Health Insurance
Major Medical Health Plans & Affordable Care Act (ACA)
A major medical health coverage is a type of long-term medical insurance that meets the mandate essential health benefits(EHB) standard regulated by the ACA. Most of its plans are sold on the healthcare insurance marketplace through private or public insurance carriers or off-exchange through a licensed broker allowed to sell qualifying health plans or directly from an insurer as long as they’re fully compliant with the ACA.
The best option is to purchase your Major Medical plan on-exchange during the open-enrollment. Purchasing your plan on-exchange may qualify you for premium subsidies, which keeps your premiums more affordable. You could also choose to purchase your health plan, not offered on-exchange, off-exchange through licensed brokers with no subsidies. Be aware that a qualifying event like changing jobs or getting married could also allow you to qualify for a special enrollment throughout the year.
Major medical plans are designed to cover most individuals’ and family’s expenses associated with serious illness or hospitalization once their deductible is met. Most of the on-exchange plans are either health maintenance organizations (HMO) or exclusive provider organizations (EPO) depends on the insurer. They both cover preventive services, including check-ups, immunizations, and screenings, at no additional cost to the insured. Below are the ACA ten minimum essential health benefits for any insurance carriers operated in the marketplace:
- Prescription drugs
- Pediatric services
- Preventive and wellness services and chronic disease management
- Emergency services
- Hospitalization
- Mental health and addiction services
- Pregnancy, maternity, and newborn care
- Ambulatory patient services
- Laboratory services
- Rehabilitative and habilitative services and devices
But if you’re in need of any other types such as preferred provider organizations (PPO) or point-of-service (POS), or even health savings accounts (HAS), you might want to consider off-exchange plans.
Short Term Medical
Whether you’re in need for temporary medical coverage for an emergency, you missed open enrollment period, or you are ineligible for the on-exchange insurance coverage or job-based health insurance plan, or unable to afford private insurance plans, short term medical is the answer to your prayer.
The short term is designed to help bridge gaps from one life event to another without a comprehensive health care plan. A short-term plan is not considered major medical coverage and it’s not regulated by the Affordable Care Act (ACA). But it’s still a type of medical health insurance providing short term medical type benefits for unexpected accidents and illnesses.
Short-term plans are sold outside the exchanges and they’re not required to meet the same standards as medical plans sold on the exchanges. Their coverage varies depending on the plans and the insurer, so it’s important to read and understand the exclusions and limitations before buying the plans.
Short term plans’ premiums tend to be lower than unsubsidized major medical plans. They are based on many factors, including your health status and the benefit level you select. Their deductibles are significantly higher. Limited coverage for most services like preventive care, doctor visits, urgent care, emergency care, prescriptions, and no coverage for pre-existing conditions.
Dental Insurance
As most people would agree, a healthy mouth is a key to a beautiful smile. Maintaining such a smile and good oral hygiene could be costly without a dental plan. Even when underutilized or consider it not a good deal, having dental insurance coverage could come handy in the event of complicated dental issues.
Individual dental insurance is designed to help you maintain an overall healthy mouth. Whether you’re looking to do just a simple dental check-up, restorative care, or orthodontic treatment, you can get from a basic preventive plan to a full term standalone dental plan. Dental care or treatment depends on the type of dental plan chosen.
Most dental plans have a yearly maximum benefit, not including coinsurance and a deductible to pay before coverage kicks in. Once your coinsurance and deductible are met, your dental insurance pays a percentage of your dental costs up to the maximum benefit. It’s important to contact one of Phanald IT agents for better guidance as to which plan will better fit your dental needs.
Vision Insurance
Just as dental insurance, a vision insurance plan, although not required, could be a helpful coverage. Some people may disregard it, but it makes it easier and more affordable to get eye care.
A vision insurance coverage is only designed to cover routine preventive eye care and prescription like eyeglasses or contact lenses. Anything related to a real health issue or an eye disease (such as cataracts or injuries to the eye), will turn to your medical insurance.
Most vision insurance plans are considered as discount plans or wellness benefit plans because of their specific benefits package and discounts for an annual premium.
As with any insurance product, make sure you know what you’re buying. You should judge your coverage need based on your usage. Phanald IT agents will be happy to help find you the right vision coverage needed.