Health Insurance Plans
We offer individual and family health insurance policies directly through carriers and on the Federally Facilitated Marketplace (FFM). More details can be found at www.HealthCare.gov.
The Affordable Care Act (ACA) requires that all United States citizens have health insurance or face a penalty. The ACA also requires that insurance companies include the 10 Essential Health Benefits in all of their plans, which include hospital coverage, doctor visits, diagnostic tests, drug coverage, maternity care, preventative care, and pediatric services.
The Affordable Care Act has changed the way we purchase and benefit from health insurance. There are no pre-existing condition riders or underwriting questions (apart from being a smoker). No one can be denied a plan for any reason or be rated-up due to health conditions. This means that all Americans can get affordable coverage no matter what their health situation.
There are two different avenues you can take to enroll in a health insurance plan. You can buy a plan directly from the insurance carrier, or if you think you may be eligible for government subsidies, you can apply through the Federal Marketplace. Some states have their own exchange to purchase health insurance. The states where we are licensed are now all on the Federal Marketplace. Premiums are based on age, zip code and smoking status.
We find that, while the marketplace is not complex, it does have its quirks. Creating a profile and entering your financial information is not always as straight forward as you would think. Selecting a plan also can be confusing. We donít recommend that you necessarily pick the cheapest plan available. The key thing to picking the right plan is the network of doctors and the drugs you take.
Many of the plans on the marketplace are Health Maintenance Organizations (HMO). This means that you MUST see doctors in that plan's network. It is critical that you ensure your doctors are in the network or you will not be able to see them. Some of the plans are Preferred Provider Organizations (PPO). This means that you can see doctors out of the network. Typically you have a higher deductible, out of pocket maximum and co-pays for services.
Since the plans all have drug coverage, you also need to ensure that your drugs are covered and understand how the plan covers the drugs. Does it have a separate drug deductible, or is the medical deductible combined with the drug deductible? How does the plan rate your drug and what are the co-pays?
Depending on your income, you may qualify for premium and/or cost subsidies. Find out more about these subsidies and how they can lower your costs.
If this sounds complex, it is. You only have one chance each year to change your plan. That timeframe varies every year, but typically encompasses November to the end of January. As with all insurance, there are Special Enrollment Periods (SEP) if you have a life event such as birth, death, marriage or loss of employer coverage.
At Imagine Insurance Advisors, we fully understand all the of ins and outs of the healthcare coverage and choices. We can help you navigate the system finding the plan that best fits your and your familyís needs.