Health Insurance Coverage Options
TYPES OF PLANS
- INDIVIDUAL FAMILY PLANS are individually underwritten; which means that the insurance carrier rates based off of your age and location. These plans are now subject to an Open Enrollment Period (November 1st-December 15th). During the Open Enrollment Period you can make changes to your existing plan or enroll in a new plan. Once approved, you are responsible for 100% of the premiums.
- SHORT TERM PLANS are an affordable option for those in-between jobs or looking for an affordable option to COBRA and ACA Plans (aka Affordable Care Act Plans). These plans do NOT cover pre-existing conditions and wellness visits are subject to the deductible. If you qualify, these plans go active 24 hours after the application is received.
- CRITICAL ILLNESS/ACCIDENTAL PLANS provide a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed in the insurance policy (usually cancer, heart attack, or stroke). The point of the plan is to offset a higher deductible individual or family plan
KEY TERMS TO KNOW
- CO-INSURANCE is often confused with CO-PAYMENT. A co-payment is typically fixed while the co-insurance is a percentage that you pay after the deductible has been met. It is expressed as a pair of percentages with the carrier’s portion stated first. The maximum percentage you will be responsible for is generally no more than 50%. Once your out of pocket maximum has been met, the carrier will assume responsibility for 100% of any additional costs. Common co-insurance percentages are 70%-30%, 80%-20%, and 90%-10%. There are also zero co-insurance plans available where the carrier pays 100% of your medical expenses after your deductible has been met.
- OUT OF POCKET MAXIMUM is the amount you pay before the carrier is responsible for 100% of your medical expenses. The out of pocket maximum is a combination of your deductible and co-insurance.
- DEDUCTIBLE is a fixed amount you are responsible for before the carrier begins to pay their share. A higher deductible means lower health insurance premiums.
- “OBAMACARE” is considered a policy that qualifies for financial assistance. Assistance is being offered as a monthly subsidy which is applied to your premium and/or cost sharing, which is a reduced deductible. These policies MUST be purchased through the Marketplace. A certified agent can assist in the enrollment process.
POLICY UPDATES DUE TO THE HEALTH CARE REFORM took effect March 2010:
- Dependents are now covered to age 26
- Pre-existing conditions are automatically covered
- There is no cap on coverage
- Wellness visits/preventative care are covered with no out of pocket cost to you
- Health insurance also provides coverage for dental, vision, and Medicare supplements.