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.
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.
Health Insurance Providers on the ACA work like Group Plans provided by Employers - Everyone is accepted.
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.
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 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.
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)
People who are either disabled or make less than approximately $12,700 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. To see if you qualify for Medicaid, please review the following link.
Plans can be completely customized to meet the needs of the insured versus plans on the Marketplace that are a one size fits all.
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.
When Employers provide health coverage as a benefit, it is normally heavily subsidized. Also, it does not have any Caps. Meaning the Employer shares most of the cost and covers 100% of any catastrophic illnesses and accidents after a deductible.
This is also a great option for 100% covered catastrophic illnesses and accidents after a deductible. Additionally, this health coverage can be subsidized for individuals and families who make less than a pre-determined household income per calendar year. For the household income qualifications, please use the following link for more information.
For an individual or household to qualify for Under Written health coverage, the person or persons must be healthy with no pre-existing conditions. For example, no diabetes, heart disease, strokes or cancers. Additionally, if someone does not qualify for subsidies with either Employer Coverage or from the Market Place, this coverage is always more affordable and provides the insurer better benefits.