There is a difference between public and private insurance. Health insurance is one of the most complicated concepts in the United States. Find out which coverage is more beneficial to you and your family by visiting your local health insurance provider.
The Exchange
Healthcare.gov is the website that allows people to buy health insurance on the Obamacare exchanges.
The Affordable Care Act Obamacare exchanges are government regulated. They must meet all of the government regulation that has been defined under the law. The plan will offer benefits that most people actually need, according to a spokesperson for the Department of Health and Human Services.
Public health care is affordable for lower income families. You can apply for subsidies that will significantly lower your out-of-pocket cost.
If you do not qualify for the subsidies, you will have to pay out of pocket before seeing any real insurance benefits. High deductible plans are often high deductible plans, meaning you’ll have to spend a significant amount of money out-of-pocket prior to seeing real benefits.
If you do not qualify for the subsidies, you will have to pay out of pocket before seeing any real insurance benefits.
Private Insurance Options
Private health care insurance is purchased anywhere except the marketplace. You can research insurance options and determine the best company for your needs. There are even private insurance exchanges that allow you to choose a provider best suited for your need.
Private insurance plans may offer lower deductibles and co-pays than those offered on the marketplace. For higher premiums, you may be able to purchase an insurance policy that offers additional benefits such as more out-of-network options.
The new tax plan for individuals who do not carry insurance will no longer be issued to those who don’t carry insurance. If you are not covered under an employer plan, you must look at the pros and cons of health coverage through the private and public marketplace or self-insure.
For people with children or medical concerns, health insurance is truly a necessity. If you are a low-income family who needs health insurance, it is likely more appropriate to work with a public health care policy that can be affordable, if you are eligible for the government subsidies.
If you are within the middle to higher income brackets that would not receive a government subsidy, it is best to consider a private insurance plan. Consider a higher premium plan with lower deductibles if that is an affordable option for your family. If you’re in the upper middle to lower income brackets, consider a higher premium plan.
What Is Individual Health Insurance?
Individual health insurance provides Americans with annual medical costs coverage. Insurance prevents individuals from being hit with crippling healthcare fees in the event of injury or illness.
Before Obamacare, insurance providers could deny coverage due to medical status or charge exorbitant premium fees. Affordable healthcare is available to all, no matter their health status, says the White House.
Individual health plans offer a range of benefits, including outpatient care, prescription drugs, maternity care, hospitalization, mental health, and pediatric services.
Unless you have a qualifying life event, individual health insurance can only be purchased during the open enrollment period (November 1 and December 15 in most states).
The Affordable Care Act is available in all states and the District of Columbia. The marketplace offers a variety of different individual health insurance plans, as well as subsidies for individuals needing help to cover health insurance costs. Health care exchanges can be found at healthcare.gov or state insurance exchanges.
Off-exchange health insurance can be more expensive or cheaper than buying on the marketplace. The average cost of a private plan could be as much as per year.
Types of Individual Health Insurance
Affordable Care Act (ACA) Plans
The ACA is designed to prevent high healthcare expenses in the face of a medical emergency. There are different plans available to meet every individual’s healthcare needs.
Short-Term Plans
Short-term health insurance is available all year-round but usually provides much less coverage. Short-term plans are often selected by individuals who missed the deadline to apply for an ACA plan during the open enrollment period.
Indemnity Plans
Also known as “fee-for-service”, indemnity plans pay a predetermined amount of money for medical services received. Because the insurer’s contribution is set, individuals can visit any doctor or specialist they like.
YOU MIGHT NEED PRIVATE HEALTH INSURANCE IF:
A Young Adult 26 Years of Age or Older
Unemployed
A Part-Time Employee
Self-Employed
A Business Owner With Employees
If You Retire (or Your Spouse/Parent Retires)
Affordable Care Act/Obamacare Options For Individuals
Individual health insurance is separated into bronze and platinum levels. Bronze coverage will pay 60% of your out-of-pocket costs; platinum will pay 90%. The more coverage that you choose, the more it will cost you.
What Is Short-Term Health Insurance
When you’re outside of enrollment periods, switching health plans, or require emergency coverage, short-term health insurance is a good option.
Short-term health insurance (temporary health insurance), unlike long-term health plans, does not meet the Affordable Care Act’s provisions (ACA). Pre-existing conditions are not covered, and you may be turned down for coverage.
Short-term plans can last anywhere from a month to a year and are not renewable. In most cases, policies are only designed to cover significant medical events. Treatments for substance addiction or mental diseases are not covered.
What Does Short-Term Health Insurance Cover?
The coverage of each short-term health plan differs depending on the plan type and the insurance carrier. Short-term health plans, on the other hand, are exempt from meeting the same standards and coverage levels as long-term health plans since they are not required to follow ACA guidelines.
Preventive care, doctor visits, urgent care, and emergency treatment are usually covered under short-term medical insurance plans. Prescriptions may be covered under some plans.
Short-Term Insurance Exclusions
Pre-existing conditions and maternity coverage are two notable exclusions to be aware of. Furthermore, preventative, dental, vision, and mental health services are frequently overlooked.
Any pre-existing conditions must be disclosed prior to enrollment (any condition that you took medication, consulted a health care professional, or have been treated for in the past 6 to 36 months before the start of the policy). If you fail to report any pre-existing conditions, your insurance policy may be cancelled.
Although short-term health insurance is not for everyone, it does have its uses. Short-term plans are frequently used to bridge coverage gaps between plans or until the Open Enrollment Period begins. It’s for this reason that it’s often referred to as “gap health insurance.”
Similarly, short-term plans do not have a preferred healthcare provider clause, allowing participants to choose from a wide range of healthcare experts around the country. In addition, most plans have cheap rates, and coverage can begin as soon as one or two days after an application is submitted.
Even though short-term health insurance may not be for everyone, it may be the best health coverage option for you.
If you’re between jobs, a short-term plan can be the best option — especially if you didn’t choose COBRA. Short-term plans may also suit your needs if you are waiting for coverage from your group health plan or to enroll in the Affordable Care Act.
Here are some questions to consider before you decide short-term health insurance is your best option:
- Are you in good health with no pre-existing conditions?
- What premiums and out-of-pocket expenses can you afford?
- Do you qualify for subsidies or Medicaid?
- How long do you need coverage?
- Do you need a full range of coverage benefits, or are your lifestyle and health suited to the coverage short-term plans provide?
- Are you outside of the Open Enrollment Period?
- How quickly do you need health insurance?
How Much Does Short-Term Health Insurance Cost?
Like all different insurance types, the cost of short-term insurance depends on the plan. As an enrollee, you will be responsible for a monthly premium, deductibles, copayments, and out-of-pocket costs.
Because short-term health insurance does not cover as much, premiums are often much lower than ACA plans. In 2018, the average monthly premium for a three-month short-term plan was $107.
The deductibles on short-term health plans are typically much higher than traditional health plans, and copayments are required for certain doctor visits.
And, of course, if you require health care services not covered in your short-term plan, you will need to pay all costs. This could include maternity care and dental care.
The Pros of Short-Term Health Insurance
If you’re still unsure of the benefits of short-term health plans with regards to your situation, here are a few pros of short-term health insurance:
1) Quick Results
You’ll often know if you qualify right after your application is complete and coverage can begin in less than 24 hours.
2) Gaps
A small gap in health coverage is how many individuals fall into a hole they can’t get out of. Short-term plans can cover these gaps between long-term plans.
3) Lower Costs
Short-term plans often incur lower premium costs than ACA plans since pre-existing conditions are not covered.
4) Flexibility
Most short-term plans allow flexible term lengths. These lengths range from one month to almost one year.
5) Choice of Healthcare Professional
Short-term plan enrollees can go to a number of different doctors and healthcare professionals.
6) Gives you options on the go
Travellers, seasonal workers, and recent graduates can utilize short-term plans to ensure they have coverage during all phases of life.
The Cons of Short-Term Health Insurance
However, there are some downsides to short-term health insurance. Short-term plans are created for people in certain situations. Thus, here are a few cons to short-term health coverage:
1) Pre-existing Conditions
You will not get coverage if you have a pre-existing medical condition. If you do, coverage will be severely restricted.
2) Many Services Denied
Short-term plans do not cover many medical issues. Preventative care, maternity care, mental illness, and substance abuse are just a few of the ailments not typically covered.
3) No COBRA
You cannot qualify for COBRA health insurance once your short-term health coverage ends.
4) Read the Fine Print
Short-term insurance plans often do not have an out-of-pocket maximum. These plans may also institute a limit on the maximum amount an insurer could pay.
5) Not Renewable
Once your short-term plans end, you cannot renew it. You may struggle to find a new short-term plan once the old one terminates if you developed a pre-existing condition.
6) No Seniors
Most short-term insurance plans deny coverage to everyone over 65 years old.
“Obamacare” vs. Short-Term Insurance
ACA health insurance (Obamacare) plans provide more comprehensive coverage and can last longer than short-term insurance. It’s also impossible to be turned down for coverage or denied the bare minimum of health benefits.
Short-term health plans were designed to help fill in any gaps in coverage that may arise; they are not intended to be used in place of a standard health plan. However, if you’re between jobs or waiting for the open enrollment period, short-term insurance can help bridge the gap
With short-term coverage, you can purchase other forms of insurance to give you additional coverage.
Accident insurance covers emergency room visits, hospital stays, medical costs, and more.
- Critical illness insurance pays enrollees a lump sum in the event of a variety of ailments, including heart attack, cancer, stroke, and many more.
- Dental and vison insurance options are also available.
Because they do not comply with ACA criteria, short-term health insurance are not available through the Health Insurance Marketplace. You can contact a private insurance provider directly to enroll in a short-term medical insurance plan.
FAQ
How Long Can I Get Coverage?
Term lengths vary by the state you live in and the type of plan. Some states allow for up to 12 months of coverage
How Quickly Can I Get Coverage?
Short-term health insurance coverage takes effect one or two days after your application is received.
Can I Renew This Type of Health Insurance Coverage?
No. If you need coverage beyond your plan, you will likely need to apply for another short-term insurance plan.
Is Short-Term Medical Insurance Limited to Annual Enrollment Periods?
Short-term medical insurance plans are available year-round, and there is no need to wait for the open enrollment period.
Do Short-Term Health Insurance Plans Have High Deductibles?
The deductibles on short-term medical plans are typically much higher than traditional health plans. Some plans start at around $1,000.
Can I Cancel Short-Term Health Insurance Anytime Without Penalty?
Policy cancellation penalties are based on the terms in your insurance provider’s policy. It is to be expected that there will be a fee for early cancellation.
Do Short-Term Health Insurance Plans Cover Pre-Existing Conditions?
No. Short-term insurance plans do not cover pre-existing conditions. Depending on your state, diagnosis or treatment would have been within the last 6 months to 3 years.
