Not everyone can afford to pay the full monthly premium for health insurance, which is why the Affordable Care Act (ACA) makes subsidies, including premium tax credits and cost-sharing reductions, available to those within certain income brackets.
But what about those that earn too much to qualify for a health insurance subsidy but who don’t make enough money to offset the costs of rising health insurance premiums and healthcare costs?
If this sounds like your situation it’s worth shopping around for ACA-compliant major medical insurance (which many people still call by the nickname “Obamacare”) and even identifying non-Obamacare health insurance alternatives.
We’ll explore some of your options, below.
Get the best deal on your Obamacare major medical plan
It’s still good practice to carry major medical insurance. However, because you don’t qualify for health insurance assistance, it makes sense to comparison shop for major medical insurance outside of HealthCare.gov and your state’s exchange.
Two common sources for major medical insurance sold in the private market include:
- Private, online health insurance exchanges (e.g., eHealthInsurance.com) that quote and sell plans from different companies. Learn more about how to shop for health insurance plans online.
- Licensed health insurance producers (i.e., agents and brokers) in your area. Decide if working with an agent is right for you, and use Agent Finder to locate assistance near you.
Going off-exchange may provide you with additional carrier, plan and network options. That’s great if you are not eligible for a subsidy and want to save money, prefer a certain carrier, or want to ensure you have access to a specific doctor or hospital.
But what if you’re still facing a plan with a high deductible in order to make the monthly premium payments work? Is there anything to help mitigate your out-of-pocket expenses?
Add supplemental insurance
The general rule of thumb when it comes to health plan costs is: low premium = higher deductible and vice versa.
It may seem contradictory to buy additional health insurance when you feel financially strained, but that could be a solution.
Gap health insurance may help with a high deductible health plan
Supplemental products known as medical gap insurance pay a fixed-cash benefit. You can assign benefits directly to the hospital or other healthcare facility, or receive the funds and use them to cover other healthcare expenses, rent, groceries or childcare.
Many people opt to use their gap medical benefits to help pay for their major medical deductible, especially if they have a high deductible health plan (HDHP).
Hospital indemnity plans to supplement ACA major medical
Hospital indemnity plans are not considered ACA-compliant minimum essential coverage, and in some states you must already have a major medical policy in order to obtain supplemental hospital indemnity coverage. These plan benefits can help pay for out-of-pocket expenses resulting from hospitalization, chemotherapy, surgery and critical illness.
- Pay fixed benefit amounts for covered medical care at a specific duration (e.g., per day, per week, per visit): For example, a plan may pay a $2,000 surgeon benefit per surgery and an inpatient hospital confinement benefit of $1,000 per day.
- Pay fixed benefit amounts, regardless of what your provider bills for medical services: For example, if your plan’s surgeon benefit is $2,000 per surgery and you receive a surgeon bill for $2,100, your benefit remains $2,000 and you will be responsible for paying the $100 balance.
- May be used along with short term health insurance or major medical insurance but do not coordinate benefits with those policies.
If a high-deductible major medical plan paired with medical gap or a hospital indemnity plan doesn’t sound right for you, an alternative health insurance option may be a solution.
Non-Obamacare alternative health plan options
If you don’t have an ACA-compliant plan, are you prepared to pay fully out of pocket for unexpected healthcare? That could be anywhere from a $200 urgent care visit to tens of thousands of dollars for hospitalization and a surgery.
You may want to consider short term medical benefits in order to obtain some level of coverage.
Short term medical coverage as non-Obamacare insurance
Short term medical insurance is a temporary solution designed to help with larger medical claims resulting from injuries and unexpected illnesses.
Short term health benefits often include but are not limited to:
- Hospital room and board
- Emergency room treatment
- Surgical services
- Ambulance services
Short term insurance provides limited benefits when compared to major medical, but premiums may be lower.
Remember, major medical plans are ACA-compliant, guaranteed-issue (meaning they include coverage for pre-existing conditions) and include coverage for essential health benefits, while short term health insurance does not provide any of those features or guarantees.
Add-on products to help cover expenses with or without Obamacare
Whether you enroll in a major medical plan or choose an Obamacare alternative, you may want to consider the following add-on products to lower your out-of-pocket medical expenses:
Dental insurance can help lessen what you pay for routine oral care such as cleanings and exams as well dental work such as fillings and root canals.
Telemedicine provides you with access to 24/7 telehealth services, anywhere you’ve got mobile or internet connectivity. Board-certified doctors can remotely treat minor ailments such as cold, flu, ear infections, urinary tract infections, and more for just a few dollars per consultation. Telemedicine is not insurance.
An Rx discount card can help reduce what you pay out of pocket for prescription drugs. It’s simple to use: You present it at a participating pharmacy to access your discount. A prescription drug card is not insurance.
Summary + next steps
We covered a lot of ground in this article, but if you’re feeling the middle class squeeze it boils down to a variety of coverage options to help curb healthcare expenses:
- Shop around and obtain the most affordable ACA-compliant major medical policy that you can find.
- Supplement your high-deductible major medical plan with a medical gap policy to help you with out-of-pocket expenses.
- Utilize only non-Obamacare health insurance options such as short term medical insurance.
- Add benefits, including dental insurance, telemedicine and Rx discount cards to help reduce what you pay out of pocket for healthcare.
Still not sure how to proceed?
Call 888-855-6837 to speak with an agent who can answer your questions and get you an instant quote.
Use Agent Finder to seek personalized advice from a knowledgeable insurance agent in your area.
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