HEALTH INSURANCE

Health insurance is necessary not just to prevent and treat illnesses, but also to be compliant with the Affordable Care Act. We will help you find out if you are eligible to receive subsidies to offset the costs of health insurance and help you choose a health plan with a carrier that meets your specific needs.

Understanding Your Health Insurance Options

As a consumer, you can choose healthcare plans for you and your family directly from the carrier through the state-run marketplace or the federal marketplace. (See the resource links to the right) However, when you work with the Marc Sigmon Insurance Agency, our certified health agents can help you determine which options best fit your needs.

Choosing health insurance isn't a straight forward process when you consider monthly premiums, co-payments, cost-of-share expenses, doctor networks, specialist referrals, etc. We all know how expensive healthcare can be out-of-pocket, which is why health insurance is such a necessity. It's also important to be well informed when deciding on a specific carrier for you and your family's health needs and budget.

Here are some of the questions you may consider when choosing a carrier:

How often do I see a doctor?
How many prescriptions am I prescribed regularly?
Do I need to see a specialist?
Which is more important (monthly costs or annual out of pocket expenses)?

With health insurance you can

Prepare for the unexpected.
Access preventive care services – like checkups, which are covered at 100%.
Receive treatment for illnesses and injuries
Seek specialty services such as mental health, physical therapy, and more.

*Ask us about individual products such as dental, vision, cancer, or indemnity plans which are available alongside other lines of insurance.

RESOURCES

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What Are Essential Health Benefits

Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB).

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:

These essential health benefits include at least the following items and services:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services including oral and vision care

According to the Affordable Care Act, plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.

Footnote: This is a brief overview of Essential Health Benefits required by the Affordable Care Act. You should read thoroughly and understand the benefits offered before purchasing any insurance policy.