Individual Health Coverage Options

 

Qualified Health Plans:

These type of health plans comply with the patient protection and affordable care act (PPACA).  This is commonly known as the Affordable Care Act (ACA) or “Obamacare” which went into effect on January 1, 2014.  This type of policy is guaranteed issue to anyone with pre-existing conditions.  Applicants of the same age who live in the same geographic location will pay the same premium, regardless of gender or pre-existing conditions.  There are two class of rates- tobacco and non-tobacco.  Additionally, all ACA plans must include these essential benefits.

• Ambulatory surgical services
• Emergentcy room coverage
• Inpatient hospital care
• Maternity and newborn care
• Mental health and substance abuse
• Prescription drug coverage
• Preventative and wellness check ups
• Contraceptive

All the plans have a similar structure and include a maximum out of pocket.  There are no limits on covered medical expenses, no lifetime cap.  There are 4 plan levels:

• Platinum- lowest deductibles, richest benefits
• Gold- Slightly higher deductibles and usually higher out of pocket
• Silver- Most popular, cost sharing reductions (CSR) for people who qualify based on income
• Bronze- Higher deductible catastrophic coverage for anyone trying to purchase coverage at the lowest rate

Tax credits (government subsidies) are available for those who qualify.  These types of policies can usually be purchased during the open enrollment period which runs from November 1^st and ends on January 15^th outside of the enrollment period.  Individuals and families may qualify for a special enrollment based on a qualifying event.

 

Non-Qualified Health Plans

Much more affordable coverage, especially for anyone not eligible for a tax credit.  This type of coverage may include policy limits and a lifetime cap.  This coverage is usually medically underwritten, which means your current health status will determine your eligibility.  These plans can be purchased anytime throughout the year.  These plans are very flexible for various reasons:

• Usually much more affordable
• In between jobs or waiting for employer benefits to start
• Recent college graduate looking for employment
• Recently retired and waiting for Medicare to begin
• Waiting for open enrollment
• Cobra is too expensive

*As noted, these plans are not ACA compliant and are not required to provide the minimum essential benefits that are mandated by the ACA.

Available companies for both qualified and non-qualified coverage

• Blue Cross Blue Shield of Louisiana
• Vantage Health Plan
• Ambetter
• United Healthcare in select markets