Individual Health Insurance Marketplace

A few years ago, just about everyone agreed that the state of US health care was a mess. People weren’t being treated properly or receiving suitable preventive care, and part of that was because the individual health insurance industry was notoriously full of individual health care providers who wouldn’t pay claims based on loophole-riddled policies. It was such a mess that the Affordable Care Act (A.C.A) was instituted, which resulted in massive changes.

One of these notable changes is the creation of an individual health insurance marketplace for each state so that people with low to moderate income who couldn’t get affordable health coverage in Ohio were able to receive tax credits that helped them pay for their premiums.

More People are Buying In

The A.C.A was established in 2014, and by the end of that year roughly 8 million people signed up for health insurance coverage through their state’s Individual health insurance market. By the end of 2015, 11.7 million had signed up.

• About 380,508 people signed up through the Ohio health care exchange in 2014. That’s a 15% increase from the individual health insurance plans Ohio residents who signed up in 2013.

• The number of Indiana individual health insurance enrollees went up to 231,276. That’s an increase of 35% for health insurance Indiana individual plans.

• The change in Tennessee was even more dramatic with a 40% increase in enrollees. The number of enrollees that individual health insurance Tennessee saw went up to 340,904.

It’s pretty much the same story for every state. If you’re looking for insurance, now is the time to get it. You should get term insurance first.

What is term life insurance?

  • This is an insurance policy that has a defined set of premiums (your monthly payments), the cost-sharing structure, and the benefits for a given amount of time. Term life insurance can be good for just a year, or you can get one that lasts for up to 20 or even 30 years.

Facts about the Marketplace

If you’re thinking about getting insurance from the Marketplace, here are some facts you need to know about.

• Open enrollment is over for 2016 now, obviously. You can qualify for enrollment if you sign up before January 31st in 2017.

• You may also qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

• The marketplace is where people can get insurance when they can’t get insurance anywhere else. That means you can’t get insurance from Medicare, Medicaid, CHIP, or from your employer.

• If you already have insurance through your workplace, buying an insurance plan from the Marketplace will require you to pay the full price. The only exception is if your workplace insurance doesn’t meet the set standards, but then most workplace insurance plans do meet these standards.

• If you already have Medicare, you won’t be able to switch to a Marketplace insurance plan, get supplement coverage through the Marketplace, or even buy a Marketplace dental plan.

• Your savings through the Marketplace depends on how much you will earn for the year, the number of dependents, and where you live. So let’s say you’re married and living in Indiana.

o If your income for the year is less than $22,108 then you can get free or low-cost insurance coverage from Medicaid.

o If your income is between $22,108 and $39,825 then you can get a Marketplace health plan with lower monthly premiums. You also pay less for out of pocket expenses.

o If your income is between $39,826 and $63,720 then you can get a Marketplace plan with lower monthly premiums.

o If you earn more than $63,720 you should just buy from other sources. You won’t get any savings in the market place because you’re going to pay the full price.

• You can apply for a Marketplace plan online.

• The Marketplace was set up so that everyone can get insurance. There’s no more excuse not to have insurance, and so if you don’t have a provider then you may be penalized. You will have to pay either $695 per adult and $347.50 per dependent child, or pay a penalty that equals 2.5% of your income. You will pay the larger amount of the two penalties.

How Can You Buy Insurance?

When buying individual health insurance Cincinnati Ohio residents (and residents of other states) can go about it through one of several ways:

• You can go through the state Marketplace. This is a fairly common way to get cheap health insurance around Cincinnati, OH. Here reputable individual health insurance providers can offer affordable health insurance for families and health insurance for self-employed workers.

• Instead of getting OH individual market health insurance, you can instead go directly to an individual provider of health Ins. You’re essentially cutting out the middleman function of the marketplace, as the Cincinnati individual health ins. market charges the insurer additional fees that can be passed on to you. The individual health insurance Indiana residents can therefore receive may be much more affordable.

• For Cincinnati individuals interested in group health insurance plans, it’s often possible to get health insurance from your workplace. It’s often part of the individual employee benefits packages and required for companies that have at least 50 employees. The individual health insurance plans Indiana businesses offer for their employees are often designed to help attract and retain their qualified workers.

• You can also just look for the assistance of a broker, who can help you find the most suitable insurance plan for your specific need. A good broker will have a range of different health insurance plans in your state you can choose from. They can help you by clarifying and comparing the various costs, benefits, networks, and coverage.

Out of Pocket Costs

Just because you pay your monthly premiums on schedule every month doesn’t mean that you still don’t share part of the costs of the medical services you receive. Wouldn’t that be nice though? But the reality of cost-sharing is an aspect of insurance you need to know about. Here are some terms that you may encounter, and which you need to be familiar with:

Copay. This is the predetermined dollar amount you have to pay out of pocket for specific types of health care. For example, your policy may require you to pay $30 every time you visit your doctor, and the insurance company pays for any fees that go beyond that amount. The greater the amount you pay for your monthly premiums, the lower the copay. In some cases, there may not even be copays at all. (Tip: pick a copayment option you can afford if you visit your doctor’s clinic often.)

Deductible. This is the amount you have to pay out of pocket every year for the covered medical services, before your insurance provider starts to pay their full share of the costs. So let’s say your deductible is $3,000 for the year. This means you will have to pay the first $3,000 worth of health care you receive. After that, the insurance company can then shoulder some of the cost of the medical services. However, preventive services are covered by the insurance company even before you’ve reached your deductible limit. Most health insurance plans also pay for a part of the doctor visits and prescription drugs before you meet your deductible limit. (Tip: try to keep your deductible amount to 5% of your gross annual income at the most.)

Coinsurance. This refers to the predetermined percentage of the cost of the medical care you have to pay for. Let’s say you’ve reached your deductible, so now your insurance provider can then help you out. Now you undergo a medical test that costs $2,000 and your coinsurance rate is 25%. That means you only pay $500 for the test while your insurance company pays last $1,500.

Out of pocket limit or maximum. This is the amount of money you will have to pay for out of pocket costs, including what you pay for deductibles, copays, and coinsurance. When you reach this limit, the rest of the cost will be totally (100%) shouldered by the insurance company. The maximum limit for an individual plan is $6,600 and $13,200 if you have a family health insurance plan. So if you’re in an individual plan and your total expenses run into $20,000 then you may just have to pay $6,600. The missing $13,400 will come from your insurer.

Buy Insurance Now

Aside from avoiding the penalty, you benefit from health insurance in several important ways:

• You can get discounted rates for various medical services. Without insurance, you may have to pay twice as much—or more.

• It can protect your finances from unexpected medical bills:

What if you get into an accident?

Such an event can really cost a lot of money and it may even lead you to bankruptcy. It can cripple your business as well.

• You can get critical care services that are unavailable for the uninsured.

• It encourages a healthy lifestyle since you’re more able to afford checkups.

There simply is no excuse anymore for not having any insurance. Contact us for a plan today.

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