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Health Insurance

from Holder Insurance Agency

Health Insurance

A healthy body is a happy body, and there’s no better way to preserve your health and your family’s health than with a health insurance policy from Holder Insurance Agency.

Let’s face it, medical treatments aren’t cheap. Without health insurance coverage you could end up paying off medical bills for the rest of your life. Holder Insurance Agency can help you find an affordable healthcare plan that’s right for you. Contact one of our friendly agents today to learn more.

Individual Health Insurance

The Affordable Care Act (ACA) has made significant changes to how individual insurance policies are rated and the benefits that these policies provide. Individual insurance policies and provisions are also regulated by the state where the policy is purchased.

Individual policies are often purchased with the advice of a professional insurance producer due to the complexity of coverage offerings and the premium cost. The health insurance advisers at Holder Insurance can help you purchase insurance through the Marketplace or direct with the insurance carrier.

Pre-existing medical conditions are no longer a factor when purchasing individual coverage. Enrollment is limited to Open Enrollment once per year and limited opportunities during the year as a result of a special enrollment right. A qualifying life event that triggers the special enrollment right is typically marriage, divorce, birth or adoption of a child or a change in income, among others. It is not a voluntary loss of employer coverage.

All policies must cover the same set of Essential Health Benefits. The essential health benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services
  • Prescription drugs
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services
  • Rehabilitative and habilitative services and devices

The richness of the benefits under the plan is defined by a metal tier. These tiers are based on the percentage the plan pays of the average overall cost of providing essential health benefits to members:

  • Platinum plans are the most generous and more expensive. These are designed to pay as much as 90% of medical expenses
  • Gold plans are designed to pay 80% of medical expenses
  • Silver plans are expected to pay 70% of medical expenses
  • Bronze plans are expected to pay 60% of medical expenses

It’s important to note that the metal tiers reflect what the plans will pay on average. These percentages are not the same as coinsurance, which calls for an individual to pay a specific percentage of the cost of a specific service.

Another category of individual plan is the catastrophic plan. A catastrophic plan must meet the requirements of the metal plans, but benefits are very limited. Catastrophic plans are an option for individuals under the age of 30 or others who have received a “hardship exemption” from the exchange due to other health coverage being deemed unaffordable.

How are premium rates determined?

Premium rates both on and off of the marketplace are determined by the age of each individual who will be covered by a plan, whether or not they use tobacco, where a person lives (zip code) and the level of plan (metal tier) that they select.

Individuals may be eligible for government subsidies (tax credits) to help pay for premiums. Subsidies are available only for coverage purchased through the Marketplace. Subsidies are calculated based on the modified adjusted gross income for the year and the household size. Subsides may be available to individuals with incomes between 100% of the Federal Poverty Level (FPL) and 400% of the FPL.

Individuals may also qualify for savings on out-of-pocket costs when they obtain medical care. These savings are called "cost-sharing reductions." Cost-sharing reductions reduce the amount an individual pays for out-of-pocket costs such as deductibles, coinsurance and copayment. They are available for Silver plans purchased through the exchange for individuals with incomes no higher than 250% of the FPL.

Common Health Insurance Terms

When discussing health insurance with an agent, it helps to understand some of the common terms you’ll hear. Below you’ll find definitions to some of the most common health insurance terms.

  • Deductible - The amount of money you pay toward medical bills before your insurance coverage begins.
  • Co-pay - A specified amount of money you pay upfront for doctor visits and prescription refills.
  • Coinsurance - The percentage of medical bills you pay after meeting the deductible.

To learn more about Ocala health insurance, call and talk with one of our agents today. We’ll guide you toward a more secure future.