There are two ways of purchasing Individual Health Insurance. One way is to purchase the plan directly from the insurance company and the other way is buy those same plans though www.healthcare.gov aka as the “Obamacare” website. Below is a brief description of each. 2017 will be a very difficult year with Maricopa County losing United Healthcare, Assurant, Meritus, Humana, Blue Cross Blue Shield, Health Net, and Health Choice of Arizona. At this point there will only be three insurance companies offering small HMO based plans and the Department of Insurance has released approved rate increases of 58%-122.8%! Cigna, Aetna and Phoenix Health Plans will be the only insurance companies offered for 2017.

Off Exchange Health Insurance

This is where the consumer purchases the health plan directly from the insurance carrier’s website or broker portal. It is always a good idea to utilize the professional advice of a licensed broker as this is an easy insurance product to get wrong. Brokers serve as a valuable resources that can help a consumer navigate and understand doctors and hospital networks and the definitions and mechanics of your policy. Since health insurance prices are fixed by law it only makes sense to get free advice on such a complicated product. If someday insurance companies stop paying commissions then we may see a broker consulting fee come into play. The nice thing about buying “off exchange is that the consumer maintains a direct connection and ability to work directly with the insurance company on things like billing and claims. There is no “Obamacare representative” that you have to deal on behalf of the insurance company. The other nice aspect is that there is no burden of proof on the consumer for things like proof of income or wages. The only negative is the fact that those who qualify for a financial subsidy will not be able to receive the government assistance unless they purchase their plan via the “Obamacare” website www.healthcare.gov.

On Exchange Health Insurance

When we use the term “On Exchange” we are referring to purchasing your plan through the federal website www.healthcare.gov aka known as “Obamacare”. For our clients the only reason that people should purchase through this site is if we determine that the client is eligible for a sizeable subsidy. We don’t want to go through all the headaches and risks for audit that are attached to this process for a few dollars per month. We recommend that unless your subsidized premium is fairly substantial, and you are willing to provide lengthy documentation, that you consider not going “on Exchange” and purchase your plan“Off Exchange”. If that is not an option then we will help navigate the consumer through the process and help them choose the best plan for their needs. The benefits of the subsidized plans can be the reduction of monthly premiums as well as reduced copays, deductibles also known as “Cost Sharing”. Cost sharing only works on Silver level plans and the consumer needs to understand that a Silver level plan can often have benefits as good, or better benefits than a gold or even platinum level plan. The formula for determining a subsidy is a moving target determined by the amount and age of the people being insured relative to their household family income compared to the Federal Poverty Limit. This is a floating number and is determined each year and based off of the second lowest cost silver plan available in the local market. Bottom line is you want a FFM Certified licensed agent to guide you through this. All of our agents at Phoenix Health and Life Insurance are experience in this field.

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