Is Independent Health Insurance Right for You?

Since the major provisions of the Affordable Care Act took effect last year, health insurance and the government-mandated portals have been the center of attention. The health care reform law, which is designed to ensure access to quality, affordable healthcare coverage was actually passed in 2010.
The federal government will reap a hefty fine from those who choose not to enroll when they do not already have a health care plan. Failure to comply means confiscation of tax refunds starting at $95, or 1 percent of a citizen’s total income for the first year without health coverage. Fines can grow to about 2.5 percent of income by 2017.

The online marketplace has received so much coverage that other avenues to find health insurance coverage for individuals or families have been largely ignored. Citizens who do not have access to employer coverage, or don’t want it, can also purchase independent insurance coverage by going outside of the government exchange. Citizens can find affordable options that are best-suited to their needs by going directly to an insurance company, or using insurance brokers or agents.

Some states have their own online exchanges: California, Connecticut, Colorado, the District of Columbia, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont and Washington state. You and your family may even qualify for Medicaid or the Children’s Health Insurance Program if your income is low enough. Naturally, eligibility rules vary widely from state to state. If these options do not apply to you, going outside of the exchange to purchase independent insurance is not a gamble.

All health insurance policies, whether sold through the government exchanges or elsewhere, must comply with the Affordable Care Act. This means that they are required to offer the same essential benefits: ambulatory patient and prescription benefits, emergency care, mental health services, hospitalization, preventive and wellness care, pediatric care, maternity and newborn care, rehabilitative services, and laboratory services. Plans purchased outside of the exchange are also prohibited from denying coverage if you’re already sick. Insurers who sell policies must sell the same plan for the same price.

Most of the hullabaloo about using the online marketplace lies in the possibility of qualifying for subsidies that can lower your premiums. Whether or not the policies you find outside of the exchange will be a better deal than the ones on the exchange will vary largely by market. To find a local broker or agent that can help you find a plan outside of the exchange, visit the National Association of Health Underwriters. When taking this route, it is important to remember that agents will only be able to show plans from insurers they work with. These services will usually be free to utilize since agents and brokers get their commissions from insurance carriers. An agent or broker’s insurance expertise can be valuable, especially to uninsured people who’ve never bought a health plan before.