WHY BUYING HEALTH INSURANCE TODAY REQUIRES A TRUSTED ADVISOR
From Day 1, Jerry S. Pearlstein Insurance Ltd. has been dedicated to providing entrepreneurs, sole practitioners, artists and 1099ers with benefits big companies provide their employees. Individual/family health insurance has proved the most important and the most complicated.
If you are under 65, the Affordable Care Act (Obamacare) governs the major medical health insurance available to you. Download How ACA Has Changed here.
- Individual/family major medical health insurance must be a “Qualified Health Plan” with benefits and protections defined by the Act. They include universal acceptance, maximum out-of-pocket expense limits, no claim limits, free wellness services and more.
- Many companies that provide group health insurance have chosen not to serve the individual/family market. For 2018 (and 2019) there are only 3. Only one serves Chicago and all the surrounding counties.
- Not all plans cover all doctors and hospitals. It is critical to know that the doctors and hospitals you want to use are covered by the plan you buy. While the government Marketplace (Exchange) has all the plans, they don’t have accurate information of plan coverage in our area. We do.
- The Act limits when you can buy or change your individual/family health insurance. Open Enrollment is November 1 – December 15. A “life qualifying event” triggers a Special Enrollment Period. Events include losing your job with benefits, turning 26, marrying, divorcing, adding or losing a dependent, moving. You must apply within time limits of the event and provide specified proof of the event.
- The government offers assistance paying premiums (tax credits) as well as cost sharing of out-of-pocket expenses like deductibles, co-pays and out-of- pocket maximums. The assistance is given based on annual projected gross household income.
We are fully accredited by the state and federal governments to get you the plan you need and any assistance you are eligible for. We have been 90+% successful in determining your eligibility for assistance and getting it for you.
- Group health insurance complies with the Affordable Care Act.
- It covers all doctors and hospitals.
- It can be started at any time.
- While a business must offer the insurance to all owners and employees, only one needs to participate.
- A Special Enrollment Period, November 15-December 15, waives requirements for a percentage of enrollees and contribution by the owner.
Non-compliant health insurance is available.
- Catastrophic and Indemnity plans offer more access to care and are less costly than ACA plans.
- BUT they are not Qualified Health plans. They do not offer universal acceptance. They do not offer benefits like free wellness visits.
- In 2018 a tax penalty of up to 2.5% of adjusted gross household income may be levied by the IRS for not having ACA health insurance. The penalty is scheduled to disappear in 2019.