Health Insurance

Under the Affordable Care Act (ACA), both small group and individual health plans, whether fully insured and offered on or off the Exchange/Marketplace, are mandated to include essential health benefits (EHB).

These essential health benefits represent the minimum criteria for all Marketplace plans, with the option for plans to extend additional coverage. A comprehensive view of each plan’s offerings can be accessed by comparing them directly within the Marketplace.

Outlined under the Patient Protection and Affordable Care Act, essential health benefits encompass several key categories:

• Ambulatory patient services (outpatient care without hospital admission)
• Emergency services
• Hospitalization
• Maternity and newborn care (before and after childbirth)
• Mental health and substance use disorder services, encompassing counseling and psychotherapy
• Prescription drugs
• Rehabilitative and habilitative services and devices for aiding those with injuries, disabilities, or chronic conditions to regain physical and mental abilities
• Laboratory services
• Preventive and wellness services alongside chronic disease management
• Pediatric services, including oral and vision care

According to the Affordable Care Act, plans covering benefits categorized as Essential Health Benefits, regardless of size or whether they are self-funded, are required to provide these benefits without annual limits or lifetime maximums.

Note: This serves as a concise overview of the Essential Health Benefits stipulated by the Affordable Care Act. It is imperative to thoroughly review and comprehend the benefits offered before selecting any insurance policy.

Short-term health insurance policies offer a viable alternative outside the annual open enrollment period, especially for those without a qualifying event. These plans typically provide extensive coverage when other options aren’t available due to their exemption from Affordable Care Act regulations and the absence of restrictions tied to open enrollment periods.

When does opting for a short-term policy make sense? It’s beneficial when faced with a qualifying event that triggers a special enrollment period, necessitating the acquisition of an ACA-compliant plan within a 60-day window. However, choosing a short-term policy means forfeiting the opportunity to switch to an ACA-compliant plan after the open enrollment period ends. Yet, if open enrollment is missed without a qualifying event, a short-term policy can offer coverage for up to six months in most states.

These plans come with varied premiums, deductibles, and benefit limits, often at a lower cost compared to ACA-compliant major medical plans. This affordability might enable purchasing a plan with a lower deductible and higher benefit limit. Additionally, for healthy applicants, immediate individual or family coverage is possible, with plans that activate almost instantly. Flexibility in choosing doctors and hospitals is common, although in-network providers might offer financial advantages.

Coverage under short-term health insurance includes a range of medical services, encompassing physician visits, surgeries, outpatient and inpatient care. However, these plans have limitations and do not cover routine office visits, maternity, mental health, preventive care, or preexisting conditions. Also, they involve medical underwriting, potentially leading to rejection for applicants with significant preexisting conditions. It’s essential to review the exclusions listed in any policy.

Feel free to reach out if you’re considering short-term health insurance as an option for your needs.

For individuals below 65 seeking health insurance, there exist four primary avenues for coverage. We specialize in aiding you in identifying the ideal choice tailored to your financial plan and requirements.

• On-Exchange Plans (Affordable Care Act – ACA) These plans, overseen by the Centers for Medicare and Medicaid Services, often offer subsidies based on qualifying criteria, easing healthcare expenses. Our guidance ensures a step-by-step approach to finding the most suitable plan for your needs.
• Off-Exchange Plans If subsidy eligibility isn’t met, direct purchase from a carrier is an option. We assist in comparing plans, enabling enrollment in a plan aligning best with your needs and budget.
• Short-term Major Medical Coverage Ideal for bridging gaps during transitional phases, these plans offer swift activation, flexibility in dropping coverage, diverse deductible choices, and the ability to reapply for another term.
• Hospital Indemnity Insurance This plan disburses fixed amounts per day, week, month, or visit, offering coverage for hospital stays, surgeries, ambulance trips, and intensified ailments like stroke or cancer. Variants may provide lump-sum payments for shorter admissions or regular disbursements for longer stays.

Navigating these options might seem complex, but our expertise is dedicated to guiding you through the process. Reach out to us today for assistance!

The enrollment window this year is shorter, so acting fast is crucial. If you miss the December 15 deadline, getting 2019 coverage is impossible unless you qualify for a Special Enrollment Period. Plans from Open Enrollment kick in on January 1, 2020.

In the Marketplace, every health insurance option guarantees comprehensive coverage, encompassing doctors, medications, and hospital visits. You can compare plans based on price, benefits, quality, and other crucial features. Private companies run these insurance coverages.

During shopping, the Marketplace presents coverage details transparently. All costs are outlined upfront, providing a clear view of expenses and coverage before making a decision. Health insurance companies cannot deny coverage or charge more due to pre-existing conditions or gender.

Potential savings on monthly premiums might be available through a premium tax credit upon Marketplace application. The credit’s amount hinges on the estimated household income for 2019 specified in the application.

Coverage is divided into four categories: Bronze, Silver, Gold, and Platinum. Your choice affects monthly premiums, the portion of bills you pay for services like hospital visits or prescriptions, and your annual out-of-pocket expenses. Catastrophic policies are also available for those under 30 or with very low incomes.

Choosing coverage entails balancing monthly premiums with out-of-pocket costs. Higher-premium policies typically cover more medical costs when you seek care, leading to lower out-of-pocket expenses. Conversely, lower-premium policies mean higher out-of-pocket costs but lower monthly premiums.

In essence:

• Lower premiums mean higher out-of-pocket costs when seeking care.
• Higher premiums result in lower out-of-pocket costs during medical care.

Ultimately, understanding this balance is crucial when selecting your health coverage.