Typically, health insurance is designed for people under the age of 64.5 years old while people over the age of 64.5 would qualify for Medicare. Health Insurance is the type of insurance coverage that pays for medical, surgical, and prescription drugs that the insured (policyholder) uses during the coverage date period. Depending on the type of plan and coverage you purchase, this will entail how much of the expense will be paid for by you (insured) or the insurance company. In most cases when insurance premiums (monthly payments) are high, you pay for better coverage, meaning you will pay less Out-of-Pocket on the expenses incurred.
Each health insurance plan states what percentage of the expense will be covered by the insurer and what percentage must be paid by the insured. This is called Co-Insurance. Some plans may instead have a set dollar amount that must be paid by the insurer on the services used. This is called Co-Pay. These rates by differ based on the type of services and/or medical event inquired. Ie. Visit for primary care vs Specialist, Type of Tests/Surgery, Pregnancy, Hospital Stays, etc.
Seek plan details for further information. Some plans may also have what’s called a deductible. A deductible is the amount of money you may need to pay Out-of-Pocket before your health insurance provider pays for the rest of the bill.
Open Enrollment is a set date period when people can purchase new health insurance coverage and/or change their existing health insurance plan. The General Date period for Open Enrollment is from November 1st – January 15th. This date period can be different for some selected STATEs. During this period, everyone is eligible to purchase a new health insurance plan and/or change their current health insurance coverage.
Outside of this Open Enrollment Period is called SEP (Special Enrollment Period). During this time, you may be eligible to purchase and/or change your health insurance if you experienced what’s called a Special Event in the past 60 days. Below is a list of what’s considered to be a Special Event.
If you haven’t experienced any of these Special Events during SEP, you are NOT eligible to purchase traditional health insurance during this time. However, you may be eligible to enroll for what’s called Short Term Health Insurance. Short Term Health Insurance is the type of insurance coverage that will provide the insurer with temporary medical, surgical, and/or prescription drugs. These short-term plans can be purchased from 1 – 12 months and are typically more affordable compared to traditional health insurance plans. They may sometimes also have less benefits and/or higher deductibles/co-pays/co-insurance.
The type of plan that gives you access to doctors and hospitals within its network. These plans tend to be cheaper compared to PPO however they also come with less benefits. These benefits are usually the type of doctors and hospitals that may be covered.
PPO plans usually give more flexibility when choosing a doctor and hospital. There is usually a wider network of doctors and hospitals that you may visit and are covered. You may also choose doctors and/or hospitals outside of this network and you may still be covered. The costs for PPO is usually higher compared to HMO plans along with the deductible.
Traditional Indemnity plans also known as traditional health insurance is normalized health insurance coverage where you pay basic monthly premiums along with potential co-pays, co-insurance, and/or deductibles.
Temporary health insurance that plans can be purchased from 1 – 12 months and are typically more affordable compared to traditional health insurance plans. They may sometimes also have less benefits and/or higher deductibles/co-pays/co-insurance.
Medicaid is a federal and state government funded program that helps pay for the cost of health insurance to underprivileged individuals who can’t afford it. Individuals who may have certain disabilities may also qualify. People who are considered to be under the poverty line may be eligible for Medicaid and the eligibility is different by STATE. Your household income, household size (number of people living in the home) will determine if you can receive benefits. You MUST also be a U.S citizen or permanent resident for at least 5 years and a resident of the STATE where you will be receiving coverage.
Medicare is a federal government funded health insurance program setup for people who are over the age of 64.5 and also those under the age of 64.5 who have certain disabilities. People who are over 64.5 can qualify for Medicare if they have been a US citizen or permanent resident for more than 5 years AND have paid Medicare taxes for at least 10 years.
If you haven’t paid for Medicare taxes for at least 10 years, you can still qualify for Medicare, however you may have to pay a set amount for Medicare Part A.
If you are under 64.5 you may qualify for Medicare if you suffer from End-Stage Renal disease or End-Stage Kidney disease, Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease, or if you are permanently disabled and have been receiving Social Security Disability for the past two years.
Open Enrollment is a set date period when you can enroll for new Medicare coverage or change your existing Medicare plan. Medicare Open Enrollment is generally from October 15th – December 7th. Medicare Advantage Open Enrollment is from January 1st – March 31st. Outside of these enrollment periods are called SEP (Special Enrollment Periods). You may qualify to get new coverage or change your existing plan if you turn 64.5 during this time or if a special event occurs in your life.
Medicare Part A is Hospital Insurance. It covers things such as inpatient hospital care, overnight stays in hospitals or skilled nursing facilities, home healthcare visits, and medical supplies and drugs used during any of these stays. It can be free if you paid for Medicare taxes for at least 10 years.
Medicare Part B is Medical Insurance. It covers things such as services from doctors, outpatient care, home healthcare, medical preventive services, and medical equipment. Medicare Part B is usually not free and the majority have to pay for this coverage. The average monthly premium for Part B is around $150 however this may be higher based on your level of income.
Medicare Advantage is a health insurance plan that’s backed by private health insurance companies which replaces Medicare Part A and Part B and also gives additional benefits. This will usually include coverage on prescription drugs, hearing, vision and dental services. The additional benefits may vary depending on the private health insurance plan you select.
Medicare Part D is prescription drug coverage and is backed by private health insurance companies. It covers the cost of prescription drugs for both generic and brand name drugs however this may vary depending on the plan you purchase. The cost of Medicare Part D can vary depending on your plan.
Medicare Supplemental plans are extra health insurance plans bought from private health insurance companies. These plans are labeled as Part F, G, K, L, M and N, and each plan has different coverage benefits. The most popular Medicare Supplemental plan is Part F which covers both Medicare deductibles and all copays/coinsurance so that you don’t pay anything Out-Of-Pocket.
People love to use HealthPlans when shopping for their health insurance coverage as we are able to make things quick and easy for them. Shopping for coverage can be very difficult based on the variety of so many different plans and we make this easy by taking the information they provide and predicting what plans would be best. We help connect insurance shoppers with our partners that will be able to assist and help deliver the best quote based on their needs.
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