Individual Health Insurance FAQ’s

Below is a list of Frequently Asked Questions on Individual Health Insurance.

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Can coverage be denied?

Starting with effective dates January 1st, 2014 and on, no individual can be denied health insurance based on medical status, all plans are guaranteed issue.  No conditions can be excluded from your coverage either.  You can start signing up for these plans October 1st, 2013, often referred to as open enrollment.  To find a plan that fits your needs, Visit our individual health quote page.

Is short-term insurance still available?

Yes!  Short term plans run for a set number of months (you choose the length of the policy when you purchase) and expire at the end of the term.  Short Term policies are not considered Major Medical, and therefor do not have to abide by the new health care reform law.  Because of this, a short term option can be much more affordable.  But remember, because they are not major medical, they only cover certain conditions and usually exclude benefits such as preventive care and pre-existing conditions.

What happens if I don't purchase coverage in 2014?

If you don’t have a qualified health plan for the 2014 year, you will face a fine, often referred to as the Individual Mandate, when you file taxes for the 2014 year.  The fines start low and increase over three years when they are fully phased in in 2016.  You can see the fines below.

  • 2014: 1% of Household Income (Minimum of $95/adult, $47.50/child to a max of $285/family)
  • 2015: 2% of Household Income (Minimum of $325/adult, $162.50/child to a max of $975/family)
  • 2016: 2.5% of Household Income (Minimum of $690/adult, $347.50/child to a max of $2,085/family)

What assistance is available to help pay premiums?

Starting in 2014, there will be premium tax credits available to help qualified individuals and families purchase individual health insurance.  Premium credits are available to those making up to 400% of the Federal Poverty Limit.  The premium is then capped at a certain percentage of your income.  You will not pay more in premium than that amount.  Subsidies are based off of the average cost for a Silver Level plan in your geographic location, which is set by your state’s Department of Insurance.

To see what income levels are eligible for a premium tax credit, you can view the chart below.

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To apply for a plan, simply visit our Individual Health Quote page and start your application!

What is an Insurance Marketplace or Exchange and how to I access it?

If you qualify for a premium tax subsidy, you must complete a subsidy application through the Public Exchange, also known as the Public Marketplace.  Many insurance carriers are integrated with the Public Exchange and you can access the subsidy application and the qualified plans through an insurance agency, just like ours!

To start your application today, simply visit our Individual Health Quote page and start your quote.  During the application process, you will be able to access the Public Exchange to complete your subsidy application.  If you have any questions on how the process works, simply contact our office!

Will purchasing through a broker or agent increase my premium?

No!  You pay the same premium whether you purchase direct from the company or through an agent.  The benefit of buying through an agent is that you are able to quote many carriers at one time, saving you time.  You also have someone to contact when you have questions regarding plan selection, the enrollment process, claims, and any other questions you may have!  When purchasing through an agent, you have a personal advocate in your corner!

Should I buy and HSA plan?

HSA plans are high deductible health insurance plans.  They have no copays and everything goes towards your deductible.  Because of this, premiums are usually lower than traditional PPO plans.  In addition, you are able to open a tax free bank account called a Health Savings Account where you can contribute a set dollar amount pre-tax and use the money to pay for medical expenses.

HSA/High Deductible Health Plans work well for those who are healthier, as they don’t go to the doctor as much, or those who are really sick, as they will max out their deductible and out of pocket no matter what plan they are on.  You receive the added tax benefit on an HSA.  Plus, HSA plans usually decrease the total out of pocket (Deductible, Out of Pocket and Copays) than a Traditional PPO plan.

When is Open Enrollment for the new health care reform plans?

Open enrollment runs from October 1st, 2013 until March 31st, 2014.  You must sign up coverage during these times, otherwise you will have to wait for the 2015 Open Enrollment Period, which is October 15th, 2014-December 7th, 2014.  The only caveat to this is if you have a loss of coverage throughout the year, then you can sign up for an individual policy outside the Open Enrollment Periods.

Are subsidized plans full coverage policies?

Yes!  All policies, subsidized or not, are full benefits policies, similar to those offered by businesses.  You will have your choice of plan design (PPO, HMO, HSA) and networks.  Below is a partial list of benefits included in the policy.

  1. Ambulatory Patient Service
  2. Emergency Services
  3. Hospitalization
  4. Maternity and Newborn Care
  5. Mental Health and substance use disorder services, including behavioral health
  6. Prescription Durgs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory Services
  9. Preventive and Wellness Services
  10. Pediatric services, Include Dental and Vision Care

About Optimized Benefits

Optimized Benefits is a Boutique Firm dedicated to providing smart solutions to the small and mid-sized business owners and their Employee Benefits plans
we have a focus on Retirement (401K) and Group Health plans

Contact Us

55 W Wacker Dr 14th Floor
Chicago IL 60601

312 263 1590 X 101

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