Health Insurance Plans

When you need Comprehensive Health Coverage

While many people are not required to have comprehensive coverage per the recent repeal of the Individual Mandate of the ACA, you may, however, need it.  Accordingly, if you qualify for a subsidy, or have a pre-existing condition and expect to use a lot of health services, the Marketplace may be your best option for comprehensive coverage today.  Our partner, HealthSherpa is a FREE RESOURCE with live people on staff to help you decide which options are best for you.  Simply put, they help you make the best use of your marketplace health insurance plan.  Click the link to the right to get started.

Learn more about comprehensive health plans and the Marketplace

 Health Maintenance Organization Or HMO
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

The public health insurance Marketplace (also referred to as an “Exchange”) is where you can purchase health insurance (also known as Obama Care) for you and your family.  A plan from the marketplace is considered a comprehensive major medical plan and also contains the essential health benefits as established under the Affordable Care Act (ACA) law.  When you purchase your health insurance through the marketplace, you are guaranteed issue regardless of any pre-existing condition and you may be eligible for a subsidy (premium tax credit) to help off-set high premiums.  When you visit our partner’s website, HealthSherpa, they will be able to help you determine if you are eligible for a subsidy.

The essential health benefits are as follows:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription Drugs
  • Mental health and Substance Abuse disorder services
  • Rehabilitative and habilitative services and devices
  • Pediatric services, including oral and vision care
  • Preventive and wellness services, and chronic disease management

Are you required to buy health insurance?

Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.

When can you enroll?

It’s important to know that you can only purchase your health insurance during the annual open enrollment which is November 1 to December 15th of each year, or unless you qualify for the special enrollment period.

What if you miss the deadline?

You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

  • change in legal marital status
  • a change in the number of dependents
  • a change in place of residence and the current carrier is not available
  • significant cost or coverage change
  • a change in coverage of a spouse or dependant
  • a COBRA qualifying event
  • legal judgements, decrees and orders
  • entitlement to Medicare or Medicaid
Wellness Benefits

Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy.  Your plan from the Marketplace will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.  

Don’t need comprehensive coverage? 

Consider affordable Non-ACA Medical Plan or a Supplemental Health Plan to protect you in case of an emergency or critical illness.

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