Types Of Individual Health Plans
Individual health insurance plans dont differ in terms of benefits. However, plans vary on costs, how theyre structured, which doctors accept them and which prescription drugs they cover.
Health plans in the ACA marketplace are divided into four metal tiers to make comparing them easier. The tiers are based on the percentage of medical costs the plans pay and the portion you pay out of pocket. Out-of-pocket costs include deductibles, copayments and coinsurance. Find out more about copays and coinsurance.
The percentages are estimates based on the amount of medical care an average person would use in a year.
- Bronze — Plan pays 60% of your health care costs. You’re responsible for 40%.
- Silver — Plan pays 70% of your health care costs. You responsible for 30%.
- Gold — Plan pays 80% of your health care costs. You responsible for 20%.
- Platinum — Plan pays 90% of your health care costs. You responsible for 10%.
Bronze Silver And Gold Plans: Understanding Metal Tiers
The different metal tiers in the Health Insurance Marketplace determine how health care costs are split between you and the insurance company. The more responsibility put on the insurance company, the higher your the cost of your premiums will be.
Some states also have a policy with a very high deductible called a Catastrophic health insurance plan. You can also get a Platinum plan in some states, which offers the lowest deductible but the highest monthly premium. A Catastrophic plan is best for the young and very healthy, while the Platinum plan is for those who expect very high medical bills.
Choosing The Plan Thats Right For You
Choosing an individual health insurance plan that best fits your needs depends on a few different factors. Consider the following aspects and determine how theyll affect your plan:
- Provider eligibility and choice: Want to keep your current doctor? Make sure theyre in-network first. Also, make sure youre comfortable with the providers covered under the plan.
- Medication eligibility: Medication coverage can vary widely by form, brand and prior approval requirements. If you take regular medications, youll want to make sure theyre covered appropriately.
- Premiums vs. out-of-pocket costs: If you frequently visit the doctor, lower copayments can be easier to manage but will have higher premiums. Alternatively, if you rarely see a doctor, lower premiums and higher out-of-pocket costs might be a good choice.
- Network resources: If you dont have much patience for phone calls, reimbursements and paperwork, you may want to look for a provider with particularly strong customer service or few requirements on your end.
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How To Get Individual Health Insurance
How can you buy an individual health plan? The health insurance marketplace, run by the U.S. Department of Health and Human Services and about a dozen states, is the ACA exchanges website that offers you a menu of your coverage options. The site lets you compare individual health insurance plans and find the best health insurance to buy for individual.
You simply enter your information, including your income, and the site provides your coverage options, including estimated costs. Thats the place to start when looking for your insurance options.
Not all insurers sell plans through the government-run health insurance marketplace. You can find more individual and family options by shopping directly through health insurance companies that offer plans outside the exchanges. That will take more work to compare the insurers, but you may also find a plan that better fits your needs outside of the exchanges.
Now, lets take a look at when you can buy individual health insurance and the types of plans and other options.
A Business Owner Who Has Employees
If you start a business and you have employees, you might be required to offer them health insurance. Even if its not required, you might decide to offer health insurance to be a competitive employer that can attract qualified job candidates. In this situation, you will be required to purchase a business health insurance plan, also known as a group plan.
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Key Features Of Individual Health Insurance
Given below are some of the best features of an individual health insurance policy:
- The health insurance for individuals provides coverage solely for the insured person.
- The insurer here protects the policyholder against certain medical expenses as per the amount of premium paid by him/her.
- Under individual health insurance plans, hospitalization charges are covered as part of the policy.
- The individual policies come with Lifetime renewal.
- These plans allow tax deductions as per section 80D of Income Tax.
- The individual plans provide coverage costs for surgeries, hospital rooms, doctor’s fees and for tests done in the laboratory among others.
- In the individual mediclaim policy, the person covered under the plan requires to pay a fixed amount called co-payment for availing health services.
- In these plans, pre, post hospitalization costs are included.
- They also allow coverage against critical diseases.
How Much Flexibility Do You Want In Your Plan
When choosing an individual health plan, you want to consider the type of benefit design. Health maintenance organization plans are the most common plan design in the individual market. eHealth estimated that 49% of individuals plans are HMOs.
HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.
Exclusive provider organization plans make up one-third of individual market plans. These plans dont allow you to get care outside of the network, but you also dont need a referral to see a specialist.
Preferred provider organization plans are the most common type of plan in the employer-sponsored health insurance market. Forty-seven percent of employer-sponsored health plan members have a PPO. However, only 16% of individual health insurance plans are PPOs.
PPOs are more flexible. You can see doctors both in your network and outside the network. You dont have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.
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Expert Advice: Finding Affordable Health Insurance
Associate Dean of Graduate Business Programs and Professor of Finance at the University of Portland’s Pamplin School of Business
Your Options If Youre Not Eligible Through Your Employer
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If your employer doesnt offer you health insurance as part of an employee benefits program, you may be looking at purchasing your own health insurance through a private health insurance company.
A premium is the amount of money that an individual or business pays to an insurance company for coverage. Health insurance premiums are typically paid monthly. Employers that offer an employer-sponsored health insurance plan typically cover part of the insurance premiums. If you need to insure yourself, youll be paying the full cost of the premiums.
It is common to be concerned about how much it will cost to purchase health insurance for yourself. However, there are various options and prices available to you based on the level of coverage that you need.
When purchasing your own insurance, the process is more complicated than simply selecting a company plan and having the premium payments come straight out of your paycheck every month. Here are some tips to help guide you through the process of purchasing your own health insurance.
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How Should You Compare Health Insurance Companies For The Self
There are a few things that you should keep in mind when shopping for health insurance as a self-employed person. These include:
- Premium: Your premium is the amount youll have to pay each month for your health insurance policy. You should look for a plan with a premium that fits your budget.
- Deductible: Your deductible is the amount you have to pay out of pocket before insurance begins to cover the cost. Plans with higher deductibles typically have lower premiums, and vice versa.
- Copays: Copays are the amount you have to pay out of pocket for a given service, like seeing a primary care physician. Look for policies with low copays when possible.
- Prescription coverage: If you have any prescription medications, look for a plan that covers them.
- In-network physicians: If you already have a doctor or physician youre happy with, you should make sure to see whether or not theyre in-network for your new health insurance policy.
- Customer satisfaction: Look for insurance companies with high customer satisfaction ratings and good customer reviews.
- Company reputation: Its a good idea to research the insurance companys reputation, including whether or not theyve had past scandals or issues.
What Is The Most Affordable Health Insurance By State
The cost of health care depends on where you live. Major carriers in every state offer affordable health insurance policies on HealthCare.gov. Here are the lowest premiums available for every state, along with the number of major carriers .
Low-Cost Health Insurance Premiums
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act -certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. Shes always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
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Overview Of Healthcare In Ghana
Ghana has one of the most advanced healthcare systems in Africa due to its public insurance system, known as the National Health Insurance Scheme . Prior to the public insurance system, Ghana used a cash and carry scheme that required payment for any treatment upfront, which prevented a lot of people from accessing care.
The government launched the NHIS in 2003, which focused on treatments for malaria, respiratory diseases, diarrhea, diabetes, hypertension, and other local needs. While individuals who are enrolled in the NHIS are more likely to seek treatment when sick, visit clinics, and obtain prescriptions, the out-of-pocket expenses remain high for many. Even though flexible premiums make it possible for low-income and self-employed individuals to access care, waiting lists can be up to six months for these groups.
Despite the fact that the expenditure on healthcare has increased in the past decade, Ghanas healthcare infrastructure has yet to reach the same standards of developed nations. This is especially true outside of the capital city of Accra and other large urban areas.
Can I Buy Health Insurance On My Own
How much is individual health insurance? You can expect to pay a monthly premium of $225-$327 for one person.
If youre self-employed or unemployed, and dont have access to affordable health insurance through work. You can buy individual coverage from the open marketplace. Do your research beforehand to make sure you qualify for coverage and know the income limits and other requirements.
You might also find another source of health care coverage such as private insurer, but make sure to read all the terms so that there are no surprises at renewal time.
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How Much Insurance Do You Need
Protect your loved ones by protecting your income – learn how much.
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Fill out this form with as many details as you can and one of our associates will get back to you. Or you can call us at 1-888-626-8543 with the following details to submit your claim:
- The policy number
Health Insurers Cant Reject You
Health insurance companies cant turn you down for coverage or charge you sky-high premiums because youre sick or have a health condition, such as diabetes and heart disease. Before the ACA, people with health problems faced higher premiums to cover a pre-existing condition or couldnt qualify for an individual health plan at all.
Health plans also have to offer a comprehensive set of 10 essential benefits, including:
- Rehab services
- Vision and dental for children
And they cant cap the dollar amount of benefits you receive in a year or over a lifetime. However, insurers must cap your maxium out-of-pocket costs for the year.
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Affordable Individual And Family Health Insurance Plans
Nothing is more important than the health of you and your family. Thats why Progressive Health by eHealth makes searching for individual and family health insurance plans so simple. With eHealth, you can search the largest selection of plans available online using helpful comparison tools, empowering you to find insurance that works for you. As soon as you submit your application, eHealth will advocate on your behalf to get you the coverage you need, entirely free of cost.
Protect what matters most get a quote for individual or family health insurance now. Have more questions about your health insurance options? Learn more with our Health Insurance 101 guide.
What You Should Know About Affordable Individual And Family Health Insurance
- Insurance access varies: How you get health coverage depends on whether your employer offers coverage, your age, income, and other factors.
- Consider overall affordability: An affordable health insurance plan isnt just based on monthly premium, but all of your out-of-pocket costs including deductibles, copays, and coinsurance.
This guide provides guidance and resources for how to find affordable health insurance including:
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Understand And Compare How Health Plans Are Structured
Know the differences between a health maintenance organization , preferred provider organization , exclusive provider organization , point of service plan and high-deductible health plan with a health savings account.
Dig into the details of what the health plans cover. For instance, how will the plan cover the prescription drugs you take? Make sure the healthcare providers you want to use are in the plans network. Otherwise you will pay more out of pocket or may not have coverage to see them.
In addition to reviewing the premium youll pay for the plan, estimate how much youll pay out of pocket for the amount of healthcare you expect to use in the next year.
If you rarely need medical care, it probably makes more sense to choose a plan with a higher deductible and lower premium than to pay a high premium for a plan with a low deductible. However, if you have a family and expect will need at least some health care services, a lower deductible could be the best choice.
Best Individual Health Insurance
The best health insurance companies offer exceptional customer service, seamless claims processing, great provider choices, flexible care options and affordable premiums. They are also reputable, exude financial strength and have a proven track record of success.
Here are Benzingas top picks for providers with the best individual coverage:
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Terms To Know When Quoting Individual Or Family Health Insurance
Finding a health insurance plan that covers your family and fits your budget requires a little familiarity with insurance terms. After all, if youre not sure what co-insurance or deductible means, you may not know the true cost of your health insurance. Heres a quick rundown of the most common terms youll see when comparing plans and how they shape the total cost of your plan:
- Premium: Your premium is the amount you pay on a monthly or other regularly scheduled basis to keep your coverage.
- Deductible: Your deductible is the annual amount you pay out of pocket for medical care before your insurance pays out.
- Co-pay: A co-pay is a fixed amount you pay for certain services, such as X-rays or specialist visits. Depending on the policy or insurer, your co-pay may count towards your deductible.
- Co-insurance: This is the percentage of your medical bills you pay once you reach your annual deductible. Some plans may pay for all your covered services after you meet your deductible.
When you quote health insurance with eHealth, you can see each plans office visit co-pay, deductible, and monthly premium amount all at once, making comparison shopping easy.
Get The Best Individual Health Insurance Coverage
Wondering how to get health insurance from a reputable provider thats affordable and meets your needs? All you have to do is enter your ZIP code to receive a customized offer. It only takes a few minutes of your time to inquire, and theres no obligation to purchase coverage if the quoted offer isnt a good fit. Shop around for different providers until you find an individual health insurance plan thats perfect for you.
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Deduction On Preventive Health Check
YIn addition to the hospitalization expenses, tax exemption benefits are also provided on the out-patient department or OPD consultation charges as well as expenses incurred on diagnostic tests. You can avail tax benefits on cash payments also. Unlike other medical expenses that require payments either through debit/credit cards, cheques, or internet banking to avail tax exemption benefits.
Please note that the above-mentioned benefits are as per the current tax laws prevailing in the country. Your tax benefits may change subject to tax laws. It is advisable to reconfirm the same with your tax consultant. This is independent of your health insurance premium value.