Which Health Insurance Plan is Right for Me?
Trying to determine what insurance you or your family need or qualify for can be a struggle. Do you need employer group insurance, private insurance, or Obamacare insurance? Obviously, if you can’t get health insurance through your employer, you’ll want to explore the individual health insurance options. But what if you can get health insurance through your employer? Could you score a better rate by waiving coverage? BE VERY CAREFUL!
Keep reading to find out why.
Group Health Insurance
Group health insurance coverage is a health insurance policy that is purchased by an employer and is offered to employees (and typically to the employees’ family members) as a benefit of working for that company. It is usually part of a comprehensive benefits package that employers provide for employees.
Millions of Americans have health insurance coverage through their employer or the employer of a family member. Typically, employers will pay a minimum of 50% (but can pay up to 100%) of the monthly premium for an employee, but may elect to pay for spouse and dependents. Your employer is only obligated to pay 50% of your (employee) premium, but may elect to pay for more, but they are not required to do that. The group insurance plan, however, has to offer it to the spouse and dependents, but isn’t required to pay for them. They may offer to do so, but again, they are not required to. The portion that you do pay is taken from your pre-tax earnings, which will add up to significant savings for you.
In a vast majority of cases, sticking with the group health insurance plan offered by your employer is your best bet. With a group health insurance plan, you may have access to benefits that you wouldn’t be able to afford with an individual health insurance plan.
As of November 2022, now the spouse and dependents MAY qualify for a government subsidy, even if the employee is offered coverage. It depends on how much the premium is compared to household income. Click here for more details: Have You Been Offered Health Insurance At Work?
An employer can offer one plan or several plans, and sometimes they’ll offer a group dental and vision plan also. The employer selects the plan they offer the group, not the employees. Once a year the insurance will renew the policy, and the group will have “Open Enrollment” for their employees which will happen one month before the group insurance plan renews. This is a critical time for the employee to make decisions about whether they want to participate in the group insurance or not. If the employee misses out, they may not have insurance until the next “Open Enrollment” for the group.
Typically, if your employer offers group health insurance, your coverage will start shortly after your hire date, so you don’t have to worry about a long gap in coverage while you wait for the Open Enrollment Period. If you do have a 30-to-90-day window before your benefits kick in, we can help you with a “Short Term Health Insurance Plan”.
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What Is a Health Insurance Network?
Whether you’ve had the same health insurance company for years or switched to a new health insurance company, the variance in cost is directly related to whether a healthcare provider is within your health insurance company’s network (if you have a PPO), if you have a deductible to satisfy first, or if you have a co-pay.
What is a Special Enrollment Period?
The special enrollment period is always within 60 days of a life event. A “Life Event” is an event such as the birth of a baby, losing group coverage through an employer, losing coverage due to a move to Nevada, marriage, any many other scenarios.
Health Insurance Quotes
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Private Health Insurance
Not everyone has access to employer-subsidized group health insurance. Luckily, you can get comprehensive, affordable coverage by purchasing health insurance through Nevada Health Link (and most likely qualify for Government assistance to help you pay your premiums).
When an individual or family shops and selects their own health insurance policy, whether the coverage has a government subsidy or not, this is a private health insurance plan. A major medical plan will cover your medical bills, hospitals, surgery, doctors, labs, prescriptions, mental health, maternity, preventive visits, etc.
You can also buy a qualified health insurance plan “off exchange” meaning your plan is going to cover all the benefits offered through Nevada Health Link, but you are buying the insurance through the insurance company without any government assistance. Many times you’ll have additional options you won’t have through Nevada Health Link.
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Similar to choosing other types of insurance like auto, home or life insurance, you can choose from a variety of insurance companies and many levels of plan coverage (Platinum, Gold, Silver, Bronze) to meet your budget and health care needs. These health insurance plans also vary in deductibles, co-pays, prescription costs, monthly premiums, doctor networks and hospitals etc.
Currently, all (ACA compliant) private health insurance plans, whether they have a government subsidy or not, may not “underwrite” you (they can’t look at your health history, height, and weight, etc.) before they enroll you. Other plans like short term or limited liability (that are not ACA compliant) can underwrite you based on your health history, height and weight, pre-existing conditions, etc. Short Term plans generally will not cover free preventative, mental health, maternity, and the prescription plans they offer may be limited.
If your plan only pays a certain dollar amount, like $1,000 for emergency room visits, it may be a “limited liability” health coverage plan. This is NOT a qualified health plan. A major medical plan will cover all the above-mentioned items and more, without a cap. You will have a “maximum out of pocket” limit, which means, once you meet your out-of-pocket max, the insurance company will pay for everything else up to no limits.
It’s wise to request the help of a licensed health insurance agent/broker so they can explain how the plan works. This is a FREE service to the individual because the insurance company pays them to assist you.
At Nevada Insurance Enrollment We Can Help
If you are unsure of which insurance will work for you, here at Nevada Insurance Enrollment our health insurance agents can help you determine which one you or your family should choose. Call us for more information.
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Recent Posts
What Is a Health Insurance Network?
Whether you’ve had the same health insurance company for years or switched to a new health insurance company, the variance in cost is directly related to whether a healthcare provider is within your health insurance company’s network (if you have a PPO), if you have a deductible to satisfy first, or if you have a co-pay.
What is a Special Enrollment Period?
The special enrollment period is always within 60 days of a life event. A “Life Event” is an event such as the birth of a baby, losing group coverage through an employer, losing coverage due to a move to Nevada, marriage, any many other scenarios.
What Is a Qualified Health Insurance Plan?
A Qualified Health Plan, or QHP, is a health insurance plan that provides coverage for the 10 essential benefits outlined in the 2010 Affordable Care Act. Qualified Health Plans MUST cover these 10 items without any lifetime or annual limits on these “Essential Health Benefits.”
Waiting Period for Dental Insurance Explained
If you have recently signed up for dental insurance, you may notice that your plan has a waiting period. Understanding what services are covered right away and what services you must pay for entirely out of pocket can help you make informed decisions about getting necessary work done.