Is Individual Health Insurance Right for Your Retirees?

For your retirees or workers that aren’t yet eligible for Medicare but need health coverage, individual health insurance may be the right fit. Perhaps your workers have recently lost their spousal coverage, or maybe they plan to retire before they turn 65 (that is, before they are eligible for Medicare).

Regardless of the circumstances, individual health insurance can give your retirees the benefits they need to bridge the gap between their employer coverage and their Medicare eligibility. If you know of employees or retirees looking for coverage, RetireMEDiQ can help.

Continue reading to learn more about individual health insurance options.

Individual Insurance Options

There are three types of individual coverage available in the United States.

  • Marketplace Plans
  • Short-Term Plans
  • Medi-Share/Faith-Based Plans

Marketplace Plans

Made possible by the Affordable Care Act (ACA), Marketplace plans are offered by private health insurance companies. All marketplace plans are network-based. Most use health maintenance organization (HMO) networks. They cover pre-existing conditions and have no lifetime coverage limits.

All Marketplace plans cover 10 essential benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalizations
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services (including dental and vision care)

Open enrollment for Marketplace plans is Nov. 1 to Dec. 15 each year. You may also qualify for a special enrollment period in any of the following circumstances:

  • Change in household size
  • Change in residence or income
  • Change in status (such as being denied Medicaid/CHIP, gaining lawful presence in the United States, or being released from incarceration)
  • Loss of coverage within a 60-day window (not including a loss of coverage from a short-term plan or voluntary disenrollment from a COBRA plan before expiration)

Tax credits are available for individuals on these plans, unless other “affordable” coverage is available through an employer or a spouse. If a worker or retiree has job-based insurance, the amount they pay will depend on whether the employer’s coverage meets certain standards of affordability. Affordability is determined by the amount they would pay for self-only coverage, since this applies to individual insurance plans.

Coverage is deemed affordable if the individual’s share of the monthly premiums (for the lowest-cost self-only coverage meeting the minimum value standard) is less than 9.78 percent of their household income.

Short-Term Plans

Short-term plans may be the right option for anyone who needs coverage for less than a year. For example, workers being laid off or retiring six months before their Medicare eligibility may seek out this type of plan.

Also offered by private insurance companies, short-term plans tend to be more affordable than Marketplace plans (when someone doesn’t qualify for premium tax credits). But unlike Marketplace, short-term plans are medically underwritten and do not cover pre-existing conditions.

Lifetime limits on short-term plans range from $1 million to $2 million, as they are intended to be used in emergency situations, not for planned care. Coverage can generally start any day of the year (forgoing an open enrollment period), but short-term plans are not guaranteed renewable once they expire.

Medi-Share/Faith-Based Plans

Medi-Share plans are based on religious beliefs. Since they do not meet the federal guidelines for the ACA, they are not eligible for tax credits. As such, they tend to be more expensive. Individuals on these plans pay into a pool from which claims are paid—depending on available funds and determined by the plan.

Medi-Share benefits vary, and common health care needs may be excluded from coverage or subject to a waiting period. We recommend reading the plan documents carefully before enrolling to understand how a plan will care for your medical needs.

Exploring Individual Health Plans With RetireMEDiQ

The health insurance landscape can be overwhelming, but that’s why we’re here. Our team of trusted advisors will work to find the right individual health plan for your retirees, all at no cost. We’ll begin by assessing their individual needs and priorities. Then, we research different plan options to find the right health insurance plan for them.

Schedule an appointment or call 1-877-268-2863 to speak with an advisor.

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