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Health Insurance

Affordable Health

Affordable Health Insurance Coverage

With rising healthcare and prescription drug costs across the country, finding affordable health insurance has never been more important. With that said, there are dozens, and dozens of health care plans sold each and every day from hundreds of carriers around the country… So which one is right for you? Sadly, there isn’t a one size fits all or a customizable plan where you only pay for what you need. In order to stay competitive, most insurance companies provide a certain level of coverage, sharing the expense with the beneficiary. This is why understanding how health insurance works and what coverage is right for you is so important.

There are a few main types of plans or terminology that we want to familiarize you with. Those plans are Obamacare health insurance plans, employer-based group health insurance plans, qualified health plans, catastrophic plans, short-term health insurance, indemnity health insurance plans, and gap insurance (accident, critical illness, telemedicine, etc). I know that sounds like a lot, but it is important that you know the difference.

Affordable Care Act Plans (Obamacare health insurance plans)

Under the Affordable Care Act in March of 2010, in order to curb rising health care and insurance costs, the government stepped in to provide more structure and consistency behind how and what a private insurance company can offer. All of the plans under the ACA are considered “major medical” health care plans meaning they cover both major and minor medical issues. They are created and administered by private insurance companies and regulated by the federal government. Each plan must cover what was defined as the “10 essential health benefits” which include office visits, prescription drugs, hospital care, maternity care, pediatric care, preventative medicine, and more. The key feature of an ACA plan is the fact that you cannot be turned down based on a pre-existing medical condition or prior medical history.

In order to make these plans affordable, originally, the government provided subsidies to private insurance companies in order to bring down the overall cost. While these subsidies are still in effect, the cost of many ACA plans can be overwhelming.

Employer-based Group Health Insurance Plans

Most medium to large businesses in the country offer some type of health insurance benefits to their employees. Thanks to the Affordable Care Act, that became mandatory for employers. As of 2018, businesses with fifty or more employees are required to provide full-time (or equivalent) employees and their family members with essential health care coverage. These “group plans” vary by employer and are typically negotiated annually by the employer and carrier. Employer-based group health insurance plans can be lucrative based on the buying power of the company however that may not be the case with smaller businesses.


Qualified Health Plan

Under the Affordable Care Act, a Qualified Health Plan is an insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage.”

Catastrophic Healthcare Plans

A catastrophic healthcare plan is exactly what it sounds like. This is a health insurance plan that helps pay for unexpected emergency medical costs such as hospital visits, qualifying surgeries or medical procedures, urgent care visits, loss of limb, and more. These plans are typically designed to supplement other types of healthcare plans that are lacking benefits in this area. They can also be used in circumstances where the individual doesn’t have any other type of coverage, but just wants to cover large out of pocket expenses. Some plans also cover things like annual checkups, flu shots, and other preventative medicine procedures.
Catastrophic plans are offered by many carriers, but cost, deductibles, and qualifications vary greatly depending on the carrier and type of coverage purchased. Some carriers also require a health screening to help determine the level of risk they are taking on.

Short Term Health Insurance Plans

Short term health insurance plans are lucrative for individuals seeking coverage for a specific period of time to fill a gap or transitional period. This is common when an employee is transitioning careers or going back to school for a period of time. These plans provide protection against unexpected medical bills for a limited period of time. Depending on the plan, they can cover major and minor medical issues, or you can find plans that provides specific coverage for say just minor or just major medical issues.

Short term healthcare plans can be somewhat challenging to obtain based on your medical history. Typically, these plans require a health screening in advance and an in-depth underwriting review. This is because the risk to the carrier is higher than a normal health insurance plan. Typically, the maximum amount of time you can have a short-term plan is 12 months and most health insurance companies will limit the number of times you can repurchase the plan.

Indemnity Health Insurance Plans

As a result of rising health insurance costs, indemnity plans have seen strong demand as they provide a pre-determined amount of coverage for specific services. Depending on the type of indemnity plan, you can choose the level of coverage and services you want covered which makes it appealing to most consumers as they have more control over their health insurance costs. These plans are also beneficial to the carriers as it encourages beneficiaries to take charge of their health insurance cost to minimize their out-of-pocket expenses.

At Greystone Insurance, we offer a number of Indemnity Health Insurance Solutions such as New Era Health Saver Plus Gold Edition. This plan offers policyholders the ultimate in flexibility, tools, resources, and value-added benefits. With simple, transparent benefit coverage amounts for things like doctor visits, preventative care, surgeries, hospital stays, and more, you always know where you stand. Traditional health insurance plans fail when it comes to providing a one-size fits all option. The fact is, when it comes to healthcare, there simply isn’t a one-size fits all option. With the New Era plans, you are actually rewarded for smart healthcare management, meaning when you shop around for affordable healthcare, you can actually put money back in your pocket!

To illustrate the statement above, under a New Era Health Saver Plus Gold Plan, assuming you take the “Preferred” package, your reimbursement rate for a typical doctor visit is $160. As a smart consumer, you found a physician that only charges $100 for a typical doctor visit. Using this example, you would actually receive a check for $60. Sounds too good to be true, right? There is a lot to go over when it comes to getting the most out of this plan so we encourage you to give us a call so we can walk you through the details and make sure an indemnity plan is right for you!

Gap Insurance Plans

Lastly, we have gap insurance plans. Gap insurance plans provide additional levels of protection where it counts. Examples of gap insurance plans are catastrophic accident plans, critical illness plans, specified disease plans, hospital plans, and more. These plans provide coverage or benefit for specific illnesses or situations. As an example, if you purchased a health care indemnity plan, although you have coverage for major and minor medical, what happens if you were in a car accident that required an extended hospital stay or major rehabilitation? Your health indemnity plan might not provide the level of coverage you need and so most carriers will provide some sort of gap insurance plan to cover you.

Plans, cost, and coverage all vary so it is important that you work with a licensed insurance agent and truly read the fine print. Each policy provides its own terms and conditions, and it is important that you know what those are in advance.

Have A Licensed Independent Insurance Agent Help You…

As you can see, nothing is simple with health insurance. With so many plans, rules, and coverage options, it is important to have someone who is educated in health insurance by your side. At Greystone Insurance Solutions, we are here to help navigate the complexities of insurance industry to ensure you have the coverage you need! With things like plan limitations, potential out-of-pocket expenses, coverage gaps, and more, you need an advocate on your side. Don’t waste another minute, contact us today for a free health insurance review.