Health Insurance Options

Reviewed: November 20, 2014
By FinanceWeb

Customized Private Approaches

There are health insurance options outside of the Affordable care Act. One can get private insurance contracts directly from health insurance companies, authorized brokers and sales agents. Although nearly every policy has been influenced to some extent by the fundamental reforms of the national health care reform effort, one can find greater ranges of choices and flexibility in the private market. Shopping through an agent or broker can allow a broad search of the market for particular elements. For example, among the leading hospitals in the U.S., many do not accept the insurance providers available on healthcare exchanges. Of the top U.S. Hospitals, only two are required to accept every form of insurance by the laws of the state that created them; they are Massachusetts General and Johns Hopkins University Hospital.

Open Season Limits

In the ACA health care exchanges, there are authorized enrollment periods. Beginning November 15 of each year and continuing until the new year. Individual enrollments stop after open season unless one qualifies for a life events exception, such as childbirth or death of the insurance provider spouse. Some people may wish to acquire interim coverage, and the private market can meet these needs. There may be situations involving minors and parents in shared custody in which private insurance provides the desired coverage and flexibility for services. Many ACA plans are essentially local in character, and they may not easily accommodate persons who must live in different geographic areas for parts of the year. HMO and PPO networks either limit or penalize out of network services, and this might cause higher out of pocket expenses and co-insurance costs.

Employer Health Insurance Options

Employers are a major source of health insurance coverage in the United States. These health insurance benefits often provide a large number of choices for individual and family coverage. Given the employer’s contribution, the costs may be significantly lower than comparable insurance purchased on an exchange. For some consumers, employer plans may not provide the necessary mix of services or service locations. Some consumers require specialists not available through a company plan without significant additional costs. Employees who opt for ACA plans can use their tax credits to reduce the monthly costs of premiums.

CO-OP Health Insurance Options

These organizations are a specialized part of the Affordable Care Act, and they are sufficiently different to warrant explanation. The Affordable Care Act authorized loans and assistance from the Centers for Medicare and Medicaid Services to form Consumer Operated and Oriented Plans. And many states have at least one such organization. These non-profit structures provide direct services and contract for network coverages in defined service areas. They are noteworthy for the direction of reducing costs, increasing competition, and returning profits to value for the consumer-owners. One such CO-OP in Colorado was able to drive its premium charges down by 12 percent from the first to second year of operations. The expected increase in medical services costs is a major driver of insurance premium increases. These CO-OP models have an important potential to drive costs down by plowing back profits and increasing service capacities without increasing costs to the consumer. Other firms seeking to expand market shares will have to compete with these lower cost trends.

Community and Culture Based Providers

In some areas with traditional ethnic communities, distinct minority groups, and near Indian Reservations, community-based programs have a special appeal and role. Language is a key factor for some communities that have retained their cultural identities. Community-based services may be a more effective brand of outreach and community engagement than other health resources. Examples are on the Chinese community-based service organizations in Northern California, and LGBT healthcare organizations in Colorado.

Companies Not On the Exchanges

While there are large numbers of high-quality insurers on the nation’s health insurance exchanges, some firms do not participate. To purchase insurance from these companies, one must use private sources. However, should a consumer purchase a plan that does not meet the standards of the ACA, they may have to pay a tax penalty as if not covered in 2015.