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Searching for Healthcare Plans - Helpful Information and Links

Searching for Healthcare Plans- Helpful Information and Links

Searching for Plans / ACA (Affordable Care Act) Insurance Marketplace Exchange: If you are not currently covered under your parent’s plan or another health plan; or you have currently lost coverage through no fault of your own (such as your current policy ending and no longer available); you may want to search for plans through the ACA Insurance Marketplace (also known as the ‘Exchange’). This is a key feature of the ACA. The Marketplace allows you to shop online to search for the right health insurance plan for you. You can’t be denied or charged more due to a pre-existing condition.

The general Open Enrollment dates for the ACA Marketplace are: November 1st through January 31st. Anyone can search for health plans during this timeframe.
Enrollment Date Exceptions: You may still be able to obtain coverage through the Marketplace before or after those dates if you currently have no health insurance due to certain circumstances (such as losing coverage through no fault of your own; current policy ending, dropped from parent’s coverage, etc).
This is explained at the ACA/Healthcare.gov website.
Here is the link and contact information for the ACA Insurance Marketplace Exchange:
www.healthcare.gov or contact ACA Exchange:
Available 24/7: 1-800-318-2596 / TTY: 1-855-889-4325

Searching for Plans Outside of the Marketplace:

You may also search for `Individual Health coverage plans’ by searching the Internet or specific health insurance company websites, such as Blue Cross/Blue Shield, United Healthcare, Aetna, Cigna, Humana and others. There are also companies set up to search plans for you that are not a part of the ACA Exchange and can provide quotes for Individual plans & Short-Term plans even before or after the Exchange open enrollment. Some Individual, catastrophic or Short-term health plans do not have all of the Affordable Care Act Benefit mandates (such as unlimited coverage and no pre-existing condition exclusion). Per the ACA.gov definitions, they may or may not be considered as ‘minimum essential coverage’.

To see what type of plans the Government (IRS) considers that qualify as Minimum Essential Coverage, please go to this Link*:

http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage

Here are a few types of insurance plans they list as “qualifying” minimum essential plans (there are more, but these are the most common ones, and are summarized):*

  • Plans you purchase from the Insurance ACA Marketplace (aka Online Healthcare.gov Exchange)
  • Individual Health Insurance you purchase directly from an insurance company
  • Health Insurance provided through a student health plan when available
  • Catastrophic Plans
  • Children’s Health Ins Program (CHIP)
  • Most types of TRICARE coverage
  • Most Medicaid coverage

The last column on the above irs.gov link also lists what is NOT considered as Minimum Essential Coverage.
*It is up to each individual to determine what plan is right for them and if it is considered as Minimum Essential Coverage.

When searching outside of the Marketplace, below are a few companies that can provide Short-Term/Individual Health Plans. There are many plans available to search through.
These are only a couple examples for reference*:

Gallagher Plus/w Sports Accident- Short Term Plan: Link: http://tempmedsales.alliednational.com/?affiliate=30862

United Healthcare One/ Short Term Plans: Link: https://www.uhone.com/insurance/short-term

E-Health Short-Term Plan Search Website: E-Health Link: https://www.ehealthinsurance.com/

*Note: Finding the right plan varies from person to person depending upon their needs, so it’s important to check the benefits and exclusions of each plan to see if it is right for you.
Stetson University does not endorse or recommend any particular insurance company, search website, or health plan. The information provided in this document is for assistance and reference purposes only and includes no guarantee of accuracy.

Whether you search for plans within the ACA Marketplace, or via the Internet for Individual or Short-Term plans; when deciding upon a plan, it is recommended that you review the proposed plan very carefully to include, but not limited to reviewing the following important items:

  • Overall Max Coverage Amount (Limit): Per each Accident/Illness? Per Year? No Limits?
  • Check for any coverage sub-limits on specific procedures or services
  • In-Network medical providers and doctors in your area: Most insurance companies cover more of the cost if you use their ‘In-Network’ or “Preferred” doctors and medical providers. And some will not provide coverage if you go to a medical provider or doctor ‘outside’ of their provider network. Check the plan to see what the rule is for this. Check out their Preferred `Provider Network’ to make sure there are sufficient hospitals, urgent care, Radiologists, labs, and specialists (such as Orthos, ENT’s, etc) in the area you will be accessing them. This is usually done by zipcode. Stetson University’s Zipcode to search for providers is: 32720 Many are nationwide, so you may want to check the listing in your home area as well.
  • Health Services on Campus: You may want to check with the campus Health Services to see if they accept the plan you are considering in case you need to or wish to seek treatment there.
  • Deductibles: The amount you will pay out of pocket for medical costs before the insurance company will begin paying their share of medical bills. (often it is an annual deductible, but some medical services may have a ‘per-visit’ or ‘per illness/accident’ deductible.
  • Co-Insurance Coverage: The amount or percentage of your medical bills that the insurance company will pay for. (Example: 80%/20% Co-Ins = Insurance Co pays 80%; You pay 20%)
    • Usually the Insurance Company starts paying medical bills at the Co-Insurance coverage % amount after you have met the plan deductible.
  • Co-Pays: Some Plans will have a set Co-Pay Amount such as for doctor visits or for prescriptions which you pay to the doctor/pharmacy.
    • The Copay for a doctor visit is usually the only amount you pay for that visit (unless extra medical supplies or procedures are done).
    • Copay Amounts for Prescriptions can vary depending upon if the Rx is Generic, Brand, or Non-Preferred.
  • Prescription Coverage: Check to see if Rx’s are covered at a % or with a set Co-Pay.
  • Exclusions: Read through the insurance company’s exclusions to find out what is not covered.
  • Pre-Existing Health Condition Exclusion (is there one listed in the exclusions?) - This exclusion means that if you had any health issues prior to signing up for the plan; they will not pay any medical bills for those pre-existing health issues for the timeframe they note in the pre-existing exclusion (can be anywhere from 6 months or 1 - 5 yrs) - Most Short-Term plans have pre-existing exclusions.
  • Note on ER Visits: Many insurance companies will not pay for medical costs at the Emergency Room if you seek treatment there that is NOT considered as a “Medical Emergency”. It is often better to go to an Urgent Care/Walk-In clinic or a regular doctor if your issue is not a true emergency.
  • Medical Emergency: Check the health plan to see what their definition is of a “Medical Emergency”. Also, find out what Urgent Care/Walk-In Clinics are available in the Provider Network in your area.