John Smith of Miami, FL
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2020 Health Insurance Open Enrollment
People get health insurance plans for a variety of reasons. Here are some of the basics that health insurance plans will provide coverage for:
- Covering wellness visits
- Covering lab work to make sure everything is ok with you
- Covering sick visits to the doctors
- Covering sick visits to the Emergency room or urgent care centers
- Covering illness or injury that results in hospitalizations
- Covering basic medical procedures, surgeries etc.
Health Insurance Plans for Individuals and Families
In life many things are unexpected — like being diagnosed with a serious illness, or a hit and run car accident — your hospital bills can quickly become insurmountable when faced with these medical issues. Health insurance isn’t just about leveraging that financial risk. Your health plan will decide if you can choose the doctor you want for your treatment. Your health insurance plan will decide if you can seek treatment at the best cancer center, as opposed to the facility closest to you. Your health insurance will decide whether you can get a second opinion from a doctor or not. The list goes on, and there are many factors to consider before choosing the right health insurance policy for you and your family.
Any good health insurance plan — whether Major Medical, Short Term or Group Insurance — would cover your basic benefits such as inpatient and outpatient services, routine medical visits, prescription drug coverage, preventative care and more. Most plans do not come with Dental and Vision coverage and therefore these will need to be added later.
The main factors that affect your health insurance costs are your age, location, whether you smoke or not, and your income. In some cases your medical history will be taken into effect. Plans purchased through Obamacare or the Healthcare Marketplace are what we call Guaranteed Issue and they can not deny you for your medical history. Outside of open enrollment and the Marketplace, the carriers do not follow those same guidelines and they can deny you for medical reasons.
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Health Insurance Plan Types
Private Health Insurance
When referring to “private health insurance” we are referring to any health insurance plan that is not through state or federal government. Instead it is offered through a company, broker or other private entity. Some private plans have benefits that meet the minimum essential coverage requirements of the ACA(Obamacare). Some plans such as short-term health plans or plans that offer catastrophic coverage, may offer extra benefits, but most likely will not meet the ACA requirements.
COBRA isn’t actually insurance. It’s a law. The Consolidated Omnibus Budget Reconciliation Act allows an eligible employee and their dependents to continue their current group coverage for 18 months after their employment stops. While COBRA can be expensive, we recommend speaking to an agent before opting out of those options.
A HMO or Health Maintenance Organization have some upsides and downsides to them. The main benefit is in most cases HMOs have lower premiums than PPOs. You will have to choose a PCP or Primary Care physician. You will have to go to him for everything and if you want to see a specialist you will need to go to your PCP first and get a referral. You have no out of network coverage so you will only have access to the doctors in your network.
A PPO or a Preferred Provider Organization will have a slightly higher cost in most cases than an HMO. But there are many benefits to using a PPO network. The most obvious is that you do not have a PCP, so you can choose which doctor you go see. You can also go directly to see a specialist without a referral. With as PPO plan you have access to out-of-network coverage. But check to see because the coverage usually changes.
Health Care Market Exchange
John Smith of Miami, FL