Individual, Family & Self Employed
Without a solid health insurance policy, one serious accident or illness could lead to major financial loss.
Many plans on the market today that appear to be solid major medical plans, yet they have some policy exclusions or limitations that consumers easily overlook. Even some reputable carriers offer relatively affordable plans that leave out important benefits.
The Individual Health insurance Market is not easy to Navigate.
It’s quite challenging to find good advice because agents receive little to no compensation for selling ACA plans. What is an ACA plan? The Affordable Care Act (ACA) requires insurance companies to meet certain conditions for a plan is to be considered “ACA-compliant”. An ACA plan is the most popular type of individual/family health plan.
With ACA Plans, pre-existing conditions are covered and plans are required to include the 10 Essential Health Benefits. For a list of these benefits, click HERE. Plans can be purchased on or off the Marketplace. If you think you qualify for a subsidy (Advanced Premium Tax Credit) based on your income, then you want to go the Marketplace – www.healthcare.gov – to determine how much you would receive.
Hundreds of thousands of people qualify for a large subsidy, so they pay very little for their health insurance. Even though the networks and benefits might not be great, the very low cost usually trumps everything else.
If you earn too much money to qualify for a subsidy, then there is no reason to go through the Marketplace. You will involve a middle-man (the government) when applying for coverage. You will be much better off purchasing coverage OFF the Marketplace (AKA, the Exchange). See below for the carrier links.
Three ACA Carriers Available in Metro Atlanta.
- Blue Cross Blue Shield – Available both on and off the Exchange Click HERE for BC/BS (ANTHEM) Quotes They currently have the lowest rates in GA.
- Kaiser Permanente – Available both on and off the Exchange Click HERE for Kaiser Quotes
- Ambetter – Only available on the Exchange at www.healthcare.gov
Alliant Health offers PPO plans, but they are only available in some counties in North Georgia.
Provider Networks: With the exception of Alliant Health, all carriers offer HMO plans only It is important to chec provider networks to find out if your doctors and your preferred hospitals are in the network.
Drug Formularies: Check your medications to find out how much you will pay. Also, carefully review the pharmacy plan benefits. Often times, you’re required to meet your deductible before the plan pays for brand-name drugs. Generics do not require a deductible.
Alternatives to ACA Plans
Should you consider a Non-ACA Plan? We call these “Alternative” plans.
1) Income: If you (your household) will likely earn more than 400% of the Federal Poverty Level in 2019, then you will not qualify for a subsidy. If you’re not sure about your income, please click HERE to see if you qualify.
2) Health: If you are good health and do not have any serious pre-existing conditions, then you might not need an ACA plan.
Alternative plans may be a better option for the following reasons:
- The Shared Responsibility Payment (AKA: penalty / fine) no longer applies. The Individual Mandate was repealed as of January 2019. You will not be penalized for not having an ACA compliant plan.
- The typical premium is 40% to 50% lower than a comparable ACA plan.
- Short-term Medical plans no longer have a 3-month limitation. You can keep STM plans for up to 12 months and renew for up to 36 months.
- Most STM plans have strong, national PPO networks.
- You can enroll in a plan any time during the year.
ALERT: Numerous insurance companies appear to offer quality health insurance, but the plans are often weak with caps, limitations, and policy exclusions that can leave you exposed to large out-of-pocket expenses. When you search online for “health insurance”, the top results are usually the ones offering these poorly designed plans. Buyer beware.
Since agents are not compensated well (or at all) with ACA plans, they will usually steer you towards alternative plans and minimize the risks you face. Don’t allow this to happen.
Alternative Health Insurance Options
- Option 1. *Short-term Major Medical. Pre-existing conditions are not covered. You can enroll anytime of year. PPO or Indemnity plans available. Check out plans and rates by clicking here. The plans we recommend allow you to keep your policy for one year and renew it (without requalifying) for up to 3 years.
* Short-term Major Medical is somewhat of a misnomer since plans now last much longer than the previous short durations (3 to 6 months). Some Short-term medical plans are not very good; other plans are solid major medical policies. Read the exclusion list. These plans typically do not cover maternity or mental health benefits.
- Option 2. A Health Care Sharing Ministry Plan with Medi-Share or other companies. You can check out the plans by clicking here. You can enroll anytime of year. Plans offer access to a large, national PPO network. There are a couple of other Health Care Sharing Plans with less stringent eligibility guidelines.
- Option 3. Small group plan. If you are a business owner and have at least one W-2 employee, this could be a viable alternative. We can prepare comparison quotes with several carriers.
Conclusion – Health Insurance for the Individual, Family & Self Employed
Understanding all your options and choosing the best plan isn’t easy. Sometimes, it makes sense to split family members up on different plans, depending on individual health and circumstances.
The good news is that you can make new plan choices every year during Open Enrollment from November 1 to December 15. You’re not locked in to a plan long-term.
There is a wide range of products on the market today and many carriers offering unique insurance plans. It is important to know what type of health insurance you are buying and that takes the experience, expertise and the care of a health insurance advisor. That’s why we’re here…we know all the pitfalls of buying health insurance and we help our clients make the best informed choices.
