Individual Medical Insurance-The How, What, Why and When

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How To Buy A Medical Insurance Plan

Individual Medical Insurance can be purchased in two ways since the inception of Affordable Care Act or as it is sometimes known Obamacare.    Regardless of how you purchase the insurance, the plan must include all Essential Elements outlined in the Affordable Care Act in order to be called a Qualifying Health Plan. The two ways of purchasing an Individual QHP is Off Market Place or directly from the insurance company and On the Federally Facilitated Market Place   which is also www.healthcare.gov.  Right now HF Insurance Professionals only offer plans in Texas so this is what I will be discussing.  You can  obtain a QHP via an employer’s group plan as well, but we’ll categorize non-group plans as Individual plans purchased by an individual or family. You can shop on your own, but the easiest and fastest way to buy your coverage is via an insurance agent who is FFM certified and experienced at selling Qualified Health Plans. Feel free to contact us if interested.

What are The Essential Elements of a Qualified Health Plan?

Essential health benefits or elements include at minimum the following:

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  1. Outpatient care—Doctors’ visits or medical services you get and are not admitted to a hospital
  2. Visits to the emergency room
  3. In-patient hospital care when you are admitted into the hospital or skilled nursing facility
  4. Well-Baby care
  5. Mental health and substance abuse services:  Encompassing behavioral health treatment, counseling, and psychotherapy
  6. Prescription drugs
  7. Devices and service you need while recovering from or treating an injury, disability or chronic condition.  This is including physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and so on.
  8. Lab Tests
  9. Preventive services  or care for managing a chronic disease (diabetes for example.)
  10. Pediatric services which include dental and vision for children

Why to Buy a Medical Insurance Plan

Young boy with red cast isolated on white backgroundThe most important reason to buy medical insurance is for the health and well-being of your family and yourself.   Other reasons include:

  • Purchase a Qualified Health Plan to avoid tax penalties at the end of the year.  The penalty for not having insurance in 2015 is $325 per adult, $162.50 per child and up to $975 for the family.  This could also be 2% of the family’s annual income minus the federal tax filing threshold for the size of the family. You would pay the higher of these two options.
  • The plans cover pre-existing conditions. Current and past conditions will not affect your premium.
  • You may qualify for a premium tax credit.  This credit can lower your monthly premium and out of pocket expenses such as copays and co-insurance.

When to Buy Medical Insurance

There are two times or periods when you can enroll in a medical insurance plan.vector illustration of modern icon

  1. Open Enrollment- This occurs annually.  You can enroll in a plan or move to a new plan if you have one already.  The Open Enrollment Period occurs November 1, 2015, to January 31, 20115.
  2. Special Enrollment Period- You can enroll in a plan outside of the Open Enrollment period only if you qualify for Special Enrollment Period.  You can qualify for a Special Enrollment period if you experience a change in family statuses such as losing employer coverage, the birth of child or marriage.  There are other situations that might prompt this right refer to www.healthcare.gov to see if you qualify.  You have 60 days after the qualifying event occurs to enroll in medical coverage.

It can be confusing to know when to buy a medical insurance plan as well as knowing if you are getting a Qualifying Health Plan.  Hopefully the information above will help get you started.  However, the best thing to do is to contact your experience licensed Health Insurance Agent.  He/She can guide you and make the process quick and fast.

 


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