The process of searching for a health insurance plan can be daunting. You know that you need coverage, but there are so many different options, terms, and networks. You need an expert that understands the industry and can help you navigate it all to find the best plan for your needs and budget. Let us work with you to understand your needs so that we can customize a benefits package that will serve you and your wallet.

Individual and Family Health Insurance Options

• Marketplace Health Insurance
• Off Marketplace Health Insurance
• Short Term Health Insurance
• Medical Sharing Plans

As an independent health insurance brokerage, we impartially help you compare plans that match your specific needs for affordable health insurance coverage, provided by the most respected insurance companies.

Marketplace Health Insurance (ACA Plans)

AFFORDABLE CARE ACT or OBAMACARE PLANS

The Affordable Care Act or ACA is a healthcare reform law that was enacted back in 2010 to help more American’s have access to affordable, quality health insurance coverage. The law also assists individuals who fall between 100% to 400% of the federal poverty limit (FPL) with subsidies to help pay for the insurance premiums. For plan year 2022, 89% of enrollees in marketplace coverage qualified for subsidies, also known as advance premium tax credits. And even better yet, these plans cover pre-exisiting conditions!

What Does Marketplace Health Insurance Cover?

In order for an insurance company to be eligible to offer individual health plans on the marketplace, they must cover the 10 essential benefits to be considered major medical coverage.

10 Essential Benefits of Marketplace Coverage

• Ambulatory patient services (outpatient care you get without being admited to a hospital)
• Emergency Services
• Hospitalizations (surgery and overnight stays)
• Pregnancy, maternity, and newborn care
• Mental Health and Substance Use Disorders
• Prescription Drug Coverage
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventative and Wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

So as you can see, this is quality coverage, but plans can vary greatly based on your location. Some of the carriers that we represent include; United Healthcare, Cigna, Blue Cross Blue Shield, Molina, Ambetter, Oscar, Christus, Ascension, Baylor Scott & White to name a few. Not all plans are offered everywhere, so it is always best to work with a licensed independent agent to see what plans are available near you.

Who Can Qualify for ACA Marketplace Health Insurance?

There are many different factors that makes individuals eligible for subsidized Obamacare health insurance. Here is a list to name a few:

• For individuals, if you are between the ages of 26-64, and you do not have access to affordable group health insurance through your employer, you may be eligible for ACA coverage.
• You are a US citizen or you are lawfully present in the United States for the duration of the plan year.
• Your income falls between 100% – 400% of the Federal Poverty Level based on your tax household and filing status. If you are married, you must file jointly.
• You are self emplyed and your MAGI falls between the 100% – 400% of the Federal Poverty Level.
• If you are retired and do not have access for a job based health insurance plan

When Can I enroll in an ACA Marketplace Plan?

The Open Enrollemnt Period for ACA Marketplace health insurance runs from November 1-January 15 each year. You can enroll directly through my enrollment link. If you missed the open enrollment period, you may be eligible for a special enrollment period, or SEP.

Special Enrollment Period (SEPs)

• If you or someone in your household recently lost qualified health coverage in the last 60 days
• Moved to a new zip code or county
• Had a baby or adopted a child, or placed a child for foster care
• Got married
• If your income falls between the 100% -150% of the FPL. (This is a temporary SEP and is subject to change.)
• If you moved to the United States or became a US citizen.
• Got divorced or legally seperated and lost your health insurance coverage.
• Leaving incarceration
• If you lost Medicaid or CHIP coverage during the redetermination

Call us to discuss if you are unsure whether or not you may qualify for a special enrollment election period. This is constantly changing, so it doesn’t hurt to check and see.

Short Term Medical Plans

For those who do not wish to participate in the Marketplace ACA plans, or if you find them to be unaffordable, there are still options. Many individuals who are between jobs and do not want to purchase COBRA due the high cost, often find short term medical plans to be a viable option. Also, retirees that are not yet Medicare age find short term plans to be a good bridge between coverages. College students that need health coverage would also be a good fit for such a plan.

Temporary health plans do not offer the same array of benefits like ACA plans or other job sponsored plans, but they do offer peace of mind when it comes to emergencies. Some of their features include: lower monthly premiums, flexible term lengths from 30 days to a year, and same day approval in many instances. Most of these plans have national PPO networks, so you are not out of luck if you travel a lot.

Medical Sharing Plans

Another option that many individuals and families are opting for are the medcial sharing plans. Now, as this is also considered an alternative healthcare plan, they are not regulated by the state department of insurance. This means that these plans may not cover all sickness or injuries, pre-exisitng conditions, or chronic condtions. There may be wating preiods to join, they may pay less for each service, and limit their total yearly payments. At the time of this article publication, Schuler Insurance Services does not offer any medical sharing plans.

You Need to work with a Trusted Advisor

In conclusion, there a variety of health insurance options available to individuals and families. The best options for you will depend on your needs and individual circumstances. If you are eligible for Marketplace insurance, you may want to consider that option. If you are eligible for a Marketplace plan, or the cost is prohibitve, a short term plan or off marketplace plan may be the right choice for you. Medical sharing plans are not regulated by the government, and they do not have to meet the same requirements as ACA plans. However, they can be a good option for healthy individuals who are looking for low cost healthcare options.

If you need help determining what health insurance option is best for you, fill out the form on your right. One of our trusted health insurance advisors will be in touch with you to review your needs and match you with the best coverage plan available.

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