Individual Insurance

Before the passage of the Affordable Care Act or Obama Care health insurance plans could charge more for pre-existing conditions, decline to cover you, and/ or you may have a 12 month wait period before your pre-existing condition would be covered. That wait period could extend to anything that your pre-ex could cause.  In addition, it also eliminated lifetime caps and gave out of pocket maximums that the insured would have to pay in a year. Meaning that if you had a $7000 out of pocket maximum, but you had a $50,000 surgery then the most you would pay for the entire year would be the $7000.

 

To be considered an ACA plan then they must provide the following, doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.

If all plans are virtually the same what are the differences?

Networks!​

The name "Network" comes from the large group of physicians, hospitals, and other health care providers that have agreed to provide medical services to a health insurance plan's members at discounted costs. Each insurance companies have different networks some have the same and some have only one. In either case most of the time this determines a large part of the rate.

Rates and premiums are also based on age. Someone who is 25 will pay less than someone who is 50. However, there are also tax subsidies that help people pay for their premiums as well.

Each insurance brand may offer one or more of these four common types of plans:

What is an HMO? HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP.

PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits.

POS stands for A point of service plan, is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice.

High-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for having a health savings account.

Rates and premiums are also based on age. Someone who is 25 will pay less than someone who is 50. However, there are also tax subsidies that help people pay for their premiums as well.

Tax Credits

The premium tax credit is a refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Health Insurance Marketplace, also known as the Exchange, beginning in 2014. The size of your premium tax credit is based on a sliding scale.

 

Another way to look at it is when you have children and pay for day care or have a house and pay property taxes and interest you get a tax credit at the end of the year. Depending on your income your credit is adjusted. The tax credit for health insurance is that same principle, but you get to use it in advance instead of at the end of the year to help pay your insurance premiums.

Types of Plans

There are 5 different types of plans, Bronze, Silver, Gold, Platinum, and Catastrophic

Catastrophic: Catastrophic policies pay less than 60% of the total average cost of care. 

 

·         Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.

 

 

Bronze: covers 60% on average of your medical costs; you pay 40%

 

·       Bronze plans have lower premiums, higher deductibles, and higher out of pocket maximums. These plans are generally for healthier people that may go to the doctor once or twice a year and do not take medications on a regular basis.

 

Silver: covers 70% on average of your medical costs; you pay 30%

 

·         Silver plans have medium premiums, medium deductibles, and about the medium out of pocket maximums. Silver plans also have what is called Cost Sharing Reduction (CSR). A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.” This is also based on income. This plan works best for people that either qualify for the CSR and/or have some health conditions that require regular checkups, testing, and medications.

 

 

Some Bronze plans and Silver plans also have what HSA plans these plans do not have copays and you pay everything up front until you reach the deductible. You can pay for services through an HSA account. A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.

 

 

 Gold: covers 80% on average of your medical costs; you pay 20%

 

·         Gold plans are fourth plan and these are these plans have high premiums, low deductibles and lower out of pocket maximums. These plans are for people with serious health concerns. Have regular doctor appointments and being treated for serious illnesses.

 

 

Platinum: covers 90% on average of your medical costs; you pay 10%

 

·         Platinum plans are the highest premium plans and have the lowest deductibles and out of pocket expenses. This plans work best for those who very serious health concerns.

 

 

When finding the right plan for you remember budgets (premium amounts, copays, tax credits, and cost sharing options and of course networks of your doctors. This plans work best for those who very serious health concerns.

 

Rates and premiums are also based on age. Someone who is 25 will pay less than someone who is 50. However, there are also tax subsidies that help people pay for their premiums as well.

For a free no obligation quote or review please contact June Johnson @

920-284-6067 or june.64@live.com

Health insurance can be complicated. Let us make it simple in your time of need.

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Health insurance can be complicated and you want to work with someone whom you can trust. As an independent agent working with multiple providers, June is able to make sure you get the right coverage you need at the right price.

Schedual a one on one meeting with June today!

Contact J.A. Johnson

Health Insurance

 

Our Office

645 W Ridgeview Dr. Ste 124 Appleton, WI 54911

 

      (920) 284-6067

 

      june.64@live.com

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Neither J.A. Johnson Health Insurance or it's agents are connected to the Federal Medicare Program