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INDIVIDUAL UNDER 65 HEALTH INSURANCE

The Affordable Care Act (ACA) provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available.

 

UNDER THE ACA:

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  • You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans. Davesurance uses HealthSherpa, an Enhanced Direct Enrollment pathway approved by the Centers for Medicare & Medicaid Services (CMS).

  • Insurers can't refuse coverage based on gender or a pre-existing condition.

  • There are no lifetime or annual limits on coverage.

  • Young adults can stay on their family’s insurance plan until age 26.

  • Seniors who hit the Medicare Prescription Drug Plan coverage gap or "donut hole" can get a discount on medications.

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Note: In response to the coronavirus pandemic, you may be eligible to apply for coverage through the Health Insurance Marketplace during the special enrollment period, February 15 - August 15, 2021.


Read the full text of the ACA and learn more about its provisions and relationship to patients,
insurers, businesses, and families.

HEALTH RESOURCES FOR PEOPLE

WITH DISABILITIES

If you have a disability, you have three options for health coverage through the government:

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Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply. 


Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Learn about eligibility, how to apply and coverage.


Affordable Care Act Marketplace offers options to people who have a disability, don’t qualify for disability benefits, and need health coverage.

SHORT-TERM MAJOR MEDICAL PLANS

Short Term Major Medical plans have been around for a long time. The short term plans differ from a regular major medical plan in several areas. They are first and foremost a short term option and not a good idea for more than three to six months.


Some of the popular reasons people get them are:

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  • Less money than a typical ACA plan monthly premium.

  • Coverage could start in as little as 24 hours. A good option if you find yourself in-between plans.

  • If you didn’t like the chosen company the term is short and can be switched at the end of term.

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Some of the reasons why a short term plans may not me a good fit:

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  • Pre-existing conditions are not covered. And as I like to warn people, anything that could be connected to a pre-existing condition probably won’t be covered either.

  • The ten essential health benefits outlined in the ACA plans are usually not covered. Things like routine physicals, pediatric dental and vision, mental health, etc.

  • If you do get sick or hurt on the short-term plan you are only covered until the term ends. If you still have that condition, it would now be a preexisting condition for the next short-term plan and would likely not be covered.

  • There are dollar limits on how much the short-term carrier will pay.  Short term plans can range from $250,000 to around 2 Million dollars. ACA plans are not restricted.

  • The government doesn’t like them because of the belief that the plans keep healthy people out of the ACA insurance pool increasing prices for those on ACA plans.

 

 

 

If you go to Dave’s Resource page you can see options for some reliable Short term carriers.

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