Health Assessment Step 1. Calculate Rates & Subsidy


Know your health insurance options in 2014

2014 Health Plan Options

Medical Insurance for Public On-Exchange Metal

Health Coverage for Public On-Exchange SHOP

Medical Insurance for Private Off-Exchange Metal

Health Coverage for Private Off-Exchange Group

Health Plans for Short Term Medical (STM)

Health Plans for Fixed Indemnity Plan (FIP)

Health Insurance Quotes for CHIP-Child Medicaid

Health Insurance for Medicaid & Medicare

The Affordable Care Act (ACA) imposes the Individual Mandate, which requires you to be covered by Minimum Essential Coverage (MEC) or pay a tax penalty on your federal tax return.

Insurance polices that meet the MEC requirement must provide all Essential Health Benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements as required by ACA, including guaranteed coverage regardless of pre-existing conditions and Minimum Loss Ratio (MLR) refund rules.

Unless you're covered by an existing government, military or tribal plan, you must be covered by a MEC plan or pay a tax penalty on your federal tax return. For plan year 2014, the penalty is $95 for an individual, maximum $295 per family, or 1% of your income, whichever is greater.


2014 Health Plan Matrix

ACA Provisions ONX
Metal
ONX
SHOP
OFFX
Metal
OFFX
Group
OFFX
STM
OFFX
FIP
Medicaid (Income Qualification) Medicare (Age and Disability Qualification)
Eligible for Government Tax Subsidies Yes
Minimum Essential Coverage (MEC) Yes Yes Yes Yes Yes Yes
Guaranteed issue coverage regardless of health Yes Yes Yes Yes Yes Yes
Pre-existing conditions covered Yes Yes Yes Yes Yes Yes
ACA Compliant policy limits and cost sharing Yes Yes Yes Yes N/A N/A
Minimum Loss Ratio (MLR) refund rules Yes Yes Yes Yes N/A N/A
Essential Health Benefits ONX-Metal ONX-SHOP OFFX-Metal OFFX-Group OFFX-STM OFFX-FIP Medicaid (Income Qualification) Medicare (Age and Disability Qualification)
Ambulatory Yes Yes Yes Yes Yes Yes Yes Yes
Emergency Yes Yes Yes Yes Yes Yes Yes Yes
Hospitalization Yes Yes Yes Yes Yes Yes Yes Yes
Lab & X-Ray Yes Yes Yes Yes Yes Yes Yes Yes
Maternity Yes Yes Yes Yes Yes Yes
Mental/Nervous Yes Yes Yes Yes Yes Yes
Pediatric Oral Vision Yes Yes Yes Yes
Prescription Yes Yes Yes Yes Yes Yes Yes Yes
Preventive Yes Yes Yes Yes Yes Yes
Rehabilitation Yes Yes Yes Yes Yes Yes Yes
Substance Abuse Yes Yes Yes Yes Yes Yes
Enrollment ONX-Metal ONX-SHOP OFFX-Metal OFFX-Group OFFX-STM OFFX-FIP Medicaid (Income Qualification) Medicare (Age and Disability Qualification)
Public Government Exchange Yes Yes N/A N/A
Private Exchange Yes Yes Yes Yes Yes Yes N/A N/A
Employer Yes Yes N/A N/A


Minimum Essential Coverage (MEC)

Public Exchange Individual Metal (ONX-Metal)

Bronze, Silver, Gold, Platinum - 'Metal' insurance plans that are listed on the Public Federal/State Exchange and are eligible for cost reduction subsidy discounts. These plans are subject to ACA and provide all Essential Health Benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements as required by ACA, including guaranteed coverage regardless of pre-existing conditions and Minimum Loss Ratio (MLR) refund rules. These plans satisfy the Individual Mandate.

Public Exchange Group Metal (ONX-SHOP)

Bronze, Silver, Gold, Platinum - 'Metal' insurance plans that are listed on the Public Federal/State SHOP Exchange and are NOT eligible for cost reduction subsidy discounts. SHOP plans are available to small businesses and offer the employer a tax credit if certain requirements are met. SHOP plans are subject to ACA and provide all Essential Health Benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements as required by ACA, including guaranteed coverage regardless of pre-existing conditions and Minimum Loss Ratio (MLR) refund rules. SHOP plans satisfy the Individual Mandate.

Private Exchange Individual Metal (OFFX-Metal)

Bronze, Silver, Gold, Platinum - 'Metal' insurance plans that are NOT listed on the Public Federal/State Exchange and are NOT eligible for cost reduction subsidy discounts. Not all carriers offer subsidized public exchange plans. Some may offer different plans on the private exchange. These plans are subject to same rules as Public ONX-Metal plans and provide all Essential Health Benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements as required by ACA, including guaranteed coverage regardless of pre-existing conditions and Minimum Loss Ratio (MLR) refund rules. These plans satisfy the Individual Mandate.

Private Exchange Group Metal (OFFX-Group Metal)

Group Metal insurance plans are only available through your employer. These plans are NOT listed on the Public Federal/State Exchange and are NOT eligible for cost reduction subsidy discounts. Employers pay a portion of the premium, with the remainder withheld from employee wages in payroll. OFFX-Group Metal plans are subject to same rules as ONX-Metal plans and provide all Essential Health Benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements as required by ACA, including guaranteed coverage regardless of pre-existing conditions and Minimum Loss Ratio (MLR) refund rules. OFFX-GMM plans satisfy the Individual Mandate. If your portion of the premium is greater than 9.5% of your income, you may qualify for a premium assistance subsidy to purchase a ONX-Metal plan on the Public Federal/State Exchange.

Open Enrollment Bridge Plans

Private Exchange Short Term Medical (OFFX-STM)

Short Term Medical insurance plans are limited to 12 months of coverage and are NOT listed on the Federal/State Marketplace/Exchange and are NOT eligible for cost reduction subsidies. These plans are NOT subject to ACA and therefore have limits and exclusions of certain Essential Health Benefits such as maternity coverage, mental illness or pre-existing conditions. You must be in good health without certain health conditions to be purchase a short term medical bridge plan. These plans are an extremely affordable 'bridge' for people that need insurance coverage until the annual open enrollment period (AEP), or that chose not to purchase a metal plan. These plans do NOT satisfy the Individual Mandate.

Private Exchange Fixed Indemnity Plan (OFFX-FIP)

Fixed Indemnity insurance plans are NOT listed on the Public Federal/State Exchange and are NOT eligible for cost reduction subsidies. Fixed indemnity plans are NOT subject to ACA and therefore have limits and exclusions of certain Essential Health Benefits such as maternity coverage, mental illness or pre-existing conditions. You must be in good health without certain health conditions to be purchase a fixed indemnity plan. Rather than pay your medical bills directly, fixed indemnity plans pay a fixed cash benefit to you for different accidents or illness. For example, depending on the plan, you might receive $2000 per day if hospitalized, or $400 per ER visit. If you cannot afford a Metal plan, a fixed indemnity plan is an affordable alternative. Fixed indemnity plans do NOT satisfy the Individual Mandate.

Supplement Plans

Accident (OFFX-Accident)

Accident plans are a vital component to a family health plan, especially when you still have small children or live an active lifestyle. Out of pocket expenses such as major medical deductibles, prescriptions, and lost hours at work add up quickly. These plans provide immediate cash benefits for expenses your major medical plan does not cover. Most Hybrid plans will bundle an accident plan to offset the higher deductible, and is an excellent way to lower your total plan cost.

Critical Illness (OFFX-CI)

Critical Illness plans play a key roll in paying for expenses related to a major illness. This not only helps provide cash for things that your base major medical plan does not cover, it also provides cash benefits for out of pocket expenses such as deductibles and copays. Premiums for major medical coverage continue to increase rapidly, and as they do people choose higher deductibles to reduce their premiums and stay on budget. Adding the appropriate critical illness coverage to a major medical policy with a high deductible is much more cost effective than trying to buy down your out of pocket expense with a low deductible major medical plan. Most Hybrid plans will bundle critical illness coverage with a high deductible to save thousands in annual major medical premiums.

Dental (OFFX-DENTAL)

Dental insurance helps keep your teeth and gums healthy and protects against unexpected dental expenses. Regular dental care can mean more than a brighter smile, it could also mean better overall health. Dental plans are NOT listed on the Public Federal/State Exchange and are NOT eligible for cost reduction subsidies. Dental plans are NOT subject to ACA and therefore have limits and exclusions of pre-existing conditions. Dental plans do NOT satisfy the Individual Mandate.

Vision (OFFX-Vision)

Vision insurance helps with cost of contacts, frames and lenses. Vision plans are NOT listed on the Public Federal/State Exchange and are NOT eligible for cost reduction subsidies. Vision plans are NOT subject to ACA and therefore have limits and exclusions of pre-existing conditions. Vision plans do NOT satisfy the Individual Mandate.

Government Programs

Children's Health Insurance Program (CHIP)

CHIP-Child Medicaid The Children's Health Insurance Program (CHIP) provides health coverage to families with incomes too high to qualify for Medicaid, but can't afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage. People covered by CHIP are exempt from the Individual Mandate.

Medicaid

Medicaid provides health coverage for people with income below 133% of the Federal Poverty Level, families and children, pregnant women, the elderly, and people with disabilities. Medicaid programs must follow federal guidelines, but they vary somewhat from state to state. People covered by Medicaid are exempt from the Individual Mandate.

Medicare

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). People covered by Medicare are exempt from the Individual Mandate.

Tricare and Veterans Health

Tricare and Veterans Health is the federal health insurance program for military and veterans. People covered by Tricare or Veterans Health are exempt from the Individual Mandate.