Five Things to Know About Individual Health Insurance Coverage

By Cathy Aquino, Director, Government Sales, Independent Health
Five things to know about individual health insurance coverage

Now more than ever, it’s important to have access to high-quality and affordable health care coverage. But what if you are currently unemployed? Or your employer doesn’t offer a group plan? Or you’ve recently turned age 26 and are no longer eligible to be covered under your parents’ policy?

If any of these scenarios apply to you, there’s no reason to feel discouraged. You still have the option to purchase a private insurance plan directly from a health insurer or broker, or through a health insurance exchange. According to the Congressional Research Service, 43 million Americans were enrolled in individual/non-group health insurance products in 2018.

If you are currently uninsured, you would normally have to wait until this year’s Open Enrollment Period (which runs from November 1, 2020 through January 31, 2021) in order to enroll in an individual plan. However, due to the COVID-19 pandemic, there’s currently a Special Enrollment Period that allows you to purchase coverage today.

In order to make sure you select the plan that best meets your needs, here are the answers to five commonly-asked questions that consumers have about individual health care coverage:

1. What is a health insurance exchange?

The Affordable Care Act (ACA) mandated that health insurance exchanges be provided for each state. The exchanges are regulated, largely online marketplaces, administered by either federal or state governments, where individuals, families and small businesses can purchase private insurance plans. The New York State of Health (NYSOH) Marketplace is the system established exclusively for New York state residents. The NYSOH Marketplace gives you an easy way to compare individual plans so you can choose the one that’s right for your health needs and your budget.

2. What type of individual plans are available to me?
Health insurance form, pen and calculator

There are a variety of qualified health plans and insurers for you to choose from. All individual plans provide essential health benefits, include in and out-of-network coverage, and follow established limits on cost-sharing (i.e., deductibles, copayments, and out-of-pocket maximum amounts).

As part of the ACA, insurance companies are required to categorize their individual products into four “metal tiers:” Platinum, Gold, Silver and Bronze. These metal tiers make it easier for you to differentiate between the plans with the highest level of coverage (Platinum) and lowest level of coverage (Bronze). This means that Platinum plans have the highest monthly premium rates, but the lowest out-of-pocket costs and deductibles. Conversely, the Bronze plans have the lowest monthly premiums but higher out-of-pocket costs and deductibles.

3. What if I need coverage for my family?

Most individual plans give you the ability to choose coverage for both you and any dependents that you have. Coverage options may include Family, Individual and Spouse, and Individual and Child(ren). Your premium rate will vary depending on the option you select.

4. What if I can’t afford an individual plan?

By purchasing a plan through the NYSOH Marketplace, you may be eligible for a subsidy to either reduce your monthly premium or your out-of-pocket expenses. You can use the Marketplace website to determine your eligibility for financial assistance or if there are other lower-cost health plans you or a family member qualify, such as Medicaid and Child Health Plus (for children under the age of 19). Please note: Financial assistance is not available if you purchase a plan directly from an insurer or broker.

If you’re under the age of 30 or meet federal eligibility requirements, you may be able to enroll in a Catastrophic health insurance plan, which have low monthly premiums but very high deductibles. This can be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured; however, you pay most routine medical expenses yourself.

5. Will my individual plan include a deductible?

Most individual products include a plan deductible, which is the amount you would owe out-of-pocket for health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,500, your plan won’t pay anything until you’ve met your $1,500 deductible. The deductible may not apply to all services.

If you choose an HSA-Qualified plan, you can use a tax-advantaged Health Savings Account (HSA) to help pay for qualified medical expenses while you’re in the deductible phase or after you’ve met it. Any unused HSA dollars grow tax-free, earn interest and carry over year-to-year. They can be saved for retirement and invested in mutual funds. An HSA can be especially beneficial for sole proprietors due to the pre-tax cost savings.

Independent Health is here for you

When it comes to individual products, Independent Health has the lowest overall premium rates for most tiers in the Western New York market for 2021. Our plans include unique benefits and services to help you get and stay healthy. Plus, they use the same provider network as our employer-sponsored plans regardless of whether coverage is purchased directly through us or through the NYSOH Marketplace.

If you need help understanding your individual coverage options or are ready to purchase a plan, you can speak with one of our RedShirtsSM by calling (716) 505-8515 or 1-855-210-9930 (TTY: 711), Monday through Friday from 8 a.m. to 5 p.m. For more information about our individual products, visit independenthealth.com.


ABOUT THE AUTHOR:
Cathy Aquino is director, government sales, for Independent Health’s government products, including individual direct-pay products, Medicare Advantage and State programs (Medicaid Managed Care and Child Health Plus). Aquino, who has more than 25 years of experience in health insurance, holds a bachelor’s degree in public communications from the State University College at Buffalo.

 

Disclaimer: The above commentary entails the views of the author and not necessarily the views of the Buffalo Niagara Partnership.