Obamacare is a great option for individual and family health insurance in Texas and across the country. However, there are some drawbacks – the biggest of which is that you can only enroll during certain times of the year if you don’t qualify for a special enrollment period. If you need insurance outside of open enrollment, there are six other options you can consider.
Non-Marketplace Private Plans
Private plans purchased outside of the Marketplace are similar to Obamacare plans, but they do not offer any premium tax credits or subsidies. Policyholders will be responsible for paying rate increases as they occur. In addition, non-Marketplace plans do not have to accept applicants with pre-existing health conditions.
Private plans do include the ten essential health benefits that all Obamacare plans include, so you can be sure these plans offer just as much comprehensive coverage. Provider networks and coverage levels will depend on the plan itself. Some include out-of-network benefits, while others do not. Also, private plans often have a wider range of prescriptions that are covered. This is helpful for people who need specific, name-brand prescriptions. Typically, Obamacare plans only include generic prescriptions in their formularies.
People who are not eligible for Obamacare tax credits may want to consider one of these private plans because they are often cheaper than paying the full price for Obamacare. Of course, the person would also need to be relatively healthy since those with pre-existing conditions will not be issued a plan. That is part of what makes these plans cheaper – the pool of enrollees is generally healthier, which keeps medical costs lower.
Non-Marketplace individual and family insurance plans are customizable. You can choose to add some benefits, such as substance abuse counseling, or reject others, such as maternity coverage. Enrollment is open year-round, and you can also drop your plan at any time. Be aware of any coverage gaps within the plan. Some have waiting periods, and if you or your family were to get sick or have an accident during that time, you would not have coverage available to you.
Short-Term Health Insurance
Short-term health insurance plans are for those who need temporary coverage to fill in a gap between insurance plans. For example, maybe your current employer’s insurance ended, but you started a new job and will be on a new group plan in three months. If your previous employer’s coverage is too expensive for COBRA, you might want to consider a short-term medical plan to cover you for the next few months. Most short-term plans can only be renewed for up to one year.
These plans are not meant to be used for routine care. They do not include the ten essential health benefits required of ACA plans. Benefits for preventive care, maternity services, and prescription drugs are not covered. Instead, they are a safety net for unexpected injuries and illnesses. Since their coverage is limited, they are often much cheaper than either Marketplace or private health plans. Like other non-Marketplace plans, insurance companies that offer short-term health insurance do not have to issue plans to those with pre-existing health conditions. The insurance company can also choose to drop your coverage if you get sick.
High-Deductible Health Plans
High-deductible health plans or HDHPs are a great choice for individuals who either don’t mind paying the high deductible or are so healthy that they likely won’t utilize the insurance plan. To offset the high deductible, HDHPs have inexpensive monthly premiums.
High-deductible insurance plans typically include the ten essential health benefits, including preventive care services. Enrollees will have to pay the full amount for any services until they have paid the entire deductible, which is usually several thousand dollars. Preventive services are the exception. The insurance company must pay for in-network preventive services like annual checkups, vaccinations, mammograms, and well-woman exams prior to the member meeting the deductible.
One advantage of an HDHP is that members are eligible to open a Health Savings Account (HSA). Members can fund the account with pre-tax income, thereby lowering their annual tax bill. They can spend their HSA funds on qualified medical expenses or invest them in whatever options are available within the account. If they invest the money, it will grow tax-free. Once you turn 65, you can use the money for non-medical expenses as long as you pay ordinary income tax. The HSA is a great way to help pay the high deductible if you need to. Otherwise, the money in the account will continue to roll over from one year to the next.
High-deductible plans are not a great choice for people who have chronic conditions or are not financially stable enough to save money for the deductible. However, they’re a great choice for healthy individuals who rarely get sick or see a doctor.
Catastrophic Health Insurance Plans
You can purchase a catastrophic plan through the Marketplace, but they’re a little different than the other plans available. (The other options are Premium, Gold, Silver, and Bronze, called the metal-tiers.) Catastrophic plans are only available to people under the age of 30 or who qualify for a hardship or affordability exemption through the ACA.
Catastrophic plans include coverage for the ten essential health benefits found in other ACA plans. However, they have a higher deductible that you must meet before coverage begins. Currently, that deductible is $8,700 for an individual and $17,400 for a family.
Like HDHPs, these plans are meant for worst-case scenarios or extreme medical emergencies. Healthy individuals or those who simply cannot afford any other plan are the only ones who should consider this coverage. However, if you are eligible for a subsidy, you cannot use that subsidy towards the premiums for a catastrophic plan.
Primary Care Memberships
Primary care memberships are also called “concierge medicine.” These are not insurance plans, nor do they operate like insurance. Instead, primary care memberships are offered by providers to either individuals or employers, bypassing the insurance company altogether. If you enroll in a primary care membership, you pay a monthly or yearly retainer in exchange for a specific list of services.
For example, you may have a $75 monthly membership fee. In exchange, the provider agrees to perform services like exams, pediatric services, and other mostly routine services. (Surgeries are typically not included in these models.)
These plans are also called “direct-pay medicine,” “membership medicine,” and “direct primary care (DPC)” plans. They are an affordable option for those who cannot pay Obamacare premiums and many providers (and consumers) like the simplicity of not having to worry about involving an insurance company. However, these plans may not be a great idea for those with chronic conditions or who are not in the best health.
If you have a choice in providers who offer these membership plans, choose a facility that has a wide range of physicians that way, you have access to a larger array of services.
Health-sharing plans are offered by religious ministries. They provide coverage for care that is consistent with their Biblical teachings, like alcohol and drug addiction treatment, sterilization procedures, and prenatal care. Health-sharing plans are often cheaper than comprehensive medical insurance since they don’t include the same essential benefits and aren’t actually considered insurance. (They are not required to maintain any of the ACA rules.)
Also called faith-based health plans, members who enroll share the cost of their services with others in the plan. Many of these plans have become defunct because they were unable to provide the funds for medical services.
If you’d prefer not to get an ACA plan or just want to know more about the alternatives to Obamacare, call CoverMile. We’ll take the time to learn what kind of coverage is best for you and then shop to find competitive rates. Our services are completely complimentary, so what do you have to lose? Give CoverMile a call today.