what health insurance is right for you?
employer plan
Employer plans can be the BEST options for individuals. I usually recommend individuals to stay on their employer plan, unless their employer is willing to give them a stipend towards an outside plan that gives better coverage. For a family, it can be very expensive to add spouses and dependents to an employer plan, so sometimes it’s more cost effective to put the spouse and dependents on their own plan tailored to their individual needs!
public market (obamacare)
ACA plans, also known as Obamacare are the BEST option for individuals that don’t have access to an employer plan and that qualifies for a large government subsidy (usually $20k-$30k pre-taxed income). It is also the best option for individuals that have major health problems because these plans are not based on approval. However, if you are a family and you make too much money to qualify for any government subsidies, and maybe only one person suffers from a medical problem, I would suggest putting that person on the public marketplace and looking at more cost effective options for the rest of the family.
private market
Private Plans are BEST for individuals or families that are healthy and do not qualify for any government subsidies (Makes $35k+ combined pre-taxed household income). These are medically underwritten plans, so they are approval based and exclusive association memberships. Private plans group together all healthy people so, because they know they are insuring healthy people, they can provide better coverage at a competitive rate compared to the public and even some employer plans. Private plans also offer upfront benefits before satisfying a deductible, and will keep you covered in all 50 states!
other plans
medi-share plans
- Medi-share plans are typically cheaper plans, but similar to multi-plans, not actual insurance. These plans operate from a large pot of money, so once that money is gone, so is the coverage.
multi plans
- Multi-plans (Pivot Health as an example) are usually cheap and PPO which are the pros for these plans. However, they are $0 deductible plans, with no max out of pocket, so any major claims, you would be responsible for financially covering. There is a 12-month waiting period on all pre-existing conditions as well. The most terrifying part of a multi-plan is on the “insurance” cards, there are disclaimers stating that these plans are NOT insurance and they are not responsible for any claims.
short term plans
- Short term plans (Mass Gen or Golden rule are popular ones) are plans that only last 1, 3, 6, 9, or 11 months. There is no coverage available for pre-existing conditions for the first 12 months. These plans do not protect assets and can lead to bankruptcy due to caps in coverage. This means they can cap your coverage from $100k-$2million, so if you have a 4 million dollar medically necessary surgery, you would be responsible for the remainder. Sometimes there are decent short term plans that work as a bridge until open enrollment opens back up, but just like the name describes, it’s only meant for a short term.
pros & cons
employer plans
pros
- Usually great coverage
- Employer Pays a Percentage most of the time
- Taken out of check, pre-tax
- Can include PPO Options
cons
- Not always the best coverage
- Employer doesn’t always have to pay a portion depending on how many employees they have.
- Can be very expensive to add spouses and dependents
public market (obamacare)
pros
- Great for someone who qualifies for large government subsidies. (household income, $20k-$34k)
- No approval process, accepts everyone
- Good for someone with major medical issues
cons
- Coverage does NOT travel state to state
- Expensive if your income is high
- Can owe money back to them if you make more than what you stated when you signed up the year prior
- Have to renew each year
- No coverage until the yearly deductible is met
private plans
pros
- PPO Network (Largest Network, Coverage follows you from state to state)
- Guaranteed renewable plans available, you never have to renew these plans and only go through the approval process once. (meaning you can stay on the plan until you are 65 and cannot be kicked off or rates can never increase based on your usage or claims history)
- Great coverage at a lower cost
- Accident protection and catastrophic coverage
- plans available with upfront benefits prior to having to meet a deductible
- Personal advisor that comes with the plan.
- Great for Travel Nurses, Truck Drivers, Contractors, Self-Employed, Small Business Owners, Cosmetologists, Oral/Dentistry
cons
- You have to go through an approval process
- Does not have good coverage for maternity, drug & alcohol rehabilitation or mental health.
- 12-month waiting period for pre-existing conditions.
Medishare plans
pros
- Cheap
- Do not have to be approved
cons
- Insurance cards say “not insurance”, so they legally have no obligation to uphold their end of the deal.
- It is a Fund, so you buy into it with other individuals and when you need to utilize your “insurance” you pull from that pot, however, once the money runs out, so does the coverage.
multi-plans
pros
- Cheap
- PPO (Large network)
- Do not have to be approved
cons
- $0 deductible which means there is no max out of pocket (meaning you could be responsible for any large medical bills that exceed what the insurance company is willing to pay.
- 12-month waiting period for pre-existing conditions.
short term plans
pros
- Can be a good option to bridge a gap between coverages.
- Most do not require to go through approval process
cons
- Only 1, 3, 6, 9 or 11 month plans
- No existing conditions covered
- Doesn’t protect assest
- They can opt into returning your premiums so they don’t have to cover you at all.
- Caps on your coverage ($100k-$2million)
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