HEALTH INSURANCE OPTIONS
Health Insurance covers the cost of an individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.
Types of Group Health Insurance
Fully-Insured Health Plan
The more traditional way to structure an employer-sponsored health plan. The company pays a premium to the insurance carrier. The premium rates are fixed for a year, based on the number of employees enrolled in the plan each month.
Level-Funded Health Plan
With Level Funding, and the proper use of Stop Loss Insurance, the employer pays a monthly cost that is the maximum cost. No matter how many claims occur in a month, the employer will never pay more than the maximum cost. After all claims are paid for the year, a portion of the unused money in the claim fund is returned to the employer according to the contract terms. Annual claim deficits are covered by the Stop Loss Insurance.
Minimum Essential Coverage (MEC Plan)
Under the Affordable Care Act (otherwise known as “Obamacare”), everyone must have health insurance that covers their basic health care needs. This required coverage is called, “minimum essential coverage,” or MEC, and it covers 100% of the government’s mandated preventive services. Prior to 2019, before the financial penalties were appealed, the Individual Mandate required that everyone had health insurance or pay a tax penalty. Even though the financial penalties were repealed on the Federal Level, the following states currently have their own Individual Mandates – California, New Jersey, Massachusetts, Rhode Island, Vermont, and the District of Columbia.
Types of Individual Health Insurance
Comprehensive Health Insurance
Under the Affordable Care Act (otherwise known as “Obamacare”), everyone must have health insurance that covers their basic health care needs. Your insurance plan must cover ten minimum essential health care services. These are: outpatient services; emergency services; hospitalization; maternity/newborn care; mental health and substance abuse services; prescription drugs; rehabilitation (for injuries, disabilities or chronic conditions); lab services; preventive/wellness programs and chronic disease management; and pediatric services.
Short Term Health Insurance
Short Term Health Plans are designed to provide temporary insurance during unexpected coverage gaps. Short Term Health Plans cover a number of medical expenses, such as doctor visits (subject to deductible and coinsurance), urgent care, ambulance service, emergency room care, diagnostic testing, surgery, inpatient and outpatient hospital benefits, and hospital confinement benefits. However, Short Term Health Plans do not meet the minimum essential coverage requirements under the Affordable Care Act, also known as Obamacare, as they can exclude pre-existing conditions, preventive care, prescription drugs, mental health, maternity care etc.
Fixed Indemnity Plans
Fixed Indemnity Plans provide medical network discounts and offer cash back for specific services, such as doctors visits, x-rays and labs, hospitalization, and prescription drugs. They are considered supplemental plans and exclude pre-existing conditions for one year.
Medicare Supplement Plans
Medicare Supplement plans are offered through private insurance companies. These Medigap plans help pay some of the hospital and medical costs that Original Medicare doesn't cover, such as copayments, coinsurance, and yearly deductibles.
Prescription Drug Part D Plans
Prescription Drug Part D Plans can be added to Medicare Part A (Hospital) and Medicare Part B (Medical) to pay for medications
Areas we serve in-person include all of Palm Beach and Broward counties ,including and not limited to, Delray Beach, Boca Raton, Highland Beach, Boynton Beach, Lake Worth, West Palm Beach, Deerfield Beach, Pompano Beach, Coconut Creek, Coral Springs, Parkland, Fort Lauderdale, Jupiter, Sunrise, and Hollywood.