It’s more important than ever to make sure you and your family have the health insurance you need to stay healthy and happy. Luckily, you also have more options than ever when it comes to choosing the health plan that’s right for you. Between the ACA Health Insurance Marketplace, short-term health insurance, health share plans, and more, there’s something for everybody. So if you’re still unsure and need help shopping for the right plan, you’ve come to the right place.
Major Medical Insurance in Iowa
Back in March of 2010, the Patient Protection and Affordable Care Act (AKA “Obamacare”) was passed into law. Love it or hate it, this legislation has helped millions of Americans find affordable, comprehensive health coverage that has even been credited with saving lives. But the laws regarding the ACA have changed recently, and it’s important for you as a consumer to know how these changes will affect you and your family while shopping for health coverage.
For starters, there is no longer an individual mandate on the federal level, which means you won’t be charged a financial penalty for not having coverage when you file your taxes in April. But it’s still a really bad idea to gamble with your finances by choosing not to purchase coverage. That’s why millions of Americans still sign up for a plan during Open Enrollment (November 1st – December 15th) every year. All you have to do is fill out a simple application at HealthCare.gov and you’ll be able to shop for a plan that same day. You may even qualify for a generous subsidy.
There are a few reasons why ACA plans are preferred by people who don’t won’t or can’t get qualifying coverage through their employer – not the least of which is their guaranteed issue status. Guaranteed issue major medical insurance policies are those that cannot reject you for coverage, no matter how sick you may be when you apply. Furthermore, your preexisting conditions can’t be used against you as an excuse to jack up your premiums and make your coverage prohibitively expensive. Even if you’re considered “high risk”, the only things that can justify a higher premium for you are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another reason these plans are so popular is because you are guaranteed to get all 10 of the Essential Health and Wellness Benefits that medical experts agree are necessary to provide effective, low-cost, preventative care for patients. Those benefits are:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Lastly – and most importantly for many people – are the subsidies that most Americans qualify for. As long as your annual income is between 138% – 400% of the federal poverty level based on your household size, you’ll qualify for a subsidy which will make your monthly premiums that much more affordable. For many Americans, these generous subsidies mean the difference between whether or not they can actually afford their healthcare. Take a look at the chart below to see whether or not your income might make you eligible for a subsidy.
|Household Size||Annual Income (138% of FPL)|
If your income is below 138% of the FPL, you won’t qualify for a federal subsidy and will likely have to pay for an ACA plan completely out-of-pocket. But there is one other option for Iowa residents: Medicaid. Not only has Iowa agreed to accept federal funds to expand Medicaid to certain low-income individuals, but as long as your income is 133% or below the FPL, you don’t have to be disabled or pregnant in order to qualify; low-income, able-bodied adults can still apply and likely receive coverage. For more information on eligibility requirements or to apply online, you can visit the Iowa Department of Human Services website.
Short Term Health Insurance in Iowa
Iowa has more stipulations in place to make ACA plans and subsidies easily accessible and affordable for most residents. But what happens if you still don’t qualify for a subsidy, or if the plan you qualify for is still unaffordable? Well, you might want to look at short-term health insurance. These relatively low-cost health plans wouldn’t necessarily exempt you from the individual mandate if it were still the law of the land, but they can protect you from catastrophic healthcare costs for up to 3 years if you choose to stay covered by one of these plans.
What’s so special about short-term health insurance? For one, your average monthly premium costs about 33% less than the monthly premium of an unsubsidized ACA major medical plan. And although you won’t get all 10 of the Essential Health Benefits, you will likely have an option to purchase most of the benefits you need when you sit down with an insurance agent to build your plan. Some plans will even let you add extras like dental, vision, or an indemnity supplement. These organizations operate independently of the federal government, so you won’t have to fill out an application at HealthCare.gov if you want short-term insurance. But just because the government doesn’t have any hand in the day-to-day business doesn’t mean there aren’t helpful regulations and consumer protections for you. If you feel your short-term health insurance provider isn’t making good on the benefits they promised you, you can take them to court and dispute any unpaid or insufficiently paid claims.
And while many of those short-term health insurance benefits are attractive to many people, there are some drawbacks you might want to consider before making a purchase. These plans will require you to submit yourself for medical underwriting, which means no guaranteed issue status. If you have a preexisting condition, your short-term health insurance provider can and likely will either refuse to sell you coverage, or charge you a much higher rate than a low-risk, healthier person. You’ll likely have to pay a high deductible (usually $5,000 or more) in out-of-pocket costs before your benefits will kick in and your health insurance provider will start paying out your claims. Short-term health insurance doesn’t have caps on your total out-of-pocket costs; but you will likely face lifetime and annual caps on the benefit payouts you are eligible to receive. And even if you want all of the Essential Health Benefits and are willing to pay for them, most short-term health insurance companies simply won’t offer to sell you that type of coverage (mental health services is a common example) because of how prohibitively expensive it is.
Christian Health Plans/Health Share Plans in Iowa
The heyday of the Christian health plan/health share plan occurred during the earlier years of Obamacare when the individual mandate was still a requirement. Like many things in the US, there was a religious exemption for individuals who purchased a Christian health plan instead of shopping for coverage through the ACA. But don’t be confused: these plans don’t meet all of the legal requirements to qualify as equivalent to a major medical plan from the Health Insurance Marketplace. That being said, many people find them to be a cost-effective, viable alternative to major medical coverage.
On paper, health share plans seem to have a lot in common with short-term health insurance. Just take a look at their many similarities:
- No guaranteed issue status
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
At the same time, though, these types of plans are very different from one another. Participation in these plans is considered voluntary, meaning you don’t have a contract between you and your provider. This lack of a contract means that you don’t have any legal rights or consumer protections if, for example, they decide to refuse to pay out on your medical claims. You will also be expected to follow “participation guidelines” which could be as simple as ending all tobacco use and declaring a specific faith to signing a contract that affirms your belief in specific religious values. When you’re paying for your health share plan costs, you’ll pay a “monthly share amount” instead of a monthly premium, and you’ll likely end up paying an “unshared amount” or a “personal responsibility amount” instead of deductibles, copays, or coinsurance.
Fixed Indemnity Plans in Iowa
Fixed indemnity plans – whether you’re looking at a hospital plan, a doctor plan, or some sort of combination – are more useful as a supplement to major medical insurance rather than a replacement. They can even be helpful for supplementing your out-of-pocket costs with a short-term health insurance or a health share plan. What we’re saying is that these plans, on their own, don’t offer enough benefits or coverage to qualify as a legitimate replacement for qualifying ACA coverage. But they are beneficial if the monthly premiums are less than what they pay out in medical claims.
The “fixed” part of fixed indemnity describes the fixed amount of money that gets paid out per day, per week, per month, per incident, or per visit, as determined by your plan. These payments likely won’t cover all of your medical costs, but they can certainly help. But you’ll have to deal with the same annual/lifetime benefit caps, as well as the lack of guaranteed issue protections. You may still end up getting rejected or charged substantially more by your provider for having preexisting conditions, just like you would with a Christian health plan or short-term health insurance.
Discount Cards in Iowa
Medical discount cards have one very important thing in common with fixed indemnity plans: they can be a great way to take the edge off your out-of-pocket medical costs, no matter what type of coverage you already have – but they are not an adequate replacement for major medical coverage. They work similarly to something like AAA or AARP: you pay a fee, usually monthly or annually, to participate in the discount card program. After that, you start using your card at participating retailers and providers once you receive it in the mail. You’ll get a discount off your medical expenses and purchases when you pay, and you won’t have to deal with filing claims or waiting for reimbursements.
Medical discount cards in Iowa can save you money on prescription drug costs, vision care, dental care, and some select medical services. But make sure you do some research into your medical discount card provider before you sign up for a plan, especially if it seems like it might be too good to be true. It’s not unheard of for discount card companies to fudge the numbers on how big of a discount you might receive, or who is actively participating in their program. All it takes is a few phone calls to figure out whether their advertised savings are as good as they promise. But finding the right medical discount card can be an essential part of curbing your out-of-control, out-of-pocket medical costs.