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Individual and Family Plans

 Individual and family health insurance is health insurance coverage that is available to individuals and families. The majority of people get health insurance through their employer. When employer sponsored plan is not offered or you are not eligible or the plan have limited benefit. 

They usually fall in the following categories. 


  • AFFORDABLE CARE ACT PLAN
  • SHORT TERM PLANS
  • MEDICAL INDEMNITY PLAN 
  • PREPAID MEDICAL PLAN


Affordable Care Act

Simply the ACA also known as Obamacare was signed into law in March 2010. Designed to extend health insurance coverage to  uninsured  Americans. Prevents insurance companies to deny you coverage due to preexisting conditions and must cover 11 essential health benefits .

Affordable Care Act Open Enrollment Period

Every year you have an opportunity to apply for coverage for an ACA plan on Healthcare,gov marketplace platform.. This platform has all the insurance carriers in one place participating in the exchange.  This period is usually start November 1st, and go through December 15th. This is called the Open enrollment period. This can be done with the help of insurance professional at no cost to you or you can navigate the Marketplace on your own. During the application you will be asked several question on your household size and income along with other information, this information can also qualify you for subsidies ( advance tax credit) that can be applied to your monthly premium to help reduce the cost. 

The plans take effect no earlier than January 1st. 

What if you need to apply for coverage outside of open enrollment ? 

The have what is called a Special enrollment period, if you have a qualifying event during the year you will have the opportunity to apply for coverage. See guide to all qualifying event at Healthcare.gov (Typical qualifing evernt is loss of employment coverage, marriage, moving, had a child,


Short Term Medical

 Short term health insurance is a type of health plan that can provide you with temporary medical coverage when you are between health plans, outside enrollment periods, and need some coverage in case of an emergency. However, to get the most out of a short term health plan, you need to understand how they work, what they cost, and what they cover.  

These plan typically do not cover mental health, pregnancy or  pre existing medical conditions. You do have to answer medical questionnaire  when applying. There are no advance tax credit for these plans  

You can cancel coverage whenever you’d like without penalties, you can keep the plan for fill the gap of 3,6,9, 12 months, You can get high deductible plan or copay options several options for your individual & family need. 



Indemnity Plan

 Hospital and doctor fixed indemnity insurance, often called fee for service insurance or fixed benefit insurance, pays a set benefit after you receive specific covered medical services. 

You’re paid that benefit regardless of other coverage you have. You get cash that you can use to help offset expenses your health insurance might no cover, you have to answer a series of medical questions to apply and qualify. Plans vary in what services they cover, and generally do not cover services resulting from preexisting health conditions.

if you have a high deductible and are in general good health this might be a plan to help you cover any unforeseen expenses. 



Prepaid Medical & Discount Medical Plan

 They are not insurance - Prepaid Health Clinics arrange health care services on a managed care basis. This means company arranges for medical services through a network of credentialed and contracted providers: physicians(primary, specialty), diagnostic, and other health care professionals in an organized and cost-effective manner. DPO provides access and the right to receive medical services from a network of health services providers at a substantial discount. Typically they have a fee per service or discount and a network of providers you  use for treatment,usually overseen by the  Office of Insurance Regulation , These plans are not ACA compliant, they do not offer hospitalization,policy does not medical expenses coverage, minimum essential coverage or essential health . 

They are affordable , they usually have some set pricing for services and treatment, they can offer discounts for a variety of treatments. 


 



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