The Ultimate Guide To Buying Private Health Insurance

Like car insurance or home insurance, the health insurance also insures the person from losses with the difference that these losses are caused by illness or any other health  injury. You pay a premium payment to the insurance company every month and they cover you in the event something health or injury related should happen. They pay a portion or all of the bill depending on the deductible and coinsurance you have on your plan. With Health care reform in effect since January 1st of 2014 the rates are based on so many different factors including age, zip code, household size, and even household income. The good thing that does not apply anymore is health history as there are NO health questions on a health application, therefore no such thing as pre existing conditions.

Many employers especially mid to large sized company’s offer an employer health insurance plan. These plans are known as group employer plans. If you are buying the insurance plan through your employer then it is essential to know that some employers offer you a single insurance plan with one insurance  company and some provide you the ability to choose from multiple plans and several different insurance companies. In most cases the employer will pay a portion of the premium payment to the insurance company. The employee will be responsible for the remainder usually deducted from his or her paycheck. In general employers usually pay at least 50% of the health insurance premium payments. If the group is large enough and the age of the group is on the younger side the rates will be extremely affordable. Typically if the employer is paying for at least 50% of the cost and if the median age of the employees is under 40 years old the cost for the employees will be far better with the employer plan than if they went out and purchased on their own.

Many mid to small businesses are pushing their employees to purchase health insurance on an individual level. This is common if the workforce is primarily lower income or blue collar. Many examples of these situations are small machine shops, welding shops, mechanic shops or small construction companies with a workforce under 25 employees. There are rules regarding this if the employees are already covered on a group plan. If that group plan cost the employee more than 9.5% of their gross income they are eligible in open enrollment to withdraw from the employer group plan and enroll with an agent in a marketplace plan that will typically be better coverage and lower cost. If the employer group plan is only costing the employee 9.4% or less of their gross income they are ineligible by the marketplace to purchase as their group employer plan fits the government guidelines for that family as affordable coverage. What we typically find is that smaller blue collar working class employers with under 25 employees are charging the employees at or above 9.5% for the cost of the insurance. Many of those employees due to income and household size would more than likely qualify for a plan on the individual side that would cost them only 3 to 5% of their gross income and be just as good of coverage and or in many cases far better.

When the employer has a workforce of 25 employees or less and the majority of the workforce is earning less than $50,000 a year more often than not the employer is overpaying just as much as the employees are for their employer group plan. It is highly recommended someone in this situation sit down with an agent and discuss the options for the employees purchasing coverage on their own. In many cases the employee is actually paying less than they were out of their paycheck and they have a better plan. The best part is the employees can choose any plan they want and the group no longer applies. What is great about this is that it takes the employer out of the ever growing expensive health insurance business. It puts the power in the employees hands and everyone is saving money with better coverage. It usually is a win win for all parties so again if your business or maybe your employers business sounds like they would be a fit It would be a good idea to pursue and look into the individual side of healthcare.

Unlike Canada and United Kingdom where health insurance is taken as every citizen’s right and is provided by the state, in USA the responsibility to get insured goes to an individual unless he is elder, disabled or a veteran.

We can understand your difficulty of finding the best Health Insurance, but with the help of an experienced Health Insurance Agent, the process is made easy. There are many things that you need to consider before buying a private insurance plan.

Types of plans

Since healthcare reform went into effect health plans have actually become more standard. Whether you purchase from the marketplace or through the insurance company you are going to be directed to what is known as metal plans. Bronze, Silver, Gold and Platinum. The same exact plans you see on the marketplace are going to be the same exact plans you see when looking at that particular insurance companies website. There is no difference. The difference comes into whether that person qualifies for a subsidy which is the government paying a portion of that plans premium payments to the insurance company. Make sure you are sitting with a certified marketplace agent that can show on and off marketplace. The agent should ask you some questions about your household size and income. This will let him or her know whether it is better to shop through the marketplace or skip the income requirements and purchase right through the insurance company. It is key to note that the Agent gets paid exactly the same whether you purchase through the marketplace or through the insurance company. It makes NO difference. Most agents prefer the customer qualifies for subsidy and using the marketplace as the agent is paid commission on the full price of the premium. Not necessarily what the customer pays. Example: If Blue Cross insurance premium is $1,000 a month, but the customer qualifies for $800.00 a month in subsidy then the customer only pays $200.00 to the insurance company for $1,000 a month plan.  The agent, however gets a commission % from the insurance company  of the full $1,000 a month plan regardless what the customers portion is. The agents commission have NOTHING to do with the price or cost to the customer. Price is same whether use an agent or not.

It is important to note that all qualified affordable care act plans will have a metal attached to them, whether it be Bronze, Silver gold or platinum. If it does NOT have a metal as part of its name it is NOT considered an ACA plan. There are two other types of plans that confuse people that are NOT ACA plans. One is what is known as a short term plan. A short term plan offers coverage for 1 to 6 months and typically covers the person up to 1 million in coverage. This plan is NOT considered an ACA plan and is generally good for those who want coverage to bridge them over to the next enrollment or employer coverage. Having a short term plan does not disqualify you for a penalty. If someone chooses to just carry short term insurance they will be penalized for not having adequate ACA coverage. The other type of plan is called an indemnity plan. This is a limited benefit plan that is becoming less and less popular as one is better off purchasing a short term plan if they want low cost and don’t mind paying the penalty. An indemnity plan covers portions of things but only in small amounts. Example: pays up to $800 a day for hospital stays and up to $15,000 for a certain surgery.  Very limited and not recommended by most veteran senior agents in the business. Nonetheless if someone does purchase this type of plan they will be penalized. It is highly recommended by not only the government but insurance experts that a customer only consider purchasing a metal plan to avoid dealing with pre existing conditions and avoid paying a tax penalty.

Plans in more detail

The health metal plans are all going to cover the same thing. The old days of pre health care reform were far different. Before January of 2014 different companies, different plans covered different things different ways. Those days are effectively gone now due to the law. Wether it is X, Y or ABC insurance company Metal plan your cancer and heart attack,maternity  or mental illness are going to be covered. The companies all have to cover what the government says and mandates. The biggest difference and choice comes down to 3 things. Deductible, Hospital doctor network and Cost.  The worrying about is this or that covered is GONE! The new Law also mandates that all preventive health including preventive blood work mammogram, pap smear, PSA test and preventive colonoscopies be covered at 100% with no deductible. Even if you are in individual with a deductible of $6,600 on a bronze plan your preventive is covered 100%.

Typically the metal plans deductibles will look like this:

Bronze plans: $6,600 individual/$13,200 family

Silver plans: $2,000 individual/$4,000 family

Gold Plans:      $250 individual/500 family

Platinum plans:$100 individual/200 family

One thing to note is that if you are working with an agent and you qualify for subsidies silver plans will offer you a reduced deductible as well. The government will Not only pay a good portion of the premium payment but cover up to 94% of the cost of your deductible if you are in a certain lower income bracket. They will not do so on any other metal plans but silver. This all depends on how one answers the questions when sitting or talking with a licensed agent. 

If you are looking for the best Michigan Health Insurance then there are many insurance companies that provide you that but how to find the best one that will suits your needs? Many just call the marketplace direct. When you speak with someone at the marketplace they are NOT licensed agents. They are navigators. They are not trained on deductibles, coinsurance or networks in your particular area. They are meant to help you facilitate the application. We have seen many people come to us that just called direct and 9 times out of 10 they are in the wrong plan. Sometimes its them being put in a gold when they should be in a silver with cost share. Many times they think they have a gold when in fact they have a bronze. The most common mistake we see from people who just purchase directly through marketplace without the help of an agent is the wrong plan for their network area. Many times a big insurance company will have an inexpensive plan, however it is a very very limited small network. The navigators and the customer does not realize and mistakenly signs up for this plan and later realizes this is not the same ABC insurance company network I had before. We Can help you navigate those issues and make sure the 3 big things Deductible, Network and cost all fit what you are looking for. If you have any query related to the private health insurance, contact us anytime. We ensure the proper guidance for our customers.