Short Term Health and Fixed Benefit Plans
We love and exist to serve the senior market. That said, many of our clients have spouses or family that are under 65. Many of these friends and family also need health insurance. In an effort to serve these people we also offer individual health insurance.
The individual health, or under 65 market as it is sometimes called, is a very dynamic market. It is also a bit of a moving target for agents to keep up with.
If you are under 65 and have been on social security disability for at least 24 months you are eligible for Medicare as well as Medicare Advantage plans.
Today, with few exceptions there are 3 paths available on the health plan highway to use an analogy.
The Affordable Care Act or ACA is currently still the law of the land. These plans all include what are called minimum essential coverage.
Pre-existing conditions, pediatric dental, mental health and other benefits must be included in a health plan for it to be considered ACA compliant.
There has been efforts made to remove the individual mandate from the ACA to give people more options and choices but the ACA is still on the books.
ACA plans are also known as Marketplace plans. On Marketplace plans means plans that have part of the premium and/or copayments subsidized by the government. Off Marketplace plans are the same plans but they are not subsidized by the government.
Depending on your income you may be eligible for a help with your monthly plan premium. In some cases you may also receive help with your deductibles and copayments too.
Healthcare dot gov is the site you would visit to see if you qualify or not.
Short Term Health plans are another path you can take. These plans are not ACA compliant so you need to be aware of that up front.
These plans have deductibles you can choose from ranging from $1,000 to $5,000 or more depending on the company. Once you meet the deductible most plans have an additional out-of-pocket limit.
You can pick 70/30 plans, 80/20, 90/10 plans even 100% plans depending on the company. Between the deductible and out-of-pocket limit you would pay your share and the insurance company pays their share. Once you hit the limit the plan pays healthcare costs for the remainder of the benefit period.
Currently Short Term plans are 90 day plans that reset deductibles and out-of-pocket limits each 90 days. Some plans can auto renew up to 4 times giving you up to a year of coverage. State laws differ on renewing these plans. Check with your agent on this.
Short Term medical plans generally don’t cover pre-existing conditions or prescription drugs.
Short Term plans have national provider networks and offer good catastrophic medical coverage.
Fixed Benefit plans are the third path people can take. These plans also do not generally cover pre-existing conditions during the first year. They have no deductible and can be kept year after year. They have national networks that provide re-pricing of services as well as paying fixed amounts for services used.
Fixed Benefit plans are not as good at catastrophic coverage as their Short Term options. These plans are also not ACA compliant under the law.
With Short Term plans or Fixed Benefit plans we recommend adding an accident medical and hospital rider to the plans.
This market is always changing. If you are looking for individual health coverage give us a call and we would be happy to give you some quotes to look at.