Health Insurance Plans
Health insurance is essential in preventing overwhelming medical expenses, and with numerous sources available, each having specific guidelines and eligibility criteria, it's crucial to choose a policy that adequately caters to both your financial and medical needs.
Are you searching for a major medical plan or supplemental plan to fill in the holes in your current plan? A major medical plan is offered through the Affordable Care Act (ACA) also known as Obamacare or Marketplace coverage. You can also get major medical coverage through an employer-sponsored plan.
Individuals and Families Health Insurance
What are ACA Plans?
ACA (Affordable Care Act) plans are sold on the Marketplace or Exchange. ACA plans provide individuals and families the ability to enroll in an ACA health insurance with pre-existing conditions. You do not have to answer medical questions to enroll on an ACA plan. You may be eligible for a premium tax credit (subsidy) that will reduce the cost of your monthly premium.
All ACA plans must provide coverage for the following 10 minimal essential benefits:
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Ambulatory patient services (outpatient care you get without being admitted to a hospital)
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Emergency services
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Hospitalization (like surgery and overnight stays)
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Pregnancy and newborn care (both before and after birth)
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Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
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Prescription drugs
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Rehabilitative and habilitative services and devices
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Laboratory services
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Preventive and wellness services and chronic disease management
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Pediatric services, including oral and vision care
All ACA coverage networks are HMO or EPO. PPO plans are not offered on the Marketplace.
What Are HMO Plans vs PPO Plans?
HMO (Health Maintenance Organizations) plans require the use of a PCP (primary care physician) to coordinate your healthcare. Your PCP will refer you to a specialist within your coverage network of doctors and hospitals. There is no out-of-network coverage on these plans. As a result, HMO plans are generally less expensive than PPO plans.
PPO (Preferred Provider Organization) plans provide you with the ability to pick the doctor of your choice without a referral. These plans provide in-network and out-of-network coverage to allow more flexibility. As a result, the cost of PPO plans may be higher than HMOs.
EPO (Exclusive Provider Network) plans are similar to HMO plan but the coverage network is smaller. Like an HMO, you can only see doctors, specialist, or use hospitals in the covered service network.
What Is The Cost Of An ACA Plan?
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The cost of an ACA plan can be as low as $0 per month. Through tax credits, also known as a subsidy, the cost of your health insurance plan can be lowered providing you access to affordable deductibles, copayments, and coinsurance options. The cost of the plans can also vary based on the insurance carrier and plan options.
When And How Can I Enroll?
There is an annual open enrollment period the begins November 1 and ends January 15th. If you want your ACA plan to start January 1st, you must enroll by December 15th. If you enroll after December 15th your coverage will begin February 1st. There is a Special Enrollment Period that allows many people to qualify for health insurance coverage outside of the annual enrollment period. For instance, if you had a change in employment, marriage, moving, divorce, lost employer coverage, birth of a child are just a few life changing events that trigger a Special Enrollment Period.
Ancillary Insurance Plans
Short Term Medical Insurance
STM (Short Term Medical Insurance) plans are ideal for those who are in transition between jobs, or a temporary contracted employee. These plans are also great for those who are transitioning from employer-sponsored coverage to Medicare. These plans are often PPO plans. They can included deductibles, copayment, coinsurance, and out of pocket maximums. Short term medical plans also include annual and lifetime coverage limits. To enroll in a STM plan you will have to pass health questions, but you can enroll at anytime.
Fixed-Indemnity Health Insurance plans are fixed benefit plans that provide daily benefits for covered services such as doctor visits, hospitalization, routine care, and more. These plans will pay a set of daily benefits for covered services, regardless of what the doctor or hospital charges. These benefits can be paid directly to the insured. You can enroll in these plans at anytime because there is no enrollment period. These plans fill in the gaps of STM or high deductible and high copayment ACA plans. Below are some other supplemental plans we offer.
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Dental, Vision, and Hearing
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Accident Plans, on and off the job coverage
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Hospital Plans
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Cancer Plans
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Critical Illness Plans
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Out-of-Pocket Protection Plans, similar to gap plans
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Home Health Care Plans
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Short Term Care Plans, similar to Long Term Care
Healthy, Informed, and Prepared!
Ready To Get HIP?
If you are new to Medicare or already enrolled in Medicare and want to learn more about your coverage, then we’re here to help you stay healthy, informed, and prepared. Feel free to give us a call or click the link below today, and we will find a time to talk about your specific coverage and the ways you can use it.
Our Mission
At The HIP Insurance Crew, LLC, each of our clients is unique. We don’t believe in an “one-size-fits-all” approach to offering insurance. We provide individual solutions for each of our clients and serve as advocates should you need one.
