Wise-up Wednesday from Zane Benefits: Purchasing individual health insurance for dental practice staff

Learn where and when to buy individual health insurance as well as what could influence a person’s decision to buy a Marketplace or off-Marketplace plan.

Jul 13th, 2016
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Purchasing health insurance for your dental team might seem like a daunting task, just one more thing to add to your already filled schedule. But there are several ways to make it easier. The experts at Zane Benefits explain some of these ways so that your staff will be covered.

The process of purchasing individual health insurance for the first time might seem daunting to many dentists/practice owners. Fortunately, it’s really not too complicated. This guide provides helpful information on where and when to buy individual health insurance, as well as information on factors that could influence someone’s decision to buy a Marketplace or off-Marketplace plan.

Where to purchase individual health insurance

A handful of options exist for those wanting to buy individual health insurance. First, plans are available online through the Affordable Care Act (ACA) Marketplaces. A number of states and the District of Columbia have their own Marketplace websites; for those residing in the remaining states, applications for an individual plan can be made through HealthCare.gov.

The second option is to purchase a plan directly from an insurance company. People can contact any health insurance company and inquire about plans that are available in their area. HealthCare.gov has a plan finder to help individuals find private coverage outside of the Marketplace.

Third, individual health insurance can be purchased through a broker or agent. While a broker will sell plans from a variety of health insurance companies, an agent typically works on behalf of only one company. A person does not need to pay extra fees to use the services of an agent or broker, and either one can assist by comparing plans and processing enrollment.

Finally, people can purchase individual health insurance from online sellers such as HealthSherpa. These sites can help with plan comparisons and enrolling with an insurance company.

When to purchase individual health insurance

Insurance that qualifies for the minimum essential coverage under the ACA cannot be purchased year-round. Instead, people can buy individual health insurance only during an open enrollment period, if there is a qualifying life event, or if there is a change in employment. Because all private insurers have adopted the ACA’s open enrollment period, this limitation applies regardless of whether the individual insurance is purchased on or off-Marketplace. The open enrollment period for this year ended on January 31, 2016, and open enrollment for 2017 will run from November 1, 2016, through January 31, 2017.

Special enrollment periods apply in certain situations. For example, Native Americans are permitted to enroll at any time, as are people who qualify for Medicaid. An individual may also qualify for a special enrollment period if he or she has experienced a qualifying event such as marriage, divorce, a change in citizenship status, or a change in the number of dependents.

If open enrollment has passed, short-term plans can be found outside of the Marketplace. However, these will not count as minimum essential coverage under the ACA and the fee for being uninsured must still be paid.

Differences between Marketplace and off-Marketplace plans

First, all qualified Marketplace and off-Marketplace plans cover the same basic benefits, count as minimum essential coverage, and offer identical rights and consumer protections. The chief differences between Marketplace and off-Marketplace individual plans lie in the cost, and in the benefits offered above the minimum requirements.

Only Marketplace individual health insurance plans offer cost assistance through tax credits, subsidies, Medicaid, or the Children’s Health Insurance Program (CHIP), so getting an individual insurance plan from the Marketplace is generally the best choice if a person qualifies for assistance. Even if a someone is eligible only for a small amount of cost assistance, a Marketplace plan typically remains preferable because any given unsubsidized plan is more costly than the most expensive subsidized plan.

If a person’s income is above $46,680 annually, it makes sense to shop around on and off of the Marketplace. This is because the cost of insurance includes more than just the monthly premium (for example, copayments, deductibles, and more), and if an individual intends to use a lot of health care services in the coming year, it's wise to shop around for the best terms and conditions. Shopping outside the Marketplace will also provide a wider variety of plans. No agent or broker will have access to every plan available in every region, so those who want to shop around will need to reach out to various sources to get a thorough view of the options.

Conclusion

Purchasing individual health insurance does not have to be complicated—one just needs to begin the process of enrollment by going online or contacting an agent or broker. The choice to purchase a plan on the Marketplace depends mostly on whether someone qualifies for cost assistance. If one can receive even a small subsidy, it is usually more financially beneficial to buy a plan on the Marketplace.

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To learn more about implementing simple HR best practices, download the whitepaper “The Dental Practice's Guide to Individual Health Insurance Reimbursement.” Wise-up Wednesday is presented bi-monthly from the experts at Zane Benefits. One Wednesday a month features Human Resource issues, and the other Wednesday discusses health benefits.

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