Understanding Your Health Insurance Options
Health insurance is a critical to helping you control your health care costs. You pay health care companies a premium – a set amount of money each month - and you get benefits to pay for your eligible health care expenses. This can include regular doctor checkups or injuries to treatment for long-term illnesses.
You can purchase individual health insurance through the Health Insurance Marketplace on your own or we can help you work through your options. although it’s called individual health insurance, you can also find plans to cover your family.
We all know how expensive health care can be. That’s why it is so important to have health insurance so you’re prepared for when you or your family have medical needs. With health insurance you can
- Prepare for the unexpected.
- Access preventive care services – like checkups, which are covered at 100%.
Essential Health Benefits
Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB).
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:
- These essential health benefits include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services including oral and vision care
According to the Affordable Care Act, plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.
Footnote: This is a brief overview of Essential Health Benefits required by the Affordable Care Act. You should read thoroughly and understand the benefits offered before purchasing any insurance policy.
Short-Term Medical Insurance - Temporary Coverage
Outside of the individual market’s annual open enrollment period a short-term health insurance policy might be your best option, especially without a qualifying event. Short-term plans generally provide the most comprehensive coverage available outside of open enrollment.
Short-term policies have been around for some time. They are a good option for people who are between jobs or waiting for a new employer’s coverage to become effective. Unlike regular individual major medical plans, short-term health insurance policies are not regulated by the Affordable Care Act and their sale is not limited to open enrollment windows.
When does a short-term policy makes a lot of sense?
If you experience a qualifying event that triggers a special enrollment period, you’ll need to apply for an ACA-compliant policy (on or off-exchange) during your special open enrollment period, which lasts for 60 days in most cases. If you opt for a short-term policy instead, you won’t have the option to switch to an ACA-compliant plan after your open enrollment period ends. But, if you miss open enrollment and haven't experiences a qualifying event, a short-term policy will provide you with up to six months of coverage in most states.
Short-term plans are typically offered with a selection of premiums, deductibles and benefit maximums. The policies are considerably less expensive than ACA-compliant major medical plans, so you may find that you can afford to purchase a plan with a low deductible and a high-benefit maximum. Plus, healthy applicants can secure immediate individual and family coverage, with plans that can start almost immediately.
The policies also cover a range of physician services, surgery, outpatient and inpatient care. In addition, policy holders can often choose their own doctor and hospital without restrictions, though there may be financial incentives for using in-network providers.
What short-term health insurance won’t cover
Short-term major medical plans may be a great fit for healthy folks who just need temporary coverage, but the plans weren’t designed to cover everything, and they do not provide coverage for all of the ACA’s essential benefits.
They typically won’t cover your routine office visits, maternity, mental health or preventative care – and they won’t cover preexisting conditions. They also still use medical underwriting, which means that applicants with serious pre-existing conditions may not be able to get short-term coverage. Be sure to check the list of exclusions on any policy.
Give me a call to find out if short-term health insurance is option for you.
Pre-65 Health Care Insurance
If you're under the age of 65 and need health insurance, there are 4 basic options available to you. We can help you determine the right choice based on your budget and needs.
On-Exchange Plans (OBAMA CARE – Affordable Care Act)
The plans are administered through the Centers for Medicare and Medicaid. Many people qualify for subsidies based on qualifying factors to help with their health care costs. This is typically the first step in finding the right plan for you and we'll guide you thru the process step by step.
Off-Exchange Plans
If you don’t qualify for a subsidy you can purchase health insurance directly from a carrier. We can help you compare plans and enroll in one that best meets your needs and budget.
Short-term major medical
These type plans are a great alternative for consumers looking for major medical coverage. Short Term health insurance, sometimes called Term health insurance or Temporary health insurance, is designed to bridge gaps in your health care coverage during times of transition. These plans allow you to:
- Start your coverage fast, as soon as the next day in many cases.
- Drop your coverage without penalty.
- Choose from a range of available deductible amounts.
- Apply for another term of coverage if needed.
Hospital Indemnity Insurance
Hospital indemnity insurance is a type of plan that pays a set amount – per day, per week, per month, or per visit. In addition to a hospital per diem, a more comprehensive plan might feature payments for an ambulance trip, surgery or maternity visit, or increased payments for intense ailments such as stroke or cancer. Benefits can disburse in lump sums for short admittances or on a daily or weekly basis during longer visits.
As you can see, there are many options to choose from with different benefits and payment methods. We're here to help you through the confusion. Contact us today!
What is Health Insurance Marketplace?
This year the enrollment period is shorter than in previous years, so it’s important to act quickly. If you don’t act by December 15, you can’t get 2019 coverage unless you qualify for a Special Enrollment Period. Plans sold during Open Enrollment start January 1, 2020.
Every health insurance option in the Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on:
- price,
- benefits,
- quality, and
- other features that may be important to you.
Insurance coverage run by private companies
When you shop at the Marketplace, coverage information will be laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you pay and what coverage you receive before you make a choice. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.
You may save on your monthly premiums
When you apply for coverage in the Health Insurance Marketplace, you’ll find out if you qualify for a premium tax credit to help lower your premium, which is the amount you pay each month to your insurance plan. The amount of your premium tax credit depends on the estimated household income for 2019 that you put on your Marketplace application.
Coverage falls into four categories
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your out-of-pocket costs —the total amount you’ll spend for the year if you need care. The categories are
- Bronze
- Silver
- Gold
- Platinum
The Marketplace also offers "catastrophic" policies to people under 30 years old and to some people with very low incomes.
Balancing monthly premiums with out-of-pocket costs
As with all health coverage, you will still have to pay a monthly premium.
- Premiums are usually higher for policies that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold policy, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
- With a Bronze policy, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
- Platinum policy will likely have the highest monthly premiums and lowest out-of-pocket costs.
The policy will pay more of the costs if you need a lot of medical care.
In general, when choosing your health coverage, keep this in mind:
- the lower the premium, the higher the out-of-pocket costs when you need care;
- the higher the premium, the lower the out-of-pocket costs when you need care.
