There are other plans available year-round that are not individual major medical coverage. Most of these plans are not recommended as stand-alone coverage (with the exception of short-term plans, which can be adequate stand-alone coverage if you're healthy and you know that you need the coverage for only a short time; they are usually not at all adequate for longer-term coverage). These plans are not regulated by the Affordable Care Act, which means they can exclude pre-existing conditions, impose dollar caps on your coverage, and don't have to cover the ACA's essential health benefits. In most cases, these plans cannot really be compared with an employer-sponsored plan, since the coverage will be so much lower quality. If an insurance offer sounds too good to be true, read the fine print carefully. It may end up being a poor substitute for real health insurance, and you don't want to learn those details after you have a major claim.
A good place to start is HealthCare.gov. This is the health insurance exchange created by the The Patient Protection and Affordable Care Act, and is a one-stop shop for private individual market health insurance plans (note that the exchange itself is run by the government, but the health plans for sale in the exchange are all private, from the health insurance companies with which you're already familiar). People in 39 states use HealthCare.gov to enroll in individual market plans. The other 11 states and the District of Columbia have state-run exchanges, and you'll be directed to their sites from HealthCare.gov when you select your state.
Public health insurance is provided or subsidized in some way by the federal government. Medicare, Veteran benefits, and insurance provided to federal employees are all examples of public health insurance. Private health insurance, on the other hand, is provided by private companies. The CDC estimated that in 2017, 65 percent of Americans under age 65 were covered by private insurance.
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But the ACA changed all that. Medical underwriting is no longer used, although applicants can now only enroll during open enrollment or a special enrollment period triggered by a qualifying event (similar to how enrollment works for employer-sponsored plans). Essential health benefits are now covered on all new individual major medical plans in every state. And millions of people are receiving premium subsidies that cover the majority of their premiums for plans purchased in each state’s health insurance exchange (the ACA’s consumer protection reforms apply to plans sold outside the exchanges as well, but the subsidies are only available in the exchange). The ACA also limits the percentage of premiums that insurers can use for administrative costs, including profits and executives’ salaries; insurers have refunded billions of dollars to consumers as a result of the new rules.
But it's also worth noting that if they keep the employer-sponsored plan for the whole family, the premiums will almost certainly be payroll deducted on the pre-tax basis. On the other hand, if they opt to buy an individual market plan, the premiums would only be tax deductible to the extent that they (along with other medical expenses) exceed 10 percent of the family's household income, and assuming that the family opts to itemize their tax deductions (increasingly rare now that the Tax Cuts and Jobs Act has greatly increased the standard deduction).
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But it's also worth noting that if they keep the employer-sponsored plan for the whole family, the premiums will almost certainly be payroll deducted on the pre-tax basis. On the other hand, if they opt to buy an individual market plan, the premiums would only be tax deductible to the extent that they (along with other medical expenses) exceed 10 percent of the family's household income, and assuming that the family opts to itemize their tax deductions (increasingly rare now that the Tax Cuts and Jobs Act has greatly increased the standard deduction).
Individual and family health insurance plans can help cover expenses in the case of serious medical emergencies, and help you and your family stay on top of preventative health-care services. Having health insurance coverage can save you money on doctor's visits, prescriptions drugs, preventative care and other health-care services. Typical health insurance plans for individuals include costs such as a monthly premium, annual deductible, copayments, and coinsurance.
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