The Health Insurance Individual Market

Even with all the shouting and finger-pointing going on in Congress the Patient Protection and Affordable Care Act (PPACA or ACA) just keeps rolling on even through budget over runs, time constraints, and congressional hearings.

But let’s not forget what the ACA’s fundamental goal is all about — to help roll the millions of uninsured and underinsured legal Americans who are struggling with health care costs. The premise of the ACA is to provide affordable, accessible, multi-carrier, minimum essential health coverage options through a new health insurance marketplace (also known as Exchange) come October 1, 2013 for plan year beginning January 1, 2014. It is designed mainly for those whose income is up to 400% of the federal poverty level. These Americans will have assistance in offsetting their insurance costs by new premium tax credits based on their percent level of poverty. Note, according to the Department of Health and Human Services (HHS), the 2013 federal poverty level for one individual is $11,490 and a family of four is $23,550. Four hundred percent of that is $45,960 and $94,200 respectively. We are talking about approximately 48 million people who will potentially be covered under the new ACA requirements!

It seems like all the emphasis is on the uninsured/underinsured and their premium tax credits, but what happens to all those same Americans who earn MORE than 400% of the federal poverty level? No one ever talks about ‘them’! Not to worry, that’s where the individual, open market comes into play. Marketplace? Individual Market? Open Market? I know it’s confusing as the ACA calls their health insurance exchange a “marketplace” and the health insurance business uses the term ‘individual market or open market’ for those purchasing insurance without the assistance of premium tax credits and directly from an agent, broker, or insurance carrier.

So, once the ACA’s health insurance marketplace is open for enrollment in October, the insurance carriers will still be required to provide the same essential minimum benefit coverage to all that need health insurance on the individual market as well. That’s where companies like us can help you out. You can call up your local insurance agent, broker, or carrier, or search on-line for insurance quotes from insurance companies or the insurance carrier. There are those of us that will assist you in getting the insurance you need at the right price.

Ah, but there is one more twist to the new health insurance requirements. While you are mandated to have health insurance by 2014, you are NOT required to purchase it through the marketplace. So, even after you’ve filled out the marketplace’s required 21-page application and you find out you qualify for a premium tax credit, it might not be the best option for you. You may find that a health insurance plan available on the individual market might be better suited to your needs – premium costs, deductibles, co-pays, etc. I keep stressing this make sure you compare ALL your available options BEFORE you purchase your insurance plan. And remember, you have an agent or broker ready and willing to help you through this new frontier.

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