Yearly Archives: 2017

Individual Health Insurance Plans And Obamacare

A little more than 50% of the population in the US have health insurance through their employers. About 15 million people buy their own insurance. Buying your own health insurance can be a very daunting task. You should know which option will work best in your favor and it should be affordable as well. Individual health insurance plans in a nutshell are health insurance plans which you purchase on your own rather than being offered by a employer. The best way to search for such a health plan is to go to a insurance company’s website and look for their online tools to compare the plans and their related costs. The best way to keep the costs affordable and meet your coverage requirements is to follow some basic guidelines as we discuss below:

[dropshadowbox align=”center” effect=”lifted-both” width=”400px” height=”” background_color=”#ffffff” border_width=”1″ border_color=”#dddddd” ]TIP: Effective 2014, individual health insurance plans cannot deny or charge you higher premium if you have a pre-existing health condition. As of now, insurance companies can charge you a higher premium if you wish to purchase an individual health insurance plan for yourself or your child with a pre-existing condition.[/dropshadowbox]

Affordability Checklist For Individual Health Insurance Plan

Identify What Is Relevant To You: Nobody can predict, what will happen the very next moment when it comes to illness and injuries. However, there are certain medical treatments which we know will require attention in the near future like the on going preventive care, any specific health problem which you might have, like heart disease and also maternity coverage. Not all individual health insurance plans offer maternity coverage.

Don’t Get To Tempted To Buy: When it comes to our own self and family’s health insurance needs, we are driven by emotion and as a result instead of applying our mind and some logic we think through our heart. Honestly, even i did initially. This results in paying exorbitant amount for health plans. Analyse your financial budget and cross check your affordability before deciding on one particular health insurance option. One’s age plays a major role when it comes to reducing cost. Someone who is young and healthy, would choose an individual health insurance plan with a

higher deductible amount

 (Out Of Pocket expense which you need to pay before the insurance company coverage kicks in). As a young person, paying high deductible amount can reduce your monthly premiums considerably and save you a lot of money in the long run.



Check The Health Care Provider: Not all are comfortable in going to a new doctor as per the health insurance policy bought. Check with your long term serving family doctor if he is a part of the network which you have chosen through your individual health insurance plan.

Hoe Much Will You Be Paying: Always get a clarity on the amount which you will have to pay as a premium each month. There are a lot of hidden costs like coinsurance and co-payment which can add up to your expense every time you go for medical treatment. Knowing your expenses is vital here.

Patient Protection and Affordable Care Act (PPACA): This one is not so helpful right now but will affect individual health insurance plans costs drastically in 2014 and beyond. If your family income is less than 400% of the federal poverty line then you would be eligible for premium subsidies on individual health insurance plans. Premium subsidies are provided under PPCA for individuals purchasing individual health plans through health insurance exchanges. Please note, if you have a health plan through your employer then you are not eligible for these subsidies. For further details, you can refer this article: Individual Health Insurance Premium Subsidies In Exchanges.

2014…. Change Is Coming……..


The Affordable Care Act Perspective For Individuals

  • According to the health care law, if you have a pre-existing condition and hence have not been able to obtain health insurance on your own or rejected by private insurance companies, you can get individual health insurance through Pre Existing Condition Health Insurance Plan.
  • I am sure you or someone in your knowledge has faced the dilemma of mis-selling and got deprived of health insurance benefits. If you feel that you were promised coverage for something which is denied by your insurance company then you have the right to appeal. More information can be accessed
  • Effective 2014, if your family income is less than or equal to $88,000 for a four member family and your job does not provide you affordable health coverage then you can may be eligible for tax credits which will eventually help you to pay for individual health insurance plans.

How Does An Individual Health Insurance Plan Compare Against Group Plans

It is important to understand the differences between individual and group health plans as both have their own merits and disadvantages. Choose which suits you the best:

Individual Health Insurance Plans & Pre Existing Conditions
In most states, you can be turned down for individual health insurance if your pre-existing medical condition is of serious nature (eg: HIV or Cancer). Having said that, you do have health insurance options like PPACA (Patient Protection and Affordable Care Act) provides a pre-existing condition health insurance plan for states which do not have their own health programs.

Medicare Advantage Plans and Enrollment – 2018

What Is a Medicare Advantage Plan? In this article we will cover Medicare Advantage Plans only. If you wish to seek more information on different types of health insurance plans, you can check this article on our site Types Of Health Insurance. Medicare advantage plans, are a collaboration between Medicare and a private health insurance company to give you combined benefits of Part A (Hospital Insurance) and Part B (Medical Or Doctor Insurance). Medicare Advantage plans includes HMO’s PPO’s and Fee For Service plans. All Medicare advantage plans provide you with prescription drug coverage. Some of the top companies providing Medicare Advantage Plans are United Health, Blue Cross and Humana. Medicare advantage plans are like all inclusive deals. They are often referred as Medicare Part C (Medicare plus Choice). If you are eligible for original Medicare Coverage then you are also eligible for Medicare Advantage Plans however it is important to consider the fact that as these plans are on offer through private insurance companies there might be some additional eligibility criteria. Always read the offer document carefully. Initially you have to enroll first into Medicare Part A and Medicare Part B before you can sign up for Medicare Advantage. Enrollment for these plans vary throughout the year. The only coverage which might not be covered in Medicare Advantage is the hospice care ( End of Life Care provided by health professionals and volunteers).


What Are The Different Types Of Medicare Advantage Plans Available Today

The types of Medicare Advantage plans are listed below:

  1. HMO Plans
  2. PPO Plans
  3. Fee For Service Plans
  4. Special Needs Plan (SNP’s)
  5. HMOPOS Plans (HMO – Point Of Service Plans), and
  6. MSA Plans (Medical Savings Account)


Eligibility Criteria For Medicaid Advantage

  • To be eligible for medicare advantage you have to be enrolled in Medicare part A and B.
  • You should be residing in an area where the plan is offered, and
  • You should not be having an end stage renal disease at the time of enrollment.

Medicare Advantage Plans Coverage

A Medicare Advantage plan shouldn’t be confused with the original Medicare coverage. It is a kind of alternative (second option) when compared to original Medicare. Coverage provided by these plans are mentioned below:

  • These plans cover all hospital and medical related services included in Part A and Part B.
  • You cannot be denied enrollment in Medicare advantage plan if you have any per-existing condition unless it is ESRD (End Stage Renal Disease). If ESRD comes to picture after you have opted for Medicare Advantage then you cannot be dropped from the coverage.
  • These plans also cover urgent and emergency care.
  • A lot of Medicare advantage plans also offer coverage for vision care, health and wellness programs and dental care coverage.
  • Some of these plans are called as Medicare Advantage Prescription Drug (MAPD) which also provide coverage for prescription drugs. (Medicare Part D)
  • Most of these plans are managed care plans. Meaning either they are HMO’s (Health Maintenance Organization) or PPO’s (Preferred Provider Organization). Due to this nature you might have to first opt for a PCP( Primary Care Physician) who will then refer you to one of the network’s hospital’s or medical centers.

EnrollmeFor Medicare Advantage 2013 Has Begun. Oct 15th 2012 To December 7th 2012


Cost Of Medicare Advantage Plans

The cost associated with medicare advantage depends on a lot of questions which might be in anyone’s mind among us:

  • Do you have to pay extra premium for medicare advantage plan over and above your medicare part A and B?
  • Are you allowed to use out of network medical providers?
  • Do you have to pay any deductible amount?
  • Are you entitled to any additional benefits and what is the cost?

Medicare contributes a fixed amount to your advantage plan each month. Your provider is responsible for paying the expenses for health and medical care. Cost will vary from one provider to another. As these plans are offered by private health insurance companies you might have to pay certain additional premiums and out of pocket expenses. Now as per the latest news from the CMS( Center for Medicaid and Medicare Services) the average cost of monthly premium in case of medicare advantage plans will be around $32 approx. in 2013. This number will surely vary on case to case basis and it’s mention here should only be considered for reference purposes.

Where To Enroll For A Medicare Advantage Plan

You can check this website for further details: – Medicare Plan Finder

or, you can also call on: – 1-800-MEDICARE (1-800-633-4227) for further information.

Your enrollment to Medicare starts 3 months before you turn 65 and ends 3 months after you turn 65. So, if you turn 65 today 30th October 2012 then you have the range between 30th July 2012 up to 30th January 2013 to get yourself enrolled.

Need To Know Facts About Medicare Advantage Plans

Some additional information which might be useful to you:

  • If you choose an HMO plan, you have to opt for a PCP (Primary Care Physician) and you cannot go out of network for treatment.
  • If in case your existing medicare plan provider opts out of the network you have the option of joining another advantage plan or continue with original medicare plan.
  • Medicare Advantage and Medigap (Medicare Supplemental Insurance) don’t go hand in hand. Meaning, till the time you are enrolled in an advantage plan you don’t require Medigap. Your Advantage plan covers everything offered in Medigap (Part D) through Medicare Advantage Prescription Drug (MAPD).


n New Mexico, the Open Enrollment deadline has not been extended. However, customers who were unable to successfully enroll in a plan by March 31 may still qualify to sign up on a case-by-case basis. Call 1-855-99-NMHIX to add your name or find out if you’re still eligible.