When shopping for health coverage, it is very important to understand your current situation and what type of health coverage you may or may not have in comparison to what coverage is available to you. Below you will find the different types of health coverage available and what they offer.
Employer Coverage:
Group coverage or employer-based coverage is typically your best option for benefits. Most employers offer traditional major medical insurance coverage that has deductibles, co-pays and co-insurance so that will most likely be your best option. The biggest perk to having employer-based coverage is that the employer typically pays 50% of the actual premium so for example, if you have $200 per month coming out of your pay checks for
your healthcare, then typically the employer is paying the other $200. So, the actual premium of that policy is $400. That is why COBRA is expensive and unaffordable for most people. It is the same coverage that you had through your employer however the employee must take on the total cost because the employer no longer contributes towards the premium. Bottom line, having employer-based coverage will beat out any private health
insurance coverage available to you when comparing apples to apples.
Qualified Health Plans:
Qualified Health plans are the best alternative to employer-based coverage. These plans are available through the Marketplace. They are built the same way as traditional major medical insurance with deductibles, co-pays and co-insurance. Even though these plans are the best alternative, some people can’t afford them, or they don’t qualify for the plans outside of Open Enrollment. Open Enrollment is typically the last couple of months out of
the year so outside of that, the only way to purchase a QHP is through Special Enrollment which requires a life changing event. Please refer to the “Market-Place Page” for more information on that. QHP’s don’t have limitations on pre-existing conditions and they cover services like Mental Health, Maternity and Substance Abuse that other private plans will not cover. It is also important to consider that most QHP’s are now HMO, so
they don’t provide coverage beyond state lines. Make sure you know whether your plan has a PPO/EPO network or HMO network before making your decision.
Faith Based Plans:
If you are not in Special Enrollment or can’t afford a QHP, then a faith-based plan is a great alternative. Faithbased plans are not defined as insurance because they are not built with co-pays, co-insurance or deductibles. Instead, they have consult fees, member shared responsibility amounts and plan-sharing. Faith-based plans or health sharing plans provide great health benefits and services at an affordable price. These plans are separate
from the Affordable Care Act so therefore you don’t have to wait until Open Enrollment or qualify for Special Enrollment to purchase one. They are available all year round. Most faith-based plans have a waiting period on pre-existing conditions however it typically applies to hospitalization and surgery. So, you can still use your health sharing plan for pre-existing conditions for services such as office visits, prescriptions and lab work.
Always reference your plan to get a full list of limitations and exclusions.
Short-Term Plans:
Short-Term medical plans are great alternatives if faith-based plans are too expensive. A short-term medical plan provides coverage from 30 days up to 365 days depending on that state you live in. These plans provide some office visits and catastrophic coverage. They are built with co-pays, deductibles and co-insurance so they are more like traditional health insurance. Where they lack in benefits is pre-existing conditions. Short-term
medical plans do not provide coverage for pre-existing conditions, so these plans are designed for those who don’t need coverage for chronic conditions and instead, need benefits for unexpected situations. A short-term medical provides substantial coverage in the hospital or surgeries after you meet your deductible, so they provide the insured with peace of mind while they are insured under these plans.
Fixed Indemnity Plans:
A fixed indemnity plan is a great alternative if you can’t afford faith-based plans or a QHP. Fixed Indemnity plans provide fixed benefits for services such as office visits, lab work, hospitalization and surgery. They are not built with deductibles, co-pay or co-insurance. Instead, they pay a set dollar amount of services rendered. Some of them have no waiting periods on pre-existing conditions and others only have a waiting period for
hospitalization and surgeries. These plans are great options for those that have chronic conditions and need coverage until Open Enrollment. They don’t pay as much as QHP or Faith-Based plans do which is why they are more affordable however if you don’t have the option for more coverage, they serve their purpose until the other plan options become available.
Remember, no matter what you are looking for, it is important to know how much coverage you are getting. So, make sure to ask questions about your potential coverage and what it covers and what it doesn’t cover before making your decision. At Next Level Benefits, we make sure you have a great experience and make sure you are more informed than when we first spoke with you. We want our clients to understand how insurance works before they make their decision on what type of plan is right for them. We are not interested in a quick sales transaction. We are more interested in understanding what our clients need and want to get out of their healthcare. So give us a call today so we can take your insurance experience to the Next Level.
