Health Insurance in the United States is provided through Private Insurance Companies or Federal/State government programs. Private insurance is generally provided through an employer/group plan or an individual/family plan. Well known government programs are Medicare and Medicaid/Access. Below is a brief review of different parts of the health insurance industry.
Affordable Care Act (Obama Care)
This legislation was passed in 2013 and changed the landscape of health insurance. Here is a brief summary of the Affordable Care Act.
- Most people in the U.S. are required to have health insurance that meets minimum standards. If not, the person must pay a penalty for not having health coverage. This penalty begins in 2014 and increases each year through 2018.
- Insurance companies cannot ask medical questions or underwrite individual health applications. Thus, anyone can purchase health insurance regardless of his/her health conditions. Companies can ask if a person uses tobacco and can charge a higher rate based on tobacco use.
- Insurance companies cannot impose pre-existing condition limitations or waiting periods on policies. Thus, a person is covered for existing health conditions immediately.
- Some individuals may qualify for premium reduction (tax credits) and cost sharing (lower co-pays and deductibles) if their household size and income fall within certain ranges. We can assist you on the federal health insurance exchange to determine if you are eligible for premium assistance.
- You can purchase health insurance during the open enrollment period. You may also purchase health insurance during the year if you qualify for a special election such as losing your group health insurance, moving into a new area, life change event, etc.
Medicare is a federal program for most people 65 or older as well as those who have been on Social Security Disability for 24 months or have End Stage Renal Disease (ESRD).
Medicare is a cost sharing program where Medicare pays towards medical expenses and you are responsible for the balance. It is strongly recommended that you purchase additional coverage to protect against significant potential out of pocket expenses. We offer high quality Medicare Supplement, Medicare Advantage, and Part D Rx plans. We will help you find the most appropriate plan and you confirm your doctors and medications are covered. Medicare has different parts:
- Medicare Part A-pays toward for Hospital & In-patient expenses
- Medicare Part B-pays toward Physician & Outpatient expenses
- Medicare Part C-Combines Parts A&B and transfers Medicare to a private insurance company
- Medicare Part D-Helps pay for prescription drug costs through 3 different phases of coverage
We have extensive experience to assist you in choosing the right Medicare plan. Please contact us for a no obligation information.
CHIP (Children’s Health Insurance Plan)
This program provides health insurance options for children under the age of 19. All children are eligible for coverage through CHIP regardless of income. Some children will qualify for free or subsidized CHIP based on their parents/guardian’s income. Those that don’t qualify for reduced premiums will pay the full cost CHIP premium. We can assist you by enrolling your child in a CHIP program. This is often superior coverage to many employer group plans.
Medicaid (also known as Access)
This program provides health coverage to people at or near the poverty level. You must contact the state Medicaid office to determine if you are eligible for Medicaid benefits. Unfortunately, we cannot help you enroll in Medicaid.