Individual & Family Health Insurance

Individual & Family

Here's everything you need to know about Health Insurance

Alex was born with a genetic bleeding disorder known as hemophilia, which means his blood doesn’t clot properly. This condition has necessitated the self-administration of intravenous medicine every other day since childhood. Despite leading an active and healthy lifestyle, his medical expenses exceed $1 million annually due to the high cost of his medication. Health insurance provides essential protection for Alex and his family against these exorbitant bills.

As an independent agent, Alex is licensed and partnered with various insurance companies, enabling him to tailor a plan to meet your specific needs and objectives. He will guide you through the enrollment process and help you select the insurance plan that suits you best. Contact Alex today for a complimentary consultation to explore your health insurance options and determine if you qualify for an advanced premium tax credit, which can significantly reduce your insurance costs.

INDIVIDUAL & FAMILY HEALTH INSURANCE: Protecting What Matters Most

Individual and family health insurance plans offer a range of benefits that provide coverage for medical expenses, preventive care, prescriptions, hospital stays, and more.

Key Features

Premiums, Deductibles, Co-Payments, and Co-Insurance: Understanding these terms is crucial. Premiums are the monthly payments you make for coverage, deductibles are the amount you pay out-of-pocket before insurance kicks in, co-payments are fixed fees you pay for specific services, and co-insurance is a percentage you pay for specific services.
Coverage Options: Choose from a variety of plans tailored to your needs, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and High Deductible Health Plan (HDHP) options. Each plan type offers different levels of flexibility in choosing healthcare providers.
Essential Benefits: Individual and family health insurance plans typically cover essential benefits like doctor visits, hospital stays, prescription medications, preventive care (such as vaccinations and screenings), and maternity care.
Network: Most plans come with a network of healthcare providers, including doctors, specialists, hospitals, and clinics. Staying within the network often results in lower out-of-pocket costs.
Out-of-Pocket Limits: Every plan has an annual out-of-pocket limit, beyond which the insurance covers 100% of covered medical expenses. This protects you from catastrophic healthcare costs.

Advance Premium Tax Credits: Making Health Insurance Affordable

Health insurance can be expensive, but the Affordable Care Act (ACA) introduced a mechanism called Advance Premium Tax Credits (APTC) to make coverage more accessible to individuals and families. APTC is designed to lower your monthly insurance premiums, ensuring that you’re not burdened by high insurance costs. Contact Alex today to see if you qualify.

Eligibility: Your eligibility for APTC is determined based on your income, age, household size, and other factors.
Application: When you apply for health insurance through HealthCare.gov or your local state Health Insurance Marketplace (also known as on Exchange), you can simultaneoulsy apply for APTC. The marketplace will determine if you qualify for these credits.
Credit Amount: The amount of APTC you receive depends on your income and the cost of the benchmark insurance plan in your area. It’s designed to limit your premium payments to a certain percentage of your income.
Direct-to-Insurer Payment: In most cases, the APTC is paid directly to your insurance provider. This reduces your monthly premium, making your coverage more affordable.
Reconciliation: At the end of the tax year, when you file your federal income tax return, your actual income will be reconciled with the estimate you provided. If there’s a difference, your tax refund or tax liability will be adjusted accordingly.

Advance Premium Tax Credits: Making Health Insurance Affordable

Which plan do I choose?

Health insurance plans through Healthcare.gov or your local state Health Insurance Marketplace are classified into four metal tier levels, in order form least expensive with higher out-of-pocket costs:

Bronze: 60% insurance company pays (40% of bills your responsibility)
Silver: 70% insurance company pays (30% of bills your responsibility)
Gold: 80% insurance company pays (20% of bills your responsibility)
Platinum: 90% insurance company pays (10% of bills your responsibility)

If you qualify for an APTC mentioned above, then choosing a Silver plan would be the only metal tier that includes a cost-sharing reduction. This is a discount that lowers the amount you pay out of-pocket for things such as deductibles, co-pays, and co-insurance. In summary, the APTC would reduce your cost of insurance, and the Silver plan would reduce the cost you pay for medical services.

Health insurance can be confusing to navigate by yourself. Alex is licensed and contracted with numerous health insurance companies. Contact Alex today for a free consultation to learn more about your health insurance options and to see if we can reduce your cost of health insurance.

Simplify the search for Health Insurance plans.

Contact Alex for a no cost review of your Health Insurance needs.

*By submitting your information you agree to be contacted by Alex Ell, a licensed agent, to discuss Medicare Advantage plans, prescription drug plans, and/or Medicare supplement insurance

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We do not offer every plan available in your area. Currently we represent 9 organizations which offer 60 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.