Health Insurance Plans
MAJOR MEDICAL PLANS (Affordable Care Act): aka Obamacare
- I sell individual, family, and group Health Insurance.
- Will cover all pre-existing conditions from day 1 start date.
- Covers Maternity and suicide
- 2 Health questions: Do you use tobacco and are you pregnant?
- 95% of plans are HMO.
- Must get a referral from your Primary Care Provider to see a specialist.
- Will not cover medical services out of network except for true emergency.
- Deductible and Maximum out of Pocket apply to all plans.
- A single must earn at least $12,750 in 2021 to qualify for a APTC (tax credit/subsidy)
- No limit on how much Insurance will cover yearly or lifetime.
- Two or more unrelated people working 32 hours or more for same business entity.
- Family members can be included in the insurance plans, health insurance not a must.
- HMO and PPO available, as well as self-funded plans
- Owner must pay at least 50% of premium for company to get tax benefits.
- Can include extra benefits such as Legal Shield, ID Shield, Dental, Vision, Pet Insurance, Roadside Assistance
SHORT TERM MEDICAL: may be perfect for those in transition:
- Recent graduate or student no longer eligible under parents’ health insurance plan
- Between jobs or out of work
- Waiting for other coverage plan to begin
- Retired early and needing to bridge to Medicare eligibility
- Can’t afford your Cobra or Major Medical plan
- Good for 1 month up to 3 years, can cancel plan anytime
- Must answer no to all health questions
- You choose deductible, maximum out of pocket, co-insurance and maximum coverage up to $1 million.
- Limited preventative care benefits
- Teledoc available sometime extra fee or copay applied
FIXED INDEMNITY PLANS:
- About 40-50% less expensive than Obamacare with no or little Advance Payment Tax Credit
- Pays you a fixed amount or schedule for medical services.
- Deductibles only apply to hospitalization for more than 24 hours.
- PPO networks such as Aetna, Cigna, First Health, PHCS, and Multiplan Ltd. Plans good nationwide, cost less to stay in network.
- 12 Month waiting period on pre-existing conditions.
- Never covers Maternity.
- Good up to age 65
- Small annual increases possible based on age
- Preventive care covered after 60 days.
- Can be rated up, must answer all health questions and names of medication.
- Limit of $1-$2 Million per year, $5 Million per person per lifetime
- Teledoc usually included free of charge.
Global / Travel Health Insurance Plans
- Will cover you when traveling outside of the USA.
- Covers foreign person visiting the USA, student, relative, temporary worker
- Available to Ex-pats living or working abroad.
- Foreign students coming to the USA or Canada to study
- Study Abroad
- Does not cover pre-existing health conditions.
- Will cover transportation to closest qualified hospital or repatriation to home country.
- Cover limited loss of luggage during travel.
- Covers trip interruption due to illness while on trip.
- You choose deductible, maximum coverage, and length of coverage. Policy is renewable.