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Depending on your needs, you do have options to choose from for your health insurance, and we will be happy to explain and assist with your
options.
HealthCare Reform plans
These plans are ACA compliant and follow the
Government's requirements and are underwritten by insurance companies. Finding
a low premium and a low deductible are not the only items you should be looking
for. There are other items like networks, co-pays, etc. which are just as
important. Since premiums are the same whether you do the research or we do, which would give you the better peace of mind? We make enrolling on or off the Marketplace easier for you.
So when can you enroll? Normally you can only enroll or change plans is during the OEP (open enrollment period). The open enrollment period for 2024, starts November 1, 2024 through December 15, 2024, with the earliest effective date of January 01, 2024. Unless you have a life changing event and qualify for a Special Enrollment Period (SEP).
Enrolling on the
Market Place: If
your MAGI or total family projected income for 2025 qualifies you for a tax credit
(the Government paying a portion of your premium), enrollment must be via the
Market Place. Most of the plans are HMO, so it is very important we
verify your doctors are in the plan's network you enroll in. Also, since some
of the plans have secondary prescriptions deductibles, it is best we also
verify medications. Also keep in mind, the Government might want you to verify your income, if you are requested to verify your income and you do not respond, you will lose your tax credit (see under our Resources/Important Links, what is required).
Enrolling off the Marketplace: If
you don't qualify for a tax credit, we may want to look at some of the plans
offered off the Marketplace. You can still enroll in the same plans offered on
the Marketplace, but you also have greater plan options, especially finding
PPO plans with the off-Market Place plans. Also, for 2024 there are some additional carriers entering with plans on & off the Market Place.
What happens if you don't enroll in an ACA plan or have credible coverage: The ACA’s individual mandate has been removed, so there are other options out there which might fill your health and financial needs as well...We are just an email or phone call away to go over your options.
Explanation of plan Terminology
The Deductible basically comes into play only if you end up
in the hospital, have surgery or diagnostic services. The higher the
deductible, the lower the premium.
Co-Insurance (you are co-insuring with the insurance
company) comes into play with most plans, after the deductible has been met.
In the case of 80/20, which means the plan pays 80% and you are responsible for the
20%. The amount of co-insurance varies between plans.
Total out of pocket or the T.O.P. number is a combination
of the deductible and co-insurance and once both are met, most plans pay 100%
Co-pays are a fixed amount, and this could be for a doctor visit,
procedure or prescription. Normally the deductible does not have to be
satisfied first.
Types of different plans
All Co-Pay Plan: Normally there is not a deductible and for all
visits & procedures, you are responsible for paying a co-pay.
HSA Plan: Are a triple tax saving plan and can be combined
with a Health Savings Account. Except for your wellness visits, you are
responsible for all expenses (at the contracted rate) until the deductible has
been met and then the plan pays 100%. These plans, since they have a higher
deductible, are more cost effective and we would be happy to explain in more
detail.
Short Term Medical
These plans offered by most of the major carriers, have been
around for a while. They give catastrophic coverage in case of a
hospitalization etc. and most of them are PPO plans giving you a larger
network. However, most of them do not give you the wellness and doctor visits. There have been a lot of recent changes in the industry, with longer terms, co-pays to visit doctors etc., just to name a few. BUT be careful! Not all short-term medical plans are the same! You don't want to find out when you need to use it, to find out the coverage is not what you thought. Want to learn More?
Ancillary Plans
There have been some positive outcomes from HealthCare reform, and one of them is the availability of many different types of ancillary products.
Because of costs, many people end up choosing a higher deductible (the higher the deductible, the lower the premium and of course vice versa) with your health insurance plan. In many instances, having a higher deductible works, particularly if you are healthy. But if an accident occurs, you will have to deal with the higher deductible and co-insurance costs. You may want to consider an accident supplement particularly if you have children. With the accident supplement, it works in conjunction with your health insurance and will cover your deductible. There are also hospitalization plans which can cover your deductible and some even have indemnity options which will pay you a daily cash payment. Disability plans can assist if you are unable to work.
Dental & Vision plans are also ancillary products and be sure you check out our section devoted to that type of coverage.
With the guidance from an agent, you can find the type of coverage which can be customized to fit your needs and not just a generic plan.
Hope this
helped you understand a little more about health insurance.
Whether you need an HMO or PPO plan, we would be happy to assist in answering any questions or
concerns you may have.
There is never a fee for our personalized service.
Always Remember...We are only an email or phone call away.
Are you confused by all those Acronyms?
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Do You want to know more? If you see a word in this COLOR, just left click the word and learn more.
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