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Individual and Family Health Insurance Options

Health insurance is the most vital investments we make, especially with astronomically expensive healthcare cost. This cost further escalates, if hospital visits, surgery or other serious measures are also required. In such a scenario, health insurance is the only way to ensure that you are not struck covering these emergency medical costs. Individual and family health insurance is an insurance that you purchase on your own for your self and your family either through a government or private exchange. Health care companies charge you premiums, a set amount of money each month, and you are eligible for the health care expenses that are paid by the insurance companies. Usually the health care expenses include regular doctor checkups or treatment for long-term illness. Individual health insurance can be purchased through the Health Insurance Marketplace or directly from a health insurance company on your own. Though it is called individual health insurance but you can find plans to cover your family too. Health care is quite expensive and hence it is a smart idea to have individual and family health insurance, so that you are prepared for the adverse time when you or your family have medical needs.

Types of Health Care Plans / Health Insurance Options

Affordable Care Act Insurance or Obamacare

As per the Affordable Care Act, everyone with a few exceptions should be covered by medical insurance that meets the ACA requirement of minimal essential coverage. Some of the features of Affordable Care Act include:

  • ACA health plans are guaranteed issue, means no one can be turned down for coverage or charged a higher price based on preexisting heath conditions.
  • All ACA health insurance plans cover the same ten essential health benefit areas such as preventive care, maternity care, prescription coverage etc.
  • Enrollment to the health insurance plans is limited to an annual open enrollment period, which is usually in November and December unless you have some qualifying reason for special enrollment.
  • Depending on your income level you may get some tax credits and subsidies that may cut your monthly premium cost.
Affordable Care Act

Points to Consider while Choosing a Health Insurance Plan

Choosing a health insurance plan for yourself and your family is a vital decision that you should do after considering several factors that will eventually help you in taking a sound and informed decision and will also allow you choose a perfect health plan. Factors that need your serious considerations include:

  • Every health care plan comes with certain clauses and hence you must read the fine print carefully prior deciding on a heal plan.
  • While selecting a plan, always check that whether you have the right to visit any hospital, doctor, clinic or pharmacy of your choice or not?
  • Does your health plan include treatment from specialists like eye doctor or dentist?
  • Does your plan cover treatment of special conditions like physical therapy, pregnancy, and psychiatric visits.
  • Whether all medications prescribed by the physician will be covered or not?
  • Home care or nursing home care expenses are included in the coverage or not?
  • The maximum amount which you need to pay from your pocket to get the cover from the insurance company.
  • How any dispute related to bill or service is handled?
  • Get yourself acquainted with terms like deductibles, co-payments and co-insurance.
Family Health Insurance Plans

Why Individual and Family Health Insurance is Important?

Buy a broad range of Individual and family health insurance plans from leading insurance carriers. Browse and compare the plans to find one that suits your budget and health needs.

It is the Law

In U.S it is essential for everyone to have a qualified health care coverage under the Affordable Care Act. If you don’t have a health insurance then you may have to pay a penalty.

Prepare for the unexpected

In U.S it is essential for everyone to have a qualified health care coverage under the Affordable Care Act. If you don’t have a health insurance then you may have to pay a penalty.

Stay Healthy

In U.S it is essential for everyone to have a qualified health care coverage under the Affordable Care Act. If you don’t have a health insurance then you may have to pay a penalty.

FAQ on Individual and Family Health Insurance

Individual and family health insurance is a type of health insurance coverage offered to individuals and families, rather to employer, groups, or organizations. There are many people who don’t have access to employer-sponsored coverage can seek coverage through Individual and family health plans. People will find a variety of individual and family health plans available at extremely affordable prices.

Generally Individual and family health plans are categorized as indemnity plans or managed care plans. However, the major difference between the plans are in terms of choice of health care providers, out-of-pocket costs, and how bills are paid. Indemnity plans offer a broader selection of healthcare providers compared to managed care plans. Besides, these plans pay their cost share only after receiving bills, which means insured first have to pay up front and then obtain reimbursement from their insurers.

Different types of managed care plans are available in the market that include HMO, PPO, and POS plans. Enrollees of managed care plans generally have to use healthcare provider networks. Network healthcare providers agree to renders services to managed care members at pre-negotiated rates and then submit the claim to the insurance company on behalf of the patients. People generally have less paper work and lower out-of-pocket costs with a managed care plan and a broader choice of health care providers with an indemnity plan.

People can buy individual health plan meeting government coverage standards only during the annual open enrollment period, unless they have a special circumstance like getting married, losing job, having a baby. All such special circumstances create a special enrollment period. People who need to make changes in their health plans due to special circumstances can make changes during special enrollment period. However, if people don’t have a qualified life event, then open enrollment is the only time when they can make changes.

Generally, there are two ways to buy individual or family health plans, people can either buy directly from a health insurance company or they can purchase through their state’s health insurance marketplace. A health insurance marketplace is a government funded health insurance portal showcasing individual and family plans of multiple insurance companies. People living in states that have their own marketplace can buy individual plan from their state exchange or if their state does not have their marketplace, then they can purchase through the federal marketplace.

Every individual should remember that as long as their income doesn’t exceed 250% of the poverty level, they are eligible for cost-sharing subsidies. And if you buy a Silver plan, cost-sharing subsidies are automatically included in your plan whereas premium subsidies are available on any Bronze, Silver, Gold or Platinum plan. Cost-sharing subsidies reduce the copays, deductibles and coinsurance and hence you pay less each time you use your coverage and your out-of-pocket expense on your plan is also reduced. This ensures that you overall pay less if you require a lot of medical care throughout the year. Now if you earn $24,000 per year it means that you are under 200% of the poverty line and your out-of-pocket expenses will be capped at $2,600 in 2019. If you select a Silver plan after your coverage under parent’s plan expires, your plan will have an actuarial value of 87%, which is much better than a Gold plan and equally good as a Platinum plan but available to you at a price of Silver plan. The increased actuarial value will let you enjoy better coverage right form the beginning and even if you don’t have medical expenses that are enough to hit the out-of-pocket maximum during the year. However, if you buy a Bronze plan instead, then you will definitely pay low premium or you may pay nothing in premium but you will have to bear the full out-of-pocket expenses that comes with Bronze plans. Thus, as long as you buy Silver plan, your cost-sharing subsidies will be incorporated in the plan depending upon your income. For a single individual the HHS has capped maximum out-of-pocket costs on Silver plans to $2,600 if you earning is in between $12,140 and $24,280 and $6,300 if your earning is in between $24,281 and $30,350.

A family plan generally include separate child premium for a maximum of three children age 20 or younger. So, it will depend on your children’s age. However, adult children of age 21 to 25 included in a family plan are charged with the adult rate, irrespective of the number of dependent children in the family.

Let us understand this with examples:

In a Family A there are seven insured members, two parents in their 50s along with five children of age 19, 17, 15, 13 and 11. The healthcare price of this family will include premiums of parents along with premiums for the three children, since all the five children are younger than 20.

In a Family B also there are seven insured members, two parents in their 50s and five children of age 23, 21, 17, 15 and 12. The premium of family will include charges for all seven members. Adult premium rates will be applicable for the parents and the two children above the age of 20 years. Though the children premium rate will be less than their parents as they are in their early 20s. Beside the three younger children less than of 20 years will be charged with the applicable child premium rate. Now suppose if this family had a sixth child under 20 years of age then his premium would not be calculated as the family has already reached the maximum of three.

The health care law was reformed with the idea to remove the barriers to insurance coverage for Americans who remained uninsured due to pre-existing conditions or cost issues. The law removes most of the barriers so that health insurance exchange cannot turn you down because of pre-existing condition and it would also won’t exclude pre-existing conditions from their coverage or charge higher premiums based on the medical history. These regulations are applicable to all major individual health plans irrespective of the fact that whether they are sold though the exchange or off-exchange.
Patients’ Bill of Rights included in Affordable Care Act helps customers in the following ways:

  1. Insurers cannot revoke the customer’s coverage because of an unintentional error in an application.
  2. Insurers cannot set lifetime limit on customer’s coverage
  3. The customers are ensure to choose the primary care doctor of their choice from the plan’s list.
  4. Children under the age of 26 years are allowed to be covered under their parent’s plan.

Customers need to understand that health insurance is not only available for purchase during open enrollment or if customers experience a qualifying event. The limited enrollment windows apply on and off the exchange. If anyone tries to enroll outside the open enrollment without a qualifying event then the enrollment will be rejected. So, the days of getting turned down of health plan due to medical history is no longer currently possible but one can be turned down based on the application timing.

Individuals and families who earn less than 400% of the Federal Poverty Line is entitled of a federal subsidy, which is known as the Advanced Premium Tax Credit. This subsidy is a part of the Affordable Care Act that helps you pay health insurance premium, making it more affordable for all. A tax credit is an amount which you can take in advance to lower your monthly premium. At the time of applying for health insurance in the marketplace, you estimate your expected income for the year and if you qualify for a premium tax credit based on your estimate, then you can use any amount of the credit in advance to reduce your premium cost. At the end of the year, if you take more premium tax credit in advance then you will have to pay back the excess at the time of filing your federal tax return. If you take less than the amount you qualify for tax credit then you will get the difference back.

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