Health Insurance

 

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.

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