Navigating Health Insurance with Health Plan Advocates

Navigating health insurance plans can be a daunting task. With so many options available, it can be difficult to know which plan is the best fit for you and your family. That’s why it’s important to have a health plan advocate on your side. A health plan advocate is a professional who specializes in helping individuals and families understand their health insurance options and make informed decisions about their coverage.

A health plan advocate can help you understand the different types of health insurance plans available, including employer-sponsored plans, individual plans, and Medicare and Medicaid. They can also provide guidance on how to compare plans and find the one that best meets your needs. They can help you understand the cost of each plan, including premiums, copays, and deductibles, as well as any additional benefits or coverage restrictions that may apply.

Essential Vocabulary for Quoting Individual and Family Health Insurance

Quoting individual and family health insurance can be a complex process, and it is important to understand the essential vocabulary that is used in the process. Here is a list of the most commonly used terms when quoting individual and family health insurance:

• Premium: The amount of money that is paid to the insurance company for coverage. Premiums can be paid monthly, quarterly, or annually.
• Deductible: The amount of money that is paid out of pocket by the insured before the insurance company begins to pay for services.
• Co-pay: The amount of money that is paid by the insured at the time of service. Co-pays are usually a set amount, such as $20.
• Co-insurance: The percentage of the cost of a service that is paid by the insured. For example, if the insurance company pays 80% of the cost of a service, the insured would be responsible for the remaining 20%.
• Out-of-pocket maximum: The maximum amount of money that the insured is responsible for paying during a policy period. Once the out-of-pocket maximum is reached, the insurance company pays 100% of the cost of services.
• Network: The group of doctors, hospitals, and other healthcare providers that have agreed to provide services at a discounted rate for the insurance company.
• Non-network provider: A doctor, hospital, or other healthcare provider that does not have a contract with the insurance company. Services provided by non-network providers are usually more expensive than those provided by network providers.
• Exclusions: Services or treatments that are not covered by the insurance policy.
• Pre-existing condition: A medical condition that existed before the policy was purchased. Pre-existing conditions may not be covered by the policy.
• Lifetime maximum: The maximum amount of money that the insurance company will pay out during the life of the policy.
• Waiting period: The amount of time that must pass before the policy will begin to cover certain services or treatments.

Individual ACA Health Insurance

Individuals who have lost job-based health benefits may be eligible to purchase a qualified health plan that meets the requirements of the Affordable Care Act (ACA) during a Special Enrollment Period (SEP). SEPs provide individuals with the opportunity to purchase health benefits outside of the annual Open Enrollment Period (OEP). To determine eligibility for a SEP, individuals should review their job-based health benefits and confirm that they have been lost.

How Can I Get Individual Health Insurance?

You can get individual health insurance for individuals through a Special Enrollment Period (SEP). An SEP gives you 60 days to enroll in a comprehensive health insurance plan — for you only, or you and your family — after a qualifying life event. You can enroll as soon as your qualifying event occurs. There are several qualifying life events that can make you eligible for an SEP, including:¹

• Job loss
• Marriage
• Divorce
• Adopting/having a baby
• Moving to a new ZIP code
• Loss of employer-sponsored health coverage
• Becoming a U.S. citizen

How Much Is Health Insurance Without a Job?

Individuals who are not employed may be eligible for subsidies to help cover the cost of health insurance plans under the Affordable Care Act (ACA). Subsidies can be used to lower the cost of monthly premiums and out-of-pocket expenses. There are two main types of subsidies available to individuals who qualify: premium tax credits and cost-sharing reductions. Premium tax credits can be used to reduce the amount of monthly premiums, while cost-sharing reductions can be used to reduce the amount of out-of-pocket expenses associated with a health insurance plan. Individuals who are interested in purchasing an ACA health insurance plan should take the time to research their eligibility for subsidies in order to maximize their savings.

• A premium tax credit is a type of subsidy that can help lower your monthly premiums, if you’re eligible. You can choose to have the credit paid directly to your health insurance provider to be applied toward your premium,² or you can claim your premium amount when you file your income tax return.³
• A cost-sharing reduction (CSR), also called “extra savings,” is a type of subsidy that can help lower your out-of-pocket costs, including deductibles, copayments, and coinsurance. If you qualify, you have to enroll in a Silver plan to get the extra savings.

You can check your eligibility for these subsidies online.