate lessons because I've now experienced the authentic, internal satisfaction of having achieved the level of black belt, and also all my friends are scared of me'."

Now that I have solved a major crisis of our times, I believe I deserve a donut.  But first I need to go tell my 3 year old to start looking for a job.  

Tweetin' for Dollars

By now your probably know that the only reason your business isn't much more successful is because you have not yet properly harnessed the power of social media.  Sensing the urgency to tap this limitless source of… um…  something that leads to making money, you signed up for Facebook, LinkedIn, Twitter, Google+, Tumblr, and even all the minor ones that no one pays any attention to.  You've also spent hours trying to get your profile just right on each of these sites, hoping to capture both your professional cred as well as your personal style and charm.  And then you've spent weeks scrolling through endless lists of "people you may know" trying to decide whether ex-boyfriends and girls who were mean to you in junior high school qualify as good potential social media contacts.  You've grown your lists of Friends, Followers, Connections and Circle members, and you've learned how to use hashtags, twitter slang, and bad grammar to express complicated ideas in 140 characters or less.

So where's the money you've been promised?  According to the experts, about $17 million, or one third of Lady Gaga's income can be attributed to her twitter following, so where's your 17 mil?  Or 7 mil?  Or 7 bucks even?  

So far, you've looked at countless photos of people's lunches, children and cats, and read your so-called-friends' witty witticisms, and you still haven't made a dollar.  In fact, you're spending so much time reading and following so many sources on so many sites, that you hardly have time to work.  

But this IS work, you tell yourself!  Social media campaigns are an essential component of business marketing.  Every article on Twitter tells you so!  And you have become very popular around the water cooler because of your thorough knowledge of daily internet memes, and also because you can now throw around the word meme.  I don't know, maybe you just need to buy more followers or pay professional tweeters to tweet things that are more clever than your own thoughts.   

And who's reading your tweets and posts, anyway?  Who are these people who follow you?  Will any of them hire you?  I guess that depends on what it is you do.  If you're a Kardashian, for example, and you are in the business of pure self promotion, then yes, this is an essential part of your platform, because it involves more people in your life (if that were even possible) and makes them more apt to watch your reality show, and buy your products.  But for some other kind of business, like if you're a structural engineer or a an accountant, maybe not.  I mean some people may enjoy reading your input on subjects like the correct way to position support beams under a house, or maybe something amusing about the Alternative Minimum Tax, and one or two people might hire you, or remember to refer someone they know to you because you wrote a clever tweet, but let's be real about the potential return before you overspend either your time or your money in this endeavor. 

Face it, you just really like to snoop around the personal lives of people you tangentially know, or look at videos of cats, so let's not pretend this is business development.  Unless you're a professional cat video researcher.  Or trying to find America's next Favorite Cat.

Mostly, social media gives you a little free advertising, and a great way to waste a lot of time while telling yourself you're working.  The most profitable way to use social media?  Turn it off for a while and just get some work done.  

But only after you've read my blog, of course.  And do you follow me on Twitter yet?  

Making Some Bread

Many wonderful, talented people I know are unemployed right now.  Are you one of those people?  And have you already read my column on what you can do to make a few bucks?  Well, I can't hire all of you myself, but I do have a few thoughts on how a person might reimagine the idea of finding work.

First of all, as you may have noticed, lots of employers aren't hiring, so you're going to have to find other people to hire you.  Also, your skill set may not really match the requirements of too many employers, so you might have to create your own profession.  You may have really strong knitting skills and you might be able to sing the entire second side of Led Zepplin II (with air guitar solos), but you may not feel quite as comfortable with payroll accounting software.  You're going to have to use some creativity to figure out how to take something unique that you can do well and convince people to pay you to do it.   Look, just a few years ago we didn't have "Home Stagers" and "organizers", and now those people get paid to come rearrange your furniture and tell you what you should throw out, so who's to say there aren't people out there who are interested in having you come put together outfits for them (I actually know someone who does that) or put together musical playlists for them ?

First you must inventory your personal skills, including all kinds of life experience and things you may not think qualify to make the list (i.e. "I have exceptionally good penmanship", "I have an uncanny ability to amuse cats", "I can recite every word of the movie Airplane by heart", "I can text very quickly while walking").  Then, look at the list and start composing ideas of services you might be able to offer.  

Ok, now eliminate the ones no one will pay you for.  

You must think outside the box.  How can you apply your skills in an usual way to create something different?  Lots of people paint on canvas, but not that many paint art on cakes, and I'm sure lots of people would enjoy a more interesting cake.  And perhaps you can combine your exceptional penmanship and encyclopedic knowledge of the movie Airplane to write beautiful, but inappropriate Airplane quotes on the walls of flight schools.  And don't let that degree in Performance Art go to waste!  Capitalize on the fears of every dinner party host by offering to provide puppet shows to stave off any awkward mealtime silences.  Or perhaps you are very tactful, and can offer a service for delivering bad news to people.  And maybe you can deliver that news with a keepsake, comforting, hand-knit scarf.  Or some pajamas.  And a bottle of scotch. 

Ok, I'm going to stop giving away all my best ideas, you'll have to hire me for my business-inventing business to get more.

I also know someone with a business-naming business, by the way, and you can hire him to create a catchy name for what you do. 

But you can't just create a cool service and then wait for the phone to ring.  You'll have to do some marketing to make people aware of their need for your unusual service.  How will people know they need a personal, in-home sourdough bread making coach if you don't use your tweeting skills to tell them?  And when they do become aware of your services, these potential clients need to find convincing evidence on the internet, like maybe blogs that your friends have written about how their bread making is now completely transformed because of you, or articles you've written for other blogs on the intricacies of flour choice, in order to establish your professional cred.   

Another advantage of creating your profession is that if you are the only sourdough coach, no one can really dispute the notion that you are the best sourdough coach, see what I mean?  And I can say all this with great confidence because I have unusually strong problem solving skills, which I have used to become one of the world's foremost Business Imaginators.   In fact, I'm thinking of offering a certification program, which you can soon register to take (for a small fee).