What does Jack do during a health consult?

Hello all! Thanks for taking the time to read this post. I thought it would be a good idea to give you all a little more information about what I do to help American families find the best coverage for their situation. When you have been employed with great employer health insurance, the process can seem extremely daunting. IT IS NOT! It can be broken down in black and white depending on what is the most important to your family. Let’s get started!

For people who have employer coverage, the cobra option rarely is very appealing due to how expensive the cost is. Why is cobra so expensive? The reason why cobra is so expensive is because your employer no longer helps pay for your family’s health insurance coverage. As a result, the premium price is usually much more expensive than what you could find with Obamacare insurance or a private insurance option. Even for the family of the employee, the employer coverage can be quiet expensive as well and cause people to want to explore other options.

What is Obamacare or the Affordable Care Act (ACA) plans? Obamacare, ACA, and marketplace are all synonymous terms. All three terms mean the same thing and can be used interchangeably. President Obama made a stand to protect those individuals that have pre-existing conditions from being denied insurance. As a result, these plans along with employer sponsored coverage WILL cover for preexisting conditions from day one. This is great! What is also great is that based on your income level you can qualify for a subsidy. The subsidy will allow your family to get a quality health insurance plan at a discounted rate IF your income level is below 400% the federal poverty line.

What if your family doesn’t qualify for a subsidy based on your income level? This situation is very common and my answer for this is that there are other options. A lot of people take the term “Affordable Care Act” offensively because they don’t find it affordable due to not qualifying for a subsidy. For healthy families that don’t qualify for a subsidy, private insurance is generally the most cost-effective option with the most flexibility to use your coverage. While your income level is not taken into consideration for the rate of your plan, your health is. Private insurance plans that cover you catastrophically (or with a deductible and max out of pocket) can decline to offer you health insurance coverage due to pre-existing conditions.

While private insurance is not the best option for all, who do they best serve? Private insurance plans are great for people that don’t qualify for too much of a subsidy and can pass medical underwriting. For example, someone that broke their arm 6 months ago, but is now cleared with no restrictions would pass underwriting since the insurance company knows that this ailment has been taken care of to this point. People with certain conditions such as diabetes, Crohn’s Disease, or Rheumatoid Arthritis will never get approved for an underwritten plan.

The last topic that I want to highlight is right versus the wrong type of coverage for your family. The right kind of coverage is not necessarily the cheapest option or the one with lowest copays for doctors visits etc. In my opinion, people buy insurance for the peace of mind to protect their out-of-pocket exposure as much as possible to prevent going bankrupt due to medical bills. This is and always will be my chief concern for my clients and those that I educate. Some plans are “limited benefit plans” or “short term plans” are what you need to know about these plans are why they are cheaper than plans that are more traditional style of plans. Limited benefit plans don’t have a deductible, which sounds great, but with them not having a deductible there is no maximum out of pocket. With no max out of pocket, if you have a $100,000 claim you could be responsible for the lions share of this debt. Short term plans need to be carefully selected as well in that if you are dropped from the plan when its not open enrollment you are again on the hook for the medical bills even if you had the coverage when the plan started.

I hope this helps you guys understand the market for health insurance outside of employer sponsored coverage. My goal is never to overwhelm people with this information, but I always want people to be as educated about their insurance decisions as possible. An educated buyer is the best buyer!

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