We understand individual health insurance and Medicare can be complicated. Our expert advisors are here to help you understand your options and choose the best plan for your unique situation.
Individual Health Plans for Under Age 65
Individual health insurance plans are designed for individuals and families who cannot obtain health insurance through an employer.
Our individual health advisors can help you understand your options and walk you through every step of the application process. Healy Individual Health offers a wide variety of health insurance programs for individuals and families, including:
Short term medical plans bridge a gap in your medical coverage caused by losing group coverage. The gap is typically less than 120 days while you wait to become eligible for a new employer health plan. If there is no planned start date for a new employer plan, you might consider a more permanent option offered by a Marketplace plan.
Short term plans require medical underwriting and can only be in force for up to 364 days before a new policy would need to be written. The coverage can take effect immediately but there are limitations on preexisting conditions and should be considered a catastrophic policy.
Marketplace plans are permanent health insurance options that provide the most protection for individuals that are not able to attain health insurance through an employer. Marketplace plans have specific enrollment periods where individuals can enroll in a new plan.
Losing group coverage is the most popular reason to qualify for a special enrollment period. Otherwise, individuals must wait for the annual election period which runs from November 1 to December 15 each year. Keep in mind that plans start on the first day of the month after you enroll.
Premiums for marketplace plans are adjusted based on your household income, making these plans more affordable for individuals and families.
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Medicare Health Plans for Over 65 or Disabled
Is your head spinning trying to understand your Medicare options? You aren’t alone.
Here’s a short summary:
- Medicare coverage is available for those individuals that are
deemed permanently disabled by the Social Security
Administration or 65 years of age or older.
- Medicare consists of two parts (Part A and Part B) and is
designed to cover medical care that is deemed medically
- Part A include coverage for hospitalization, hospice care, short
term stays in a rehab center and blood transfusions.
- Part B covers all medical related expenses including but not
limited to outpatient surgeries, laboratory tests, x-rays,
physical therapy, and doctor’s appointments.
- Medicare does not cover prescription drugs, dental, hearing
and glasses/contacts. However, prescription drug coverage is
mandatory and every individual that is Medicare eligible must
be on a creditable drug plan.
- Part A is typically offered at no cost, assuming you meet the
eligibility criteria while Part B has a monthly premium assigned
that is based on your household income.
- In addition to enrolling in Medicare, you should consider
purchasing a Supplement (Medigap) plan along with a
standalone prescription drug plan or an Advantage plan that
would include a prescription drug plan. Both options provide
financial protection when presented with a medical event that
is covered by Medicare guidelines.
Our expert advisors can answer your questions and help you understand your options and choose the best plan to fit your situation, including:
There are a variety of Supplement plans available with the most popular being F, G and N. There are other plans available, and each provides specific parameters for payment of covered medical related expenses.
Supplement plans respond to claims after Medicare has made a coverage decision. If Medicare denies a claim, the supplement will not provide any coverage. The monthly premium cost of a supplement is more than an Advantage plan, but you will not have to navigate a network of providers and the out-of-pocket expenses are much less when services are rendered.
An Advantage plan, also known as Part C, combines Part A and B along with Part D (in most cases) to provide a single source for your medical care. You continue to pay for Medicare, but your carrier determines all coverage decisions, versus Medicare if you purchase a Supplement.
Advantage plans have a much lower premium than Supplements but typically require the participant to pay some amount when services are rendered. Plans have a maximum out of pocket limit, which protects participants from a major financial impact should they encounter a significant medical event.
Advantage plans are very similar to group/employer plans as they often include copays, coinsurance, deductibles and out of pocket maximums, along with a network of medical providers.
All Medicare eligible individuals must maintain creditable prescription drug coverage (Part D) or be subject to a penalty if enrollment is delayed. Part D can be purchased as a standalone product when combined with the purchase of a Supplement plan or included with most Advantage plan options.
If you continue working beyond your 65th birthday and you are covered by your employer-sponsored health insurance, you will receive an annual notice from the carrier that indicates whether your plan is creditable or not with regards to Medicare established guidelines. Some individuals might have continued access to prescription drug coverage after they retire through union or other retiree benefits, but most need to purchase a plan when they enroll in Medicare.
Medicare is complicated.
Need dental insurance or other ancillary products? Healy Individual Health can help you every step of the way, from choosing the best product to completing the application.
Dental insurance is important to consider at all ages but especially as you approach Medicare age and beyond. Advantage plans often include preventative dental coverage and a small limit for additional services, while traditional Medicare only covers simple tooth extractions.
Individuals can purchase a standalone dental plan that provides coverage for routine cleanings along with money available to help offset the cost of other services such as filings, crowns, and bridges. Dental plans can also provide orthodontia coverage for families with children under the age of 18.
Vision coverage includes the cost of the eye exam along with allowances for frames and lenses or contact lenses depending on the plan chosen.
Hospital indemnity plans can be purchased in conjunction with any individual medical insurance plan. The policy will provide access to cash should you be hospitalized and meet the plan requirements, to help cover the cost of deductibles or other costs associated with your hospital stay.
Critical Illness policies provide access to cash should you encounter an illness or medical event that is covered by the terms of the policy such as a heart attack, cancer, stroke, or other major illness. The money can be used for non-traditional expenses associated with the illness such as childcare or transportation costs to the medical facility.
If you plan to travel outside the United States, it is best to purchase a travel medical policy. There is often coverage for emergency care under an individual or group health insurance policy, but there are many additional benefits of a travel medical policy. Assistance with evacuation in the event of a natural disaster or civil unrest are some of the benefits along with repatriation of remains and medivac services.
Your individual or group health insurance plan often covers medical emergencies, but many medical providers want payment before services are rendered. You will be asked to pay for the event and then seek reimbursement when you return. Purchasing a travel policy will make the claims process seamless and allow you to travel with added peace of mind.
Life insurance can help with burial and other final expenses so you can preserve your resources for gifting and other needs.
Prepare for future expenses associated with your need for extra help as you continue to age. Whether you need 24/7 care at a nursing home or want to stay at home with hired help, long term care insurance will help lessen the financial responsibility. Several options exist to meet your unique situation.
Individual and Senior Health Benefits
Individual and Senior Health Benefits Advisor & Risk Advisor
More about Carsten
Carsten Schmidt is an Insurance Advisor focused on personal insurance products including, home, auto, life, and health insurance. He also assists individuals with Medicare enrollment along with offering long-term care insurance products.
Carsten is the President of Bethany Miracle Village, Inc. which is a nonprofit organization he established with his wife Renee to serve the people of Kikube Village in Uganda. Over the last five years, the organization has constructed a nursery school and primary school on 22 acres of land that is now enjoyed by over 500 students. The campus has 10 acres dedicated to teaching eco-friendly farming and animal husbandry techniques to promote the sustainability of the earth’s resources.
Carsten is Past-President of the South Bend Rotary Club where he served in many capacities since joining the club in 1998. In addition, he is the Past-President of the board of Leadership South Bend/Mishawaka. Carsten is active in Holy Family Parish where he previously chaired the Finance Council and Parish Council.
Individual and Senior Health Benefits Administrative Associate
More about Kelci
Kelci Schmidt is a graduate of Indiana University in Bloomington with an English degree. After graduation, Kelci lived in Portland, Oregon, for several years before returning home where she decided to join her father in the insurance business.
She earned her Health and Life license in the fall of 2021 and completed her American Health Insurance Plans (AHIP) certification in 2022. Kelci provides administrative support in addition to offering individual health insurance options, including Marketplace and Medicare-related products to our clients. She lives with her best friend Clementine, a rescue dog and loyal companion with a gentle spirit.