When Not To Get An ACA-Compliant Plan

Ideally, everyone would qualify for subsidies and would never be caught mid-year without a health insurance plan. But in the real world, there are situations where a health plan compliant with the Affordable Care Act is undesirable or temporarily unattainable.

​That's where other options come into play, such as short term health insurance and alternative plans like an indemnity plan.

When Might A Short-Term Plan Work Best?
Non-ACA-compliant plans can only be sold "short-term." But the definition of short-term can be anywhere from 3 months to 3 years (after two renewals) depending on which state you live in. There have been extensions of how long you can have a short-term plan in recent years, but some limitations still remain.

If you live in a state that hasn't adopted the ACA Medicaid expansion program, then you might fall into a coverage gap. Or, you might be ineligible for subsidies due to the "family gap," which means it is too expensive to add family members to your employer-based plan but you don't qualify for premium subsidies for an ACA plan either.

If you make 400% or more of the federal poverty line, then you will not qualify for subsidies. And yet, the cost of the health insurance might still be rather high and unaffordable to you.

The above are all good reasons to seek a short-term or alternative health plan. Plus, these types of plans tend to cost a lot less (lower premiums), even if they don't provide as comprehensive or full of coverage and may make exclusions based on preexisting conditions.

What About Alternative Health Insurance Plans?
In general, alternative plans are used as supplements to your main health plan and not as substitutes. But in a pinch, they can do to get you through a time period when you are stranded without access to regular insurance. They are certainly much better than having no coverage at all.

Dental and vision insurance plans are a great option. They can save you money and keep your ocular and oral health in top shape. Since adults aren't covered for most eye and oral care issues in regular health plans, these are great to get whether or not you have a main plan.

Critical illness insurance covers you against major catastrophic illnesses and health conditions, while accidental injury insurance does the same thing for accidental injuries. Indemnity health insurance will normally cover both illnesses and injuries in one package.

The great thing about supplemental policies is that they usually pay you a lump sum benefit that you can use any way you need to. That means they can help cover things primary health policies don't such as ambulance rides, loss of income, extra hotel and meal expenses, and more. They also tend to have zero deductibles and relatively low premiums. They only cover a more limited range of scenarios, but they are good for catastrophic insurance.

Be sure to consult a health insurance agent to help you sort through all your options. There are always options, and finding the right one as quickly as possible will protect your health and save you money!

To learn more, contact Summerlin Benefits Consulting today to speak with an experienced health insurance broker!