How Health Insurance Works

The healthcare coverage provided for most Americans is through their employer. Over 155 million receive their health coverage through their jobs. Tens of millions more receive health care coverage through government programs like Medicaid, Medicare, and the VA. But as of 2017, almost 28 million Americans do not have health insurance coverage and that number is once again increasing due to cost. For the uninsured, most would like to find affordable health care protection. As they pursue health coverage, one of the first options considered is through an online enrollment application at Healthcare.gov. This is the most common route when they are looking for Affordable Care Act (ACA) compliant coverage, also known as Obamacare.

Obamacare plans are considered comprehensive coverage because the federal government mandates each plan offered cover 10 essential health benefits. These benefits include maternity, prescriptions, mental health and substance abuse, as well as other important services. With a health plan that provides comprehensive benefits there is a higher premium. In order to make the coverage more affordable, the federal government will pay part of the monthly premiums in the form of financial subsidies, for those with lower incomes.

The subsidies are paid out to the tune of millions of dollars, to the four insurance companies in Georgia that offer Georgians health coverage through Healthcare.gov. They are Kaiser, Blue Cross Blue Shield, Alliant, and Ambetter. For the uninsured, if your income qualifies you for financial assistance through subsidies, these are the four choices of companies for coverage. The unfortunate news is that even with subsidies, Obamacare health insurance is still unaffordable for many individuals and families.

Moving beyond government financed health insurance, the plan that I believe warrants consideration for those without insurance, is called Limited Term Health Insurance. Many of these plans have been enhanced for 2019, due to changes in rules and regulations governing the plans. The Term Health Insurance policy, for many, is an excellent option for affordable “major-medical” health coverage. These plans are now available in Georgia but they are NOT Obamacare compliant plans and DO NOT cover all the benefits that Obamacare covers. As a result, they are not a substitute for an ACA compliant/Obamacare plan. The key point is that for those who have no health coverage, these plans present an excellent option for some limited coverage and are definitely worth learning about.

For Solopreneurs and small business owners, in tailoring a Benefits Plan, we start with health insurance.

We consider an ACA compliant (Obamacare) plan for you or your business through healthcare.gov. We then consider a Term Health Insurance plan, for you and/or for your individual employees. The preferred plan I recommend is through UnitedHealth. UnitedHealth Group and its subsidiaries is the largest health care organization in the country with over $225 billion in revenue and over 300,000 employees.

With both ACA compliant Obamacare health plans, as well as with Term Health Plans, there can be significant cost sharing, which occurs in the form of deductibles, coinsurance, and co-pays. Cost sharing amounts are in addition to the monthly premiums you pay. More and more Americans, even with employer-based health insurance, are having to factor into their budget each year, increasing deductibles and coinsurance amounts. The increasing deductibles and coinsurance percentages are in addition to the annual increases in monthly premiums. Make no mistake, if you haven’t noticed, healthcare coverage can be expensive!

Once the decision on a health plan is determined, and based on your benefits budget, we then consider the other insurance plans that help close the financial gaps that illness and injury can cause. Depending on the severity of the injury or illness, the financial gaps can be quite large. To close that gap, we evaluate several other benefits including accident, hospital, critical illness, and disability insurance plans.