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hi my name is Stephanie apt and I know
just how confusing the world of health
insurance can be so today I'm just
breaking down what your options
essentially are if you're shopping for
an individual health insurance plan so
when most people come to me wanting a
new individual major medical insurance
plan they essentially have two main
options there are a couple other options
that I'll mention at the end but most
people decide to go either one of two
ways when it comes to buying an
individual health insurance plan and the
first option is getting a qualified
health plan now a qualified health plan
is what most people think of when they
think of a health insurance plan so it
meets the Affordable Care Act guidelines
so it includes all those essential
health benefits
it covers all and every pre-existing
condition there is no medical
underwriting you don't have to answer
any health questions to apply and it
covers all of your preventative care at
100% things like well checks routine
physicals vaccinations routine
preventative screenings those are all
covered at no cost to you per the
Affordable Care Act guidelines it also
covers maternity care mental health
benefits pediatric dental and vision
benefits those are all going to be built
into qualified health plans and most
qualified health plans are eligible for
tax credits savings if you can qualify
based on your income and your household
size now qualified health plans are
generally more expensive especially if
you don't qualify for a tax credit
because they do cover all pre-existing
conditions you know there's no medical
underwriting they take any one whether
you're sick or healthy so the rates are
going to be a little bit higher and also
most qualified health plans have very
limited smaller networks of doctors that
you can see so they're going to
typically be HMO or EPO types of plans
and I want to explain a little bit about
what that means so with an HMO plan you
have no coverage out of the plans
network so you can only use
doctors and hospitals that are you know
on that list that take that plan and
with an HMO plan you must establish a
primary care physician and you need
referrals from your primary care
physician when you want to go see a
specialist with an EPO plan it's kind of
just like an HMO plan you can't go to
any doctors that are not in the plans
Network the network is gonna be limited
to your region
typically your state your County and
with an EPO plan however you don't need
referrals to see a specialist generally
now the other option that you have is to
do a short term major medical plan now
new legislation has made it so you can
now again purchase kind of a long term
short term major medical plan so
starting October of 2018 you can
purchase a 12 month short term major
medical plan and then you can continue
to renew that up to 36 months short term
major medical plans don't meet the
Affordable Care Act guidelines so they
don't cover pre-existing conditions
that's the real biggie I'm not going to
cover any pre-existing conditions they
do usually require medical underwriting
there's a few plans that don't but most
plans require you to answer a series of
health questions in order to qualify
also these plans don't include any
maternity benefits you know you're not
going to have your preventive care
covered at 100% but these plans are
generally less expensive because they do
require medical under age you have to be
able to health qualify for these plans
they're able to keep costs down because
of that and also with short term major
medical you can typically get a really
large network PPO plan that lots of
doctors accepts now with a PPO plan
it stands for preferred provider
organization you can go to any doctor
you want and you will have coverage
however you will pay less lower
deductible lower copay lower cost share
if you're using a preferred provider and
generally there's a lot more doctors in
a PPO plan network
than in an HMO plan network so if you
live in Central Texas which is where a
lot of my clients are that's where I am
and you want a qualified health plan
there are only five companies in 2018
that even offer qualified health plans
and they are all HMO or EPO plans and we
reviewed what that means so they're all
going to be those closed network plans
coverage will only be you know in Texas
or in Central Texas those will be the
only in network doctors and you only
have coverage if you're using an
in-network doctor I do want to mention
that with HMO and EPO plans you do have
emergency coverage nationwide so if
you're traveling people always ask what
if I'm traveling and I you know
something happens if you have a true
life-threatening emergency you will have
coverage anywhere you are it will be
covered as if it's an in-network service
however you can't just go to the doctor
because you have a coffin you're in a
different state and expect that to be
covered has to be a true emergency
emergency room visit now in Central
Texas most plans are offered on and off
exchange for qualified health plans so
on exchange means it's offered through
the healthcare marketplace you can find
the plan on healthcare.gov and if you
qualify based on your income you could
get a tax credit which is a government
subsidy that's going to help you pay for
your health insurance plan and based on
your age your income and your household
size that's how they'll determine how
much tax credit you're eligible for and
then your monthly premium due to the
insurance company can change accordingly
off exchange means that you're buying
the plan directly through the health
insurance company or not going through
healthcare.gov whether you go on or off
exchange you're still gonna find you
know the HMO and the EPO plan networks
it's gonna be the same there's often a
misconception that well if I go on
exchange way less doctors take my plan
than if I go off exchange but really in
our area it's going to be the same type
of HMO and EPO networks whether you're
going on exchange or off exchange so
some questions to consider when you are
make
your choice do you need coverage for any
current medications or any pre-existing
conditions if you do you might want to
look at a qualified health plan if not
you may save some money by going with a
short-term major medical plan are there
certain doctors or hospitals that you
want to keep in network that's a really
important one especially if you're going
with qualified health plans you do want
to know which doctors are important to
you which hospitals are important to you
to keep and also are you comfortable
paying the full out-of-pocket cost until
you meet the plans deductible so in
other words are you comfortable paying a
lower monthly premium but knowing that
you have to maybe pay a little bit more
when you go to the doctor's office or if
you need a medication or would you
rather pay a little bit higher monthly
premium and know that you just have a
set copay every time you go to the
doctor every time you go pick up a
medication these are some of the
questions that you just want to have
answers to in your mind and that'll help
you narrow down what plans are going to
be the best for you your needs in your
lifestyle if you have any questions or
you need any plans specific information
for your area please feel free to reach
out to me you can call me at eight eight
eight four six five nine seven two eight
during the busy open enrollment season
the best way to reach me is email you
can email me 24/7 Stephanie at apt
insurance agency comm thank you so much
for watching I hope you found this video
helpful and I look forward to helping
you soon
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