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Individual Health Insurance Plans
Individual Health Insurance Overview
When it comes to individual/family health plan options, there can be anywhere from 50 to well over 100 different plans to consider. Our team members are able to help you evaluate these options based on your needs and budget. We explain your plan options, help determine eligibility of a subsidy (tax credit), manage the enrollment process for you, and service your health insurance needs throughout the year.
BROWSE SOME OF OUR POPULAR CARRIERS:
Five Common Health Insurance Coverages for Individuals in Louisiana
Health Maintenance Organization (HMO) Plans
HMO plans require members to choose a primary care physician (PCP) who will coordinate their care. Typically, PCP referrals are needed to see specialists, and services are generally covered only if they are provided by in-network providers. HMO plans often have lower premiums and out-of-pocket costs but provide less flexibility in provider choice.
Preferred Provider Organization (PPO) Plans
This comprehensive health insurance plan provides more flexibility in selecting healthcare providers. Members can see any doctor or specialist without a referral, whether in-network or out-of-network. While using in-network providers results in lower co-pays and higher coverage, out-of-network services are also covered at a lower percentage. PPO plans generally have higher premiums compared to HMO plans.
Exclusive Provider Organization (EPO) Plans
EPO plans combine elements of HMO and PPO plans, offering a network of providers that members must use for coverage to apply. Unlike an HMO, individuals with no primary care physician are required, and referrals to specialists are typically unnecessary. However, out-of-network services are not covered except in emergencies. EPO plans are suitable for those who prefer more flexibility without the costs associated with a PPO.
Point of Service (POS) Plans
POS plans also blend features of HMO and PPO plans. Members select a primary care physician to manage their care and provide referrals to specialists. They can also find care outside the network but at higher out-of-pocket medical costs. This type of plan offers moderate premiums while providing a balance between managed care and flexibility.
High Deductible Health Plans (HDHPs)
High Deductible Health Plans can offer lower premiums with higher deductibles. These plans are often paired with Health Savings Accounts (HSAs), allowing members to save pre-tax dollars for medical expenses. HDHPs are suitable for individuals who are generally healthy and do not need frequent medical care. It only serves as their safety net for unexpected healthcare costs.
We’re not partial to any company, we’re partial to you! Our goal is to make sure you get the best benefits within your budget and that you understand your plan. We are a full service agency at no cost to you.
Individual Health Insurance Agents
Frequently Asked Questions
Have questions? We’re here to help.
1. When is open enrollment?
Open enrollment starts on November 1st each year. The ending date changes year to year; this past year was 11/01/2024 – 1/15/2025.
2. Can I get coverage outside of Open Enrollment?
Yes, if you have a qualifying life event (QLE), or if your income is under 150% of the Federal Poverty Level, or if you are enrolling based on the Family Glitch, you could be eligible for a special enrollment period.
3. Can I change plans in the middle of the year?
Typically, no. There are a few exceptions if you have qualify for a Special Enrollment Period.
4. What are qualifying life events?
a. Loss of health coverage
i. Losing existing health coverage, including job-based, individual, and student plans
ii. Losing eligibility for Medicare, Medicaid, or CHIP
iii. Turning 26 and losing coverage through a parent’s plan
b. Changes in household
i. Getting married or divorced
ii. Having a baby or adopting a child
iii. Death in the family
c. Changes in residence
i. Moving to a different zip code or county
ii. A student moving to or from the place they attend school
d. Other qualifying events
i. Changes in your income that affect the coverage you qualify for
ii. Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
iii. Becoming a U S Citizen
iv. Leaving incarceration (jail or prison)
5. What is a subsidy?
A subsidy is an APTC: Advance Premium Tax Credit. If you qualify for a premium tax credit based on your estimated Adjusted Gross Income, you can use any amount of the credit in advance to lower your premium.
6. When I enroll, does coverage start immediately?
Generally, coverage begins on the 1st of the month. During open enrollment, you must enroll by the 15th of the month to get an effective date of the 1st of the following month. Example: Enroll by December 15th for coverage to begin on January 1st.
If you are eligible for a Special Enrollment Period, you may enroll through the last day of the month, and coverage will still begin on the 1st of the following month. Example: Enroll on June 30th and coverage can begin on July 1st.
7. Am I eligible for Marketplace coverage (coverage through healthcare.gov)?
To be eligible to enroll in Marketplace coverage, you must live in the United States, can’t be incarcerated, and must be a U.S. Citizen or national (or be lawfully present)
8. What is a 1095-A?
This is a tax form that will be mailed to anyone that had Marketplace coverage during the year. The Marketplace has until the end of January to mail this form to you. Don’t file your taxes without it. Your 1095-A contains information about Marketplace plans any member of your household had the previous year, including: premiums paid; premium tax credits used; and a figure called “second lowest cost Silver plan” (SLCSP)
Need help locating yours online because it didn’t come in the mail? Ask your agent, we’re here to help!
Allied Benefits Solutions Can Help You Find Your Ideal Individual Health Insurance in Louisiana
At Allied Benefits Solutions, our agents can guide you in choosing a suitable health insurance plan. You can expect personalized support that always aligns with your preferences, helping you secure the best coverage. Don’t go through this process alone—let us help you find the right plan that safeguards your health and peace of mind.
Reach out to our company today to work with our individual health insurance broker.