Individual/Family Health Insurance

There is much confusion in the health insurance market today due to the Affordable Care Act laws. The new health laws affect ALL your major medical health insurance choices because they now govern what plans are available, what the plans are required to cover, when you can purchase health coverage and ultimately the cost of these plans.

These new plans are call “Qualified Health Plans”. It does not matter if you purchase a plan through the Federally Facilitated Marketplace (the Exchange government website) or directly from the carrier (people think of these as Private Plans)-the ACA laws affect all major medical health plans.

Defining Characteristics of a Qualified Major Medical Health Plan under the ACA

• Plans are required to cover pre-existing health conditions.
• Must offer unlimited benefit maximums
• Qualified plans can only be purchased at Open Enrollment (Nov 1-Dec 15th of each year) unless you qualify for a Special Enrollment Period (due to losing another qualified major medical health plan at no fault of your own, within 60 days)
• Highest Premiums. Unfortunately, the many ACA rules have put the cost of qualified plans out of reach for many consumers.
• Qualified Major Medical plans are now required to cover these:
  • 10 Essential Health Benefits:
    1. ambulatory outpatient services
    2. emergency services
    3. hospitalization
    4. maternity and newborn care
    5. mental health and substance abuse disorder services, including behavioral health treatment
    6. prescription drugs
    7. rehabilitative and habilitative services and devices
    8. laboratory services
    9. preventive and wellness services and chronic disease management
    10. pediatric services

Pros:

• Prices 30-50% lower than ACA plans
• NPOS networks available
• Underwriting allows for lower prices
• New plans offer options to prevent Pre-existing from starting over
• Enroll any time of year

Cons:

• Can be rejected based on health conditions
• Pre-Existing conditions Not covered
• Does not cover most preventive healthcare
• Pre-existing condition starts over with each new Application

Short Term plans have a limited time set for each plan and they are more limited in what they cover. Once the plan expires, you reapply and everything is reset on the plan, including the deductible and pre-existing conditions. You can apply for or renew these plans anytime throughout the year.

However, there are new exciting plan options that now allow you to avoid the restarting of the pre-existing clause if you enroll in the plan correctly. Certain plans allow you to apply once, for up to 3 insurance coverage terms, that can equal almost 3 years of coverage. With those specific plans your pre-existing condition exclusion does not restart if you apply for all 3 terms at once.

In the past Short-Term Medical plans were used most often when someone was between major medical coverage at their job. But due to the ACA restrictions dictating when you can apply for a major medical plan and the high cost of those plans, short term plans are used much more often these days. Especially by healthy people looking for protection against large, unexpected expenses.

There are good uses for these plans, but you need to be very careful about what you are purchasing. If you understand the plan, you can make an educated decision about if this type of plan is right for your situation.

Terri Potter can help with that so give her a call @ 770-452-9335.

Read about our suggested Short Term Plans HERE!!

Pros:

• Can save you 40-60% compared to ACA plans.
• Reimburses you a pre-set amount for services
• More customization
• PPO networks

Cons:

• Can be rejected based on health conditions
• Pre-Existing conditions Not covered initially
• Plans are more complex
• Claims to file to save the most

An Indemnity plan is often referred to as fee-for-service plan. These types of plans pay a set amount for different healthcare services. This gives your health insurance with a little more freedom than found in most other plans. This is kind of like insurance was back in the day, before HMO networks came along.

Some indemnity plans do give you access to a network of providers, usually a large PPO network. Or sometimes you can submit your bills for reimbursement to the insurance carrier and they will send cash directly back to you. Some plans reimburse on the Medicare Fee Schedule. They allow you to buy one, two or even three times the Medicare reimbursement rate. That way you can customize your plan. I do want to clarify that this type of plan is NOT an ACA qualified health plan and they do not cover pre-existing conditions.

To learn more about this option call Terri Potter @ 770-452-9335.

Pros:

• Innovative healthcare delivery model allowing better Dr/Patient care than insurance allows
• Provides high-quality, 24/7 access to your personal Primary Care Physician
  • Dr. available in office, by phone, secure message text, or video
• Low cost for labs, imaging, medications, specialty consultations
• Membership only $100 per person per month
• Works well with Indemnity plan mentioned above
• Can be used with Medicare or any insurance product for the bigger stuff

Cons:

• Closed group of doctors but growing very quickly!
• Currently available mostly in Atlanta and surrounding areas

A Better Healthcare Delivery Model

Most doctors are in the healthcare business to help people. They want to give their patients the care and attention that people desire in a healthcare professional. They want to be able to focus on their patients. Unfortunately, in the current healthcare system, most doctors can only spend around 8 minutes with a patient. 8 minutes! There must be a better way.

There is a group of doctors in Georgia that want more out of practicing medicine. They want to put the Caring back in healthcare! They desire to provide high-quality, affordable primary care services that are accessible with 24/7 access to care.

And they are making it work! It is thought that a good primary care doctor, that really knows you, can handle 80% of your care. That gives your doctor better coordination of your care.

This works by pairing it with one of several different insurance options to help with those rare, high cost of catastrophic care.

To learn more about this healthcare delivery system, call Terri Potter @ 770-452-9335.

A Biblical Approach to Healthcare

These are NOT insurance products. They work by members sharing in each other’s medical expenses. These memberships can be joined at any time of the year but are not for everyone as they are lifestyle based. However, they are growing quite large due to their popularity since the start of the Affordable Care Act.

And some of them use a very large network of providers. I had a doctor in charge of the insurance for a very large physician’s practice in Atlanta tell me he would rather have his patients in a sharing ministry than some of the ACA plans available now. He said, “at least with these plans we know we will get paid”.

To learn more about these options call Terri Potter @ 770-452-9335.

Questions? Send us an email!