Health Insurance

The Affordable Care Act (ACA), also referred to as Obamacare, was a law that was passed to make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower the cost of health insurance for households with incomes between 100% and 400% of the federal poverty level (FPL).

If you are needing individual Health Insurance, you should check out the following link or give me a call. The link will make it easier to find coverage that you might want to have.

Get a quote and signup online for Health Insurance under the Affordable Care Act

A health insurance policy is an essential part of American life that many can’t afford to ignore. Lack of health insurance can result in serious financial repercussions for anyone who requires medical treatment. An unexpected hospital trip, or surgery can cost tens of thousands of dollars without insurance – leaving consumers in excessive medical debt that they may have difficulty financially recovering from.

In 2010, former President Barack Obama signed the Affordable Care Act (ACA), which radically changed health insurance for individuals. The Marketplace is still active today and facilitates the enrollment of millions of Americans for health insurance plans each year.

As a licensed health insurance agent, I help individuals select insurance plans that best fit their needs. I can assist you with your application for health insurance through Healthcare.gov and recommend options that will provide the level of coverage you anticipate requiring.

Health Insurance Is a Non-negotiable

Few people can afford to go without health insurance. The risk of sustaining a severe injury or illness is simply too great to avoid obtaining coverage. Individuals and their families risk unexpected, costly medical bills without health insurance coverage. 

You can obtain the health insurance you need through any of the below means:

  • Employer-sponsored coverage
  • Health insurance companies
  • Health Insurance Marketplace

If you need health insurance for 2023 and can’t obtain it through your employer, take advantage of the open enrollment period to purchase health insurance. The initial open enrollment period is November 1, 2022, through December 15, 2022, for coverage starting on January 1, 2023.

If you miss the December 15, 2022, deadline, you can still purchase a plan through January 15, 2023. However, your coverage won’t start until February 1, 2023.

Plan Types

Four typical insurance plan types you may find include the following:

Exclusive Provider Organization (EPO)

An EPO provides medical services to individuals who use specific doctors, specialists, or hospitals in a plan’s network. Individuals who require care outside of the network typically need to foot their own costs, except in the case of an emergency. Individuals who choose the EPO will enjoy reduced premiums but may not have coverage with their preferred providers if they aren’t in the network.

Health Maintenance Organization (HMO)

HMOs have been around for several decades. HMO networks try to reduce medical expenses for their plan participants by limiting coverage to only doctors or specialists who participate or contract with the HMO. Usually, people who choose HMOs must live or work in a specific area to qualify. 

Out-of-network care isn’t available from HMOs unless an emergency occurs. The focus of most HMOs is on prevention and wellness, so it may not be the appropriate solution for someone with an ongoing pre-existing illness.

Point of Service (POS)

POS plans are relatively new to the insurance world. You’ll pay for every doctor’s visit, but reduced out-of-pocket costs are available for individuals who choose providers in the POS network.

If you require the care of a specialist, you’ll need to get a referral from your primary care physician. Without a referral, you won’t be eligible for plan savings and may need to pay the entire cost of your visit.

Preferred Provider Organization (PPO)

A PPO is the most flexible of all the health insurance plans. You can visit doctors, specialists, and hospitals in or out-of-network. 

Visiting doctors and facilities in the network will reduce your out-of-pocket expenses. However, you can see doctors outside your network for additional costs. 

Get Help Choosing the Right Plan For You

Selecting a health insurance plan can be confusing and complex. You want to ensure that you choose the right plan for you, with consideration of your healthcare needs and budget. 

I can explain the various options available, including their advantages and disadvantages. Don’t leave your health to chance – seek advice from a qualified health insurance broker who knows how each plan works.

Health Insurance Plans Available

Four primary classifications of health insurance plans are available to individuals under the age of 65. They include on-exchange plans, off-exchange plans, short-term major medical, and hospital indemnity insurance.

On-Exchange Plans

On-exchange plans include those primarily subsidized by the government, including Medicaid. Individuals who receive an on-exchange plan may qualify for fully-paid health insurance or tax credits to offset their monthly premium costs. 

If you believe you qualify for an on-exchange plan, I can assist you in taking the guesswork out of your application. I will assist you in applying for the program that meets your needs and advise you of the appropriate documentation that meets the ACA’s requirements.

Off-Exchange Plans

An off-exchange plan is appropriate for individuals who don’t meet the criteria for a subsidized on-exchange plan. You’ll be able to purchase your insurance directly through an insurance carrier.

Off-exchange plans can be complicated, and you’ll need to understand the coverage in each plan to make the best decision on health insurance for yourself and your family. I can assist you in understanding the scope of each plan and its cost. Together, we can select the coverage that meets your family’s needs and your current budget.

Short-Term Major Medical

A short-term major medical plan is appropriate for individuals who need a short-term solution for their healthcare needs during significant life changes. The plans all offer major medical coverage.

Purchasers of short-term major medical plans can obtain coverage that starts quickly – sometimes as fast as the following business day. Short-term major medical plans are highly customizable. You can choose the level of coverage you need, as well as your deductible amount. 

Once your short-term major medical plan ends, you may be able to renew it if necessary.

People currently in-between jobs or waiting for their new employer’s health insurance to kick in will find short-term major medical insurance an attractive option. These plans are not available in every state.

When To Choose a Short-Term Major Medical Plan Versus an ACA-policy

If you qualify for a Special Enrollment Period (SEP) with the Healthcare Insurance Marketplace, you may not be sure whether the ACA plan is appropriate or if a short-term major medical plan makes more sense.

An ACA plan makes more sense when you plan on sticking with your coverage for longer than six months. Short-term major medical plans are meant to be temporary solutions.

If you enroll for a short-term major medical plan, be aware that you will not be able to change your plan to an ACA option once your SEP window closes. 

If you have no qualifying event for SEP coverage, a short-term major medical plan may be your only alternative. However, you’ll find a wide variety of plan options, and you’ll be able to customize your deductibles and coverage. Short-term major medical plans are often cheaper than purchasing an ACA-compliant plan through the Healthcare Insurance Marketplace.

The plans also have fewer restrictions, so you’ll have your choice of physicians – but choosing an in-network doctor may be less expensive.

Keep in mind that short-term major medical plans do not include many of the essential benefits of ACA-compliant plans and might not be available where you live. You might not be eligible for regular doctor visits or maternity care coverage through a short-term medical plan.  People with pre-existing conditions may find it challenging to obtain a plan, as some insurance underwriters will not cover their illnesses or diseases.

Hospital Indemnity Insurance

Hospital indemnity insurance is appropriate for individuals at risk of needing hospital care, such as those with existing heart problems or a prior history of cancer. A hospital indemnity insurance plan covers an unexpected hospital stay for a given period, typically based on days, weeks, months, or visits. 

Some hospital indemnity insurance plans offer additional coverage for ambulatory services, surgeries, or childbirth. Special coverage is also available for individuals at risk of stroke or cancer.

Employer Group Health Insurance

If you’re a business owner seeking to purchase group health insurance for your employees, I can introduce you to the various plan options that are available. We can identify the various alternatives that meet your needs and are affordable for your organization.

Typically, employers must purchase their plan annually. Employees can decide between the plans available to them and make a decision that’s appropriate for them.

Purchasing employer group health insurance isn’t easy, so you might want an experienced hand who can navigate you through the various alternatives.

Health Savings Accounts

Health savings accounts offer tax advantages that individuals, families, and businesses can take advantage of. To enroll in a health savings account, you must have a high-deductible health insurance plan. A high-deductible plan has some risks since you will likely be responsible for the majority of your medical bills if you experience a sudden illness or develop a disease.

However, healthy individuals may find a high-deductible plan advantageous, especially if they maximize their yearly savings toward the plan. Under the 2023 tax rules, individuals can contribute up to $3,850 tax-free toward their HSA, and families can contribute up to $7,300.

Any money not used toward medical expenses for the year rolls over to the following year. Some HSAs contain investment options, so it’s possible to grow your savings over time. 

When you withdraw money from an HSA, you must keep all records of your purchases. You’ll need them to prepare your tax returns. 

Qualifying for Health Insurance with the Healthcare Insurance Marketplace

Individuals who qualify for health insurance with the Healthcare  Insurance Marketplace must:

  • Reside within the United States
  • Be a U.S. citizen or national
  • Not be in jail, prison, or otherwise incarcerated

If you meet the basic qualifications, you can select a health insurance plan during the open enrollment period or if you qualify for a SEP after the open enrollment period ends.

Enrollment Periods for the Healthcare Insurance Marketplace

From November 1, 2022, through January 15, 2023, all individuals who meet specific requirements can choose to enroll for a health insurance plan through the Healthcare Insurance Marketplace on Healthcare.gov.

Open enrollment only lasts for a short period; after that, you’ll need to qualify for a Special Enrollment Period (SEP) to obtain 2023 health insurance for yourself and your family. 

Individuals who typically need to obtain their health insurance through the Marketplace include those who don’t have coverage through an employer’s policy, are unemployed, self-employed, or don’t have access to health care through other means.

If you don’t enroll for health insurance during open enrollment for 2023, you can only obtain it if you qualify under a SEP. Changes in your life situation that meet the requirements for a SEP include:

  • Loss of qualifying health insurance, such as by changing jobs or stopping work
  • Increase or decrease to the size of your household
  • Change in local residency that impacts the health insurance plans available to you
  • A change in your eligibility for Marketplace coverage, such as a change in your income
  • An enrollment mistake or plan error
  • Other circumstances, generally on a case-by-case basis

In most cases, you have 60 days from the date of the qualifying event to enroll in coverage. If you are enrolling in Marketplace coverage for the first time, you may need to submit documents to prove SEP eligibility.

NOTE: If you experience a change in household income throughout the year, you should report this change to the Marketplace as soon as possible as it may affect the amount of financial assistance that you are eligible for. I can also help you update your Marketplace application on HealthCare.gov as well.

Premium Tax Benefits

If you enroll for health insurance through the ACA’s Health Insurance Marketplace, you may receive certain tax credits to pay for your coverage. 

A premium tax credit is available to individuals whose income falls within the range of 100% to 400% of the federal poverty line as of 2022. The income requirements are a bit complex and involve comparing the size of your household alongside specific earnings levels. 

Additional restrictions also apply to the tax credits. Individuals who file a tax return with a filing status of married filing separately will probably not qualify for the tax credits. In addition, you can’t be eligible as a dependent on someone else’s tax return.

People with access to affordable healthcare through their employer or government plans like Medicaid, Medicare, or Tricare are ineligible for tax credits.

If you’re unsure whether you qualify for the tax credits available through the Health Insurance Marketplace, Thomas Marchant can evaluate your situation and determine whether you meet the criteria.

Essential Health Benefits

All plans available through the Health Insurance Marketplace must provide essential health benefits. Plans may include additional coverage in some cases. 

Under the Patient Protection and Affordable Care Act, all plans must provide these essential health benefits:

  • Preventative and wellness services, including management of chronic diseases
  • Emergency services and hospitalization
  • Ambulatory services, including outpatient care without admission into a hospital
  • Prescription drug benefits
  • Laboratory services
  • Maternity and newborn care, both before and after a baby is born
  • Substance abuse treatment, including counseling and psychotherapy
  • Mental health services
  • Rehabilitative services and equipment for individuals with injuries, disabilities, and chronic conditions
  • Pediatric services 

Under the rules stipulated by the Affordable Care Act, all plans must include these benefits without annual limits or lifetime maximums.

Free Preventative Health Care

In addition to the essential health benefits, plans available through the Healthcare Insurance Marketplace must provide free preventative healthcare, with no charge for copayment or coinsurance. 

Even if you have not yet met your yearly deductible, you are still entitled to free preventative health care as long as you see a physician within your network. 

The preventative health care services available include:

  • Alcohol misuse screening and counseling
  • Blood pressure testing for all adults
  • Cholesterol screening for adults of certain ages or who are at high risk
  • Screening for mental health disorders, including depression
  • Diabetes Type 2 screening for individuals with previously diagnosed high blood pressure
  • Diet counseling for individuals at increased risk of health problems associated with being overweight
  • One-time screening of men with a history of smoking for abdominal aortic aneurysm
  • Recommendation for aspirin use to prevent cardiovascular disease
  • Colorectal cancer screening for adults over the age of 50
  • Obesity screening and counseling for all adults
  • Sexually transmitted infection (STI) prevention and testing for adults at high risk
  • HIV screening for all individuals aged 15 to 65 and others of high risk
  • Recommended immunizations 
  • Lung cancer screening for adults aged 50 to 80 who have a history of smoking
  • Statin-preventative medications for adults aged 40 to 75 who are at high risk
  • Syphilis screening
  • Tobacco use screening and cessation products and services for current smokers
  • Tuberculosis screening for adults at high risk
  • Hepatitis B testing for people at high risk
  • Hepatitis C testing for individuals aged 18 to 79
  • HIV prevention medication for HIV-negative individuals who are at risk of contracting the disease

Everyone is obliged to themselves, their family, and friends to take advantage of free preventative healthcare services to lower their chances of contracting severe illnesses or diseases. The healthcare services are free of charge as long as the patient seeks care from an in-network physician. 

I Can Help You With Your Health Insurance Needs

I am a licensed independent health insurance agent, and I am passionate about helping others find the coverage that they need. I am licensed in 47 states. I currently live in Waipahu, Hawaii, and am a former U.S. Marine and retired from the U.S. Navy. 

I will help anyone who needs assistance obtaining health insurance. I am highly familiar with the complexities of the ACA, Obamacare, and the various alternatives to the Health Insurance Marketplace. 

Contact me today to schedule your appointment! I offer local help in Hawaii and can also provide help over the phone and over the computer.