Individual Health Insurance
We can help most people find a medical insurance plan that fits their budget, from a plan that offers generous coverage to a high-deductible plan designed primarily to protect your family from the cost of catastrophic illness. These plans will meet the requirements of the Affordable Care Act health care reform law, so you will not have to pay a penalty.
You can also buy supplemental insurance plans that will pay some of the costs your health insurance plan won’t cover. These include hospitalization insurance (or hospital indemnity insurance), critical illness insurance and cancer insurance. These supplemental insurance plans will pay benefits that you can use however you choose if you are hospitalized or suffer a covered illness.
You can read more here about the different medical insurance plan types: PPOs, HMOs and POS as well as high-deductible plans.
Medical insurance plans with full coverage fall into three major categories:
Preferred provider organization (PPO) plans:
PPOs are the most common type of health plan today. A PPO contracts with a network of doctors; plans typically reimburse a higher percentage of fees for in-network doctors. Members can use non-network providers but will have higher copayments. Plans usually include features to avoid unnecessary health expenditures, such as requiring pre-authorization for elective procedures or a primary care physician’s referral for visits to specialists. Most plans also include wellness or disease management benefits designed to keep your employees healthy and control your claim costs.
Health maintenance organization (HMO) plans:
An HMO requires members to use physicians within the HMO’s network; HMOs typically do not pay anything for out-of-network treatment, except in case of emergency. HMOs give your employees less flexibility in provider choice, but often cost less and involve lower out-of-pocket payments than other plans.
Point-of-service (POS) plans:
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.
Health Savings Accounts (HSAs)
If you want protection from catastrophic illness but you want to pay less in premiums you can take advantage of a high-deductible health plan linked to a health savings account. These plans offer lower premiums than a plan with full coverage. You can use the savings to build funds in a health savings account, which you can use for any tax-qualified healthcare expense.
Only individuals with an eligible high-deductible health plans and no other health insurance can have an HSA. You use account balances to pay for qualified health expenses; funds can accumulate from year to year.
Some employers fund their employees’ HSAs; employer contributions to an HSA are not considered taxable income. Contributions you make, up to the annual maximum, are tax deductible. Withdrawals used for eligible medical expenses are not taxable, and interest on your funds is also not taxable.
Medicare Supplement, or “Medigap” Plans
Seniors face a bewildering array of health plan choices. Should you stick with Original Medicare, which provides only hospital and medical coverage? Original Medicare, plus a Medicare Supplement from a private insurer? Or should you opt to buy a Medicare Advantage plan through a private insurer to take care of all your health insurance needs?
To learn more about the various types of Medicare coverage, click here.
Medicare Supplement, or “Medigap” Plans
If you have Original Medicare (Parts A and B), a Medicare Supplement plan can fill the “gaps” left in your coverage, including deductibles, co-payments and uncovered services.
Medicare Part B has a monthly premium. For an additional low monthly premium, which you’ll pay to a private insurer, a Medigap plan can help you avoid unpleasant financial surprises. Policies cover individuals only (no family coverage), so you and your spouse will need separate policies.
Medicare Advantage plans (also called “Part C”) take the place of Original Medicare. Written by private insurance companies, they include all the benefits of Medicare Parts A and B, and often include other coverage, such as Medicare prescription drug coverage (Part D), sometimes for an extra cost.
If you have a Medicare Advantage plan, you do not need (and cannot use) a Medicare Supplement policy.