Individual Medical Insurance Coverage - What you need to know

Individual Medical Insurance Coverage – What you need to know

There have been many changes to individual health and medical insurance plans for the last few years and it’s important to know the key components to get the right coverage for you and your family.

The basics of Individual Medical Plans

Individual Medical Plans are regulated by the government and are described as “metal levels”, Platinum, Gold, Silver, and Bronze.  Simply, the differences are the monthly premium amount, co-pays and coinsurance cost shares between the insurer and subscriber for the benefits.  Individual plans are age and generally, modified community rated. They are also allowed to impose a tobacco use surcharge.

Pre-Existing Conditions and the Ten Essential Minimum Benefits

Insurers cannot exclude coverage for pre-existing conditions and must include Ten Essential Minimum Benefits to be ACA compliant:

  1. Ambulatory care
  2. Emergency services
  3. Hospital coverage
  4. Pregnancy/maternity and newborn care
  5. Pediatric services (including dental and vision)
  6. Mental health and addiction treatment
  7. Prescription drug benefits
  8. Rehabilitative coverage
  9. Laboratory services
  10. Preventative services and chronic disease management

The Individual Mandate and required health insurance – Is it still required?

The individual coverage mandate was discontinued in 2019.  However, the enrollment timeframe and accepted eligibility events have mostly remained the same.  You must have a qualifying event or enroll at open enrollment time. The time frame has been from November 1 to January 15th annually.

How we can help…

Individual Health Insurance is available directly with our partners, Regence, Likewise, and Kaiser Permanente for select plans. Additional insurer and tax subsidized options are available directly on the WA Healthplanfinder. For a direct plan quote, check of eligibility and enrollment, visit our Individual Medical page and choose form our list of partners.

To have one of our licensed agents review your options to see what is best for you and your family please fill out a quote request form  or give us a call.

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