Individual and Family Health Insurance
What is the difference in Group and Individual/family health insurance?
Group health insurance, also referred to as “Company Insurance” requires that you work for a business that offers employer health insurance. This type of health insurance is offered by companies to their full-time employees that qualify. To qualify an employee must work a minimum number of hours each week (typically 31 or more) and meet a probationary period (30-60 days) to qualify for health insurance. The owners of the company generally cover a portion of the employees’ health insurance cost.
The second type of health insurance is individual and family insurance. This type of insurance is purchased by the individual directly from the health insurance company. The individual normally pays all the monthly health insurance costs for their family. However with the advent of the Marketplace in 2014 the insured’s annual income may qualify his family for a tax credit (through www.healthcare.gov) which can reduce the monthly cost of health insurance. The details of how these tax credits work is described below in the “Types of individual and family insurance options” section.
When possible, its best to enroll in a group health insurance policy. A couple of reasons is that the employer usually helps the employee, and in some cases his dependents with their month premium as part of his compensation plan with the employer. The other good reason is that group health insurance plans generally offer better and more comprehensive benefits than you can find in an individual health plan. So, what happens when your employer doesn’t offer group health insurance, or you are self-employed. You must purchase your own health insurance for your family.
Types of individual and family health insurance options
1) Individual Health Insurance (ACA) “Marketplace”
One option is to select an ACA (affordable health care) plan through www.healthcare.com. Which is also referred to by these common terms “Obamacare”, The Market Place, or The Exchange. What a “marketplace” policy requires is that you set up a profile on www.healthcare.gov and complete an application. The main reason to consider enrolling in a Market Place plan is the potential tax subsidy.
What a tax subsidy is in basic terms is a reduction in your monthly costs for health insurance based on your annual income. To determine your tax subsidy, we recommend that you consult with your tax preparer or CPA to calculate your Adjusted Gross Income (AGI) for the year you wish to apply. To enroll in a Market Place plan, you have several options to choose from, you can
Do it yourself, go directly to healthcare.gov and have one or their representative help or have a licensed health insurance broker like our staff at Texas Health Now, PLLC help you.
What are the advantages of working with us to enroll in an ACA (Market Place) Plan?
- We are licensed Texas health insurance agents and trained to help you.
- We are certified by www.healthcare.gov to sell health insurance plans in Texas on the Marketplace website.
- We can help you evaluate all your health insurance options not just those on the www.healthcare.gov web site. Some of the best options for your family may not be on this government web site.
- We can help explain how a tax subsidy works with your new health insurance policy. And the possible savings you may realize if you apply. But as previously mentioned you should always seek tax advice from a licensed tax preparer or CPA to determine what income to include on your application. We cannot help you with this information.
- We do not charge ANY FEES for our services since we are paid directly by the insurance companies, we write policies for in Texas.
- We will help you every step of the way with your application, getting it approved and any follow up if necessary. Plus, after the policy is issued if you have questions, you can call us and speak with a familiar voice rather than contacting a large “call center”.
- We will send you reminder’s each year before “open enrollment” that we need to talk/meet to evaluate your current plan to help you determine if you need to make changes for the new year.
2) “Off Exchange” (ACA plan)
A second option if you don’t qualify for a tax subsidy for health insurance is to enroll in an “Off Exchange” ACA Plan. An off exchange plan is similar in benefits to the Marketplace plan except you pay the Full Cost of the health insurance policy.
What are the advantages of having us assist you with your “Off Exchange”ACA insurance
- We will help you evaluate which health insurance plan is best for you and your family.
- Since we are local agents based in Plano, Texas you have one source to assist with your concerns and questions about your health insurance policy. We are here for you during your initial enrollment as well as each year when you get your renewal notice.
- We monitor and research current trends and changes in the health insurance industry so we can advise you which is the best option health insurance option for you both now and in the future.
- We specialize in Texas health insurance, so if you need to make a change in the future and you want to switch to an employer type group plan, we can assist you with small business health insurance. When you reach the point in your life that you or a family member needs help with your Medicare options we can assist as well.
3) Short term or “Catastrophic Coverage”
A third option to consider for individual health insurance is a short term or Catastrophic Coverage. What is a short-term policy? This type of policy is a little different than the previous two policies (On and Off Exchange). A short-term policy requires that you answer a series of medical questions to qualify for coverage, while the two previous policies did not require you to answer heath questions.
So why choose a short-term policy when the other options require no medical and health evaluation. The main reason to choose a short term plan is that if you are healthy then you can save significantly on the monthly cost of your health insurance premiums. So essentially the short-term health insurance company is “rewarding you” for being in good health with better rates than the other two options. Now we realize that a short-term health insurance policy is not appropriate for everyone, but for those who qualify and want an option to reduce the high costs of health insurance it is an excellent alternative.
Features and Benefits of Short Term Health Insurance Policy
(This list of benefits is for illustration purposes only) full benefits vary between companies.
- Policies can be written from 1 to 12 months You have the flexibility to enroll in a short-term policy for as brief as 1 month up to 12 months. Some companies have longer terms if you prefer.
- Short term policies are an excellent affordable choice for these situations
- Loss of group coverage and COBRA is too expensive
- Going through a divorce and needing to reduce monthly expenses
- Waiting on group insurance with a new employer (30,60, 90 day waiting period)
- College graduate who is interviewing and has not secured a job with group benefits yet
- Someone new to this country who doesn’t qualify for a traditional plan
- An individual or family that wants to be “Covered for the Big Things” in life that happen like a car wreck, cancer, etc .
- Health insurance questions are required for enrollment. If you don’t have any pre-existing conditions, then these health questions will help you qualify for a better monthly premium than a ACA policy
- Pre-existing Restrictions - Pre-existing conditions are excluded from coverage. If you have serious health issues this type of plan is not the right choice for you and we strongly recommend you enroll in an ACA policy.
- Preferred Health Status (in some cases) - Some Short-Term health insurance policies offer “preferred status” for heathy individuals which means they get even better rates than the standard questions on a typical short-term application. This additional group of questions means you can realize even greater savings on your monthly premium.
- Nationwide PPO network – With ACA plan mentioned previously it is generally difficult to find a PPO network. With the short term companies that we represent you can generally have access to a nationwide PPO network.
- Flexibility to Enroll in a Short Term Plan when You want- All ACA plans have specific guidelines when you are eligible to enroll. Typically, you enroll during open enrollment each year that occurs annually in the Fall (Nov/Dec). Or you have a special event occur in your life such as a birth, divorce, or loss in group coverage with your employer. This Special Enrollment Period (SEP) provision allows you and your family permission by the government and insurance company to enroll outside of the traditional open enrollment time frame. With a short-term policy, you can apply any time in the year if you can answer the health questionnaire