Individual and Senior Health Benefits

BUSINESS INSURANCE

Individual Health Plans for Medicare Beneficiaries

Carsten Schmidt

Individual Insurance Advisor

Kelci Schmidt

Individual Insurance Associate

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

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

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.

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 necessary.
Part A includes coverage for hospitalization, hospice care, short term stays in a rehabilitation 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 D 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.

Type of Plans

Our expert advisors can answer your questions and help you understand your options and choose the best plan to fit your situation, including:

Supplement Plans

There are a variety of Supplement plans available with the most popular being 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. 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.

Medicare is complicated.

Advantage Plans

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.

Prescription Drug Plans

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.

We Can’t Wait to Meet You

If you have any inquiries for us, please don’t hesitate to reach out. We would be happy to respond to your queries.

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HEALY GROUP

Individual & Senior
Health Benefits