Individual Comprehensive Major Medical Plans (Obamacare Plans)

The Patient Protection and the Affordable Care Act (PPACA), known as Obamacare, is one of the major pieces of legislation to affect the U.S. health care system. It dramatically affects Individual Comprehensive Major Medical Plans.

Changes in Obamacare Benefits and Protections

The major changes in Obamacare Benefits and Protections include:

  • After Jan. 1, 2014, no coverage can be limited or denied because of pre-existing conditions, regardless of the age of the covered individual.
  • The guaranteed issue requirement is expanded to ensure that health insurance companies will offer all of their individual and group market plans to any eligible individual in a state, regardless of health status. Also, health insurance companies must offer to renew or continue in force coverage at the option of the policyholder; a provision known as guaranteed renewability.
  • Annual and lifetime limits may not be imposed on the dollar value of coverage of essential health benefits.

Qualified Health Plans (QHPs) and the Five Levels of Coverage

With the Health Insurance Marketplace, individuals and small businesses may buy only high-quality, health plans, known as Qualified Health Plans (QHPs). All plans are from private insurance carriers.

All QHPs:

Despite the fact that Qualified Health Plans are standardized and share the common levels of coverage, they can vary. For example:

  • Some plans may cover additional benefits
  • You may have to see certain providers or use certain hospitals
  • The premiums, copays and coinsurance will be different in different plans
  • The quality of care can vary
  • Some plans will be structured differently, like high-deductible plans

Affordable Health Insurance Options

To help low- and moderate-income families to reduce the cost of health insurance, the federal government provides two affordability programs:

Premium Tax Credit

Cost-Sharing Reductions

Both of them are available only through the Marketplace when you enroll in one of the metal levels Qualified Health Plans (QHP). It is assumed that you are not eligible for other minimum essential coverage, such as affordable employer-sponsored coverage, Medicaid, CHIP, and Medicare.

Plan Types

Individual Comprehensive Major Medical Plans: HMO and PPO

HMO and PPO Individual Comprehensive Major Medical Plans are the most comprehensive and the most expensive types of coverage. They include both catastrophic coverage and routine medical care.

Individual Comprehensive Major Medical Plans without a deductible have the highest premium; they are normally HMO plans based on the copay, rather than on coinsurance.

Comprehensive Major Medical Plans with a deductible, on the other hand, have a lower premium: the higher the deductible you choose, the lower the premium. Most of the plans are PPO plans, but some of them are HMO plans. In-network deductibles are normally applied to services such as hospital and emergency care. For doctors’ visits, preventive services and screenings, the deductibles are waived and copays are used.

Many companies also provide less expensive ‘proactive’ plans. The premium is lower because the plan network is smaller. It has several tiers (such as Preferred, Enhanced and Standard), and your cost depends to the tier your doctor or hospital belongs to.

Individual Comprehensive Major Medical HDHP (HSA Compatible)

Comprehensive Major Medical High Deductible Health Plans (HDHP) are plans with high deductibles – normally $1,500 – $5,000 per individual, and $3,000-$10,000 per family. The deductible is normally applied to ALL medical services (including drug expenses), except for preventive care. PPO’s are the most common HDHP.

It is because of the high deductible that the HDHP premium is relatively low.

Comprehensive Major Medical HDHP does not often include any additional expenses after the deductible has been met, as long as you are staying within the network (0% coinsurance).

The tax-advantaged Health Saving Account (HSA) may be used together with HDHP. HSA is a tax-free savings account (similar to a 401(k)) that is used for future medical expenses: deductibles, coinsurance and other qualified medical expenses. HSA allows portability (it stays with you even if you change jobs), annual rollover, and tax-free investment earnings and gains.

A Comprehensive Major Medical High Deductible Plan may be a good option if you are healthy or if you have enough HSA savings to cover your medical expenses.

Let Liberty Medicare help you choose an Individual Health Plan

Liberty Medicare is here to help you learn about the Health Insurance Marketplace and assist with eligibility determination for enrollment in a Qualified Health Plan (QHP) and for insurance affordability programs, which include Medicaid, CHIP, premium tax credit, and cost-sharing reductions. We will help you to compare plans, and enroll in coverage.

As an independent insurance agency, we will provide you the benefits of objectivity in reviewing multiple plans. We’ll help you to understand the insurance industry jargon and ‘fine print’.

All of our services are offered to you at no cost. We’ll help you to compare Comprehensive Major Medical Plans in your area based on:

  • Benefits
  • Cost
  • Doctor access and network limitations
  • Prescription drug coverage
  • Extra benefits
  • Plan quality

Liberty Medicare represents many well-known Individual Comprehensive Major Medical providers in Delaware, Maryland, New Jersey, and Pennsylvania. Learn more about all benefits of working with Liberty Medicare.

If you are considering buying an Individual Comprehensive Major Medical Plan (Obamacare plan), let us guide you. To see real quotes from insurance providers, fill out our Individual Health Quote form or give us a call at 877-657-7477.