Our individual/Marketplace plans are headed up by Ted Officer, who is a Certified Financial Planner (CFP®) . We are a free service to help you find a plan, get you enrolled, help with any marketplace documentation required. Rather than you trying to figure it out which plan is best for you, we will advise you and get you enrolled. If you have issues with your plan, instead of calling the insurance company or marketplace, simply call or email our office and we’ll handle it for you. I’ll also help you each year to update your coverage to make sure you have the best plan for the upcoming year.
We help you decide each year what plan is best for the next year. When deciding on a plan, you are not making a lifelong decision. You are only deciding what do to for the remainder of the year or the upcoming year. Each year we help our clients evaluate their best course of action based on their anticipated needs.
Types of Individual and Family Solutions Available
Individual /Family plans offered by vaious insurance companies, which comply with the regulations of the Affordable Care Act (ACA).
Alternative coverage that are not regulated by the ACA/Marketplace plan which can be significantly less expensive
Plans that reimburse you a limited amount when you need care
Religious based plans that share expenses among members
Membership to a specific primary care practice.
Affordable Care Act/Marketplace Major Medical Plans
Q: Which clients are these plans best suited for?
1. Ineligible for group coverage
2. Qualify for lower rates based on income (in 2021 the limit was lifted so most people now qualify)
3. Have pre-existing conditions
The Affordable Care Act was put into effect in 2014 and regulates health insurance sold by insurance companies. This law affects ALL your major medical health insurance choices because they now govern what plans are available, what the plans are required to cover, when you can purchase health coverage and ultimately the cost of these plans.
There are plans sold on healthcare.gov and also plans that are offered only through brokers or the insurance company directly.
Defining Characteristics of a Qualified Major Medical Health Plan under the ACA
Plans are required to cover pre-existing health conditions.
Must offer unlimited benefit maximums.
Qualified plans can only be purchased at Open Enrollment (Nov 1-Dec 15th of each year) unless you qualify for a Special Enrollment Period (due to losing another qualified major medical health plan at no fault of your own, within 60 days)
Qualified Major Medical plans are now required to cover these.
10 Essential Health Benefits:
ambulatory outpatient services
emergency services
hospitalization
maternity and newborn care
mental health and substance abuse disorder services, including behavioral health treatment
prescription drugs
rehabilitative and habilitative services and devices
laboratory services
preventive and wellness services and chronic disease management
pediatric services
Short Term Medical Plans
Q: Which clients are these plans best suited for?
1. Ineligible for group coverage
2. No significant pre-existing conditions
3. Income is too high to qualify for lower rates offered under the affordable care act regulated plans
4. Want protection from a catastrophic medical event
5. Looking to save money on premium as they can be half the cost of Affordable Care Act/Marketplace regulated plans
6. Looking for a PPO with a large network of providers
Short Term plans are offered by name brand insurance companies for one month to three years. Once the plan expires, you reapply for a new plan from one month to 3 years. Each term is a new policy and everything is reset on the plan, including the deductible and pre-existing conditions. You can apply for or renew these plans anytime throughout the year.
We recommend one year plans that end January 1 of each Year. You will have the option of switching to an Affordable Care Act regulated plan that covers pre-existing conditions if needed or reapply for another year with a short term plan.
There are good uses for these plans, but you need to be informed about what you are purchasing. If you understand the plan, these plans are a good money saving alternative.
Indemnity/Limited Benefit plans
An Indemnity plan pays a limited amount for different healthcare services. Plans pay a flat dollar amount for each type of service. We don’t recommend these plans as they are limited. The purpose of insurance is to protect against a catastrophic event. These plans offer benefits to cover routine things that most people incur routinely. However, for a catastrophic medical event they can leave clients with significant medical bills. We do not recommend these plans.
Faith Based Sharing Plans
A Biblical Approach to Healthcare
These are NOT insurance products. They work by members sharing in each other’s medical expenses. These memberships can be joined at any time of the year but are not for everyone as they are lifestyle based. Clients like these plans as they typically pay very well for routine small medical expenses. However, the purpose of insurance is to cover a large catastrophic event. These plans are a promise to raise funds as best as they can to cover members medical expenses. For about the same cost, we recommend that healthy clients purchase a short term plan which is a written contract with a major insurance company that will pay claims for a catastrophic event.
Concierge/Direct Primary Care Doctor Group
Membership to a primary care practice which allows better and longer access to a primary care physician. Pairs with another insurance plan such as an Health Savings Account eligible high deductible plan or a short term plan. Most Concierge providers do not accept insurance so this is the only want to access them.
Dental And Vision Insurance
You can look at dental and vision plans as “anyway money”. If you get two cleanings per year or a vision exam or glasses or contacts, you will spend the amount of the premiums if you are not insured…anyway. However if you need work beyond two cleanings you are that much further ahead because you have insurance to cover part of those expenses. In addition, if you are self employed, the premiums are tax deductible so you are turning money you are spending anyway into a tax deductible expense.
For Dental and Vision we recommend United Healthcare. There are two plans I recommend, The Primary Preferred allows you to see any Dentist. The Premier Choice pays very little if you go out of network.
