Individual Health Plans from Coventry One / Health America One

Coventry One is an established and respected Fortune 500 national managed health care company providing a variety of health coverage for people of all ages, including Individual Health Insurance Plans for people under the age of 65 who are not eligible for Medicare. (Individual Health Plans also include coverage for the family members). Coventry One has more than 5 million members. Its coverage includes 25 U.S. States, and Liberty Medicare is appointed in five of those states: Delaware, Illinois, Kansas, Ohio, and Pennsylvania. Health America One is affiliated with Coventry One.

Health America One – Individual Health Insurance in Pennsylvania and Ohio

The Coventry One family of brands includes Health America One. Health America One provides affordable and comprehensive health coverage for individuals and families in Pennsylvania and selected counties of Ohio.

Health America One has been in the health care business for over 35 years. According to the recent Health America news release, “HealthAmerica is among the nation’s top health plans for the seventh consecutive year… The current commercial health plan ranking puts HealthAmerica in the top 10 percent of health plans in the country for quality of care, customer satisfaction and accreditation… It has been ranked as one of the highest rated health plans in the nation by the National Committee for Quality Assurance’s (NCQA)“.

Coventry One / Health America One Benefits

  • You may select one of the multiple plans that fits your needs the best.
  • There are in-network and out-of-network providers. In-network providers include not only regional networks, but also the Coventry National Network (one of the largest in the country) for out-of-area service. The Coventry National Network has more than 5,600 participating hospitals and 585,000 doctors and health care professionals. All plans also allow you to access out-of-network providers (for higher out-of-pocket costs). No referrals are needed to see a specialist.
  • Lifetime Maximums are unlimited.
  • You may obtain emergency care from any physician, and the benefit coverage is at the in-network level
  • Health America One has the standard approach to Medical Underwriting and Pre-Existing Conditions. There are exclusionary riders that amend health policy by eliminating coverage for a specified, known, or pre-existing condition.
  • The Maternity Benefit is included with all Choice 1 and Copay series plans (see below).
  • There are Basic Dental benefits (not available on Rewards plans), and Vision Discount Card benefits.
  • Rates are guaranteed to stay the same for the first 12 months from the date your policy become effective. The health plan is guaranteed renewable as long as the premium is paid and you (and your dependents) stay in the same area. The premium will never be changed based on claims filed or changes in health status.

See How to Buy Individual Health Insurance Plan for questions to ask and tips to use in buying an individual health plan.

Health America One – Individual Health Plans

Here is an overview of Health America One plan types. Choose the category that fits you the best:

  • Copay Plans: These are the most comprehensive plans, providing maximum protection and cost predictability. They are ideal for people looking for strong benefits and the lowest out-of-pocket costs.
  • Choice 1 Plans: Similar to Copay Plans but more affordable. Compared with Copay plans, more services are allowed only after deductible is met.
  • QHDHP Plans with or without HSA: These are 100% and 90% Qualified High Deductible Health Plans (HDHP) with the financial flexibility of Health Savings Account (HSA). Normally no services are available until the deductible is met, but after that most services come with no charge
  • Rewards Plans: The most economical high-deductible, low-cost plans. Out-of-pocket costs are the highest, but monthly premiums are the lowest.

See Individual Health Insurance Plans for overall descriptions of Individual Health Plans.

Table 1 below provides the benefits and premiums for similar plans within each category:

  • Copay 90% $2,000 – $2,000 Deductible with 10% Coinsurance
  • Choice1 $2,000 – $2,000 Deductible with no Coinsurance
  • QHDHP 100% $2.500 with HSA – $2,500 Deductible with no Coinsurance after Deductible has been met
  • Rewards $2,500 – $2,500 Deductible

Premiums are shown for two scenarios (zip code 19096 is assumed):

  • Individual single man, 40 years old
  • Family of father (40 years old), mother (38 years old), and 2 children (15 and 17 years old)
Plan / Benefits Copay 90% $2,000 Choice1 $2,000 QHDHP 100% $2,500 with HSA Rewards $2,500
Premium (Individual) $198 $150 $132 $126
Premium (Individual & Family) $594 $508 $445 $426
Annual Deductible IN – Individual: $2,000; Family: $4,000 IN – Individual: $2,000; Family: $4,000 IN – Individual: $2,500; Family: $5,000 IN – Individual: $2,500; Family: $5,000
OUT – Individual: $4,000; Family: $8,000 OUT – Individual: $4,000; Family: $8,000 OUT – Individual: $5,000; Family: $10,000 OUT – Individual: $5,000; Family: $10,000
Maximum Annual Copay IN – Individual: $3,000; Family: $6,000 IN – Unlimited IN – Individual: $4,000; Family: $8,000 IN – Individual: $5,000; Family: $10,000
OUT- Individual: $6,000; Family: $12,000 OUT – Individual: $10,000; Family: $20,000 OUT- Individual: $8,000; Family: $16,000 OUT – Individual: $10,000; Family: $20,000
Inpatient Copayment IN – 10% IN – No Charge after Deductible IN – No Charge after Deductible IN – 15%
OUT – 50% OUT – 30% OUT – 50% OUT – 50%
Office Visit IN – Primary: $20; Specialist: $40 IN – Level1: $20; Level 2: $40 (after Deductible) IN – No Charge after Deductible IN – Primary: $40 (after Deductible); Specialist: $60 (after Deductible)
OUT – 50% OUT – 30% OUT – 50% OUT – 50%
Laboratory & Radiology IN – Lab: 10%; X-Ray: $40 after Deductible IN – No Charge after Deductible IN – Lab: No Charge after Deductible; X-Ray: $25 after Deductible IN – 15%
OUT – 50% OUT – 30% OUT – 50% OUT – 50%
Outpatient Surgery IN – 10% IN – No Charge after Deductible IN – No Charge after Deductible IN – 15%
OUT – 50% OUT – 30% OUT – 50% OUT – 50%
Emergency Room IN – $200 plus 10% (after Deductible) IN – $200 after Deductible (waived if admitted) IN – $150 after Deductible (waived if admitted) IN – $400 after Deductible (waived if admitted)
OUT – $200 plus 10% (after Deductible) OUT – $200 after Deductible (waived if admitted) OUT – $150 after Deductible (waived if admitted) OUT – $400 after Deductible (waived if admitted)

Table 1. Different types of Health Plans with similar Deductibles

Naturally, you may reduce the health plan monthly premium by increasing its deductible. Table 2 illustrates this for Copay Plans, Table 3 for QHDHP Plans.

Plan / Benefits Copay 100% $0 Copay 100% $1,200 Copay 80% $500 Copay 90% $2,000
Premium (Individual) $382 $236 $223 $198
Premium (Individual & Family) $1,149 $711 $671 $594
Annual Deductible IN – Not Applicable IN – Individual: $1,200; Family: $2,400 IN – Individual: $500; Family: $1,000 IN – Individual: $2,000; Family: $4,000
OUT – Individual: $5,000; Family: $10,000 OUT – Individual: $2,400; Family: $4,800 OUT – Individual: $1,000; Family: $2,000 OUT – Individual: $4,000; Family: $8,000
Inpatient Copayment IN – $350/day; 5 day maximum IN – No Charge after Deductible IN – $250 plus 20% per admission after annual deductible IN – 10%
OUT – 50% OUT – 50% OUT – 50% OUT – 50%

Table 2. Copay Plans with different Deductibles

 

Plan / Benefits QHDHP 100% $1,250 with HSA QHDHP 90% $1,500 with HSA QHDHP 100% $2,500 with HSA QHDHP 90% $3,000 with HSA
Premium (Individual) $160 $140 $132 $117
Premium (Individual & Family) $542 $472 $445 $397
Annual Deductible IN – Individual: $1,250; Family: $2,500 IN – Individual: $1,500; Family: $3,000 IN – Individual: $2,500; Family: $5,000 IN – Individual: $3,000; Family: $6,000
OUT – Individual: $2,500; Family: $5,000 OUT – Individual: $3,000; Family: $6,000 OUT – Individual: $5,000; Family: $10,000 OUT – Individual: $6,000; Family: $12,000
Inpatient Copayment IN – No Charge after Deductible IN – 10% IN – No Charge after Deductible IN – 10%
OUT – 50% OUT – 50% OUT – 50% OUT – 50%

Table 3. QHDHP Plans with different Deductibles

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For help finding the best Medicare or Individual Health Plan for you, please contact Liberty Medicare or call us at 877-657-7477.

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