Types of Health Plans

Finding the right health insurance plan is easier once you understand the options that are available to you. During Open Enrollment, which is November 1, 2024 through January 15, 2025, you can enroll in an Obamacare/ACA plan – that is, a plan that meets minimum requirements as set forth by the Affordable Care Act.

Outside of the Open Enrollment period, you may be eligible to enroll in an Obamacare/ACA plan if you experience a qualifying life event, such as moving to a new state, having a baby, or getting married or divorced. This is called the Special Enrollment period, and lasts for 60 days after the date of your qualifying life event.

If you would like to enroll in a plan outside of the Open Enrollment period and you do not qualify for Special Enrollment, you can consider enrolling in an alternative plan, such as a short-term, limited/fixed indemnity, or critical illness plan. These types of plans typically do not cover preventative care, and are designed to protect you financially in the case of an accident or if you need serious medical care. You will have to pay out of pocket for most routine care with these types of plans.

Types of Obamacare Plans

All Obamacare/ACA plans are placed into four metal level categories, and all offer the exact same level of quality health care, with the difference being in premium and out-of-pocket cost ratios. All of these plans cover Ten Essential Health Benefits as set forth by the Affordable Care Act. These benefits include: 1) ambulatory care; 2) emergency services; 3) hospital coverage; 4) maternity and newborn care; 5) pediatric services (including dental and vision); 6) mental health and addiction treatment; 7) prescription drug benefits; 8) rehabilitative coverage; 9) laboratory services; and 10) preventative services and chronic disease management.

Making a decision about which metal level plan you should choose involves thinking about your plan usage. If you plan to go to the doctor frequently, you will likely be better off choosing a plan with a higher premium and lower out-of-pocket costs as you will save money in the long run. On the other hand, if you don’t plan to go to the doctor frequently, you may save more by enrolling in a bronze or silver plan, where your monthly premiums are lower, but your out-of-pocket costs when you do go to the doctor are higher.

Individuals of certain income levels may also qualify for government assistance to pay for their insurance costs. The Premium Tax Credit is designed to help pay for monthly premiums, and Cost-Sharing Reductions help low income individuals pay for out-of-pocket costs.

Catastrophic plans are a fifth type of plan, but they are only available to individuals who meet eligibility requirements. Although they have the lowest monthly cost, the benefits are primarily limited to emergency situations, and you must meet certain eligibility requirements.

To qualify for a Catastrophic plan, you must either be under the age of 30, or have a hardship exemption at any age. You may qualify for a hardship if you are experiencing:

• Homelessness;
• An eviction/foreclosure;
• A notice of shutoff from your utility company;
• Domestic violence or a death in the family;
• A natural or man-made disaster.
• Bankruptcy or substantial debt from medical expenses;
• An increase in expenses due to caring for an ill, disabled, or aging family member;
• Claiming a child as a tax dependent who was denied Medicaid or CHIP;
• If you won an appeal for previously being denied a qualified health plan, but were denied eligibility at the time;
• You lost coverage in the past, but found qualified health plans to be unaffordable;
• Some other hardship related to obtaining health insurance.

Alternative Plans

Short-term Plans

Short-term insurance plans are an alternative option to ACA/Obamacare plans. But, they currently can only be purchased for short periods of time, and typically only cover catastrophic situations. If you have a short-term plan and need medical attention, you will have to pay out of pocket for any circumstances that are not considered catastrophic.

Still, short-term plans can be a good alternative for individuals who just want to be covered in case of emergency for short periods of time, or until they can enroll in an ACA/Obamacare plan.

Fixed or Limited Indemnity Plans

Fixed or limited indemnity plans are different from most insurance policies in that these types of plans will provide a specific cash pay-out to the policy holder if they incur an illness or injury that is outlined in the policy.

The idea behind fixed indemnity plans is to provide some financial protection against unexpected medical expenses.

Fixed indemnity plan benefits typically apply to a specific number of days, weeks, or visits and the amount remains the same regardless of the actual cost of those services. These plans are also sometimes referred to as hospital indemnity plans because they typically cover medical expenses resulting from hospitalization, surgery, chemotherapy and radiation services.

Critical Illness Plans

Critical illness insurance covers what the name says – critical illnesses. Typical illnesses this type of insurance covers include cancer, heart attack, stroke, and certain other illnesses that may vary based on the policy.

Because of the nature of this type of policy, which is designed to only cover serious illnesses, you will still have to pay out of pocket for treatment of any condition that is not described as a covered condition in the insurance policy. This means that any preventative care – such as regular doctor check-ups – or even urgent care treatment is not covered, and you will be responsible for paying out of pocket for the entirety of the cost.

To start comparing plans, please submit your zip code to begin the process. You can also call (855) 339-0012 to speak with an agent.