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ACA (Obamacare)

Obamacare plans are major medical insurance plans that have the ten essential health benefits required by the Affordable Care Act (ACA).. These plans can be purchased on the federal marketplace or through your state exchange during the annual open enrollment period that runs November 1 - December 15 or during a special enrollment period if you have a qualifying life event that leaves you uninsured. ACA plans are an excellent option for those seeking a plan that includes maternity and mental health benefits, individuals who could qualify for a financial subsidy to reduce the cost of their health insurance, or for those who have a pre-existing condition. Not sure if you qualify? Get a free quote right now.

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Medicare

This is a federal health insurance program primarily for individuals age 65 or older, younger people with disabilities, and for people with End Stage Renal Disease (permanent kidney failure). There are four parts to Medicare - Parts A, B, C and Part D. Part A is for hospital coverage. Part B is for outpatient medical coverage (like doctor office visits). Part C is a Medicare Advantage Plan, and Part D is prescription drug coverage. Medicare Advantage Plans (Part C) are accessible through private insurance companies and must offer the same benefits as Parts A and B of Original Medicare, but the rules are different along with costs and restrictions. They also include more benefits, such as vision, dental, hearing, and health/wellness plans. Another add-on value to Medicare coverage is the purchase of a Medicare supplement or “Medigap” plan that fills the “gaps” in insurance that Medicare doesn’t cover (like a deductible).

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Short Term Medical Health Insurance

A short-term health plan is temporary health insurance that can be purchased for as little as 30-days up or for up to 364-days to fill an immediate uninsured need.. Plans use the same terminology as major medical insurance, like deductible, coinsurance and copays, but since it is for temporary needs, it does not cover all of the same health benefits that an ACA health plan would, like maternity or substance abuse. The coverage is primarily for unexpected accidents and illnesses that could occur while an individual is waiting to join a permanent major medical plan, which keeps costs lower.

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Health Benefit Indemnity Insurance (Hospital Indemnity +)

Health benefit indemnity insurance (HBI) combines hospital indemnity insurance with other supplemental health insurance services that pay a fixed dollar amount for commonly used medical services, including hospital and doctor office benefits. If you experience a covered medical event, such as a hospital stay, then HBI pays a set fee in cash directly to you or the hospital designated by you. HBI is more than just hospital indemnity as it can also include supplemental indemnity payments for a critical illness diagnosis or unexpected accidents. Indemnity insurance is not considered an ACA-qualified plan, but it can be used as a supplement to a major medical ACA plan to help cover a deductible or out-of-pocket expenses.

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Dental Insurance

Dental insurance for many people is part of their employee benefits package. However, if you don’t have access to employee benefits or missed your employer’s annual open enrollment period, purchasing an individual dental insurance plan can help you maintain good dental hygiene while helping you avoid expensive dental costs Dental coverage can include basic cleanings up to major services. See if dental insurance is right for you!

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Telemedicine

Telemedicine is two-way communication platform between a medical professional and a patient, typically through a smartphone or computer. During the conversation, a U.S. board-certified doctor or nurse can diagnose and prescribe medication for an illness in minutes. From the comfort of your home, you can visit with a medical professional 24/7 for most conditions they would typically diagnose in an Urgent Care clinic, saving you both time and money. Find out if telemedicine services are the right fit for you!

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Frequently Asked Questions

The required essential benefits are designed to ensure everyone in the individual and small employer group major medical health insurance markets has comprehensive coverage for specific services in accordance with ACA guidelines. These benefits are:

  • Outpatient services (e.g. office visits)
  • Emergency room services
  • Inpatient services (hospitalization)
  • Maternity
  • Mental health and substance abuse
  • Prescription drugs
  • Rehabilitative and habilitative services (e.g. physical and occupational therapy)
  • Lab services
  • Preventive services (e.g. physicals, mammograms, etc.)
  • Pediatric dental and vision

ACA health insurance is the federally mandated health insurance law of the land, also known as Obamacare. It governs individual and family plans and requires ten minimum essential benefits. Anyone can apply, and those that are under the 400% poverty line can receive a financial subsidy to curb the cost of their health insurance. Enrollment is available November 1-December 15 in most states. If you have a life situation that leaves you uninsured, you might be eligible for the special enrollment period to get coverage.

Short term medical insurance is not ACA insurance. It is temporary insurance for those who need immediate coverage. Like ACA insurance, Short term health insurance includes benefits such as hospital, lab and x-rays, but it does not include all ten of the minimum essential benefits and it does not cover pre-existing conditions.

Many individuals apply for both Medicare Part A and Part B so they have doctor coverage and hospital coverage. However, if you are interested in additional benefit structure and pricing, check out Medicare Advantage Plans, which is known as Part C to see if it fits for your life situation. Medicare Part C includes Part A and B benefits, but is offered through a private health insurance company instead of the federal government and may offer additional benefits and may have some other varying differences. If you take prescription drugs, it’s smart to look into Part D, which is the prescription drug benefit of Medicare.

Indemnity insurance such as a health benefit indemnity (a hospital indemnity often combined with other supplemental insurance services) is not major medical insurance Instead, it provides a cash payment directly to you (or to the provider you identify) when you experience a covered event, like unexpected hospitalization. You can choose how to use your benefit dollars and it helps defray the cost of medical expenses, both the expected like co-pays and deductibles, and the unexpected, like lost wages. Indemnity plans help protect you financially.

Dental insurance is an added benefit that is not covered by your health insurance plan. Cleanings, crowns or root canals are not covered by your health insurance plan. But dental insurance will help ease the cost of these types of medical expenses. However, unless you have employer group health insurance, dental insurance is not available unless you purchase coverage on your own. It’s a good idea to determine what kind of coverage you might need for you and your family.

Telemedicine is low-cost access to U.S. board-certified doctors who can treat symptoms and prescribe medications over the phone or through video chat, just like a visit to Urgent Care. Unlike the doctor’s office, you get a personal visit from the comfort of your home 24/7, even on holidays! If you have a high deductible or don’t have a doctor's office copay option on your health plan, telemedicine is much more affordable than paying out-of-pocket for a doctor's office visit that takes you away from work or home.

Health insurance can help protect you financially from the medical bills - like an accident or illness diagnosis you were not expecting. Paying for medical care out of pocket 100% can get extremely expensive. Surgical treatment for a broken arm averages $16,000. But with health insurance coverage, you will be able to manage your expenses. Not only does health insurance help you access providers like hospitals and doctors, it helps cover your expenses. Depending on your plan, you may have to meet a deductible and pay a co-pay amount for doctor’s visits, but insurance can cover a significant portion of your insurance bills. For example, the average ACA bronze level plan deductible is $5,900, but there is no lifetime max (e.g. an amount beyond which, insurance doesn’t have to pay). You can secure lower deductibles with higher level ACA plans (silver, gold, platinum) and with Short term health insurance. Short term life insurance plans do have a lifetime maximum, so if choosing a short term plan, check the amount. Often, for a few extra dollars, you can secure a lifetime maximum of $500,000 or more.

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ACA DISCLAIMER

SHORT TERM HEALTH INSURANCE, HEALTH BENEFIT INDEMNITY INSURANCE (HBI), SUPPLEMENTAL INSURANCE AND CANCER INSURANCE ARE INSURANCE OUTSIDE OF THE AFFORDABLE CARE ACT (OBAMACARE). THESE PRODUCTS TYPICALLY DO NOT COVER PRE-EXISTING CONDITIONS AND DO NOT INCLUDE ALL TEN OF THE MINIMUM ESSENTIAL BENEFITS OF OBAMACARE. HBI, SUPPLEMENTAL AND CANCER INSURANCE ARE DESIGNED TO PROVIDE ADDITIONAL BENEFITS TO MAJOR MEDICAL INSURANCE.

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