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Private Health Insurance

Individual plans offering more choices and greater flexibility

Private Health Insurance Plans

Private Health Insurance (Off-Exchange Plans)

When it comes to individual health insurance for you and your family at a high level it comes down to 2 options: Marketplace plan or Private plan.

When doing your research you may see different names for private health insurance plans. They might be referred to as:

• Off-Exchange Plans

• Non-marketplace Plans

• Private Health Plan

Private health insurance plans can be purchased directly from insurance companies or through individual agents like myself! These "off-exchange" plans differ slightly from marketplace options in several ways:

• They are not eligible for financial subsidies.

• Though classified as major medical plans, they still provide the essential health benefits required by law.

• You can buy private plans online, through brokers, or directly from insurers. Commissions for these sales are paid by the insurance carrier and do not increase your final cost.

• Networks may be broader because the insurer avoids additional administrative fees tied to marketplace plans.

Other "off-exchange" options include indemnity, critical illness, and short-term plans. While these do not qualify as ACA-compliant health coverage, they offer lower premiums and may suit healthy individuals looking for more affordable alternatives.

Do Private Plans offer the same coverage as a Marketplace Plans?

In a lot of cases there are only minor differences in coverage. As in any buying scenario, it's important that you read the fine print to know exactly what you're buying. Sometimes there are differences that, depending on your unique situation, could put you in a difficult situation.

One such situation is pre-existing conditions. Private plans could exclude coverage for pre-existing conditions. Not knowing this, you could by purchasing a plan that will deny coverage for existing ailments.

When buying a private plan make sure and request the Summary of Benefits and Coverage. This document will go into great detail about what's covered with the plan.

Do Private Insurance Plans cost more?

By law, Marketplace Plans are priced based solely on five factors. Check out our blog post on 9/26/24 for more details on those five factors.

Non-marketplace plans are not limited to 5 factors. They can be offered and priced on other factors, including gender, health status, and health history. This variance will definitely cause a difference in price. Whether it's more or less depends on your unique situation.

Non-marketplace plans may also exclude some benefits required under the ACA, such as imposing a benefit dollar cap. This is not always true.

There are several different types of private health insurance

• Individual health insurance: Covers a single person

• Family health insurance: Covers multiple family members, such as a spouse and children

• Dental and vision insurance: Covers dental and vision care expenses

• Short-term health insurance: Provides temporary coverage for people who have a gap in coverage, such as when changing jobs

• Catastrophic health insurance: Designed for healthy, young people who want to protect themselves from major medical expenses

• Supplemental health insurance: Complements existing health coverage

How to choose a Insurance Plan

When choosing a plan, you can do a lot of the research yourself. In this day and age, a lot of people do that. However, at some point there is value to having an agent work with you when finalizing your choices. This is true for several reasons.

First, it doesn't cost you thing to get an agent's recommendation and opinion. The health insurance carrier is paying the agent's commission and it has not bearing on the price you're going to pay. Find a quality agent that knows what they're talking about let them help you.

Secondly, there may be fine print you need to be aware of. On the outside, the plan looks really good and the price is right but there could a be a few key coverage pieces missing. Think of it like going to buy a used car. The salesman is your best friend. You see the car you want after doing all your research but when you get to the lot and start talking, he tells you the car has some issues and you really want to steer away from it based on what you told him you wanted. An agent that's looking out for you, can tell you why a certain plan is way cheaper than all the others. Maybe you're ok with why it's cheaper but at least you know why and are making an educated decision.

Third, you may need an exception at some point. Sometimes there may be a medical condition that needs an exception or something that needs to be rushed. Your agent should have a relationship with a carrier rep to be able to make a phone call and try to get something done. As agents, we can't always get things to go the customer's way but sometimes we can because we have an established relationship with a carrier rep or underwriter and we can tell a story where they get the full picture and are able to get an exception approved.

Heartwood has solutions to your insurance problems

Regardless of the problem you're trying to solve, Heartwood has a wide variety of health insurance solutions. That means you only have to know one phone number, one name, one agent to call. No matter the issue you're having, we can work with you and provide you with a solution that will meet the needs of your individual situation.

Let us help. Let us make your health insurance buying process easier and less confusing. Click the link above to call our office or click the "Contact Us" link below to have one of our agents reach out.