For those who don’t have access to employer-sponsored plans, coverage on the individual market is an option. This market has changed dramatically as a result of the Affordable Care Act. Prior to 2014, in most states, individual coverage was medically underwritten, which meant that coverage was only available for purchase if the applicant was at least fairly healthy, as the insurance companies would closely scrutinize your complete medical history when you applied. Coverage in the individual market was typically not as robust as employer-sponsored health insurance; maternity care, prescription drugs, and mental health care were often missing from the coverage. And people who purchased individual market coverage prior to 2014 had to pay the whole premium themselves.
There are premium subsidies available in the exchange, but you're not eligible for them if the plan offered by your employer is considered affordable and provides minimum value (this is true for your family members as well, if they have access to your employer-sponsored plan, even if the employer-sponsored plan is only affordable for the employee's portion of the coverage; this is known as the family glitch). Most employer-sponsored plans are affordable and do provide minimum value. So if you're shopping for an individual market plan instead, chances are high that you'll have to pay full price for it, without any subsidies.
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.
We understand how frustrating it can be to find affordable health insurance in Texas that maintains the level of coverage you need. This is why we treat each of our clients with the respect and personalized service you expect. We will provide custom health insurance quotes so you can choose the low cost health insurance necessary to give your family the peace of mind in being able to see the doctor whenever you or a family member needs it without worrying about how you will afford it.
These plans meet all the requirements of the health care law, including covering pre-existing conditions, providing free preventive care, and not capping annual benefits. If you have one of these plans, you won’t have to pay the fee that people without coverage must pay through the 2018 plan year. (Note: Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies.)
Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Group Universal Life (GUL) insurance plans are insured by CGLIC. Life (other than GUL), accident, critical illness, hospital indemnity, and disability plans are insured or administered by Life Insurance Company of North America, except in NY, where insured plans are offered by Cigna Life Insurance Company of New York (New York, NY). All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.
HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in a health plan. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
How do the benefits differ? What would you owe in out-of-pocket costs if you were to be injured or get seriously ill? How does that compare with your out-of-pocket exposure on the employer-sponsored plan? Are your doctors in the network of the individual plan? You'll want to carefully consider all of these things before switching, and keep in mind that you won't be able to rejoin your employer's plan until the next open enrollment window offered by your employer.
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.
According to a Kaiser Family Foundation analysis, in 2018, the average American worker with employer-sponsored health insurance contributed $1,186 for a single employee health plan and $5,547 for a family health plan. Since this is an average, some employees may be paying much more (employers paid the bulk of the total premiums, which averaged $6,896 for single employees and $19,616 for family coverage).