Individual & family health insurance is coverage that is purchased on an individual or family basis, as opposed to being offered by an employer. While health insurance encompasses a wide range of insurance policies from insurance coverage for the costs of doctors and hospitals, to policies which are designed for a specific need like long-term care or disability insurance, typically when a person refers to health insurance, they generally mean the type of coverage for medical bills, hospital charges, doctor costs, surgery, etc.
Considerations while selecting a plan to fit your needs
- Network - There are several types of plans such as PPO, HMO, EPO, and POS. Each of these have their benefits as well as areas of possible coverage gaps.
- Deductible - This is a per year amount you will have to pay toward your medical bills (unless a special limit or copay applies) before the insurance company pays its share. There is a wide range of deductible options and HSA (Health Savings Account) eligible plans for larger deductible options.
- Coinsurance - This is the percentage of the medical bills you will share with the insurance company once your annual deductible is met, up to the annual maximum out of pocket limit.
- Copayment or Copay - Your copayment, or copay, is the flat fee for certain services, such as a doctor office visit, or a specialist visit, urgent care visit, ER visit, hospital stay, prescriptions, etc.
The Affordable Care Act has created many changes in the individual & family health insurance market. Plan offerings vary drastically from years past. Tax subsidies are offered to eligible persons and families. Plans are now purchased during open enrollment, or within a certain timeframe after a qualifying event.
It is important to talk with a health insurance specialist to navigate through all the different carrier options, plan options and the implications of the Affordable Care Act. Talk with a MirState insurance agent today to help understand your options!