Individual Health Insurance

Policies for people that aren't connected to job-based coverage  

Preventive care

Did you know that all new health insurance must cover preventive care for free? These services help put the focus on keeping you healthy before you become sick. This includes routine check-ups, patient counseling, screening tests, and immunizations. Plans must offer these services at no cost to you when the services are provided by in-network doctors. This means they can’t charge a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Metal Categories

 

There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.

No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income.

Health Care Costs 

 

You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

Plans & Networks

 

HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).


Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.


Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.


Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

Catastrophic Health Plans

Who can buy a Catastrophic plan?

• People under 30


• People of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable)
 

• Catastrophic health insurance plans may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.

• If you’re eligible to buy a Catastrophic plan, you’ll see them displayed when you compare plans in the Marketplace.

 

What Do Catastrophic plans cover?

 

• Catastrophic plans cover the same essential health benefits as other Marketplace plans.
 

• Like other plans, Catastrophic plans cover certain preventive services at no cost.
 

• They also cover at least 3 primary care visits per year before you’ve met your deductible.

How much Do Catastrophic plans cost?

 

• Monthly premiums are usually low, but you can’t use a premium tax credit to reduce your cost. If you qualify for a premium tax credit based on your income, a Bronze or Silver plan is likely to be a better value. Be sure to compare.  

 

• Deductibles — the amount you have to pay yourself for most services before the plan starts to pay anything — are very high. 

CALL RJ CLARITY CONSULTING TODAY

Arizona (602) 806-7800 

New Mexico (505) 600-2422  

North Carolina (919) 867-1303 

Toll-Free (800) 456-8050

Calling one of the numbers above will direct you to a licensed sales agent

Medicare 101                                    What We Do                                         Who We Are                                Contact Us

RJ-Clarity-Insurance.png

Arizona (602) 806-7800

New Mexico (505) 600-2422

North Carolina (919) 867-1303

Toll-Free (800) 456-8050

  • google plus, google 2015, g+, new google
  • Yelp
  • LinkedIn
  • Facebook
download.png