Without quality health insurance in place, the cost of being treated for the most basic services can be a bank account draining process. For this reason, each person should ensure that they always have current coverage. Previously, it became a legal responsibility with the passage of "The Affordable Care Act," despite millions of Americans remaining uninsured. The legal requirement to purchase mandated medical benefits ended two years ago, although an experienced professional is needed to review and explain the differences of non-Obamacare and compliant policies.
Although the penalty was not severe the first year (just $95), it gradually increased to 2.5% of household income for noncompliance. A knowledgeable broker always kept you compliant, and also helped compare all Exchange plans that were offered on the State and Federal Marketplace. For persons that miss the Open Enrollment deadline (or choose not to obtain coverage), many low-cost options are offered, although out-of-pocket expenses are often higher than conventional plans. Limitations are are also common on plan duration, office visit and prescription drug copays, and covered preventative benefits.
For example, premiums on short-term plans are generally very low. However, deductibles and maximum out-of-pocket expenses are often significantly higher than standard plans. And instead of unlimited benefits, maximum coverage is generally $500,000-$2 million. Office visits and prescriptions are typically subject to a deductible, and preventative benefits are generally not covered at 100%. In recent years, however, Urgent Care and telemed visits are often offered without having to meet a deductible (copay only). Limited preventative benefits may also be provided at no charge, although on many temporary plans, the deductible must be met.
While we assume we will always be healthy, tomorrow is always an uncertainty, and a multitude of illnesses, sickness or an accident, could occur at any moment in time. Your coverage will give you preventive benefits and security, but first you must choose the policy that will meet your needs. And yes, that can be very challenging, considering how many reputable carriers offer coverage in most states. And of course, the Open Enrollment deadline must not be missed, which typically ends in December 15th. Senior Medicare enrollment ends on December 7th, although plan options are quite different than plan choices for applicants under age 65.
Further complicating the decision-making process is that not all companies participate in State Marketplaces. For example, although Blue Cross (Blue Shield) previously participated in every State Exchange, they have now withdrawn from several areas. Heavyweight carriers Aetna, Humana, UnitedHealthcare and others have exited the states where they previously offered coverage. And since the number of participating carriers has decreased in most states, in many situations, you may not be able to choose your preferred company, if you want a federal subsidy. In many counties, there is only one available carrier, and a limited number of available plans. Several states only have two available companies participating on the Exchange.
A Broker Or Insurance Agent Can Help
Whether you’ve been covered under different plans in the past, or are new to the process, one thing always remains the same- choosing the right policy can be tricky. There are an enormous amount of essential terms for you to understand in order to select a policy that will live up to your expectations while remaining within your budget. Learning how to get a healthcare quote online is not an easy process. There are many challenges and obstacles, and our job is to simplify the process, and review your best options.
Fortunately, that’s where an agent or independent broker can help. They are experts in researching and finding coverage, and can help you choose a personalized policy that meets or exceeds your budget and benefit expectations. Federal tax subsidies can help reduce premiums if you are eligible. Typically, if your income falls under 400% of the Federal Poverty Level, you will receive financial assistance. If under 100% (sometimes higher in Medicaid Expansion states), you may be eligible for Medicaid. Marketplace plans can also be purchased without any federal subsidy, although applicants in their 50s (and especially 60s) will pay a much higher premium.
If you're in between levels (and millions of persons are), comparing Bronze, Silver and Gold plans (and sometimes Platinum and Catastrophic) is needed before applying for coverage. An experienced agent/broker typically provides much more assistance than a "navigator." Navigators are often unlicensed and not full-time workers in the health insurance field. Funding for navigators has drastically reduced in many states, since their effectiveness has been questioned by many persons.
Your representative can give you personalized attention that you can’t get anywhere else. With their in-depth knowledge of the various carriers and policies, they can quickly and easily assist you in obtaining a policy and also servicing the contract in future years. That’s much more effective than having to call a 1-800 number and speaking to a stranger every time you need help, especially, if you are re-routed outside the US. Although the Healthcare.gov agents and customer service representatives are generally fairly helpful, their level of experience is generally inferior when compared to licensed agents. Typically, they are not located in your state, and are not familiar with local carriers and plans.
Your agent also can explain all of the details that may be hard to understand, as well as address any and all concerns that you may have. While online links and resources may offer a bit of assistance, speaking to an expert that you already know and trust is the preferred option. When the State Exchanges began operating four years ago, suddenly, you needed to consult a broker to determine the best plan to purchase, and understand what tax breaks you would qualify for.
Open Enrollment typically begins in November each year, and lasts for 45 days. Pennsylvania's Open Enrollment period extends to January 15th. Previously, the period was 90 days. Fewer companies and plans are now available, and non-Obamacare plans have become more popular, and are available throughout the entire year. However, most plans offered after the OE period ends, do not cover pre-existing conditions, and generally have high out-of-pocket expenses for major surgeries and hospital confinements.
For persons that prefer working online with their broker, modern quote engines will allow you to compare, shop and even purchase your policy without seeing anyone in person. But a quote engine still can not interpret which of the many options best fits your personal budget. That's why most experienced agents utilize a combination of experience and online applications. The Obamacare federal subsidy must also be correctly calculated, or a reduction of a tax refund may result the following year. Changes in income and family composition can impact the amount and eligibility of a subsidy. Medicaid and Medicare eligibility, if applicable, must also be considered.
With the latest information and unbiased advice working for you, viewing the best offers while getting a better policy is something you can always count on. Shopping and comparing multiple plans is necessary if you are going to get the lowest rates. Each carrier offers various policies in different areas, so your provider network will also have to be checked to verify your physicians are participating. Specialists, hospitals, and other medical facilities should also be checked. Ancillary products, including, dental, vision, and hearing, may no longer be offered by specific companies. Investment products should be purchased by financial institutions, and not health insurers.
Don't Try To Do Too Much Alone
An experienced broker can explain the variations in policies, what specific terms mean, and guide you through a sometimes-complicated enrollment process. You will always get coverage that is tailored for your needs when you have the experts working on your side. Yes, just like Nationwide! Typically, consumers should request to work with brokers that have at least 20 years of experience in the healthcare business. An independent broker will represent more carriers than a captive agent. For employer-related benefits, a Group broker is the best option.
Also, a "captive" broker only represents one carrier, while an "independent" broker represents several companies. Since coverage is often customized, it's important to be able to view many company offers, and not just one or two. Often, if you need supplemental coverage, the primary and secondary plans may be more cost-efficient if issued by separate carriers.
As a licensed professional who has made it his job to provide you, his or her customer, with the best policy at the lowest possible rates, you're also in "good hands." (Yes...just like Allstate!) As premiums and coverage change over the years, he/she can take the time to update your existing policies and make any appropriate recommendations. Unbiased advice is always a great tool to have. But it is also important to stay abreast of all the changes (especially in the healthcare field) that occur. Rates typically change each year for both Senior and under-65 products. But plan designs can also change, and often, specific policies are discontinued, and new options become available.
Why would you not want to receive free advice from an experienced broker when they are there ready to serve you? With benefits as previously mentioned, you can see why it is always advisable to consult with someone who will have your best interests in mind at all times. Typically, you can choose to meet face-to-face or simply communicate via email and/or phone. Generally, hard copy brochures are no longer sent.
There is no cost to use the services of a licensed agent, and they are accessible for extended hours. You can contact them any time that you would like to have all of your questions answered, and your concerns addressed. If you can find a person that is experienced and is located near you, that’s a great start! And of course, you can contact us directly for the same expert help. Regardless if you are reviewing Senior Medicare products, or under-65 plans, we are just a phone call or email away.
Our website helps you find apply for the right plans. You can choose whether to apply direct, or with the help of a broker. Regardless of which option you select, there are never any fees or obligation. Our guidance and assistance is always free, including helping with the enrollment process on State Health Exchanges. We can also help you to determine your eligibility for a federal subsidy, and review your potential eligibility for Medicare or Medicaid benefits.