Don’t have insurance through an employer? You may need individual health insurance.
Get health insurance with the flexibility of cost and coverage.
If you are not offered health insurance through your employer, individual coverage may be the right fit. You may qualify for cost-sharing reductions and/or tax credits that can make your plan more affordable. As a local agency, we have the experience to guide you through your options and assist you every step of the way.
What should you consider when choosing a policy?
Depending on your health level and appetite for risk, you can often find a policy and price that’s just right for you. The four main variables to consider include the deductible, copayment, annual limits, and the actual coverage offered in your policy.
- Coinsurance: The percentage you pay for a covered service after the plan’s allowed amount is applied. For example, if the allowed cost is $100 and your coinsurance is 20%, you pay $20. Many plans require you to meet your deductible before coinsurance applies. After you reach your Out‑of‑Pocket Limit, coinsurance no longer applies for the rest of the plan year.
- Copayment: A set dollar amount you pay for a covered service at the time of care. The amount varies by service—for example, $25 for a doctor visit or $10 for a prescription. After you reach your Out‑of‑Pocket Limit, copayments no longer apply for the rest of the plan year.
- Deductible: The amount you must pay each plan year for covered services before your insurance begins to share costs. For example, with a $1,000 in‑network deductible, your plan may not pay for most covered services until you reach that amount. Some services—like many preventive care visits—are covered before the deductible, and certain benefits, such as prescription drugs, may have their own separate deductible.
- Out‑of‑Pocket Limit: The maximum you pay in a plan year for covered services before your insurance covers 100%. Once your spending on deductibles, copayments, and coinsurance reaches this limit, your plan pays the full allowed amount for covered services. Premiums do not count toward this limit.
APTC & max out of pocket.
- Advanced Premium Tax Credit (APTC): A federal tax credit that lowers your monthly health insurance premium. If you qualify based on income and other requirements, the credit can be applied directly to your monthly bill or claimed on your federal tax return. You must apply for financial assistance to determine eligibility.
- Cost‑Sharing Reduction (CSR) – A discount that lowers your deductibles, copayments, coinsurance, and out‑of‑pocket limit. To receive CSRs, you must qualify for financial assistance
Preventative care is typically taken care of.
When getting individual health insurance, insurance providers typically pay up to 100 percent of the costs of preventative health care, such as checkups, screenings, and vaccines. This is an important aspect to know when selecting a health insurance policy.
Health insurance can be a complicated subject. Contact us to learn more about it and your coverage options.
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