By Trish Pearson
Insure Your Future
Trish Pearson
If you google “affordable health insurance plans for individuals,” a variety of responses appear. They are listed as cash pay health plans, faith-based plans or “medishare.” Some ads even show the logo for well-known insurance companies, which makes them look more legitimate.
In Connecticut, individual health insurance is only available through the health exchange. The two companies that participate are Anthem Blue Cross Blue Shield and ConnectiCare. These are Affordable Care Act plans, which means they must conform to all the benefits that are included in the ACA. The non-ACA approved plans, such as those mentioned above, may include restrictions and exclude preexisting conditions or health issues that occur within a given time frame after the policy is in effect.
Specifically, the non-ACA plans do not have to cover everything from day one. Over the past month I have received two calls from people who purchased one of these plans and were subsequently diagnosed with a serious medical condition, only to discover that conditions diagnosed within the first 30 days were not covered. This made the insurance worthless. Fortunately, we were able to find a path to getting them proper coverage outside of the open enrollment period.
There are several main differences between ACA and non-ACA plans. Not as many medical conditions may be covered in the non-ACA plans. Preexisting conditions such as diabetes, cancer, heart disease or other chronic conditions may be excluded but cannot be excluded on ACA plans. There may be a maximum amount that a non-ACA plan will cover, whereas an ACA plan provides a maximum out-of-pocket amount that a person can be expected to pay. Non-ACA plans do not have to cover screenings such as mammograms, colonoscopies or physicals, whereas ACA-compliant plans do. There is also no “anonymous shopping” on non-ACA plans; you cannot get a quote without providing a phone number and email address (it’s not hard to figure out why). Anyone can get an estimate of plans and cost for ACA plans by going to accesshealthct.com, putting in some basic information such as county, age for each person who needs coverage and adjusted gross income. There is no tracking or record kept unless you create an account. Finally, medications may or may not be covered on the non-ACA plans.
The non-ACA plans are not underwritten by an insurance carrier, but rather create a pool of money which is funded by the premiums from which they pay claims. However, if someone needs insurance outside of the annual open enrollment period of Nov. 1 to Jan. 31 and they do not qualify for a special election period (change in life circumstances), there are short-term insurance policies which do provide basic coverage and are backed up by insurance companies.
Remember, if it looks too good to be true it probably is. You get what you pay for, not what you may expect. If you are considering purchasing a non-ACA plan, consult a professional who can make sure you understand the limitations and confirm that there are no other options available.
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or [email protected].
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