Bryan Bledsoe - Health Coverage Engineer
Medicaid and Medicare
Affordable Care Act Plans
Deductibles
The more the monthly premium, the lower deductible. If you do not want to pay a large monthly premium, most deductibles average $8,000 out of pocket until it is met.
Networks
The more the monthly premium, the better the network. Better and bigger networks have a strong negotiating stance with Providers - Less out of pocket for the Holder.
Group Plans
Health Insurance Providers on the ACA work like Group Plans provided by Employers - Everyone is accepted.
HMO versus PPO Plans
HMO
The Holder will choose a Doctor upon Issuance. When the Holder leaves their geographical area (County or State), 100% of the cost is paid for by the Holder.
PPO
The Holder can go to most Doctors in the Country, and, the Holder does not need a referral to a Specialist from the Doctor - Minimizing Costs.
Open Enrollment
November of Each Year
Open enrollment begins November 1st of each year for the Market Place. This being said, individuals companies typically have their open enrollment at the same time, they can opt for a different month.
Qualifying Events
People who have a qualifying event can change their health coverage outside of open enrollment.
- Lost or Losing Health Coverage
- Change in Household Size
- Change in Primary Place of Living
- Change in Eligibility
- Enrollment Error
- Offered an Individual Coverage HRA or QSEHRA
- Other Situations (talk to your Licensed Health Agent)
Medicaid and Medicare
Who Qualifies?
People who are either disabled or make less than approximately $12,500 household income in a calendar year can qualify for Medicaid. Anyone 65 years of age or older qualifies for Medicare. Supplements are needed to get additional coverage for prescriptions, as an example.
Underwritten Coverage
Plans
Plans can be completely customized to meet the needs of the insured versus plans on the Marketplace that are a one size fits all.
Who Qualifies
People must go through a qualifying/verification process with an underwriter to determine eligibility based on health. For this reason, premiums are normally more affordable due to the insurance company not paying as many claims each year. Additionally, premiums do not increase as much as plans on the Market Place increase each year.