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1. tina18
   Member

   I was wondering if anyone has an idea what to do if you have a large family with a decent income for health insurance. Currently we pay 12k$ for horrible insurance. We pay another 5k for copays and doctors out of network when we need to (the coverage is awful but the best insurance is 18k a year).

   We then pay another 7-12k for dentistry (including braces for my children). The total bill is around 30k a year. This is ridiculous since I have employees not paying 1 cent for health care - which I dont mind - but they have much better coverage from child health plus or medicaid. Does anyone have any idea what we can do?

   Posted 3 months ago #

2. gavra_at_work
   Member

   Does anyone have any idea what we can do?

   Earn less. You may save money by doing so.

   Not for nothing did Romney say: "I'm not concerned about the very poor. We have a safety net there. If it needs repair, I'll fix it."

   Posted 3 months ago #

3. akuperma
   Member

   Get a job with a company that offers family health insurance. Often this results in lower income. Often one spouse works for the insurance and the other has the job for parnassah.

   With Obamacare you should have less trouble getting insurance, but it might cost a lot.

   Remember that braces are in most cases a luxury that only the best insurance covers. If the family is beyond childbearing years (i.e. mother well past 40), and no one has a serious problem, high deductible policies might be cheaper (for most families the only big ticket item is childbirth). One can also go uninsured (at least until Obamacare kicks in) and try to wrangle cheaper prices for doctors who get paid in full up front (rather than the doctors having to do their own wrangling with insurance companies). With no insurance or a high deductible policy, health savings accounts become practical. Rigging a flexible savings account can also cut the costs by about a third (if you live in a high tax state).

   Posted 3 months ago #

4. apushatayid
   Member

   Your medical expenses, including premiums are tax deductable provided they exceed 7.5% of your income. Based on the 30k figure you give, unless you have annual income greater than 375k or so (I am guesstimating) this should not be an issue. You must also itemize (fill out a schdule A) when doing your tax return (this means, you must file a tax return, which I assume you do). Why dont you speak to your accountant.

   Posted 3 months ago #

5. real israeli
   but missing New York

   Every child under the age of 18 is eligible for Child Health Plus. The question is only whether or not you will need to pay a premium. Check out the charts online to see what you'd be eligible for but if you have a large family, it probably won't be a lot. Then, put yourself and your wife on a couple plan (Healthy NY if you're eligible). It should come out much cheaper. You can get empire through CHP which most doctors accept. There are no copays for CHP

   Posted 3 months ago #

6. Working on it
   Member

   I had this exact issue a couple of years ago. I was making too much to be on healthy NY but not enough to be able to afford a decent plan. I was lucky to find a person that brokers different plans and he was able to offer several options that do not have an income requirement. The plan that works best for me is a high deductible one from Oxford. It is a family plan and it costs about $11,000 plus a $2400 deductible (between all members combined), after which it is the regular $20 copay per visit. It doesn't sound so much cheaper than the one you have now but they have an excellent network and I have not had any problems so far. I believe he also deals with Dental plans. If you want the contact information, please ask the mods to allow you to email me and I will be happy to forward the information

   Posted 3 months ago #

7. tina18
   Member

   "Your medical expenses, including premiums are tax deductable provided they exceed 7.5% of your income. Based on the 30k figure you give, unless you have annual income greater than 375k or so (I am guesstimating) this should not be an issue"

   even braces? family dentristry?, out of network doctors?, co pays? all that is tax deductable? I will speak to my accountant but I have never heard that. also - for child health plus - its around 150$ each child and no cap if you do not qualify which is alot if you have 6,7, 8 children.

   Posted 3 months ago #

8. real israeli
   but missing New York

   for child health plus (which does not cover braces) if you have 6 children, you can be earning 12,544 each month and qualify to pay just 180 each month for it in total. For each additional child you have, you can add 1,274 per month. Do you earn more than their qualifications? If you do, why can't you afford insurance for 1,000 each month?

   Posted 3 months ago #

9. yungerman1
   Member

   If you are already paying 17k for health insurance, it may be worth it to purchase better insurance which is a little more but without all the copays.

   You should consider dental insurance although I dont think they would cover orthodontists.

   Either way, you should sit with an insurance broker who can best guide you.

   Posted 3 months ago #

10. tina18
    Member

    'If you do, why can't you afford insurance for 1,000 each month? '

    I can do the 1000k a month - but think its crazy to pay 2500 a month (and still have worse coverage then people who do not pay a penny). I also pay 40k a year tuition, so the 2 combined is not a pleasant number.

    yungerman1 - the best policy is 18k without dental. with dental for a large family its back to where Im paying now.

    Posted 3 months ago #

11. A Heimishe Mom
    Member

    I have B"H always had employer group health insurance so I can't vouch for the CHP numbers offered be realisrali, but as to the tax deducatbility of every copay, prescription, dental, orthodontia etc I CAN vouch. If your premiums are out of pocket (meaning not deducted from a paycheck) then add that in as well. If the total exceeds 7.5% of income, then the entire amount is deductable.

    Another option is, if you write the pemiums off as a business expense somehow (ask your accountant how that option works) you can save that way as well.

    Posted 3 months ago #

12. bp27
    Member

    A heimishe mom - You can only deduct the amount above 7.5%, not the full amount.

    I personally can vouch for CHP. You can make a pretty good salary and still be easily eligible. For our b'h large families, the fact that the per child premium is capped at 3 children is a tremendous savings. It it truly a pleasure having no copays and no deductibles, which is what I had with my old insurance which costed a fortune in premiums.

    Posted 3 months ago #

13. real israeli
    but missing New York

    In the OP it says that the best insurance would cost $18,000 a year. That would divide into $1,500 each month. Assuming you have a family of 8 (6 kids), which is the smallest number you gave, you'd be paying 1500 for insurance and 4000 for tuition each month. You'd also be earning more than 12,500 each month.

    Posted 3 months ago #

14. tina18
    Member

    I appreciate everyone's input.

    'In the OP it says that the best insurance would cost $18,000 a year.'

    18k a year but dental + braces for a large family is 7-12k (plus some copays im sure) . also the 12,500 is before taxes, not after. so if I am making 13k, its really 10k at most per month. so 7 out of 10k goes for health and tuition. what about food, mortgage, car?

    Posted 3 months ago #

15. A Heimishe Mom
    Member

    bp27: I may be wrong, but I was under the impression that your expenses need to exceed 7.5% of income, but then you can claim the full amount. It is clearly spelled out on irs.gov which way it is. What is included is also clearly spelled out.

    Posted 3 months ago #

16. bp27
    Member

    From irs.gov Publication 502:

    How Much of the Expenses Can You Deduct?

    You can deduct on Schedule A (Form 1040) only the amount of your medical and dental expenses that is more than 7.5% of your AGI (Form 1040, line 38).

    Posted 3 months ago #

17. apushatayid
    Member

    Unless Tina18 has an AGI greater than 400k, some portion of the 30k she mentioned is deductible.

    Regarding CHP, the State of NY Dept of Health website has a calculator that helps determine eligibility and premiums (if any) based on family size and income.

    Posted 3 months ago #

18. real israeli
    but missing New York

    I actually posted the max income without paying full premium for families with at least 6 kids for chp. It does not sound like op can be eligible for chp with less than $60 premium (which is max before full). To screen for eligibility, visit nyc.gov/accessnyc

    Posted 3 months ago #

19. tina18
    Member

    'I actually posted the max income without paying full premium for families with at least 6 kids for chp.'

    no I am not. Full premium is 150 per kid with no max. so 150*6 is 900$ just for the kids. Then another 900 for us is 1800 plus braces and co pays for us, some out of network , and we are back to square one. My main point is that paying zero gets you more then paying 30k - this is silly.

    Why should the employee get better (for free) then the employer who pays so much?

    Posted 3 months ago #

20. golden mom
    Member

    i agree child health plus is the best and most dr except and u wouldnt pay thru ur nose even if u make nicly
    i think there is st for adults too call diffrently maybe family heaalth plus but u know what even if u have to pay as a couple u still will be saving a fortune

    Posted 3 months ago #

21. real israeli
    but missing New York

    The max income for family health plus is MUCH lower than the $60 premium of chp income limit so if op is not eligible for chp, she/he is not eligible for fhp either.
    Tina18: did u look into healthy ny as a plan for your whole office. I know they have business plans. Perhaps if your whole place is on it you would be able to get on too, without them looking at your individual income. check out healthyny.com for all their rules.

    Posted 3 months ago #

22. tina18
    Member

    'The max income for family health plus is MUCH lower than the $60 premium of chp income limit so if op is not eligible for chp, she/he is not eligible for fhp either.'

    I cannot get on to CHP unless I pay the full premium as I stated which is 900$ just for the children without braces.

    I am on a plan similiar to HealthyNY. There plans are horrific. Its GHI with a fortune of co pays , no dental and certainly low braces.

    We did get a hold of a broker by the way who is helping us on the dental side (of course not braces like medicaid pays for).

    Posted 3 months ago #

23. yungerman1
    Member

    Why dont you enroll in a flex spending account?

    Its not a deduction on your income tax, its money that is set aside prior that is not taxed.

    Depending on your income you need to determine which would be the greater benefit to you.

    Posted 3 months ago #

24. apushatayid
    Member

    "Why should the employee get better (for free) then the employer who pays so much?"

    Are you saying that you provide insurance for your employees? If so, why is your family not part of the group plan purchased for your employees?

    If you are not, what are you paying so much, for? Perhaps creating a group for your employees would benefit you/your business in some way. Speak to a broker and your accountant.

    Posted 3 months ago #

25. tina18
    Member

    'Are you saying that you provide insurance for your employees? If so, why is your family not part of the group plan purchased for your employees?'

    I do not - they are on family health plus and its free. I offered it but they smartly refused. WHy would they take my bad insurance if they can have good insurance from the state?

    'If you are not, what are you paying so much, for? '

    Im paying the discounted rate - 1100 per family. The copays, dental, braces, out of network....add up to 30k total as I explained.

    The law needs to be that if you pay full premium of 150 per child, it should be capped at 3 and then Im somewhat happy.

    all the plans of CHP, your capped at 3 children, except if you pay the full premium your not capped. so if you have 8 children, its 150 *8 just for kids. I already spoke to 3 politicians who are looking into this. It will only affect families who make good incomes with large amount of children. Will keep this room posted if anything changes (im not holding my breath)

    Posted 3 months ago #

26. real israeli
    but missing New York

    If employees are getting free insurance, it is probably medicaid.

    Posted 3 months ago #

27. tina18
    Member

    'If employees are getting free insurance, it is probably medicaid. '

    its family health plus

    Posted 3 months ago #

28. real israeli
    but missing New York

    Just for the sake of clarity:
    Medicaid and FHP are under the same program - they are both under HRA. CHP is something else.
    Medicaid is for lower income - it is covers a bit more than FHP in terms of senior care and it covers braces. Other than braces, there is no real difference between the two programs other than FHP allows you to have a bit of a higher income (it is very difficult for adults to qualify for medicaid) and FHP can sometimes charge a 3 to 6 dollar co-pay.
    FHP is only for adults over the age of 19 so I'm assuming your employees also have either free CHP or medicaid.

    Posted 3 months ago #

29. tina18
    Member

    Im not sure. They dont pay anything for them and all there kids are on CHP.

    Posted 3 months ago #

30. real israeli
    but missing New York

    I am sure. Many doctors and pharmacies opt not to charge the $3 copay but they have an option of charging it - check it out on their benefit cards - it says it. If they are on FHP, all their kids are NOT on CHP - any baby under the age of 1 is automatically on Medicaid as are children up to age 5. Only children between the ages of 6-18 are eligible for CHP if the parents are eligible for FHP. Check out income eligiblity for both and you'll see (or just ask your employees) For the children, there are no premiums or copays

    Posted 3 months ago #

31. tina18
    Member

    'Only children between the ages of 6-18 are eligible for CHP if the parents are eligible for FHP. Check out income eligiblity for both and you'll see (or just ask your employees) For the children, there are no premiums or copays '

    that is why I want to be on it - but I cant unless I pay 150$ per kid (and no cap meaning you pay 150 X as many children as you have)

    Posted 3 months ago #

32. real israeli
    but missing New York

    Based on what I understand from what you are saying, you are self employed. Do you have any three months of the year where your income is low enough to grant you chp eligibility?

    Posted 3 months ago #

33. tina18
    Member

    'Based on what I understand from what you are saying, you are self employed. Do you have any three months of the year where your income is low enough to grant you chp eligibility? '

    it goes by 3 months or last year?

    Posted 3 months ago #

34. apushatayid
    Member

    If the parents qualify for FHP (aka medicaid) the children do NOT qualify for CHP, they also qualify for FHP. If the parents and children all qualify for FHP, might I ask if you pay them little more than minmum wage?

    If none of your 30k annual outlay is deductible you are earning in excess of 400k. Unfortunately, the government doesnt care that you pay full tuition for 8 kids (or whatever that number might be) it is not one of the criteria on their eligibility chart for CHP. I admit, it is a bitter pill to swallow, but think what your employees might be saying about someone who pays them so little that they qualify for medicaid.

    Posted 3 months ago #

35. greatest
    Member

    Apy: If she raises their salaries, she'll have to fire some employees.

    Posted 3 months ago #

36. tina18
    Member

    'If the parents qualify for FHP (aka medicaid) the children do NOT qualify for CHP, they also qualify for FHP. If the parents and children all qualify for FHP, might I ask if you pay them little more than minmum wage?'

    some of it is deductible - when did I say its not? my point is I still do not have as good insurance as the people who pay zero. If we pay them more they will leave, they want to get payed what they are being get paid cause "the poor get richer"

    Posted 3 months ago #

37. real israeli
    but missing New York

    apy: I do not know where you are taking your info from but this is the general way it works:
    The first thing they screen for is Medicaid. Medicaid works both by family size and age - the categories are: pregnant women and up to age 1, ages 1-5, ages 6-18, 19 and up. The pregnant women and infants have the highest eligibility rates, 1-5 next, etc.
    If someone does not qualify for medicaid:
    Ages 19 and up are screened for FHP. FHP is under the same program as medicaid but has greater income allowances. It is ONLY for ppl over age 19.
    Children through and including 18 qualify for CHP if they are not eligible for Medicaid. However, based on the families income, a premium might have to be paid, and as the OP said, if the income is high, they may only be eligible with full premium (which btw is NOT necessarily 150 - it can be 238 for empire too.... depends on which plan you choose).
    Children can never be on FHP and adults can never be on CHP

    Tina18: you have two options when applying for medicaid/chp... you can give them last year's tax return or you can use what is called a "three month form" where you fill in any income and expenses you had in the last three months, and deduct expenses from income. This might help you be eligible, especially if your business is one which has ups and downs. For CHP, you are not required to notify them if your income goes up until the next time you need to recertify (a year later). With medicaid you are. It might be worth it for you to wait till a low period, and apply for chp then.

    Posted 3 months ago #

38. tina18
    Member

    yasher koach everyone for answering. This is a great thread. I think the politicians I spoke too (so far) agreed that for CHP if you pay full premium it needs to be capped at 3 children the way it is for any other level at CHP. If anyone has anyone influential at the state level please send them this link. CHP is at the state level so a congressman or senator wont be any help -

    Posted 3 months ago #

39. charlie brown
    Member

    tina18 - check the insurance plans available from Freelancers Union.

    Google "freelancers union insurance" check on their website if you are eligible to join (if you're self employed or a 1099 contractor etc). They have some decent health and dental plans.

    Posted 3 months ago #

40. tina18
    Member

    'Tina18: you have two options when applying for medicaid/chp... you can give them last year's tax return or you can use what is called a "three month form" where you fill in any income and expenses you had in the last three months, and deduct expenses from income. This might help you be eligible, especially if your business is one which has ups and downs. For CHP, you are not required to notify them if your income goes up until the next time you need to recertify (a year later). With medicaid you are. It might be worth it for you to wait till a low period, and apply for chp then. '

    this is good advice. thanks

    Posted 3 months ago #

41. tina18
    Member

    'tina18 - check the insurance plans available from Freelancers Union.'

    I will - great - thanks

    Posted 3 months ago #

42. apushatayid
    Member

    RI. I'm not sure whàt facts you are referring to. With that said, FHP is Medicaid for those 19 and older. CHP A is Medicaid for those umder 19. Both programs have zero premiums or copays for services. CHP B has a schedule for premius based on income/family size. Premiums are capped at three children as long as one is eligible at one of the subsidized premium levels. CHP has no copays for services.

    For what it is worth, having been enrolled in FHP, there truly is no such thing as a free lunch. Many providers have opted out of accepting these plans because the payout is lousy and the patient pays no copay on top of the lousy payout, leaving fewer providers for more clients resulting in worse service. The plans are also strict HMOs with zero out of network coverage and referrals to specialists are not easy to come by. CHP B has a lot of the same limitations but a more extensive provider network so services are better.

    The full premium level Tina18 refers to is basicly the insurance company saying, you are past the subsidized level, but we will happily sell you a policy, on our terms of course.

    Posted 3 months ago #

43. real israeli
    but missing New York

    apy: you are right about the fact that medicaid for children used to be referred to as chpa. However, medicaid changes their rules quite often and they no longer call it chpa - it is just called medicaid. A 19 year old can very possibly be on medicaid and not fhp - as i said, that would be based on income. if it's a very large family or very low income - it's plenty possible - i've seen it. fhp most definitely does have an option for doctors to charge a copay of up to $6 - if you dont believe me - call hra at 800-692-6116 and ask them directly. what you said about chp is correct - it can be free or have a minimal premium based on income/family size and this premium is capped at 3 children. Each of these plans has many doctors on it - it may not be the ones you are used to using. If you want a list of providers - call the health plan you are on - they will be more than happy to send you a book - i believe the smallest book is still made of over 500 pages of doctors names. You are also correct about the full premium level - if you dont qualify for the 60/child premium - you are over their income limit and can pay the full amount for coverage.

    Posted 3 months ago #

44. real israeli
    but missing New York

    sorry, the hra hotline i 866-692-6116, not 800

    Posted 3 months ago #

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